Am I a good candidate? How many grafts would I need? FUE vs FUT?

[giegnosiganoe]

Hi folks,

I'm 25 years old, been balding since around 18 years old. I hopped on dut/min May 2019, and have mostly seen maintenance. I'm starting to think of getting a hair transplant to recover some ground, and wanted to get some opinions on my situation.

Recent pictures: https://drive.google.com/open?id=1_LSOP32vBwErFlL5nsoNKiRxk3mWxk1y

Pictures from around 5 years ago - I was happy with my hair and would like to go back to that (crown not pictured, but it didn't really have any loss): https://drive.google.com/open?id=16gQahJ7f6GTiPJOYSsjShta6QHY5uJq3

Some questions: Am I a good candidate? Where would you recommend placing grafts? Should I try improving the crown/midscalp? How many grafts would I need? FUT vs FUE? Recommended US doctors?

I'll be seeing a US doctor in a couple of weeks for a consultation. Any advice on how I can get the most out of the appointment? What kind of diagnosis should I expect (that I can hopefully share with other doctors to see what they think is the best course of action).

Thanks a lot in advance, would appreciate any help.

Edit: would also like to add that I believe my hair type is "fine and straight".

Edited January 31, 2020 by giegnosiganoe

[LaserCap]

Nice set of photos.  Not a bad set of hair either.  Not coarse, not thin - let's call it medium caliber. (You do not have "fine" hair.  Be thankful.  It would take more grafts to achieve the same result). You also seem to have a bit of waviness.  This will also help you as you'll have more lateral coverage - which you are currently enjoying).

I particularly take notice of the way you style your hair.  Smart to comb it to the side so you get some shingling and enjoy the illusion of density.  The part-line, however, is always the weakest point.  I'll venture to say, if you were to part it on the other side, it would be the same.  Thus, if you were to cut your hair very short, it is likely an early 5A pattern would surface.  Whatever you do, please continue the medication and consider adding another modality.  Rogaine, Laser, PRP.  The mechanism of action of each is totally different and you can enjoy synergy when used simultaneously.  

Your hairline has receded and it seems you are still losing in that area.  Look at the shafts.  Some seem thinner than others.  My suggestion would be to reinforce the hairline and blend grafts to the area right behind it to avoid the "island effect."  Continue meds.

You seem to have nice donor.  You can confirm this with an in person evaluation.  

How many grafts will depend on the doctor and the way he likes to approach the case.  Some can achieve great density while others are still the process of figuring it out.  Check out photos of cases similar to your own and take note of the number of grafts it took.  

What part of the Country are you in - or will be in?  Are your travel plans flexible?

[1978matt]

I'd say you don't have the best density.  Maybe on the low side of average.  There is retrograde thinning above the ears and nape area.

FUT would probably be best in the long term and offer the most grafts, combined with some FUE later down the line.

I'd give it until May to see if the meds have truly halted progression, and try shaving your head in the interim.

You probably need about 1500-2000 grafts for a better hairline, but I'd leave the crown alone at this stage.

[Dr. Glenn Charles]

I would recommend only doing conservative work in the hairline area. Maybe 1300-1500 FU's. This could be done with either FUT or FUE. I do not think you have enough hair loss in the crown region at this time that could be improved with a hair transplant. Continue with preventative measures as long as no side effects occur.

[OliverAtom]

3 hours ago, 1978matt said:

I'd say you don't have the best density.  Maybe on the low side of average.  There is retrograde thinning above the ears and nape area.

FUT would probably be best in the long term and offer the most grafts, combined with some FUE later down the line.

I'd give it until May to see if the meds have truly halted progression, and try shaving your head in the interim.

You probably need about 1500-2000 grafts for a better hairline, but I'd leave the crown alone at this stage.

+10000 Totally agree 100% with 1978matt

Good luck!

[giegnosiganoe]

Thanks all.

I am located on the west coast and am talking to a few of the big names.

@1978matt I tend to agree with your assessment.

When you say I don't have the best density, are you talking about the regions prone to loss, or the donor area as well?

I agree that FUT seems to be the better call if I want to maximize the number of lifetime grafts, I'm just worried about the scar stretching, or it being visible at shorter lengths. I usually go with a 3 guard on the back and sides, and given that my hair sticks straight out at that length(the hairdresser always mentions it), I'm afraid it might be easily seen from an upwards angle (e.g. if i tilt my head forward). I guess I'd have to start going with a taper.

