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Hair loss getting worse (on Big 3), weak donor area. What are my options?


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Hi all,

I'm a bit lost right now and could use some advice. I compared my pictures from Dec 2018 to Dec 2019 and I see worsening hair loss, doesn't seem like the Big 3 is doing anything. I'm also not a great candidate for a HT

  • June 2018 - Started Minox and Nizoral.
  • Aug 2018 - Started Fin.
  • May 2019 - Rejected by Erdogan for weak donor area.
  • June 2019 - In person eval from Rosanelli (also rejected me for weak donor area).
  • June 2019 - In person eval from Diep (estimated 2,000-5,000 hair grafts to cover the frontal area. The FUE prices are $16,500 for 2,000 grafts and $19,500 for 2,500 grafts. The FUT prices are $12,000 for 2,500 grafts and $20,000 for 4,500 grafts). He was not concerned with my weak donor area - which in itself is a bit concerning as two other HT surgeons had concerns.

Seems like my options right now are:

  1. What I'm currently doing - No HT, Big 3, Toppik.
  2. Give up on HT but continue Big 3 - No HT, Big 3, Buzz + SMP.
  3. Give up altogether - No HT, Quit Big 3, Buzz + SMP.
  4. Hair System.
  5. Continue exploring HT options.

 

HAIR LOSS (1 YEAR, 1st Pic is 2018, 2nd pic is 2019)

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Front (Dry). 1st Pic is 2018, 2nd pic is 2019

849930164_FRONT-DRY0219.thumb.JPG.f8f00cfda53ccd91964ed80c74648916.JPG1440978969_FRONT-DRY1119.thumb.JPG.23c9a8210238f7516ca069e8f5463de0.JPG

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Front (Wet) 1st Pic is 2018, 2nd pic is 2019

1608470364_FRONT-WET0219.thumb.JPG.12fb2f139807ea0a764e9c442006badb.JPG1414688205_FRONT-WET1119.thumb.JPG.c71b59b9cba9bae75812f7cedf9ff94b.JPG

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Top (Dry) 1st Pic is 2018, 2nd pic is 2019

1550655910_TOP-DRY0119.thumb.JPG.f1b78f66e2c0f415ded3dd1de576366f.JPG473847410_TOP-DRY1119.thumb.JPG.325f847f319b3c6a58da260f7ed3a656.JPG

 

Quote

Top (Wet) 1st Pic is 2018, 2nd pic is 2019

539516209_TOP-WET0119.thumb.JPG.54c50c06297191f7d8da1855320fdedc.JPG1678779059_TOP-WET1119.thumb.JPG.6af0ca7f527fc662613d211e89da70d3.JPG

DONOR AREA

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Medium Length

1051406496_REAR-DRY0419.thumb.png.691885f618bee6102868eee8f3424958.png1340094085_REAR-DRY0419(Combed).thumb.png.e07b4450be0c849f3eb718bb1010db3f.png

 

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Short

IMG_2102.thumb.JPG.7eab4053312a03ce5dd3b61bf1e19eac.JPG

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Buzzed

811091120_REAR-DRY0119.thumb.JPG.59269bfd04cfb528956057e95b808e75.JPG

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It does look like you have some thinning in your donor, I would actually consult with a dermatologist and see what they tell you maybe you have DUPA? Erdogan is really good when it comes to donor management, so if he rejected you than thats something to think about, on the other hand I would not consider Diep he is not good with donor management.

Stay on the medication for now, I would actually stop nizoral, personally I think it's overrated, it does more harm than good, your hair looks really dry and frizzy and that might be because of nizoral, also if you read the label on the shampoo one of the side effects listed is hair loss, I would stop nizoral for now, consult with a dermatologist, and maybe consult with a few more doctors and see what they say, maybe someone like Hasson & Wong, if you get rejected by other doctors then I would not consider a hair transplant for now, keep us updated and best of luck.

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6 hours ago, BjornBorg said:

Looks like you have a good headshape. And you have enough hair that it will look like you have some kind of hairline if you buzz it.

