Can I dream of Hair ? Recommendation needed. TIA

[dreamingofhair]

Hi All,

First & Foremost, THANK YOU for the wonderful contributions to the forum. I had been lurking around for over a week & learned a lot so far. 

As I am seriously contemplating about getting my HT done ASAP - thought its time for me to jump in & take recommendations / feedback. 

I am 31 years old, with some history of baldness within the family. I started thinning hair around 23-24 but it went terribly bad in the last 2-3 yrs. I have not taken Finasteride or any similar drug till date. Experimented with minoxidil for 3-4 months in 2019 but discontinued due to dryness and itching of the scalp. 

 

1) First & Foremost, can you please let me know what stage of hair loss am I currently at (in Norwood scale) ? And also, what is the estimate going forward ? For greater clarity, I would like to know if my hair loss is stabilized or am I expected to deteriorate further with time ?

 

2) In my current condition, is it recommended to get Finasteride ASAP and then perform the hair transplant procedure after a few months OR can perform surgery without the need of finasteride?  

3) What are the possibilities of complete coverage (including crown area) with a relatively decent density? Am I a good candidate ?

4) Based on my research so far (not very extensive) - I am inclined to do FUT to optimize my available donor area. However I am confused about the strategy. Ie, does it makes sense to have a combo mega session - FUT + FUE + BHT OR take it slow & have a smaller FUT for the hairline and then perform another FUT+FUE or FUE alone after 14-20 months time frame to achieve complete coverage. 
 

5) I am based in Canada (but of Indian origin) and thus inclined to do the procedure in India (but open to other geo locations primarily Canada, US & Europe). Cost is also a deciding factor. My preferred budget will be upto 3USD / graft but flexible to increase it within margin.

 

I had been eyeing on the following clinics 

1) H&W, Vancouver - Dr. Wong (out of my current budget but open to it if i don't find a better choice)
2) Eugenix, Delhi - Arika Bansal  (slightly varied as they only perform FUE) 
3) Medispa, Jaipur - Suneet Soni 
4) Satya Hair Clinic - Shail Gupta (need to gather more info as there isn't much reviews available here)

5) Amrita Hospital Plastic Surgery Unit - Sundeep Vijayaraghavan (need to gather more info as there isn't much reviews available here)

6) Hattingen, Germany 

Open to comments & recommendations. Pics attached (I cut my hair short - usually guard 1-2. Last haircut ~ 32 days back) 

Edited November 30, 2021 by dreamingofhair

[Curious25]

1 hour ago, dreamingofhair said:

1) First & Foremost, can you please let me know what stage of hair loss am I currently at (in Norwood scale) ? And also, what is the estimate going forward ? For greater clarity, I would like to know if my hair loss is stabilized or am I expected to deteriorate further with time ?

 

2) In my current condition, is it recommended to get Finasteride ASAP and then perform the hair transplant procedure after a few months OR can perform surgery without the need of finasteride?  

3) What are the possibilities of complete coverage (including crown area) with a relatively decent density? Am I a good candidate ?

4) Based on my research so far (not very extensive) - I am inclined to do FUT to optimize my available donor area. However I am confused about the strategy. Ie, does it makes sense to have a combo mega session - FUT + FUE + BHT OR take it slow & have a smaller FUT for the hairline and then perform another FUT+FUE or FUE alone after 14-20 months time frame to achieve complete coverage. 
 

5) I am based in Canada (but of Indian origin) and thus inclined to do the procedure in India (but open to other geo locations primarily Canada, US & Europe). Cost is also a deciding factor. My preferred budget will be upto 3USD / graft but flexible to increase it within margin.

1) NW6 with pretty substantial retrograde alopecia - *potentially* DUPA. 
 

2) Finasteride will always be recommended if it is possible to be taken by the patient. 
 

3) It depends on what you define as relatively decent density - however your retrograde alopecia certainly impacts on the amount of grafts available that you will have. Your occipital looks ok, and beard looks ‘ok’ , not the strongest, but certainly graftable. You will be a hard case for whoever takes you on, and may need to combine body hair as well as beard and scalp hair - along with SMP. 
 

4)Consult with surgeons who perform both types of procedures and gather their senses of direction, and take on board the pro’s and con’s for what each suggests. 
 

5) Eugenix would be the obvious clinic for you to consult with as they tend to do very well with these types of cases - however I would ensure it would be with with either Dr Bansal or Dr Sethi. 
 

Good Luck 

Edited November 30, 2021 by Curious25

[Z--]

The back of the donor looks solid to me and it's good that you have beard grafts as with your level of loss, you'll certainly need to pull from there. The concern here is that the sides are very, very diffuse. I'm not sure it's DUPA given the strength of the donor, but I think I'd check with Eugenix to see what's feasible.

Why did Wong deny you? If he thinks you aren't a candidate, I'd very much think twice on this.

