New to HT initial feedback needed

[marioX]

Hi all,

I've visited this forum a few times in the last 4-5 years never having the courage to go any further than spending 1-2 hours looking at others cases. I haven't been to any consultations yet. I'm looking for general feedback if you all think I'm a good candidate for HT or what the problems may be.

I've had a general hair loss since my early 20s. I did minoxidil for a few years but then stopped because my scalp would be too irritated even when using the right shampoos. I had then a decent amount of shedding in my late 20s, was stable for 2-3 years and then another one which brings me to the current state at 37. The last period of hair loss coincides somewhat with doing testosterone shots which seems to possibly be a side effect (my testosterone level is very low, it wasn't done for workout purposes), I haven't done testosterone for the last 2 years though.

I would do the surgery, if a good candidate, somewhere outside of the US, wherever recommended after researching the facilities. I don't have a problem with going to Mexico, Turkey, Belgium or any of the clinics recommended here. I would be able to be there for 2-3 weeks if needed.

My donor area I think looks less dense than in reality, I don't know if it was the lighting/flash.

Let me know what you think.

Thanks!

[Eugenix Hair Sciences]

You are Grade 5V on the Norwood Hamilton Scale of baldness.

You shall require:

Frontal zone: 3000 grafts approximately

Mid scalp: 500 grafts approximately

Crown: 2500 grafts approximately

For the preservation of the pre existing hair as well as the sustainance of the transplanted hair, you can opt for finasteride. It can be very helpful. Finasteride prolongs baldness on the scalp. You can try it for a couple of months and observe its results prior to committing to the medication.

[Mike10]

you do not seem like good candidate considering your donor. 

[Rahal Hair Transplant]

Mario,

To be completely honest, based on the photos alone I don’t think you’re a good candidate for her transplant surgery.

You have a substantial amount of bald area to cover Norwood Class 5V borderline 6 based on the thinning in the lower crown region) and your donor area looks exceptionally thin. In fact, my initial concern is that you might have DUPA or Diffuse Unpatterned Alopecia.  If you do, your donor area is not safe due to the miniaturization which means that it may likely continue to thin or fall out even if transplanted to the recipient area.

Hair transplant surgery works on a principle known as donor dominance and thus, maintains its original properties even when moved.  That’s why DHT resistant hair such as hair on the sides and back the scalp doesn’t fall out even when transplanted to an area of the scalp where natural hair falls out. Thus, the opposite is also true.

Those with DUPA (which includes thinning/miniaturizing hair on the sides and back of the head) don’t make good hair transplant cabinets because miniaturizing hair moved to the recipient area Will maintain its original properties and course which means it will likely continue to thin out.

Now even if you don’t have DUPA, you have to consider the supply and demand principle of hair transplant surgery. Donor hair is already limited and with a shorter supply due to a low density donor, you simply won’t have enough to provide any real coverage or density to such a large balding area.  

A Norwood 5A/V Area would require approximately 22,000 follicular units (FUs) to re-create “true density“ which is essentially an approximate number based on how much natural hair one has in that area before any thinning begins.  In terms of density that’s typically on average anywhere between 60 to 80 FU/cm2 plus or minus.  To create an adequate illusion of density, one would require approximately 50% of that which would be approximately 11,000 FUs Which is typically anywhere between 30 to 40 Fu/cm2.

Bow keep in mind that hair is not evenly distributed and more density is typically added to the crucial areas like the hairline in the frontal region while the mid scalp and crown areas are typically provided with less density.   That’s why many cases such is yours can still look quite full with only moderate signs of thinning in the less crucial areas such as the crown with maybe only 7000 to 8000 FUs.

Long story short, depending on The actual size of your scalp and area to cover, hair coarseness/hair shaft diameter and hair color to scalp color contrast ratio, 7000 to 8000 FUs Could provide you with a pretty full looking and natural head of hair with only a mild appearance of thinning in the back of the midsection and crown areas.  

However, by looking at your photos alone, I really don’t think you have the donor hair for that and if you’re lucky, hey skills and experience surgeon might be able to extract half of that safely.  

That said, I think the best thing to do is to consult with a skilled and experienced surgeon will who will give you a completely honest assessment as to whether or not you’re a candidate. Anyone could take you on as a patient and perform hair transplant surgery on you.  But if you’re not a good candidate, you’ll be very disappointed with the results.

if you’d like to schedule a one on one information session with Dr. Rahal who will give you an honest assessment t if your case, please send me a PM and I can get this setup for you.

Best wishes,

Rahal Hair Transplant 

 

Edited July 7, 2022 by Rahal Hair Transplant

[Eugenix Hair Sciences]

You are Grade 5V on the Norwood Hamilton Scale of baldness. You shall require:

Frontal zone: 2500 grafts approximately

Mid scalp: 500 grafts approximately

Crown: 2500 grafts approximately

You can also take finasteride for prolonging baldness on your scalp.