I know this is what noone on a hair restoration forum wants to read. But have you tried buzzing it all to a zero and growing a beard?

^ Great advice I always think buzzing should be the first thing you do. Some guys really like it and it's the safest and cheapest option. I did it for a year and I hated it, but everyone is different.

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  • May 2019 - Rejected by Erdogan for weak donor area.
  • June 2019 - In person eval from Rosanelli (also rejected me for weak donor area).
  • June 2019 - In person eval from Diep (estimated 2,000-5,000 hair grafts to cover the frontal area. The FUE prices are $16,500 for 2,000 grafts and $19,500 for 2,500 grafts. The FUT prices are $12,000 for 2,500 grafts and $20,000 for 4,500 grafts). He was not concerned with my weak donor area - which in itself is a bit concerning as two other HT surgeons had concerns.

 

Given the comments and cases I’ve seen recently on this forum..........why am I not surprised at Diep being happy to proceed where others wouldn’t..........

only thing I could add would be to try PRP with doctors who developed a protocol that works.....Dr Arocha seems to be one....perhaps big three + PRP could be final nudge needed to see regrowth.......if feedback is weak doner and meds arent stabilizing hair loss currently I would be hugely hestitant around doing anything HT related 

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17 hours ago, Abi28 said:

It does look like you have some thinning in your donor, I would actually consult with a dermatologist and see what they tell you maybe you have DUPA? Erdogan is really good when it comes to donor management, so if he rejected you than thats something to think about, on the other hand I would not consider Diep he is not good with donor management.

Stay on the medication for now, I would actually stop nizoral, personally I think it's overrated, it does more harm than good, your hair looks really dry and frizzy and that might be because of nizoral, also if you read the label on the shampoo one of the side effects listed is hair loss, I would stop nizoral for now, consult with a dermatologist, and maybe consult with a few more doctors and see what they say, maybe someone like Hasson & Wong, if you get rejected by other doctors then I would not consider a hair transplant for now, keep us updated and best of luck.

I've been to a derm and they weren't really knowledgeable about hair loss - all they did was prescribe me Fin. Is there any MD besides HT surgeons and derms that could diagnose DUPA? 

13 hours ago, BjornBorg said:

Looks like you have a good headshape. And you have enough hair that it will look like you have some kind of hairline if you buzz it.

I know this is what noone on a hair restoration forum wants to read. But have you tried buzzing it all to a zero and growing a beard?

Unfortunately I am not able to grow a full beard, only patches :( 

7 hours ago, Melvin-Moderator said:

^ Great advice I always think buzzing should be the first thing you do. Some guys really like it and it's the safest and cheapest option. I did it for a year and I hated it, but everyone is different.

I'll plan to take the plunge soon and just buzz it off. If I can accept it... then I can do SMP and close the door on this permanently.

7 hours ago, pre-screened said:
  • May 2019 - Rejected by Erdogan for weak donor area.
  • June 2019 - In person eval from Rosanelli (also rejected me for weak donor area).
  • June 2019 - In person eval from Diep (estimated 2,000-5,000 hair grafts to cover the frontal area. The FUE prices are $16,500 for 2,000 grafts and $19,500 for 2,500 grafts. The FUT prices are $12,000 for 2,500 grafts and $20,000 for 4,500 grafts). He was not concerned with my weak donor area - which in itself is a bit concerning as two other HT surgeons had concerns.

 

Given the comments and cases I’ve seen recently on this forum..........why am I not surprised at Diep being happy to proceed where others wouldn’t..........

only thing I could add would be to try PRP with doctors who developed a protocol that works.....Dr Arocha seems to be one....perhaps big three + PRP could be final nudge needed to see regrowth.......if feedback is weak doner and meds arent stabilizing hair loss currently I would be hugely hestitant around doing anything HT related 

Thank you for your feedback. I've heard so much mixed feedback about Diep... during our in person consultation, I felt very rushed which did not instill me with confidence.