[dreamingofhair]

54 minutes ago, Z-- said:

The back of the donor looks solid to me and it's good that you have beard grafts as with your level of loss, you'll certainly need to pull from there. The concern here is that the sides are very, very diffuse. I'm not sure it's DUPA given the strength of the donor, but I think I'd check with Eugenix to see what's feasible.

Why did Wong deny you? If he thinks you aren't a candidate, I'd very much think twice on this.

Wong didn't deny me. Infact they responded favourably - it's just that the cost is tad on the higher side. 

H&W estimates ~5000+ Grafts for complete coverage but they aren't fully confident (as of now with just photos) if my donor area can support that much. They classified me as a DPA 6 candidate. 

As @Curious25suggested, I am getting a feel from all major doctors to figure out what are their preliminary analysis & to gather sense of direction. Just got response from H&W, Medispa & few others. Waiting for Eugenix & Hattingen to have a comprehensive view. 

[Berba11]

You look like you could be a difficult case, and on that basis, I think a $3 per graft a budget is going to be limiting. You'll want the very best of hands on this and that won't come cheaply.

Someone like Mwamba in Belgium or Dr Pradeep Sethi at Eugenix might well relish such a case (if Hasson & Wong aren't interested).

[dreamingofhair]

4 minutes ago, Berba11 said:

You look like you could be a difficult case, and on that basis, I think a $3 per graft a budget is going to be limiting. You'll want the very best of hands on this and that won't come cheaply.

Someone like Mwamba in Belgium or Dr Pradeep Sethi at Eugenix might well relish such a case (if Hasson & Wong aren't interested).

Yea, $3 is not an absolute number. Flexible on it as i rather have it performed close to perfection. 

Waiting for evaluation from Eugenix. Never contacted Mwamba. Will explore that. Any other recommendations?

[Z--]

7 minutes ago, dreamingofhair said:

Wong didn't deny me. Infact they responded favourably - it's just that the cost is tad on the higher side. 

H&W estimates ~5000+ Grafts for complete coverage but they aren't fully confident (as of now with just photos) if my donor area can support that much. They classified me as a DPA 6 candidate. 

As @Curious25suggested, I am getting a feel from all major doctors to figure out what are their preliminary analysis & to gather sense of direction. Just got response from H&W, Medispa & few others. Waiting for Eugenix & Hattingen to have a comprehensive view. 

Noted. And yes, absolutely agreed that this will very likely require 5k+ grafts. Honestly, it'll be an expensive procedure -- at least $30,000 given the number of grafts needed. Would really recommend saving up a bit. On the bright-side, there isn't much left to lose, and the list of doctors you're looking at are all very good -- and if fine with them, you could alternatively just opt to doing multiple procedures (e.g. 2k-3k grafts from H&W on first pass and then save up before doing the next 2 - 3k grafts).

Best of luck!

[DrTBarghouthi]

I just came across this post. I strongly urge you to be on finasteride for 6 months and keep a close eye on the donor. You do need a good number of grafts and the donor would better be in its best form before jumping in. 

[deeznuts]

Most of what I was gonna say has been said by other people already (i.e. donor looking kinda weak) but one thing I do have to add on is that you would need to curb your expectations since your donor and your degree of balding mean you should not be expecting native density or perfect coverage.

[digi23]

You should probably start with FUT and you should be on Finasteride for 6+ months before you go through with surgery.

Hasson & Wong would be the best option since Hattingen is almost the same price.

Would not really recommend Medispa, seen some questionable behaviour from them, like doing a pre surgery consultation 1 am and the surgery should be 7 am. Not sure if its a India thing, but in Europe that would be pretty crazy behaviour.

Edited November 30, 2021 by digi23

[dreamingofhair]

5 hours ago, DrTBarghouthi said:

I just came across this post. I strongly urge you to be on finasteride for 6 months and keep a close eye on the donor. You do need a good number of grafts and the donor would better be in its best form before jumping in. 

Thanks, Yes - just got a prescription for finasteride. 

I had come to the reality that given my current stage, for optimal results regardless of procedure & surgeon - I will need to be on medication (Finasteride) for foreseeable future. So I think it is better to evaluate finasteride first and see if I can tolerate it without significant damage. If in case, I have adverse effects with finasteride - then there is not really much point in spending $$$ on surgery as the results will be relatively short lived. 

As of now I had decided to get some blood work done - Testosterone (Total & FSH), Sperm count and DHT (i read about LC/MS analysis - need to figure out where I can get it done in Canada) to establish a baseline. Get on Finasteride for ~3 months primarily to evaluate adverse affects rather than potential gains (as they are evident only after 6+ months time frame). Get my blood work done again after 75-90 days and compare against baseline. If i don't see tragic demerits - i can conclude that, I will be able to pursue Finasteride for the long run. 

