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How to get from a NW4 to a NW0 [For Real]


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(if this section is not related to this, I would like to ask the moderators to move this thread to the appropriate category)

 

For 18-60 year olds

 

STEP 1 - Evaluation:

The very first thing you should do is go to a dermatologist and ask for an evaluation including a blood test (dht & free testosterone) to figure out what is causing your hair loss and if you have high levels of dht.

Your doctor will most likely give you a prescription: finasteride 1mg daily (or dutasteride 0.5mg if you have diffuse thinning, or a combination of both) & minoxidil 10% with azelaic acid which is a more potent agent.

STEP 2 - Preparation:

While you are on finasteride/dutasteride & minoxidil, you will have to book with a top surgeon, like FueExpert, De Freitas, or Pinto, as there are long waiting queues and it might take up to 2-3 years to get an appointment. Be prepared to do more than one operation, if needed. This is perfect because by the time you will have the operation, your hair will be thicker and you will gain some ground back.

STEP 3 - Optimise:

There are plenty of anecdotal reports that RU58841, Breezula, or Castor Oil may improve your condition, but don't go crazy over these options.

What you need to do is buy a dermaroller (ideally 1.0mm long , use it 3x/week but not too hard, you need to have plenty of time to heal between each session, also wait for 30 minutes before you apply any topicals). In addition to that, make sure you do not have any vitamin deficiency, (if you have an issue get a supplement with iron, zinc, vitamin B6 & D3, extracts are not necessary). You also need to use a good 20mg/g Ketoconazol shampoo 3x/week, the rest of the days just use a normal one, don't go crazy here either.

STEP 4 - Optimise more:

You may want to add an early PRP session, alongside with a good LLLT cap, one with. >270 diodes, 3x/week for 30 minutes or so. 
 

Make sure you are consistent with these. When the day of the operation comes, be loud and clear regarding your dream hairline. You might want to use beard hair for the crown part, or do micropigmentation around your donor area, if it is too depleted. I would expect to move down one level from the medication (i.e. if you are NW3 -> NW2, within 2.5 years) and another 1.5 level with each transplant session that you take. It is likely that you will land with a NW1 or NW0 after 5-6 years, maybe sooner if you are a little above average, maybe way sooner if you are a hyper responder.

 

Good luck, never give up.

 

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Okay, there's some sound advice. Like taking Finasteride, Minoxidil and Microneedling to fit your specific situation. 

However, saying things like go from a Norwood 4 to a Norwood 0 is a flashy clickbait title and not a realistic approach. 

Hair restoration is the first port of call, and treatments depend on each individual situation. The blood test being a good idea to check for any deficiency of vitamins and hormone imbalances. 

Finasteride combined with Nizoral and Microneedling for some is best as a starter and check progress over 12 months. Minoxodil can be added in later and usually left till last imo because you want to block the root cause of MPB which is DHT. Minoxodil helps restore through a different mechanism of action and doesn't prevent the root cause. Plus, if you combine Fin/Min, you never know what results came from which treatment and then have to keep using indefinitely or take a huge risk of waiting for that tumbling jenga tower to realise what Minoxodil supported. 

Also, Microneedling at 1mm or 1.5mm shouldn't be as aggressive as 3x a week. 1x a week is sufficient. 

Follow my first Hair Transplant Journey! 

Eugenix Hair Sciences | Dr Priyadarshini Das | Full Temple Point Restoration + Hairline | 2010 Grafts

https://www.hairrestorationnetwork.com/topic/63935-eugenix-norwood-2complete-temple-point-restoration-hairlinemay-20222010-graftsdr-priyadarshini-das/

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I don’t think it’s realistic to believe you can go from Norwood 4 to Norwood 0 the best hair transplant I’ve ever seen from Hasson @Aftermathwent from Norwood 4 to Norwood 1 and he’s an outlier in every sense. 

Check out my final hair transplant journey

My Final Hair Transplant Journey (Over 9K Total FUE Grafts) 

View my thread

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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1 hour ago, GHTJourneya said:

(if this section is not related to this, I would like to ask the moderators to move this thread to the appropriate category)

 

For 18-60 year olds

 

STEP 1 - Evaluation:

The very first thing you should do is go to a dermatologist and ask for an evaluation including a blood test (dht & free testosterone) to figure out what is causing your hair loss and if you have high levels of dht.

Your doctor will most likely give you a prescription: finasteride 1mg daily (or dutasteride 0.5mg if you have diffuse thinning, or a combination of both) & minoxidil 10% with azelaic acid which is a more potent agent.

STEP 2 - Preparation:

While you are on finasteride/dutasteride & minoxidil, you will have to book with a top surgeon, like FueExpert, De Freitas, or Pinto, as there are long waiting queues and it might take up to 2-3 years to get an appointment. Be prepared to do more than one operation, if needed. This is perfect because by the time you will have the operation, your hair will be thicker and you will gain some ground back.

STEP 3 - Optimise:

There are plenty of anecdotal reports that RU58841, Breezula, or Castor Oil may improve your condition, but don't go crazy over these options.

