General advice and opinions needed for thin hair FUE

[W A]

I had been researching a TON and have tried i-Grow and a couple months of Rogaine.  I started liking the Turkey doctors, but realized that they may be too far/out of comfort zone.  During the pandemic, I went and shaved my head (since I'm not going out anyway), and just to see what it looks like bald since I also thought about SMP.  Not bad, actually.

Initially, there was a doctor not too far away, FUT about $4500 I think, but the "manager" seems unprofessional and I didn't have a good vibe on the place.
Other US doctors were around $10K starting.

I started emailing Dr.Nader since he's a pretty good middle ground and have had good reviews.  After seeing my photos (2 years ago), he said that I may not be a good candidate since I had thin hairs.  He asked to get my blood test to see if if the donor area could thin out more and or gene related.  I never heard back after sending my blood test.

Fast forward, I mainly use Dermmatch concealer and would have the idea of doing more current research on and off.  I think nothing really changed and there's less reviews of doctors on many hair loss sites/forums.  I emailed Dr.Nader again (different email) and showed him the pics, along with what I was hoping to get (very conservative).  Eventually Brenda said that he things 2000 to 2500 would be sufficient.  I thought the price got higher, but maybe that was just me.  My family would go with me (or not at all), even though there is nothing to see (attractions) and do (just hang in the clinic the whole time).  Regardless of how people say that it's pretty safe (driven to and from the hotel).  Additional $700 in airfare.

I have the photos I sent him and pretty much, to cover the frontal part with some hairline (permanently thinning look is ok than what it is now).  Top part, I won't see, so not as important and can probably be concealed better than front, which under the sun, to me just looks painted.

I did an online/phone consultation with Dr.Cooley, also recommended 2000 grafts, much more expensive!  Plus PRP recommendation

I did go to another doctor in person and the doctor thinks I'm a good candidate, but maybe only about 2000 grafts for $10K plus topical ointments and PRP, etc.

On the back part of the pic, the doctor in person said only the bottom area is harvestable since higher than that, is now thinning.

Thanks.

 

 

Edited August 11, 2021 by W A
changed pic

[Silent1234]

Combination of FUE and then SMP would probably work better for a case like your. SMP can be used post to make thinner areas look thicker on top, including the donor region following FUE and any retro grade thinning you may have (above the ears).

[W A]

Thanks!  I forgot about that.  I did mention to one of the doctors at some point that I'm even ok with over harvesting since I can technically do a close shave/fade... almost like a flat top.  That will mostly be the SMP part.  I'm normally tapered on the back and sides and raising that up is fine.

[W A]

I am now crossing Dr. Nader off the list (well there's only one) and going back to square one.  I wanted to tell my wife if it's safe to go to his area and I saw the news that there were multiple dead recently with drug cartel violence. 

My next candidate might be Dr.Shapiro or Dr.Arocha - I think this will about double what it would cost with Dr.Nader, and yes, I know that cost isn't everything, hence continued research.  

[LaserCaps]

I appreciate the fact you tried Rogaine and laser therapy - but unfortunately not for long.  It typically takes a good year to see what exactly you'll experience.  Did you at least experience retention?  Have you thought of PRP and perhaps even Fin?  Your hair is rather short and it shows a great deal of thinning.  There may be even some retrograde going on.  I would encourage you to let your hair grow out a good 3-4 weeks and repost.  I would also suggest a good/strong medical regimen for a year and see what happens.  If things remain the same, I would dissuade you from moving forward.  If there is improvement, you can then consider hts understanding you will have to continue the use of whatever modalities you choose to use. 

[W A]

Thank you for your response.  Here are my current hair.  PRP right now is still 50:50 and as I remember Fin needs to be prescribed by my primary Dr right?  

Now if I plan to do HT in the next few months, I was in the mindset of letting the Dr see the natural state of my hair vs a regimen(ed) one so as to gather grafts that are resistant.  I think my end game might be to not rely too much on medicine/products to maintain since the hair transplanted are already naturally resistant - am I wrong?

