Deciding between H&W or Eugenix for NW6 w/ fine hair

[Grouse]

Thanks to this extremely helpful community, I've gone from overwhelmed with options to deciding between 2 surgeons: H&W and Eugenix.

 

Any advice for how to decide between these two? Pictures of my situation included - I have fine, straight hair and am on my way to NW6, so not ideal characteristics.

 

From what I can tell, the pros / cons look like:

H&W:

Pros: Less travel time, can tell they're detail oriented (Dr. Hasson called out my sides from topical fin in the past may have been due to micro needling via my long email! good eye), extremely well respected and long track record.

Cons: Don't use beard hair as much

 

Eugenix:

Pros: Best in class for high NW cases, liberal use of beard hair, extremely well respected here

Cons: Longer travel time, less years to see how cases age over time (not too worried about this though)

 

Anyone had to make this decision before and have some advice?

[Gatsby]

Have you had a consultation with either? This will further help with your decision making. Can I ask how old you are and are you taking finasteride? Do you feel your hair loss has stabilized? Both are great but ask what each can do for you and tell them what your goals are? I think with Eugenix you obviously won't have to rely on scalp grafts so much. All the best which ever way you go!

[civic]

Based on photos i would chose H&W for FUT, hair characteristics appears on thin end. Donor is not too strong to withstand large fue without loooking sparse.

[Grouse]

27 minutes ago, Gatsby said:

Have you had a consultation with either? This will further help with your decision making. Can I ask how old you are and are you taking finasteride? Do you feel your hair loss has stabilized? Both are great but ask what each can do for you and tell them what your goals are? I think with Eugenix you obviously won't have to rely on scalp grafts so much. All the best which ever way you go!

Both have said I’m a candidate for 3.5k - 4k grafts, may need a second surgery for the crown later. I’m 30 and on minoxidil only. 
 

Had really bad sides from liposomal fin (Farmacia Paratti) @ 1% in the past. May try topical dutasteride thru FUE clinic first to stabilize and hope for the best with sides…

20 minutes ago, civic said:

Based on photos i would chose H&W for FUT, hair characteristics appears on thin end. Donor is not too strong to withstand large fue without loooking sparse.

Interesting! H&W didn’t mention FUT, said donor was average to above average. Maybe I’ll ask them about this option. Thanks!

Edited March 8, 2022 by Grouse

[hairman22]

I would go with Zarev. 

Most of his patients dont take propecia & he gets everything out of your donor.

Yo will have to wait a while but i think he is worth it.

Im in a bit of a similar position.  I have more hair & had a transplant bt I am a NW 6 in the future.

 

So I am going to Zarev next year to get an exam of my scalp

[Gatsby]

I agree with you @hairman22. However I don't believe (from the work that Zarev has so far shared) that @Grouse has the scalp donor for this? I hope I'm wrong.

[hairman22]

6 hours ago, Gatsby said:

I agree with you @hairman22. However I don't believe (from the work that Zarev has so far shared) that @Grouse has the scalp donor for this? I hope I'm wrong.

For sure not 11,000 grafts. But Zarev will get more grafts than anyone else

 

Look how he got 11,000 grafts here 

 

That guy's donor looks average

Edited March 8, 2022 by Melvin- Moderator
removed link

[NARMAK]

I would say if you're not averse to it, H&W with an initial FUT procedure and future strip for a potential second before switching to FUE might benefit you the most long term. 

Your donor area looks weak to be frank. It's very patchy in that above picture maybe exaggerated by lighting but indicates retrograde alopecia and that would make it even tougher. 

As you said, H&W have their track record and imo with the potential future progression, FUT is probably better for you to start with alongside the fine hair and possible donor issues long term. 

[1978matt]

Shave your head to see if you can live with the look.  If it's a yes, then do a conservative FUE to the front 3rd.  2000 grafts tops.

With your donor, short hairstyles are immediately gone if you go FUT.

Overall it's a tough call if you cant tollerate oral Fin.

[shiba1985]

H and W hands down for me between those two options. Reason being Long term track record over two decades, and more jaw dropping results. 

Liposomal finasteride probably increased ur serum levels more than a 0.5 or 1 mg finasteride would have. I would give oral finasteride a chance if you have never. People automatically think topical has lower sides but that is not the case with finasteride. 1% finasteride means there is 10 mg in 1 ml. I think you aborb about 25%. so you 2.5 mg is entering your systemic circulation. Not a math whiz so could be off with my calculations. 

Edited March 8, 2022 by shiba1985

[Hair4Days]

2 hours ago, 1978matt said:

Shave your head to see if you can live with the look.  If it's a yes, then do a conservative FUE to the front 3rd.  2000 grafts tops.

