i ' m searching your opinion

[manuel_1989]

Hey community,

first of all, my englisch ist not the best, sorry for that. I hope i'm right here to remove my last consider.

My name is Manuel and i came from Berlin, i am 33 years old and i lost my hairs for the last seven years i guess.

My father and grandfather were already bald when they were 18. The father form my mom died young so i didnt know his hair status.

I wear a hairsystem in the tonsure area so i shave this area, maybe i have a little bit more hairs in this area i dont know, just for information.

Since december 2021 i take minoxidil oral 2,5mg per day to improve my hair status.

In december 2021 i was in belgium and visit Dr. Bisanga. He checked my donor an tell me:

 

- my donor is good with the average density about 73 FU/cm²

- i have good hair groups ( two - three hairs per graft )

- bisanga advises for the front a conservative hair line with about 2400 - 2500 grafts and for the tonsure 2000 grafts

- in the first surgery bisanga he would take 3500 grafts and in the second surgery ( 9 months later ) 900-1000 grafts

 

What do you think, can i get a good result? If you have more questions so please ask me

 

best regards

 

 

 

[1978matt]

The plan is good and I think the results will be good.

[NARMAK]

If it was Dr Bisanga himself giving you those details, he knows what he's talking about. 

You never mentioned whether you're using Finasteride. Just that you have 2.5mg Oral Minoxidil. By itself, it will only help mask the progression of DHT based hair loss. You should be using both imo. 

It can help preserve what you have for much longer. 

[manuel_1989]

So far i have no taken finsateride. I would like to try without.

Do you think the tonsure will close again or much better?

 

 

[NARMAK]

58 minutes ago, manuel_1989 said:

So far i have no taken finsateride. I would like to try without.

Do you think the tonsure will close again or much better?

 

 

Trying without Finasteride is like jumping out of a plane without a parachute imo. 

You take a massive risk of losing your natural hair and needing more hair transplants in the future. 

If you can try it first and see how you respond, that's better for you. 

[manuel_1989]

First of all thanks for the answers.

Ok that dosn‘t sounds good.

For many people it works without finasteride, didn‘t it.

If i dont take finateride, should i not have a hair transplant?

What about my tonsure, what would you say?

Are there any other opinions? I would be very grateful.

[LaserCaps]

You have an advanced pattern.  

If you've shown the propensity to lose, you will continue losing.

Propecia, Rogaine, PRP and Laser are the modalities we typically refer to when dealing with this condition.  The mechanism of action of each is totally different and are thus synergistic when used simultaneously.  Propecia, by the way, is now available in topical form.  Ask your doctor if this could benefit you.

It is important to consider the donor is a limited resource for most, if not all, patients.  You have to be judicious with your grafts. It is common in this industry to always give more value to the frontal area.  It is the area you see when looking in the mirror, and it's the area other see when they interact with you.  Having hair there will always serve you well.

Medical therapies tend to be far more effective in the crown.  So, while you are addressing the front and mid-scalp, you could be doing the medical regimen.  A year later, pending your level of happiness in the front/and confirming the efficacy of the medications, you could then consider working farther back into the pattern to minimize the size of the crown.  

[NARMAK]

2 hours ago, manuel_1989 said:

First of all thanks for the answers.

Ok that dosn‘t sounds good.

For many people it works without finasteride, didn‘t it.

If i dont take finateride, should i not have a hair transplant?

What about my tonsure, what would you say?

Are there any other opinions? I would be very grateful.

I do apologise, i'm not familiar with the word "tonsure". 

People like Melvin on this forum can't use Finasteride due to side affects but if you don't have side affects and can use, it generally makes sense to use it and help keep your natural hair for as long as possible so you don't have to deplete your donor area and not have good density. 

[Mike10]

If it weren't for Finansteride, I think a lot more people would do a HT

[LaserCaps]

Perhaps.  I think a lot has to do with the education the doctors provide prior to surgery. His job is to do what you want, but also to keep you from doing something he knows is going to result in something less than natural.  Thus, for the patient that decides not to do any type of medical therapy, I would start by asking about family history of hair loss.  If all the guys ended up being a class 6, for example, I would then start looking at how exactly a 6 pattern losses hair.  (A strong forelock in a very conservative location, with well recessed corners, and little density in the mid-scalp.  Nothing in the crown).  If you're OK with that look, then I would say - go for it without the use of meds.  

A better scenario is to do all modalities for a year.  It truly takes that long to find out what you'll accomplish. Based on the result you can then decide if continuing the meds is worth the time and money.  

