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HCH

NW5 - HT consultation

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Hi Guys,

I just had a face to face consultation with one of the best Doctors here in UAE.

He suggested a 2200 grafts to restore the hairline and 1000 for the crown.                                                                                                                                                                                                          Of course the medical treatment (Fin + Monox) is very essential in my case as this is the only way to maintain the existing hair and prevent future hair loss.

The donor hair is average but he can easily extract 3000 to 3500 in one session without over harvesting the safe zone.

Basically, i have seen 3 patients who did their procedures with the same Doctor and it looks like they got a good result after 1 year. Not sure how things will go after 3 or 4 years.

I need your opinion guys as i am really confused especially that two surgeons advised that i am not suitable for a hair transplant based on my donor hair pictures.

I have posted 2 sets of pics (1st in 2019 & 2nd in 2017). 

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the fact that he is suggesting 1000 for the crown alone discredits him. I am not sure I would move forward with him.

you seem to be a candidate based on your donor, but I would have very realistic expectations. focus on the hairline and frontal 1/3. maybe start with strip to maximaize grafts you can use.

 

good luck

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Hi

Looking at your photos, in my opinion, your donor has thinned pretty rapidly since your 2017 photos sadly. You wouldn’t want to go through the trouble and pain and financial pain just to get a 2-3,000 graft hair transplant that thins your donor region even more and a possibility that those donor hairs only last on your recipient are for a few years before they too fall out.

With that said photos can be misleading and it’s best to get in person professional opinions as many as you can and like I mentioned to someone else here, look into SMP and microneedling and possibly give it a chance for at least 3-4 months before any HT procedure because 1,000 grafts that doctor quoted you just for your crown will not do much for your area size.

Good Luck!

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If you want to see an example of how microneedling your crown might be of help then check out my thread in the Open Topic section.

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I agree that 1000 grafts in your crown would accomplish very little. It does appear that your donor density has decreased over past 2 years so you need to be careful not to over harvest. You might want to consider having done only in frontal and mid scalp areas before committing to crown area.

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Thanks all for your advice, much appreciated.

Actually, I have been exploring the HT option for 3 years and have consulted many Doctors in Europe, Turkey & Middle East but still hesitant to proceed.

Everyone suggested a different treatment plan (FUE/ FUT/ FUE + FUT) except Erdogan and Lorenzo who refused my case due to donor hair instability.

As i noticed, my donor density looks good when my hair grows up to 5 or 6 cm (as you can see in my 2017 pics) while it looks thin when i cut my hair very short.

Now after long research, i started using Minoxidil 5% twice a day and Finasteride 1 mg on alternative days (trying the microneedling also is not a bad idea as Cosmo advised). This will help me determine the effect of the medicines in case i decided to go for HT in future.

I am not really focusing on my crown and not sure if i can lower my hairline as my donor will be depleted assuming that it's very weak.

Now my main worry is my donor density and unfortunately all the Doctors who i have consulted here don't do a proper test to provide you the exact density %. They just say it's average.

Is this approach makes sense? what do you think about my donor density? 

 

 

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Pretty awesome a doctor took the time to post on your thread.

9 minutes ago, HCH said:

Erdogan and Lorenzo who refused my case due to donor hair instability.

As i noticed, my donor density looks good when my hair grows up to 5 or 6 cm (as you can see in my 2017 pics) while it looks thin when i cut my hair very short.

If I were in your shoes I'd exhaust all non surgical first for at least a year and try and see if my hair loss stabilised. Take photos every 3 or so months so you can keep track of things. Im no expert but based on the thinning areas id be worried youd end up a NW7. The hair above your ears looks quite thin as well so id be concerned about your donor generally. Erdogan and Lorenzo are both highly respected surgeons in this community who are known for their donor management skills (they both also use graft calculators) so their recommendations should be taken with some weight.

What worries me is your assertion that your donor looks good at 5 or 6cm ... even those who have had their donors overharvested,look good at that length. And I personally don't think it's good enough for the doctors there to not to do a proper test. While I have seen some doctors perform surgery on patients with weak donors those cases are rare, and those patients were properly assessed and taken through all the risks. 

Wish I knew more to help bro. Good luck

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10 minutes ago, transplantedphil said:

Pretty awesome a doctor took the time to post on your thread.