Are you suggesting shaving my head to see what the miniaturization looks like across my scalp? I'd be totally open to it if I didn't think I'd look like utter shit. Can a hair transplant doctor track and determine whether I've halted my progression using one of those hair microscopes instead? Are there some specific measurements that I should ask for when I go for my consultation next week?

1500-2000 grafts seems about right.

How probable do you think it is that I can bring my hair back to how it was in the before photos? The actual hairline isn't too different (if you take the lowest remaining hairs, even if they are very sparse). It's mainly filling in (most of) the density between NW2 to NW3 (maybe a bit further as well).

Thanks again, this means so much to me. I'm finally getting closer to having a full understanding of my situation and what I can do about it.

Edited January 31, 2020 by giegnosiganoe

[1978matt]

4 hours ago, giegnosiganoe said:

Thanks all.

I am located on the west coast and am talking to a few of the big names.

@1978matt I tend to agree with your assessment.

When you say I don't have the best density, are you talking about the regions prone to loss, or the donor area as well?

I agree that FUT seems to be the better call if I want to maximize the number of lifetime grafts, I'm just worried about the scar stretching, or it being visible at shorter lengths. I usually go with a 3 guard on the back and sides, and given that my hair sticks straight out at that length(the hairdresser always mentions it), I'm afraid it might be easily seen from an upwards angle (e.g. if i tilt my head forward). I guess I'd have to start going with a taper.

Are you suggesting shaving my head to see what the miniaturization looks like across my scalp? I'd be totally open to it if I didn't think I'd look like utter shit. Can a hair transplant doctor track and determine whether I've halted my progression using one of those hair microscopes instead? Are there some specific measurements that I should ask for when I go for my consultation next week?

1500-2000 grafts seems about right.

How probable do you think it is that I can bring my hair back to how it was in the before photos? The actual hairline isn't too different (if you take the lowest remaining hairs, even if they are very sparse). It's mainly filling in (most of) the density between NW2 to NW3 (maybe a bit further as well).

Thanks again, this means so much to me. I'm finally getting closer to having a full understanding of my situation and what I can do about it.

Just the donor density looks below the standard "80 fu/cm2". 

Shaving head to see if you can live with the look, but yes it might make the thinning areas more evident. 

A crappy scar is very doctor dependent. Idd stick with the konior, gabels, h&w, cooleys, bisanga, feriduni and shapiros of this world. 

The only way to see if your loss has stopped is waiting, though some doctors may be prepared to take miniaturisation readings and track them over time. 

You before hairline looks reasonable in terms of shape/position. Density is the big question. 

Something that looks close to original density may be possible and look quite good with styling (side part and brushed over for a layering effect). 

Questions? I'm your shoes I'd like an assessment of likely lifetime balding area and number of grafts that could be achieved long term. That might mean good density over 2/3rds of the top and a thin crown. 

Edited January 31, 2020 by 1978matt

[alboz]

So what is standard hair deensity nowadays?

[giegnosiganoe]

Took some videos and cut my hair today, so wanted to get some more opinions.

Long hair with flash: https://www.youtube.com/watch?v=XwbmrZRwCwM

Buzzed 16mm on top, 9mm down to 5mm on the sides and back.

Short hair with flash: https://www.youtube.com/watch?v=Mqs_otMLFsY
Short hair without flash, focusing more on hairline: https://www.youtube.com/watch?v=hgWNnHVnkLg

Doesn't look as bad as I thought it would, I think I'll continue doing this for the foreseeable future.

Thoughts on treatment? What would you do in my situation? Definitely don't have the best donor (plus I have retrograde), but I'm not sure if that's due to thinning or if it has always been sparse.. I still feel like I could at least get a small-ish HT to fill in the temples where it's very diffuse, as well as reinforcing the frontal band in general, and that should make a good difference. The midscalp to crown, I'm not too worried about. Once my hair grows a bit longer I can just use concealer.

also, if i did want to transplant into the crown/midscalp, how many grafts do you reckon id need? secondly how do people think I would fare with SMP there? When I look at my side profile, I seem to still have enough hair there for a 3D look. its just that much more skin can be seen through the hair

Edited April 20, 2020 by giegnosiganoe