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Recommendations for FUT, FUE, Combination of FUT+FUE , BHT


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Hello guys!

Just like many of you in this platform, I am also here to seek help regarding hair transplant recommendations. I have been balding for few years now. I started loosing frontal hair first, and my forehead increased. My hair at the crown and front would not grown longer compared to hair at sides and back. Some pictures I found from few years ago that shows my balding crown.

126515558_05_CEL_TRIP_a(27).jpg.f0e2bc4afbf8ec82958d0f96fde13baa.jpg teamphoto1.jpg.ccc25a2f5d9f69c0d9118331f2c80673.jpg

My baldness is hereditary from dad's side. I will attach some pictures of progressive balding, and some changes in the past few months due to medicines.

To give you an intro, I am from India and currently working in Malaysia. I have been contemplating a hair transplant, but the surgery, medicine (the effects or side effects) stopped me from proceeding. I have equally gone worrying about progressive baldness after a transplant, which might end up looking weirder in later years. 

In the past few months I have tried some medications. I went to a famous skincare doctor in Malaysia - Dr. Ranjit. "Ranjit Skin Specialist Laser & Hair Clinic". He gave me two medicines, and I could admit it showed some improvement, but I started getting a bit worried about his medicines because he never really tell me what the actual medicine is. He only gave a slip that mentioned the ingredients. I have no idea why a doctor have to be secretive about medications. 

Dr. Ranjit Singh's Medication Description.jpeg

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Out of my fear of the unknown medicines, I decided to consult some other doctor who would prescribe me a known medicine, which I can read about online, and understand better about it's side effects, or even the cost for the matter. I spoke with few clinics in Malaysia - Glojas, Inder Kaur, Nathan's Skin and Laser to name a few. I proceeded with Nathan's clinic because Dr. Ruban sounded friendly and he called me on phone to talk about my hair loss once he saw my photos. However when I met him in person he seemed to be too busy and impatient to talk to me properly.

Anyhow, that being said right now I am on medications from him (since September 2019):

  • Dutasteride 0.5mg twice a week
  • Minoxidil 2.5mg every day
  • Minoxidil 15% topical 

You can see my progress after taking medicines from Dr. Ranjit and Dr. Ruban over the past few months.
Prasil-Hairloss-04-08-19.thumb.jpg.7b71350a5990a9cf1f5d27fad2eb09fb.jpg

Prasil-Hairloss-04-11-19.thumb.jpg.1e7e1f2b764e048f2c76415a74a83a17.jpg

Prasil-Hairloss-01-12-19.thumb.jpg.c06f9f54bb2080bf7ee4dbb77090273f.jpg

I think at this point I want to go for a hair transplant, after I see the medicines taking effect on my crown. Perhaps a transplant + post transplant medicines could be more effective. I don't see many good hair transplant results from clinics in Malaysia, compared to India. So I was considering to do it from India and I did speak with few clinics:

  1. Eugenix
  2. MedLinks
  3. Medispa
  4. Dr. Madhu's Hair Hospital & Research
  5. DHT Clinic
  6. Thai Hair Clinic

Everyone has different price and quote, obviously but most of them told me I need to do within a range of 4000 - 4500 grafts in a single or double sitting surgery. I am almost deciding on Dr. Suneet Soni from Medispa, and the quote from his clinic seems reasonable. I quite liked some of his results on YouTube, though I am a bit skeptical about FUT marks on the head. They call it a "trichopatic" closure or something, but to be honest all clinics have some kind of fancy name for their "technology" of surgery. 

While I was deciding on Dr. Suneet, I came across Dr. Suradej Pong from THTC. Now that he is in Thailand, and nearer to Malaysia, I may want to consider him as well. I was actually impressed to see that he mentions to keep hair longer to cover the grafts donor and recipient area after the operation. 

It will be really helpful if someone could suggest me some places near to Malaysia, within Malaysia or around here, or even maybe in Turkey, Korea or so. I would like to look for few more options before deciding. Right now I only have few Indian clinics in my mind. I think I could look for an option nearby in Malaysia. 

Anyways, that's pretty much about it. I hope someone can help me with some suggestions for my baldness.

Thanks guys, in advance. 

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UPDATES:

14 Dec 2019: Spoke to Dr. Suneet Soni on phone, and he said that he 4000 or slightly higher grafts can be transplanted (and could consider beard hair too, if required). I asked few doubts I had regarding the scar, progressive hairloss, medications. Dr. Suneet was very polite and kind, and answered to all my questions. If there are surgery scars visible, options in the future are: small amount of FUE transplant, or SMP

Edited by skallig
Added more photos, updates on my research
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Simple.  If FUE go to Eugenix.  If FUT or FUT + FUE go to Medispa.  For a 1st surgery both of these clinics use the most advanced equipment w/very qualified surgeons & are very reasonably priced.  Both get consistent high-quality yields and very little transection.  Both use microscopes to refine & check the quality and to prepare the grafts for implantation.

