WHAT SHOULD I DO?

[Massimo94]

Hi Group,

I’m a 26 year old male and suffer from difused alopecia since my eary 20’s. I’ve had two operations done on my hairline with some success (as you will see in the picture). I’m currently on 1mg fina per day and was on 0.5 mg fina the last six months!

As you will see from pictures taken under the light I’m a potential NW5 with my forelock, midscalp and crown areas soon to be emptied unless fina keeps me that way for the next years. My previous hair transplant experiences in Greece were average at best. I was never consulted to take any medication and the overall results and approach  were not satisfactory.

On my first transplant I had approx. 1700 grafts placed and on the second 1440 grafts. In the pictures below you will see my donor area so you can better estimate what my donor capacity is. 

I’m currenty examining doctors such as Dr. Pekiner, Bruno Fereira, Hattingen and Cyprus (HDC). 

My hair situation is complicated because it will take a lot of skill to go in between the miniaturised hair and create density of over 40g/cm. That’s why I need your help to guide me towards the best doctors that can go in and create that density with the maximum chance of success. Because I’ve already had two transplants I need the third one to be a good one or else I’m out of donor hair!

 Thanks a lot!

[Gatsby]

You appear to still still have a good looking scalp donor supply going by your pics. You have used 3,000 plus grafts already. I don't know how long you have been on 1mg per day of finasteride but it can take up to a full two years for it to have full effect to know if it will stabilize your loss (though 6-12 months is more common). If you go forward with surgery at some point in the future you may want to consider adding beard grafts as a donor supply to preserve your scalp donor. Eugenix are at the forefront with the use of beard grafts mixed with scalp grafts. Who performed your surgery in Greece? Keep researching and asking questions. All the best!

[Massimo94]

Hi there!

The first surgery in Greece was with DHI and the second surgery with Ioannis Gkouras at hair genesis clinic. 
Previous doctors have said that my donor can give up to maybe 5000 more grafts.

[SLA]

I agree with @Gatsbythat Eugenix could be a very good choice. Google 'Eugenix diffuse' and you will find  a video by Dr. Sethi talking about hair transplanting in diffuse patients.

Hope this helps!

[Guanyu76]

Would you look into getting an FUT?

[deitel130]

Is all hair on top only transplanted? If yes, you should not worry about permanent shockloss from an experienced surgeon as they would shave down the recipient area to see the existing hair. Your donor looks good. Also, the hairline seems fine I think you should focus on the mid and see if you can get light crown coverage or leave the crown for a future procedure.

[Massimo94]

Hi!

Anything that’s behind the hairline is not transplanted hair. I fear that it will take a very talented surgeon to go in an increase the density in those areas (forelock mid and crown ) as it still has miniaturized hair and the danger of shock loss is real. I’ve looked at various clinics I haven’t seen many cases like mine with diffused thinning across the head.

[Doron Harati]

@Massimo94 I am the consultant and coordinate center of HDC, I myself had a repair procedure by Dr. Maras, in some photos it looks very thin, some photos it looks too early for a procedure, we need to check it.

[Britanium]

Consult with a few decent clinics, HDC/Eugenix and Vertex @DrTBarghouthi spring to mind! 

[Melvin- Admin]

Are you on finasteride and minoxidil? At this point, getting additional work could be dangerous, if you’re not stabilized. 

[Massimo94]

On 1/9/2021 at 9:14 PM, Melvin-Moderator said:

Are you on finasteride and minoxidil? At this point, getting additional work could be dangerous, if you’re not stabilized. 

Hi Melvin,

I was on 0.5 fina for 6 months and since 1 month I’m on 1 mg. Do you think if it stabilizes in 2 years I could be a good candidate to increase density in the mid, forelock and crown area ?

[Melvin- Admin]

18 minutes ago, Massimo94 said:

Hi Melvin,

I was on 0.5 fina for 6 months and since 1 month I’m on 1 mg. Do you think if it stabilizes in 2 years I could be a good candidate to increase density in the mid, forelock and crown area ?

I definitely think you should give it some more time, let the meds take effect.

[Massimo94]

Hi guys,

 

I wanted to give an update on my hairloss condition as the past two months I’ve noticed that my crown and mid scalp have started thinning more aggressively even though I’ve been on 1mg fina since January 2021. Ive attached the pictures.

 

My main concern however is about the condition of donor area. I’ve attached a picture of my donor (post two operations approx 3000 grafts taken already). What do you think of it ? Can it support another 1 or 2 operations to cover the entire head? The picture only shows part of the central and the left side of the donor. 

[Gatsby]

It can take up to two years to see the full benefits of finsteride so I think it's presumptuous to measure how well you will respond to finasteride after 6-7 months. Having said that you are basically sporting an almost shaved look in the donor area. I would grow it out a little and continue on the meds seeing that you are tolerating 1mg a day. I would definitely rule out anymore surgery for at least another year to see how the mid section and crown responds to medication. I often state in my posts that a hair transplant needs to be planned for the life span of the patient. Don't worry you have options so don't stress. Patience unfortunately is basically Latin for 'hair transplant surgery.'

