Are These Red Flags?

[Newbie2TLS]

Hi all. I just joined. I'm starting to notice my hairline recede and the crown start to thin a bit. I've researched my options for a month. I just had a consultation with a very popular hair transplant doctor . And during the consultation, I noticed a few things that were red flags to me. I'm hoping you guys can tell me if you think they're red flags, too. I don't want to name the doctor because  I just want an unbiased opinion. 

Here are the things I thought were red flags during my consult:

1. We had a video conference consultation (he never saw me in person), and with just a few pictures and literally 2 second look at my hairline over video (he spent majority of the time looking away, including at his computer), he recommended 1,500 to 2,000 grafts. No talk about where the hairline I wanted should be, no talk about where he thought the recession was, nothing. It was 1500 to 2000 grafts and how soon can we schedule it.
2. The number of grafts seems very high since, to be honest, he uses .9 to 1 mm punches and if I measured 1 mm squared across the area where I think he'd put in grafts, it seems too small to fit in that many grafts unless you overlapped them. 
3. He said he would insert some grafts where there was already hair to anticipate future hair loss. And said shock loss "is rare," and "minimal." But I've seen a lot of anecdotal evidence of people realizing after surgery that inserting grafts in an already fairly populated area was a bad idea.  I'll concede here I haven't researched shock loss or where the grafts are actually inserted but generally from before and after pics it seems limited to areas that have very little to no hair (not areas with a good amount of hair).
4. When I mentioned I was considering trying topical finasteride with minoxidil, he said topical finasteride doesn't work. Period. He said only oral finasteride works, and there were tests done on different types (oral, injection, topical) and they show only oral works. That's not true. A quick search for related studies shows that it does work topically: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/
5. I mentioned using Rogaine (5% minoxidil). He said it might work for the crown where it was just starting to thin (not bad enough to do any transplant there). But he said it won't work on the hairline that he wanted to fix. Period. Won't work at all apparently and that's why companies that sell it can only say it works on the crown (which is where it works). But my understanding is that minoxidil was approved by the FDA based on studies done only on the crown, and so that's what it was approved for. Since there were no studies on the hairline presented, the FDA didn't approve it for the hairline and prevents companies from saying it works on the hairline. But that doesn't mean that it does not work on the hairline.  The vast majority of hair specialist say it does work on the hairline, there's nothing that would suggest it doesn't, and there is a lot of anecdotal evidence showing it does. 
6. He seemed to want to schedule me to do the surgery this month or maybe next. He says people are backing out because of the Coronavirus situation and so easier to get in sooner than later since those who booked appointments at a later time likely won't move their appointments. But how can I schedule an appointment for my surgery in less than a month when the only thing substantiating his recommendation for the surgery is a few photos and a glance at me on video (no talk about where I wanted the hairline to be, he looked at his computer most of the time, etc.).
7. I asked about specifics, and he said it would be determined the day of the surgery, including where my hairline should be, what size punch he'd use, etc. So I would have to put down a downpayment and agree to pay the remaining balance a few days before the surgery, all before even figuring out these specifics....
8. I asked if he would do the surgery. He said he would, he always does. Yet I've seen many posts on here and other forums suggesting the day some people showed up it was a technician who did the work.

Do you think the above are red flags or do you think I'm overreacting on some points? Please let me know your thoughts. This doctor is supposed to be good at what he does. But it seems so inappropriate to jump into $15,000+ commitment based on the above. 

I'm leaning toward holding off on it and using the topical finasteride/minoxidil solution for a few months and see how it works. Below is a video of a guy who makes it himself (I'm getting it from a dermatologist directly though so easier) and on his channel you can see results after 7 months from bare scalp at the hairline to hair. And after 6 to 9 months, if I'm at a worse position I think I'll come back and consider the transplant again. But I don't want to waste a year to only find out I might as well have gotten a transplant. 