Edited by Biceps
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An observation: I read about this forum poster and his SEVEN HT surgeries. This is frightening to me because:

  1. He is a handsome man and would pull off a buzzed/bald look easily
  2. He is married and in his 40s - why is he still seeking more hair?
  3. All the responders in the thread were encouraging of his seventh transplant

I mean no negativity to him with this observation. It's just making me think - do I really want to be taking Fin, applying Minox everyday, paying for HTs for the next 20 years? (I'm 26). 

I hate that I'm losing my hair, but I'm struggling on how much energy I want to devote into this... 

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16 minutes ago, Biceps said:

I've been to a derm and they weren't really knowledgeable about hair loss - all they did was prescribe me Fin. Is there any MD besides HT surgeons and derms that could diagnose DUPA? 

Maybe check with an other derm, consulting multiple doctors is always good

9 minutes ago, Biceps said:

I mean no negativity to him with this observation. It's just making me think - do I really want to be taking Fin, applying Minox everyday, paying for HTs for the next 20 years? (I'm 26). 

I hate that I'm losing my hair, but I'm struggling on how much energy I want to devote into this... 

I feel you man, it's mentally exhausting, I had a failed procedure a few years ago then I had a repair procedure in the summer, now coming up on month 4 post op and I haven't seen much yet, still early but I am honestly kinda over the whole hair loss thing, I feel like sometimes it's best to accept things and just move on, maybe you can stay on meds if you are not dealing with any side effects, for me minoxidil gave me side effects and I had to stop, I am using fin but I am also dealing with side effects now and I think I am about to stop pretty soon just waiting to see the results of my hair transplant, it's like you are playing a catch up game, try consulting with a few more doctors and if you get rejected I would say it will be time to move on.

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23 minutes ago, Biceps said:

 

Thank you for your feedback. I've heard so much mixed feedback about Diep... during our in person consultation, I felt very rushed which did not instill me with confidence.

Diep never met a dollar he didn’t like......from what I can see

just because you swing for the fences and hit a home run every now and again doesn’t make you an elite player....Diep pumps out enough results to feed YouTube.......the not so lucky end up here. Of course my opinion but one which Is increasing I feel amongst this community.

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45 minutes ago, Biceps said:

An observation: I read about this forum poster and his SEVEN HT surgeries. This is frightening to me because:

  1. He is a handsome man and would pull off a buzzed/bald look easily
  2. He is married and in his 40s - why is he still seeking more hair?
  3. All the responders in the thread were encouraging of his seventh transplant

I mean no negativity to him with this observation. It's just making me think - do I really want to be taking Fin, applying Minox everyday, paying for HTs for the next 20 years? (I'm 26). 

I hate that I'm losing my hair, but I'm struggling on how much energy I want to devote into this... 

Well he's not your average patient. He got a few bad surgeries in the 90s and was left with little choice but to get it repaired. 

The repairs were successful so why not maintain or improve it? He also works in the industry so may have had a couple for free as well. 

Whatever the case, it feels good to have hair. 

4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013

1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018

763 FUE grafts (2,094 hairs) with Ray Konior, MD - January 2020

Proscar 1.25mg every 3rd day

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Looks like you are based in California. I d suggest visiting a couple of other respected guys in that area like Carmen and Mohebi. 

Never met them myself but they seem like two of the more ethical guys out there. If your donor is suspect I'm sure they won't BS you. 

4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013

1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018

763 FUE grafts (2,094 hairs) with Ray Konior, MD - January 2020

Proscar 1.25mg every 3rd day

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1 hour ago, pre-screened said:

Diep never met a dollar he didn’t like......from what I can see

just because you swing for the fences and hit a home run every now and again doesn’t make you an elite player....Diep pumps out enough results to feed YouTube.......the not so lucky end up here. Of course my opinion but one which Is increasing I feel amongst this community.

This is total BS, @FUEblonde1985 @baldlivesmatter @bondi @m0dthispny @JBlonde @HairlessUser @E39 not to mention me. His resume speaks for itself. I recommended him to one of my best friends, and he is currently 4.5 months and is another homerun. There are only a handful of surgeons with as many stellar results on YouTube and the forum and he is one of them.