If I were in your shoes I'd exhaust all non surgical first for at least a year and try and see if my hair loss stabilised. Take photos every 3 or so months so you can keep track of things. Im no expert but based on the thinning areas id be worried youd end up a NW7. The hair above your ears looks quite thin as well so id be concerned about your donor generally. Erdogan and Lorenzo are both highly respected surgeons in this community who are known for their donor management skills (they both also use graft calculators) so their recommendations should be taken with some weight.

What worries me is your assertion that your donor looks good at 5 or 6cm ... even those who have had their donors overharvested,look good at that length. And I personally don't think it's good enough for the doctors there to not to do a proper test. While I have seen some doctors perform surgery on patients with weak donors those cases are rare, and those patients were properly assessed and taken through all the risks. 

Wish I knew more to help bro. Good luck

Thanks bro for your honest advise and yes i am so happy to hear Dr. Glenn opinion :)

I just wanna mention that Dr. Erdogan and Lorenzo recommendations are based on pictures and not in person consultation.

Dr. Erdogan 2 years back suggested 6000 grafts FUE with a bit lower hairline but i wasn't really convinced as i don't believe any Dr. can harvest more than 3000 grafts in one session from the donor safe zone.

Back to your comment about my assertion about my donor, i am just trying to say that the comparison between my donor 2 years back and now doesn't help for assessment as the hair length makes a huge difference. i am thinking to keep my hair grow a little more and then reevaluate.

Doctors here will do a proper test only when you book for a surgery. My last consultation was even paid and when i asked the Dr. for the exact density he said it will take long time to test and need tattooing which can be done only before the surgery. Honestly it's like a fish market here.

 

 

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Yeah its just with my amateur eyes looking at your donor, (if its all cut to the same length) i think it looks a bit patchy. The pics below it looks a bit diffuse throughout. That's why Id be worried about you. 

Best to take photos at the same length if you can as well otherwise you cant really compare. 

Doctor's dont do a test unless you book for surgery in UAE? lol. Sort of proves they aren't legit. 

7 hours ago, HCH said:

 

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Hello HCH .  I hope you are well.

Take your time before making any major decision as you need to get your doner area properly assesed while pictures can only give a general guide  .  You must consider that medication might not help you in the long term for a variety of different reasons , so it might be wise not to totally depend on it helping you. You seem to have retrograde alopecia which is thinning over the ears and at the lower down on the back of your neck so that is another factor which leaves your doner restricted to a smaller area to harvest grafts from.  

Having said the above you still have options.  Find out how much doner you have. ?  What are your realistic expections ?  Seriously consider BHT in the form of beard grafts to help with more potential of doner for decent density and coversge of your transplant. If put in the right surgeons hands with lots of experience and proven results with combination of HTs and Beard grafts together it could make a significant difference.  

One of the clinics that are experts on the above and are recommended on this forum and beyond with great doctors are EUGENIX Hair Science's  who have proven results with patients with limited doner supply .  I think it was Harin and more patients ( or a very similar name ) who posted a thread of their situation which proved an amazing outcome.

I hops the above helps HCH. All the best.

.................Paddy..........

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6 hours ago, paddyirishman said:

Hello HCH .  I hope you are well.

Take your time before making any major decision as you need to get your doner area properly assesed while pictures can only give a general guide  .  You must consider that medication might not help you in the long term for a variety of different reasons , so it might be wise not to totally depend on it helping you. You seem to have retrograde alopecia which is thinning over the ears and at the lower down on the back of your neck so that is another factor which leaves your doner restricted to a smaller area to harvest grafts from.  

Having said the above you still have options.  Find out how much doner you have. ?  What are your realistic expections ?  Seriously consider BHT in the form of beard grafts to help with more potential of doner for decent density and coversge of your transplant. If put in the right surgeons hands with lots of experience and proven results with combination of HTs and Beard grafts together it could make a significant difference.  

One of the clinics that are experts on the above and are recommended on this forum and beyond with great doctors are EUGENIX Hair Science's  who have proven results with patients with limited doner supply .  I think it was Harin and more patients ( or a very similar name ) who posted a thread of their situation which proved an amazing outcome.

I hops the above helps HCH. All the best.

.................Paddy..........

Hi bro, i really appreciate your advise.