 

Edited April 7, 2020 by Newbie2TLS

[Melvin- Admin]

If you don't feel comfortable choose a different surgeon period. I don't think some of the things that were said is wrong. Topical finasteride isn't a proven treatment period. Minoxidil doesn't work in the hairline, so none of that information is wrong. I don't see what punch size has to do with the number of grafts you need? Wheres' the correlation. Recipient sites are created using a different blade, you might be confused. I would not schedule surgery now or in the next month. In my opinion, you need to use this time to consult with as many surgeons as possible, and once this clears up you'll be able to have a decision. I don't see anything necessarily wrong with the information you were given. There is no way a surgeon will be able to give you all of the details you're requesting without seeing you in person. That said, as mentioned earlier, if you don't feel comfortable or you got a bad vibe, cross them off your list and move on.

[Newbie2TLS]

2 hours ago, Melvin-Moderator said:

If you don't feel comfortable choose a different surgeon period. I don't think some of the things that were said is wrong. Topical finasteride isn't a proven treatment period. Minoxidil doesn't work in the hairline, so none of that information is wrong. I don't see what punch size has to do with the number of grafts you need? Wheres' the correlation. Recipient sites are created using a different blade, you might be confused. I would not schedule surgery now or in the next month. In my opinion, you need to use this time to consult with as many surgeons as possible, and once this clears up you'll be able to have a decision. I don't see anything necessarily wrong with the information you were given. There is no way a surgeon will be able to give you all of the details you're requesting without seeing you in person. That said, as mentioned earlier, if you don't feel comfortable or you got a bad vibe, cross them off your list and move on.

I was hoping to avoid your answer. And I mean this in the kindest way possible so please don’t take it negatively. I’ve read a lot of threads on this forum and one of the most consistent things I’ve seen is how negative and aggressive you can be when people start to have an honest discussion about hair loss and hair treatment. You especially get aggressive when someone merely implies they don’t agree with a doctor’s approach, almost as if you’re paid to make these posts. 
 

The fact is that NOTHING is “proven” in medicine. There are only studies that support certain conclusions and from those studies we gain comfortability with doing certain practices. There have been enough studies (along with anecdotal evidence) now showing that topical finasteride can work comparably to oral finasteride without affecting the testosterone levels in the body. If you are aware of a SINGLE study in which it did not work, then please cite it. But do not aggressively put my positions down with basic statements like “topical finasteride isn’t a proven treatment period.” By that standard, hair transplants aren’t a proven treatment (apparently just a bunch of anecdotal evidence and studies showing they improve hair density).

The same with your minoxidil comment. Granted, I haven’t seen studies that applied it to the hairline, but I also haven’t seen (and you haven’t cited) a single study showing that it does not work on the hairline. What we’re left with is anecdotal evidence that shows improvement to the hairline after continuous use, along with just basic logic that hair follicles in the back aren’t much different than those at the hairline so minoxidil studies showing it works in the back should similarly apply to the hairline.

Comments like yours (and the doctor’s) are why some reasonably educated people (including myself) hesitate to get hair loss treatment, cause you make generalizations and muddy the information waters with little to no scientific backing. At least you couched your answers with “it’s not proven.” But for a doctor to say “it does not work, period.” That’s a hard statement, borderline (If not actually) fraud if it induces someone to forgo alternatives and get treatment from that doctor. 

Again, I don’t mean the above to be taken negatively. Just standing up for myself and my ability to have an honest fact-based discussion. If you do not agree with a point, please provide reasoning and/or citations. General put downs are not good for anyone. 

I do agree re punch size since I may have been confused about the insertion process versus extraction. 

 

Edited April 7, 2020 by Newbie2TLS

[Newbie2TLS]

Also, as a heads up to private messengers asking me to name the doctor, I won’t do that. The point here isn’t to bad mouth any particular doctor. In fact, the one above, I think has awesome results and I’d be honored to get those results for myself. But I’ve never had work done like this before, so I have no idea what’s normal and what is not. And like a lot of people I’m anxious and scared to do it. It could very well be the case that the above is normal in getting a hair transplant, but I’m just not aware of it since I never had one before. I just have prior medical experiences to base it on and those involved more hands-on interactions and nuanced guidance. I’m trying to figure out if that’s also the standard here or are hair transplants really not that big of a deal that it is just a matter of booking an appointment and getting it done (assuming the doctor gives good results). 

