33 year old male needs advice (pictures attached)

[Revale]

Hi,

I'd like to get some advice for hair restoration.

I'm now 33 years old and noticed hair loss for the first time when I was 26/27.

My temple area is receding and my crown area has thinned a lot.

I have scalp psoriasis. I got treatment for it but as soon as the treatment stops it comes back. Only the part with hair is affected. Not everywhere though.

Until now, I have visited 3 hair transplant clinics in Tokyo for consultation.

The first one said, that they can transplant 3,000 grafts for about 25.000 USD.

The second clinic said that they don't recommend so many grafts because they're unsure how my scalp condition would affect the result. Instead, they would transplant some graft in my temple area (where I have no skin issue) and a few hundred (not sure if I remember that correctly) in the crown area to see what the result would look like.

The third clinic advised me against a transplant because I would still have too much hair on the crown and therefore no space to plant the grafts (and maybe they also considered the skin issue - I don't remember well).

I also contacted a Turkish clinic. We had a very short video call. They would transplant 4,000 grafts, but I would have to count for 7 days how many hairs I'm losing per day. If it's less than 100, I could do the surgery. If it's more, not. 

Honestly, I didn't know how to count that. I counted in the morning the hair I could see in the bed. It were between 30-50. Therefore, my estimation was, that I'd lose about 80-100 per day. 

2 of the clinics mentioned Finasteride and Minoxidil, but I declined, because I'm unsure about the potential side effects.

The thinning on my scalp keeps progressing and I feel that I need to do something about it. 

What would you guys do if you were in my position?

[NARMAK]

Do NOT go for a hair transplant yet. 

You have underlying issues you need to address and you seriously need to imo re-assess and think about starting Finasteride. It's the main defence against male pattern hair loss by blocking the DHT component which is the most damaging. 

I also wouldn't hop straight to Minoxodil just yet but give Finasteride a go first. I'm just a smidge younger than you and began Dutasteride (stronger than Finasteride) at 31 after years of avoiding it because of online horror stories and crap people would say to scare you away. Happily on it for 10 months now and hoping for many more years of effect. 

You are also diffuse thinning which means that there's a good chance Finasteride could work well on you to help regrow those areas. However you need to see a dermatologist and find a way to keep the scalp psoriasis at bay, maybe using something like T-Gel or something similar and then keep using it 1x a week or so even after the recommended period. I do this myself for the dandruff issues i have. You can also try Nizoral which contains a 2% ketoconazole which has mild Anti-Androgen properties that can help a little. 

Ultimately you look like you have a good hairline already and once you get your scalp condition addressed and hopefully can be on medication, you may realise you don't need a significant amount of hair grafts at all and with the potential budget cited as $25k USD, you literally could have the world as your oyster if you did go ahead with it. 

[Britanium]

Have you seen a dermatologist who specialises in hair loss? I also have scalp psoriasis and it does go through phases, you will always find someone who is willing to do a hair transplant, but they may not have your best interests in mind. 

If your thinking of a med regime then please discuss with your own Dr/Gp and/or a Dermatologist, it’s certainly something that’s needs exploring, but professional advice is needed here. 

[Britanium]

I think you need to look at some of the clinics that are recommended here:

https://hairtransplantnetwork.com/best-hair-transplant-surgeons
 

Some which will give you invaluable advice are @DrTBarghouthi(Vertex), Dr Bisanga (BHR), Eugenix… 

Im just not sure the clinics you have consulted with so far are the best for you, who was the Turkish clinic ? 

[Revale]

I don't really understand Finasteride yet and its potential side effects. For now, I'd prefer to stay away from it (same as Minoxidil). I have a strong dislike towards putting chemicals into my body. Even more than going bold and/or shaving my head. 

The Turkish clinic which I have consulted was Dr. Bicer: https://www.ozlembicer.com/

I didn't know that there are dermatologists who specialize in hair loss. The second clinic asked me to consult with my dermatologist and ask her if I can get a hair transplant. She said yes, but I'm not sure if that was a "qualified" or a "please leave now" yes.

[LaserCaps]

37 minutes ago, Revale said:

Hi,

I'd like to get some advice for hair restoration.

I'm now 33 years old and noticed hair loss for the first time when I was 26/27.

My temple area is receding and my crown area has thinned a lot.

I have scalp psoriasis. I got treatment for it but as soon as the treatment stops it comes back. Only the part with hair is affected. Not everywhere though.

Until now, I have visited 3 hair transplant clinics in Tokyo for consultation.

The first one said, that they can transplant 3,000 grafts for about 25.000 USD.

The second clinic said that they don't recommend so many grafts because they're unsure how my scalp condition would affect the result. Instead, they would transplant some graft in my temple area (where I have no skin issue) and a few hundred (not sure if I remember that correctly) in the crown area to see what the result would look like.

The third clinic advised me against a transplant because I would still have too much hair on the crown and therefore no space to plant the grafts (and maybe they also considered the skin issue - I don't remember well).

