First time Poster - Advice.

[Balding_CPA]

Hello everyone!

I’ve been lurking for a long time but now that I’ve finally been promoted I’m getting serious about a hair transplant I’ve wanted for a long time and would love some advice. Im 33 years old. 

I’ve done all the noobie research and feel up to speed on most topics but was wondering if any others could offer advice on my specific situation. 

I’m not on any medications and for now, it’s a bit of a deal breaker for me. I was recently quoted for 4,000 grafts. 2k to restore the hairline and another 2k to correct the crown. About $20K for a FUE operation in South Carolina, USA. 

I know my stubbornness on not wanting to take a daily pill for the rest of my life will draw a lot of attention but what are the realistic expectations I should have if I’m okay with more procedures down the road? 

My father’s side of the family has no history of even receding hairlines and my mother’s side varies. Grandfather is completely bald while my uncles show no significant signs in their late 60s. 

I do believe I’m decided on wanting to go FUE over FUT but would be open to opinions. I first noticed my crown thinning about 8 years ago and it has been a very slow progression to the photos attached below. I understand by not taking Fin and repairing the crown with the line leaves room for the midsection to continue to thin and the need for an additional operation but is this something that can be planned for? I wasn’t quoted on how many grafts could be harvested from my donor area. 
 

I’m excited to commit to the surgery but a lot of conflicting information has me questioning my confidence in the decision. I’d love some insight from everyone before I put down my deposit next month. Based on my photos, what else should I consider? What does the community suggest?

Thanks in advance! 

 

[HappyMan2021]

I can never recommend a hair transplant to anyone who is not willing to take Fin or Dut. Especially if you have never ever taken it before, so you can't say you would even have sides

5 minutes ago, Balding_CPA said:

I know my stubbornness on not wanting to take a daily pill for the rest of my life

Are you opposed to taking a blood pressure or cholesterol medication if needed for life? I don't see how Fin is any different than this. 

Your hairloss is fairly significant and I only see it getting worse without a DHT blocker. 

[LaserCaps]

Many components at play here,  

First, you refer to medications as Finasteride.  As you know, Finasteride, Rogaine PRP and Laser are the modalities we typically refer to when dealing with this condition.  Are you open to the other ones? (The ones external to you - and, by the way, Fin is now available as a topical solution).

What are your goals? What are you trying to accomplish?

No meds? OK.  Think of the front and top as the horizontal part of the head.  You can go back as far as you can horizontally on the pattern so as to minimize the size of the crown.  As the hair grows, and you comb it back, you can cover the area but with the hair.

We want to be age and pattern appropriate.  A class 6, for example, will keep a forelock, a bit of density through the mid-scalp and nothing in the crown.  If you are planning on zero meds, That's the way I would approach it.

It is important to realize the hair in the front grows forward, the hair in the middle grows forward and it shingles.  In the crown, however, we all share the whirl.  The hair grows outwards from the point. It would take tons of grafts to fill it.  You'd be better served by working the front and top first.  Once happy with the density, you could then tackle the back...Oh, but wait....

No meds, more loss.  Say you go on to lose all they hair you currently have...which is a possibility if you do not want to protect it.  

And the cycle continues........

Rogaine, PRP, Laser....What if these helped you retain what you have. Would that be an option?

[Gokuhairline]

welcome and congrats on your decision....I will go against the 99% of users here and say it does NOT matter if you are NOT on finasteride , dutasteride, minox, any other medication....does it help if you will ? who knows ? will you get side effects? who knows ? thats a decision you have to make, plenty guys here that have gone the no medication route and seen amazing results.  one thing I am big on is genetics, that you cannot control with anything, no pill, if you see that you are continuing to thin out and lose on top then you probably lose more after a transplant and might have to get a 2nd one, if you have stabilized the loss then you are ok to go ahead and get it done, lastly the doctor and team you chose will have a big impact, not sure SC is known for this type of procedure , with that budget you can go to some of the top guys in Europe or some in Chicago, Canada, . good luck. 

[NARMAK]

You can definitely roll the dice and get a hair transplant if you want. Just realise this. If you concentrate your first procedure on the frontal hairline, then crown. If the midscalp then thins out, you could be left with this wonky looking patch slap bang in the middle of your head. 

Not even attempting to try medication imo even at a low dose is folly. But hey, you do whatever you want to. Nobody else has the right to try force you etc. but as mentioned, you're not helping to deal with the primary form of your hair loss and tbh, you probably already are like at a Norwood 4/5.

