Eugenix is where I should go, right? (26, NW 5/6)

[general-etwan]

Finally deciding I want to have a HT done. This is a bit of story: MPB runs very aggressively in my family and I started losing my hair around age 15. I've never even known what it's like to have a full head of thick hair as an adult because I started buzzing my head in my early teens and then it just disappeared rather quickly. By 22 I had lost pretty much all the hair on top. NW 6. For years I just accepted it, but that meant suffering in silence. (Age progression pics: https://imgur.com/a/drWI9yl) I felt like I had no options. A dermatologist offered me finasteride at 22 and I rejected it because I was (irrationally) scared after reading too many horror stories online about it. Last year, I gave hair systems a try since my father has worn systems since 20s and I never would've known if he didn't tell me about 3 years ago. That's how great they can look. I wore systems for about 9 months, and enjoyed certain aspects of it...including the look...but ultimately that became too annoying for my lifestyle and it's not something I wanted to do forever. 

I made the decision to begin taking finasteride in late December 2021, while still wearing systems. I quickly noticed that when the system was being removed at the salon, I had more hair growth on the top of my head than I had seen in years. I subsequently ditched the systems and am back to being bald, but I've worn hats everywhere since my teens so I'm just used to covering it now. As soon as I ditched the systems, I added in minoxidil 2x/day, microneedling occasionally, and nizoral shampoo. 

In just 4 months, I've noticed substantial regrowth of lost hair, which I assume is primarily from finasteride (4 days/week) but likely a combination of this entire regimen I finally decided to dedicate myself to. I've heard that finasteride can sometimes take 6 months to show noticeable improvement, so the fact that it began happening immediately in my case was a huge boost of hope. I feel like I've gone from a NW 6.5 to 5ish in just these 4 months. I've also experienced no negative side effects, so we're completely good there.

Prior to all of this, I was essentially not a HT candidate because I had lost so much hair already: https://imgur.com/a/LnmEGre

I had a consultation with Dr. Bernstein in NYC in 2020 and they kindly rejected me because they said 1) I had too much area to cover and not enough donor grafts for what they desired to see, and 2) they require patients to take finasteride for 1 year first to see what can be stabilized or regrown, which I had not begun at the time. I was discouraged, but that was all before I've achieved this regrowth now.

After 4 months of fin + min + minox + nizoral: https://imgur.com/a/TQm4C93

Accepting the hair loss has never been something I settled on, and it's the horseshoe-looking pattern that has always bothered me more than anything else. I can accept thin hair, I can accept a high hairline, but the ring pattern that is so visible...it's unacceptable to me and I am determined to resolve it to the best of my capacity. Even if I can just get back to a NW 3 or 2 with better permanent framing of my face and hair on top that I can grow to some length, I will be thrilled. 

I've done some research lately on HT centers and it seems Eugenix in India is the best place to go for a higher Norwood case like me. USA is far too expensive, and most clinics in Turkey are probably too risky to justify the cheap cost (and I hate risky). 

I don't know exactly how many grafts I will require, but I assume somewhere around 5000-7000; a large haul still, even assuming finasteride will hang onto some of that regrown hair. Eugenix has different packages to choose from...the question is, which one should I go with? How important is it to have one of the founding doctors or experts involved in my case? I think the highest I'd be willing to pay for is the Premium Package ($2.74 per graft), which brings Dr. Bansal into most of the transplant except for final implantation. But I feel like even the Exclusive Package ($1.57 per graft) could be sufficient. I just want some uniform hair on top of my head at this point that can stop me from wearing hats forever!

I appreciate any advice anyone could give me on if Eugenix is the place to go and anything I should know about this process. Thank you!

Edited May 6, 2022 by general-etwan
Pictures

[Britanium]

Could you post the pics directly here on the thread so they show ? Thanks 🙏 

[Britanium]

Eugenix are not the only ones doing really good work with the higher Norwood levels, yes they are presenting a lot of cases but it’s important to consider other Clinics/Drs also. You have a very large area to cover, this is going to depend on your goals/expectations, realistically how much hair can you expect to get ? Personally I would say a lot more than the numbers your thinking. 7k would get you some coverage sure, but what would it be like in terms of density ? 

Some other names I will throw out are @Dr. Felipe Pittella, Dr Zarev, Hattingen, Dr Bisanga, Fuegenix, @DrTBarghouthi, Dr Mwamba & HDC.. 

