Is it too late for me? What results can I expect?

[WhereIsMyMind]

Hey, 32M here. I finally took the plunge 1 year ago for HT and consulted a few top EU surgeons. I would like to go for Couto but waitlist is just too much so I'm probably going with Freitas. First consult he basically told me that my diffused crown area is way too big for a transplant and I'm not good candidate. I also asked Lorenzo for a second opinion, and he said the same, I'm not a good candidate. My heart sank because I thought I saw much worse successful cases in this forum 

Always was a bit stubborn with medication, but after seeing every surgeon reject me I went full on it as I understood there's no other choice, 2.5mg Oral Minox+0.5mg Dutasteride as recommended by Freitas, and have been 1 year on it now.

Goals
I want a good, full head of hair, with dense hairline result. If crown is a bit thinned I don't mind as long as no visible scalp is showing and hairline looks dense.
I will do as many transplants as needed, with whoever is needed, money is not an issue. If I have to repair heavily harvested donor with even more procedures (BHT repair, SMP, etc..) I'm up for it too. If it takes 10 transplants, I'll take it. I just want a great result and wont be satisfied otherwise. Please let me know if I'm being delusional.

Hair quality
I have DPA thinning on the whole NW6 area + also Retrogade Alopecia which lowers my donors from the sides. However, my donor area on the back is insanely thick, and now even more after medication, 0 thinning and its soooo thick, never been this thick.

My hair has definitely improved a lot, but the crown is not going to improve any further I think. It was almost slick bald previously and too far gone.

Donor area expectations
With Retrogade Alopecia, realistically, how many donors I could yield? More than 4K is too optimistic right?

Surgery
Freitas told me to come back after >6 months on meds or he wouldn't do it. I guess now he should accept me?
He proposed to do a 1st transplant to restore the hairline, and rejected the idea of implanting anything on midscalp or crown until a 2cnd transplant.

Help me out decide the best plan forward
My main doubt, is this a good approach? (1st transplant only hairline). What if my donor can only yield 4-4.5K graft and he will use like 2.5K-3K for hairline, leaving almost no donor left?.... basically midscalp/crown would be impossible to recover if treatment doesn't progress? Would a nice hairline with balding crown look ridiculous?

Some guidance would be appreciated... I'm pretty insecure right now because the doctors rejecting me but I believe with dedication and money should be possible to have a great result, right? 

Thanks a lot in before!!

Current state of hair

 

Edited August 10, 2022 by WhereIsMyMind

[mister_25]

 

1 hour ago, WhereIsMyMind said:

Goals
I want a good, full head of hair, with dense hairline result. If crown is a bit thinned I don't mind as long as no visible scalp is showing and hairline looks dense.
I will do as many transplants as needed, with whoever is needed, money is not an issue. If I have to repair heavily harvested donor with even more procedures (BHT repair, SMP, etc..) I'm up for it too. If it takes 10 transplants, I'll take it. I just want a great result and wont be satisfied otherwise. Please let me know if I'm being delusional.

First off, transplants are a illusion of density. Recreating native density is not smart or possible as it requires a lot of grafts. Density is subjective in my opinion and its different for everyone. Its also good that your willing to travel and space it across multiple transplants, be advised that you generally wait a year between transplants. You might need to curb your expectations a bit, don't expect when its wet that its light proof. Its also a really good thing that you are open for travel, spending the necessary money. If you go to the right surgeon you will probably not need to do any work in your donor. I've seen worse case scenarios get really good results but they all had really spectacular donors.

 

1 hour ago, WhereIsMyMind said:

Donor area expectations
With Retrogade Alopecia, realistically, how many donors I could yield? More than 4K is too optimistic right?

Your donor reminds me of mine. With retrograde its reduced surface area but the area where it counts as crazy thick. You might need to curb your expectations based on how dense you want to achieve, also you have quite a bit of native hair on your frontal-third which can work for you so out of all the Norwood 6s I've seen that want a result your asking for, i think you are one of closer ones that are able to achieve it your goals, given you stabilize and don't lose any more hair. Here are some photos of mine for comparison although keep in mind we might have different hair characteristics so you might need more/less grafts/cm2

Now when I asked based on the photos I provided with the clinic I chose. They said that I would 7000-8000. If retrograde affected 20% of my donor then it would be around 5500-6500. These are not necessarily accurate because I havent had them examine me.

Some doctors can get more out of it like Dr Zarev who purposefully overharvest a donor but does it in a homogenous extraction patterns. You should do your research on that cause it might be useful in your case. You are most likely going to need to use beard hair or body hair. How is your beard? and also is your hair fine/medium/coarse?