[Spring15]

Man I would consider a hair system 

[Berba11]

You've either got to give it more time (because of your age and to see what finasteride can do longer term), or you'll want to start speaking with clinics that can utilise beard grafts across the midscalp so as best to preserve your donor area in case you have any future loss when you're older.

If you've had two surgeries already and you're only 26 then I'm guessing you must have been around 23/24 when you had your first surgery? The benefit of hindsight is a wonderful thing but this sort of situation really is why it's important to be patient and not get a HT too young.

If you're not using Minoxidil, you probably want to start and give it some real legs. Finasteride & Minoxidil as a combo is a good bet, and if you give it enough time to see if they are working, you'll be much better placed to make a decision about a future HT.

Can your donor area support another significant HT *with* a super short buzz like in the photo? Probably not (without being visible), but that's not a good indicator. Many people get 5-6000 grafts out of their donor regions and with a little bit of growth, it's covered completely. I'm sure yours would be fine, especially if you can tap into beard grafts as well.

[SD1984]

I would hold off on anymore surgeries. Though thin, you still have a lot of hair on your head so really having a HT would probably create a good amount of shock loss unless you went to one of the most skilled surgeons out there. Have you ever thought about the possibility of a hair system behind that natural hairline? Also, you'd be a great candidate for hair fibers. 

Just curious you had around 3100 grafts transplanted.... where were they all used exactly

Edited July 21, 2021 by SD1984

[Melvin- Admin]

When did you get your surgery? It’s risky as you can end up with net gain unless you stabilize your hair loss.

[Massimo94]

8 hours ago, SD1984 said:

I would hold off on anymore surgeries. Though thin, you still have a lot of hair on your head so really having a HT would probably create a good amount of shock loss unless you went to one of the most skilled surgeons out there. Have you ever thought about the possibility of a hair system behind that natural hairline? Also, you'd be a great candidate for hair fibers. 

Just curious you had around 3100 grafts transplanted.... where were they all used exactly

Hi there. 

The first operation in 2017 added 4100 hairs (not sure how many grafts) in my front mid and crown m, but mostly in my front to restore my receding hairline. 
The second operation for 1400 grafts added density to the hairline as the natural hair behind the transplanted had falled. In my second transplant the doc attempted to add density to the forelock with limited success.

I haven’t transplanted anything in the mid scalp or crown pretty much. My estimate is that I would need 3000 grafts from a very skilled surgeon to cover my thinking forelock mid and crown. I probably will hold off for another 2 years however I wouldn't want to wait too long and have this entire area empty out completely. 

I wouldn’t consider a hair system ever. I’m using fibers now and then and they are a good substitute so far.

My main concern is to 1) make a plan with a skilled surgeon who can transplant between natural hairs and 2) ensure that my donor can deliver the grafts.

 

 

 

[Massimo94]

9 minutes ago, Melvin- Moderator said:

When did you get your surgery? It’s risky as you can end up with net gain unless you stabilize your hair loss.

Both surgeries in Greece.

The first with DHI in 2017. I believe they butchered my donor a little cause I think they used too large punches.

The second was in 2020 with a private clinic in Athens.

[Berba11]

30 minutes ago, Massimo94 said:

Hi there. 

The first operation in 2017 added 4100 hairs (not sure how many grafts) in my front mid and crown m, but mostly in my front to restore my receding hairline. 
The second operation for 1400 grafts added density to the hairline as the natural hair behind the transplanted had falled. In my second transplant the doc attempted to add density to the forelock with limited success.

I haven’t transplanted anything in the mid scalp or crown pretty much. My estimate is that I would need 3000 grafts from a very skilled surgeon to cover my thinking forelock mid and crown. I probably will hold off for another 2 years however I wouldn't want to wait too long and have this entire area empty out completely. 

I wouldn’t consider a hair system ever. I’m using fibers now and then and they are a good substitute so far.

My main concern is to 1) make a plan with a skilled surgeon who can transplant between natural hairs and 2) ensure that my donor can deliver the grafts.

 

 

 

Do you have any photos of your 1st & 2nd surgeries that you can share so that it's easier to see exactly what work was done on each occasion?

[Melvin- Admin]

18 hours ago, Massimo94 said:

Both surgeries in Greece.

The first with DHI in 2017. I believe they butchered my donor a little cause I think they used too large punches.

The second was in 2020 with a private clinic in Athens.

I would honestly hold off on surgery. If you’re using fibers that should help, you’re barely 26, you got your first surgery way too young. Let’s see how this develops in a few years. That way you can strategize your grafts better.