What would you do? (pictures included)

[mephesto]

Hello everyone, I'm 29 years old and have been balding since I was 18.

I'm looking for some advice on my HT procedure. I'm still undecided between FUE and FUT at the moment, mostly because of the potential for future hairloss concerns.

I've had consultations with FUE and FUT doctors in the US. Both have suggested 2000-2500 grafts on the front and about 1000-2000 grafts in the crown area.

I'm fairly certain I will need future procedures as my family tends to be NW5/NW6. However, I've been diligent with Finasteride and Nizoral for 5 years so that has definitely helped stabilize my hairloss.

My question:

Should I get FUE first? I tend to wear my hair short on the sides and back, but if FUT will  be better for me, I can live with longer hair. Although, I don't see why someone can't do FUE then FUT afterwards (I always hear Strip first then FUE).

I would probably opt for FUT if I needed a second operation but I imagine that happening in my late 30s.

Also, I've been told an FUE for me would be a 2-day operation if 3,000 grafts or more.

I have attached pictures at the bottom. One is with a short haircut which I like (a #1->#4 fade) and the other with my hair grown out.

Thanks for any advice!

(New pics coming soon)

Edited March 31, 2019 by mephesto

[LaserCap]

Thanks for posting the photos, good job.  The ones on the left only serve to confirm, if you let your hair grow a bit, it will cover.  So FUT is in play.  And, the reason to do transplants is to have more hair, not less.  So the question becomes, if you had longer hair permanently, would that be OK.

By considering FUT you now have MORE supply to work with,  You can exhaust all FUT first and then have FUE available should you need it in the future.  When you visit with the doctor, have him check elasticity.  Ask him how many grafts lifetime he believes you have and make a record of it.

Now, the photos on the right.  It seems you have diffused thinning throughout the entire head.  And it seems it is a large pattern.  If you were to do nothing, it is likely you will end up 6-7.  Do you have family history of hair loss?  What pattern do they have?

For the doctor that suggested doing grafts in the crown, I would run away as fast as I could.  When you first interact with people, or see yourself in the mirror - what do you see?  The front.  This should be the area of concern.  Besides, because of the whirl in the crown, everyone, by definition, has to be thin in that area.  Once the front and middle are done, (assuming you will continue the use of medical therapy), you can then decide to move farther back into the pattern with transplants depending on many factors including efficacy of the meds, donor availability, etc.

Lastly, the contrast between the color of the hair and the color of the skin.  There are a number of techniques available today that would help minimize the contrast.

With all technical advances, it is an exciting time to consider hair restoration.  PROVIDED you find the right ARTIST for the job.  Go to consultations, view tons of results of cases similar to yours.  

[mephesto]

27 minutes ago, LaserCap said:

By considering FUT you now have MORE supply to work with,  You can exhaust all FUT first and then have FUE available should you need it in the future.  When you visit with the doctor, have him check elasticity.  Ask him how many grafts lifetime he believes you have and make a record of it.

Hi Lasercap, thank you for the great information!

My doctor said I potentially have about 9000 grafts lifetime, but is not sure how that will be affected as I continue to age.

Quote

Now, the photos on the right.  It seems you have diffused thinning throughout the entire head.  And it seems it is a large pattern.  If you were to do nothing, it is likely you will end up 6-7.  Do you have family history of hair loss?  What pattern do they have?

My family does have a history of hairloss. Most of them are NW5 on my father's side, and NW6 on my mother's side. There are a few who are NW1/NW2 (like my brother who's older than me). I've been told I'm an NW3.5

Quote

For the doctor that suggested doing grafts in the crown, I would run away as fast as I could. 

He suggested that we can possibly improve the crown area, but not actually go all in on the crown and that the hairline would be the focus. Sorry, I should have clarified that.

Thanks again Lasercap, FUT is definitely something to consider. I prefer having a shorter hairstyle which FUE would be great for, but who knows how many more grafts I'll need in the future. I've spent about a year researching this and still haven't come to a conclusion.

