Temple restoration with future planning

[missingtemples]

Hey everyone,

I'm looking for some advice regarding a potential hair transplant and progression of my hair loss. To give you some information about me:

• I'm 30 years old
• I believe I started losing my hair around 6 years ago.
• My hair loss hasn't been aggressive so far. My temples are receding and I've probably lost some thickness but not to the level that I would consider it diffuse thinning.
• I've been using Rogaine foam once a day for 4-5 years. 
• I use a ketoconazole shampoo once or twice a week.
• I dermastamp once a month, if I don't forget.
• I prepare a topical solution with 60 ml minoxidil and 4mg of finasteride(4 propecia pills) and use that twice a week. Now I know this is an extremely low dose and I'm fully aware that this might not be doing anything at all. But I tried finasteride before, once with the recommended dose which started giving me side effects in a month and once with .25mg twice a week which gave me side effects after 7 months. So I prefer this very low dose topical solution with potentially 0 benefit to using the pills. I might even stop this.

As you'll see in my photos, my temples are receding. I'm not actually that displeased about it. But, I know I'll most likely keep losing and there will come a time where I'm displeased and want an operation. So instead of waiting and having a larger operation done, I'm thinking about starting small and using my donor very conservatively and most likely having 2. and 3. operations in the future. I know these will be needed especially because I'm not on finasteride. Honestly right now even a tiny restoration done on my temples would satisfy me. So I'd really like to hear your opinions about this plan. Does it make sense to go down this path without being on finasteride? If so, how many number of grafts would be required in your opinion for a small operation?

I'm Turkish so I would go to a clinic in Turkey. I've been doing research here and on the turkish forum and I've decided to reach out to a few clinics.

- ASMED: I've filled out their detailed form and mentioned I want a small operation and don't want to use finasteride. They replied saying that the final evaluation would of course be done at the clinic but from the photos I've sent, they are proposing 3000 - 3500 grafts and recommend finasteride. The hairline they drew was quite at the front too. Now, this number I feel is too big for a plan like mine and I got the feeling that they didn't really read what I had written in the form.

- HLC: They acknowledged my plans to be conservative in their reply which was great and offered to transplant 2500 - 3000 grafts. They said they came up with this after considering my donor and my hair loss progression.

- Dr. Keser: I am waiting for a reply. Honestly, his results are what I want. Low grafts, high yield and great hairline design. But it looks like Dr. Keser isn't as available these days.

- Dr. Pekiner: I am going to send an email to see what he thinks.

Last two photos I've attached are with wet hair and camera flash. Thanks for reading up to this point. I would appreciate any advice. 

 

 

 

 

[duchaine]

HLC Ankara or Demirsoy Istanbul for a cheaper option.

[Melvin- Admin]

It’s clear you will develop an aggressive balding pattern in time. I would caution trying to lower your hairline and restore your temples. I can see thinning in the crown. As for surgeons, I would broaden your horizon, Dr. Bisanga is a great option in Athens, as is Dr. Maras with HDC. 

[missingtemples]

48 minutes ago, Melvin-Moderator said:

It’s clear you will develop an aggressive balding pattern in time. I would caution trying to lower your hairline and restore your temples. I can see thinning in the crown. As for surgeons, I would broaden your horizon, Dr. Bisanga is a great option in Athens, as is Dr. Maras with HDC. 

Thanks Melvin. My dad is a Norwood 5 - 6 with some thin hair on his crown. He lost a lot of hair but spread across many years. Our patterns look similar. Given that and the fact that I don't want to use fin, would you recommend waiting for my hair loss to progress or getting a small operation now?

[Britanium]

If it’s not displeasing you at the moment then I would wait. Like you mentioned it doesn’t appear it’s that aggressive balding (can always change)

Maybe get some face to face consultations when you can? They could give you a indicator where it’s heading.

It’s a tough choice to make though. I always wished I never had FUT for example.Mine was a difficult balance of how many grafts to use up front and then share with the crown. 

If/when the loss appears on your crown you will also have to decide how the grafts get dispersed. 
 

We all have a finite amount of grafts available  it takes careful and future planning to make the most of them. 
 

 

 

 

[Melvin- Admin]

1 hour ago, missingtemples said:

Thanks Melvin. My dad is a Norwood 5 - 6 with some thin hair on his crown. He lost a lot of hair but spread across many years. Our patterns look similar. Given that and the fact that I don't want to use fin, would you recommend waiting for my hair loss to progress or getting a small operation now?

Definitely wait until you have more hair loss. Once your hair loss progresses, you’ll be able to create a better master plan and utilize your donor supply better. A norwood  5-6 would be happy with your current hair, so those temples won’t matter once the rest starts to go. It’s always better to have a higher more receded hairline with even density and coverage, rather than a low unnatural hairline and nothing in the back.

