Combo Fut/Fue or Fue?

[Havar]

Hi!

man 44, never meds, never surgery. Norwood 6. consultation with  Bisanga  3 years ago. Stable loss. B recommended Combo fut/Fue 5000 graft or Fue in 2 sessions. I am a bit worried about fut scar. How much will it show usually? Anyone done Combo ?  Thank you.

[Britanium]

Bisanga scars are pretty invisible once healed. But with any FUT it will rule out very short cuts. I started out with FUT (x2) and then moved to FUE (x3) 

Being a Norwood 6 you got to have a long term game plan. Can you share any pics ? 

 

Edited November 15, 2020 by JohnAC71

[champybaby]

It depends on your goals. And it would help if you could post a picture. IDK your specifics, but you say you're a NW6. If I were in your shoes, I would opt for FUT, FUT, followed by filling in the scar (with beard hair, ideally) and then FUE, FUE. This will maximize your donor supply and give you a better head of hair.

I'm sure you will be satisfied with a FUT/FUE combo of 5K grafts. It will also give you immediate results in re: to the amount of hair on your head, too. But you will certainly need more as you age. And that's where you will have issues, as your donor supply will be limited. My suggestion certainly will cost you more money, and it will certainly mean more time out of the public eye as you recover, but in exchange you will have a better looking head of hair for a much longer time.

So my best advice is to ask yourself which of these two scenarios sound more appealing to you. You can certainly do a 4K FUT in one session.

[Havar]

Thank you JohnAC71 and Champybaby. Here are some pics

[Britanium]

I’m looking at your donor area and it honestly doesn’t seem that strong to me. Have you had a recent consultation? Be interested to see what they would say. 
Maybe consult with Eugenix? They excel at these type of cases. 

Edited November 15, 2020 by JohnAC71

[Melvin- Admin]

What are your expectations? You are at least a Norwood 6 bordering Norwood 7.

[ciaus]

Your thinning dips pretty far in the back, and there's some patchy areas below that, agree with @JohnAC71 about your donor strength.

Are you sure about loss being stable since your consult 3 yrs ago with picture evidence, or are you going by how you remember checking in the mirror?

Also in your OP you mention that you've never been on meds -are you against getting on finasteride? Dr Bisanga's patient advisor posted a video topic about thinning in the donor area at this link here and said good candidates for transplants have less than 20% thinning in their donor areas. I'm actually waiting on a reply to a question that I asked there about whether someone getting on finasteride and strengthening their donor would be enough to change his mind.

 

 

Edited November 15, 2020 by ciaus

[Melvin- Admin]

I agree with what others have said, the donor seems weak. It could be the lighting in the pictures. Where do you live? Have you consulted with a surgeon in person?

[deitel130]

Has there been any changes since your consult with Dr. Bisanga? Was it in person? He probably recommended the combo so that you can get the most grafts probably over a 2 day surgery. You may want to just focus on front and mid for now as trying to cover too large an area will not leave you satisfied. You can then plan for crown in the future. You can even consult with Eugenix as they have a lot of experience using a combination of scalp and body hair where they implant body hair nicely between scalp hair so it blends in. If you prefer shorter cuts see if 5000 FUE is an option or a combination of scalp and body. I believe Dr. bisanga also does body hair.

[Britanium]

Do you still have the pics from 3 years ago when you consulted with Bisanga? My worry would be if you do have a FUT between the red lines @ciaus shows you could end up unsatisfied and you couldn’t even have your hair that short.

And in the case of FUE it’s going to be tough to determine what is your safe zone and also could end up looking over harvested.

Sorry that it’s not sounding particularly positive, but we can only go on what we see. 

Edited November 15, 2020 by JohnAC71

[champybaby]

To be candid, if you did 5K I’d make an appt after surgery to get scar filled in. If you do 5K, you appear to have at best, IMO, several hundred grafts left. 

I can see now why* the doc made the FUT/FUE recommendation. As others have said, you should focus on front, with a *very* mature hairline (which is not a bad thing IMO)  and the top of your head. I don’t believe you will have enough left to cover crown with the sort of results you desire given your donor area.
 

I know a lot less about SMP, but have seen some amazing results, but you must go to the absolute best. Given your situation, that might be something worth exploring. When combined with some FUE it can have a really strong impact, I hear. The downside is the upkeep. 

good luck. 

