Transplant at 22 NW3. Quick question.

[Dev123]

Hey there. I’ve been balding since I was ~19. I’m 22 now with a NW3.

I’ve contacted surgeons like Hasson & Wong, as well as Feller & Bloxham regarding my situation with pictures included/my personal history.

They both said that they would do it and that I am a good candidate, both of them recommended ~3000-4000 grafts - H&W in particular said that they could achieve great cosmetic results around the 3000 range.

I’m not looking to have a Bollywood hairline, just want to have a conservative revival of my mature hairline, and for them to work back towards the crown a bit. I would do FUT.

Essentially, my question is this - will hair surgeons with such top reputations as these two practices have recommend hair transplants to anyone in my situation/age group? I’m concerned that despite the great rep, and with it being a business, they will do these kinds of transplants regardless of the actual “candidacy level” of the patient.

I’m not exactly sure why they would consider me a good candidate. Maybe it’s because my temples have disappeared and hair is growing down my neck on the opposite side of my skull. Just gotta put it back where it came from…

Before anyone asks, I talked to my derm about fin prescription and am waiting on a urologist appointment for their opinion, and blood tests to rule anything else out.

[Melvin- Admin]

Both of these surgeons are ethical, they refuse patients all the time. That said, I would tell you NOT to get an HT at your age. I don’t know your hair loss without pictures. But you’re too young. My fear is that hair loss could accelerate and you be stuck with a gap. Can you share pictures?

[Dev123]

Here’s a few shoddily taken pics. As a dude with long(er) hair, it’s pretty easy to see the thinning up front, although it’s pretty hard to see anything happening on the back of head.

Looking at it with a comb, I don’t see any thinning or loss anywhere but the entire frontal half of my scalp.

Again, I wouldn’t mind a conservatively designed hairline in order to save the donor area for any future procedures down the line. I really appreciate you taking the time to peek at this!

[Melvin- Admin]

Are you on medication? You have aggressive hair loss. You will most likely be a Norwood 5/6 by 30. I say this as someone who was in a similar position. I had even more hair at 22. I don’t believe getting an HT at this point is wise, especially if you haven’t given hair loss medication enough time to work. 

You are not a Norwood 3, you are advancing to a Norwood 4/5 the hair looks diffuse. Things can take a turn VERY quickly.
 

This was me at 23 vs. 28

[Dev123]

No, I’m not on any meds. Going to talk to a urologist before jumping on the fin/min regimen. I tend to not have a great relationship with medication, so I’d like to discuss further with a doc other than my derm. I know the statistics and how relatively rare sides are, but it’s still a worry.

And yes, my father is a NW7 so that is something I come to expect. Definitely not going to get any better without meds, that I know.

I find it curious that these two surgeon groups would recommend such a large hair transplant so readily, especially with my age and obviously aggressive hair loss. I’m wondering how much they would plan to cover with the recommended 3000-3500.

I definitely don’t want to have an island 🏝 refuge patch on the front of my head and the Dead Sea in the back/top.

I know this is a loaded question, but do you think there is any merit in getting a transplant in a few years after I (presumably/hopefully) stabilize?

[Savemyhairline]

That is looking more like a NW4+ unfortunately. The good news is you haven’t tried meds yet and being a diffuse thinner, you could have a very good response like I did and get down to the NW3 realm, hopefully. You are really young though with quite aggressive loss. I wouldn’t even think about a HT until you’ve been on the meds for around a year. I’m very surprised H&W said you are a good candidate given your age and the fact you aren’t on meds….you would probably have a decent frontal third then the rest behind it would go in the next 5 or so years if you went that path without meds. And/or your native hair in your frontal third would disappear completely and the transplant  would look no better than you currently do. The reality is you need to be on something that inhibits DHT (fin/dut) and ideally minoxidil, or any HT you get will not be worth it in a couple years time. Best of luck 

[mister_25]

I am also 22 and going for a hair transplant with Hasson and Wong. I asked Doug from H & W what makes me a good candidate and he replied with

• Good Donor Hair
• Use of Medication (Finasteride at the time of the email for 13 months, now 17 months)
• Manageable area to cover

Although my case is more severe than yours, I don't think they would accept a patient that they didn't believe was a good candidate. You should definitely stabilize your hair loss before you consider a transplant regardless of your age.

