31yo NW2.5 considering frontal transplant, photos included

[hair4now]

Hi all, I'm considering a hair transplant and would appreciate your feedback on any of the below. Specific questions at the bottom.

Self-assessment

• NW2.5 (?)
• Pale white skin and thick strands of black, semi-wavy hair
• Maybe some initial diffuse/crown thinning (see skin showing in crown in photo with longer hair). Not sure whether this "normal" vertex skin under direct bathroom lighting.

Goals for transplant

If I move forward with a transplant, I'd hope for an outcome like this: https://forum.hairsite.com/t/rahal-fue-norwood-2/28647

History / meds

• First noticed temple recession around age 21. Been mildly bothered by it for about 10 years but wanted to wait until my 30s to consider a transplant.
• Started finasteride at age 22 (2011) and have fortunately kept most of my hair since then, except a slow loss at the temples. Never used min.
• I've included a photo from 2011 to show stability. I've always had a high forehead.
• Also included a photo of a super rough-cut possible hairline drawn by Dr. Nadimi when I went in for a short consultation last year.

Family history

• Dad is mid-60s with NW3 hairline and a lot of diffuse thinning, including on crown. But no totally bald spot on vertex. See pic. His dad was NW3-4, some of his uncles were bald by their 90s.
• Mom's dad had NW2/NW2.5 in 50s, died young.
• My dad's hair roughly looked like mine does now when he was in his 30s (he wasn't taking meds, obviously).
• Weirdly, my younger brother's hairloss seems to almost advanced as my dad's, but he is only in his late 20s. Substantial diffuse thinning. Not taking meds.

Plan

• Go to Nadimi, who I consulted with last year. Pending her availability, probably get transplant sometime next year around age 32.
• FUT instead of FUE to save donors just in case I need future operations. I have been wearing my hair short in quarantine but generally have it longer. And honestly, I don't think having a thin FUT scar would bother me that much if my hairline was less receded. But I suppose that's easy to say now.
• Use fin indefinitely. I see to tolerate it well and it seems to be working.
• Be prepared to get more transplants in the future if my hairloss advances like my brothers.

Questions

1. Does my plan sound reasonable? Or too aggressive?
2. Does it look like initial stages diffuse/crown thinning? How can I be sure?
3. Random question related to crown thinning: I heard that Propecia is much more effective on the back of the head than the front, and that if I'm taking it I can expect to keep my crown hairs indefinitely. However, I cannot find anything to back up this claim and it sounds unlikely. Has anyone heard that assertion before / know where it comes from?
4. Is my skin / type a good candidate for transplant? I worry about having such pale skin showing through.
5. Anything else I should be thinking about?

Thanks in advance!!

 

Edited October 11, 2020 by hair4now

[1978matt]

1 hour ago, hair4now said:

Questions

1. Does my plan sound reasonable? Or too aggressive?
2. Does it look like initial stages diffuse/crown thinning? How can I be sure?
3. Random question related to crown thinning: I heard that Propecia is much more effective on the back of the head than the front, and that if I'm taking it I can expect to keep my crown hairs indefinitely. However, I cannot find anything to back up this claim and it sounds unlikely. Has anyone heard that assertion before / know where it comes from?
4. Is my skin / type a good candidate for transplant? I worry about having such pale skin showing through.
5. Anything else I should be thinking about?

1.  Seems ok.  My suggestion below.

2. Hard to tell but it looks minimal.  Either ask a doctor to look or buy a USB microscope...

3.  Fin slows the rot, but doesn't stop it.  It works on all DHT prone hair, for most people.  The thing is though, if you're going to thin in the hairline first then even with fin, you will still thin there first - just slower than you would have naturally.  I've not read the details but the clinical trials for fin probably took hair measurements in the crown, so the manufacturer can only claim it works in the crown.

4. Not the best but you appear to have a lot of donor hair.

5. Maybe dutasteride if you really wanted to go full force against 5 alpha reductase.  Tricky finding a doctor willing to prescribe.

[Curious25]

1. Does my plan sound reasonable? Or too aggressive? Very reasonable, and well thought out too 
2. Does it look like initial stages diffuse/crown thinning? How can I be sure? No. To be sure, get an in person consultation with a decent doctor and the use of their dermascope. 
3. Random question related to crown thinning: I heard that Propecia is much more effective on the back of the head than the front, and that if I'm taking it I can expect to keep my crown hairs indefinitely. However, I cannot find anything to back up this claim and it sounds unlikely. Has anyone heard that assertion before / know where it comes from? I’ve heard hypotheses regarding this to be attributed to the fact that usually frontal hair loss is the most common start for patients with MPB - therefore tends to be what instigates people to jump on medication. When this occurs, the majority of the time, the hairs on the front are ‘Too far gone’ for finasteride to work it’s magic, therefore it appears the effects on the crown and mid scalp are superior to that of the front. That’s one assumption. 
4. Is my skin / type a good candidate for transplant? I worry about having such pale skin showing through. No, it would be deemed as the worst possible contrast there is (black hair vs white skin) however your hair characteristics and donor density appear to be above average from the photos provided. 
5. Anything else I should be thinking about? Consulting with more doctors. As good as Nadimi is, it’s always wise to shop around with other top tier surgeons to gain a wider sample of feedback. 
    

Very nice presentation of your case. You are obviously already pretty well versed, and seem like an excellent candidate to me. 

[hair4now]

Appreciate the feedback and support. Looks like next year will be the year

[giegnosiganoe]

I agree with the others, seems like a no brainer. I'm just surprised that you want to go with FUT given your overall situation. It doesn't look like you'll ever need the extra grafts, and I wouldn't want to risk an unsightly scar (which even with the best surgeon, I'm pretty sure there's always a chance)

[hair4now]

Update: scheduled for May 2021!

>I'm just surprised that you want to go with FUT given your overall situation.

Thanks for this. I'd been under the impression that FUT vs FUE was largely a tradeoff of donor depletion (better with FUT) vs scarring (better with FUE).

But after reading this thread, sounds like there are more factors to consider, and most of them favor FUE, especially for NW2.5.

I am now leaning towards FUE. Thanks for chiming in.

 

 

[Curious25]

Thats a very old thread, and FUE has came on leaps and bounds since then, however the points are still relevant. 

From looking at your pre op case - I would have probably looked at FUE from the get go. 

So you're scheduled in May next year, congrats! FUE with Nadimi? 

[giegnosiganoe]

Ah yes, that thread is a goldmine of reasons in support of FUE for lower NWs.

Hope you come back to update us on how your procedure goes.

[Bill-Dr-Rahal]

Hair4now,

Well it looks like you’ve certainly done your homework and have mapped out a pretty educated plan. But I do agree with many of the others who are a bit surprised that you would consider strip over FUE at this point in time. As others have already stated, FUE has Sprung forward substantially and many of the top doctors in the world are regularly performing FUE with exceptionally high levels of success, on par with strip. So in my opinion, I would consult some of the worlds leading physicians regarding FUE versus strip and do some more research before deciding which one is right for you.

best wishes,

Bill