Another question about potential transplant

[arthurSam]

Hello,

I am a new member of the forum. Thanks you very much for all of you, I have now I think a best understanding on Ht and the evolution of Alopecia with the help of the comments I saw here.

I am 45 years old and I take minox since 20. I think I am Norwood 4 and I am thinking about Ht. I think I drop my hair slowly, but I saw somewhere that the more agressive part is at 50-60 …

I would like to know if some users here done a HT with a nordwood like me at my age, and with same experience with minox. Specialy, I would like to know if they took Fina or not, and if without fina it is conceivable to get 1 Ht that work for say.. 10 years before do onother one ? And with fina ?

At my age, do you think the best strategy is to wait say… 53-54-55 to see if agressive hair lost arrive before doing anything ? 

Unfortenatly I do not have lot of old picture, the only one I got when I was 35 is the last one (with the cat 🙂 ) What is bad for me I think is that my brother is bald since his 25-30 but he never took Minox. My mother's side uncle is galb too. My mother's side grand parent was not galb and for my father I don't know because I fall seriously ill and died very early.

Thanks you very much in advance for your comments !

 

Edited May 13, 2022 by arthurSam

[Rahal Hair Transplant]

Arthur,

welcome to this hair restoration forum Community. I’m not sure exactly where you heard that aggressive hair loss begins between 50 and 55 years of age but that’s typically not true. Obviously everybody is different but most people experience the most aggressive part of hair loss anywhere from their early 20s to their early to mid 30s.  In fact, at 45 years of age, I’m guessing that you’re not going to experience much more hair loss.

Like I said, anything is possible and everybody is different but based on the photos you presented, you seem like an excellent candidate for hair transplant surgery.  By looking at the photos, it appears that you’re not experiencing any hair loss in the midsection or crown and that your hair loss is limited to the hairline and possibly the temple points.

personally, I would think that a hair transplant megasession of between 3000 to 4000 grafts would help you to restore a relatively youthful looking hairline and give you the density you need to achieve a very full and natural looking head of hair.  You also appear to have a dentse looking donor area so I believe he would be a good candidate in achieving what I suggested.

that said, you sure to take your time and research surgeons and select one that has a proven track record of producing outstanding results.  Personally I recommend starting by researching surgeons recommend by this community and then narrow your selection down to 3 to 5 surgeons you were impressed with the most and then consult with them.

Personally I recommend starting by researching surgeons recommend by this community and then narrow your selection down to 3 to 5 surgeons you are impressed with the most and then consult with them. Look both at results presented by clinics and their patients. That will help you narrow your selection down.

I recommend researching this community and learning everything you can about our transfer surgery and what can be realistically achieved in expert surgical hands.  

I represent Dr. Rahal Who is recommended by this community and a highly esteemed member of the Coalition of Independent Hair Restoration Physicians.  if you have any questions or I can help you in anyway, don’t hesitate to post to reply or contact me privately.

Best wishes,

Rahal Hair Transplant

 

[DrMunibAhmad]

Nobody can certainly tell if it's the right time for a transplant or not. Without finasteride it would be just a gamble game, and then wait to see what happens. You could probably do 10 years with the transplant, but is probably okay enough for you to make a decision? 

Your overall situation looks really good. I mean, my hands start to itch when i see this case. 

 

 

[1978matt]

You could have a HT for sure, without FIN.

I would do an FUE of around 2000 grafts, basically to fill in the area behind your forelock.  Basically a secondary hairline once the forelock erodes over time.  Not the best drawing below but you get the idea.

Edited May 13, 2022 by 1978matt

[arthurSam]

Hello,

 

I saw some professionals and I would like to have your opinion please.

I would like to get a hair line that is not to "perfect" because I never got a perfect one... So the picture below are a example of what is poposed to me.

To do this job they think that 1200 FUE is ok. Do you think that I can get a good result with this for that project ?

Thanks you very much !

 

 

 

[Dillpickle123]

It won’t be very dense I think for that hairline it would be closer to 2000 grafts your trying to achieve a mature look

[Eugenix Hair Sciences]

23 hours ago, arthurSam said:

Hello,

 

I saw some professionals and I would like to have your opinion please.

I would like to get a hair line that is not to "perfect" because I never got a perfect one... So the picture below are a example of what is poposed to me.

To do this job they think that 1200 FUE is ok. Do you think that I can get a good result with this for that project ?

Thanks you very much !

 

 

 

You are Grade 2 on the Norwood Hamilton scale of baldness. 1500 to 1700 grafts would be required for the hairline that has been drawn.

[Al - Moderator]

As long as you don't try to get an aggressively low hairline and stick to something like the hairlines you have drawn on you then I don't see why you should keep waiting years to get it done. I also think it will take a bit more than 1200 grafts, but even that will be more than what you have now, so if you are on a budget and don't mind possibly going back in a year or two to fill it in if you feel you need to then there shouldn't be an issue. Just keep in mind that there's a higher chance you will feel it's not dense enough with only 1200 grafts rather than 1800 or more

[civic]

1.5k grafts is more than enough with good surgen. Most people got used to seeing hairmills pack 6k grafts into NW2s & assume thats what it takes. It's the skill set of doc that matters most, graft survival rate, angle placement. Hairmills pack more than needed to possibly compensate for poor yield growth, bad angle placement etc. Eugenix gave you good & accurate graft # for your case. Remember, less is more. 