Edited May 6, 2022 by J.A.C

[Britanium]

It’s good that you have already seen some impressive results happening from your med regime, most people will see improvements after 6 - 12 months, so your definitely ahead of the curve.. 👊

[general-etwan]

5 minutes ago, J.A.C said:

It’s good that you have already seen some impressive results happening from your med regime, most people will see improvements after 6 - 12 months, so your definitely ahead of the curve.. 👊

Yes, that has given me hope. I'm glad I decided to try finasteride and the regime that I regrettably hadn't gotten on sooner...and that is why I think a transplant can be doable now. Can't break the bank though. Looking for $10-17k to get to at least a NW 2-3. Thanks. 

Edited May 6, 2022 by general-etwan

[Britanium]

The thinning I can see at the side isn’t a great sign… is it the same on both sides of your scalp ?

[general-etwan]

1 minute ago, J.A.C said:

The thinning I can see at the side isn’t a great sign… is it the same on both sides of your scalp ?

It's on both sides and it's been that way for almost 10 years now. I've always had that patchy look right above the ear, only visible when buzzed short. It really hasn't changed, and maybe finasteride will even assist in strengthening the more gray areas of the donor area over the months. Will see...

[Britanium]

1 minute ago, general-etwan said:

Yes, that has given me hope. I'm glad I decided to try finasteride and the regime that I regrettably hadn't gotten on sooner...and that is why I think a transplant can be doable now. Can't break the bank though. Looking for $10-17k to get to at least a NW 2-3. Thanks. 

If I can be blunt here.. it would take the right Dr/Clinic and a few procedures, with the loss I can see and the thinning at the sides ? It’s going to prove tough to get back up the Norwood levels. You need to be so careful, it’s good your responding from the meds, but I’m not convinced you have enough to get a adequate result.

It would take maybe a combo of either FUT/FUE and Beard grafts to get the numbers up, and I think it would definitely break your bank unfortunately 😬

[general-etwan]

9 minutes ago, J.A.C said:

If I can be blunt here.. it would take the right Dr/Clinic and a few procedures, with the loss I can see and the thinning at the sides ? It’s going to prove tough to get back up the Norwood levels. You need to be so careful, it’s good your responding from the meds, but I’m not convinced you have enough to get a adequate result.

It would take maybe a combo of either FUT/FUE and Beard grafts to get the numbers up, and I think it would definitely break your bank unfortunately 😬

Dr. Zarev and some of the others you mentioned earlier...I have no way to get to him, for example. Seems impossible. Tried to consult with him and couldn't. Seems like people are waiting years. He only shows limited cases and mostly not western Caucasian men like me, so still a little in the dark in my opinion. 

I'm not sure the numbers would need to go much higher than 7 or 8k for what I'm expecting. I saw another post here of a Eugenix case of a completely bald man and he looks to have gotten 5-6k. He might not have thick density, but not all of us expect that...the decrease in ring pattern visibility can be huge in itself. It's more important for me to have more uniform density across the entire head than a certain density in a certain area.

The standard package at Eugenix is $0.98/graft. That keeps me well in my range. I'll be okay there. I think there are a lot of good options money wise.

Edited May 6, 2022 by general-etwan

[Britanium]

Just now, general-etwan said:

Dr. Zarev and some of the others you mentioned earlier...I have no way to get to him, for example. Seems impossible. Tried to consult with him and couldn't. Seems like people are waiting years. He only shows limited cases and mostly not western Caucasian men like me, so still a little in the dark in my opinion. 

I'm not sure the numbers would need to go much higher than 7 or 8k for what I'm expecting. I saw another post here of a Eugenix case of a completely bald man and he looks to have gotten 5-6k. He might not have thick density, but not all of us expect that...the decrease in ring pattern visibility can be huge in itself. 

The standard package at Eugenix is $0.98/graft. That keeps me well in my range. I'm good there!

It’s going to take a online consultation with Eugenix to get a better idea of what they can achieve. It’s difficult not to compare to others, and that’s ok to a certain degree, but no 2 people are the same in terms of area to cover, or donor areas. With the right hairline, let’s see how many they would propose 👍🏽🙏

[Britanium]

@ZoomsterFor example had extensive loss, and he’s now at over 11600 grafts, and I think he’s tempted for another top up.. 

But yes it’s all about expectations, as your already on Fin and have a very realistic approach then it’s certainly possible that you could have a procedure. 

[Britanium]

9 minutes ago, general-etwan said:

The standard package at Eugenix is $0.98/graft.