1 hour ago, Dev123 said:

I know this is a loaded question, but do you think there is any merit in getting a transplant in a few years after I (presumably/hopefully) stabilize?

How I see it and in my opinion as someone the same age as you, you have a chance with your first line of defense being medication. I was fortunate to get regrowth and went from borderline bald to having significantly better hair on top.  If you aren't happy with the results of medication then you can consider a hair transplant but only if you've stabilized your hair loss for a extended period of time. If you do not stabilize your hair loss right now you will head into Norwood 4 as I can see small miniaturization in your midscalp.

If you would like to see my results on medication, I posted it in a previous thread if that would help you get peace of mind or be more optimistic. 

Best of luck!

[Dev123]

Thanks guys. Be well! Will update on any medication taken.

[Dillpickle123]

Surprising that they do think your a good candidate at your age tbh, on the forum your going to hear more conservative answers rarely do you see anyone younger then 25 post results because they’re usually rare, I would say that if your 22 and your a Norwood 3 or under and on medication and it’s stabilized and your conservative on grafts then it’s acceptable but your case it looks worse then a Norwood 3 and no medication usage I’ve consulted with many docs and even though I’m similar in age they’ve all have agreed to do surgery on me given my use of medication and my hairloss being a Norwood 2 of course it’s ideal to wait your stabilized because you can bald behind the grafts and it will look weird  

[Mike10]

At 22 you are never a good HT candidate! That  and the fact that these clinics did not even discuss medication with you is unetical!!  Furthermore, I do not think the agressive Hasson approach is suitable for a 22 years old. I am not too familiar with Bloxhams work. 

I would  advise against a HT at 22. If you'e so desperate to do it, you need be on propecia for at least a year with good effect and without sides, and go for a good Dr with a conservative approach.

 

[hockeyman]

Was it Doctor Hasson or Doctor Wong who assessed your pictures?

 

[mafpe]

in my opinion you should later draw an image as if you will be filling for a NW6, so be conservative and don't pack it all super dnse at the front or move the hairline down by much, otherwise you might not have any left later for the existing native area.

reason is it's possible in a decade you will have front but no crown if you do otherwise, which is devastating. you can find the example here... 

 

hopefully it won't come to that, but better safe than sorry i think.

[Eugenix Hair Sciences]

You are Grade 3V on the Norwood Hamilton scale of baldness. You shall require:

Frontal zone: 2800 to 3000 grafts approximately with adequate density

For the mid scalp and crown, you should use medications. Finasteride can help prolong baldness. It can also help in increasing the density on your scalp. You can try finasteride for a couple of months and observe its effects and then decide to continue with it.

[Yan bio]

11 hours ago, Melvin- Moderator said:

Both of these surgeons are ethical, they refuse patients all the time. That said, I would tell you NOT to get an HT at your age. I don’t know your hair loss without pictures. But you’re too young. My fear is that hair loss could accelerate and you be stuck with a gap. Can you share pictures?

Just a general note about this logic (with no relaion to H&W or anyone in particular): when someone refuses a patient, it doesn't mean they're being ethical. If you're having full schedule (1 month waiting list or 1 year waiting list), there's no reason for you not to refuse a patient - your supply is already smaller than demand anyway and refusing a patient does not represent any potential loss of money.

[JoselitoElGallo]

13 hours ago, Dev123 said:

Hey there. I’ve been balding since I was ~19. I’m 22 now with a NW3.

I’ve contacted surgeons like Hasson & Wong, as well as Feller & Bloxham regarding my situation with pictures included/my personal history.

They both said that they would do it and that I am a good candidate, both of them recommended ~3000-4000 grafts - H&W in particular said that they could achieve great cosmetic results around the 3000 range.

I’m not looking to have a Bollywood hairline, just want to have a conservative revival of my mature hairline, and for them to work back towards the crown a bit. I would do FUT.

Essentially, my question is this - will hair surgeons with such top reputations as these two practices have recommend hair transplants to anyone in my situation/age group? I’m concerned that despite the great rep, and with it being a business, they will do these kinds of transplants regardless of the actual “candidacy level” of the patient.