With your donor, short hairstyles are immediately gone if you go FUT.

Overall it's a tough call if you cant tollerate oral Fin.

I’ve heard of this approach before. What does it actually accomplish though? The ability to wear a shaved head with a stubble look in the front? I’d assume with 2k grafts spread out in the donor there would be no scarring 

[1978matt]

17 minutes ago, James C said:

I’ve heard of this approach before. What does it actually accomplish though? The ability to wear a shaved head with a stubble look in the front? I’d assume with 2k grafts spread out in the donor there would be no scarring 

It gives you something of a 'get out' assuming as you say that scarring is minimal in the donor. 

So say for instance you have two HTs totalling 4000 grafts, but hairloss gets the better of you long term, you can still buzz to a low grade and have decent facial framing from the frontal grafts.

You could then maybe have a small HT to tidy things up and cut your losses. 

[Grouse]

Thanks all! Yeah I was surprised how optimistic H&W and Eugenix were given my donor looks not great in harsh lighting + short. Maybe I'll optimize for an in person consultation first if at all possible.

 

Donor is thick and seems great when grown out a bit. But short and under direct lighting it seems not the best. 

 

Maybe I'll also reconsider doing topical Dut or something too... Thanks everyone!

[Grouse]

7 hours ago, hairman22 said:

I would go with Zarev. 

Most of his patients dont take propecia & he gets everything out of your donor.

Yo will have to wait a while but i think he is worth it.

Im in a bit of a similar position.  I have more hair & had a transplant bt I am a NW 6 in the future.

 

So I am going to Zarev next year to get an exam of my scalp

May I ask how you got in touch? Zarev seems to be too busy to respond, no?

[Hair4Days]

3 hours ago, 1978matt said:

It gives you something of a 'get out' assuming as you say that scarring is minimal in the donor. 

So say for instance you have two HTs totalling 4000 grafts, but hairloss gets the better of you long term, you can still buzz to a low grade and have decent facial framing from the frontal grafts.

You could then maybe have a small HT to tidy things up and cut your losses. 

This approach is underrated. It’s safe and doesn’t carry a whole lot of risk. Pro-FUT people would argue “you lose the ability to shave Going Fue as well” - which i don’t necessarily agree with. I’ve seen many donors that look untouched after fue. But that was at lower graft numbers. At 4K grafts I’m not sure how it would look. 

[Hair4Days]

2 hours ago, Grouse said:

Thanks all! Yeah I was surprised how optimistic H&W and Eugenix were given my donor looks not great in harsh lighting + short. Maybe I'll optimize for an in person consultation first if at all possible.

 

Donor is thick and seems great when grown out a bit. But short and under direct lighting it seems not the best. 

 

Maybe I'll also reconsider doing topical Dut or something too... Thanks everyone!

Hair tends to always look a little more transparent when it’s cut shorter. Even for people with no hair loss. Mine is the same way. Grown out it’s super thick looking, but when i do a number 2 on the sides it looks thinner. Not sure at what length is a better  way to rate ones donor quality though. 

[1978matt]

32 minutes ago, James C said:

This approach is underrated. It’s safe and doesn’t carry a whole lot of risk. Pro-FUT people would argue “you lose the ability to shave Going Fue as well” - which i don’t necessarily agree with. I’ve seen many donors that look untouched after fue. But that was at lower graft numbers. At 4K grafts I’m not sure how it would look. 

Yes, it also depends on the competence of the doctor involved.  Once you start pushing well over 4000 grafts the ability to bic shave kind of diminishes regardless of FUT or FUE.

However, a very low grade may still look half decent.

[Melvin- Admin]

If you choose H&W definitely go FUT first. They are both excellent clinics and both are in my opinion top of the industry for high Norwoods. You can’t go wrong either way.

[civic]

2 hours ago, Grouse said:

May I ask how you got in touch? Zarev seems to be too busy to respond, no?

I think Zarev is very selective with his clients just like Cuto. Check closely their before/after, most if not all their patients have ideal hair characteristics. I totaly respect them being overly selective, they want to keep their portfolio pristine. Not many doctors have such philosophy, and that is fine as long as patient understands the outcome might not be as expected. They both have lomg wait list, might not be worth waiting months or yr for consult only to be turned down. But try, perhaps they do online photo assessment to advise if its even worth the wait.

[rob7331]

Both clinics would be a fantastic choice, although as a Canadian if I had the money I'd go H&W.

