61 y/o looking for advice on pursuing HT.

[Pilk]

31 minutes ago, Melvin- Moderator said:

It’s probably a good idea not to do the midscalp as you might get shock loss. It would be best to blend everything in together and the graft number seems reasonable.

Is shock loss to existing hair permanent?  

[Britanium]

3 minutes ago, Pilk said:

Is shock loss to existing hair permanent?  

Depends on if it was on the way out anyway.. typically we see shock loss in the donor area grow back. But in the recipient area it can be a risk. Eugenix can examine your hair in person for miniaturisation. 

Edited September 15, 2021 by JohnAC71

[Pilk]

3 hours ago, JohnAC71 said:

Depends on if it was on the way out anyway.. typically we see shock loss in the donor area grow back. But in the recipient area it can be a risk. Eugenix can examine your hair in person for miniaturisation. 

Interesting.  Lots of learning to do and things to consider.  And I guess by 'on its way out' meaning hear that was destined to fall.  My hair really hasn't changed much for a while now.  I am going to start Fin and Min this weekend.  

Edited September 16, 2021 by Pilk

[Pilk]

So I'm beginning to think about US-Midwest locations.  I see several MD's listed on the site from Chicago/Minnesota/Texas.  If a guy wanted to stay close to home is there a clinic recommendation for my type of hair loss?  Many of the US before and after seem to be multiple sessions with smaller graft numbers.  Compared to Eugenix, for example, what could someone expect to pay in the states?  Is it double?  4x?  more expensive?  

[MachoVato]

The US, generally speaking, is much more conservative in terms of hairlines and dense packing. There are few cases where I see the results are dramatically lower and dense. It seems the best transplants are, in fact, the most expensive. Typically, good doctors start around $5/graft. But it quickly goes to $7-$10/graft (for FUE, FUT is usually less). 

This is why many of us elect to go overseas. Brilliant (perhaps top 25 in the world) doctors are around $3-6/graft. 

Bisanga is under $6/graft. Eugenix (top package) is less than $5/graft. De Freitas is around $3. There's only a few US/Can doctors I'd select over these guys. 

[Gatsby]

5 hours ago, Pilk said:

So I'm beginning to think about US-Midwest locations.  I see several MD's listed on the site from Chicago/Minnesota/Texas.  If a guy wanted to stay close to home is there a clinic recommendation for my type of hair loss?  Many of the US before and after seem to be multiple sessions with smaller graft numbers.  Compared to Eugenix, for example, what could someone expect to pay in the states?  Is it double?  4x?  more expensive?  

Prices do vary a lot. However I would base the results of which surgeon you choose by who you feel will give you the goals that you are aiming for. Find a surgeon that turns out similar results that you want on a regular basis with patients who have a similar hair loss as yours. Now where that surgeon resides I would put last. You've waited for so many years now. If you have to wait a bit longer for the 'right' surgeon for you so be it. I myself am scheduled to have surgery with Eugenix after years of research and already I have been waiting for over a year and a half due to Covid flight restrictions. I live in Australia and the earliest it looks like I can travel is early next year sometime. I'm 54 now but the wait will be worth it. All the best!

[Pilk]

Question of those traveling to India....were you comfortable (feeling safe) during your stay.  I've brought the idea to my wife and she is ok with everything except the travel to India.  I know nothing about the surrounding, etc. but it seems from all the testimonies safety wasn't a concern or at least was not brought up.  I'm am going to consult with a few more doctors and make a plan.  

[JDEE0]

As someone who has travelled around a fair few countries, you'll be absolutely fine. If you're that concerned, then I imagine you could just go straight from the airport to Eugenix, stay there at the accommodation the whole time and then leave back to the airport when ready.

But really, you should see the country a little, see some sights, eat some food etc whilst you're there in my opinion. The crazy traffic would realistically be the most dangerous part of your trip by far! 

[Pilk]

1 hour ago, JDEE0 said:

As someone who has travelled around a fair few countries, you'll be absolutely fine. If you're that concerned, then I imagine you could just go straight from the airport to Eugenix, stay there at the accommodation the whole time and then leave back to the airport when ready.

But really, you should see the country a little, see some sights, eat some food etc whilst you're there in my opinion. The crazy traffic would realistically be the most dangerous part of your trip by far! 

I'm not that concerned but the misses has reservations.  I'd likely be traveling alone.  Appreciate the input. 

[Pilk]

So did a virtual consult with Dr. Nadimi at the Chicago Hair Institute.  Not encouraging but I think she's just being honest.  I don't see myself going back for a second sitting at my age and starting to wonder if may not be a good idea.  I'd love to have hair but don't want to make matters worse if I'm a borderline candidate.  Going to get a few more consults and see if I hear consistent messages from the clinics.  

