Considering a HT and would appreciate input

[Reddish]

Hi all! Similar to some who've posted here before me I'm a longtime creeper on the forum but only recently created a profile and built up the courage to post. 

I'll try to keep my post short but I wanted to get the input of everyone here on my current situation and any thoughts or suggestions in terms of next steps.

A bit about me: I noticed I was losing hair around 24. I'm currently 31 and have been on 1mg fin/daily for ~4 years which seems to have at least slowed the loss. I have a history of hairloss on both sides of my family so while this was expected, it obviously still sucks lol.

I've been consulting with a few HT surgeons which I discovered through the recommended list here and your all's experiences (huge thank you to everyone who has shared their journeys!!). The general consensus seems to be ~2000 grafts for frontal third and hairline restoration. Their opinions on donor is that it looks strong but I don't have any specific metrics on it apart from that.

In terms of my current plan (and please I'd love feedback here as there are likely things I'm missing) I'm thinking of going with the ~2000 grafts for the frontal third and hairline for the first surgery. From what I've read, once you've had one HT you should generally expect to have another in your life so I'm going on the assumption this will be the case for me as well. 

With that in mind, after the first one I plan to wait the 12+ month's until it's  healed up and see if I need to do more to either top that up or start thinking about going in and improving density in the crown and midscalp at some point in the future. In the meantime, from the clinic's I've spoken to it seems I may be able to maintain my crown with a regimen of oral and topical meds. I think it's reasonable to expect I'll continue to lose hair to some degree in my crown and midscalp so my thought is that waiting awhile to see how that develops may be the best way to approach it, rather than going for the full monty from the start and having to do upwards of 3000 or more grafts at once. Again, would really appreciate thoughts on this!

Anyway I think that's enough rambling from me. Thanks for making it this far and sharing your thoughts if you have any

[NARMAK]

The first hair transplant usually does focus on the framing of the face with the frontal hairline. 

Most will advise a conservative design to account for potential hair loss down the line. You have been on Finasteride for 4 years which usually can show if you took pictures the situation on the top. Personally i would say you look a bit thinner (think mine has become a bit like that) and might benefit from Minoxidil 

Your temple points look like they're receded back completely and if you want to have those back too, which personally i'm in a similar situation and do, there's only a handful of options imo who can adequately do that right. 

Your darker hair to contrast ratio probably isn't helping with regards to the crown and scalp showing too but hopefully if Minoxidil can help there, as it usually does then it will give better coverage. 

What dosage of Finasteride are you on? 1mg everyday? 

[JoeMan]

If you only require 2k grafts for the front, why not put 500-700 in your crown while you're at it? This might not fill your entire crown but I bet it keeps you solid for a couple of years.

That's what Dr. Ferreira did for me, but it was 200 in my crown. I think if you are doing temple, at least from what I hear, you should only pick between a few Dr's. I'm not familiar with who other than hearing Eugenix but other people on here can surely offer suggestions. Take your time and choose wisely before taking the plunge. 

 

Good luck!

[Reddish]

 

8 hours ago, NARMAK said:

The first hair transplant usually does focus on the framing of the face with the frontal hairline. 

Most will advise a conservative design to account for potential hair loss down the line. You have been on Finasteride for 4 years which usually can show if you took pictures the situation on the top. Personally i would say you look a bit thinner (think mine has become a bit like that) and might benefit from Minoxidil 

Your temple points look like they're receded back completely and if you want to have those back too, which personally i'm in a similar situation and do, there's only a handful of options imo who can adequately do that right. 

Your darker hair to contrast ratio probably isn't helping with regards to the crown and scalp showing too but hopefully if Minoxidil can help there, as it usually does then it will give better coverage. 

What dosage of Finasteride are you on? 1mg everyday? 

Thanks for the reply and the feedback!!

I've been thinking of getting back on Minoxidil but need to refresh myself and see if anything has changed since I tried it 4-5 years ago but then stopped (no real reason I stopped just mid 20s laziness I imagine).

Agree the temple points are pretty much non-existent at this stage. I'd definitely be interested in bringing them back, especially if it provides an overall better aesthetic  - I think I've seen posts before on the forum that suggest HTs without the temples tend to not look at great in the end. Any thoughts on this one way or the other?

Also if you don't mind me asking, which Drs. in your opinion tend to do the best with that type of thing? I wasn't aware of the specialist nature of the temple area work and as @JoeMan below mentioned something similar I'd like to learn more there.

Re Finasteride I'm on 1mg everyday (apart from the occasional day I forget 😅) 

 

 

[Reddish]

5 hours ago, JoeMan said:

If you only require 2k grafts for the front, why not put 500-700 in your crown while you're at it? This might not fill your entire crown but I bet it keeps you solid for a couple of years.