1 hour ago, WhereIsMyMind said:

Current state of hair

The way that your hair loss pattern is, you are destined to be Norwood 7. You can clearly see where the thinning ends on your donor and with retrograde its looking like you will be a tough case if you are unable to stabilize. If you stabilize your hair loss you could get full coverage if you maintain your native/existing hair with transplanted hair to add to it.  

My Recommendations:

I think you should go to someone that is known for handling Norwood 6/7s with low donor area. You have really thick where it matters but with retrograde its reduced area so donor management will be key in your case. Freitas is good and has a really good portfolio and is one of the only ones I would let touch my head, but there are other doctors out there that skills fit your situation. I would advise you take a look on this forum and have look at Zarev, Eugenix (Dr Sethi) and Pitella. There are other doctors on this forum that have great success in Norwood 6/7 ranges but the big results like HugoX and Zoomster are the most known Norwood 6/7 recoveries.

 

 

[GoliGoliGoli]

Need to see more pics including the front from straight on but you dont look like NW6. NW4 if anything

[HHH]

Can you upload a picture of your facial hair? Could use some for the crown.

[WhereIsMyMind]

37 minutes ago, mister_25 said:

 

First off, transplants are a illusion of density. Recreating native density is not smart or possible as it requires a lot of grafts. Density is subjective in my opinion and its different for everyone. Its also good that your willing to travel and space it across multiple transplants, be advised that you generally wait a year between transplants. You might need to curb your expectations a bit, don't expect when its wet that its light proof. Its also a really good thing that you are open for travel, spending the necessary money. If you go to the right surgeon you will probably not need to do any work in your donor. I've seen worse case scenarios get really good results but they all had really spectacular donors.

 

Your donor reminds me of mine. With retrograde its reduced surface area but the area where it counts as crazy thick. You might need to curb your expectations based on how dense you want to achieve, also you have quite a bit of native hair on your frontal-third which can work for you so out of all the Norwood 6s I've seen that want a result your asking for, i think you are one of closer ones that are able to achieve it your goals, given you stabilize and don't lose any more hair. Here are some photos of mine for comparison although keep in mind we might have different hair characteristics so you might need more/less grafts/cm2

Now when I asked based on the photos I provided with the clinic I chose. They said that I would 7000-8000. If retrograde affected 20% of my donor then it would be around 5500-6500. These are not necessarily accurate because I havent had them examine me.

Some doctors can get more out of it like Dr Zarev who purposefully overharvest a donor but does it in a homogenous extraction patterns. You should do your research on that cause it might be useful in your case. You are most likely going to need to use beard hair or body hair. How is your beard? and also is your hair fine/medium/coarse?

The way that your hair loss pattern is, you are destined to be Norwood 7. You can clearly see where the thinning ends on your donor and with retrograde its looking like you will be a tough case if you are unable to stabilize. If you stabilize your hair loss you could get full coverage if you maintain your native/existing hair with transplanted hair to add to it.  

My Recommendations:

I think you should go to someone that is known for handling Norwood 6/7s with low donor area. You have really thick where it matters but with retrograde its reduced area so donor management will be key in your case. Freitas is good and has a really good portfolio and is one of the only ones I would let touch my head, but there are other doctors out there that skills fit your situation. I would advise you take a look on this forum and have look at Zarev, Eugenix (Dr Sethi) and Pitella. There are other doctors on this forum that have great success in Norwood 6/7 ranges but the big results like HugoX and Zoomster are the most known Norwood 6/7 recoveries.

 

 

Thanks a lot for the detailed response man. So if you also had retrogade and still could harvest around 5.5k follicles that sounds very nice. You have very long hair in those pics and I have it really short but it seems we are very similar case!

I still think that having a solid dense hairline gives the most "illusion of density" for your buck, it is like the main requirement for good result imo, and my fav surgeons for hairline design are Couto and Freitas. Maybe having first HT centered on hairline then book a 2cnd HT full crown recovery with Zarev or any surgeon willing to use BHTs would work? I dont particularly like those high norwood surgeons hairline designs. At the same time I dont like how the hairline specialized surgeons treat high norwoods in the mid/crown either. Mix them both and win?  Does that approach make sense?

[WhereIsMyMind]

On 8/8/2022 at 10:34 PM, GoliGoliGoli said:

Need to see more pics including the front from straight on but you dont look like NW6. NW4 if anything

My hair is naturally very thick and coarse, but on the affected area it is wispy and thin. What I mean is that im thinning in a NW6 pattern, but its true that visually, it could be categorized as NW3.5-4 I guess. They told me I'm NW6 before these pictures, now my hair quality improved quite a bit with Dut/Minox

On 8/8/2022 at 10:49 PM, HHH said:

Can you upload a picture of your facial hair? Could use some for the crown.

