An Intro & HT research/journey of a NW5/6

[urbanite88]

Hey guys, been lurking around these forums for months now and just wanted to introduce myself before I start posting!

Background

37 yo healthy male based in UK with Norwood 5/6 level hair loss pattern. Been losing hair since 21, really became noticeable by others around 25. I've always had super thick dense hair, that people complimented me on, and in my teenage years, rather difficult to style due to the thickness.
Hair loss was enough of an issue to affect my mental health and my confidence in certain situations. Overtime that only got stronger. Started finasteride at 31 through a private prescription years after my useless doctor tried to make me feel vain for seeking out this treatment at age 25, when according to him I had "plenty of hair"!?. MPB runs through most of my family, though mine seemed to have started/progressed a lot earlier compared to older relatives.

While the finasteride stabilized the loss somewhat, it never really helped grow back any hair. Thinking I probably could have halted half my loss had I started finasteride at 25, is rather upsetting. I had tried Regaine (5% minoxidil ) in earlier years with little success. Also used 12% from Belgravia alongside the fin, which I have been on for around 3 years, with a little better success of thickening existing hair. While my hairline/temples has probably receded between 2-4 inches since my youth, what really bothered me the most was my crown. I always felt conscious of it every time I got a glimpse of it on the mirror and could not shake off for days on end. I tried laser light treatments too, but that just seemed way too clunky. In the last 3 months, I also started derma-rolling with a 0.5mm roller, just to keep my existing hairs in good shape in prep for the HT more than anything.

I had been thinking about hair transplants for years, but wanted to explore all non-surgical avenues first, which I think I well and truly have now. Really started serious research over the last 18 months, and it's been a process of real highs and lows, at times feeling disheartened and ultimately just exhausting. I discovered various HT forums in the last 6/7 months, which really helped with my research based on following concrete case studies which helped rule out doctors who just were not up to it. So I am ever so grateful for communities like this

My initial focus was just in the UK, but ultimately, I had to broaden the search to consider Turkey, Belgium, as far as India. In total I have had 20+ consultations with various doctors. The range of proposals were as varied as the countries the doctors were from! I was offered between 1800-2000 grafts, just for the hairline/top half to 5000+ grafts over two day sessions to cover the front and crown. The assessment of my donor area ranged from "limited" to "very good". All 4 UK doctors I visited in person however were consistent in their assessment that my donor was good for 2 procedures up to 4000-4500 grafts. One of those doctors stated by donor density was 85 FU/cm2. I was starting to build a consensus of what was possible/achievable for me and what aligned with my preferences.

Given the current state of the world, I really just wanted to find a good doctor in London, but the options of suitable doctors for my specific case were thin on the ground. There are several good doctors in London but unfortunately, I just could not find any with a convincing history of working on NW5/6 patients.

I should state, I also tried to reach out to Dr Balls in the UK, Dr Couts and Dr Freitas in Spain but they were all oversubscribed and I was looking at a timeline of late 2022, just not an option for me. Eventually I shortlisted 3 doctors.

Dr Arshad from the Hair Dr in Leeds, Dr Ozlem Bicer in Turkey and Dr Arika Bansal of Eugenix in India. Dr Bicer was an unlikely contender for me, due to patchy communication and it generally being difficult to really build a rapport with the clinic, many things lost in translation. At first look she seemed mostly to do very dense packing front hairlines, great results but fewer crown work. But there was something about Dr Bicer's profile and some of her patients that really captured me, I was drawn to couple of patients I found relatable and who were in similar stages of hair loss to me, who underwent transplant and reported a good experience.

Unfortunately, India was soon not an option at all. Then also in early January I believe, Turkey banned UK travellers from entering. For a few weeks, I thought the choice was pretty much made for me. Dr Arshad seemed to be a great, so I was happy to explore further into that. Problem is, when I eventually managed to talk to him on video (I already had a date booked in April just prior to it) it was very very short. A couple of things he said concerned me, in particular that he may not be able to give me any coverage in crown if I wanted good results in the hairline/top first. This off course, after I had already had extensive discussions with Sommiya, the practice manager about my concerns and wishes and how I wanted even a little coverage in my crown so that I wasn't totally bald in one area. The second thing that stood out to me, was when asked about the various extraction/incision punch sizes, he stated, for me he would probably use 1.2mm incisions (cant remember if he actually meant extractions here) since I look to have thick hair. That worried me a little, as I though that must mean more bleeding and longer recovering time (one of the things that's held me back from HT for so long is because I am of a nervous disposition, I do not like seeing blood or needles much!). I had looked into this topic enough to get a sense that skilled and experienced surgeons should be able to use 0.8-0.9mm punch sizes to extract multiple hairs, and not use bigger ones, just because its easier.

I had to take a step back and could not proceed with the April date. I tried to arrange a further call, even suggesting to get a train up to Leeds for a face to face consultation, but unfortunately that was not possible due to the clinic no longer offering face to face meetings as the best way to minimize the covid risks to the clinic.

In the meantime, I followed through with a final consultation with another Harley Street clinic I had already arranged months prior, which ended up being rather disappointing. I kept communications with Ozen, Dr Bicer's coordinator, and toyed with different scenarios in which I could achieve the results I would be happy with there. Dr Bicer stated I would need 7000+ grafts over 2 sessions a year apart to get both crown and hairline/top done. First session would be for 3800 grafts, and the second session only confirmed after that, if my donor was good enough. Initially they had a couple of dates in May and then no availability until September. But the May dates came and went by.
At this point I was all too aware how much time and energy I'd already dedicated to this process, and I felt like I had already waited too long to do this, I just wanted to make a decision and get it done this summer/autumn. And with covid still lingering on, it seems now is as good as ever for some downtime to recover and being able to work from home during the worst bits!