For the cheapest package yes, but 18% is also added (Indian tax), I quite like the work of Dr Priya Das who is doing the work on the next tier up. 

[John1991]

"I've never even known what it's like to have a full head of thick hair as an adult..."  That's rough, man.  Obviously there are actual diseases and what not that are far more serious than something like hair loss, but I empathize with your situation.  I really hope you end up getting results similar to some of the good ones I've seen in NW 5/6 cases that went to Eugenix.  I hope there will come a day when some super dutasteride w/out the sides comes into existence.  

[DrTBarghouthi]

4 hours ago, J.A.C said:

Eugenix are not the only ones doing really good work with the higher Norwood levels, yes they are presenting a lot of cases but it’s important to consider other Clinics/Drs also. You have a very large area to cover, this is going to depends on your goals/expectations, realistically how much hair can you expect to get ? Personally I would say a lot more than the numbers your thinking. 7k would get you some coverage sure, but what would it be like in terms of density ? 

Some other names I will throw out are @Dr. Felipe Pittella, Dr Zarev, Hattingen, Dr Bisanga, Fuegenix, @DrTBarghouthi, Dr Mwamba & HDC.. 

Thanks for the mention @J.A.C

@general-etwan can you kindly share some beard photos too. I do think that beard will need to be utilised and probably from the beginning. It all depends on how much coverage you’re looking at though. But 6-7000 is what this requires ideally. 

[Gatsby]

You will need a serious number of beard grafts to address your hair loss. Possibly 3-4K in addition to using your scalp donor grafts. You’re a good responder to meds and they may even help more in time. As a high Norwood like myself I would suggest contacting Eugenix who are highly skilled in managing this number of beard grafts. All the best. 

[mrmane85]

If you're going to start this process then you'll most likely need 3 surgeries, likely over 3 years, as you want to be careful of not over harvesting your donor.

This is good because your plan it out correctly and you will end able to save between each procedure to ensure you only work with a top surgeon. 

Good luck

[Bandit90]

I can totally empathise with your situation, I too never experienced a full head of hair in adult life to balding at 15 years old! 

I agree, with other posters you are going to need a least two surgeries and give up some beard hair, but it's a small price to pay for a good result!

I too started for a similar position to yourself. I have just come out my first procedure with Dr Sethi in March, and going for round two in October. But I can hand on heart say it was the best decision i've ever made!  

[Nw7HPE]

How is your beard/body hair ?

[NARMAK]

OP, just looking at your 4 month results on those three things is showing good response BUT you can actually improve it further. Start Microneedling!!! 

Use a derma pen once a week at 1mm to 1.5mm and you will likely get even better results. 

Because you probably buzzed it down to wear hair systems, it probably exaggerated your hair loss because follicles weren't getting enough oxygen etc. So i would recommend you to stay on the path to hair restoration rather than going for a transplant just yet. 

I know this SUCKS to hear because it's all about your 20s and being cool, but i would honestly say to save up and see how your progress is with the medication for 12-24 months at least. You're still on the younger side in terms or aggressive hair loss and it possibly going. Ideally getting to your 30s with great response probably could make you a better candidate. 

 

[Mountinvan]

Glad you did such a thorough post. If you had your ideal situation, what would your hairline look like? Maybe you could photoshop a proposed result? I wouldn't limit your artistic creativity to any of your previous age stages since you are likely to have to sport a more mature look. I think if you pick the right clinic/surgeon you are going to be one happy young man. We are so lucky to be living in a time when we have options other than hats and powder wigs. Also, Melvin is testing out a laser cap and am wondering whether he would recommend using that modality now or waiting to after you have your procedure?

[Dally6]

15 hours ago, Gatsby said:

You will need a serious number of beard grafts to address your hair loss. Possibly 3-4K in addition to using your scalp donor grafts. You’re a good responder to meds and they may even help more in time. As a high Norwood like myself I would suggest contacting Eugenix who are highly skilled in managing this number of beard grafts. All the best. 

Im new to this HT journey and investigating options. Im told I'm a NW5 based on the pics I submitted to a reputable clinic. Another clinic told me I need 4500 graphs.Either way I need a lot of and my hair loss will continue as I wont take meds. Based on my research it would be appear an FUT would be a best initial option (as it wont exhaust my donor region), but I would much rather get an FUE. However, I didn't know taking hair from the beard was an option. I have a thick beard.

I guess my question is: instead of an FUT now + FUE later (as I was planning), could I not get an FUE now + Beard extraction later?

