Are doctors being straight with me?

[hairlosssucks92]

Hi everyone!

 

First time poster here but I've been reading Reddit/HRN/HLT a ton the last 3-4 years.

 

Quick background: 28, male, 5 years on finasteride (no rogaine) and have experienced hairloss since 19. I've pretty much kept my hair quite well with Finasteride but can tell I'm slowly losing.

 

I've been speaking to a few doctors, both highly respected and in SoCal, about how many grafts if I do get a HT.

 

I've been quoted about 1200 grafts for the hairline and anywhere from 300-500 grafts for the crown (not the crown itself but the area to the top of the crown, in front of swirl). Seems like this would run anywhere from 8-10K, cost isn't a huge issue for me at the moment so I'm OK with that.

 

I'm more wondering if doctors have been honest with me in regards to a few points:

 

1] Do I really need a HT? I mean I know I can get one, but will I experience shock loss?

2] My hairline is really quite far back, difficult to style frankly and that's where I'd like to focus my efforts with minor work in the crown.

3] I've been on finasteride for 5 years and have had no troubles. I will continue to stay on it regardless of transplant.

4] I'm young at 28 but none of the doctors said i'm not eligible, is that a bad sign?

 

Anyways, any insights / thoughts would be greatly appreciated. The doctors I spoke to are well regarded but honestly, I'm a bit skeptical as this business can be a bit tricky to navigate.

 

Thanks everyone

 

 

 

[1978matt]

Nobody 'needs' a HT, so I would not expect a doctor to comment on that.  No doctor can guarrantee you wont get permanent shockloss either.

Only you can decide if the risk v reward is worth it.

The plan sounds decent.  Not sure about the crown.  Depending on how you wear your hair it might not look too bad currently.  Obviously in your second photo you damped it down to show the loss.

Once you've done one HT youre pretty much committed to another 2, maybe even 3 later down the line.  But if you're ok with that...?

 

Edited September 20, 2020 by 1978matt

[gillenator]

If the hairline work includes closing the temporal lobe areas and reinforcing the entire frontal hairline, it may very well take more than 1200 grafts to complete keeping in mind that it would involve mostly if not entirely single hair grafts.

If it were me I would not do any work in the crown as the potential risk for shock loss outweighs the small gain that you may attain...so I agree with matt.

You have enough hair volume to simply hide the crown thinning with how you brush or comb that area.

[ciaus]

In terms of age, the longer you wait the better because your loss pattern emerges more, but the general consensus for the youngest age ethically around here is 25.

Based on your pics I'd try to put it off. Have you tried concealers? Like Dermmatch and/or Toppik hair fibers on your crown especially while you wait for enough loss to justify the risk of a procedure. The forum moderator has alot more loss in his crown area and uses Dermmatch quite well to conceal it, he made a video topic linked below showing how he applies it. You can use that everywhere on your head including the front, but it won't help you bring down your hairline unfortunately, though maybe you can find a hairstyle with the extra thickness it can add to your hairs in the front so that instead of combing your hair straight back, you can comb it to the side so it lays on your forehead a little.

 

 

 

 

[Gabreille Nelson Mukhia]

1] Do I really need a HT? I mean I know I can get one, but will I experience shock loss?

- If you want to restore the hairline then yes, you will require a hair transplantation procedure. You could experience temporary shock loss.

2] My hairline is really quite far back, difficult to style frankly and that's where I'd like to focus my efforts with minor work in the crown.

- Since you are taking finasteride, you can go for the recommended grafts in the crown.

3] I've been on finasteride for 5 years and have had no troubles. I will continue to stay on it regardless of transplant.

- Thats commendable.

4] I'm young at 28 but none of the doctors said i'm not eligible, is that a bad sign?

- At your age, you hold a fair candidacy for a transplantation procedure, given that you are willing to maintain the use of Finasteride.

 

Wish you all the best and great results!

[DrTBarghouthi]

1] Do I really need a HT? I mean I know I can get one, but will I experience shock loss?

Given your age and the recession in the hairline/ loss in crown, then you are eligible for it if you feel that it is causing you difficulties styling/ anxiety etc. There are candidates that we try to avoid / discourage from transplanting due to several factors, but to me you seem like a suitable one. 

2] My hairline is really quite far back, difficult to style frankly and that's where I'd like to focus my efforts with minor work in the crown.

I believe the hairline/frontal zone will need a bit more than 1200 grafts. However, I would hold from doing the crown at this stage. Doing few hundreds is still a fair option. Being conservative with the crown is key here.

3] I've been on finasteride for 5 years and have had no troubles. I will continue to stay on it regardless of transplant.

This is advisable so as to maintain your crown as much as possible and prevent further hairloss elsewhere. 

4] I'm young at 28 but none of the doctors said i'm not eligible, is that a bad sign?

In general, most patients over 24-25 are potential candidates. In some cases even younger. Proper examination and consultation is needed to assess. 

 

Best of Luck !!!

[hairlosssucks92]

Thank you so much everyone, very helpful comments, I appreciate you all taking the time to discuss this :)

 

It seems like I am probably OK to move forward on the hairline but may need to think more about the crown. I can actually hide it if I do a bit of a comb over but thought, "if I'm going to be going in, why not get a bit of work done there as well"?. I may need to re-think that.