You will have to be realistic in your expectations and settle for a pretty high hairline. Especially without medication in order to not burn through grafts that are lowering the hairline and later would be needed behind. 

[Balding_CPA]

I appreciate these replies. They are what I expected and exactly what I’m looking for. 

I was actually surprised when my Dr. explained it would be no problem to forgo Fin or Dut since it seems like a necessity on this forum. I understand the important role they play in the whole process but I had hoped that my loss, when stabilized, wouldn’t be too much more severe than it’s current state given family history. I know that may be naive and a poor way to plan but I was holding out hope. In my mind having the surgery last for 5-10 years and then getting another down the line didn’t seem too big of an issue as long as I went about planning for the remaining loss. It seems that may be a far bigger gamble than I expected. 
 

I believe the only thing holding me back from committing to either medication or the topical is the fact that once you stop use all progress is lost anyways. Maybe I’m not as committed as other members if that is acceptable to them. I’m not trying to reverse or stop hair loss but rather stabilize naturally and transplant accordingly. 

I can understand taking the meds through younger years and then “letting it go” at a more suitable age but I don’t think thats the approach I want to take. 

[Britanium]

Have you seen the forums recommended list:

https://www.hairtransplantnetwork.com/Consult-a-Physician/hair-transplant-surgeons.asp?sr=HRN-MOB

 

[Britanium]

Which clinic have been consulting with ? Just curious 🤨 Are you open to travel ? Would open up a lot more possibilities for you.

Taking Fin is a personal choice, totally up to the individual. Not everyone will consider Oral/Topical meds for life. You seem to realise what will happen going forward, and that’s likely a future hair transplant and more loss. 
I don’t take it, and am now 50 years of age. My Norwood pattern was a 6. 5 hts and counting …. For me it had contra-indications with other meds I was taking. 
 

[NARMAK]

2 hours ago, Balding_CPA said:

I appreciate these replies. They are what I expected and exactly what I’m looking for. 

I was actually surprised when my Dr. explained it would be no problem to forgo Fin or Dut since it seems like a necessity on this forum. I understand the important role they play in the whole process but I had hoped that my loss, when stabilized, wouldn’t be too much more severe than it’s current state given family history. I know that may be naive and a poor way to plan but I was holding out hope. In my mind having the surgery last for 5-10 years and then getting another down the line didn’t seem too big of an issue as long as I went about planning for the remaining loss. It seems that may be a far bigger gamble than I expected. 
 

I believe the only thing holding me back from committing to either medication or the topical is the fact that once you stop use all progress is lost anyways. Maybe I’m not as committed as other members if that is acceptable to them. I’m not trying to reverse or stop hair loss but rather stabilize naturally and transplant accordingly. 

I can understand taking the meds through younger years and then “letting it go” at a more suitable age but I don’t think thats the approach I want to take. 

Here's the thing. Finsateride/Dutasteride is basically like a dam. It holds hair loss for the most part at bay. How well depends entirely on your genetics and how aggressive your hair loss is. Usually the rules of thumb are the younger you are and the more aggressive the hair loss, and as you get older it slows down. Never stopping in most. 

Medication however helps most people that are in the usual middle areas and prevents hair loss as much as possible and holding it back. So you hold onto more hair and thus need less grafts over time. A very important factor considering the donor area is finite. 

As mentioned, you can roll the dice, just remember it costs you money for a hair transplant, takes 12 months for results and there's not a 100% survival rate guarantee.

[Melvin- Admin]

The "don't get a hair transplant without fin" is dogmatic in my opinion. Now, it is definitely advisable to get on some form of medication, whether it be minoxidil, finasteride, nizoral, laser therapy, or all. You don't have to take the oral version of finasteride, the topical version works just as well, with lower chance of side effects. Keep in mind, it is more expensive. You aren't a difficult case. I do agree that 4K grafts seems reasonable for your case. The price seems reasonable as well in the US that would be about $5 per graft, which is on the lower side cost-wise. I would recommend submitting consultations to many of our recommended surgeons. Do not choose the first surgeon you meet, do your research and use our forum as a resource. 

https://www.hairtransplantnetwork.com/Consult-a-Physician/hair-transplant-surgeons.asp?sr=HRN

[Z--]

Kind of silly to compare Fin, which is known for having potentially severe side effects, to life saving medication. It's a hair transplant and its just hair - it isn't unreasonable to forgo Fin if you aren't comfortable with the risk of side effects and, if anything, I'd be wary of anyone claiming its necessity. Obviously, being on Fin is helpful, but plenty of forum users - including folks with much worse loss than you and are posting in this exact thread no less - have had successful transplants without Fin. 

