Peer Advice Needed

[lgm524]

I am about to the pull the trigger and schedule my first hair transplant but thought I should seek peer advice as my final step. 

The first group of pictures was when my hair had become long and unruly due to COVID and not being able to get a haircut.  The second group of pictures are after I finally gave in and buzzed it all off. I think buzzing it all off and seeing what I was actually working with was what finally made me decide to go forward with a transplant.  When it was long, it was easy enough to hide with styling (even if I was only fooling myself). 

I have had 2 in person consultations and had 2 virtual consultations. I sent the buzz cut pictures for a virtual consultation with Hasson and Wong and they responded that I am "not a good candidate for surgical hair restoration" This threw me for a loop as I have seen cases far worse than mine and none of the other 4 consultations agreed with that assessment. 

The surgeon I am planning to go with has recommended 1800-2000 FUT strip surgery. I was initially 100% against the strip and only wanted FUE but he did a good job getting me to consider FUT instead. He is planning on a conservative hairline which was underwhelming at first but he did a good job of convincing me on that as well. 

I like him and feel good about going forward but thought I should ask you all to be my final consultation.

PS- I am 36, started receding in my early 20s but have seemed to slowed down/stabilized for the most part. I am not on fin. A year ago I had to have corrective gynecomastia surgery which I can not say for sure was caused by fin but it is enough to make me not want to risk it by using it again. 

 

[Gatsby]

Hi Igm524, First off well done on being patient on waiting to have a hair transplant. When H+W knocked you back did you ask them for their reasons? Over the lifespan as you know, MPB will continue until you reach a Norwwod6/7 at some later stage. This is just my 5 cents worth.

If your preferred procedure is FUE then I would stick with FUE over FUT. Secondly 2,000 grafts will not be enough to cover an entire bald scalp (thinking ahead for the future). Try and find out how many scalp grafts you will have access to in total. Will this number be enough if you reach a Norwood 6 level? There are many excellent hair transplant clinics that pride themselves on performing incredible work on Norwood 6 patients. Eugenix being just one of them. I am in no way stating that you are a Norwood 6 but you have to have a game plan that will cover MPB over the lifespan. If down the path you ever decide to shave your head you will regret having FUT as opposed to FUE (from my own experience). Just something to think about but it may not be an issue for you. Keep researching don't be discouraged. I personally know of one hair transplant surgeon who only performs 1,500 FUE grafts. The sole reason for this is because he is now so old that 1,500 grafts is all he can perform in one session! Do lots of homework. Wishing you all the best.

[lgm524]

Thank you for your input Gatsby. H+W said "Your final pattern of loss is aggressive and your donor reserves may be limited. It would not be in your best interest in their opinion to have a procedure right now." The suggested I get on Fin for a year and resubmit photos (previous gynecomastia makes this not something I want to risk). 

I had preferred FUE because I was afraid of the strip scar and believed that FUT was outdated but after seeing pictures and videos of the scars of the surgeon's previous transplants it really did not seem as bad as I built it up to be. I also since learned that FUE has a higher rate of transection which lead me that it isn't necessarily the superior choice. I have also seen pictures of badly mottled donor areas from FUE which almost concerned me as much as the scar and I figured that with a strip scar I could at least SMP or FUE into it down the road (or is this not a good way to think about it?) 

[Britanium]

Be nice if you could get more grafts out of a FUT as your going to need them looking at your current loss.

Your safe donor zone does not appear that great so FUT the way I would go. I think you would need at least 3000 grafts if not more to get a reasonable result.

Building a new hairline is going to take a lot of grafts. 

[Melvin- Admin]

I think FUT would be best to maximize donor supply. You also highlighted something very important, which is that buzzing your head reveals the truth! We often fool ourselves, we stay in denial. That why I think everyone who wants an HT to buzz first. You realize if you can live bald, and you get a better idea of the extent of your hair loss.

[aaron1234]

If you're not willing to go on fin then don't get a transplant.  Most of your native hair behind your hairline will be vulnerable to permanent shock loss after a procedure.  Your donor region looks miniaturized even to the naked eye.

[Taken4Granted]

Very similar situation here, similar age and pattern also. I’ve had 4 gyno surgeries directly related to fin and will never go back to it. In my experience, any history of excess tissue there makes you prone to future problems even after surgery and on a lower dose.

Still, I’m srsly considering HT, knowing it commits me to a long-term strategy to maximize donor harvest over maybe 3 surgeries. I had great results on fin but I doubt it makes any difference to the long-term outcome. At least I wouldn’t count on it. It just delays. What would have been a problem at 40 becomes a problem at, say, 50-60, depending on the person. I’m sure there’s a lot of gray area there, but I think it’s more the timing and strategy of your HT that depends on fin, not so much surgery in general. I have no credibility on this, curious what others will say to that.

However, I think the shape of your head makes it a less urgent problem for you. With a dome like that, bald isn’t necessarily cosmetic/social death. Maybe experiment with that look for a while. If you get botched, your current situation will seem pretty nice.

Edited June 17, 2020 by Taken4Granted

[Melvin- Admin]

33 minutes ago, Taken4Granted said:

Very similar situation here, similar age and pattern also. I’ve had 4 gyno surgeries directly related to fin and will never go back to it. In my experience, any history of excess tissue there makes you prone to future problems even after surgery and on a lower dose.

