Considering a hair transplant - Looking for advice on my situation

[victormaitland]

Hi all,

Firstly, a huge thanks to all the guys who spread positive energy on these forums and provide honest advice and feedback to others.

I would appreciate your opinion on a few things before I begin consulting with clinics. Please see my pics attached as well as some info on me. 

Age: 37

Hair loss: See my pics, my hair loss is slightly atypical. I essentially have a bald spot right behind my hairline. My hairline has not receded. I have a strip of thicker hair through the centre, and a larger bald spot at the back which has expanded in the last few years. I don't know for how long i will retain the middle strip of thicker hair in the centre so I need to consider how my potential transplant will conceal this when it happens. 

Current regimen: I currently take 2.5mg of Finasteride a week which is well below the 1mg a day that is recommended. It has significantly slowed down my hair loss even at a low dose. However I would like to stop Finasteride one day if possible, I am not a fan of some of its effects, I have taken it on and off for 15 years and it works for me, but numbs out any sexual feeling when I take it over an extended period of time. I am also taking 2.5mg of oral minoxidil a day which has been effective and I am happy to continue taking it.

Donor area: My donor area is thick I believe that the hair quality is good. Unless there is something else I should be looking for, I am not too concerned that this will be an issue. 

My questions:

1. Looking at my photos, are there any specific things you think I need to consider in getting a hair transplant? or, that i need to ask a surgeon?

2. Is my case more difficult given my 'diffuse style' hair loss behind the hairline? Should I expect a good outcome? (Also, I am convinced that my hairline itself is going to diffuse over time. This will be tricky because one day I may need to do an additional transplant to fill the hairline and centre.)

3. Any other advice? 

 

Thanks for your perspectives!

[victormaitland]

Thanks for the informative reply qui bono. I can now see that I definitely have the Ludwig style of balding. You made the observation in another thread that it can be more easily hidden with concealers, you are absolutely right about this. Concealers have allowed me to quite convincingly hide the balding even at an advanced stage, heck I have even hidden it from myself! It is only recently that I have accepted how bad it has gotten. 

The examples you have provided give me a lot of hope. Cheers

[Dr. Damkerng Pathomvanich]

So sorry for the late reply.

He is 37 years old and still very young. From the pictures he has intact hairline at least 2 cm2, hair loss at right side of the hairline is more than the left. The bridge is quite thick but the crown is quite bald. He has coarse, wavy black hair and seems to have good density. His hair loss is still on going, the bridge will be thin and bald in the future as well as the hairline will thin as time goes by. If he wet his hair and comb up, the balding area behind the hairline will be wider than seeing in the picture.

I think he is a good candidate for hair transplant. My rough estimate, he might needs 1000 grafts more or less at front and 2000 grafts more or less at crown to have full head of hair. He can have FUT or FUE or combo to achieve good result. Of course he needs to maintain his hair loss with minoxidil and finasteride.

[victormaitland]

Thanks for your response Dr Pathomvanich.

Yes I am most concerned about my hairline thinning over the years, this will happen slowly, but surely. On my left temple the hairline itself started to thin slightly and this was a big concern. When I went back on propecia 2.5mg a week, this virtually halted it, or slowed it down significantly.

As for the bridge, if it slowly goes after I have already filled the bald patches on the crown and the especially the front, I think I will get away with it not being very visible at all. 

Any work that a surgeon does, I would particularly like their opinion on if it is worth 'reinforcing' my hairline with grafts, or if it is better to leave it and not disturb the viable hairs that are still there. I will no doubt raise this when I make enquiries. 

[victormaitland]

Hi All,

Just an update to my post earlier this year:

I have booked for a two day session in January - one day address the crown, and one day to address the front section. 

Do surgeons actually ensure that follicles are placed around the existing hair follicles? Or do they just place them in the general area and it all sorts itself out? Just curious about this. I have a bridge of hair that has not miniaturised as much, as well as an intact hairline. I am worried about shock loss in these areas.

[dotdashdashdash]

On 12/22/2021 at 12:04 AM, victormaitland said:

Hi All,

Just an update to my post earlier this year:

I have booked for a two day session in January - one day address the crown, and one day to address the front section. 

Do surgeons actually ensure that follicles are placed around the existing hair follicles? Or do they just place them in the general area and it all sorts itself out? Just curious about this. I have a bridge of hair that has not miniaturised as much, as well as an intact hairline. I am worried about shock loss in these areas.

Good luck on your procedure! Keep us posted with how it goes.

[Dr. Damkerng Pathomvanich]

I usually transplant the grafts around the existing hair follicles. However, if inside the existing hair follicles, there are some miniaturized hair further inside, I would replace that and inform the patient regarding the shock loss. This is, again, depending on the individual surgeon's judgement and patient communication.