Should I proceed?

[Mat16]

Hello,

So I was having an online consultation with dr Freitas who has the most amazing looking results in my opinion and he suggested 2000 grafts for my frontline and temples. I asked him when it’ll be possible to proceed with the procedure since I am only 23 years old and he said, that since my hair loss is not aggressive it would be possible to do it when I am 24 provided that I will be taking finasteride (suggested 0.5mg every day). I am currently taking finasteride and I’m trying to reach my desired dose of 1mg MWF. Last time I tried, I suffered side effects so I hope now it’ll be better.

 

my question to you is if I should proceed with this procedure. Hair loss has made my life so difficult and I would be extremely happy to sort it out. I am attaching my current photos (last are directly under the harsh strong light). Also I have posted my photos approximately two years ago so if you want to see how my hair loss is progressing you can find it in my profile.

 

thanks a lot

[HairEnthusiast101]

I probably wouldn’t even touch your head because it appears to be already very great, but of course that is up to you.

[Britanium]

Yeh, entirely you’re choice, but I don’t see a hair transplant being needed. If the med regime stops any further loss then great 👍🏽 

[Rahal Hair Transplant]

Mat16,

To be completely honest, you’re only showing pictures of your hairline and you have very mild hairline recession if that. You’re not showing any photos of the top of your scalp which leads me to believe that you aren’t experiencing any thinning up there.

The concern that I have is that young people are usually very dramatic about even the smallest signs of hair loss and want to instantly and immediately fix it hoping that they will look exactly like they did before experiencing any signs of thinning.

But what if you lose a lot more hair? What if finasteride doesn’t work for you? Or what if it works but it only slows things down and doesn’t stop it completely?

Lowering your hairline now when you’re barely experiencing any hair loss is very risky if you end up losing more hair. 

What is your family history of hair loss like? Does anybody on your mother‘s or father side of the family have any advanced degrees of balding? If so, that is a possibility for you although it is not definite.

Long story short, there are a lot of risks for young people with minimal hair loss getting a hair transplant. I would suggest waiting as long as possible and suggest using non-surgical solutions for as long as you can to see if it really can stabilize your hair loss for the long term.  Because ultimately, if it doesn’t work and you experience advanced degrees of thinning, the last thing you want is a low, youthful looking hairline with tons of hair loss behind it. It will look very unnatural and you will regret it.

Best wishes,

Rahal Hair Transplant 

Edited April 10, 2022 by Rahal Hair Transplant

[gillenator]

Very well said!…👍👌

[Mike10]

What the consultant from Rahal is excellent. I have been saying all along that in a lot of cases Finansteride will not halt but only slow down hair loss in the long term. 

Edited April 10, 2022 by Mike10

[Gokuhairline]

you will lose the vellus hairs on your hairline, those are the signs of loss, so keep in mind that in 3-7 years they will be gone and possible more , plan accordingly. 

[baldiee]

Since you are really young and not showing aggressive signs of hair loss - i say wait a few years to see the progression of it. You look great - i’d be happy with that amount of hair at 24. Focus on other things in life  

Reassess around age 27-28+. If your crown is stable, you can fix the frontal hairline. If you can tolerate finasteride without any side effects, then take that to protect your crown. 
 

You don’t want to use up so many grafts right now to fix/lower the hairline. And then years down the road, you run out of grafts to keep up with hair loss towards the back of your head. Donor hair is limited. We want to make sure you are set up safely in the long-term. Good luck! 

[baldiee]

Also try not to freak out so much. You CAN fix your hairline in the future. You will have a good hairline again. Hair transplants really do work. So don’t feel like this is how you’re going to look for the rest of your life. I can relate to losing your confidence/identity with even the slightest change in hair loss. Let’s first try being conservative for a few more years before committing to a hair transplant surgery. These forums will help find the right surgeon for you.

Edited April 10, 2022 by baldiee

[TheGreatPretender]

I honestly wouldnt touch it as you do have some good hair and the hair loss isnt aggressive. 

If you came in front of someone with that level of hair nobody would notice that you would be losing it. 

I do howeaver suggest to start medication ASAP so you can maintain what you have so if surgery is what you want you will be stable enough to have it. 

[Mat16]

4 hours ago, Rahal Hair Transplant said:

Mat16,

To be completely honest, you’re only showing pictures of your hairline and you have very mild hairline recession if that. You’re not showing any photos of the top of your scalp which leads me to believe that you aren’t experiencing any thinning up there.

The concern that I have is that young people are usually very dramatic about even the smallest signs of hair loss and want to instantly and immediately fix it hoping that they will look exactly like they did before experiencing any signs of thinning.