Still, I’m srsly considering HT, knowing it commits me to a long-term strategy to maximize donor harvest over maybe 3 surgeries. I had great results on fin but I doubt it makes any difference to the long-term outcome. At least I wouldn’t count on it. It just delays. What would have been a problem at 40 becomes a problem at, say, 50-60, depending on the person. I’m sure there’s a lot of gray area there, but I think it’s more the timing and strategy of your HT that depends on fin, not so much surgery in general. I have no credibility on this, curious what others will say to that.

However, I think the shape of your head makes it a less urgent problem for you. With a dome like that, bald isn’t necessarily cosmetic/social death. Maybe experiment with that look for a while. If you get botched, your current situation will seem pretty nice.

Wow 4 gyno surgeries. What made you keep going back on it, if I may ask? One gyno surgery and I’d be done with it. Hell, I’m done with it, even after a few months of bad sexual side effects.

[Taken4Granted]

Hey @Melvin-Moderator, it’s a long story. The first one was an excision to get rid of the fibrous tissue. The second one targeted the fat. I went back for a third because it came back after a few more years on fin. I did the final one because the third one wasn’t quite right. 

It’s not like I took it and things went haywire right away. For me, it was a gradual slide into more severe side effects and accumulation of estrogen+ tissue due to a slight but persistent imbalance. It was a daily struggle of weighing hair against libido and weird issues with physique. Each side of it was bad enough to cause anguish without being significantly worse than the trade off.

I also had false assumptions. I thought I’d never have to deal with gyno again after getting it removed. I thought I could cut the fin down enough to protect my hair without causing intolerable sides. I was wrong.

Eventually the hair loss caught up and the benefit was no longer worth the sides. It took a while to feel semi-normal again, but dropping the fin made all the difference. Instead of seeing the tissue slowly pile up again within a year of surgery, the results from my last round actually keep getting better and tighter. 

It’s been a very instructive experience. My lessons:

- hair loss always wins

- don’t toy with your hormones

- don’t get cheap on cosmetic surgery

- if you can live with it, leave it alone

Edited June 17, 2020 by Taken4Granted

[Melvin- Admin]

50 minutes ago, Taken4Granted said:

Hey @Melvin-Moderator, it’s a long story. The first one was an excision to get rid of the fibrous tissue. The second one targeted the fat. I went back for a third because it came back after a few more years on fin. I did the final one because the third one wasn’t quite right. 

It’s not like I took it and things went haywire right away. For me, it was a gradual slide into more severe side effects and accumulation of estrogen+ tissue due to a slight but persistent imbalance. It was a daily struggle of weighing hair against libido and weird issues with physique. Each side of it was bad enough to cause anguish without being significantly worse than the trade off.

I also had false assumptions. I thought I’d never have to deal with gyno again after getting it removed. I thought I could cut the fin down enough to protect my hair without causing intolerable sides. I was wrong.

Eventually the hair loss caught up and the benefit was no longer worth the sides. It took a while to feel semi-normal again, but dropping the fin made all the difference. Instead of seeing the tissue slowly pile up again within a year of surgery, the results from my last round actually keep getting better and tighter. 

It’s been a very instructive experience. My lessons:

- hair loss always wins

- don’t toy with your hormones

- don’t get cheap on cosmetic surgery

- if you can live with it, leave it alone

Thanks for sharing, it makes sense now. I agree with your assessments fully. 

[lgm524]

9 hours ago, JohnAC71 said:

Be nice if you could get more grafts out of a FUT as your going to need them looking at your current loss.

Your safe donor zone does not appear that great so FUT the way I would go. I think you would need at least 3000 grafts if not more to get a reasonable result.

Building a new hairline is going to take a lot of grafts. 

The surgeon mentioned that 1800-2000 was the responsible amount to do based on blood supply to the hair (I think) and some other things that went above my head but he sounded like he knew what he was talking about.

He mentioned that he had concerns about my donor region based on the pictures I sent first but in person he could see that it was mainly the lighting and my light/freshly buzzed hair. He did look at (and show me) the donor area under a microscope. I believe he said most people have 80-90 density and I was at 70-80 but he concluded that I was still a candidate for surgery. 

[BOW32]

For me,  given that you have had two in person consultations (at what I would presume to be pretty decent clinics considering H&W were on your shortlist), and no concerns were seemingly raised by each of the surgeons, I would take comfort in the fact that you can't compare the accuracy of an in person consultation using dermascopes etc. to that of just a few photos submitted online. 

I must admit, your donor area when shaved down in that picture does look like there is evidence of a NW7 pattern emerging, however it could just be unfortunate lighting - I have a colleague at work who has the thickest NW1 hair you could imagine, and during lock down he has buzzed it down, and even he looks to have areas of balding under certain angles and lights, so the lighting can make a big difference! 

For now I would continue reviewing your options whilst remaining in contact with clinics and surgeons whose work you admire, and wait until you are able to re-visit for further in person consultations. 

Have a read up on treatments that are available other than finasteride, and see whether they appeal to you/are viable, and perhaps look to start a routine combining a few. 

Your skin/hair contrast isn't high, which is advantageous, and maybe with a combination of SMP and use of BHT, you may ultimately be able to achieve a result you will be happy with. 

All the best mate! 

[Melvin- Admin]

15 hours ago, BOW32 said:

I have a colleague at work who has the thickest NW1 hair you could imagine, and during lock down he has buzzed it down, and even he looks to have areas of balding under certain angles and lights, so the lighting can make a big difference! 

This is 100% true, as an astute observer of hair, I’ve noticed even children can appear like they’re balding with short hair under bright lighting. That’s why in person consultations are so important.