 

[RecessionProof]

I think FUT with a surgeon who is really good with scars would be a safe bet. It varies from person to person, but a bunch of FUT recipients have been able to shave their sides pretty short (I made a thread polling people about this and many have said they’re able to get down to a 2 or 3 without the scar being visible... though some are unable to go below a 4 or 5). I’m about your age and was set on FUE until I realized how good the scars can look when you go to a top doctor. 

 

I often hear that FUT followed by FUE once that’s expended is the best way to optimize graft harvesting in the long run. I would ask a few doctors their thoughts on that, as it may have changed now that FUE have improved in recent years.

Edited March 27, 2019 by RecessionProof

[mephesto]

2 hours ago, RecessionProof said:

I think FUT with a surgeon who is really good with scars would be a safe bet. It varies from person to person, but a bunch of FUT recipients have been able to shave their sides pretty short (I made a thread polling people about this and many have said they’re able to get down to a 2 or 3 without the scar being visible... though some are unable to go below a 4 or 5). I’m about your age and was set on FUE until I realized how good the scars can look when you go to a top doctor. 

 

I often hear that FUT followed by FUE once that’s expended is the best way to optimize graft harvesting in the long run. I would ask a few doctors their thoughts on that, as it may have changed now that FUE have improved in recent years.

Hey RecessionProof, thanks for your input! Your thread on the cut was informative.

Here's the link for anyone who wants to look at it:

https://www.hairrestorationnetwork.com/topic/53226-fut-patients-how-short-can-you-buzz-your-hair/

As for FUT then FUE, one of the doctors I spoke to said that FUE can still produce the same level of yield as full on FUT would (that donor depletion was overblown). I have a consult coming up with a few more doctors, but I'm currently leaning towards FUE for my first procedure.

I don't think having FUE first would negatively impact a second procedure if I had one from what I've read so far.

 

[harry_potter1]

Think you should start with FUT 1st and then move to FUE later when needed.

But depend on how much are you afraid from the scar you are gonna be left with, and how much coverage do you want 

[mephesto]

8 hours ago, harry_potter1 said:

Think you should start with FUT 1st and then move to FUE later when needed.

But depend on how much are you afraid from the scar you are gonna be left with, and how much coverage do you want 

Thanks for the info. Why FUT first and not FUE first? Can I do FUE first then FUT and still get the same amount of grafts?

[Aftermath]

5 hours ago, mephesto said:

Thanks for the info. Why FUT first and not FUE first? Can I do FUE first then FUT and still get the same amount of grafts?

If you plan on doing both I’d do FUT first. FUE thins the donor area meaning that it can be hard to hide strip scars. The other way around you could even finish up by FUEing some grafts into the strip scar

[harry_potter1]

11 hours ago, mephesto said:

Thanks for the info. Why FUT first and not FUE first? Can I do FUE first then FUT and still get the same amount of grafts?

It is said that you can't do FUT after FUE, although I am sure you will find some doctors ready to do you FUT if you have done FUE prior 

Don't know the technical reasons for it tbh 

So, if you start with FUE, you are most likely ruled FUT out 

[mephesto]

15 hours ago, Aftermath said:

If you plan on doing both I’d do FUT first. FUE thins the donor area meaning that it can be hard to hide strip scars. The other way around you could even finish up by FUEing some grafts into the strip scar

Hey Aftermath, thanks for the info. I actually just finished reading your thread and thoroughly enjoyed the good progress.

Do you ever worry about having the scar? Do you ever wish you didn't have one or does it never cross your mind?

[Aftermath]

The scar isn’t a big deal for me as there is no way I’d have been able to get to where I am with FUE. And my plan has always been to get FUE into the scar at the end anyway. I did what was right for me and I wouldn’t change it. You just need to figure out what’s right for you