What happens in 15 years?

[Faxanadu]

Hi everyone. This is my first post, but have been reading the forum regularly for a while now. I am on my way to meet Dr Bisanga and really excited.

I will ask him this question but also keen to hear from you and your perspectives. I would a hair transplant to reduce my extremely large forehead and temples area. What would happen in 15 20 years, once the rest of the hair behind the transplant area thins or falls out? Some might answer “ you can have another transplant”. But my hair is fine throughout, and I’m concerned I may not have enough to cover any future hair loss in other areas, therefore leaving me with an unsightly patch your hair to the front, and an empty area right behind it. Should this be the case, could transplanted hair be removed at a later stage?

Thanks in advance to anyone who wants to provide your feedback.

Edited October 3, 2021 by Faxanadu
Typos

[follically challenged]

I too have a similar worry. It seems the main answer is to try to prevent further hairloss with meds and hope for the best...

Should the worst happen, then yes i'm pretty sure that grafts can be extracted should you choose to do so, without having too much of a noticeable appearance.

As far as i am aware, Bisanga is one of the honest doctors in this god awful industry, at times full of lies and deceit, so i am sure he will be up front with you and give you the facts. Good luck!

[Faxanadu]

Hello, and thanks for your reply. Just had my appt with Dr Bisanga. He was very honest indeed. No hair transplant for me as I don’t have enough donor hair - too fine throughout which would have resulted in a see through transplant to the front, and visible gaps on the sides and behind. Oh well. Big shame but appreciated his honesty. 

[Gatsby]

@Faxanadufor a first post that is an excellent question! 👍 It’s also a question that so many 18-24 year old guys who believe that getting a hair transplant will solve all their problems never ask. 

[BLE123]

That's surprising, your hair doesn't look bad from those pics.

Is it the thickness of the hair that's the issue or just not enough of it? Do you have a pic of the donor?

[Faxanadu]

3 hours ago, BLE123 said:

That's surprising, your hair doesn't look bad from those pics.

Is it the thickness of the hair that's the issue or just not enough of it? Do you have a pic of the donor?

Thanks. It’s surprising but I sort of knew deep down…the issue seem to be both according to Bisanga. My hair is naturally fine and just not a lot through I guess! He confirmed what I had feared… But I appreciated his honest feedback. He said I would have needed at least 2000 grafts to achieve the density I needed to slightly lower my hair and temple line. And even then he couldn’t guarantee it, plus he said I would be left with visible holes in my donor area. 
 

He was accompanied by a British doctor, who told me my only real option was to switch from Minoxidil foam to the oral tablets, which he said he’d prescribe. Oh well. Let’s hope for stem cell harvesting to become a reality at some point in the future. 

Here are a couple of pics I have just take of my donor area.
 

[JDEE0]

The answer is that this is why you use meds such as finasteride. In doing so, you can be confident that your loss is being slowed drastically and that you very likely won't suddenly have lost all your hair in 15 years time. 

The other answer is genetics, you might only be destined to reach a NW4 or so, in this case even without using meds, you'd need another HT at some point yes, but then you'd be alright. Obviously no one can predict the future though and it's not wise to bet on luck of the draw. Hopefully, you have both of these things in that you use meds consistently and your genetics aren't particularly strong in terms of pushing you higher up the NW scale.

Then there is the potential for future treatments that may come out in the next 10-20-30+ years, we very well might (at the very least) have drugs that can completely halt the progression of MPB somewhat soon, and then whatever else is over the horizon. Who knows, but I personally think we will get to a point where the decision to have a HT will be mostly limited by financial reasons rather than hesitations over continued loss etc. in the not too distant future. 

I was also confused as to why Bisanga was saying he couldn't perform surgery on you because your hair is too 'fine throughout' when reading your initial post as this isn't a factor of candidacy generally speaking. But from your second set of pictures, it appears you unfortunately have DUPA, meaning that your hair is miniaturising throughout and not that it is just fine in calibre. Surgery is unfortunately not an option unless you can rectify this through the use of meds, and even if you do manage to, you really will have to rely on them forever in order to not revert to your previous state of thinning throughout. 

Here is a good video from Lorenzo on the subject, maybe it will help you: 

 

[Faxanadu]

2 hours ago, JDEE0 said:

The answer is that this is why you use meds such as finasteride. In doing so, you can be confident that your loss is being slowed drastically and that you very likely won't suddenly have lost all your hair in 15 years time. 

The other answer is genetics, you might only be destined to reach a NW4 or so, in this case even without using meds, you'd need another HT at some point yes, but then you'd be alright. Obviously no one can predict the future though and it's not wise to bet on luck of the draw. Hopefully, you have both of these things in that you use meds consistently and your genetics aren't particularly strong in terms of pushing you higher up the NW scale.