I also contacted a Turkish clinic. We had a very short video call. They would transplant 4,000 grafts, but I would have to count for 7 days how many hairs I'm losing per day. If it's less than 100, I could do the surgery. If it's more, not. 

Honestly, I didn't know how to count that. I counted in the morning the hair I could see in the bed. It were between 30-50. Therefore, my estimation was, that I'd lose about 80-100 per day. 

2 of the clinics mentioned Finasteride and Minoxidil, but I declined, because I'm unsure about the potential side effects.

The thinning on my scalp keeps progressing and I feel that I need to do something about it. 

What would you guys do if you were in my position?

It is truly amazing what curly hair can do.  It gives you more lateral coverage.  The photo you've shared with us does show diffused thinning throughout.  If you were to shave, it is likely it would show a very advanced pattern with a lot of miniaturized hair.  

There are two types of loss. The type you see and the type you don't.  What you see in the pillow, brush, shower, etc..is normal.  The follicle gets tired of producing and it goes into a dormant period.  3-4 months later the hair returns.  This happens randomly to all the hair in your head.  Hair loss is different.  You don't see it.

Under a bright light look at the hair in your hairline and corners.  Notice some strands are really thick and some not.  Some seem so thin you can't hardly see them.  We refer to this process as miniaturization.  Eventually the hair dissipates and disappears.  Once gone, it will never return.

Propecia/Rogaine/PRP/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.  Try them all and give them a year.  Below are some issues to be aware of.  

Propecia and Rogaine are considered to be the best medications for retention in the crown.  The problem is one of expectations.  Eventually people become frustrated when they see no visual change not understanding the medications are not meant for you to grow anything. Rather, they are intended for you not to lose any more.  So, if a year later you look the same, the meds did what they were intended to do. You can achieve a visual change with PRP/Laser.

Two things can happen with PRP and Laser combination.  (It typically takes 12+months to see the results of a transplant procedure.  When you add PRP/Laser, we typically see the same result in 6 months).  The combo can also help reverse the miniaturization.  The key here is to find a provider that knows how to do the PRP.  Not all PRP's are created equal.

It is important to recognize the donor area is limited and finite.  Be judicious with your grafts.  Any benefit you can get from the medical modalities could have an impact in the overall approach and number of grafts.  It would be in your best interest to do the meds and give them a year.  Move forward based on what you achieve.  

[Britanium]

It’s worth looking for a trichologist, and yes some dermatologists will have knowledge or specialise in hair loss.

Dr Bicer is well regarded here and is also forum recommended, She is very experienced and so is definitely one to consider.

Edited March 30, 2022 by J.A.C

[Revale]

I find that PRP/Laser approach interesting.

[Britanium]

Just now, Revale said:

I find that PRP/Laser approach interesting.

Just be careful when it comes to PRP, so many clinics use it for a “cash grab” and it’s very debatable on how effective it actually is. At best I have seen it assist with early growth after a hair transplant, at worst and much more common it does nothing. 

[Revale]

Just now, J.A.C said:

Just be careful when it comes to PRP, so many clinics use it for a “cash grab” and it’s very debatable on how effective it actually is. At best I have seen it assist with early growth after a hair transplant, at worst and much more common it does nothing. 

Yeah, that is my concern, too.

[Britanium]

@Melvin- ModeratorAppeared to have some success with using laser in the early stages of his most recent hair transplant.. but again I think the vast majority of users are not seeing any benefit.. 

[LaserCaps]

1 minute ago, Revale said:

Yeah, that is my concern, too.

Agree.  Most clinics do not know how to do this.  If you hear the word "sessions," run in the opposite direction.  This till typically involves doing a syringe size worth of PRP, a few shots and that's it.  Not even a local is used.  Not good.

[Nw7HPE]

There is not much evidence that PRP halts or regrow anything , same with laser . Being realistic goes a long way in saving you lots of money and also disappointment .

[Britanium]

Just now, Kashnw7hope said:

There is not much evidence that PRP halts or regrow anything , same with laser . Being realistic goes a long way in saving you lots of money and also disappointment .

Exactly this 👍🏽 

[LaserCaps]

1 minute ago, J.A.C said:

@Melvin- ModeratorAppeared to have some success with using laser in the early stages of his most recent hair transplant.. but again I think the vast majority of users are not seeing any benefit.. 

It's just like anything else.  Most lasers do not provide even 1 Joule of power in any given treatment.  LaserCap provides 4.  It is prescription strength.  

[Nw7HPE]

I d say , Microneedling is more proven than PRP or laser but even with that you need to be realistic . 

[Revale]

Just now, Kashnw7hope said:

I d say , Microneedling is more proven than PRP or laser but even with that you need to be realistic . 

What can microneedling potentially achieve?

[Nw7HPE]

Some mild fuzz regrowth after months . 

