Been getting a lot of differing opinions. Could use some guidance

[FluffyPanda]

Hi there! First-time poster so apologies if this is in the wrong section. I'm currently 32 years old (33 soon) and I've had consultations with multiple recommended HT surgeons suggested from this forum to get some opinions over my situation, namely if I should get a HT, what areas should be treated, and what expectations are. The main things that were unanimously agreed upon was that I should do a HT for the frontal region and that I should start finasteride. I've now started finasteride 0.5mg daily for a few weeks. I've gotten told I'm anywhere from Norwood 3-6/7. For me personally, the area that bothers me the most is the crown/scalp region which is also where I'm getting multiple opinions. I've had some say I'll lose everything, I've had some recommend doing a HT on the front and mid-scalp and to leave the crown alone, I've had some say finasteride should reverse a lot of the thinning and the crown will be ok on finasteride. I feel like I'm just at a loss on what to do at this point besides continuing finasteride. I would love to do a HT, but I honestly don't know how much it's worth doing just the front if the rest of the scalp is basically going to die off, or if a HT can/should be done for the crown/scalp region. This whole ordeal has been quite frustrating as I'm sure you can imagine, and my self-confidence has definitely taken a hit, but lurking this forum has been really nice to know I'm not the only one struggling out here 🙂

[NARMAK]

Here's my personal take on things. Stay on Finasteride and see if you can increase the dosage to 1mg every day sooner so you block the maximum DHT possible. 

The next thing i would urge you to do is add Minoxodil into your routine and Microneedling with a derma pen once a week at 1mm to 1.5mm. You should also maybe try use a 2% ketoconazole shampoo like Nizoral. 

If there's any inflammation on the scalp, seb derm, dandruff etc. You should take care of that too. Also do a blood test to make sure your vitamin levels are all okay. 

I would then tell you to save up money and research the clinics who deal with your hair type and ethnicity to put out the sort of results you want. 

Give the hair restoration at least 12 months to work its magic. The majority of the results are achieved then and hopefully puts you in a better position. 

[hairman22]

Your donor looks very good apart from some nape thinning

 

Your skin looks great btw.

[LaserCaps]

Diffused thinning, some retrograde.  

One of the first concepts I like to cover with patients is donor limitation.  Typically, there is not enough to provide full density in the front, top and back. Thus, if we have a limitation, where do we need to put the hair so that it serves you well now and in the future?  When you look at yourself in the mirror - what do you see? How about when others interact with you? It is for these reasons that we give the front a bit more value. Eventually, as you let the hair grow, it will allow you to cover the back.  

Medical therapies tend to be far more effective in the crown.  And, considering the whirl, it's ok to be thinner in that area. 

It is likely both FUT and FUE will be available to you.  Considering both would allow you to have access to your entire donor.

Given your pattern, I would encourage you to visit with a doctor for an in-person evaluation.  Try to do as many grafts as you can afford.

 

[Melvin- Admin]

Don’t touch the crown, the hairline is the worst part. I would focus on the front and midscalp, that could completely transform your appearance.

[FluffyPanda]

Thank you guys for all the feedback!

8 hours ago, NARMAK said:

Here's my personal take on things. Stay on Finasteride and see if you can increase the dosage to 1mg every day sooner so you block the maximum DHT possible. 

The next thing i would urge you to do is add Minoxodil into your routine and Microneedling with a derma pen once a week at 1mm to 1.5mm. You should also maybe try use a 2% ketoconazole shampoo like Nizoral. 

If there's any inflammation on the scalp, seb derm, dandruff etc. You should take care of that too. Also do a blood test to make sure your vitamin levels are all okay. 

I would then tell you to save up money and research the clinics who deal with your hair type and ethnicity to put out the sort of results you want. 

Give the hair restoration at least 12 months to work its magic. The majority of the results are achieved then and hopefully puts you in a better position. 

So I've been researching clinics, and the top 2 I feel most confident in for now are Dr. Bicer in Istanbul and Dr. Carman in San Diego.  I'm about to start residency this summer so it'll probably be awhile until I can actually get enough time off to actually get this procedure done, so we'll see where the medications take me til then!

 

6 hours ago, hairman22 said:

Your donor looks very good apart from some nape thinning

 

Your skin looks great btw.

Haha thank you! Guess avoiding the sun by spending my entire life indoors does lol. I'm not sure if the nape thinning is from some electrolysis I had done to remove hair on the nape of my neck to clean up the area, or from actual retrograde alopecia.

 

6 hours ago, LaserCaps said:

Diffused thinning, some retrograde.  