The photos you sent show an advanced hair loss pattern.  Your final coverage and density will be limited by donor graft availability since your balding zone is too large to provide full coverage with thick hair in a single session.  Based on the limitations of donor supply I typically recommend that an initial session for men with advanced hair loss patterns focus on the frontal and midscalp regions.  These regions are most important to the overall cosmetic result and an initial session that recreates the hairline and provides coverage over the midscalp will allow the best use of your limited donor supply.  A crown restoration can be done at a later date should you desire coverage there and should your donor supply allow for a second graft harvest.   I believe that you will need at least 2500-3000 grafts to produce a good frontal/midscalp restoration.  It may be possible to perform even more grafts during the restoration session, but your donor area will have to be inspected in person to assess your graft availability.

[JDEE0]

26 minutes ago, Pilk said:

So did a virtual consult with Dr. Nadimi at the Chicago Hair Institute.  Not encouraging but I think she's just being honest.  I don't see myself going back for a second sitting at my age and starting to wonder if may not be a good idea.  I'd love to have hair but don't want to make matters worse if I'm a borderline candidate.  Going to get a few more consults and see if I hear consistent messages from the clinics.  

The photos you sent show an advanced hair loss pattern.  Your final coverage and density will be limited by donor graft availability since your balding zone is too large to provide full coverage with thick hair in a single session.  Based on the limitations of donor supply I typically recommend that an initial session for men with advanced hair loss patterns focus on the frontal and midscalp regions.  These regions are most important to the overall cosmetic result and an initial session that recreates the hairline and provides coverage over the midscalp will allow the best use of your limited donor supply.  A crown restoration can be done at a later date should you desire coverage there and should your donor supply allow for a second graft harvest.   I believe that you will need at least 2500-3000 grafts to produce a good frontal/midscalp restoration.  It may be possible to perform even more grafts during the restoration session, but your donor area will have to be inspected in person to assess your graft availability.

I happen to think you could have decent results considering your age and level of loss. You're unlikely to really loose much more hair at all now, especially if your loss has been stable for a long time at this point, and although yes you are an advanced Norwood, your crown doesn't dip and your sides are high.

Your donor seems ok, nothing spectacular, but looks just fine all things considered. Considering that you're 61, I'm sure a conservative hairline height and placement of density would suit you very well. It would be a different story at 25 or 30, but at your age, even relatively sparse coverage that gets a bit thinner as you go back towards the crown, leaving it with light coverage, usually looks great and completely ordinary (although I do think you've got enough donor for adequate density and coverage, if you absolutely won't do more than 1 session, I think you can achieve what I said in one go). 

However, to achieve it in one go, Nadimi's sort of approach isn't going to cut it; that would be good for a multiple session plan (which is what I personally believe is best in most cases for the record, so nothing wrong with it at all). You need to go to someone who specialises in 'mega-sessions' which are procedures of say 5000 grafts and upwards in one go. There are only a few clinics in the world worth considering for this in my opinion, and even less who are consistently impressive. I would strongly just recommend contacting Hasson and Wong as they are probably the absolute best for these mega-sessions, explain to them that you really just want to get what you can done in one session and walk away after that (knowing that results will always be limited if you're adamant you'll never come for a 2nd op). 

I think they'll be able to do what I said in one go; frame your face nicely with decent, appropriate density for your age with a gradual decline in coverage towards your crown. 

(You could also consider Eugenix of course, but you didn't seem too keen on the travel and H&W are as good if not better). 

Edited September 28, 2021 by JDEE0

[JDEE0]

1 minute ago, JDEE0 said:

 

 

Edited September 28, 2021 by JDEE0

[ITA]

I agree with @JDEE0,  An alternative to H&W, for your situation, could be Dr. Muresanu's HATTINGEN HAIR TRASPANT and his wife, in Switzerland, produce excellent results on high Norwood, try to contact them.

[Pilk]

24 minutes ago, JDEE0 said:

I happen to think you could have decent results considering your age and level of loss. You're unlikely to really loose much more hair at all now, especially if your loss has been stable for a long time at this point, and although yes you are an advanced Norwood, your crown doesn't dip and your sides are high.

Your donor seems ok, nothing spectacular, but looks just fine all things considered. Considering that you're 61, I'm sure a conservative hairline height and placement of density would suit you very well. It would be a different story at 25 or 30, but at your age, even relatively sparse coverage that gets a bit thinner as you go back towards the crown, leaving it with light coverage, usually looks great and completely ordinary (although I do think you've got enough donor for adequate density and coverage, if you absolutely won't do more than 1 session, I think you can achieve what I said in one go). 

However, to achieve it in one go, Nadimi's sort of approach isn't going to cut it; that would be good for a multiple session plan (which is what I personally believe is best in most cases for the record, so nothing wrong with it at all). You need to go to someone who specialises in 'mega-sessions' which are procedures of say 5000 grafts and upwards in one go. There are only a few clinics in the world worth considering for this in my opinion, and even less who are consistently impressive. I would strongly just recommend contacting Hasson and Wong as they are probably the absolute best for these mega-sessions, explain to them that you really just want to get what you can done in one session and walk away after that (knowing that results will always be limited if you're adamant you'll never come for a 2nd op). 