[marioX]

Thanks for comments.

How can I tell if I have DUPA? Would this require an expert to look at it?

In general on the donor area being low density. To get a fair assessment can it be done with a virtual consultation or should I consider going to someone local here in person? I assume there's methods to check what the hair per cm2 is in the donor area that is accurate enough if they do it in person but just a video consultation may be not good enough.

I think the pictures look a lot worse than reality but maybe that's just wishful thinking   ... I did realize that after taking the pictures that the crown is in much worse shape than I thought 😕

[ticker]

On 7/7/2022 at 5:52 PM, Rahal Hair Transplant said:

Mario,

To be completely honest, based on the photos alone I don’t think you’re a good candidate for her transplant surgery.

You have a substantial amount of bald area to cover Norwood Class 5V borderline 6 based on the thinning in the lower crown region) and your donor area looks exceptionally thin. In fact, my initial concern is that you might have DUPA or Diffuse Unpatterned Alopecia.  If you do, your donor area is not safe due to the miniaturization which means that it may likely continue to thin or fall out even if transplanted to the recipient area.

Hair transplant surgery works on a principle known as donor dominance and thus, maintains its original properties even when moved.  That’s why DHT resistant hair such as hair on the sides and back the scalp doesn’t fall out even when transplanted to an area of the scalp where natural hair falls out. Thus, the opposite is also true.

Those with DUPA (which includes thinning/miniaturizing hair on the sides and back of the head) don’t make good hair transplant cabinets because miniaturizing hair moved to the recipient area Will maintain its original properties and course which means it will likely continue to thin out.

Now even if you don’t have DUPA, you have to consider the supply and demand principle of hair transplant surgery. Donor hair is already limited and with a shorter supply due to a low density donor, you simply won’t have enough to provide any real coverage or density to such a large balding area.  

A Norwood 5A/V Area would require approximately 22,000 follicular units (FUs) to re-create “true density“ which is essentially an approximate number based on how much natural hair one has in that area before any thinning begins.  In terms of density that’s typically on average anywhere between 60 to 80 FU/cm2 plus or minus.  To create an adequate illusion of density, one would require approximately 50% of that which would be approximately 11,000 FUs Which is typically anywhere between 30 to 40 Fu/cm2.

Bow keep in mind that hair is not evenly distributed and more density is typically added to the crucial areas like the hairline in the frontal region while the mid scalp and crown areas are typically provided with less density.   That’s why many cases such is yours can still look quite full with only moderate signs of thinning in the less crucial areas such as the crown with maybe only 7000 to 8000 FUs.

Long story short, depending on The actual size of your scalp and area to cover, hair coarseness/hair shaft diameter and hair color to scalp color contrast ratio, 7000 to 8000 FUs Could provide you with a pretty full looking and natural head of hair with only a mild appearance of thinning in the back of the midsection and crown areas.  

However, by looking at your photos alone, I really don’t think you have the donor hair for that and if you’re lucky, hey skills and experience surgeon might be able to extract half of that safely.  

That said, I think the best thing to do is to consult with a skilled and experienced surgeon will who will give you a completely honest assessment as to whether or not you’re a candidate. Anyone could take you on as a patient and perform hair transplant surgery on you.  But if you’re not a good candidate, you’ll be very disappointed with the results.

if you’d like to schedule a one on one information session with Dr. Rahal who will give you an honest assessment t if your case, please send me a PM and I can get this setup for you.

Best wishes,

Rahal Hair Transplant 

 

Hello @Rahal Hair Transplant

I waited for 3 years to meet one of the elite doctor and I met that doctor recently and he gave exact reason as you described above. He told me that I have DUPA with Norwood 6 (close) and Surgery is totally out of question eventhough I am 45 age. In His opinion DUPA patients should never opt for surgery eventhough I am taking finasteride 1mg every day. I met few other elite doctors both inperson and online and they said I am a good candidate for HT. But this doctor explained the only way a DUPA patient can recover hair is thru Oral Minox plus Dutasteride. Even finasteride will not help. I am kind of very disappointed and almost gave hopes of HT because the doctor convinced me by showing the DUPA with microscopic exam. However I want a 2nd opinion because other elite doctors said i am a good candidate but they didnt do microscopic exam. Can you please let me know your opinion? DUPA patients Norwood 6 should never opt for surgery? Dr Bernstein in his youtube video also said the same.

[Eugenix Hair Sciences]

Greetings of the day, 

DUPA is an acronym for diffuse unpatterned alopecia — sometimes known as diffuse unpatterned hair loss. it is more similarly mirrors of other hair loss types like telogen effluvium, which is caused by health issues and bodily stressors. Diffuse unpatterned hair loss is different from balding in the shape of pattern hair loss. Otherwise, it is genetically and biologically similar to your standard experience of male pattern hair loss.