I’m not exactly sure why they would consider me a good candidate. Maybe it’s because my temples have disappeared and hair is growing down my neck on the opposite side of my skull. Just gotta put it back where it came from…

Before anyone asks, I talked to my derm about fin prescription and am waiting on a urologist appointment for their opinion, and blood tests to rule anything else out.

Personally I think that doing FUT on 2022 is a big mistake.

[davidn]

17 hours ago, Dev123 said:

Hey there. I’ve been balding since I was ~19. I’m 22 now with a NW3.

I’ve contacted surgeons like Hasson & Wong, as well as Feller & Bloxham regarding my situation with pictures included/my personal history.

They both said that they would do it and that I am a good candidate, both of them recommended ~3000-4000 grafts - H&W in particular said that they could achieve great cosmetic results around the 3000 range.

I’m not looking to have a Bollywood hairline, just want to have a conservative revival of my mature hairline, and for them to work back towards the crown a bit. I would do FUT.

Essentially, my question is this - will hair surgeons with such top reputations as these two practices have recommend hair transplants to anyone in my situation/age group? I’m concerned that despite the great rep, and with it being a business, they will do these kinds of transplants regardless of the actual “candidacy level” of the patient.

I’m not exactly sure why they would consider me a good candidate. Maybe it’s because my temples have disappeared and hair is growing down my neck on the opposite side of my skull. Just gotta put it back where it came from…

Before anyone asks, I talked to my derm about fin prescription and am waiting on a urologist appointment for their opinion, and blood tests to rule anything else out.

People are saying "Any ethical surgeon wouldnt do a hair transplant on someone under 25", but this does not hold entirely true in my opinion. I have seen Hasson and Wong, Eugenix, Bloxham, Hlc, Lorenzo, Mohebi, Rahal all do it before 25, which is a rather random cutoff to begin with. I guess most people agree that these are all decent surgeons.  That being said, I would not really recommend it. The risk of doing it now is just much higher than doing it in 5-7 years, since it is very unclear how your donor behaves over time. Especially for FUE, it is really hard to make out what your "safe donor zone" truly is and if you might develop something like DUPA over time.

I think you can camouflage the hair loss pretty good I am sure with Toppik/Dermmatch. With a family history of your dad being a Norwood 7, you will have to be on life-long medication probably anyway, not even only for your native hair, but also for the donor. Sure, you can get hair transplants repeatedly over the years and decades, and supplement this with body grafts as well, but with aggressive hair loss in your 20s, it is very much possible that your donor will also start thinning over time. So why not test medication for three years first before committing to this journey, make sure your hair loss is stable and you dont experience side effects. I think most people who get sides on Finasteride experience them rather fast. In your case, I just dont see much benefit from doing it now compared to in in 3-5 years, as I do not think your hair loss should impact your quality of life enormously at its current state.

In my personal opinion, medication is even more important than age (and again - please nevertheless wait until mid/end 20s, believe me, it is in your own best interest). Sure, things can still progress on Finasteride, but studies show  more than 90% are at least at baseline after 5 years, combine this with oral minoxidil and I think we are moving over 95%, while almost everyone who experiences mpb and does not take it is below baseline after 5 years. So no matter if you are a 22 year old Norwood 4 or a 32 year old Norwood 4, you will most likely lose your crown without Finasteride within the next 5/6 decades, so I think almost everyone should strongly consider medication. No matter if you do a hair transplant and then end up a NW6 by 30 or be a NW6 by 30 and then do a transplant, your loss will never magically stop and probably affect your donor in the future as well. In my view, fundamentally, hair transplants and medication basically just buy you time with hair. So one might argue, if I am destined to be a Norwood 6 at 30, why should you wait until 30 when you are a NW6 and then do the transplant in your hair line and midscalp instead getting on medication and doing a transplant on hairline and midscalp and become the destined Norwood 6 at 45? In my opinion, the real risk here is the donor. You just do not know which hair will really stay over the decades. Another advantage of waiting until your mid/end 20s is that your decision making is just more developed. Believe it or not, maybe by that time your priorities change and you actually think the shaved head is a decent option for you. 