What you need to do is buy a dermaroller (ideally 1.0mm long , use it 3x/week but not too hard, you need to have plenty of time to heal between each session, also wait for 30 minutes before you apply any topicals). In addition to that, make sure you do not have any vitamin deficiency, (if you have an issue get a supplement with iron, zinc, vitamin B6 & D3, extracts are not necessary). You also need to use a good 20mg/g Ketoconazol shampoo 3x/week, the rest of the days just use a normal one, don't go crazy here either.

STEP 4 - Optimise more:

You may want to add an early PRP session, alongside with a good LLLT cap, one with. >270 diodes, 3x/week for 30 minutes or so. 
 

Make sure you are consistent with these. When the day of the operation comes, be loud and clear regarding your dream hairline. You might want to use beard hair for the crown part, or do micropigmentation around your donor area, if it is too depleted. I would expect to move down one level from the medication (i.e. if you are NW3 -> NW2, within 2.5 years) and another 1.5 level with each transplant session that you take. It is likely that you will land with a NW1 or NW0 after 5-6 years, maybe sooner if you are a little above average, maybe way sooner if you are a hyper responder.

 

Good luck, never give up.

 

After living like this for a some years I can add another step for you.

STEP 5 - Going in therapy with a psychologist

Because of so much obsession over your hair, you cant even go 10 minutes without looking in the mirror, am I losing ground??!?!

Seriously having this regime takes extremely much time, money and effort, you have some sick dedication and you gotta love your hair more than your wife if you are going to do this week in week out for a lifetime.

If no side effects, take Finasteride 1mg a day and go on with your life is my recommendation. In the long run you will never be able to keep a regime with minoxidil, finasteride, lasercaps, nizoral 3 times a week, dermaroll 3 times a week etc etc. Its a life long commitment.

Edited by digi23
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14 minutes ago, digi23 said:

After living like this for a some years I can add another step for you.

STEP 5 - Going in therapy with a psychologist

Because of so much obsession over your hair, you cant even go 10 minutes without looking in the mirror, am I losing ground??!?!

Seriously having this regime takes extremely much time, money and effort, you have some sick dedication and you gotta love your hair more than your wife if you are going to do this week in week out for a lifetime.

If no side effects, take Finasteride 1mg a day and go on with your life is my recommendation. In the long run you will never be able to keep a regime with minoxidil, finasteride, lasercaps, nizoral 3 times a week, dermaroll 3 times a week etc etc. Its a life long commitment.

Adherence is usually a big reason most can't keep up with even topical Minoxidil applications 2x a day. 

Microneedling 1x a week imo is much more reasonable and achievable imo. 

If you actually want to spend the money, then laser caps of a certain quality do have a scientific backing but for the price, it's not worth it unless you are that concerned about eeking out every last percent of potential treatment. 

I do think the most effective treatments are Finasteride/Dutasteride as #1 and then Minoxodil in terms of efficacy. 

However, i think ultimately only an individual can decide for themselves how committed they want to be and then the rest is out of their hands. Its all down to genetics etc. and whether you respond positively to it. 

Follow my first Hair Transplant Journey! 

Eugenix Hair Sciences | Dr Priyadarshini Das | Full Temple Point Restoration + Hairline | 2010 Grafts

https://www.hairrestorationnetwork.com/topic/63935-eugenix-norwood-2complete-temple-point-restoration-hairlinemay-20222010-graftsdr-priyadarshini-das/

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7 hours ago, Melvin- Moderator said:

I don’t think it’s realistic to believe you can go from Norwood 4 to Norwood 0 the best hair transplant I’ve ever seen from Hasson @Aftermathwent from Norwood 4 to Norwood 1 and he’s an outlier in every sense. 

I agree, it might be extremely difficult to go from a NW4 to a NW0, even if you have 3-4 hair transplant sessions and even if you follow everything mentioned. I mentioned 5-6 years and micropigmentation, because I know how much time it takes and how difficult it is, but I mainly wanted to give that title to this post because I want people with NW4 to be optimistic and help themselves as much as possible.

But totally, I would say that one can go down 3 NW levels after some years, if you go down 4 levels you have to be a hyper-responder.

Keep in mind there are people that are hyper responders and are not members in this forum

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6 hours ago, NARMAK said:

Adherence is usually a big reason most can't keep up with even topical Minoxidil applications 2x a day. 

Microneedling 1x a week imo is much more reasonable and achievable imo. 

If you actually want to spend the money, then laser caps of a certain quality do have a scientific backing but for the price, it's not worth it unless you are that concerned about eeking out every last percent of potential treatment. 

I do think the most effective treatments are Finasteride/Dutasteride as #1 and then Minoxodil in terms of efficacy. 

However, i think ultimately only an individual can decide for themselves how committed they want to be and then the rest is out of their hands. Its all down to genetics etc. and whether you respond positively to it. 

I increased the frequency of microneedling from 1x/week to 3x/week and I noticed a significant improvement in terms of growing new baby hairs. It is uncertain if these baby hairs will grow to their full potential, but nevertheless I have seen some good improvement. 

I can say that minoxidil 10% with azelaic acid & microneedling can be very efficacious together, way more powerful than just using a 5% minoxidil foam twice a day.

Laser caps prevent telogen effluvium, which might make a difference in some individuals, whereas in others there might be no difference at all.

Hard to tell you if my laser cap helped me, since I have been using so many other things.

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