Currently i am trying to use medicines and see how it goes. Definitely, i am not going to consider HT unless my hair loss stabilize.

I have seen some patients with BHT but not really convinced about it especially that the hair caliber and texture makes it look unnatural.

Worst case scenario, i will buzz my hair and live with it.

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11 hours ago, Dr. Glenn Charles said:

I agree that 1000 grafts in your crown would accomplish very little. It does appear that your donor density has decreased over past 2 years so you need to be careful not to over harvest. You might want to consider having done only in frontal and mid scalp areas before committing to crown area.

Thanks Dr for your time and valuable advise.

According to my Doctor, he can do up to 3500 grafts in one session. So his plan is to focus on the front and mid scalp and then try to work on the crown with whatever grafts left. He's expecting to implant around 7500 hairs.  

What makes me step back from his plan is the hairline design which is a bit aggressive (maybe 2 cm below my existing one). Something similar to the attached pic including the temples. I don't think 2000 or 2500 grafts can cover this huge area (see Dr. Erdogan plan in 2017).

Appreciate your honest recommendation.

 

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IMO its VERY aggressive. lowering hairlines takes up a lot of grafts, and even when you lower them the hairline is the most important feature so you want the most density behind it

if this is the same doc saying he wants to place 1000 grafts in the crown well you can guess what i think of :/

as for bht there was a thread posted by melvin recently which was insightful, but again its ultimately about the patient's individual donor characteristics. while the results ive seen from eugenix are quite impressive, they mostly deal with indian patients (whod id assume) have similar calibre hair from their beard to scalp hair, and have less contrast between their hair and skin overall which makes them the ideal patients for this. bht also cycles differently so most surgeons ive spoken to seem to reserve it as a last resort. 

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5 hours ago, transplantedphil said:

IMO its VERY aggressive. lowering hairlines takes up a lot of grafts, and even when you lower them the hairline is the most important feature so you want the most density behind it

if this is the same doc saying he wants to place 1000 grafts in the crown well you can guess what i think of :/

as for bht there was a thread posted by melvin recently which was insightful, but again its ultimately about the patient's individual donor characteristics. while the results ive seen from eugenix are quite impressive, they mostly deal with indian patients (whod id assume) have similar calibre hair from their beard to scalp hair, and have less contrast between their hair and skin overall which makes them the ideal patients for this. bht also cycles differently so most surgeons ive spoken to seem to reserve it as a last resort. 

Agree with you but honestly if you see his results you would be really surprised. Also he's one of the few Doctors here who takes 1 patient /day.

In fact i have also consulted Dr. Devroye 2 years ago (see below his recommendation). he draws a very conservative hairline roughly at the same position.

"The thinning areas (1 to 5) represent an important surface. Probably it would be better to limit the transplant from the area 1 to 4. 

If you use to wear your hair short, as on your pictures, I recommend you the FUE technique. With this
technique, in one day we are able to reach from 1700 to 2000 grafts. It would be possible to plan two
days of surgeries or one day an half to reach 3000 grafts for example. 

With the FUT technique we could transfer more grafts in one day, depending on the quality and the
density of FU on your donor area, we perhaps could place more than 3000 grafts. So, with this
technique we could be able to cover the vertex (zone 5) as well, even if we do not want to reach the
maximal density. To preserve the existing hair the only solution should be to use minoxidil and/or finasteride. 

You are welcome to our clinic in Brussels for a consultation so I will be able to make a more precise
diagnostic. The consultation is free, and lasts about one hour. 

If you need any other information do not hesitate to contact me and I could also call you by phone. 

Best regards, 

Dr Devroye"

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Hello guys,

I just took these pics today before my hair cut and would like to know your thoughts.

I am still on minoxidil (twice a day) & Finasteride (alternative days) and added micro-needling 1.5 mm (once a week).

 

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Interesting. Your donor looks much healthier here than in your other pics from this year. What length is that?

I'd send them all of to a few docs for there responses (Bisanga, BLoxham, Konior, Feriduni, Gabel all gave me the most straightforward consultations)

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I wish so Phil :) it's 4 or 5 i guess.

Btw, Dr. Bhatti told me first that my donor doesn't look good and then i sent him the below photo and he advised me the following:

"Sorry for that. On the contrary the donor is lush and hairs are thick as seen in the pictures.