Then there is the potential for future treatments that may come out in the next 10-20-30+ years, we very well might (at the very least) have drugs that can completely halt the progression of MPB somewhat soon, and then whatever else is over the horizon. Who knows, but I personally think we will get to a point where the decision to have a HT will be mostly limited by financial reasons rather than hesitations over continued loss etc. in the not too distant future. 

I was also confused as to why Bisanga was saying he couldn't perform surgery on you because your hair is too 'fine throughout' when reading your initial post as this isn't a factor of candidacy generally speaking. But from your second set of pictures, it appears you unfortunately have DUPA, meaning that your hair is miniaturising throughout and not that it is just fine in calibre. Surgery is unfortunately not an option unless you can rectify this through the use of meds, and even if you do manage to, you really will have to rely on them forever in order to not revert to your previous state of thinning throughout. 

Here is a good video from Lorenzo on the subject, maybe it will help you: 

 

Hey there, thanks for your time and input. Dr Bisanga essentially said that I didn’t have enough hair at the back and sides to move to the front and achieve a “full” result. He didn’t rule it out altogether, but said I was on the “edge” of the spectrum in terms of who’s a good candidate and who is not.

Not sure if it changes anything but the earlier photos were taken with the sun starkly shining over my scalp. I have just taken a couple of pictures in different light conditions. Also worth mentioning that Dr Bisanga cut off three strands of hair to the side hence those more visible “hole”. 

I also attach a photo from 10 years ago, just out of the sea. My hair has always been so fine that, when wet, it would show the scalp throughout. Once dried up it would look much fuller and “normal”. My mother has the same thin hair. 
 

i have been using fina 1mg and minoxidil foam plus nizoral for over a year with breaks when on holiday. Haven’t seen much change. Hoping the oral mino Bisanga’s colleague will prescribe to me will bring better results. Is there anything else you recommend I could take? Saw Palmetto for example or overkill?

Thanks, and have a great evening. 

Edited October 3, 2021 by Faxanadu

[aaron1234]

Saw palmetto is a waste of time, just stick with fin and oral min and hope for the best.  Dr. Bisanga was correct to refuse you as a patient, but the meds might help you hold on to what you have.  Give dermmatch and/or toppik a try too.  

[1978matt]

Dutasteride is an option

[Faxanadu]

Hi everyone. As mentioned, I went to see Dr Bisanga and he seemed really competent and kind. His assistant was amazing.

Unfortunately he delivered some sad news which I was totally not expecting: I’m heading to NW6.

He recommended 5mg oral and fina 1mg. Is there anything you could suggest for me to keep my hair as long as possible? 

I’m 40 and I (think) have hair all over, apart from receding temples and diffused thinning. I can see through the scalp under direct light shining over my head. My friends though don’t tell me I looks bald or that my hair looks different from my 20s. 

I also asked my neurologist to switch my epilepsy medication as I have read what I am currently on (lamotrigine) has hair loss as a side effect. Many forum users report this too.

Hope you can advise on best treatment mix on top of the above. PRP? Dermaroll? Biotin? Other drugs? I am open to anything!

Below are the doctor’s notes.  

Norwood classification: Diffuse hair loss from front to back, going to a NW6
Hair Characteristics: Salt & Pepper, Slightly wavy, Fine Hair
Donor Density: Measured in 2 areas as 50/60 Follicular units per cm2, most of the follicles are 1 and 2 hair follicles
Miniaturisation: 20% miniaturised hair in the donor area 
Dermoscopy:Normal, no signs of scalp issues 
 

 

[ciaus]

41 minutes ago, Faxanadu said:

PRP? Dermaroll? Biotin? Other drugs? I am open to anything!

Be careful, while hair loss definitely sucks you don't want to give yourself more serious problems trying crazy stuff.

I'd check out these guys on youtube, they have other videos in click on their channel profiles, generally well regarded and not out to scam people. They do experimentation based on what data, studies are out there, post their results.

 

 

 

 

[Faxanadu]

57 minutes ago, ciaus said:

I'd check out these guys on youtube

This is super helpful. Thank you so much. And agree re crazy stuff - I already take meds for epilepsy so need to be careful as to what other “stuff” I put in my body. 

But have read of various other treatments, such as topical spirolactone, dutasteride instead of fina, and another one whose name I can’t remember (it’s all numbers!). Was wondering if anyone had a perfect recipe they could share - though am also fully aware that every head is different!

Just a bit depressed I suppose. Fair enough to be told I don’t have enough donor hair for a transplant.. but to hear I’m destined to NW6?! makes me even angrier as both my dad and brother have full heads of hair. 

Thank you for reading my ramblings

[Curious25]

2 hours ago, Faxanadu said:

Hi everyone. As mentioned, I went to see Dr Bisanga and he seemed really competent and kind. His assistant was amazing.

Unfortunately he delivered some sad news which I was totally not expecting: I’m heading to NW6.

He recommended 5mg oral and fina 1mg. Is there anything you could suggest for me to keep my hair as long as possible? 

