Should I proceed?

[jackiema]

I'm sorry I am late to the thread, but would you even call this hair loss? I thought his hair is perfect! 2000 hairs is crazy!!! Why would a doctor recommend that? This is why everyone needs to have several consults with different doctors and thankfully you can do them online. But really, you don't need a hair transplant, you're headed for Regret City if you do. 

[JayLDD]

15 hours ago, Mat16 said:

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.

I took 0.25mg  daily and side effects slowly crept up after about two years before I got off it. So you can't place that much stock in the drug in the short term, that's the problem. The reduction curve of DHT doesn't change much from 0.25mg to 1mg, so even if just for the sake of cost savings its always best to quarter the pill. To be blunt, if you suffered side effects in the past I'd recommend you don't push it. As I mentioned no matter the dosing pattern or doseage itself the reduction in DHT will be similar, if your body can't tolerate 1mg I'd avoid it entirely. Don't push it when your body is clearly telling you to avoid it. 

In terms of graft numbers, basically *any* hairline procedure with good density is going to be at minimum 1500 grafts. Simply because it requires a lot of single hair grafts and the frontal hairline requires the highest density across the scalp. Any less and it will begin to look a little pluggy or unnatural as your current hair behind it is still quite youthful and dense. 

Its less about age and more about the possibilities you're setting up with the procedure and the potential risks it might create. A small hairline procedure (even 1000 grafts) is the riskiest procedure you can possibly do because it means you're going to create a dense, healthy hair barrier at the very front meanwhile everything behind it is miniaturising. A strip of hairline isn't going to give you coverage to cover up thinning hair, hence why ideally your first surgery should cover the entire frontal third, or at the very least you should be budgeting and planning for two surgeries over say a three to five year period.  Its not a matter of 2000 grafts being aggressive and that you should consider say 1000-1500, its the TYPE of procedure for someone in your position that is young and hasn't tolerated finasteride well is high risk and keeps you on the hook for future surgery. What you want is to tackle the frontal third with 3-4000 grafts when you actually have significant losses at the point where you're a NW3+. 

Freitas certainly knows what he's doing but he's going to have an expectation that you have made an assessment of the risks and at the day he's not going to babysit you over those potential problems. At the end of the day problems arising that I've mentioned will have you on the hook for more surgery, and he isn't going to worry about this. 

I think the best thing you can do is wait a few years until you're clearly a NW3 and can fix the entire frontal third and in the meantime budget for multiple procedures, enough to pay for 6000 grafts with a surgeon like Freitas. I wouldn't bank on finasteride.  Money and willingness to do multiple surgeries with back up plans are more important than anything here. 

In terms of another individual here saying that you might not have genuine hairloss, they have no idea what they're talking about, you should absolutely be preparing for significant losses over the next five years and at the very least be using something like a ketoconazole shampoo to inhibit that (in general circumstances I would also say finasteride, but because you didn't tolerate it previously I wouldn't lean in that direction). Why do I say that? Because you clearly have miniaturising hair in the frontal hairline and from what you've said the crown as well. Also the recommendation of visiting a dermatologists is pointless, for the most part they'll have no idea what they're talking about, from the photos and what you've said its clear you have male pattern baldness, you don't need a doctor to tell you this, nor for them to tell you about treatment.

[Mat16]

On 4/12/2022 at 12:20 AM, JayLDD said:

I took 0.25mg  daily and side effects slowly crept up after about two years before I got off it. So you can't place that much stock in the drug in the short term, that's the problem. The reduction curve of DHT doesn't change much from 0.25mg to 1mg, so even if just for the sake of cost savings its always best to quarter the pill. To be blunt, if you suffered side effects in the past I'd recommend you don't push it. As I mentioned no matter the dosing pattern or doseage itself the reduction in DHT will be similar, if your body can't tolerate 1mg I'd avoid it entirely. Don't push it when your body is clearly telling you to avoid it. 

In terms of graft numbers, basically *any* hairline procedure with good density is going to be at minimum 1500 grafts. Simply because it requires a lot of single hair grafts and the frontal hairline requires the highest density across the scalp. Any less and it will begin to look a little pluggy or unnatural as your current hair behind it is still quite youthful and dense. 