Or do you think that there might be enough hair for the meds to regrow/make thicker to appear fuller?

[JDEE0]

To be honest, I would have to suggest you really re-think going ahead with anything unless you try medical intervention to see if it helps to improve your donor. If it does, then maybe you can, but you would have to commit to this indefinitely or go back to square one.

Your donor is very sparse - you have severe retrograde above the ears/on the sides of your head to the point that I don't think any grafts whatsoever can be taken from here.

You're also very clearly thinning into a NW7 pattern - that much is certain. It's only going to continue to thin until it eventually becomes slick bald, so if you go ahead with a transplant now and don't use/commit to meds for the rest of your life, you're eventually going to be left with a huge disconnect at the back/crown and lateral humps to the rest of your hair and almost certainly have very little to no donor available to improve things.

[LaserCaps]

The quality of your hair does not seem to be very good.  Despite your hair being plenty long, there is still an area, (particularly towards the middle), where you can kind of see through.  You may be experiencing a degree of global thinning.  I would encourage you to consult with a doctor and discuss medical therapy.  I think you have a lot of native hair you can not only save but perhaps even improve.  If you stop whatever regimen you are doing, it is likely you'll end up with a very advanced pattern and not much donor. And please, stay on it.  

[W A]

Thanks both!  I did go see a doctor in person, and they asked about medical/topical.  Maybe they were just eager for a patient, but had no problem saying I'm a good candidate.  They did try to sell the regimen for post transplant.

I didn't mean that I wouldn't want to commit to medicine the rest of my life, but in my mind, I wanted to give the doctor a natural state, since in my mind, I wouldn't want them to transplant a hair follicle that only looked good because of medicine. 

Although, I think now, what you're saying is that, it's the same-same.  The natural follicle might also just come off eventually, even though it's from a section that's resistant to shedding, but with the medical regimen, it would more than likely stay?  Oh yeah, I do use Nizoral about once a week, and take biotin 5000mg almost daily.  I did try derma roller for a few months and iGrow helment on and off.  I probably wouldn't want to use Fin due to side effects, but looks like topical dutasteride and topical minoxidil should be sufficient?  

I will ask the additional questions on my upcoming consultations.  

[aaron1234]

Just shave your head and move on with your life.  The low quality donor hair is only going to give you a low quality HT, leaving you unsatisfied with the results wishing you would have just saved your money and spared your scalp the trauma in the first place.  Just not worth it.

[Gatsby]

If you have shaved your head and thought ‘not bad actually’ then I strongly recommend that you think more about this option. You could also add SMP to this. To be perfectly honest the other option is to try Finasteride for at least 6-12 months first. If you can tolerate the drug it may strengthen your donor hair and even improve the crown. You really need to look at people like Dr Bisanga and Eugenix for a scalp/beard transplant after getting their opinion on what results you could expect. If you base your choices on a budget you are really risking a lot of scarring  and a very unhappy result. 
How old are you can I ask and also what are your goals? The final thoughts are that for any surgeon you choose you must have an excellent rapport with and excellent communication. Not just prior to surgery but even more so after the surgery. If you are equipped to shave your head (with/without SMP) then in my humble opinion this is really the safest and best option. All the best. 

[W A]

On 9/10/2021 at 5:51 PM, Gatsby said:

If you have shaved your head and thought ‘not bad actually’ then I strongly recommend that you think more about this option. You could also add SMP to this. To be perfectly honest the other option is to try Finasteride for at least 6-12 months first. If you can tolerate the drug it may strengthen your donor hair and even improve the crown. You really need to look at people like Dr Bisanga and Eugenix for a scalp/beard transplant after getting their opinion on what results you could expect. If you base your choices on a budget you are really risking a lot of scarring  and a very unhappy result. 
How old are you can I ask and also what are your goals? The final thoughts are that for any surgeon you choose you must have an excellent rapport with and excellent communication. Not just prior to surgery but even more so after the surgery. If you are equipped to shave your head (with/without SMP) then in my humble opinion this is really the safest and best option. All the best. 