Once that's established - will proceed with surgery from one of the clinics. 

2 hours ago, deeznuts said:

Most of what I was gonna say has been said by other people already (i.e. donor looking kinda weak) but one thing I do have to add on is that you would need to curb your expectations since your donor and your degree of balding mean you should not be expecting native density or perfect coverage.

Hear Hear, i don't have insane expectations - just would like to do whats best possible given circumstances. 

 

2 hours ago, digi23 said:

You should probably start with FUT and you should be on Finasteride for 6+ months before you go through with surgery.

Hasson & Wong would be the best option since Hattingen is almost the same price.

Would not really recommend Medispa, seen some questionable behaviour from them, like doing a pre surgery consultation 1 am and the surgery should be 7 am. Not sure if its a India thing, but in Europe that would be pretty crazy behaviour.

H&W against Hattingen - preference of H&W is primarily based on my geographic proximity or quality of work / results ? So far Dr. Wong's clinic had been excellent with respect to addressing my concerns - prompt and informative. I am yet to hear back from Hattingen & Eugenix

Medispa is enticing when it comes to cost as its easily palatable. I read about the 1am consultation & agree that it was very unprofessional. Kudos to the chap to have the balls to pull out at last minute. Having said that, If I am proceeding with surgery - I plan to block a weeks time and hope I could mitigate aforesaid experiences with better communication in person - may be a day or two before the surgery. 

Still contemplating whether 1 Mega - FUT + FUE (with or without BHT) makes sense or to take it slow and have smaller FUT session initially and then one FUE to close it off (along with covering the FUT scars) - all spread over few years. 

[digi23]

5 minutes ago, dreamingofhair said:

Thanks, Yes - just got a prescription for finasteride. 

I had come to the reality that given my current stage, for optimal results regardless of procedure & surgeon - I will need to be on medication (Finasteride) for foreseeable future. So I think it is better to evaluate finasteride first and see if I can tolerate it without significant damage. If in case, I have adverse effects with finasteride - then there is not really much point in spending $$$ on surgery as the results will be relatively short lived. 

As of now I had decided to get some blood work done - Testosterone (Total & FSH), Sperm count and DHT (i read about LC/MS analysis - need to figure out where I can get it done in Canada) to establish a baseline. Get on Finasteride for ~3 months primarily to evaluate adverse affects rather than potential gains (as they are evident only after 6+ months time frame). Get my blood work done again after 75-90 days and compare against baseline. If i don't see tragic demerits - i can conclude that, I will be able to pursue Finasteride for the long run. 

Once that's established - will proceed with surgery from one of the clinics. 

Hear Hear, i don't have insane expectations - just would like to do whats best possible given circumstances. 

 

H&W against Hattingen - preference of H&W is primarily based on my geographic proximity or quality of work / results ? So far Dr. Wong's clinic had been excellent with respect to addressing my concerns - prompt and informative. I am yet to hear back from Hattingen & Eugenix

Medispa is enticing when it comes to cost as its easily palatable. I read about the 1am consultation & agree that it was very unprofessional. Kudos to the chap to have the balls to pull out at last minute. Having said that, If I am proceeding with surgery - I plan to block a weeks time and hope I could mitigate aforesaid experiences with better communication in person - may be a day or two before the surgery. 

Still contemplating whether 1 Mega - FUT + FUE (with or without BHT) makes sense or to take it slow and have smaller FUT session initially and then one FUE to close it off (along with covering the FUT scars) - all spread over few years. 

Best thing is to get some evaluations from some of the best FUT clinics in the world like H&W and Hattingen. Doesnt really matter which one of them you choose, both are very good options. They should be able to do a plan for you to get the best possible result, with what looks like a limited donor and alot of loss.

[dreamingofhair]

Can someone advice me what will be the best way to rule out DUPA ? 

[digi23]

5 minutes ago, dreamingofhair said:

Can someone advice me what will be the best way to rule out DUPA ? 

To visit a Dermatologist. This does look like possible DUPA, but impossible to say by looking at a photo.

[dreamingofhair]

11 minutes ago, digi23 said:

To visit a Dermatologist. This does look like possible DUPA, but impossible to say by looking at a photo.

Great, any Dermatologist can diagnose it accurately ? If yes,  I will speak to a GP to get a referral to a dermatologist here in Canada. 

Thanks a lot

[digi23]

7 minutes ago, dreamingofhair said:

Great, any Dermatologist can diagnose it accurately ? If yes,  I will speak to a GP to get a referral to a dermatologist here in Canada. 

Thanks a lot

Someone who specialises in hair would be good, not sure if there are someone in your area. You might need to go to more than one aswell. Maybe you can ask H&W if they can recommend someone since they are in Canada aswell. Not sure where in Canada you are and how far it is to H&W but worth a try maybe.