You may not like Dr. Diep, and that is fine, but don't make these nonsense claims. 


I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice.

Check out my final hair transplant and topical dutasteride journey

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Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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19 hours ago, Abi28 said:

Stay on the medication for now, I would actually stop nizoral, personally I think it's overrated, it does more harm than good, your hair looks really dry and frizzy and that might be because of nizoral, also if you read the label on the shampoo one of the side effects listed is hair loss, I would stop nizoral for now, consult with a dermatologist, and maybe consult with a few more doctors and see what they say, maybe someone like Hasson & Wong, if you get rejected by other doctors then I would not consider a hair transplant for now, keep us updated and best of luck.

I'm mainly concerned that being on the Big 3 has not even halted my hair loss, let alone given me any gains.  

1 hour ago, 1978matt said:

Well he's not your average patient. He got a few bad surgeries in the 90s and was left with little choice but to get it repaired. 

The repairs were successful so why not maintain or improve it? He also works in the industry so may have had a couple for free as well. 

Whatever the case, it feels good to have hair. 

I see. Thank you for the context.

1 hour ago, 1978matt said:

Looks like you are based in California. I d suggest visiting a couple of other respected guys in that area like Carmen and Mohebi. 

Never met them myself but they seem like two of the more ethical guys out there. If your donor is suspect I'm sure they won't BS you. 

Thanks for the recs. I'm in NorCal but in SoCal often enough, I can make a visit to them.

23 minutes ago, Melvin-Moderator said:

This is total BS, @FUEblonde1985 @baldlivesmatter @bondi @m0dthispny @JBlonde @HairlessUser @E39 not to mention me. His resume speaks for itself. I recommended him to one of my best friends, and he is currently 4.5 months and is another homerun. There are only a handful of surgeons with as many stellar results on YouTube and the forum and he is one of them.

You may not like Dr. Diep, and that is fine, but don't make these nonsense claims. 

Hi Melvin, I also personally know people that have gone to Diep and don't doubt his skill. However it was concerning to me that after two rejections from Erdogan and Rosanelli, that Diep was willing to perform an operation on me. During the consultation when I pointed out that those two doctors said my donor area was too weak, he deflected my question with a negative statement about HT surgeons in Turkey. I did not push further at that point.

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On 12/11/2019 at 9:33 PM, Abi28 said:

It does look like you have some thinning in your donor, I would actually consult with a dermatologist and see what they tell you maybe you have DUPA? Erdogan is really good when it comes to donor management, so if he rejected you than thats something to think about, on the other hand I would not consider Diep he is not good with donor management.

Stay on the medication for now, I would actually stop nizoral, personally I think it's overrated, it does more harm than good, your hair looks really dry and frizzy and that might be because of nizoral, also if you read the label on the shampoo one of the side effects listed is hair loss, I would stop nizoral for now, consult with a dermatologist, and maybe consult with a few more doctors and see what they say, maybe someone like Hasson & Wong, if you get rejected by other doctors then I would not consider a hair transplant for now, keep us updated and best of luck.

@Biceps I would also advise to stop nizoral. With your pattern, I would also advise you to check out @CosmoKramer post/advice on rolling. Your donor isn't the strongest, and at age 26, I am nervous you may end up with extreme thinning donor area . You said that you don't have much of a beard, but I imagine you also don't have much chest hair for a BHT. If I were you, I would stay on the fin and give derma rolling a shot (with topical minox). I would do whatever you could realistically do that isn't permanent (not HT/SMP) at this point, just to see if changing some stuff up would help.

I agree with Melvin that Diep is a good surgeon. I haven't been on the forum too often in last 2 months, but I don't remember seeing any bad results from Diep in my year and change on the forums. The only concerns I've seen for Diep are his prices and his [large] punch size. Outside of that, I think he has a catalog that speaks for itself. 

Whatever you do, best of luck.