You'd get the most bang for the buck at either.  Although Eugenix probably dense packs the very frontal hairline a bit more than Dr. Soni for a 1st surgery.

FUT 1st surgery usually leaves a very thin scar 'cause it's a virgin scalp - statistically speaking.  Although any FUT surgery has a chance of a scar stretching due to individual genetics.

Good luck.  You should probably up your Dutasteride to 6X's per week or one per day - you'll only be getting the BEST effects of it this way vs 2X's per week.  I would also drop the 5% minox and exclusively use the 15% minox - it is also much more effective than 15%.  Some compounding pharmacies even make 30% minox cream - but make sure they test their 'batches' for potency and legitimacy.

Stay on those medicines - they will give your weaker hairs a better chance of surviving the stress of a hair restoration procedure and improves the overall quality of all of your donor hair.  I think you are an excellent candidate for a 4K graft procedure.  Good donor hair it looks like.

Edited by jjsrader
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Scar stretching happens - rarely on a 1st or 2nd transplant if well done.  Even so, if it happens one can either go for scar revision (cut it out and re-suture) or implant a mix of scalp and beard hair (fue) into the scar to break it up and/or SMP it.

It's a risk/reward type thing.  For many years FUT was done way more than FUE - depending on one's genetics & scalp laxity and skill of surgeon, the risk/reward for a 1st and even 2nd FUT is a statistical risk worth taking for the vast majority of FUT patients.

Good clinics that work on scar stretching could be any of the majors.  H&W, Shapiro, Bernstein or several others that have done scar revisions many times. 

Even if a scar stretches - it can be dealt with.  It is very rare to see really bad scar stretching if you go to the most experienced surgeons (2,500 surgeries or more) using good closing techniques and alot of experience w/scalps of all kinds.

Edited by jjsrader
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Hello @skallig  I had been researching for my own HT for 6 years.  I had the same concerns,  as its such an important decision to get right.

When I saw the results of @DrPradeep and @Dr Arika Bansal @Eugenix Hair Science I fly to London from Ireland to meet them both for a consultation .

Both doctors are true leaders in the field of hair restoration , with a history of unparalleled results with very natural hairlines with great density ,especially high norwood cases, and with state of the art clinics in India. The hospitality given by all the team and care at eugenix is exceptional,  you will be in great hands. 

......Wishing you all the best.....

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

 

 

 

 

 

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Hello @paddyirishman, thanks for the tip. I have gone through your article, and I keep checking for new updates there. I have contacted Eugenix too. They have impeccable results, but the price is my concern.. a bit. Medispa is affordable for me, but Eugenix is a bit too high for me. I am still considering about this, and perhaps I could switch as well. The scar stretching on FUT bothers me a bit as well. 

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Thanks for your message and feedback @skallig . Thanks for checking up on my thread also I hope it is useful to you.

 The linear scar was an issue for me also which I didnt want. Thats not to say there is absoutely no scarring in FUE, however it can be virtually undetectable in the right hands given the correct punch size.

As regarding my research into my own HT, I decided I would not let a long distance to travel put me off, as whats a few days travel in the bigger scheme of things. The other major factor that wouldn't put me off either was the cost of the HT.  One only has 1 chance to use and place those precious grafts from your doner , so you want all those grafts to be expertly handled with no root touch ,and to be out of body for the minimum time possible.  When this is carried out by really skilled surgeons and a great team around them you give yourself the best chance possible.

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

 

 

 

 

 

 

Edited by paddyirishman
To correct spelling error
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  • 2 weeks later...

Many of the FUT scars one sees now are from procedures done 30 years ago. Its much better now

You'll likely need over 2000+ grafts. In my opinion FUE is not a good option for you. I did my first FUT 3 weeks ago (i'll be doing a write at some point in the future). The scar is pencil thin already. There are multiple reasons as to why I chose FUT

1) Surface area of scarring is much much smaller compared to FUE
2) Maximizes the yield of grafts that will take hold much higher than FUE
3) If you hair keeps falling out, you can more easily do a 2nd or possibly 3rd procedure in the same scar
4) Less likely to over harvest compared to FUE area which can be an awful outcome

If you choose FUT, make sure that the surgeon is aware and incredibly experienced in doing a trichophytic closure of the scar. I'll share pictures of my closure in the near future. This will allow hair to grow through the scar and will make it blend in much better.

FUE is the buzzword in hair transplantation, but not everyone is a good candidate. Check out this presentation...

 

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  • 1 month later...

In case anyone is following thread, here is my updates:

I've postponed my initial thoughts for May 2020 HT to September or end of 2020 for two reasons, first is budget constraints, and second is with medications. I started taking finasteride 1mg everyday in the morning along with biotin. I want to do this for the next 6 months to see if I can see results (or face any sides). This would at least give me an idea what can be improved in my current "looks" and also what can be expected after a transplant. Shortly I will add an updated photo from all angles to see progress due to medications alone. 