That's what Dr. Ferreira did for me, but it was 200 in my crown. I think if you are doing temple, at least from what I hear, you should only pick between a few Dr's. I'm not familiar with who other than hearing Eugenix but other people on here can surely offer suggestions. Take your time and choose wisely before taking the plunge. 

 

Good luck!

Thanks mate that's really helpful feedback - I hadn't thought of going for a middle ground of adding a few hundred to the crown but will definitely consider it and bring it up during consultations!

The temples are for sure an area I need to put more thought and research into to understand what my goals should be around them and what that means in terms of choosing a clinic.

Thanks again  

[pkipling]

Given that you have a fair amount of hair loss and it's likely to continue to advance, I think the most important thing is working with a surgeon to determine how many grafts you have in your donor area to play with - and then you can strategically decide where you want to place them to get the most bang for your buck. With the hairline/frontal third being a top priority, you can then decide to what degree you want to address the temples and the crown, and how many grafts they think you would need for that. Once you A) know how many grafts you have to work with, and B) what your ideal end goal would be, you can then have a solid game plan on how to best move forward to achieve that. 

And if you do decide to address the temples, you'll want to really make sure it's a surgeon who excels at them as they tend to be a bit trickier to get right. All of that said, you seem to be on the right track. 

[Dr. Glenn Charles]

I think you initial plan of 2000 Fu's to frontal / hairline area is a good start. I might not have enough current hair loss in the crown region to make a big improvement. this is because you will likely have shock loss in that area after the procedure and after the new hairs grow in you may have a very similar appearance than to before surgery. In other words no big net gain. Good luck what ever you decide.

[NARMAK]

2 hours ago, Reddish said:

 

Thanks for the reply and the feedback!!

I've been thinking of getting back on Minoxidil but need to refresh myself and see if anything has changed since I tried it 4-5 years ago but then stopped (no real reason I stopped just mid 20s laziness I imagine).

Agree the temple points are pretty much non-existent at this stage. I'd definitely be interested in bringing them back, especially if it provides an overall better aesthetic  - I think I've seen posts before on the forum that suggest HTs without the temples tend to not look at great in the end. Any thoughts on this one way or the other?

Also if you don't mind me asking, which Drs. in your opinion tend to do the best with that type of thing? I wasn't aware of the specialist nature of the temple area work and as @JoeMan below mentioned something similar I'd like to learn more there.

Re Finasteride I'm on 1mg everyday (apart from the occasional day I forget 😅) 

 

 

I read that a lot of people who start Minoxodil tend to give up when it's topical and requires 2x applications a day and they cannot be bothered to keep up with the hair washing etc.

That's why i think oral minoxodil is gaining a lot of traction. So far, my adherence to Dutasteride is probably so high because you pop a pill and get on with your day. Same sort of appeal perhaps with the oral Minoxodil. My only gripe towards it being i felt i had enough body hair growth and that i didn't want to enhance it. Ironically, Dutasteride seemed to have reduced my body hair by about 20% and oral Minoxidil would probably just get it back to baseline.

I suppose you could deal with unwanted hair by lasering them off which should hypothetically get rid of them permanently. 

Regarding temple points. When i was younger i didn't realise how complicated it is to get them right and there's probably only a handful of places willing to do them in any meaningful way. Eugenix so far has been the most open with showing off such results. So they're probably a strong contender for that aspect alone imo. I'm currently planning to use them myself soon. 

I would say the framing of the face, even if you lower the hairline down won't look as good without the temple points being properly restored but if they botch it, it will look even worse. 

[Grouse]

Following. Your hair appears to be very similar to mine! Dirty blonde and maybe on the thin side. 

 

Your donor looks thick. Do you have any pictures with it cut more closely? 

[Mike10]

I would rather agree with the clinic not to touch the crown. Otherwise your hair loss seems to quite agressive for 31 so you are quite dependant on the medication you are taken. 

[NARMAK]

5 hours ago, Mike10 said:

I would rather agree with the clinic not to touch the crown. Otherwise your hair loss seems to quite agressive for 31 so you are quite dependant on the medication you are taken. 

I'd say OP having been on medication for 4 years, hopefully means he's slowed it significantly but there's an extra gear to go up to Dutasteride if he wished to do so. It blocks circa 10% more DHT at 0.5mg everyday compared to apparently 5mg/day of Finasteride apparently based on one study measuring scalp DHT. 

I think i had sides on it for about 1.5 months but then levelled out and feel generally fine. Nothing i basically am not willing to handle for the potential benefit of keeping my hair longer term. 