[Revale]

My scalp condition is actually "Seborrheic dermatitis" - not psoriasis. The doctors say that it's chronic. It will most likely always come back.

[Revale]

So basically my action plan is: 1) Get the "Seborrheic dermatitis" under control. 2) find a good hair transplant surgeon. 

What I still don't know is: Do I need medication like Finasteride or Minoxidil even after a hair transplant, or does that depend on the case? My understanding is that the transplanted hair will stay for life because the hair follicles don't respond to DHT.

[Britanium]

1 minute ago, Revale said:

So basically my action plan is: 1) Get the "Seborrheic dermatitis" under control. 2) find a good hair transplant surgeon. 

What I still don't know is: Do I need medication like Finasteride or Minoxidil even after a hair transplant, or does that depend on the case? My understanding is that the transplanted hair will stay for life because the hair follicles don't respond to DHT.

Although the transplanted hair will stay, the rest of your hair will still proceed down the hair loss route, Fin will usually stop this from progressing any further (for most) or you end up chasing the loss.. IE multiple Hts. 

[JoeMan]

1 minute ago, Revale said:

So basically my action plan is: 1) Get the "Seborrheic dermatitis" under control. 2) find a good hair transplant surgeon. 

What I still don't know is: Do I need medication like Finasteride or Minoxidil even after a hair transplant, or does that depend on the case? My understanding is that the transplanted hair will stay for life because the hair follicles don't respond to DHT.

The new hair is likely to stay because it isn't susceptible to DHT but this isn't always perfect. Unfortunately the other hair that wasn't translated on the top and crown will continue to fall out eventually without medication. 

With 25k budget, stay away from Turkey. I'd consult Dr. Bisanga as he's one of the most experienced Dr's. He's likely worked with or seen cases like yours. 

[Rahal Hair Transplant]

Revale,

Based on what I’m reading, I would advise against a hair transplant at this time. I think it needs to be determined with absolute certainty whether or not your skin condition is actually causing your hair loss or if you also suffer from androgenetic alopecia (aka genetic baldness).

If the hair loss are experiencing is strictly from your seborrheic dermatitis and your hair comes back with proper treatment of the condition, then your focus should be in treating the condition to get your hair back and not surgical hair restoration.

Even if you have male pattern baldness in addition to seborrheic dermatitis, you should still get this condition under control prior to considering hair transplant surgery.

Here is another concern I have. Let’s say that you are able to get your scalp condition under control and all the hair affected by this condition grows back. Now let’s say that you still have some hair loss related to genetic baldness and you decide to undergo hair transplantation.  Since you can’t apply topical treatments and ointments to your scalp for a short time after your procedure, my concern is what might happen if the condition comes back during this time.  That could substantially affect your result and any natural hair surrounding the grafts.

I see you’ve already consulted a few surgeons. Thus, if you would like Dr. Rahal‘s input, let me know and we can set up a consultation.  Dr. Rahal is a highly esteemed Coalition member and has been recommended and highly regarded by this community, his patients and his colleagues for over two decades   

Note that I’m not usually so forward in inviting individuals to consult Dr Rahal on every topic but given the complexity of your situation, I just want to make sure that you’re given sound medical advice and you don’t do something that could potentially make your condition worse - especially because you’ve already gotten some conflicting advice.

Best wishes,

Rahal Hair Transplant 

Edited March 30, 2022 by Rahal Hair Transplant

[Rahal Hair Transplant]

Revale,

To answer your latest question about whether or not you need to continue using nonsurgical treatment such as finasteride, it depends on whether or not you’re experiencing hair loss due to genetic hair loss. Keep in mind that if you are, using finasteride might help prevent you from losing more hair and could potentially even thicken any existing thinning hair. However, you will need to continue using finasteride in order to maintain its benefit.

Thus, if you undergo hair transplant surgery which would help in restoring hair to bald and thinning areas, stopping finasteride would result in a loss of any natural hair that was benefiting due to its use.

Surgical hair restoration does nothing to stop the progression of genetic hair loss. So that’s why men still losing their hair typically use finasteride in an attempt to slow down or stop their hair from continuing to thin and undergo hair transplant surgery to restore hair to thinning or bald areas of the scalp.

I hope this helps.

Rahal Hair Transplant 
 

[Rahal Hair Transplant]

Note that hair loss due to a scalp condition such as seborrheic dermatitis is nongenetic in nature and is typically temporary. This is referred to as telogen effluvium, a temporary hair loss caused by some kind of stressor. The stressor can be anything from a medical condition to traumatic stress and can even caused by other things such as medication, etc.  Telogen effluvium is treated very differently than hereditary hair loss which is why many including myself have advise you not to undergo hair transplant surgery until your scalp condition is treated and it can be determined whether or not any hair loss you’re experiencing is due to genetics.

Sorry for the multiple posts on this topic, I just want to be thorough in addressing your situation.

Rahal Hair Transplant