But what if you lose a lot more hair? What if finasteride doesn’t work for you? Or what if it works but it only slows things down and doesn’t stop it completely?

Lowering your hairline now when you’re barely experiencing any hair loss is very risky if you end up losing more hair. 

What is your family history of hair loss like? Does anybody on your mother‘s or father side of the family have any advanced degrees of balding? If so, that is a possibility for you although it is not definite.

Long story short, there are a lot of risks for young people with minimal hair loss getting a hair transplant. I would suggest waiting as long as possible and suggest using non-surgical solutions for as long as you can to see if it really can stabilize your hair loss for the long term.  Because ultimately, if it doesn’t work and you experience advanced degrees of thinning, the last thing you want is a low, youthful looking hairline with tons of hair loss behind it. It will look very unnatural and you will regret it.

Best wishes,

Rahal Hair Transplant 

Firstly, thank you for your take on this. 
I have been following this forum for quite some time and I consider myself adequately educated in this topic (at least much more then before). I know all about the risks of having the procedure done when young. 
However, I am not looking for lowering my hairline as my family history suggest my hair won’t stay in this state. My main goal is to fill my temples for them to be levelled with my current hairline (if you know what I mean). 
Regarding to my crown, I have a small bald spot there which has been in place for some years now. My only goal is to match my temples with my current hairline

[Rahal Hair Transplant]

Mat16,

At the end of the day it’s ultimately your choice as to what you want to do. And you will always find a clinic who will transplant on young patients.

I’m not suggesting that there aren’t cases where it’s appropriate, but even based on what you’re saying… let’s say you restore your temples to match your current hairline. Now what happens if your current hairline recedes further and the sides dip down?  The risks of advanced balding may or may not be there depending on your family history but if they are, you may end up chasing your hairline by continuing to restore hair to areas behind the temple points you’ve restored.

Ultimately, I am a firm leaver in informed consent. As long as you truly understand the risks associated with any decision you make and you don’t end up making an emotional decision that you later regret, then you’ve done everything that you really need to do. The choice is ultimately yours and I trust you will make an educated one.  

Wishing you all the best,

Rahal Hair Transplant 

[JayLDD]

2 hours ago, Mat16 said:

Firstly, thank you for your take on this. 
I have been following this forum for quite some time and I consider myself adequately educated in this topic (at least much more then before). I know all about the risks of having the procedure done when young. 
However, I am not looking for lowering my hairline as my family history suggest my hair won’t stay in this state. My main goal is to fill my temples for them to be levelled with my current hairline (if you know what I mean). 
Regarding to my crown, I have a small bald spot there which has been in place for some years now. My only goal is to match my temples with my current hairline

If you'd done extensive research you'd know that surgery in your current position is a bad idea in terms of risk/reward, a 2000 graft procedure even with your current hair would be undeniably hyper aggressive and set you up immediately for future surgery in the short term. When you're not on finasteride that 2000 graft hairline (mainly temple rebuilding) will have bald spots nothing behind it within 2-3 years potentially. Filling in only small temple areas is NEVER going to result in a long term natural appearance without future surgery and should rarely be considered, at your age and without finasteride it should almost not be considered at all.  If you were closer to 40 then its a different story but you're not. 

What you want is a situation where you can cover the entire frontal third including the centre, not just fill in recession. That way even if you have further loss of hair you'll be left with something natural that doesn't force you immediately into future surgery to not look like a freak. Think about through visualising how your hair is going to decay over time once you have the surgery, not to mention the potential for permanent shock loss around the area of implantation that would rapidly require you to be in the surgical chair within even a year. No one has strong temples and a decaying frontal tuft, and that's going to be a problem. 

I might sound overly harsh, but in particular the idea of levelling your temples with the centre tuft of remaining strong hairline is nonsensical at your age with your level of loss. You're going to be left with corners of the hairline with strong, transplanted androgen immune hair and a wispy centre that is pulling back, a recipe for disaster unless you're 100% willing to go back for future surgery within a year or two. 

I know the body dysmorphia effects hairloss can have at your age but to be very clear you would barely look to the average person like you have hairloss. There are plenty of people with naturally higher hairlines than you currently have and mature hairlines (which you're not all that far beyond) are common and will only become more common for your peers over the next five years. Its not "over" for you (yet) as some overly blackpilled individuals online might suggest. 

The idea to fill in only a small amount of temple recession when your central tuft is going to be miniaturising and potentially substantially within a few years without finasteride is idiotic, period.  Wait until the point where you're a clear norwood 3-4 and can replace the entire frontal third. If you have rich parents who are going to pay for your current surgery with a high level surgeon like Freitas and then happily pay for a second surgery in a year or two if you further lose hair, then its still somewhat viable. But you should be absolutely aware of and willing to deal with a potentially necessary second surgery within a few years to keep a natural appearance. 