Its less about age and more about the possibilities you're setting up with the procedure and the potential risks it might create. A small hairline procedure (even 1000 grafts) is the riskiest procedure you can possibly do because it means you're going to create a dense, healthy hair barrier at the very front meanwhile everything behind it is miniaturising. A strip of hairline isn't going to give you coverage to cover up thinning hair, hence why ideally your first surgery should cover the entire frontal third, or at the very least you should be budgeting and planning for two surgeries over say a three to five year period.  Its not a matter of 2000 grafts being aggressive and that you should consider say 1000-1500, its the TYPE of procedure for someone in your position that is young and hasn't tolerated finasteride well is high risk and keeps you on the hook for future surgery. What you want is to tackle the frontal third with 3-4000 grafts when you actually have significant losses at the point where you're a NW3+. 

Freitas certainly knows what he's doing but he's going to have an expectation that you have made an assessment of the risks and at the day he's not going to babysit you over those potential problems. At the end of the day problems arising that I've mentioned will have you on the hook for more surgery, and he isn't going to worry about this. 

I think the best thing you can do is wait a few years until you're clearly a NW3 and can fix the entire frontal third and in the meantime budget for multiple procedures, enough to pay for 6000 grafts with a surgeon like Freitas. I wouldn't bank on finasteride.  Money and willingness to do multiple surgeries with back up plans are more important than anything here. 

In terms of another individual here saying that you might not have genuine hairloss, they have no idea what they're talking about, you should absolutely be preparing for significant losses over the next five years and at the very least be using something like a ketoconazole shampoo to inhibit that (in general circumstances I would also say finasteride, but because you didn't tolerate it previously I wouldn't lean in that direction). Why do I say that? Because you clearly have miniaturising hair in the frontal hairline and from what you've said the crown as well. Also the recommendation of visiting a dermatologists is pointless, for the most part they'll have no idea what they're talking about, from the photos and what you've said its clear you have male pattern baldness, you don't need a doctor to tell you this, nor for them to tell you about treatment.

Well definitely I know I have a hair loss problem, advanced hair loss though. People who say my hair is perfect, though it’s comforting, should take a look at my old photos from past threads on my profile. I know the surgery might be very risky at the age of 24-25 but honestly, I cannot imagine how my life will look like without it cause I’m honestly starting to be afraid of summer due to the continuous sun shining and revealing my baldness.

Do you think that maybe only a small procedure without any hairline lowering like in the picture with black lines attached could be possible? With the minimum amount of grafts possible?

btw, the picture is from approximately two years ago when I cut my hair short and I’m sure my hair loss advanced from that stage. 
 

here I am also attaching a link to my previous thread with other photos of my hair from past: 

 

[MAIZE1694]

1 hour ago, Mat16 said:

I  cannot imagine how my life will look like without it cause I’m honestly starting to be afraid of summer due to the continuous sun shining and revealing my baldness.

 

Show us recent pics of the crown. Because if its anything close to the thread from 2021 well then you ain't bald lol. Not even close.

Take a look at some of the patient threads on here of actual legit NW 4,5,6 guys. You should stay on FIN and reevaluate in a few years. (IMO)

[Mat16]

18 minutes ago, MAIZE1694 said:

Show us recent pics of the crown. Because if its anything close to the thread from 2021 well then you ain't bald lol. Not even close.

Take a look at some of the patient threads on here of actual legit NW 4,5,6 guys. You should stay on FIN and reevaluate in a few years. (IMO)

Here are the photos.

[Mat16]

and what about this conservative design? With the minimum amount of grafts possible? Would it also be dangerous?

Edited April 19, 2022 by Mat16

[Mat16]

On 4/17/2022 at 9:06 PM, Mat16 said:

and what about this conservative design? With the minimum amount of grafts possible? Would it also be dangerous?

.

[Mat16]

On 4/19/2022 at 10:01 AM, Mat16 said:

.

What if I can’t tolerate finasteride? When would be the time to have the first procedure done?