[Curious25]

Go to a reputable hair surgeon rather than a dermatologist - derm’s are too hit or miss when it comes to hair loss. Some won’t even be aware of what DUPA is. 

[dreamingofhair]

1 hour ago, Curious25 said:

Go to a reputable hair surgeon rather than a dermatologist - derm’s are too hit or miss when it comes to hair loss. Some won’t even be aware of what DUPA is. 

 

1 hour ago, digi23 said:

Someone who specialises in hair would be good, not sure if there are someone in your area. You might need to go to more than one aswell. Maybe you can ask H&W if they can recommend someone since they are in Canada aswell. Not sure where in Canada you are and how far it is to H&W but worth a try maybe.

Makes sense. 

To establish baseline before taking Finasteride - i just got the following blood work requisition done 

"Testosterone panel, Estrogen / Estradiol, FSH, LH, DHT, Free DHT, SHBG, PSA, Prolactin, Semen Analysis"  - Anything else that's a must ? 

I know that ^ may be un-necessary but i just wanted to be sure and able to evaluate the drug after few months against the baseline - especially considering it might end up being a lifelong companion

[Gatsby]

40 minutes ago, dreamingofhair said:

I know that ^ may be un-necessary but i just wanted to be sure and able to evaluate the drug after few months against the baseline - especially considering it might end up being a lifelong companion

That's an excellent decision. 👌

[Gatsby]

As @DrTBarghouthihas stated I would definitely be taking finasteride for at least 6-12 months (at a bare minimum) and see how your hair appears compared to these photos that you have posted. In terms of surgery I really feel that you would benefit from beard hair as an additional source so I would personally be opting for Eugenix. However option 1, 2, 3, and 6 that you have listed are also great options. All the best!

[Curious25]

8 hours ago, dreamingofhair said:

I know that ^ may be un-necessary but i just wanted to be sure and able to evaluate the drug after few months against the baseline - especially considering it might end up being a lifelong companion

Not at all - it’s the responsible approach to take! 

[InTheSix]

On 11/30/2021 at 4:57 PM, dreamingofhair said:

Thanks, Yes - just got a prescription for finasteride. 

I had come to the reality that given my current stage, for optimal results regardless of procedure & surgeon - I will need to be on medication (Finasteride) for foreseeable future. So I think it is better to evaluate finasteride first and see if I can tolerate it without significant damage. If in case, I have adverse effects with finasteride - then there is not really much point in spending $$$ on surgery as the results will be relatively short lived. 

As of now I had decided to get some blood work done - Testosterone (Total & FSH), Sperm count and DHT (i read about LC/MS analysis - need to figure out where I can get it done in Canada) to establish a baseline. Get on Finasteride for ~3 months primarily to evaluate adverse affects rather than potential gains (as they are evident only after 6+ months time frame). Get my blood work done again after 75-90 days and compare against baseline. If i don't see tragic demerits - i can conclude that, I will be able to pursue Finasteride for the long run. 

Once that's established - will proceed with surgery from one of the clinics. 

Hear Hear, i don't have insane expectations - just would like to do whats best possible given circumstances. 

 

H&W against Hattingen - preference of H&W is primarily based on my geographic proximity or quality of work / results ? So far Dr. Wong's clinic had been excellent with respect to addressing my concerns - prompt and informative. I am yet to hear back from Hattingen & Eugenix

Medispa is enticing when it comes to cost as its easily palatable. I read about the 1am consultation & agree that it was very unprofessional. Kudos to the chap to have the balls to pull out at last minute. Having said that, If I am proceeding with surgery - I plan to block a weeks time and hope I could mitigate aforesaid experiences with better communication in person - may be a day or two before the surgery. 

Still contemplating whether 1 Mega - FUT + FUE (with or without BHT) makes sense or to take it slow and have smaller FUT session initially and then one FUE to close it off (along with covering the FUT scars) - all spread over few years. 

You seem to be open to both medication (Finas) and FUT..  2 things that many potential HT candidates are sometimes hesitant of... As such, I think you are giving yourself the best shot at this... I agree with the rest.. experiment with Finas first.. and then, if needed, when you are ready for HT, then go for an FUT ... that way you will probably maximize your grafts and get a lot covered in your 1st HT... you can use BHT later on as and when needed..... and if you choose FUT, then I wouldnt travel out of the country, as Dr Wong is the legend in this field.... depending on when you want to do your HT, you can even start performing scalp massages that H&W recommend on their website, as that can improve your laxity/graft availability....(H&w does not perform BHT)...  if you decide that FUT is not for you... explore Eugenix..

P.s I had an FUE with Dr Wong a little while back and met him a few weeks back for a follow up...cool guy to chat with, and has a great team.. clinic is run pretty solid.

best of luck

[DH97]

Did you ever end up getting a HT?