Rejected by Erdogan for low donor area capacity - what are my options?

[Biceps]

From Erdogan:

"After analyzing your photos Dr Koray Erdoğan found that your DONOR AREA is not strong and thick as it should be for the hair transplantation. Therefore Dr Koray Erdoğan came to the conclusion that your Donor area has a low capacity for the procedure of hair transplantation."

Anyone heard of this type of rejection? Since Erdogan is so well respected, does this mean that most other surgeons share his opinion? Pics of my donor area below:

Long

Long (combed upwards)

 

Short (you can see my donor area has "gaps"?)

Buzzed (this is my default look)

 

FRONT VIEW

TOP VIEW

CROWN VIEW

Edited May 17, 2019 by Biceps

[John Doe]

Embrace a shaved head or hair fibers I’d say. Your donor area looks as thin as others recipient areas.  Not good 

[CosmoKramer]

I’d say Dr Erdogan is right, your donor doesn’t look optimal enough for an Ht and would probably look bad after if you did get an ht to be honest.

[elduterino]

not a problems if you use hair meds 

Are you on anything? 

[Melvin- Admin]

Where do you live? Have you consulted with a doctor in person?

[DrTBarghouthi]

It's a tough call at times to base the decision on photos. I think in such cases a live consultation is the best, where the donor area can be properly examined and also the areas of hairloss and then an appropriate plan can be drawn. 

[harry_potter1]

I think you should also consider FUT clinic and see if they think otherwise 

[Biceps]

13 hours ago, CosmoKramer said:

I’d say Dr Erdogan is right, your donor doesn’t look optimal enough for an Ht and would probably look bad after if you did get an ht to be honest.

Do you mean the recipient area will look bad due to weak grafts, or do you mean the donor area will look bad?

 

11 hours ago, elduterino said:

not a problems if you use hair meds 

Are you on anything? 

I have been using finasteride 1mg since last year. Are you saying it will help with the donor area?

 

4 hours ago, Melvin-Moderator said:

Where do you live? Have you consulted with a doctor in person?

California, USA. I have not, but looks like you guys are recommending I should. I will definitely talk to someone in person. I am in Northern California but I can visit doctors in LA too (I'm assuming the HT surgeons in LA are better?)

 

1 hour ago, DrTBarghouthi said:

It's a tough call at times to base the decision on photos. I think in such cases a live consultation is the best, where the donor area can be properly examined and also the areas of hairloss and then an appropriate plan can be drawn. 

Thank you, I will look for a live consultation in my area. 

56 minutes ago, harry_potter1 said:

I think you should also consider FUT clinic and see if they think otherwise 

I'm not very familiar with HTs. Are FUTs better for weak donor areas? My normal haircut is buzzed down sides and back so I'm concerned about the scar being shown.

[Lennney]

Unless you're comfortable showing a FUT strip scar or the dotting of the FUE, you'll not want to ever buzz your sides. You'll either have to "change" your hairstyle post HT or accept your hair now as is. 

I'd get a second opinion on the donor, without mentioning someone said it was too thin. If another recommended doc says it's too thin, you'll have to figure something else out or go to a someone willing to work on you.

 

Also, the doc could have said your donor isn't sufficient for your wants. Is there a delta between what you expect and what can reasonably be done? If you don't want to change your hairstyle, it may come across that you also don't want to deviate from what's possible with your situation. 

Just something to think about.

[MarshallUK]

Hi biceps,

I was also rejected by Asmeds for my donor but have seen a lot of results from them using people with donors alot worse than mine so can only put in down to me not being on finestride at the time. However I consulted 3 doctors in person who had no issues with my donor so definitely do a face to face consultation. 

[Vickykuril]

Hi biceps,

This is my first comment on this forum and I’m following this forum almost every alternate day since 2 years.

Yes ur donor is weak but your sides seems decent and it is also very important for us to see ur recipient area/balding area so we know how much area needs to be addressed/covered.