Edited July 9, 2022 by davidn

[davidn]

1 hour ago, JoselitoElGallo said:

Personally I think that doing FUT on 2022 is a big mistake.

I dont think its that easy. FUT+FUE gives you way more grafts. With FUE, you get on average 6-7k. Combined with FUT, this becomes approximately 9k. Fue leaves scars as well, so the "I can just shave" argument does not really hold as well, you will see scars and the transplanted hair does not have enough density for a natural looking buzzcut. BUT I have spoken to various SMP artists who all attest that FUE scars are way easier to hide than FUT (in an emergency scenario). I do think you can hide a FUE procedure relatively well in most cases, FUT is harder (according to the SMP artists).

Edited July 9, 2022 by davidn

[user13]

2 hours ago, JoselitoElGallo said:

Personally I think that doing FUT on 2022 is a big mistake.

Why do you think that?

[THE TRUTH]

I don't think you should get a transplant now bro. 

You're too young and you may not be satisfied with the result of a hair transplant even if it is objectively good. 

I don't wanna sound negative or pessimistic but the reality is hair transplants are crap. Even the expensive ones. Yes you heard me right. They are CRAP. 

Trading some ugly scars at the back of your head (whether it's FUT strip scar or FUE white dot scarring) for a few low density hairs on the hairline that will never match your native hair density is something that you may regret further down the road...

This is what hair transplants are all about. It's a pretty rough way to put it but that's exactly what it is. 

What if you are unhappy with the outcome ? This is something to think about twice. 

If you "just shave it bruh" you will have to deal with 2 major issues. 

A. Your balding pattern will still be noticeable. 

B. Your scars (both FUT and FUE) will be noticeable. 

This forum is great because it shows the reality of the hair transplant industry. 

Look at how many excellent results there are. There are some for sure but very few. (HugoX, Zoomster, the guy who went to Freitas and got an incredible hairline can't remember his name).  They are the EXCEPTION, definitely not the rule. 

How many people end up with crap density, failed transplant, botched jobs, weird results like Track_Rat for example or permanently damaged donors etc ? A LOT

We witness it on a daily basis here. And not just from turkish hairmills unfortunately... I suggest you spend time on the forum and research like crazy. You'll eventually come to your own conclusions. 

I think you should get on a very strong pharmaceutical stack for the moment. 

Check out MorePlatesMoreDates, Dr. Oscar Muñoz, Haircafé, The Hairloss Show for more info. 

And wait at least until you are 25. 

In the meantime you should start saving some money for future surgery. 

And go with the best of the best. 

I would be very surprised if any REAL reputable doctor agrees to perform a hair transplant on someone under 25 who is not AT LEAST on oral Finasteride/Dutasteride. 

If someone agrees then it's a red flag. Don't go. Even if the clinic is considered "reputable". 

I've seen those cases of H & W, Lorenzo, HLC doing patients under 25.... It just means they want their money and they don't care about the long term consequences for the patient. 

Then at 25 after if you are 100% sure your balding has stabilized with medication you should ask yourself the following questions:

1.  Would I be satisfied if I spend between 10 000 $ and 15 000 $  of my hard-earned money for a new hairline that is still conservative (a politically correct word for receded) and will always look seethrough under harsh artificial lighting or harsh daylight and will never look like me pre-androgenic alopecia ? 

2. Will I be commited to medication for the rest of my life in order to avoid losing more hair on the midscalp and crown ? 

3. Will I accept scarring at the back of my head that unables me to wear very short hairstyles ? 

4. Will I accept to have more surgeries down the road if required ? 

5. Will the accept the possibility of failure ? Even the top docs have failures and crap results although thanks god they are statistically minimal. 

If the answer is yes every time then yeah you'd be a good candidate for a hair transplant.  

If no, then DO NOT GET A HAIR TRANSPLANT. 

Sorry if I sound a bit pessmistic but this is the reality. 

Many people regret getting a hair transplant. Some even think it's the worst mistake of their life. Check out Gatsby's story and Miko's. 

Edited July 9, 2022 by Let me botch you

[Melvin- Admin]

14 hours ago, Dev123 said:

No, I’m not on any meds. Going to talk to a urologist before jumping on the fin/min regimen. I tend to not have a great relationship with medication, so I’d like to discuss further with a doc other than my derm. I know the statistics and how relatively rare sides are, but it’s still a worry.