One of the first concepts I like to cover with patients is donor limitation.  Typically, there is not enough to provide full density in the front, top and back. Thus, if we have a limitation, where do we need to put the hair so that it serves you well now and in the future?  When you look at yourself in the mirror - what do you see? How about when others interact with you? It is for these reasons that we give the front a bit more value. Eventually, as you let the hair grow, it will allow you to cover the back.  

Medical therapies tend to be far more effective in the crown.  And, considering the whirl, it's ok to be thinner in that area. 

It is likely both FUT and FUE will be available to you.  Considering both would allow you to have access to your entire donor.

Given your pattern, I would encourage you to visit with a doctor for an in-person evaluation.  Try to do as many grafts as you can afford.

 

So when I personally look at myself in the mirror, I see some receding hair line and also some diffuse thinning that allows the scalp to come through. Some of my friends are definitely taller than me, or I go to the gym and bend in certain positions which I feel like exposes my scalp to a lot of people, and that makes it somewhat embarrassing, which is one of the reasons as to why I was trying to fill in the crown/scalp. My initial concern with the front was what happens if I transplant hair there, and then the hairline recedes further and now it looks like there's a big gap between what remains of the old hair and the new transplanted hair. That very well could be a misunderstanding of what happens, but I'll try some in person consultations in the near future and go from there.

 

5 hours ago, Melvin- Moderator said:

Don’t touch the crown, the hairline is the worst part. I would focus on the front and midscalp, that could completely transform your appearance.

Alright I'll try to focus more on the front and mid-scalp. Is there any reason  not to touch the crown? Is that just because of limited donor ability vs area to cover?

[NARMAK]

Dr Bicer seems to come very recommended on the forum but apologies, not sure on who the other person is personally. 

All the best with your new job and hopefully finding time for the procedure. 

[SeanT1]

100% agree with Melvin, focus on hairline/frontal area.  After a few months have passed you should consider SMP for the crown area to highly improve the density.
In the meantime finasteride will do its thing, who knows!

[Gatsby]

I would go with Dr Bicer. If her plan is along the same goals as yours then you've made a wise decision. Also give the finsteride 'at least' six months as a minimum before judging the effects. If you are able to tolerate finasteride it will put you in good steed. All the best

[Ryan Daniel]

Give finasteride around 6 months to 10 months. If you believe the hair loss has stabilized, you may go ahead and get  hair transplantation if you feel comfortable with the desired clinic.  I can estimate around 2500 - 3000 grafts from front to back will do the job

Don't do it unless you find the right doctor.  Please do not trust a hair mill with your donor area, it is more precious than diamonds

Your donor area is in excellent condition and you have great temporal points which already frames your face with a youthful forehead.

The most important thing is medication

Good luck friend

[Seeking_advise]

On 3/15/2022 at 6:01 PM, NARMAK said:

Here's my personal take on things. Stay on Finasteride and see if you can increase the dosage to 1mg every day sooner so you block the maximum DHT possible. 

The next thing i would urge you to do is add Minoxodil into your routine and Microneedling with a derma pen once a week at 1mm to 1.5mm. You should also maybe try use a 2% ketoconazole shampoo like Nizoral. 

If there's any inflammation on the scalp, seb derm, dandruff etc. You should take care of that too. Also do a blood test to make sure your vitamin levels are all okay. 

I would then tell you to save up money and research the clinics who deal with your hair type and ethnicity to put out the sort of results you want. 

Give the hair restoration at least 12 months to work its magic. The majority of the results are achieved then and hopefully puts you in a better position. 

How do we add minoxodil ? 

[NARMAK]

6 minutes ago, Seeking_advise said:

How do we add minoxodil ? 

Minoxodil is usually sold under the brand name Rogaine or Regaine in the UK. It all depends where you are but usually almost every country has a product available with Minoxodil in a topical solution. You then apply this twice a day. However you need to keep using it indefinitely like Finasteride for as long as you want to keep those hair. Anything Minoxodil regrows becomes dependent on it. 

[FluffyPanda]

So I had a consultation with Eugenix today and they recommended "2500 grafts would be needed for the Hairline, Temples and Mid-scalp that would account for the frontal coverage" and that finasteride would regrow the crown. Then if finasteride doesn't regrow the crown, they said we can consider a second HT to fill in that. Does that sound reasonable from the pictures? I have some concern that 2500 isn't enough, but I'm hardly an expert in this (they also have a bunch of different packages and the most expensive one isn't THAT much cheaper than getting it done in the US but some of the other packages definitely are).

I've been trying to get some suggestions from Dr. Bicer's clinic. I sent them some pictures on 3/12, their coordinator sent me some questions on 3/13 which were answered, and then basically been on silence. Sent a follow up message a couple days ago, said they'd check, and then silence again. Not sure if that's common or not, but I've seen a lot of incredible results from her, so really hoping to have an opportunity to get her opinion on what she would do for my situation.