Also for the record I was still one of the youngest (if not the youngest that I'm aware of) patients to have FUE at my scale. I went more aggressive than almost anyone on this forum would advocate for at that age (and also had to get off finasteride) but the key was that I had back up plans for things like low yield or further losses mandating rapid future surgery. I also had more than enough in funds at the time to have even 3 surgeries within a five year period in the case I needed a repair. You've got to be willing to and have the money for multiple surgeries and potentially to go down the FUT route if you have a poor yield and require a repair when you're already on on finasteride. If your parents are loaded or you're a crypto baron then I'd probably just have surgery with Freitas in that case. Although even then risks should be seriously considered. If you're not in this position not only is it a gamble, you WILL be on the hook for future surgery due to an unnatural appearance. 

 

[Gatsby]

From my own experience of having more loss and surgery at a younger age (18) I cannot stress upon you the regrets that you will have going down the path of surgery now by the time you are 27/28. After this it just gets worse as the hair loss continues. I know this is not what you want to hear and neither did I. So please learn from what I went through and have surgery when the time is right. You really want to be a good responder to finasteride, etc. All the best!

[mafpe]

most here on forum would say that you shouldn't do it before 25, and more like, at least 30+.
i'm guessing that this come from insecurity for having a "big forehead" compared to your peers? i had that problem as well, including the "slightly" recessed hairline since high school.

the words of the people here is true, esp since hair loss isnt really a linear progression, and the problem with getting a new hairline will be the bald spot behind it after, which will look very artificial, and people WILL notice if it's not covered properly and they are looking at it, especially if your temple recessed even just a small amount, then there will be a lining where your hair seems detached (same case as the hairline).

if you are still going to go through it, my advices are :

1. a conservative hairline and graft number, because once you get older, it will be weirder if you have a very youthfull low hairline when everyone your age is having their hairline at least 2 cm higher.

2. you are ready to go on meds (minox-finas for example) to protect your existing hairline, this will minimalise the problem i wrote earlier, and if you have sides, you can try topical one.

3. when later the warning that this forum peeps gives you become true, that means you need to ready yourself to either accepting it (can still be helped with hair fiber, or just going bald), or have more procedure in order to cover the problem area as you age (this is rather normal and many does this, making it somewhat of a life commitment, and this is why i listed number 1, so you can have more later in your life)

 

question yourself, which age range in your life do you think will be most important? which age are you wanting to have a good confidence boost? people cites higher ages so they have less regret, but i think it is also as important to live your life to the fullest, if you plan to find your SO and be married at 28, i do think it is better for people to have HT if ever before the said age.

sure having one at 35 would be better in "long term result" but sometime for some people, past certain age they already set their life, and doesn't really care what other thinks, nor be as insecure anymore. If so, do they even need or even want to have an HT at that point? if no, then they simply traded their fears and insecurity in early life for a good sum of saving.

[Mat16]

8 hours ago, JayLDD said:

If you'd done extensive research you'd know that surgery in your current position is a bad idea in terms of risk/reward, a 2000 graft procedure even with your current hair would be undeniably hyper aggressive and set you up immediately for future surgery in the short term. When you're not on finasteride that 2000 graft hairline (mainly temple rebuilding) will have bald spots nothing behind it within 2-3 years potentially. Filling in only small temple areas is NEVER going to result in a long term natural appearance without future surgery and should rarely be considered, at your age and without finasteride it should almost not be considered at all.  If you were closer to 40 then its a different story but you're not. 

What you want is a situation where you can cover the entire frontal third including the centre, not just fill in recession. That way even if you have further loss of hair you'll be left with something natural that doesn't force you immediately into future surgery to not look like a freak. Think about through visualising how your hair is going to decay over time once you have the surgery, not to mention the potential for permanent shock loss around the area of implantation that would rapidly require you to be in the surgical chair within even a year. No one has strong temples and a decaying frontal tuft, and that's going to be a problem. 

I might sound overly harsh, but in particular the idea of levelling your temples with the centre tuft of remaining strong hairline is nonsensical at your age with your level of loss. You're going to be left with corners of the hairline with strong, transplanted androgen immune hair and a wispy centre that is pulling back, a recipe for disaster unless you're 100% willing to go back for future surgery within a year or two. 

I know the body dysmorphia effects hairloss can have at your age but to be very clear you would barely look to the average person like you have hairloss. There are plenty of people with naturally higher hairlines than you currently have and mature hairlines (which you're not all that far beyond) are common and will only become more common for your peers over the next five years. Its not "over" for you (yet) as some overly blackpilled individuals online might suggest. 