[general-etwan]

17 hours ago, Mountinvan said:

Glad you did such a thorough post. If you had your ideal situation, what would your hairline look like? Maybe you could photoshop a proposed result? I wouldn't limit your artistic creativity to any of your previous age stages since you are likely to have to sport a more mature look. I think if you pick the right clinic/surgeon you are going to be one happy young man. We are so lucky to be living in a time when we have options other than hats and powder wigs. Also, Melvin is testing out a laser cap and am wondering whether he would recommend using that modality now or waiting to after you have your procedure?

Thank you. To address some of the other comments as well, first: I am knowledgeable about beard and body hair being used for high Norwood cases; though my preference is do everything possible to avoid this. Even if I have to sacrifice some density/coverage on top, it may be something I'm willing to accept to avoid stealing beard or body hair. Beard hair is the only other hair I would consider, actually. Body hair has totally different androgen phases and in my opinion is not appropriate to use on the head, and I will never do that.

I also do not believe I need three procedures and certainly will not be doing that, respectfully. At most, I will agree to two, but I've seen people with my situation achieve what I think is a satisfactory look with one large procedure of 7-8,000ish grafts; or sometimes a two-day procedure. I'm not interested in having repeat procedures over the years, and I'm not just being naïve...I have thought about that for a long while and decided I want to repair this as much as possible in one go (or at most two) and then be done with it. I don't need perfection. I just need a recreated look to allow me to frame my face more appropriately and grow my hair to a longer length on top and then I believe I'll be satisfied enough. If I want a 3rd procedure sometime in life, then so be it...but I don't anticipate it unless I grow rich and have nothing better to do with my money. LOL

I will begin using a dermapen as well...need to invest in that and hopefully it can encourage some more regrowth. Feel like it's really going to hurt though lol.

Okay, now some pictures for what I am envisioning:
The light gray line is what I imagine my original youth hairline to have approximately been, before hair loss began around age 15-16. The black line is what I envision my hairline could be after a HT, at the very best. I'm trying to account for some natural looking temple recession, and obviously a higher overall hairline than the original. The areas circled in blue are areas that have been strengthened since beginning the fin + min regime (just 4 months), so I think that helps because now those areas don't demand hair to be transplanted into them, or at least not nearly as much as it otherwise would.

Also, I should say that the front of my head is more important to me than the crown. If I have to make a sacrifice, it would definitely be the crown...I'll accept a thin crown to have better coverage on the top and to create a not-weak-looking hairline. 

I want a surgeon/clinic that will be aggressive with my donor area. I understand the risks; I still want to be aggressive and take as much as humanly possible. Super short back and sides is a very popular and slick look these days, and even with some FUE scarring or depletion, I can use SMP to help fill in the illusion of lesser harvesting. I do not want to use SMP on the top but it's an option for the back/sides to help darken the area if it becomes too transparent.

Looking forward to hearing what anyone thinks! I appreciate all the replies so far. I will plan on at least getting some consultations done again soon, to see what kind of specifics I'd be working with.

Edited May 7, 2022 by general-etwan
diction

[general-etwan]

I did a 2nd version of a potential new hairline that is more conservative, which would likely be more generally realistic:

[John1991]

 "I'm not interested in having repeat procedures over the years, and I'm not just being naïve...I have thought about that for a long while and decided I want to repair this as much as possible in one go (or at most two) and then be done with it."  As someone who's 39 days post operation, I have to say this statement hits home.  I get that some cases are more difficult (yours perhaps being such a case), but the recovery for this procedure is shi*.  You, at bare minimum, end up looking worse/weird/having to explain what happened for months, you have to take time off of work, spend thousands of dollars, then wait half a year to see good (though not even final) results.  And/or are relegated to hat-dom for months.  I'm not saying it's the worst thing in the world, but if you can cut down on the number of procedures you undergo, by all means do so.  Life is too short to spend months at a time waiting to live - and feel - normal again for an elective procedure

Edited May 7, 2022 by John1991

[general-etwan]

On 5/6/2022 at 1:48 AM, DrTBarghouthi said:

Thanks for the mention @J.A.C

@general-etwan can you kindly share some beard photos too. I do think that beard will need to be utilised and probably from the beginning. It all depends on how much coverage you’re looking at though. But 6-7000 is what this requires ideally. 

Beard is very great. But I will say I'm not keen on giving any of it away. It will take me some serious convincing that it can't be done any other way and that the beard won't be sacrificed too much. Will see...