[Doron Harati]

4 hours ago, Melvin-Moderator said:

It’s clear you will develop an aggressive balding pattern in time. I would caution trying to lower your hairline and restore your temples. I can see thinning in the crown. As for surgeons, I would broaden your horizon, Dr. Bisanga is a great option in Athens, as is Dr. Maras with HDC. 

Thanks for kind words on Dr. Maras, but HDC clinic is in Cyprus, not Athens nor Greece.

Yes Cyprus and Greece are very close geographically but 2 different countries

Btw, Cyprus national language is English

[Doron Harati]

As international representor of HDC clinic, I definitely 100% agree with Melvin!

It's too early for you to have a HT now, you are barley Norwood 2, and how the heck clinics offered you 3000+ grafts?!

You maybe maybe can get 1000-1200 grafts, but it still not worth it, I mostly accept patients that at least Norwood 3, very rare I take Norwood 2 patients, 4 months ago we took a Norwood 2 paitent BUT he was 42 years old, his balding was stabilized, only needed to his hair line like you, we did him 1200 grafts, btw the procedure was done by Dr. Christina (we got 2 doctor teams).

As you said in your post, you want to have 2-3 procedures, so wait and be patient for the right time.

Also, don't waste your money on those "boosters", I NEVER recommend my clients to use these stuff, no Vitamins, no rollers, no PRP, waste of money and hopes.

Only Minoxidil help to some ppl in the crown some a bit, Propecia I am against, it helps some ppl but it sure can effect your fertility, it hurt mine over 10 years ago.

 

Hope that helps.

[Gabreille Nelson Mukhia]

On 6/3/2020 at 5:30 AM, missingtemples said:

Hey everyone,

I'm looking for some advice regarding a potential hair transplant and progression of my hair loss. To give you some information about me:

• I'm 30 years old
• I believe I started losing my hair around 6 years ago.
• My hair loss hasn't been aggressive so far. My temples are receding and I've probably lost some thickness but not to the level that I would consider it diffuse thinning.
• I've been using Rogaine foam once a day for 4-5 years. 
• I use a ketoconazole shampoo once or twice a week.
• I dermastamp once a month, if I don't forget.
• I prepare a topical solution with 60 ml minoxidil and 4mg of finasteride(4 propecia pills) and use that twice a week. Now I know this is an extremely low dose and I'm fully aware that this might not be doing anything at all. But I tried finasteride before, once with the recommended dose which started giving me side effects in a month and once with .25mg twice a week which gave me side effects after 7 months. So I prefer this very low dose topical solution with potentially 0 benefit to using the pills. I might even stop this.

As you'll see in my photos, my temples are receding. I'm not actually that displeased about it. But, I know I'll most likely keep losing and there will come a time where I'm displeased and want an operation. So instead of waiting and having a larger operation done, I'm thinking about starting small and using my donor very conservatively and most likely having 2. and 3. operations in the future. I know these will be needed especially because I'm not on finasteride. Honestly right now even a tiny restoration done on my temples would satisfy me. So I'd really like to hear your opinions about this plan. Does it make sense to go down this path without being on finasteride? If so, how many number of grafts would be required in your opinion for a small operation?

I'm Turkish so I would go to a clinic in Turkey. I've been doing research here and on the turkish forum and I've decided to reach out to a few clinics.

- ASMED: I've filled out their detailed form and mentioned I want a small operation and don't want to use finasteride. They replied saying that the final evaluation would of course be done at the clinic but from the photos I've sent, they are proposing 3000 - 3500 grafts and recommend finasteride. The hairline they drew was quite at the front too. Now, this number I feel is too big for a plan like mine and I got the feeling that they didn't really read what I had written in the form.

- HLC: They acknowledged my plans to be conservative in their reply which was great and offered to transplant 2500 - 3000 grafts. They said they came up with this after considering my donor and my hair loss progression.

- Dr. Keser: I am waiting for a reply. Honestly, his results are what I want. Low grafts, high yield and great hairline design. But it looks like Dr. Keser isn't as available these days.

- Dr. Pekiner: I am going to send an email to see what he thinks.

Last two photos I've attached are with wet hair and camera flash. Thanks for reading up to this point. I would appreciate any advice. 

 

 

 

 

 

Hello,

Hope you are well.

Keeping your plan in mind, 1500 to 2000 grafts would be more than sufficient to fill in the receding fronto-temporal areas. More number of grafts would be required only if you would want to lower the hairline. The fact that you will not be taking Finasteride makes it clear that you will have further progression of baldness in the future. It will also look odd because the transplanted hair stay and it will look like two horns coming from the fronto-temporal areas. Plus your crown is already thinning. All of this effort would be for nothing.