I think in your case, assuming you do 3 - 4k grafts, you should be fine (keeping in mind you may need one more down the line if more loss occurs from not stabilizing), but honestly, if you are okay with that risk, I wouldn't worry about it. 

[Balding_CPA]

Incredible response from everyone. I’m very grateful so many of you added your thoughts. I’ll continue to do some research on how I want to move forward but I think I’m still firmly in the no surgery or no meds options. I’m a little more open to topicals after reading the responses but still not preferred. 

I am completely open to travel for the operation but I started consults local. After a bad experience with Dr. Lindsey in Richmond, VA I decided to get a consult from Mike Vories in Charleston, SC. 

Dr. Lindsey was insistent that no one under any circumstance should get a FUE procedure and that he refused to work on my crown. He tried to be very “telling it how it is” but ultimately came off as dated and rude.

Dr. Vories has been on the other end of the spectrum. He gave an honest opinion that the crown and line were doable and said no medication was fine but he recommends it. Not much else.

I’ll use the resources provided to consider some other international or higher end domestic options but ultimately I think I need to educate myself more on what I want my total care plan to be.

For now I’m still okay with getting 4000 grafts and planning on a second down the road but I’m not closed off to the other ideas suggested.  I do think accepting the crown is probably a lower priority and working my way back from the front is a reasonable approach but the crown is my biggest source of insecurity.

Big thanks to everyone here in the forum. 

Thank you! 

[HappyMan2021]

5 minutes ago, Balding_CPA said:

Dr. Lindsey was insistent that no one under any circumstance should get a FUE procedure and that he refused to work on my crown. He tried to be very “telling it how it is” but ultimately came off as dated and rude.

Dr. Lindsay is B-list and I would not specifically seek him out unless you had some super specific personal reason to see just him. 

BUT, in his defense, many good and ethical doctors are extremely hesitant and/or will downright refuse to operate on patients under 40 with significant crown loss. "Final form" crown loss usually occurs later than "final form" hairline loss. So in his defense, he may not consider your crown loss to be stable or settled down yet (especially since you aren't taking meds....)

5 minutes ago, Balding_CPA said:

I do think accepting the crown is probably a lower priority and working my way back from the front is a reasonable approach but the crown is my biggest source of insecurity.

Based on this, I don't think you will be able to be at peace with your crown loss if only the front is worked on. 

Keep searching for docs, and perhaps you can find one who can fill in part/some of the crown in your 1st surgery. 

If you want a 100% non-bald look in your crown, you probably are looking at 2 surgeries. 

Edited February 18, 2022 by SadMan2021

[Viney]

Don't want to derail the topic but your username is great 😂.

- From a fellow balding accountant.

My Dad still has his hair, perhaps the stress of our jobs and work related study caused us to lose our hair? 

Edited February 18, 2022 by Viney

[Melvin- Admin]

1 hour ago, Balding_CPA said:

Incredible response from everyone. I’m very grateful so many of you added your thoughts. I’ll continue to do some research on how I want to move forward but I think I’m still firmly in the no surgery or no meds options. I’m a little more open to topicals after reading the responses but still not preferred. 

I am completely open to travel for the operation but I started consults local. After a bad experience with Dr. Lindsey in Richmond, VA I decided to get a consult from Mike Vories in Charleston, SC. 

Dr. Lindsey was insistent that no one under any circumstance should get a FUE procedure and that he refused to work on my crown. He tried to be very “telling it how it is” but ultimately came off as dated and rude.

Dr. Vories has been on the other end of the spectrum. He gave an honest opinion that the crown and line were doable and said no medication was fine but he recommends it. Not much else.

I’ll use the resources provided to consider some other international or higher end domestic options but ultimately I think I need to educate myself more on what I want my total care plan to be.

For now I’m still okay with getting 4000 grafts and planning on a second down the road but I’m not closed off to the other ideas suggested.  I do think accepting the crown is probably a lower priority and working my way back from the front is a reasonable approach but the crown is my biggest source of insecurity.

Big thanks to everyone here in the forum. 

Thank you! 

I like Dr. Vories approach. I recommend speaking to Dr. Cooley in North Carolina as well. There’s more than enough results out there to show FUE is comparable in every aspect to FUT, and even better in some cases.