Individuals with weak donor area should always start with FUT first period considering your Master Plan .Linear scaring can be treated with SMP (Scalp Micro Pigmentation) and u should never waste grafts for Scar revision.

Now for your first FUT HT u should choose a Dr who can take a wider strip from ur donor which covers ur sides which is decent so that maximum grafts are harvested. ( Dr haason is a master in this).Side hair is very precious as they have resistant from MPB and with FUE only few grafts can be extracted and there is transection also which damages surrounding grafts and weakens your donor.With strip entire tissue of your native hair is in your hands so that is maximum utilisation and harvest of available donor hair.

For your second FUT HT Dr can tell you whether or not its feasable cuz in your first HT most of the grafts will come from your side hairs above your ears which is in better shape.I think 2nd FUT is also viable since its always better then FUE for weaker donor areas.

3rd HT should be FUE from back very little whatever’s possible and sides mostly.

Beard HT is very good cuz hair quality is good and they have faster growth cycle then scalp hair. You can also go to an extent of extracting every beard graft!. Have a look at eugenix clinic India ( just a suggestion cuz I believe u have not done your research) 

Body hair transplant is also there and it works fine , hair quality is poor so it should be used in crown or you can fill in your donor area too! (Wink).

Genital hair transplant has also been performed and is in practice and I don’t need to explain hair quality! ( just for info).

Beard hair grafts are insanely good and body hair grafts are poor and should be used wisely. Beard hair transplant can be done along with scalp FUE so you don’t have to wait for a year and it decreases number of surgeries.

Every Norwood 5 or 6 needs three or four HTs in their lifetime for desired results

It all depends on your perspective and acceptance of realistic results. 

While writing I forgot two three very important things which I believe other members will say.

Finasteride, minoxidil, biotin tablets , prp, derma roller, laser therapy have different roles but its serves your hair...

I hope this helps

[Sean]

If you are rejected, that is assurance as high number of extractions are done vs recipient coverage area in some clinics.  

I would hold off for a bit and get multiple consults with other surgeons who use less grafts vs the recipient coverage area and get higher yield.  

No doubt, surgery should be a last resort.  Best of luck!

[Melvin- Admin]

12 hours ago, Biceps said:

Do you mean the recipient area will look bad due to weak grafts, or do you mean the donor area will look bad?

 

I have been using finasteride 1mg since last year. Are you saying it will help with the donor area?

 

California, USA. I have not, but looks like you guys are recommending I should. I will definitely talk to someone in person. I am in Northern California but I can visit doctors in LA too (I'm assuming the HT surgeons in LA are better?)

 

Thank you, I will look for a live consultation in my area. 

I'm not very familiar with HTs. Are FUTs better for weak donor areas? My normal haircut is buzzed down sides and back so I'm concerned about the scar being shown.

If you live in California, consult with Dr. Diep in Los Gatos, Dr. Rosanelli in San Francisco. They should be reasonable driving distance from you. 

[elduterino]

Whatever you decide do not go for FUT 

Not worth the scar 

I had 2 Fue and a total of 3700 grafts 

The growth yield has been very Good and the donor looks like nothing happened at all to my eyes 

In fact you can extract more grafts from Fue than Fut since you don't need to have long hair to cover the scar 

 

[Dr Blake Bloxham]

Biceps, 

I think the advice to seek doctors who perform both FUT and FUE is wise. Sometimes patients are good candidates for one and not the other. And many times patients with "weaker" donors are much better served with FUT. 

I pretty much perform a large FUT procedure daily and have a pretty good eye for evaluating donors via pictures. If those images were sent to me, I too would be a little be concerned and want to evaluate closely in person before recommending anything. However, FUT might not be the right answer here either. Melvin's advice to see, in-person, a few doctors who perform both is spot on. 

How much do you need up top? The "right" answer in the end may be conservative FUE and augmenting with something like SMP. 

[Biceps]

On 5/16/2019 at 10:20 AM, Lennney said:

Unless you're comfortable showing a FUT strip scar or the dotting of the FUE, you'll not want to ever buzz your sides. You'll either have to "change" your hairstyle post HT or accept your hair now as is. 