Edited November 16, 2020 by champybaby

[Havar]

Thank you everybody. My expectations are low, my main focus is framing the face. The light on the pictures is very strong, both in the pictures( Flash from 30 cm) and in the room. The consultation was in person with Bisanga, I live in Scandinavia. B told me there was no signs of miniaturisation. When I saw him it was personal. Before I met him I sent him pictures; he then said I was not a good candidate. He changed his mind after seeding me in person. Thank you again, my goal is just to get some improvement without looking fake. Smp could also be an alternative, anybody have some experience? Thank you.

[Havar]

44 minutes ago, Havar said:

Thank you everybody. My expectations are low, my main focus is framing the face. The light on the pictures is very strong, both in the pictures( Flash from 30 cm) and in the room. The consultation was in person with Bisanga, I live in Scandinavia. B told me there was no signs of miniaturisation. When I saw him it was personal. Before I met him I sent him pictures; he then said I was not a good candidate. He changed his mind after seeding me in person. Thank you again, my goal is just to get some improvement without looking fake. Smp could also be an alternative, anybody have some experience? Thank you.

So what I find difficult is to choose between:

a) Combo; with the chance of scar if buzz-cut

b) Fue just front with mature hairline

c) smp 

[Havar]

2 minutes ago, Havar said:

So what I find difficult is to choose between:

a) Combo; with the chance of scar if buzz-cut

b) Fue just front with mature hairline

c) smp 

D) nothing

[Havar]

15 minutes ago, Havar said:

D) nothing

Some pictures 3 years ago, bad quality, put you might get some inform. out of it.

[Raphael84]

@Havar

Thank you for sharing your photographs.

I wasn't personally your advisor 3 years ago so do not personally know your case, but having seen this thread I wanted to reach out.

Your photos are a real example of why hair loss medication can still play a very important role for Norwood 6 guys, or individuals with extensive loss. Many feel that the worse is behind them, especially as they are no longer in their twenties, and that medication would not really assist.
If I may compare your occipital donor area using the photo that you have provided from 3 years ago, alongside the photo showing your current situation.

Whilst photos can be misleading due to lighting, angles etc. It is very apparent that your lower crown has experienced quite significant decline in this 3 year period.

The 5000 combination FUT/FUE procedure that you have explained was discussed/recommended by Dr. Bisanga was likely the maximum that he felt could be harvested from your donor area at that time. Considering how your lateral humps (sides) had dropped at the time of your consultation, again likely due to the fact that no medication treatment had been used. These lateral humps would have needed to be rebuilt to attach your hairline and frontal restoration in a natural way.
This would have meant that 5000 grafts would not have offered complete coverage.

Without going into too much detail, the evolution of loss over the last 3 years, does show that your donor is unfortunately no longer of the same quality as before.
By all means reach out to your original advisor or myself in terms of sharing your up to date photos with Dr. Bisanga and requesting him to review your case and any recommendations.

Edited November 16, 2020 by Raphael84

[Havar]

25 minutes ago, Raphael84 said:

@Havar

Thank you for sharing your photographs.

I wasn't personally your advisor 3 years ago so do not personally know your case, but having seen this thread I wanted to reach out.

Your photos are a real example of why hair loss medication can still play a very important role for Norwood 6 guys, or individuals with extensive loss. Many feel that the worse is behind them, especially as they are no longer in their twenties, and that medication would not really assist.
If I may compare your occipital donor area using the photo that you have provided from 3 years ago, alongside the photo showing your current situation.

Whilst photos can be misleading due to lighting, angles etc. It is very apparent that your lower crown has experienced quite significant decline in this 3 year period.

The 5000 combination FUT/FUE procedure that you have explained was discussed/recommended by Dr. Bisanga was likely the maximum that he felt could be harvested from your donor area at that time. Considering how your lateral humps (sides) had dropped at the time of your consultation, again likely due to the fact that no medication treatment had been used. These lateral humps would have needed to be rebuilt to attach your hairline and frontal restoration in a natural way.
This would have meant that 5000 grafts would not have offered complete coverage.