[arthurSam]

Thanks fou for All.

The clinic doe not want to use more than 1200 they said that is for protecting from shock loss... I am a bit confused because I saw other surgeon who proposed me 2000-2500 but for a bigger area with a front line lower and less mature ... But I don't want to change radically so I would prefer the mature one. But they want only do the big one...

[Mike10]

I can see why you would not start now in your 40's Propecia out of the blue. 

A good first step would be to seek a reputable Dr and do a miniaturization mapping. It is difficult to predict hair loss and that is why your approach to go conservative is the right one.

Since you are already 45, one strategy could be to commit to a couple of HTs in the next 15-20 years. Then to let it go in your 60s when hair loss is likely to pick up. By then the 2 HTs may stand on their own. But please discuss with a good Dr. 

 

 

[Raphael84]

Hi @arthurSam

At 45 and based on your images, you have retained a decent amount of native hair but have recessed at the temples, which also then evolves reasonably deep behind your frontal forelock as can be seem in all of your images and highlighted in the image below.

When you shave down you will see more of a pronounced pattern and your hair length serves a purpose at current in presenting an illusion of more hair and more coverage.

Based on your hair and pattern of loss, you really want to ensure that you select the right surgeon first time and do not require further surgery to increase density etc.

With this being said, the 1200 graft count that has been quoted is low and based on the design presented, would likely result in an unsatisfactory result.
I have attached a video below that shows the demands of soft singles in the hairline alone. Considering the surface area that requires restoring and reinforcement being this, more grafts will be needed to achieve an appropriate density and achieve that "illusion of density".

By all means search for other surgeries of such a graft count to get a sense of what they may be able to achieve.

In terms of shock loss, if your native hair in the recipient areas including the transitional area of blending between zones without native hair into zones with native hair have miniaturisation, then this can occur. Having said that, to achieve a natural result, these areas will require reinforcement otherwise you will not achieve a consistent aesthetic of density and areas behind may appear thinner and so placing density will have to have this approach in mind.

[arthurSam]

Hello

I live in France so is it possible to have a personnal advice  by M. Bisanga if I go to belgium ?

Edited June 23, 2022 by arthurSam

[Hairy Henderson]

I think you would need 3k grafts.

[Raphael84]

1 hour ago, arthurSam said:

 

Hello

I live in France so is it possible to have a personnal advice  by M. Bisanga if I go to belgium ?

 

If you would have interest in consulting in person with Dr. Bisanga then of course we can explore convenient dates for you.

I will contact you privately and we can discuss further.

[Mike10]

Yes Bisanga is a always good choice. He is very ethical and thorough in his consultations.  But he also likes to stick to the rules. I am pretty sure he will recommend at least Minox oral which is IMO a pretty heavy medication. 

In addition, I think you should also visit Feriduni and Mwamba in Belgium to get different opinions on your case.

 

 

Edited June 23, 2022 by Mike10

[Raphael84]

To add some clarity and correct the opinion of the previous post to avoid any misunderstanding, in any 45 year old patient that has been committed to topical minoxidil since the age of 20, whether any changes to their regimen of medication are recommended will be based on the status of their native hair, meaning is the donor stable or may it present any concerning levels of miniaturisation which may impact surgery result and/or longevity of result.

Rather than being a case of "sticking to the rules" or not, our approach is what is most appropriate for the patient.
Whilst other clinics may proceed with surgery feeling confident of achieving growth and a result but with no regimen in place to stabilise decline that may be present and which has a probability to evolve meaning the transplant may become disconnected to native hair for example or the result may thin in the shorter term, Dr. Bisanga will recommend what he feels is necessary for the best long term approach for his patients and this is based on his 20 years of experience in the industry.

If a 45 year old patient's hair is stable with their current regimen, then there is no need to change. If their status presents concerning levels of miniaturisation, then recommendations will reflect this either via candidacy or a change/more effective regimen of medication. Again, always for the patients best interests.

Medication is a personal decision and if a patient is uncomfortable with a particular treatment, then the likelihood is that they will not continue with such a regimen regardless.

If more doctors "stuck to the rules" then the industry as a whole would find itself in a much better position than it currently does and candidacy would be based on education and appropriate decisions as opposed to sales and numbers.

I am a patient myself and used this forum for over 10 years as a patient before working in the industry. I am a patient first and foremost and would rather turn down candidacy and be honest than risk any individuals well being. We see it at the clinic day in and day out. Repair and failed surgery is higher than ever. 
Not all failures are due to poor choice in doctor. Obviously there are the anomalies but oftentimes failures are related to questionable candidacy to begin with. Medication or lack there of it can be a part of this.

It is always a good idea to consult with other clinics and doctors that you may have interest and knowledge of their work and always something that I would encourage. This way you will get a feel for who is the "right fit" for you and your personal case and situation and allows you to be as informed as possible and if you do decide to proceed with surgery, you can do so being as confident as possible in your decision of doctor.

[Mike10]

Hi Raphael, I think your post was excellent