Opinions on HT viability?

[Kvn]

Hey guys,

I’d already planned on a hair transplant due to the severity of my hair loss for my age. However, I thought it might be beneficial to hear some objective opinions (or advice) for the way ahead as far as coverage & realistic expectations go with where I’m likely heading from guys who have been through it already. 

I’m about to be 25, and as of now I’m not taking any sort of medication. But I do plan on attempting finasteride again following the transplant and seeing how that goes. I took fin from 2017 up until 2019 and it definitely didn’t improve my hair, but it did slow the hair loss slightly. 

The pattern itself is pretty visible and my hair is basically see through when I walk outside, so general general coverage is my biggest concern. In the pictures below my hair is cut to a 2 on the sides and the hair on top is generally about an inch and a half.  

 

v/r

Kev

 

[hairlossPA]

what are you expectations? is your surgery scheduled yet?

top of head looks decent. i wouldn’t focus anything on the crown at such a young age. you should hop on fin again asap. you might need to go FUT to maximize the # of graphs you can harvest in your lifetime 

[Kvn]

8 hours ago, hairlossPA said:

what are you expectations? is your surgery scheduled yet?

top of head looks decent. i wouldn’t focus anything on the crown at such a young age. you should hop on fin again asap. you might need to go FUT to maximize the # of graphs you can harvest in your lifetime 

Well, with the pattern that’s currently visible. I’m wondering what kind of expectations I should have as far as crown density goes for guys who achieve high norwoods and get transplants. It’s thinned significantly in the last four months, so I don’t plan on waiting too long to do something about that if it progresses at this speed 

[LonelyGraft]

You need to try and stabilize your loss before you consider a hair transplant. It looks like you have diffuse loss over the Norwood 6 area. Are you following the pattern of any close relatives such as your dad uncles or grandfathers? Are there any Norwood 7s in your family?

[Kvn]

1 hour ago, jj51702 said:

You need to try and stabilize your loss before you consider a hair transplant. It looks like you have diffuse loss over the Norwood 6 area. Are you following the pattern of any close relatives such as your dad uncles or grandfathers? Are there any Norwood 7s in your family?

I tried finasteride and regardless of how much it helped it did not stabilize, so I don’t believe that’s an option. Plus I’m currently overseas and unable to receive any sort of prescriptions.

My maternal grandfather has a keeps his head buzzed but definitely still has a full head of hair. He’s had slight temple recession but that’s about it. My dad and his father I’m not entirely familiar with but I’ve heard they were both completely bald. 

[LonelyGraft]

30 minutes ago, Kvn said:

I tried finasteride and regardless of how much it helped it did not stabilize, so I don’t believe that’s an option. Plus I’m currently overseas and unable to receive any sort of prescriptions.

My maternal grandfather has a keeps his head buzzed but definitely still has a full head of hair. He’s had slight temple recession but that’s about it. My dad and his father I’m not entirely familiar with but I’ve heard they were both completely bald. 

I suggest you speak with some reputable and honest surgeons that can help you plan carefully. There’s a bit of danger getting a transplant at a young age with continuing loss as your final pattern is still not apparent. You will likely need to adjust your expectations with continuing hair loss (mature hairline, focusing on frontal 1/3, etc). 

 

Please research carefully. Wish you the best of luck 

[Kvn]

11 hours ago, jj51702 said:

I suggest you speak with some reputable and honest surgeons that can help you plan carefully. There’s a bit of danger getting a transplant at a young age with continuing loss as your final pattern is still not apparent. You will likely need to adjust your expectations with continuing hair loss (mature hairline, focusing on frontal 1/3, etc). 

 

Please research carefully. Wish you the best of luck 

I’ve recently shot out a couple of consultations. I don’t feel completely heard though. I’m either being told that my hair loss isn’t severe enough for a transplant (which is crap). Or the clinics aren’t understanding that I’d taken propecia for two years without a response. And because of that I’m trying to approach this with the future in mind, as an obvious to-be NW6.

Thanks for the input!

Edited July 8, 2019 by Kvn

[Aftermath]

The thing is with this case is how low down into the donor the hairloss goes, if u get some retrograde loss and u lose hair from the nape up the the “safe” zone is very small and probably won’t give you coverage if you lose it all. The other problem is the lack of response to propecia, not sure a HT is wise. The only way I can see it looking ok long term is if you’re not really bothered about the crown and you concentrate on the frontal 2/3, which at this point isn’t bad. If you use up all your grafts on the crown and you lose the rest you won’t be able to shave it. 

I suppose another way to go if you’re good with the shaved head look is a combination of SMP and FUE.

its a tough one for me, but I think you’re being wise assuming you’re going to be a class 6

[DrTBarghouthi]

I strongly urge you not to tap into your crown at this age. You will need to be on finasteride to slown down your loss. However, with a crown that still looks unstable in terms of margins, I would leave it alone to save the grafts for other areas. You can also consider things like a hair system to cover the crown and save your donor area for the front and mid scalp. 

[Dr Blake Bloxham]

Kvn, 

At a young age with a somewhat disappointing response to preventive medications (you are not alone here), you should look at hair transplantation as a strategic and long-term game. You have limited grafts to use from the back --- and it looks like you will progress to an advanced pattern -- and a large and expanding area to cover on the top. I think you can do this with transplantation only, but you need to work smart and not waste any precious donor. 

If you came into my office, I would likely recommend the following: 

Do an FUT mega-session now of around 2,500 - 3,000 grafts aimed at addressing the "frontal 1/3rd" of the scalp. This would involve carefully (as you are a diffuse thinner and we would not want to damage the existing hair) rebuilding or reinforcing an appropriate hairline, densely addressing the frontal scalp behind it, and strategically transitioning into the "bridge" of better hair you have in the middle. I completely understand the urge to jump into the crown now, but I would highly advise against it. It is rapidly evolving and we do not know how it will end up yet. Use your grafts now to build a strong foundation in the first 2/3rds of the scalp (this is assuming the bridge will thin and you will want a second hair transplant to rebuild this) and then come up with a strategic plan for the crown later. This is where you may get into FUE and other clever approaches to obtain coverage back here or build up enough "tacking" hair where you can use a little bit of concealer, when warranted, to really make it look full. 

I would really push starting with FUT because I do believe your donor is limited. Likely enough to get 6,000 or so grafts out of with a combination of both methods (FUT and FUE), but I do not think it is sufficient for FUE alone. It also looks like you may have some thinning in the bottom region of the "donor" (retrograde alopecia) as well, so it is best to stay away from anything along the fringes of the donor for now. 

Hope this helps.