 

Appreciate it everyone, thank you!

[Sam818]

On 9/19/2020 at 2:04 PM, hairlosssucks92 said:

highly respected and in SoCal

Please be careful. I had a bad experience in so cal and if you talk to the top ethical docs in private they’ll tell you themselves how many repairs they do on guys from California and they certainly don’t have “high respect” for their work. Mohebi is the only doc that you should even consider but even then then you should think about traveling.

[hairlosssucks92]

Thanks Sam. I had been recommended Dr Mohebi however the doctors I spoke to, if I can name drop, are Dr Carmen in SD and Dr Rassman in LA. 
 

No issues with those doctors as I understand, they both come highly recommended (I think at least !). 
 

[Sam818]

Those are ethical doctors. Dr. Pak is the one doing the surgeries at new hair institute for Rassman. I can’t speak to the quality of their work as there are not many patient documented results for them which is what matters most. I highly recommend you also reach out to Dr. Gabel and also Hassan & Wong (post COVID for Canada) to compare and see which evaluation and doctor approach you like most. Those are 2 and a half hour flights out of LA which is nothing.

[O Hare 57]

I would contact Dr. Gabel.   H+W arent open due to covid.  YOu could do virtual appointment but cant get into Canada due to Covid. 

You could Maybe put 2500 in the front third and see what happens.  You are very young and hair loss never sleeps.  If you do a small amount in front you could get shock loss then  you'll  regret it and have to get 2nd procedure again.   Don't F around.  I learned this the hard way.    You may want to wait a few years B4 you do anything and see how you progress.  Here is James Garner in his 40s and then his 80s.  As you can see at 28 you have a long life to deal with your hair ahead.  Plan carefully.  Don't be rash.

[ciaus]

On 9/21/2020 at 3:51 AM, O Hare 57 said:

Don't F around.  I learned this the hard way.    You may want to wait a few years B4 you do anything and see how you progress.  Here is James Garner in his 40s and then his 80s.  As you can see at 28 you have a long life to deal with your hair ahead.  Plan carefully.  Don't be rash.

 

I agree with you except for using James Garner as an example, I think he was probably wearing a hair piece for years -better than alot of guys from his era to be sure, until he gave up and/or got so old he stopped caring. The recession in the sides, the stronger hairline with fancy combing directions look, its pretty good, but not fool-proof, looks like a piece that covers at least the front and the top of the sides, and you can see the difference in hair color which is too much to just be from hair styling products.

 

 

[1978matt]

Billy Zane, born in 1966.

Back to the Future (probably filmed 1984): Full head of hair, age 18

Dead Calm (filmed 1988): Starting to thin, age 22

Mid 1990s: Thin forelock and then wore systems in films, late 20s/early 30s.

2000+ basically NW6.

Same issue with Sean Connery.

[hairlosssucks92]

Thanks everyone, very helpful comments. Appreciate you all taking the time!

 

I'd like to move forward with a small hairline transplant but am becoming greatly concerned about potential work in the crown given that it seems like there could be a chance of shock loss.

 

Seems like around ~5% of patients experience shock loss but it seems to be permanent at times. I'm on finasteride and have been for 5 years, does that help with shock loss?

 

And generally, the doctors I mentioned, H&W, Dr. Gabel, Dr. Rassman and Dr. Carmen (who I'm leaning towards), should be able to minimize this loss correct (if at all)?

 

Thanks folks :)

[O Hare 57]

If you get a biopsy, it will tell you what percent of hairs are telogen, antigen, and miniaturizing ect.  If high percent is minaturizing you may experience more shock loss.  Happened to me.  Biopsy is about 400 bucks.  If that is the case it might be best to get a high concentration of grafts in small area like frontal third then you will have enough permanent grafts to cover area regardless of shock loss.  It cost me 25 thousand bucks to learn this the hard way.  Its worse than a hit of bad acid. Trust me...  I would work on your hairline first with high density packing.  You going to need more than one surgery, might as well get it done right the first time.  Hair transplants are like Lays potato chips.  No one can get just one.  If you on Fin and still thinning I might guess more loss in future.  Unless you want to risk flying over seas expect to pay 10 grand.  You could get megasession with HW but it will cost ya....$$$$$$$$$$$$$$$$$$$

Hairloss sucks!!!  Go see top notch doc and get proper Eval...

[gillenator]

A thorough microscopic examination of your scalp will be sufficient to know which areas are subject to loss and also the status of your donor hair.

[Al - Moderator]

On 9/22/2020 at 2:57 PM, ciaus said:

I agree with you except for using James Garner as an example, I think he was probably wearing a hair piece for years -better than alot of guys from his era to be sure, until he gave up and/or got so old he stopped caring. The recession in the sides, the stronger hairline with fancy combing directions look, its pretty good, but not fool-proof, looks like a piece that covers at least the front and the top of the sides, and you can see the difference in hair color which is too much to just be from hair styling products.

 

 

 

I don't know about that. I never thought he wore a hairpiece. I combed my hair the exact same way when I was starting to lose my hair and I always had side recession too and never had an real temple points. I had thick forelock in the front, so I could comb my side part towards the front to cover the receding edges and then let the frontal forelock sweep sideways and back to cover the other side that was receding.

 

 

[gillenator]

You look like you have a full head of hair!...😀