[Gasthoerer]

My five cent:

1. We had a video conference consultation... Many people go for surgery without any pre-op consultation except sending some pics and most of them discuss hairline etc. at the day of surgery -->  I always recommend to have a F2F consult as everyone is nervous at the day of surgery. It is a personal decision though. 
2. The number of grafts seems very high since, to be honest, he uses .9 to 1 mm punches …. You mix up several things. The proper amount of grafts is calculated via area x FU/cm2. Punchsize has nth do to with it. If you do not have particular thick hair 1mm punch seems big compared to the standard especially for hairline cases.
3. He said he would insert some grafts where there was already hair to anticipate future hair loss... This is 100 % normal only the amount depends on your type and speed of loss
4. When I mentioned I was considering trying topical finasteride with minoxidil, he said topical finasteride doesn't work. … The data on this is very poor. There is no clear evidence IMO for lower side effects or efficacy. Anyway, there is a huge discussion about oral FIN even though there are a lot of studies. 
5. I mentioned using Rogaine (5% minoxidil). He said it might work for the crown...You are right. Tests where only done on the crown of men with dark hair. More likely (to say it in most neutral way)  it works also on the front and for blond, only the effect is stronger in areas with minor loss. Most have the strongest loss in the hairline, hence it works worse in the hairline. 
6. But how can I schedule an appointment for my surgery in less than a month when the only thing substantiating … See Question 1. 
7. I asked about specifics, and he said it would be determined the day of the surgery....See Question 1
8. I asked if he would do the surgery. He said he would,... Many top clinics use techs during surgery. This is not an issue per se. But if it is not clear who does what during surgery: Not good.

[Newbie2TLS]

19 minutes ago, Gasthoerer said:

My five cent:

1. We had a video conference consultation... Many people go for surgery without any pre-op consultation except sending some pics and most of them discuss hairline etc. at the day of surgery -->  I always recommend to have a F2F consult as everyone is nervous at the day of surgery. It is a personal decision though. 
2. The number of grafts seems very high since, to be honest, he uses .9 to 1 mm punches …. You mix up several things. The proper amount of grafts is calculated via area x FU/cm2. Punchsize has nth do to with it. If you do not have particular thick hair 1mm punch seems big compared to the standard especially for hairline cases.
3. He said he would insert some grafts where there was already hair to anticipate future hair loss... This is 100 % normal only the amount depends on your type and speed of loss
4. When I mentioned I was considering trying topical finasteride with minoxidil, he said topical finasteride doesn't work. … The data on this is very poor. There is no clear evidence IMO for lower side effects or efficacy. Anyway, there is a huge discussion about oral FIN even though there are a lot of studies. 
5. I mentioned using Rogaine (5% minoxidil). He said it might work for the crown...You are right. Tests where only done on the crown of men with dark hair. More likely (to say it in most neutral way)  it works also on the front and for blond, only the effect is stronger in areas with minor loss. Most have the strongest loss in the hairline, hence it works worse in the hairline. 
6. But how can I schedule an appointment for my surgery in less than a month when the only thing substantiating … See Question 1. 
7. I asked about specifics, and he said it would be determined the day of the surgery....See Question 1
8. I asked if he would do the surgery. He said he would,... Many top clinics use techs during surgery. This is not an issue per se. But if it is not clear who does what during surgery: Not good.

This was super helpful, especially the answer to question 1. I didn’t know it was usual to discuss it on the day of the surgery. Thanks! That was the biggest concern of mine actually. And yes I def agree more studies need to be done on topical fin and minoxidil. Wish they would do them, but the studies done so far on topical fin are relatively recent (it’s a recent form of treatment) and promising. 

[Gasthoerer]

20 minutes ago, Newbie2TLS said:

This was super helpful, especially the answer to question 1. I didn’t know it was usual to discuss it on the day of the surgery. ….

You are welcome! But just to avoid any confusion: It is standard to discuss hairline etc. on the day of surgery, but I do not like this approach. I recommend to have a F2F prior to the surgery and make a plan including hairline etc. Take pics from all angles home and look at them without any pressure. You will have to live with this hairline for the rest of your life --> Better to take more time than for a haircut. And everyone is nervous at the day of surgery. 