[Mike10]

41 minutes ago, NARMAK said:

I'd say OP having been on medication for 4 years, hopefully means he's slowed it significantly but there's an extra gear to go up to Dutasteride if he wished to do so. It blocks circa 10% more DHT at 0.5mg everyday compared to apparently 5mg/day of Finasteride apparently based on one study measuring scalp DHT. 

I think i had sides on it for about 1.5 months but then levelled out and feel generally fine. Nothing i basically am not willing to handle for the potential benefit of keeping my hair longer term. 

What I rather meant is that there is a risk that Fin stops working efficiently or induces sideffects. In that case, the same would likely happen with Duta. That is an issue when you are very reliant on that medication to begin with. I hope that is clearer now

[NARMAK]

5 minutes ago, Mike10 said:

What I rather meant is that there is a risk that Fin stops working efficiently or induces sideffects. In that case, the same would likely happen with Duta. That is an issue when you are very reliant on that medication to begin with. I hope that is clearer now

I think the primary issues been shown to be that it looks like hair follicles over time might get more sensitive to DHT above what Finasteride etc. can block and that's why it's not as effective over time. 

Personally i hope we get something that's gonna block 100% scalp DHT or hell, even 60%+ with less side affects. I personally wish i didn't have to sacrifice my normal DHT for all the other benefits it does have in the body just to save hair. 

That or just give us cheap clone hair so we can have unlimited hair transplants

[Mike10]

16 minutes ago, NARMAK said:

I think the primary issues been shown to be that it looks like hair follicles over time might get more sensitive to DHT above what Finasteride etc. can block and that's why it's not as effective over time. 

Personally i hope we get something that's gonna block 100% scalp DHT or hell, even 60%+ with less side affects. I personally wish i didn't have to sacrifice my normal DHT for all the other benefits it does have in the body just to save hair. 

That or just give us cheap clone hair so we can have unlimited hair transplants

I think you may be right there on then sensitivity to DHT .As  DHT decreases with age but this does not prevent people with high age to lose a lot of hair. At this point I have given up hope for smothing to come around, then again you never know  

[Reddish]

Thanks everyone for the input, comments and feedback so far! I've got a few more consultations booked in and your contributions have helped me come up with some more specific questions I need to ask and things to understand/consider.

 

On 1/19/2022 at 4:37 PM, NARMAK said:

I'd say OP having been on medication for 4 years, hopefully means he's slowed it significantly but there's an extra gear to go up to Dutasteride if he wished to do so. It blocks circa 10% more DHT at 0.5mg everyday compared to apparently 5mg/day of Finasteride apparently based on one study measuring scalp DHT. 

I think i had sides on it for about 1.5 months but then levelled out and feel generally fine. Nothing i basically am not willing to handle for the potential benefit of keeping my hair longer term. 

I'm going to be doing more research into the different medications available as I've admittedly kind of put my head in the sand just being on Fin and not bothering to see how these treatments have progressed. The Fin has slowed the loss but it sounds like there are other options which could be good compliments or alternatives which I need to investigate so thank you.  If anyone has good resources they like and want to suggest please let me know - I know there's a space on here around the topic so I'll start there and see what I uncover.  

 

On 1/19/2022 at 5:06 AM, Grouse said:

Following. Your hair appears to be very similar to mine! Dirty blonde and maybe on the thin side. 

 

Your donor looks thick. Do you have any pictures with it cut more closely? 

Will keep an eye on yours as well as it's always nice to see journeys of those with similar hair! One thing I failed to mention in my original post is that my hair in the photos was damp, not sure how big of a difference it makes but when dry and seen in person it's noticeable I'm ginger lol.

My donor is relatively thick I'd like to think (though I might be biased  ). Unfortunately no pics with it cut closer as that's the shortest I generally keep it (these pics were ~1 week post haircut I think).

[Reddish]

On 1/18/2022 at 9:00 PM, Dr. Glenn Charles said:

I think you initial plan of 2000 Fu's to frontal / hairline area is a good start. I might not have enough current hair loss in the crown region to make a big improvement. this is because you will likely have shock loss in that area after the procedure and after the new hairs grow in you may have a very similar appearance than to before surgery. In other words no big net gain. Good luck what ever you decide.

Thanks for the input Dr. Charles!

I'm curious as I've seen it from a few of the comments on this thread: in your experience when it comes to temple points would you be able to offer any insight into what makes it such a difficult area to get good outcomes in? And a follow up to that, when the temple points are an issue (gone or nearly gone for example) do you see having them restored as a necessary part of a good surgical plan or is it more of a decision to be made on a case by case basis? Just trying to understand more around this as before posting here I hadn't considered it as an area to pay attention to for some reason (possibly because mine have been gone for so long lol). Thanks!