You will need a staged procedure for the best result.

In the first- 3500 scalp grafts for the hairline, and mid-scalp.

After 6 months the crown area shall be covered with 1800-2000 scalp grafts.

Both will be single day procedures."

Also, i have consulted Dr. Bansal who recommended a mix of scalp and beard HT but after doing a video call she suggested 2500 to 3000 for the front and mid only. A reassessment will be done after 4 months of using medicines. 

The only 2 doctors who rejected my case are Erdogan and Lorenzo, i am so worried as HT is my only option left :( 

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You’ve been given great advice. However, it’s clear your donor is not strong. It looks better grown out because the hair overlap and cover the scalp. The truth is shown when the hair is cut short. 

In my opinion, you do not have enough donor to even consider the crown. 


I do not provide medical advice, recommendations, all responses are my opinion.

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Ive had 3 HTs. my donor looks ok at 2cm length, but when i shave it anything under that it starts looking patchy. so if its 1cm it starts revealing weaknesses. 0.7mm and i start getting doctors telling me they dont know if they can perform surgery as they see overharvested areas/donor depletion etc.

When you consult the doctors do they know the length of your hair in each photo? Do they ask? Send a consult to a few of them I mentioned as I hold them all to be very honest - they'll set you straight. You case is tough to assess as it's all via photos, and your hair length in these photos seems to be hiding your miniaturisation (I read your post wrong and assumed you just had a haircut and was much shorter - sorry). i would also take Lorenzo's and Erdogan's assessment very seriously - you can always find a doctor willing to operate but it doesn't mean they should. 

Completely agree with Melvin here about everything as well. Even considering the crown at this stage would be futile and 1000-2000 grafts wouldnt do anything; it's appears to be your largest balding area and might expand even further, so any doc suggesting work there really wouldnt achieve much, especially with your donor. 

Edited by transplantedphil

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Thanks guys for your help.

Actually, i have consulted many doctors including Konior who assessed my case based on the below pics. Definitely i am not thinking to touch my crown as it will need at least 2000 grafts and my priority is my hairline and and frontal area. I am still looking to do a lab test for my donor density but it's hard to trust any local clinic here. Maybe i should go to India or Turkey for a week to check it and so a face to face consultation. Unfortunately, i can't afford going to Europe as it will cost me a fortune.

I have been reading a lot about SMP, i guess it needs a lot of maintenance and daily grooming. Not sure also if it suits me as i never shaved my head. Do you recommend such treatment ? 

 

Dr Konior You have an advanced pattern and your restoration will be limited by donor supply as your needs surpass graft availability in the donor region.  Understand that surgery will not halt the progression of male pattern hair loss, meaning that your preexisting hair will continue to thin despite any hair restoration procedure.  I believe that it is important for you to consider using minoxidil and finasteride if you hope to maintain your current hair population.  You may want to try non-surgical means for up to one year prior to surgery in order to determine if there will be stabilization or possibly density enhancement.  Your short hair style will require you to use FUE harvesting as a strip harvest could potentially leave a visible scar in the donor area.  Your donor area looks average and should have perhaps 3000 grafts available for a first session.  I would need to know more details as to your goals, i.e. desired hairline location, thoughts on the current frontal and midscalp density, and your thoughts about the crown.  One should opt for the most conservative restoration possible when supply is limited.  This equates to maintaining a high hairline, prioritizing density in the front half of the scalp, and avoiding or limiting graft placement in the crown"

 

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Bro it seems like you have different photos from different time periods, with different hair lengths - that's just going to result in different answers. You even had the same doctor (Bhatti) give you two different diagnosis based on different hair lengths, which IMO doesnt make sense.

On 9/11/2019 at 12:27 AM, HCH said:

 

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Send these around for reassessment. These photos reveal your hair miniaturisation and where you baldness pattern might eventually end up. 

Good luck sir

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I got your point bro, i am just trying to show you the difference between each set of pics at different length.

 All these pics are taken within a period of 45 days except the old set in 2017. I think the best way is to do a density test.

See below my pics today after hair cut. If you notice i have some white hairs above my ears and on the back which makes my hair looks patchy at certain angles.

Anyway, i will try to consult the Doctors you have mentioned and see their recommendation.

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