I'd get a second opinion on the donor, without mentioning someone said it was too thin. If another recommended doc says it's too thin, you'll have to figure something else out or go to a someone willing to work on you.

 

Also, the doc could have said your donor isn't sufficient for your wants. Is there a delta between what you expect and what can reasonably be done? If you don't want to change your hairstyle, it may come across that you also don't want to deviate from what's possible with your situation. 

Just something to think about.

Hi Lennney,

Thanks for your input. Regarding hairstyle - I have no qualms changing my hairstyle!

Regarding the delta - there was no discussion with Erdogan's patient coordinator in terms of my expectations vs theirs. They took my photos and video of me combing the donor area, and responded with a No. In the initial online intake form, I was very vague on my expectations - I really just want to fill out the top. I'm not expecting a miracle. I'll upload photos in my next post.

On 5/16/2019 at 10:21 AM, MarshallUK said:

Hi biceps,

I was also rejected by Asmeds for my donor but have seen a lot of results from them using people with donors alot worse than mine so can only put in down to me not being on finestride at the time. However I consulted 3 doctors in person who had no issues with my donor so definitely do a face to face consultation. 

Thank you MarshallUK. Where did you end up having your HT?

 

19 hours ago, Sean said:

If you are rejected, that is assurance as high number of extractions are done vs recipient coverage area in some clinics.  

I would hold off for a bit and get multiple consults with other surgeons who use less grafts vs the recipient coverage area and get higher yield.  

No doubt, surgery should be a last resort.  Best of luck!

Thank you Sean. In what sense do you mean surgery should be a last resort?

18 hours ago, Melvin-Moderator said:

If you live in California, consult with Dr. Diep in Los Gatos, Dr. Rosanelli in San Francisco. They should be reasonable driving distance from you. 

Thank you Melvin. I will check them out. They are very close to me. In your opinion, is their skill level on par with surgeons I hear about all the time? (H&W, Erdogan, Rahal, etc) I have no issues financially, I just want the best I can get.

11 hours ago, elduterino said:

Whatever you decide do not go for FUT 

Not worth the scar 

I had 2 Fue and a total of 3700 grafts 

The growth yield has been very Good and the donor looks like nothing happened at all to my eyes 

In fact you can extract more grafts from Fue than Fut since you don't need to have long hair to cover the scar 

 

Which surgeon did you go to, elduterino?

10 hours ago, Dr Blake Bloxham said:

Biceps, 

I think the advice to seek doctors who perform both FUT and FUE is wise. Sometimes patients are good candidates for one and not the other. And many times patients with "weaker" donors are much better served with FUT. 

I pretty much perform a large FUT procedure daily and have a pretty good eye for evaluating donors via pictures. If those images were sent to me, I too would be a little be concerned and want to evaluate closely in person before recommending anything. However, FUT might not be the right answer here either. Melvin's advice to see, in-person, a few doctors who perform both is spot on. 

How much do you need up top? The "right" answer in the end may be conservative FUE and augmenting with something like SMP. 

Hi Dr. Bloxham,

Thank you for taking the time to respond. I'll be uploading pics of my hair loss in the next post. I have a few questions for you, but they are pretty basic as I don't know much about these procedures (and anyone can jump in to answer!)

1) What makes FUT better for weak donors?

2) Are the gaps in my donor area due to retrograde alopecia / DUPA, or is it just weak donor area?

[Biceps]

23 hours ago, Vickykuril said:

Hi biceps,

This is my first comment on this forum and I’m following this forum almost every alternate day since 2 years.

Yes ur donor is weak but your sides seems decent and it is also very important for us to see ur recipient area/balding area so we know how much area needs to be addressed/covered.

Individuals with weak donor area should always start with FUT first period considering your Master Plan .Linear scaring can be treated with SMP (Scalp Micro Pigmentation) and u should never waste grafts for Scar revision.