By a twist of fate, in the last days of May, I heard Turkey was allowing Brits in again and got in touch in Ozen and they also coincidentally had a cancellation in June!

When I spoke to Dr Bicer, suddenly all the prior communication problems seemed a mute point, she seemed very warm and I did not feel rushed in the call. She assessed my donor again in video (not in the best lighting) and again reiterated my donor might not be strong enough to support both procedures. So I put forth my bottom line, given I had 3800-4000 to play with, I confirmed I would like us to sit down in person and decide how we put those to use before the surgery. As I hung up, I had a date booked in June!! Slight problem, Turkey was on UK's RED list of countries, an effective travel ban.

I will post very soon to let you all know what happens next! But here are some pics of my scalp and donor area for now

 

 

[asterix0]

Did you continue to lose hair while on finasteride? (the last 6 years from when you started at age 31?)

Your donor area looks pretty good, I think you could definitely harvest an eventual 6000-7000 grafts at least (of course spread out over 2 procedures).

[urbanite88]

Thanks man, one doctor did think I can harvest around 6000 safely but I may not need it, if they use them correctly. UK doctors are definitely on the more conservative side compared to others. 

With the finasteride, yes I think it halted any further loss in front/mid section, but the crown still did have some (maybe almost miniaturised) hair at 31.. that was pretty much gone by 34. I don't know if switching finasteride brand in-between had anything to do with it.

I had thought about switching to Dustesride 

[SLA]

Nice story @urbanite88!

I have been active on this forum close to 1 year and have seen donor assessments vary tremendously from doctor to doctor. The one that stands out to me the most is @Zoomsterwho had 7k grafts done with Eugenix (5,600 scalp and 1,400 beard). He has fine hair and a self classified donor as a little under average and was pretty much a slick bald NW6/7.

He was rejected as a candidate by the Farjo clinic some 10 years prior through photo consult and had an in person with a reputable HT surgeon in Ireland who told him they could harvest 3,500 grafts maximum through FUT/FUE/BHT.

18 months ago, when he went to Eugenix they told him his donor was good and harvested 5,600 scalp grafts (and 1,400 beard grafts) in one procedure and stated they feel he has 2k scalp grafts left to harvest in another procedure.

You can check out his thread on this forum in which you will see that he now has a full head of hair. He is returning to Eugenix in September to add more density to the mid scalp and crown.

Your hair loss is not as far progressed as @Zoomster was prior to his procedure and while I am certainly no expert, your donor looks okay and certainly not worse that his (again, I am no expert :)).

That being said, if I was looking to be restored as a NW5/6 (which I am), I might really consider a virtual consult with Eugenix (which I did) and potentially holding out for them (which I might). In my observation, they have one of the best evidenced track record of restoring higher NWs and know how to make few grafts go a long way.

I have seen good work from Bicer too, but have not seen a full restoration of a higher NW as well as not seen her work of mixing scalp and beard graft strategically to restore to full coverage. I have seen her achieve near full coverage on a higher NW, but not full.

Good luck and continue asking away!!!

 

[Melvin- Admin]

As a Norwood 6 DO NOT discredit FUT. Combining both will give you more grafts.

[Britanium]

Have you looked at Hattingen? They are doing some really good mega FUT sessions. Very good way to maximise your donor area. As Melvin mentioned FUT should be considered with higher Norwoods. BHR also do some excellent combo FUT/FUE cases. 

[urbanite88]

21 hours ago, SLA said:

Nice story @urbanite88!

I have been active on this forum close to 1 year and have seen donor assessments vary tremendously from doctor to doctor. The one that stands out to me the most is @Zoomsterwho had 7k grafts done with Eugenix (5,600 scalp and 1,400 beard). He has fine hair and a self classified donor as a little under average and was pretty much a slick bald NW6/7.

He was rejected as a candidate by the Farjo clinic some 10 years prior through photo consult and had an in person with a reputable HT surgeon in Ireland who told him they could harvest 3,500 grafts maximum through FUT/FUE/BHT.

18 months ago, when he went to Eugenix they told him his donor was good and harvested 5,600 scalp grafts (and 1,400 beard grafts) in one procedure and stated they feel he has 2k scalp grafts left to harvest in another procedure.

You can check out his thread on this forum in which you will see that he now has a full head of hair. He is returning to Eugenix in September to add more density to the mid scalp and crown.

Your hair loss is not as far progressed as @Zoomster was prior to his procedure and while I am certainly no expert, your donor looks okay and certainly not worse that his (again, I am no expert :)).

That being said, if I was looking to be restored as a NW5/6 (which I am), I might really consider a virtual consult with Eugenix (which I did) and potentially holding out for them (which I might). In my observation, they have one of the best evidenced track record of restoring higher NWs and know how to make few grafts go a long way.

I have seen good work from Bicer too, but have not seen a full restoration of a higher NW as well as not seen her work of mixing scalp and beard graft strategically to restore to full coverage. I have seen her achieve near full coverage on a higher NW, but not full.

Good luck and continue asking away!!!

 

Cheers SLA! Looks super impressive indeed!! I will be following Eugenix very closely going forward.  A 3 day back to back surgery kinda scares me though !

[urbanite88]

21 hours ago, Melvin- Moderator said:

As a Norwood 6 DO NOT discredit FUT. Combining both will give you more grafts.

I have considering and have been suggested a combined FUT/FUE procedure.

Atm my reluctance for FUT is mainly that I prefer to keep my back hair short, even when I had a full head of hair.

Secondly, I get the feeling I might have low scalp laxity issue (need to get this professionally confirmed for the future). I would probably be more keen to use beard hair first (I seem to have a fairly strong beard hair luckily )

Just posted the photos of my first Op