Surgeon recommendations

[Melvin- Admin]

51 minutes ago, anyhair said:

I will say the hair loss has stabilized significantly. Nioxin #2 is also a daily thing. But yeah, conservative hairline makes sense. To be honest, it's always been relatively high. See some pictures from 2018. ~3 years of loss by this point. I don't have tracking photos prior to this.

 

1 hour ago, anyhair said:

I'm attaching some photos from today. 

I think it is very clear that you are not maintaining, and in fact you have lost a lot of hair in the last 3-4 years. You can expect to lose even more hair in the next 3-4 years. Remember, surgery is not some quick fix, you need to treat the hair loss first. You are quickly headed towards 6/7 territory. I don't want to be quick to suggest a surgeon without telling you the truth about your hair loss. I would rather see you treat your hair loss with actual proven medications, as opposed to Nioxin, which in my opinion is a waste of money. 

[Britanium]

2 minutes ago, Melvin- Moderator said:

 

I think it is very clear that you are not maintaining, and in fact you have lost a lot of hair in the last 3-4 years. You can expect to lose even more hair in the next 3-4 years. Remember, surgery is not some quick fix, you need to treat the hair loss first. You are quickly headed towards 6/7 territory. I don't want to be quick to suggest a surgeon without telling you the truth about your hair loss. I would rather see you treat your hair loss with actual proven medications, as opposed to Nioxin, which in my opinion is a waste of money. 

He did mention he was on Fin 1mg for the last year. 

[anyhair]

1 minute ago, Melvin- Moderator said:

 

I think it is very clear that you are not maintaining, and in fact you have lost a lot of hair in the last 3-4 years. You can expect to lose even more hair in the next 3-4 years. Remember, surgery is not some quick fix, you need to treat the hair loss first. You are quickly headed towards 6/7 territory. I don't want to be quick to suggest a surgeon without telling you the truth about your hair loss. I would rather see you treat your hair loss with actual proven medications, as opposed to Nioxin, which in my opinion is a waste of money. 

Wondering if maybe you missed the top of the post? Because I do say at the top that I've been on finasteride for 1 year and it has stabilized since then. Yes -- in 3-4 years, I have lost a lot of hair. But if you look at the first photo and then the first set of photos I uploaded today (not the ones from 3 years ago), I think there's an argument for stabilization. Anyone else agree? @JC71@digi23

[Britanium]

2 minutes ago, anyhair said:

Wondering if maybe you missed the top of the post? Because I do say at the top that I've been on finasteride for 1 year and it has stabilized since then. Yes -- in 3-4 years, I have lost a lot of hair. But if you look at the first photo and then the first set of photos I uploaded today (not the ones from 3 years ago), I think there's an argument for stabilization. Anyone else agree? @JC71@digi23

Yes since you have started Fin I would say you have stabilised. A lot of clinics would ask that you have taken this step, and you have already. 

[Britanium]

I don’t know why Nioxon was mentioned ? OP mentioned Minox yes. 

Edited November 10, 2021 by JC71

[JDEE0]

7 minutes ago, anyhair said:

Wondering if maybe you missed the top of the post? Because I do say at the top that I've been on finasteride for 1 year and it has stabilized since then. Yes -- in 3-4 years, I have lost a lot of hair. But if you look at the first photo and then the first set of photos I uploaded today (not the ones from 3 years ago), I think there's an argument for stabilization. Anyone else agree? @JC71@digi23

You most definitely will have stabilised from fin now, but it is true that you're showing signs of thinning into a NW6-7 pattern, and as such, you will undoubtedly reach that NW level at some point. Might not be for decades if you stay medicated, but I think you're destined to go there in the end.

You just need to plan for this and know that it is a real possibility you will be a full blown NW6 or 7 even as soon as by the time your 30's are up, and much sooner if you stop meds.

[Melvin- Admin]

19 minutes ago, anyhair said:

Wondering if maybe you missed the top of the post? Because I do say at the top that I've been on finasteride for 1 year and it has stabilized since then. Yes -- in 3-4 years, I have lost a lot of hair. But if you look at the first photo and then the first set of photos I uploaded today (not the ones from 3 years ago), I think there's an argument for stabilization. Anyone else agree? @JC71@digi23

I missed the first post, but I think the fact is that you have lost a great deal of hair in 3 years. You have to plan your surgery as a Norwood 6/7 not a Norwood 3, because you are most definitely not a Norwood 3. Eventually, you will need hair everywhere on your scalp, and your crown extends far down so taking this into account is absolutely crucial. 

For me, I don't believe you should consider FUE unless you go to someone like Eugenix who deals with Norwood 6/7s. I would focus primarily on FUT. 