In your case the best fit is to consult a well experienced doctor, I am pasting a link for you to understand it in a simple manner. If you want a one-to-one meet with our surgeons on a video call, feel free to PM and I will be happy to arrange a call from our counsellors.  

 

Regards, 

Eugenix Hair Science 

 

 

 

 

[Rahal Hair Transplant]

@ticker ,

I think ideally, you should create a new topic to discuss your case because I don’t want to derail this thread away from Mario who started this topic.  That said, your question is a good one and I can’t just not give you an answer and wait to see if you’re going to create a new topic. So if you want to discuss this more after I post my reply, I suggest creating a new topic or send me a private message to continue discussing.

Firstly, I have a hard time using the word “never“ as I do think there are exceptions to pretty much every rule. In general however, I do agree that a DUPA patient with a Norwood class 6 hair loss pattern is simply not a good candidate for surgery.

Now, I don’t know who told you that finasteride can’t help thicken some of the thinning hair on the sides back of the scalp from DUPA because I believe it can however, I also agree that dutasteride would likely be more effective due to the fact that it blocks both types of 5-alpha reductase enzymes as opposed to finasteride that blocks only the second type.

Also let’s say for a second that you’re able to get DUPA under control with medication. And then let’s say you decide to undergo hair surgery. Just what kind of result do you think you’re going to achieve? And then do you want to bank on the fact that the medication you’re taking will work forever

Because the moment you stop taking it or if it stops working, not only will hair on the sides and back of your scalp begin to thin again, you are going to lose a great deal of your transplanted hair.

In my opinion, the risk factors are severe and easy result you achieve will be minimal compared to someone else who doesn’t have this condition.  Moreover, the results likely won’t be permanent unlike people with a donor safe zone.

I hope this helps  

Rahal Hair Transplant 

 

Edited July 14, 2022 by Rahal Hair Transplant

[Rahal Hair Transplant]

@ticker

I also want to add that while you can always get a second, third or even fourth opinion on whether or not my doctor will perform hair transplant surgery on you, the above information I gave you are facts. They are not opinions.

what I mean is, you may very well find a surgeon who will operate on you, but the risk factors are the risk factors no matter what.   So rather than focusing on whether or not A particular doctor will perform surgery on you, understand that you need to make an informed decision as to whether not to go through with surgery based on the factual risk factors that have been presented to you.  For example, you may very well achieve a decent result (for a NW6 DUPA patient) if you can get DUPA under control. And maybe the medication will work forever.   On the other hand, you have to understand that there are severe risk factors that will very likely influence the overall result both short-term and long-term.   There will always be a surgeon that will operate on you no matter what the risk factors are.   So you will have to decide whether or not spending the money and pursuing surgery is worth it.

Best wishes,

Rahal Hair Transplant 

[marioX]

Thanks for the additional feedback and @ticker  for jumping in with your case, we are in similar situations and I think it helps. I'll do a couple of online consultations and try to do something in person as well. I think it's still not clear to me if a doctor can definitely determine if some has dupa or this is more subjective and on a scaling bases ... Also if it's possible to do so with just a video call or an in person consultation that precisely determines the amount of hair density in in the donor area is needed.

Here's a few extra pictures taken another time ... given the lighting I don't think they add too much to the initial ones I uploaded but the side of the side of head pictures I think are a little better.  

[GoliGoliGoli]

I think Rahal is giving you A+ advice...

Your donor area looks severely compromised. Combine that with the sheer surface area you would need to cover to get a satisfactory result and it seems clear that you are not a good candidate for surgery, regardless of whether you find a surgeon to operate on you. 

Save yourself the money, time, and awkward scarring 

[LookMaxx]

If you’re 37 it seems like your hairloss has definitely stabilised. That’s the good news, for the most part because the hairs will continue to miniaturise slowly as you age and you clearly seem to have the NW7 pattern. But the aggressive damage seems to be done. 

The bad news is most average doctors are not going to perform on you, this is what I’ve noticed that most doctors that are praised here steer clear of difficult cases because it will ruin their reputation and they only take easy peasy nw1-3 cases. There are very few daring doctors who touch higher norwoods, they’re the truly great doctors.

Your body hair is what’s really important and if you’re lacking there too then yeah your only option is hair systems. I can’t recommend anyone as I don’t want to be held responsible if they do a bad job when I send you to them, research yourself here and elsewhere. 

You should use finasteride if you want to thicken up those dying hairs and use hair fibers, your hairloss has progressed to NW7 already that finasteride isn’t going to matter much. But the bad thing about finasteride is it will kill any new body hairs from sprouting, and body hairs are really important for higher norwoods. Try Minoxidil, maybe you’re a hyperresponder and get amazing results.