The idea to fill in only a small amount of temple recession when your central tuft is going to be miniaturising and potentially substantially within a few years without finasteride is idiotic, period.  Wait until the point where you're a clear norwood 3-4 and can replace the entire frontal third. If you have rich parents who are going to pay for your current surgery with a high level surgeon like Freitas and then happily pay for a second surgery in a year or two if you further lose hair, then its still somewhat viable. But you should be absolutely aware of and willing to deal with a potentially necessary second surgery within a few years to keep a natural appearance. 

Also for the record I was still one of the youngest (if not the youngest that I'm aware of) patients to have FUE at my scale. I went more aggressive than almost anyone on this forum would advocate for at that age (and also had to get off finasteride) but the key was that I had back up plans for things like low yield or further losses mandating rapid future surgery. I also had more than enough in funds at the time to have even 3 surgeries within a five year period in the case I needed a repair. You've got to be willing to and have the money for multiple surgeries and potentially to go down the FUT route if you have a poor yield and require a repair when you're already on on finasteride. If your parents are loaded or you're a crypto baron then I'd probably just have surgery with Freitas in that case. Although even then risks should be seriously considered. If you're not in this position not only is it a gamble, you WILL be on the hook for future surgery due to an unnatural appearance. 

 

Thank you!

 Honestly, 2000grafts seemed quite aggressive to me too. However, I have contacted dr Freitas because I thought he has a huge waiting periods and I wanted to be set to have the procedure at 25/26 as I know that having the operation before 25 is a no go. I just wanted to get the consultation out of the way and to be prepared to take the procedure in 2-3 years. But, since I consider dr Freitas to be a moral and ethical doctor, I thought his suggestion might not be that risky since they told me, that they can easily operate on me when 24 (due to my current non-aggressive hair loss). The condition however was to be on finasteride. And I am aware of the fact that fin in my case is an absolute must. 
Maybe I have a follow up question, what do you think is the optimal dosage for me to be able to have the procedure in future?

would 1mg two or three times a week be enough? I’m not sure I could tolerate more.

[Mat16]

4 hours ago, Gatsby said:

From my own experience of having more loss and surgery at a younger age (18) I cannot stress upon you the regrets that you will have going down the path of surgery now by the time you are 27/28. After this it just gets worse as the hair loss continues. I know this is not what you want to hear and neither did I. So please learn from what I went through and have surgery when the time is right. You really want to be a good responder to finasteride, etc. All the best!

Thanks Gatsby. Normally, after what I have learned here, I would never think about having the procedure before 25.  Just when dr Freitas suggested it I thought he probably knows what he’s talking about. Not sure anymore :)

[John1991]

15 hours ago, Gatsby said:

From my own experience of having more loss and surgery at a younger age (18) I cannot stress upon you the regrets that you will have going down the path of surgery now by the time you are 27/28. After this it just gets worse as the hair loss continues. I know this is not what you want to hear and neither did I. So please learn from what I went through and have surgery when the time is right. You really want to be a good responder to finasteride, etc. All the best!

I agree with your assessment that he should wait before pursuing surgery.  Especially until after he knows if finasteride can stabilize him. It doesn't actually appear to me that he needs to be "stabilized," though.  He doesn't appear to be someone who is on the verge of minor hair loss, much less precipitous loss.  This guy looks like a normal 23 year old, with a strong hairline.  It may or may not recede,  but nothing in these pictures really indicates that it will and I would hesitate to call this a "mature" hairline.  

Edited April 11, 2022 by John1991

[Mat16]

1 hour ago, John1991 said:

I agree with your assessment that he should wait before pursuing surgery.  Especially until after he knows if finasteride can stabilize him. It doesn't actually appear to me that he needs to be "stabilized," though.  He doesn't appear to be someone who is on the verge of minor hair loss, much less precipitous loss.  This guy looks like a normal 23 year old, with a strong hairline.  It may or may not recede,  but nothing in these pictures really indicates that it will and I would hesitate to call this a "mature" hairline.  

When I style it carefully, I can somehow hide the balding. However, under a harsh light as you can see (might as well be sun also) my temples are standing out so much. In the dark it’s usually fine. But your opinion about my balding is not correct sorry (I would be very happy if it was) but you can take a look on my older threats where I have shared photos from approximately two years ago, and you can see the balding there (I had shorter hair then).