 

>Edit

Quote

Hi Melvin, I also personally know people that have gone to Diep and don't doubt his skill. However it was concerning to me that after two rejections from Erdogan and Rosanelli, that Diep was willing to perform an operation on me. During the consultation when I pointed out that those two doctors said my donor area was too weak, he deflected my question with a negative statement about HT surgeons in Turkey. I did not push further at that point

I do think that the "vibe" you get from a doc is underrated. If you go to a doc you're just not comfortable with, I wouldn't do it. I'm a believer in the placebo effect and similar cases where the mindset has had "unbelievable" positive effects. I think you should completely buy into what the doctor is doing, and believe that there is no other clinc/doc you'd rather have. Having just a little seed of doubt before hand is enough to become a full-blown panic when things aren't going to expectations (like the guy who wanted to get his HT reversed like a week after). If you do go the HT route soon or eventually, you'll know it's the right doc because you'll feel it. It doesn't sound like you feel it from this visit. The good news is that there are dozens of good docs.

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12 hours ago, Biceps said:

I'm mainly concerned that being on the Big 3 has not even halted my hair loss, let alone given me any gains.  

I see. Thank you for the context.

Thanks for the recs. I'm in NorCal but in SoCal often enough, I can make a visit to them.

Hi Melvin, I also personally know people that have gone to Diep and don't doubt his skill. However it was concerning to me that after two rejections from Erdogan and Rosanelli, that Diep was willing to perform an operation on me. During the consultation when I pointed out that those two doctors said my donor area was too weak, he deflected my question with a negative statement about HT surgeons in Turkey. I did not push further at that point.

That’s fair, as I said go with your gut. Personally, I think you should buzz your head and see if you like it. Shaving is always the best option, if you can accept it.

Also, keep in mind looking at photos is vastly different than seeing you in person. We’re looking at pictures and passing judgement. It’s always best to consult with surgeons in person. 


I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice.

Check out my final hair transplant and topical dutasteride journey

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Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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You need to know if your donor is stable regarding if it has hair that is DHT resistant or if it is DHT receptive.

If your donor is unstable, meaning DHT receptive, I would never recommend that you have HT surgery.

Your entire donor needs to have a microscopic examination to determine this.

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Gillenator

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Supporting Physicians: Dr. Robert Dorin: The Hairloss Doctors in New York, NY

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3 hours ago, gillenator said:

You need to know if your donor is stable regarding if it has hair that is DHT resistant or if it is DHT receptive.

If your donor is unstable, meaning DHT receptive, I would never recommend that you have HT surgery.

Your entire donor needs to have a microscopic examination to determine this.

I see. Would a dermatologist perform this? I've gone to two HT surgeon consultations and I don't believe they did anything like this (for the donor area).

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So everyone, got H&W and Konior's responses to my pics and looks like there's no hope for me... not only am I in the percentage of men who have MPB, I am in the percentage of men who can't even have a HT. Feeling real down right now. Does anyone know of any threads where the poster is in my position? Just so I could get their perspectives on what to do.

H&W

Quote

The doctors have reviewed your photos and have determined you are unfortunately not a good candidate for a hair restoration procedure at this time. Your final pattern of loss is aggressive and your donor reserves are limited. It would not be in your best interest in their opinion to have a procedure. The amount of areas that could be covered with the present donor supply would not provide enough cosmetic benefit to warrant surgery. But perhaps just as important, as you lose more hair around any potential transplanted hair you will not have any donor hair left to improve your appearance should your pattern of loss become unnatural. Your best bet is likely to wait until such time technology has advanced enough to make you a viable candidate.

 

Konior

Quote

Your photos are not suitable to provide an assessment of your donor area.  Based on your history of being rejected for surgery because of a weak donor area, I would recommend that you have an in-person evaluation in order to provide a meaningful recommendation as to your candidacy.  The photos of your thinning zone suggest that you will eventually evolve to a class 5 pattern at very least, and possibly to even a more advanced pattern.  Any graft supply limitation because of a weak donor area will definitely limit your options for restoration.  I would caution any restoration unless you have conservative goals for final coverage and density.