I'm a little thrown however because like some members here have mentioned in the picture with the comb your donor looks strong and dense, but in the picture of your hair shorter the donor looks sparse, especially in the mid-high region beneath your crown. Could just be harsh lighting though? I hear what you mean on donor's looking extra sparse when shorter.

I'd take even more pictures and send them back to both clinics for an in-depth video consultation, making sure to raise concerns about donor capacity, shock loss etc.

The part about getting on fin (if tolerable) really can't be stressed enough. I get the sense you're on the younger side like me- we need to take care of our current hair with every tool we have, and fin is one of the best tools at our disposal. Surgery is best reserved as a final step once all other options are exhausted.

Here's 2 side-by-sides to show you what I mean. It's not apples to apples (different light and hair lengths) but it gives an idea. Left is before any treatment, right is 2 years later on fin, minox and dermarolling. No transplants at this point.

Edited March 9, 2022 by rob7331

[bald-and-bearded]

In your case, it would be a waste to use scalp hair in the mid scalp area when you can use beard or body hair. Go to someone who can use as much of body and beard hair as possible.

Dr Umar, Mwamba and Bisanga are known to use body hair extensively.

Edited March 9, 2022 by bald-and-bearded

[Melvin- Admin]

2 hours ago, bald-and-bearded said:

In your case, it would be a waste to use scalp hair in the mid scalp area when you can use beard or body hair. Go to someone who can use as much of body and beard hair as possible.

Dr Umar, Mwamba and Bisanga are known to use body hair extensively.

Beard hair should only be used when scalp hair has been exhausted. Definitely do not follow this advice. Once scalp hair has been exhausted then turn to BHT. 

[bald-and-bearded]

44 minutes ago, Melvin- Moderator said:

Beard hair should only be used when scalp hair has been exhausted. Definitely do not follow this advice. Once scalp hair has been exhausted then turn to BHT. 

I meant only in the mid scalp area (to add density and not solely rely on scalp hair).

OP looks young, isn't on Fin and doesn't appear to have great donor hair already.

The only place you can manage to put body and beard hair for density is in the mid scalp. That way, if you want to fill lateral humps later on, you will still have scalp hair. Using beard or body hair in the lateral humps would look bad.

[BurnieBurns]

Just my two cents. Even because you're having issue's finding a maintenance plan you'd want to be maximising your lifetime supply of grafts. Ron Shapiro proved that doing FUT first then FUE will give you about 2-3k more than doing either or. 

Say you did an FUT then needed another surgery. FUE and BHT would then still be an opportunity for you. Less so the other way around.

Plenty of more qualified people in the thread, I'm just in a similar boat to you

[Grouse]

 

On 3/9/2022 at 9:17 PM, BurnieBurns said:

Just my two cents. Even because you're having issue's finding a maintenance plan you'd want to be maximising your lifetime supply of grafts. Ron Shapiro proved that doing FUT first then FUE will give you about 2-3k more than doing either or. 

Say you did an FUT then needed another surgery. FUE and BHT would then still be an opportunity for you. Less so the other way around.

Plenty of more qualified people in the thread, I'm just in a similar boat to you

Awesome. No clinic has mentioned this yet, assumed it wasn't true any more with how advanced FUE has gotten.

 

I'll go back with more detailed pics and ask for video consults as well. I'll also ask about FUT first and then FUE. I'm willing to do it if it could mean the difference between getting a HT or not. 

On 3/8/2022 at 5:32 PM, rob7331 said:

Both clinics would be a fantastic choice, although as a Canadian if I had the money I'd go H&W.

I'm a little thrown however because like some members here have mentioned in the picture with the comb your donor looks strong and dense, but in the picture of your hair shorter the donor looks sparse, especially in the mid-high region beneath your crown. Could just be harsh lighting though? I hear what you mean on donor's looking extra sparse when shorter.

I'd take even more pictures and send them back to both clinics for an in-depth video consultation, making sure to raise concerns about donor capacity, shock loss etc.

The part about getting on fin (if tolerable) really can't be stressed enough. I get the sense you're on the younger side like me- we need to take care of our current hair with every tool we have, and fin is one of the best tools at our disposal. Surgery is best reserved as a final step once all other options are exhausted.

Here's 2 side-by-sides to show you what I mean. It's not apples to apples (different light and hair lengths) but it gives an idea. Left is before any treatment, right is 2 years later on fin, minox and dermarolling. No transplants at this point.

What a difference! Yeah I'm hesitant because I had such bad sides from topical, liposomal fin @ 1% in the past. Just ordered topical dut from FUE clinic after reading @mustanggoing through something similar. Fingers crossed.