I’m 40 and I (think) have hair all over, apart from receding temples and diffused thinning. I can see through the scalp under direct light shining over my head. My friends though don’t tell me I looks bald or that my hair looks different from my 20s. 

I also asked my neurologist to switch my epilepsy medication as I have read what I am currently on (lamotrigine) has hair loss as a side effect. Many forum users report this too.

Hope you can advise on best treatment mix on top of the above. PRP? Dermaroll? Biotin? Other drugs? I am open to anything!

Below are the doctor’s notes.  

Norwood classification: Diffuse hair loss from front to back, going to a NW6
Hair Characteristics: Salt & Pepper, Slightly wavy, Fine Hair
Donor Density: Measured in 2 areas as 50/60 Follicular units per cm2, most of the follicles are 1 and 2 hair follicles
Miniaturisation: 20% miniaturised hair in the donor area 
Dermoscopy:Normal, no signs of scalp issues 
 

 

Your hair looks good to me for a 40 year old. 
 

If you are able to tolerate and stick sign your oral min and finasteride, then you should be pretty well set up 👍🏻 

[gillenator]

I also concur that your hair does not look "bad", yes you have diffused loss that is generalized throughout the scalp...my mother had the same as your mom...and my 2 brothers also had a full head of hair, I was the only one hit with MPB...so, we have some things in common.

Now, what I see is a diffused thinning pattern that is more typical with the Ludwig pattern that most females who have genetic hair loss experience....and when it impacts the donor region, well, you know the rest.

I would not recommend lowering your hairline for all the reasons the doctors mentioned...it does not look bad at all.

I am curious to know what the older males in your family history look like, both maternal and paternal...are any of them bald?

Lastly, if the males in your family history do not have a similar pattern of loss like yours, then it could very well be the medication treating the epilepsy....could there be any other options that do not have hair loss as a side-effect?...maybe get some more opinions from several doctors?

[Faxanadu]

37 minutes ago, Curious25 said:

Your hair looks good to me for a 40 year old

That’s kind of you to say, thank you! 

In normal indoor circumstances, it can still be styled and look fine. 

Outdoors, even with a gentle breeze, I turn into an Elizabethan painting. 

Edited October 11, 2021 by Faxanadu
Typos

[gillenator]

Try using a strong hold hair spray.

[Kraki77]

Can you maybe post pictures from the back of your head? It would be interesting to see how that part of donor looks like in your case.

[gillenator]

It sounded like the doctors did a microscopic exam of your scalp including the donor...they stated 20% affected?

[Faxanadu]

25 minutes ago, gillenator said:

am curious to know what the older males in your family history look like, both maternal and paternal...are any of them b

Thanks for sharing your experience. So in my family:

mum, thin hair but all of it (the sort of thin that when you wash it looks very full, in between shampoos it almost shows the skin)

Dad- passed away. I remember him pre chemo and had all hair (very thin too but all of it). After chemo, baldness and all kicked in before he passed away. 
 

brother - full head and zero receding temples!

nonna (dad’s mum): went quite bald on top in her…late sixties? Proper alopecia. 
 

mums brothers: one NW6, the other one kept his hair until his seventies, that I can recall. 
 

that’s sort of it. Worth mentioning that I’ve had a HUGE forehead since I was a toddler and in my teenage years.

 

 

 

[Faxanadu]

26 minutes ago, Kraki77 said:

Can you maybe post pictures from the back of your head? It would be interesting to see how that part of donor looks like in your case.

Hey there, sure. Might take some more in proper daylight that’s all I could muster by myself tonight …

[Faxanadu]

1 minute ago, Faxanadu said:

Hey there, sure. Might take some more in proper daylight that’s all I could muster by myself tonight …

Consider I didn’t wash my hair today as I was in a rush, and it was dirty with last night’s rogaine foam and hair wax , both of which make them stick to each other. 

[Faxanadu]

28 minutes ago, gillenator said:

It sounded like the doctors did a microscopic exam of your scalp including the donor...they stated 20% affected?

Hello, yes he used a microscope and also chopped three strands of hair from different parts. Diagnosis as follows:

Donor Density: Measured in 2 areas as 50/60 Follicular units per cm2, most of the follicles are 1 and 2 hair follicles
Miniaturisation: 20% miniaturised hair in the donor area 

Recommendations:  not to do a hair transplant
due to the higher miniaturisation and the smaller follicles in your donor area. 
You don't have a DUPA, but you have quite some grafts that are also thinning in your donor area.
To help with the miniaturisation the doctor recommends to look into medication to stabilise your hair loss and reinforce your thinning hairs.

[gillenator]

My mother’s generalized thinning advanced to the point where she had to start wearing wigs in her mid-thirties…I wore hair systems for 11 years.

One of the concerns for you is risk of acute shock loss if you had a large procedure…diffused hair is more susceptible to shock and can occur in the donor region.

[Melvin- Admin]

Your hair looks great, I would consider dutasteride with mesotherapy.