Without going into too much detail, the evolution of loss over the last 3 years, does show that your donor is unfortunately no longer of the same quality as before.
By all means reach out to your original advisor or myself in terms of sharing your up to date photos with Dr. Bisanga and requesting him to review your case and any recommendations.

Thank you. No Critic to B, he was totally realistic and fine. He told me that 5 k would cover only frontal 2/3, Fue for crown later if possible. That is enough for me. On the pictures I agree with you, but keep in mind different light, Flash and that the hair is 3 mm longer on the old photos. Of course you can show B. the case, I would be glad. I would in case of normal situation ( not pandemic) of course visit him again if it is very difficult to decide just by photos. But I really want to hear from people what they recommend; smp or transplant etc so I can get as much info as possible before deciding what to do/ not.

[Havar]

24 minutes ago, Havar said:

Thank you. No Critic to B, he was totally realistic and fine. He told me that 5 k would cover only frontal 2/3, Fue for crown later if possible. That is enough for me. On the pictures I agree with you, but keep in mind different light, Flash and that the hair is 3 mm longer on the old photos. Of course you can show B. the case, I would be glad. I would in case of normal situation ( not pandemic) of course visit him again if it is very difficult to decide just by photos. But I really want to hear from people what they recommend; smp or transplant etc so I can get as much info as possible before deciding what to do/ not.

Here are donor pics in different light conditions

[Havar]

On 11/16/2020 at 4:07 AM, champybaby said:

To be candid, if you did 5K I’d make an appt after surgery to get scar filled in. If you do 5K, you appear to have at best, IMO, several hundred grafts left. 

I can see now why* the doc made the FUT/FUE recommendation. As others have said, you should focus on front, with a *very* mature hairline (which is not a bad thing IMO)  and the top of your head. I don’t believe you will have enough left to cover crown with the sort of results you desire given your donor area.
 

I know a lot less about SMP, but have seen some amazing results, but you must go to the absolute best. Given your situation, that might be something worth exploring. When combined with some FUE it can have a really strong impact, I hear. The downside is the upkeep. 

good luck. 

Thank you. Where are the best smp?

[Britanium]

SMP you say ? Paging @Gatsby

[champybaby]

2 minutes ago, Havar said:

Thank you. Where are the best smp?

I do not know. There is a section on this sub and some active members on it. Perhaps start there. The reccomendation I hear most is FUE + SMP. But do your DD on upkeep.

[Havar]

On 11/16/2020 at 12:22 AM, JohnAC71 said:

Do you still have the pics from 3 years ago when you consulted with Bisanga? My worry would be if you do have a FUT between the red lines @ciaus shows you could end up unsatisfied and you couldn’t even have your hair that short.

And in the case of FUE it’s going to be tough to determine what is your safe zone and also could end up looking over harvested.

Sorry that it’s not sounding particularly positive, but we can only go on what we see. 

Thank you! Honesty is slways the right answer. Do you think restoring just the frontal part with Fue, a mature hairline in a first procedure and then maybe a second for midscalp is ok? Then I can buzz if I want without having a fut-scar

[Britanium]

I would aim to get a in person consultation so they can get a better idea of your donor area. If FUT is out then yes maybe a FUE/SMP combo and rock the short look. 
I know last time there was no signs of miniaturisation, but think there will be upon examination now.  

Edited November 17, 2020 by JohnAC71

[Havar]

1 hour ago, JohnAC71 said:

I would aim to get a in person consultation so they can get a better idea of your donor area. If FUT is out then yes maybe a FUE/SMP combo and rock the short look. 
I know last time there was no signs of miniaturisation, but think there will be upon examination now.  

Ok

[Gatsby]

@Havaryou have a few options. One is that you could shave your head and have SMP with a conservative hairline. If you don't like it, it  will in no way rule out your other options. Apart from FUT with FUE, if it was me, I would also consider using beard donor grafts to maximize the number of grafts you could use. Look at Eugenix as they excel in high Norwoods. Have consultations with several surgeons who work with Norwood 6/7's. If your goals are realistic and a natural look (what everyone's goal should be) is what you are after then you could be very happy with a hair transplant/s. When it comes to FUE and FUT both will scar. One will leave a linear scar that can catch the eye if not done correctly and FUE risks thinning out the scalp donor region. However FUE is much easier to hide with SMP. All the best!