You could use Finasteride gel available in Italy. In our experience, it seems to have good results but there is no scientific literature for this . Oral Finasteride is obviously better with regards to the results. The following link could take you to their website: https://www.farmaciaparati.it/ 

Also, you should use the gel everyday instead of 4 times a week. 

In my opinion, going in for just the fronto-temporal areas without Finasteride should be avoided. It is not a good approach to keep going for more surgeries. Also, you could supplement your applicable Finasteride by taking Finasteride 1 mg pills twice a week. 

I cannot stress on the importance of Finasteride more in your case. Prevention of any further progression of baldness is the best possible thing to do in your case right now. 
 

[missingtemples]

Thanks for the solid advice everyone. I'll take all this into consideration and even if I proceed with a ht, it would be a very conservative one. 

 

On 6/3/2020 at 11:53 PM, Doron Harati said:

As international representor of HDC clinic, I definitely 100% agree with Melvin!

It's too early for you to have a HT now, you are barley Norwood 2, and how the heck clinics offered you 3000+ grafts?!

You maybe maybe can get 1000-1200 grafts, but it still not worth it, I mostly accept patients that at least Norwood 3, very rare I take Norwood 2 patients, 4 months ago we took a Norwood 2 paitent BUT he was 42 years old, his balding was stabilized, only needed to his hair line like you, we did him 1200 grafts, btw the procedure was done by Dr. Christina (we got 2 doctor teams).

As you said in your post, you want to have 2-3 procedures, so wait and be patient for the right time.

Also, don't waste your money on those "boosters", I NEVER recommend my clients to use these stuff, no Vitamins, no rollers, no PRP, waste of money and hopes.

Only Minoxidil help to some ppl in the crown some a bit, Propecia I am against, it helps some ppl but it sure can effect your fertility, it hurt mine over 10 years ago.

 

Hope that helps.

I find that puzzling too. I see great results from some doctors using 1000 - 1500 grafts whereas others use way more than that for a similar area. So, yeah I definitely dont want to use that many grafts at my current stage.

 

15 hours ago, Gabreille Nelson Mukhia said:

 

Hello,

Hope you are well.

Keeping your plan in mind, 1500 to 2000 grafts would be more than sufficient to fill in the receding fronto-temporal areas. More number of grafts would be required only if you would want to lower the hairline. The fact that you will not be taking Finasteride makes it clear that you will have further progression of baldness in the future. It will also look odd because the transplanted hair stay and it will look like two horns coming from the fronto-temporal areas. Plus your crown is already thinning. All of this effort would be for nothing.

You could use Finasteride gel available in Italy. In our experience, it seems to have good results but there is no scientific literature for this . Oral Finasteride is obviously better with regards to the results. The following link could take you to their website: https://www.farmaciaparati.it/ 

Also, you should use the gel everyday instead of 4 times a week. 

In my opinion, going in for just the fronto-temporal areas without Finasteride should be avoided. It is not a good approach to keep going for more surgeries. Also, you could supplement your applicable Finasteride by taking Finasteride 1 mg pills twice a week. 

I cannot stress on the importance of Finasteride more in your case. Prevention of any further progression of baldness is the best possible thing to do in your case right now. 
 

I wish I belonged in the group of people who dont get sides but I tried it with varying doses. A lower dose hit me with similar side effects after some time. That is why I'm experimenting with a much much lower topical dose even though it might be useless.

[Gabreille Nelson Mukhia]

10 hours ago, missingtemples said:

Thanks for the solid advice everyone. I'll take all this into consideration and even if I proceed with a ht, it would be a very conservative one. 

 

I find that puzzling too. I see great results from some doctors using 1000 - 1500 grafts whereas others use way more than that for a similar area. So, yeah I definitely dont want to use that many grafts at my current stage.

 

I wish I belonged in the group of people who dont get sides but I tried it with varying doses. A lower dose hit me with similar side effects after some time. That is why I'm experimenting with a much much lower topical dose even though it might be useless.

Therefore, at this age, you should try to avoid hair implantation in the mid-scalp because in the absence of Finasteride support, the shock loss of existing hair may happen and the progression of baldness might be hastened.

If you were to go for the transplant, the following areas would be a suitable option. We have marked the area for you to see what would be appropriate as per our opinion. 

 

I am also attaching a picture of a similar case lie yours. He is of Indian origin and was very young. However, we did give him the filling on his sides and he thankfully decided to take the medicines. 

 

 

To be very honest, you should avoid transplantation in the absence of Finasteride. 

Edited June 5, 2020 by Gabreille Nelson Mukhia