I think they'll be able to do what I said in one go; frame your face nicely with decent, appropriate density for your age with a gradual decline in coverage towards your crown. 

(You could also consider Eugenix of course, but you didn't seem too keen on the travel and H&W are as good if not better). 

I tend to agree with this.  I'm not looking for a 30-40yo hairline.  Something that fits my age and gives me something to comb lol.  I've buzzed in the past and it works but wasn't my favorite look.  And its just as much trouble as having hair if not more.  Thanks for the reply. 

[Melvin- Admin]

I would reconsider getting an HT if you’re not willing to think of it long term. It’s not a quick fix, and 99% of patients get more than one surgery. Maybe you’re better suited shaving. 

[Pilk]

38 minutes ago, Melvin- Moderator said:

I would reconsider getting an HT if you’re not willing to think of it long term. It’s not a quick fix, and 99% of patients get more than one surgery. Maybe you’re better suited shaving. 

That’s what I’m trying to figure out. So many young people on here trying to stay young and I get that.  Not looking for that.  I’d certainly give up a lower hairline for broad coverage even with the crown having mild coverage.  Just deciding whether  to be bald or not lol.  Options that weren’t really realistic 15 years ago are available.  

[Britanium]

Hattingen + Hasson & Wong are pretty much the best for doing the larger FUT sessions. Eugenix I would consider the best for higher Norwood levels using a combo of FUE & Beard Grafts. And Dr Bisnaga (BHR) for utilising combo hts which can be FUT/FUE together. All of these options would give you at least pretty good coverage in one HT. Dr Nadimi is very good but it’s always around 2k Transplants.  And you need so much more to make a difference. 

[RandoBrando517]

Have you considered Zarev?

[Pilk]

5 hours ago, RandoBrando517 said:

Have you considered Zarev?

Just watched one of his surgeries on youtube.  Really remarkable.  So his implantation device is done without cutting slits?  Is that DHT?  Love how clean things were after the surgery. Thanks for the recommendations. 

[RandoBrando517]

16 hours ago, Pilk said:

Just watched one of his surgeries on youtube.  Really remarkable.  So his implantation device is done without cutting slits?  Is that DHT?  Love how clean things were after the surgery. Thanks for the recommendations. 

I have no idea he’s secretive I’ve heard about his technique 

[Curious25]

17 hours ago, Pilk said:

Just watched one of his surgeries on youtube.  Really remarkable.  So his implantation device is done without cutting slits?  Is that DHT?  Love how clean things were after the surgery. Thanks for the recommendations. 

To implant a hair follicle, there has to be an opening of some kind.

I think his 'USP' as such, is a vacuum assisted punch he uses for extractions - @HugoX has had surgery with him, so he will be in a better place to help advise. 

[Pilk]

35 minutes ago, Curious25 said:

To implant a hair follicle, there has to be an opening of some kind.

I think his 'USP' as such, is a vacuum assisted punch he uses for extractions - @HugoX has had surgery with him, so he will be in a better place to help advise. 

I'm a rookie but if you got to about 4:30 on this youtube video it appears the implant and opening are simultaneous.  Much cleaner with almost no bleeding.  Maybe I'm not seeing things right here.  

Zera

[JDEE0]

15 minutes ago, Pilk said:

I'm a rookie but if you got to about 4:30 on this youtube video it appears the implant and opening are simultaneous.  Much cleaner with almost no bleeding.  Maybe I'm not seeing things right here.  

Zera

He's just using an implanter pen aka the DHI method. You insert the needle of the pen which is set to a certain depth, and then you press a button to eject the follicle into the opening you've just created. 

Still going to bleed, and anyway it's nothing special, lot's of good Dr's (including the one I have chosen for surgery) use it, as do lot's of terrible clinics.

Don't get too caught up in the method, it's fine to generally have a preference based off of the results of different doctors work who generally use X method (DHI in this case), but at the end of the day great surgeons use all different kinds of methods and have equally as good results. Skill is what matters.

[Pilk]

21 minutes ago, JDEE0 said:

He's just using an implanter pen aka the DHI method. You insert the needle of the pen which is set to a certain depth, and then you press a button to eject the follicle into the opening you've just created. 

Still going to bleed, and anyway it's nothing special, lot's of good Dr's (including the one I have chosen for surgery) use it, as do lot's of terrible clinics.

Don't get too caught up in the method, it's fine to generally have a preference based off of the results of different doctors work who generally use X method (DHI in this case), but at the end of the day great surgeons use all different kinds of methods and have equally as good results. Skill is what matters.

But they're not making an opening in advance correct?  To me its a better looking method and its certainly a cleaner method.  Probably no big effect on outcome I suppose.  

[JDEE0]

1 minute ago, Pilk said:

But they're not making an opening in advance correct?  To me its a better looking method and its certainly a cleaner method.  Probably no big effect on outcome I suppose.  

Correct. Making an opening in advance is whats called 'pre-made slits'.

With DHI the 'slit' is created as the needle penetrates the scalp and the graft is immediately ejected into this opening within a second most likely.