[Britanium]

Yup FUT should be considered here, the band where your donor area shows the best density is exactly where a strip could be taken. Hattingen or H&W are doing the best larger FUT sessions. As I mentioned earlier I don’t think your donor area looks particularly strong. 

[anyhair]

2 minutes ago, JC71 said:

Yup FUT should be considered here, the band where your donor area shows the best density is exactly where a strip could be taken. Hattingen or H&W are doing the best larger FUT sessions. As I mentioned earlier I don’t think your donor area looks particularly strong. 

Will check out various places and ask for a FUT

[anyhair]

@JC71 Should I look into Yaman/Bicer/Eugenix for Norwood 6 FUE or is FUT really the likely answer here?

[Britanium]

15 minutes ago, anyhair said:

@JC71 Should I look into Yaman/Bicer/Eugenix for Norwood 6 FUE or is FUT really the likely answer here?

I would honestly consider starting out with FUT to fully maximise your donor area. 

[AZ67]

I would suggest you before you select and method FUE or FUT. You should probaly do a proper consultation in person with a good surgeon who can calculate the density of your donor and area as well so then he can know how many grafts he can extract from your donor and if these grafts are enough to cover all of your norwood 6 area. You have to know that with FUT you will not be able to keep short hair in donor, cause of the strip and there's always a possibility that a strip can strech, especially in bigger strips.

Edited November 10, 2021 by AZ67

[Berba11]

4 hours ago, anyhair said:

I will say the hair loss has stabilized significantly. Nioxin #2 is also a daily thing. But yeah, conservative hairline makes sense. To be honest, it's always been relatively high. See some pictures from 2018. ~3 years of loss by this point. I don't have tracking photos prior to this.

I think these photos actually provide a slightly better perspective as the angle from the more recent pictures seems to be accentuating the size of your head. From these photos you could probably be looking at 3K grafts *in the right hands* for the frontal third. You'd probably be no good going somewhere that is a little more aggressive on the dense packing like HLC because that's going to require more grafts.

The question of FUT vs FUE so far as longer term planning goes will probably come down to your beard as a secondary resource. From what I can tell, you maybe don't have much of a beard that you can tap into later on, in which case FUT may well be the more sensible option.

My own hairloss is strikingly similar to yours - a clear N3 pattern up front but some signs elsewhere of a higher NW level. Luckily I have a pretty decent beard that I'm happy to use later. Additionally, I'm not bothered about the crown too much. I'd consider maybe having a few grafts added to that area if/when the need arises (hopefully a couple of decades away!), but without caring to have really good density. Just enough so that there's a decent blend with the midscalp would be more than fine for me, and it would allow a buzz cut that gets less dense as it goes further back but without being slick bald. So consider what you might be happy with later and plan accordingly. If you want  to go all out and maintain a very full head of hair front to back with surgeries, then starting with an FUT will stand you in great stead. If your goals in 20+ years are more modest for the crown then you've got more options.

You're already buzzing down (like me!), so I assume that like myself you're pretty content and comfortable sporting the shorter look. Hopefully that gives you a bit to think about!

[BDK081522]

It's great that you started medical therapy 1 year ago but this is aggressive loss for only being 25. Your crown is dipping low. Might even be headed toward NW 7. Finasteride should definitely slow your loss but probably won't stop it completely. It's imperative if you want to go the surgery route you plan for a high Norwood level even on medication as your very sensitive to the effects of DHT. I'm not suggesting you're not a surgical candidate but you have to plan very wisely. This includes going to a clinic that manages donor well and has success with higher Norwood cases. As others have mentioned it might be beneficial to start with FUT then go FUE later to maximize donor.  Look into Hasson & Wong, Hattingen, Eugenix, Bloxham, or Konior. They're all very ethical clinics and will steer you in the right direction. Know however, you're looking at spending more than $10,000 with most of these clinics for your level of loss over your restoration journey. 

Edited November 11, 2021 by BDK081522

[Future Hair Doc]

Have you thought about switching the dutasteride?

[anyhair]

10 minutes ago, Dr. Suhail Khokhar said:

Have you thought about switching the dutasteride?

I have but I'm worried about the sexual side effects. I do experience some amount of these already on finasteride

[anyhair]

2 hours ago, Berba11 said:

I think these photos actually provide a slightly better perspective as the angle from the more recent pictures seems to be accentuating the size of your head. From these photos you could probably be looking at 3K grafts *in the right hands* for the frontal third. You'd probably be no good going somewhere that is a little more aggressive on the dense packing like HLC because that's going to require more grafts.