I'm 40s and my goal is to have frontal coverage.  As I drew on one of the pic.  I was thinking I will be OK with over harvesting since I can have a close shave back (and can add SMP - thought Mark Weston in FL would be best due to his single process).  Almost like a Flat top in terms of sides and back, but mainly frontal coverage.  I have no beard/body hair source unfortunately.  I think the base rate is now about $10K.  I will not try oral Finasteride, but will go back(start again) to a regular regimen of Rogaine, derma rolling, iGrow cap, Biotin and possibly topical Dutasteride.  I will then evaluate maybe after 6 mos to see if it improved enough.  If it does, I may not need to go with HT since even after the procedure, I will likely to still continue the regimen right?  Again, I'm mostly concerned with frontal coverage, doesn't have to be full - I'm actually ok with forever thinning look, just not bald.

As far as PRP, I guess there's still no clear consensus - it works for some, it doesn't work for others, right?

[Gatsby]

10 hours ago, W A said:

I'm 40s and my goal is to have frontal coverage.  As I drew on one of the pic.  I was thinking I will be OK with over harvesting since I can have a close shave back (and can add SMP - thought Mark Weston in FL would be best due to his single process).  Almost like a Flat top in terms of sides and back, but mainly frontal coverage.  I have no beard/body hair source unfortunately.  I think the base rate is now about $10K.  I will not try oral Finasteride, but will go back(start again) to a regular regimen of Rogaine, derma rolling, iGrow cap, Biotin and possibly topical Dutasteride.  I will then evaluate maybe after 6 mos to see if it improved enough.  If it does, I may not need to go with HT since even after the procedure, I will likely to still continue the regimen right?  Again, I'm mostly concerned with frontal coverage, doesn't have to be full - I'm actually ok with forever thinning look, just not bald.

As far as PRP, I guess there's still no clear consensus - it works for some, it doesn't work for others, right?

I don't believe in over harvesting. It's just another problem along with MPB that you have to contend with down the track. I like your idea of trialing dutasteride before surgery and I would give it a full twelve months before you make a judgment on it. I respect your choice of not trialing finasteride but that would have been my first choice. I have SMP and for me it works great for covering some horrible old school 'punch graft' scars both in my donor region as well as my hairline. You may be better served with shaving your head and having SMP all over. I understand that you want hair in the front but ask a lot of surgeons about this because you don't want a band of hair growing the front and left there in twenty years marooned with only SMP surrounding it. Finally don't be focused on the price. This is a one way ticket to regret! Find a surgeon who can meet your specific needs who is recommended from the forum and get their feedback. Don't be in a rush and I wish you all the best.

[W A]

On 9/13/2021 at 3:01 AM, Gatsby said:

I don't believe in over harvesting. It's just another problem along with MPB that you have to contend with down the track. I like your idea of trialing dutasteride before surgery and I would give it a full twelve months before you make a judgment on it. I respect your choice of not trialing finasteride but that would have been my first choice. I have SMP and for me it works great for covering some horrible old school 'punch graft' scars both in my donor region as well as my hairline. You may be better served with shaving your head and having SMP all over. I understand that you want hair in the front but ask a lot of surgeons about this because you don't want a band of hair growing the front and left there in twenty years marooned with only SMP surrounding it. Finally don't be focused on the price. This is a one way ticket to regret! Find a surgeon who can meet your specific needs who is recommended from the forum and get their feedback. Don't be in a rush and I wish you all the best.

Thank you again for your thoughts.  I re-read something about some hairs that are genetically programmed not to fall out, which is what I was originally banking to be my permanent thinning hair without regimen.  But as everybody said, once everything that needs to fall off happen, the result may be worse. 

Again I will continue my regimen, continue praying for a baldness cure/breakthrough, and consult with different doctors highly rated here and other forums.