 

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Whatever you decide to do its best to make a plan in case your medication dosent do what your hoping. It might very well do ok for you in the short term,  ie 1 year to 18 months, but your hair loss will still continue regardless , whatever that timeframe will be. As you know , it's not a cure. 

Paddy

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I'm not looking at medications as a permanent solution for the hairloss. I want to observe two things:

1. Does the medication help strengthen the hair, and reduce hairloss (different medication work differently on different people)
2. Does this give me any side effects

I believe these two are crucial, because medications are *supposedly* required to be taken for the rest of your life even after HT is done, to slower down, stop continued hairloss. I am doing this step now to see how medicines work for me, because I am anyways going to take this medication after the HT.

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  • 3 weeks later...

Here's a photo of myself - an update after almost 6 months of medication. The results are exquisite, in my opinion, and clinics who had quoted for 4000 grafts are now telling me to do a 2500-3000 grafts or 4000 grafts itself, but for a far better, thicker coverage. 406225823_Prasil-Hairloss-09-02-2020(Pixelated).thumb.jpg.4265eaa03047ed1540c56d1b56b82d9b.jpg

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I consulted doctors in Malaysia by visiting their clinic, and did online consultation with doctors from India. I started taking Dutasteride and Minoxidil after consulting Dr. Ruban, but stopped those and started taking Finasteride on Dr. Arika's (from Eugenix) recommendations. I am most likely planning a HT with Eugenix in the coming months. So far Eugenix is the only clinic that seemed to care about the patient, responsive to all my questions and concerns as well. How is your situation now @kirkland?

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I am down to choosing between Eugenix and MediSpa in Jaipur (Dr. Soni). Both clinics look like a good choice but I prefer to do the FUT/FUE combo offered at MediSpa since I will need at least 7000 grafts over 2 sessions. Best to make that first session the best for yield.

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I have been in touch with Medispa as well, and had spoken to Dr. Soni over phone. I see he have good results too, but my worry is only about the permanent scar the surgery can leave, which may be visible if you cut your hair short. But I understand from his videos, and from other sources as well that a FUT is a good choice for the first transplant, maximum density, and grafts availability for future transplants as well. When have you planned to do your first surgery - this year?

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Yes, you will have a scar with FUT. My plan is to have two FUT treatments spaced over a year apart to max out my yield. Looking for a minimum of 7000 grafts to achieve what I want. The scar can be treated with SMP at a later date. Seems like the most cost effective way to camouflage it with short hair.  I have seen some great results in person with SMP on FUT scars. My plan is to go to India in November since I can take 4 weeks off from work after the surgery for recovery.

Edited by kirkland
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Wow 7000 should give you a dense cover I guess. What's your Norwood scale? And yes, there are multiple ways to camouflage FUT scars - by SMP or by body hair or FUE transplant on the FUT scars. I am a bit worried about scar stretching. This works differently on different skin type, patient, etc., I think. I have only seen one patient result so far on this forum, I think his name is @thappa. You will never know how scars would stretch on your scalp until it happens. It could happen in a year time, or while you grow older. Nevertheless FUT is a good option to get dense hair transplant. I really like @Dr. Suneet Soni transplants look on the frontal hairlines. They all look natural!! Also, the healing time is much higher right? 3 weeks or more as you get multiple stitches. I want to get the HT done as a "secret men's business", without anyone noticing that I did something on my head. I would take two weeks vacation from work, maybe topup with 1 week work-from-home and come back join office as nothing happened, haha!

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I'm a solid Norwood 6 so even 7000 grafts is probably around 30-35 cm squared of density if I do the entire bald area. Going to leave the crown alone since there is still a descent amount of hair. FUE is the way to go if you don't want anyone to find out. FUT is harder to conceal because of the longer recovery time of the donor area. Good luck. Hope you get the results you want.

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  • 2 months later...

Not sure why, but three months later the hair density has reduced at the crown area it seems. I am still continuing 1mg Finasteride and Biotin in the morning, and Minoxidil spray at night on the scalp. However I'm happy with the growth on the frontal part. Usually my hair wont grow longer like this to be abled to comb. 

 

1150697565_Prasil-Hairloss-03-05-2020(Pixelated).thumb.jpg.670f787d3cdba4da8c232160d77e3f0c.jpg

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  • 1 month later...

I don't particularly understand Finasteride, because the most recent photo I took today shows my crown area to be a bit worser than the recent months before. Hmm, does it have to do with my dose, or the brand of Fin I use? I'm not really worried the Fin cannot help me cover my crown or progressive hairloss, I'm worried thinking if this would be the cast post HT, which would mean the medication might not help me in the long run by not helping me delay the progressive balding. Any thoughts, anyone?

 

Hairloss-07-06-2020 (Pixelated).jpg

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Looks like it was working at the beginning. Did you switch to a generic finisteride? I know some people have mentioned they lost ground when they switched to cheaper generics. What is the dosage you are taking and how often?

 

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Actually yes, I only tried Propecia during 1 or 2 months, other months I was on generic Finasteride. By the way, I am taking 1mg Finasteride (daily once in the morning). 
 

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