And yes, my father is a NW7 so that is something I come to expect. Definitely not going to get any better without meds, that I know.

I find it curious that these two surgeon groups would recommend such a large hair transplant so readily, especially with my age and obviously aggressive hair loss. I’m wondering how much they would plan to cover with the recommended 3000-3500.

I definitely don’t want to have an island 🏝 refuge patch on the front of my head and the Dead Sea in the back/top.

I know this is a loaded question, but do you think there is any merit in getting a transplant in a few years after I (presumably/hopefully) stabilize?

Do NOT get a hair transplant. Big BIG mistake. I suggest getting on topical finasteride. Forget oral version. Also consider oral minoxidil. You need to be on medication for many years before considering a hair transplant. If you’re dad is a Norwood 7, you’re headed there. Getting an HT now will 💯 lead you to having an island of hair. 

[Melvin- Admin]

3 hours ago, Yan bio said:

Just a general note about this logic (with no relaion to H&W or anyone in particular): when someone refuses a patient, it doesn't mean they're being ethical. If you're having full schedule (1 month waiting list or 1 year waiting list), there's no reason for you not to refuse a patient - your supply is already smaller than demand anyway and refusing a patient does not represent any potential loss of money.

You’re assuming the surgeon have a full list. Many times they don’t, very few doctors have the luxury of turning away patients without taking a loss. I can count them on one hand. 

[Yan bio]

2 minutes ago, Melvin- Moderator said:

You’re assuming the surgeon have a full list. Many times they don’t, very few doctors have the luxury of turning away patients without taking a loss. I can count them on one hand. 

Hence the word "IF" in my original quote: 

"*If* you're having full schedule.. there's no reason for you to.."

and only ~3-4-5 surgeons? I'm genuinely surpried 😅

[THE TRUTH]

7 minutes ago, Melvin- Moderator said:

Do NOT get a hair transplant. Big BIG mistake. I suggest getting on topical finasteride. Forget oral version. Also consider oral minoxidil. You need to be on medication for many years before considering a hair transplant. If you’re dad is a Norwood 7, you’re headed there. Getting an HT now will 💯 lead you to having an island of hair. 

I totally agree with you Melvin. He should not get a hair transplant otherwise he risk becoming like Tilman and Biden. 

However I can only disagree with your statement "forget about oral finasteride". 

Some people refuse it. Fair enough. I respect that. Use alternatives. 

I don't wanna sound like the guy who is pushing it but it is important to stress that this new topical Finasteride is by no means a long term substitute for the oral version. 

No topical treatment that exists (whether it's Dr. Hasson's topical fin, Dutasteride mesotherapy, RU58841, minoxidil, fluridil, spiro, topical estradiol or whatever) could be considered a full-time equally effective standalone alternative to oral 5alpha reductase inhibitors. 

That just isn't true. 

 That said, topical finasteride is certainly better than nothing. 

[Dev123]

9 hours ago, hockeyman said:

Was it Doctor Hasson or Doctor Wong who assessed your pictures?

 

The email seemed to be mostly a general template send using a colloquial “The doctors have reviewed your case…”.

[Melvin- Admin]

13 minutes ago, Let me botch you said:

I totally agree with you Melvin. He should not get a hair transplant otherwise he risk becoming like Tilman and Biden. 

However I can only disagree with your statement "forget about oral finasteride". 

Some people refuse it. Fair enough. I respect that. Use alternatives. 

I don't wanna sound like the guy who is pushing it but it is important to stress that this new topical Finasteride is by no means a long term substitute for the oral version. 

No topical treatment that exists (whether it's Dr. Hasson's topical fin, Dutasteride mesotherapy, RU58841, minoxidil, fluridil, spiro, topical estradiol or whatever) could be considered a full-time equally effective standalone alternative to oral 5alpha reductase inhibitors. 

That just isn't true. 

 That said, topical finasteride is certainly better than nothing. 

There’s enough evidence that shows the topical version is just as effective, with less chance of side effects. Long term efficacy is unknown, but certainly short term, it’s just as good.