 

 

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32 minutes ago, Biceps said:

So everyone, got H&W and Konior's responses to my pics and looks like there's no hope for me... not only am I in the percentage of men who have MPB, I am in the percentage of men who can't even have a HT. Feeling real down right now. Does anyone know of any threads where the poster is in my position? Just so I could get their perspectives on what to do.

 

 

Sorry to hear that - but you've been given great advise by H&W and Konior + other doctors who have nothing to gain, in fact have something to lose, by telling you the truth...........you were very prudent to double/triple check with top docs.

I would proceed with trying perhaps other solutions outside the Big 3 but I'm afraid they sit outside the Big 3 for a reason because their efficacy is questionable - at a certain point i think it wise to just accept the situation. You'll find freedom in that.

Finally I would say this the frustration/disappointment you have right now would pale in comparison to the depression/ issues you would have had as a result of an unethical failed procedure. Imagine if you had proceeded with Dr.Diep advise who was happy to put you in the chair when Turkish clinics + HW + Konior had said NO.

@Melvin-Moderator i take your point on Diep......but this board should also be ready to identify when a once top tier surgeons standard/practices quite clearly begin to slip.......human nature is such that as one gets rich and comfortable, as I'm sure Diep has, one's hunger, focus & professionalism can slip. Ironically it can make some even more greedy and more inclined to 'reach' for that extra dollar. This thread is one example of Diep "slipping" and being will to operate on this guy, taking doner hair from one side of the head in an FUE procedure making a mockery of doner management best practice is another.

 

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1 hour ago, Biceps said:

So everyone, got H&W and Konior's responses to my pics and looks like there's no hope for me... not only am I in the percentage of men who have MPB, I am in the percentage of men who can't even have a HT. Feeling real down right now. Does anyone know of any threads where the poster is in my position? Just so I could get their perspectives on what to do.

 

It's funny how Diep said you are a candidate but Konior, Erdogan and H&W all rejected you, that should tell you something about Diep, luckily you took your time consulting other doctors otherwise this could have been a disaster if you went with Diep.

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I think we need to remember guys that pictures online will never replace in-person consultations. In fact, I would warrant to say that @nick1111 had a weaker looking donor area, and he had his surgery from esteemed surgeon Dr. Konior, and now his results look really good. Now, it seems that this patient saw Diep in person, and the others he sent in pictures, that is an important factor to consider. Furthermore, I don't think negative statements about tech-driven clinics in Turkey are invalid. I think this is a major concern in the industry, so much so that the ISHRS has started a campaign called "fighttheFIGHT" 

@Biceps if you are serious about having a hair transplant, you need to set up in-person consultations with several surgeons. Photos can be deceiving I can submit a photo right now and get declined from virtually all surgeons, even though I saw Dr. Konior, Mohebi, Gabel and they all said I still have at least 1,000 grafts left in the tank. Depending on the angle, and lighting you will expose more scalp, especially if you have a short haircut. 

The photo I took now was taken blurry, facing bright lights, and the light was reflecting off of my skin making my hair appear super thin and see through. This will happen with virtually any person with short hair.

For further illustration, check out the child, see where the light is shining the brightest, you can see through his scalp, now we know it's obvious he isn't balding, but if he were a grown man submitting photos, one would assume that he was developing a bald spot. 

Now take a look at the video I shot in normal lighting my hair looks normal. 

 

Screen Shot 2019-12-14 at 9.35.22 AM.png

Screen Shot 2019-12-14 at 9.42.44 AM.png

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On ‎12‎/‎13‎/‎2019 at 6:58 PM, Biceps said:

I see. Would a dermatologist perform this? I've gone to two HT surgeon consultations and I don't believe they did anything like this (for the donor area).

No, a dermatologist would not be ideal to do this type of exam, you need to find an experienced HT surgeon who performs this type of evaluation on all of their patients prior to enrolling them for any procedure.

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I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians: Dr. Robert Dorin: The Hairloss Doctors in New York, NY

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