Now for your first FUT HT u should choose a Dr who can take a wider strip from ur donor which covers ur sides which is decent so that maximum grafts are harvested. ( Dr haason is a master in this).Side hair is very precious as they have resistant from MPB and with FUE only few grafts can be extracted and there is transection also which damages surrounding grafts and weakens your donor.With strip entire tissue of your native hair is in your hands so that is maximum utilisation and harvest of available donor hair.

For your second FUT HT Dr can tell you whether or not its feasable cuz in your first HT most of the grafts will come from your side hairs above your ears which is in better shape.I think 2nd FUT is also viable since its always better then FUE for weaker donor areas.

3rd HT should be FUE from back very little whatever’s possible and sides mostly.

Beard HT is very good cuz hair quality is good and they have faster growth cycle then scalp hair. You can also go to an extent of extracting every beard graft!. Have a look at eugenix clinic India ( just a suggestion cuz I believe u have not done your research) 

Body hair transplant is also there and it works fine , hair quality is poor so it should be used in crown or you can fill in your donor area too! (Wink).

Genital hair transplant has also been performed and is in practice and I don’t need to explain hair quality! ( just for info).

Beard hair grafts are insanely good and body hair grafts are poor and should be used wisely. Beard hair transplant can be done along with scalp FUE so you don’t have to wait for a year and it decreases number of surgeries.

Every Norwood 5 or 6 needs three or four HTs in their lifetime for desired results

It all depends on your perspective and acceptance of realistic results. 

While writing I forgot two three very important things which I believe other members will say.

Finasteride, minoxidil, biotin tablets , prp, derma roller, laser therapy have different roles but its serves your hair...

I hope this helps

Hi Vickykuril,

Thanks for your detailed post! Why do you recommend FUT? Also I did not know that you could extract from the sides of the head? All the videos I see are from the back.

[Biceps]

FRONT VIEW

TOP VIEW

CROWN VIEW

[Spanker]

Few people are no candidates AT All.  Tons of people are not good candidates for their expectations.  

[Vickykuril]

2 hours ago, Biceps said:

Hi Vickykuril,

Thanks for your detailed post! Why do you recommend FUT? Also I did not know that you could extract from the sides of the head? All the videos I see are from the back.

Biceps, 

When I started researching I was a fan of FUE cuz I heard it heals faster, no scars and it's latest technology so it has to be superior . That's bullshit marketed extensively all over the internet because it's easy and anyone can do it. The truth is that yes it heals faster but it gives you so many tiny scars and it damages surrounding grafts through transection. Hair grafts (follicles) are not perpendicular and nobody knows which way the roots are below the scalp tissue so while extracting there is a chance that the graft which is been extracted can get damage cuz the angle of the root is unknown and the root was not extracted completely and that graft won't survive ( in some cases it survives and grows but after a year or two it sheds forever ). Even top doctors try to keep transection rate below 5% but it's not guaranteed it's a fact. Forget about surrounding grafts, if a beginner technician is extracting he might extract one graft and damage two surrounding grafts and the extracted graft may also be damage i.e total wastage of precious grafts. 

FUT is no doubt superior then fue cuz transection rate is very less only when the doctor makes incision to remove strip at that line it's possible rest entire grafts in tissue are safe.

ONLY trained doctors can do FUT unlike FUE . This industry is highly unethical and unregulated in US and Europe forget about other places.That is why every prospective HT patient needs to educate themselves. Do not be impatient , read every post in this forum or hire a patient educator .

If this patient is a candidate so are you . Don't forget to see his donor

 

Edited May 18, 2019 by Vickykuril
Need to add link

[Sean]

I meant last resort in the sense to try meds first and see if you tolerate them.  Finasteride, nizoral, minoxidil combo after speaking with physician.  

Also get a blood test to determine if there is underlying issues for patchiness in donor.  Vitamin d deficiency?  Thyroid tsh levels? Etc.  Or is it something else- a dermatologist can help determine this.

it seems to be diffuse and hair type looks Asian.  This itself is very delicate hair type for FUE and may not withstand high speed motorized devices nor suction based devices for graft extractions.  Might I suggest to get few more online consults with docs that have dealt with this hair type- ex Dr Diep, Dr Wong, Etc to start.

aside from that, please realize you have varying degrees of hair in front that may be shocklossed permanently if you implant in between those fragile hairs.  