[Melvin- Admin]

4 hours ago, Newbie2TLS said:

I was hoping to avoid your answer. And I mean this in the kindest way possible so please don’t take it negatively. I’ve read a lot of threads on this forum and one of the most consistent things I’ve seen is how negative and aggressive you can be when people start to have an honest discussion about hair loss and hair treatment. You especially get aggressive when someone merely implies they don’t agree with a doctor’s approach, almost as if you’re paid to make these posts. 
 

The fact is that NOTHING is “proven” in medicine. There are only studies that support certain conclusions and from those studies we gain comfortability with doing certain practices. There have been enough studies (along with anecdotal evidence) now showing that topical finasteride can work comparably to oral finasteride without affecting the testosterone levels in the body. If you are aware of a SINGLE study in which it did not work, then please cite it. But do not aggressively put my positions down with basic statements like “topical finasteride isn’t a proven treatment period.” By that standard, hair transplants aren’t a proven treatment (apparently just a bunch of anecdotal evidence and studies showing they improve hair density).

The same with your minoxidil comment. Granted, I haven’t seen studies that applied it to the hairline, but I also haven’t seen (and you haven’t cited) a single study showing that it does not work on the hairline. What we’re left with is anecdotal evidence that shows improvement to the hairline after continuous use, along with just basic logic that hair follicles in the back aren’t much different than those at the hairline so minoxidil studies showing it works in the back should similarly apply to the hairline.

Comments like yours (and the doctor’s) are why some reasonably educated people (including myself) hesitate to get hair loss treatment, cause you make generalizations and muddy the information waters with little to no scientific backing. At least you couched your answers with “it’s not proven.” But for a doctor to say “it does not work, period.” That’s a hard statement, borderline (If not actually) fraud if it induces someone to forgo alternatives and get treatment from that doctor. 

Again, I don’t mean the above to be taken negatively. Just standing up for myself and my ability to have an honest fact-based discussion. If you do not agree with a point, please provide reasoning and/or citations. General put downs are not good for anyone. 

I do agree re punch size since I may have been confused about the insertion process versus extraction. 

 

How was my response aggressive? I still think you need to take this time to consult with as many doctors as possible, and if you’re not comfortable with any particular doctor cross them off your list. I have no clue how you can take any of what I told you to be that of a paid rep. Either way, I’ll refrain from providing you any advice in the future. 
 

Best wishes, 

 

[Newbie2TLS]

1 hour ago, Melvin-Moderator said:

How was my response aggressive? I still think you need to take this time to consult with as many doctors as possible, and if you’re not comfortable with any particular doctor cross them off your list. I have no clue how you can take any of what I told you to be that of a paid rep. Either way, I’ll refrain from providing you any advice in the future. 
 

Best wishes, 

 

Sorry I didn’t mean to misread your post. Just nervous and anxious. There’s a lotta info out there to process. A lot of it is results-based but not as much about the process of going through the transplant prior to surgery. Most of the postings are as of the surgery moving forward. The doc here is in Los Angeles and he’s pricy so it’s a big investment to make before jumping into it so blindly. 

[Melvin- Admin]

14 hours ago, Newbie2TLS said:

Sorry I didn’t mean to misread your post. Just nervous and anxious. There’s a lotta info out there to process. A lot of it is results-based but not as much about the process of going through the transplant prior to surgery. Most of the postings are as of the surgery moving forward. The doc here is in Los Angeles and he’s pricy so it’s a big investment to make before jumping into it so blindly. 

I understand, right now we’re all on lockdown, its the best time to consult with doctors. Most doctors have dropped their consultation fees, and most offer virtual consultations. Don’t limit yourself to LA or even California, once life returns to normal don’t be afraid to travel to the right doctor.

 

https://www.hairtransplantnetwork.com/Consult-a-Physician/hair-transplant-surgeons.asp

here’s our recommended list, you can also use the search function on this forum to find real reviews. Perfect time to start researching.