[manuel_1989]

@LaserCaps my wish is it to have a good result in the whole area and not only in the front. So you would advise my to try oral minoxidil and finateride for a year and then think about HT again??? I wrote the family history of hair loss in the top. I m thinking i came from my moms father, my mom send me a pic when he was 45-50.

@NARMAK i mean the crown sorry

[NARMAK]

3 minutes ago, manuel_1989 said:

@LaserCaps my wish is it to have a good result in the whole area and not only in the front. So you would advise my to try oral minoxidil and finateride for a year and then think about HT again??? I wrote the family history of hair loss in the top. I m thinking i came from my moms father, my mom send me a pic when he was 45-50.

@NARMAK i mean the crown sorry

You might have better success starting Finasteride and because you already take Oral Minoxodil, you should try Microneedling with a Derma Pen. You actually might be surprised with you you respond and get some ground back. 

Ultimately you can throw the kitchen sink at something and do everything possible in your power. The rest is up to genetics and a touch of luck. 

Nobody had medication and no long term studies have been done as far as i'm aware that if a Dad didn't take Finasteride etc. and the son did, how the son's hair loss woulf progress over the same time period or whether it stops etc.

That's why imo medications is so important to use. 

[manuel_1989]

It feels like i'm back at the beginning with this topic

[NARMAK]

4 minutes ago, manuel_1989 said:

It feels like i'm back at the beginning with this topic

Sorry if it feels that way. Look, the way your hair loss is, Dr Bisanga can give you a new frontal hairline. The problem is the hair around it and if you'll lose those hair without Finasteride. 

Also, the crown area looks worse because you shave it down for the system. There's a chance you could save some of the hair there. If you can, then it means you use less grafts. 

Less grafts = Less Money. 

Hair Transplants aren't the cheapest to do properly and what's even more expensive and priceless is your donor area. You want to protect it as much as you can. 

Concentrate your first hair transplant on the front and then wait 12 months and try to use treatments on the crown area. After that, you'll know hopefully how much more hair you might need to transplant. 

[LaserCaps]

21 minutes ago, manuel_1989 said:

@LaserCaps my wish is it to have a good result in the whole area and not only in the front. So you would advise my to try oral minoxidil and finateride for a year and then think about HT again??? I wrote the family history of hair loss in the top. I m thinking i came from my moms father, my mom send me a pic when he was 45-50.

@NARMAK i mean the crown sorry

That's right.  There are only so many grafts that can be harvested per time.  It will take a year to see the full result of the transplants, (unless you do PRP). It will also take a year to see what the meds will do in the back.  Thus, you'll have more density in the front by definition, (transplants). Hopefully you'll experience enhancement in the crown because of the meds.  You can then add grafts to the crown pending the outcome.

I would encourage you to consider Fin, Rogaine, PRP and laser. 

[manuel_1989]

Thank you both for your time.

I‘m a little bit scared about finasterid and the side effects. Apparently it doesn‘t work without it

[Gokuhairline]

1 hour ago, manuel_1989 said:

I‘m a little bit scared about finasterid and the side effects. Apparently it doesn‘t work without it

not true, plenty of people on this forum have gone HT without finas and seen great results.....in my opinion those who are NOT on finas actually see early and better results, i know its a unpopular opinion but I just see I call it how I see it, there's some here search thread by thread and you will see users admit wether they are on finas or not...that said there are other factors, one that is common is they all are on the lower nowood scale 2-3 and the hair loss probably stabilized, just my opinion. 

[manuel_1989]

@Gokuhairline do you know any examples with my status?

[Gatsby]

Hi Manuel and welcome to the forum. In my humble opinion medication/s is your first option with MPB. You appear from your photos to have very thick hair which will be an asset with surgery. In my opinion (and I'm not a doctor) I would definitely recommend that you start finasteride under your doctor's guidance for at least 6-12 months to see if it can stabilize your hair loss (and maybe even improve your tonsure)! If you can tolerate finasteride and you respond positively to the drug then you are placing yourself in a great position to get the most out of your surgery. You've chosen a great surgeon in Dr Bisanga also. Wishing you all the best!

[Gokuhairline]

4 hours ago, manuel_1989 said:

@Gokuhairline do you know any examples with my status?

with your status no but the team out of eugenix has done some great cases like yours and I think the doctors recomend finasteride pre and or post but I am not sure , you can ask those who have been there.

[manuel_1989]

@Gatsby Thank you, i need to find more about finasteride. Do you know studies?

@Gokuhairline i have to check this, thank you.

 

[manuel_1989]

Another question, what‘s your opinion about micro scalp pigmentatation? Who is the best provider in europe? In the german forum i saw results from sabine dillen ( prohairclinic belgium )