 

Definitly should try meds if you can for an entire year to see where you stand.

option 2 could be using toppik or temporary smp as filler.  

Consider surgery last as if you get something done and it doesn’t turn out ok, you have very limited donor.

the right docs may be able to help but i would take a conservative approach to this.

last thing i want is for you to be a repair patient.  I really hope you have all your goals answered.  It is tough, but I definitely do not want someone to go through what I an going through.  Best wishes

[Biceps]

On 5/17/2019 at 11:02 PM, Sean said:

I meant last resort in the sense to try meds first and see if you tolerate them.  Finasteride, nizoral, minoxidil combo after speaking with physician.  

Also get a blood test to determine if there is underlying issues for patchiness in donor.  Vitamin d deficiency?  Thyroid tsh levels? Etc.  Or is it something else- a dermatologist can help determine this.

it seems to be diffuse and hair type looks Asian.  This itself is very delicate hair type for FUE and may not withstand high speed motorized devices nor suction based devices for graft extractions.  Might I suggest to get few more online consults with docs that have dealt with this hair type- ex Dr Diep, Dr Wong, Etc to start.

aside from that, please realize you have varying degrees of hair in front that may be shocklossed permanently if you implant in between those fragile hairs.  

 

Definitly should try meds if you can for an entire year to see where you stand.

option 2 could be using toppik or temporary smp as filler.  

Consider surgery last as if you get something done and it doesn’t turn out ok, you have very limited donor.

the right docs may be able to help but i would take a conservative approach to this.

last thing i want is for you to be a repair patient.  I really hope you have all your goals answered.  It is tough, but I definitely do not want someone to go through what I an going through.  Best wishes

Hi Sean,

Thanks for the advice. I definitely had a blood test done already in Jan, found out I was both Vit D deficient and subclinically hypothyroid. Both those are resolved now due to Vit D supplementation and thyroid medication, but idk how much that was affecting my hair.

You are right, it is Asian hair. I am definitely worried about shock loss. 

[Dr Blake Bloxham]

On 5/17/2019 at 7:40 PM, Biceps said:

Hi Dr. Bloxham,

Thank you for taking the time to respond. I'll be uploading pics of my hair loss in the next post. I have a few questions for you, but they are pretty basic as I don't know much about these procedures (and anyone can jump in to answer!)

1) What makes FUT better for weak donors?

2) Are the gaps in my donor area due to retrograde alopecia / DUPA, or is it just weak donor area?

Hi Biceps, 

I reviewed the pictures of your scalp, and it looks like you have pretty advanced hair loss and will require a large number of grafts; probably somewhere between 5,000 - 6,000 (eventually) to fill everything with acceptable density. I am not certain you have this in the donor, and I would not let anyone recommend surgery who did not evaluate you in-person. 

As to your other questions: 

1) FUT is typically better for weak donors because it allows you to take extensively and exclusively from the strongest part of the true safe donor area without causing any changes in global density. In other words, you can take nearly everything from a small area, create a very small amount of damage, and leave enough hair to always conceal the scar. The same cannot be said with FUE. In your situation, however, I am not sure FUT would be the best approach. With the spaces in the donor, I would not be confident that even a large strip would yield a satisfying graft number. If you came into my office and your donor looked the same as it does in those images, I would likely recommend doing very conservative FUE, combining it with SMP, and then wearing the hair cropped and short. 

2) I think it is just a weaker donor in general. It does not look like retrograde alopecia; possibly DUPA, but my best "guess" -- based on images alone -- would be classic androgenic alopecia with a weak donor area. 

Hope this helps, 

Dr Bloxham 

[Melvin- Admin]

You've been given excellent advice from Dr. Bloxham, I would not proceed with surgery without seeing a surgeon in person. An evaluation of your donor area using high-magnification is a must.