The question of FUT vs FUE so far as longer term planning goes will probably come down to your beard as a secondary resource. From what I can tell, you maybe don't have much of a beard that you can tap into later on, in which case FUT may well be the more sensible option.

My own hairloss is strikingly similar to yours - a clear N3 pattern up front but some signs elsewhere of a higher NW level. Luckily I have a pretty decent beard that I'm happy to use later. Additionally, I'm not bothered about the crown too much. I'd consider maybe having a few grafts added to that area if/when the need arises (hopefully a couple of decades away!), but without caring to have really good density. Just enough so that there's a decent blend with the midscalp would be more than fine for me, and it would allow a buzz cut that gets less dense as it goes further back but without being slick bald. So consider what you might be happy with later and plan accordingly. If you want  to go all out and maintain a very full head of hair front to back with surgeries, then starting with an FUT will stand you in great stead. If your goals in 20+ years are more modest for the crown then you've got more options.

You're already buzzing down (like me!), so I assume that like myself you're pretty content and comfortable sporting the shorter look. Hopefully that gives you a bit to think about!

Thank you so much for the thoughtfulness here From what I've seen, I don't think a super short cut works particularly well with FUE (not to mention FUT). Do you know the shortest (3?) I'll be able to go on the sides and back with a FUT?

[digi23]

28 minutes ago, anyhair said:

I have but I'm worried about the sexual side effects. I do experience some amount of these already on finasteride

If you do this, I would say you are not a candidate for a hair transplant. If you experience side effects, I would accept hairloss and move on. Its not worth it.

I think you got a good looking head so no problem to shave it. It is probably tough to hear, but without Finasteride or Dutasteride you will not be able to maintain. 

With FUT you are putting bigger scars on your head, you will not be able to shave down as much as with FUE, and with FUE your donor will not be enough to match your hairloss.  It is a tough game this but we try to give you an honest opinion, no bullshit.

Edited November 11, 2021 by digi23

[FUT4000]

On 11/10/2021 at 6:41 PM, digi23 said:

If you do this, I would say you are not a candidate for a hair transplant. If you experience side effects, I would accept hairloss and move on. Its not worth it.

I think you got a good looking head so no problem to shave it. It is probably tough to hear, but without Finasteride or Dutasteride you will not be able to maintain. 

With FUT you are putting bigger scars on your head, you will not be able to shave down as much as with FUE, and with FUE your donor will not be enough to match your hairloss.  It is a tough game this but we try to give you an honest opinion, no bullshit.

Even though you are giving an honest opinion, doesnt mean its necessarily the right one. You are telling him hes not a candidate for HT because he is experiencing sexual side effects from finasteride? He still takes them dude, and you dont have to absolutely be on finasteride to get a HT. You maximize your chances of success of course, but you cannot tell him hes not a good candidate because of the sides. 

[digi23]

2 minutes ago, rambunctious said:

Even though you are giving an honest opinion, doesnt mean its necessarily the right one. You are telling him hes not a candidate for HT because he is experiencing sexual side effects from finasteride? He still takes them dude, and you dont have to absolutely be on finasteride to get a HT. You maximize your chances of success of course, but you cannot tell him hes not a good candidate because of the sides. 

You obviously dont know what you are talking about but I can tell you why he NEEDS to be on meds for the rest of his life.

He is a potential Norwood 7 with that low of a dip in the crown area. Definitely a 6, with limited donor it looks like. He does not have alot of beard aswell. 

If he experience sexual side effects now, would it be good that he will spend the rest of his life with sexual sides just to potentially keep his hair(doesnt even need to be the case, the genetics can be too strong even on meds). 

He is a good looking dude, even shaved I think he will look good. I think if you asked 1000 girls what they prefer, a bald boyfriend or one that cannot get an erection hard enough to have normal sex, you get like 1000 of 1000 who prefer the first answer. Sometimes the truth is difficult to take, but I am not here to give anyone false hopes.

[asterix0]

Here is my recommendation, you will need likely a minimum of 3000 grafts because you also need to rebuild your temple points.

If you will not stay on finasteride as @digi23 explained, do not get a transplant. You are destined to be a Norwood 6 or 7 and do not have the donor to spare, considering it is already on the thin side.

I would also add minoxidil, it is a pain to apply 2x a day but ultimately it does work particularly in conjunction with finasteride.

Also, you absolutely must only go to an elite surgeon, as you need to use every graft wisely. Expect to pay probably at least 20k USD if you stay in North America for this, or even in Europe as you should only consult with clinics such as Dr. Lorenzo's caliber in Spain, who charge 5 euros per graft if I'm not mistaken.

 

 

Edited November 14, 2021 by asterix0