Edited April 11, 2022 by Mat16

[John1991]

OK then.  In the pictures you posted here, you don't appear to be losing hair. It's not uncommon for small amounts of recession to occur in your early 20s - that's not necessarily a sign that you're going to suffer bad hair loss, much less bad hair loss soon.  I experienced that at 23-24 (probably slightly more than you have), and didn't even get on finasteride until years after that.  I'm 31 now and my hair has hardly changed since then.  

Edited April 11, 2022 by John1991

[Mat16]

8 minutes ago, John1991 said:

OK then.  In the pictures you posted here, you don't appear to be losing hair. It's not uncommon for small amounts of recession to occur in your early 20s - that's not necessarily a sign that you're going to suffer bad hair loss, much less bad hair loss soon.  I experienced that at 23-24 (probably slightly more than you have), and didn't even get on finasteride until years after that.  I'm 31 now and my hair has hardly changed since then.  

Well these are very comforting words thanks

[John1991]

39 minutes ago, Mat16 said:

Well these are very comforting words thanks

Here's an example - my hair has been almost exactly as shown in this picture for 8 years (this picture is from last month just before turning 31).  I had some definite concern when - at 23 - I noticed that seemingly all of a sudden my hairline wasn't quite what it was at 18.  Given that you're posting on here, you're clearly more in worry mode than I was.  I would advise you that, for your mental well-being, don't go down the road of obsession that I have. You have two choices...  One is to see if you remain stable and then in 5-7 years perhaps be aggressive and go from NW 2 to a stronger NW 2 with surgery.  The other is to be (IMO) reckless and try to go from a NW 2 now to a stronger NW 2 now.  If you do and you stay stable, you end up with years worth of being a better NW 2 under your belt (though that's arguably not going to really impact your life much).  If you do and you have considerable loss, you're in disaster territory because you lowered an already solid hairline at age 24 and then are chasing to keep up with your loss.  I think the other posters (I'd imagine all of whom have more experience looking at hair loss than I do) are correct to write you words of caution.

 

Edited April 11, 2022 by John1991

[hybonix]

Your hairline looks great! Stick to the meds and see where things go! I got my transplant at 27 which was a bit young, but I literally had no hairline. I had a couple of hairs and was pretty bald, so the juice was worth the squeeze. I didn't take meds until I started researching my transplant at 27, so mine got aggressively worse. You still have a chance to keep a lot of your native hair with fin and min combo. You are in a MUCH better shape than a lot of people and I would wait until late 20s or even 30 to see where you are at. You can always lower the hairline later in life if you are stable and have an idea of how the hair loss progresses. You can always add more with future transplants as well, but having to remove hair is a pain and wastes valuable grafts that are limited...

Edited April 11, 2022 by hybonix

[John1991]

20 minutes ago, hybonix said:

Your hairline looks great! Stick to the meds and see where things go! I got my transplant at 27 which was a bit young, but I literally had no hairline. I had a couple of hairs and was pretty bald, so the juice was worth the squeeze. I didn't take meds until I started researching my transplant at 27, so mine got aggressively worse. You still have a chance to keep a lot of your native hair with fin and min combo. You are in a MUCH better shape than a lot of people and I would wait until late 20s or even 30 to see where you are at. You can always lower the hairline later in life if you are stable and have an idea of how the hair loss progresses. You can always add more with future transplants as well, but having to remove hair is a pain and wastes valuable grafts that are limited...

At his level of loss, I wouldn't even advise meds.  I think he should try Nizoral 2% for a while to thicken.  If after that it doesn't improve or he has loss, then jump on Fin.  Then minoxidil later if he wants to thicken.  Starting with the kitchen sink, as it were, is annoying because then you're using this stuff forever.  Start with as little as possible, then add things if you feel it's necessary is my take on the situation.  If these pictures aren't a major optical illusion, he's not destined for short term serious loss, so he should try to get away with as little as possible before committing himself to a lifetime of Fin and min

Edited April 11, 2022 by John1991

[hybonix]

5 minutes ago, John1991 said:

At his level of loss, I wouldn't even advise meds.  I think he should try Nizoral 2% for a while to thicken.  If after that it doesn't improve or he has loss, then jump on Fin and Minoxidil.  I didn't start finasteride (.5 every other day) until after 26 and I'm glad I waited.  If you're truly destined for severe loss early on, you're likely worse off than this guy is.

He is young, so the body is still developing. All I know is that most people who wait to take fin end up regretting it and wish they started sooner. As long as you monitor, you will be fine. So, he can try more "conventional" methods due to his loss being so minor. Biotin and nizoral. Could even use some dermarolling or stamps, but I do not want to give bad advice. I recommend talking to a dermatologist or schedule a free consult with an ethical HT surgeon who will give you the best recommendation.

Edited April 11, 2022 by hybonix