This beard is good enough for good BHT extractions ? I didn't even consider that as an option tbh

Edited August 10, 2022 by WhereIsMyMind

[mister_25]

18 minutes ago, WhereIsMyMind said:

I dont particularly like those high norwood surgeons hairline designs. At the same time I dont like how the hairline specialized surgeons treat high norwoods in the mid/crown either. Mix them both and win?  Does that approach make sense?

The lower/straighter hairline requires more grafts which can be detrimental to a final result. You might need to sacrifice more into your crown or you might need to dip into reserves that you would have saved up if your thinning progressed. 

Higher Hairline = More grafts saved for elsewhere.

10 minutes ago, WhereIsMyMind said:

This beard is good enough for good BHT extractions ? I didn't even consider that as an option tbh

Looks about average-average+ in terms of general beards I've seen out there. Not entirely sure if thats good or not for a transplanted. You have it well groomed under the jaw so I cant tell you how deep it goes or anything like that.

Zoomster is a good example of how far beard grafts can take you. 

I'm not entirely sure if this is true but I would consider you are going into Norwood 7. You can clearly see where the heavily miniturized spots are on this red lines but there is also further miniaturization happening on the blue line. That indicates to me that Norwood 7 is a possibility.

Edited August 8, 2022 by mister_25

[WhereIsMyMind]

4 minutes ago, mister_25 said:

The lower/straighter hairline requires more grafts which can be detrimental to a final result. You might need to sacrifice more into your crown or you might need to dip into reserves that you would have saved up if your thinning progressed. 

Higher Hairline = More grafts saved for elsewhere.

Looks about average-average+ in terms of general beards I've seen out there. Not entirely sure if thats good or not for a transplanted. You have it well groomed under the jaw so I cant tell you how deep it goes or anything like that.

Zoomster is a good example of how far beard grafts can take you. 

Oh ok, gotchu, so the more deep down the neck it goes the better? mine goes up all the way down to the hyoid bone so I guess for once I have been lucky with my beard... after being blessed with worst possible hairloss genetics 

[WhereIsMyMind]

15 minutes ago, mister_25 said:

The lower/straighter hairline requires more grafts which can be detrimental to a final result. You might need to sacrifice more into your crown or you might need to dip into reserves that you would have saved up if your thinning progressed. 

Higher Hairline = More grafts saved for elsewhere.

Looks about average-average+ in terms of general beards I've seen out there. Not entirely sure if thats good or not for a transplanted. You have it well groomed under the jaw so I cant tell you how deep it goes or anything like that.

Zoomster is a good example of how far beard grafts can take you. 

I'm not entirely sure if this is true but I would consider you are going into Norwood 7. You can clearly see where the heavily miniturized spots are on this red lines but there is also further miniaturization happening on the blue line. That indicates to me that Norwood 7 is a possibility.

Yeah, I basically was NW7ing before medication, but now donor has recovered into NW6 with medication, that's why that area looks almost covered but still thinning. I'm aware its not a good place to extract follicles from though. I guess I will have to seriously consider BHT as my only solution... at least to repair midscalp/crown. Im just afraid the top doctors will keep rejecting me... is my case really that hard? I have seen much crazier results here like this dude!

[mister_25]

7 minutes ago, WhereIsMyMind said:

Yeah, I basically was NW7ing before medication, but now donor has recovered into NW6 with medication, that's why that area looks almost covered but still thinning. I'm aware its not a good place to extract follicles from though. I guess I will have to seriously consider BHT as my only solution... at least to repair midscalp/crown. Im just afraid the top doctors will keep rejecting me... is my case really that hard? I have seen much crazier results here like this dude!

Captain Calico's crown dips into the Norwood 5 level, you can take a look at his pre-op and you will see what i mean, he also has curly hair which is desirable for HTs and he had ridiculously high survival rate. Also BHT isnt the only solution, I'm saying that if you add BHT it will greatly increase your chances. This is all for discussions with top surgeons that do BHT. Keep in mind that he had 7000 grafts which is a large amount and more so than the 5500-6500 range mentioned earlier in my case.

Edited August 8, 2022 by mister_25

[WhereIsMyMind]

Thanks again! My hair is actually curly too, but it can't be noticed when the donor is short and the thinned hairs lost the curls. I didn't know this was a positive but I can see why now. 

From all gathered I basically got that:
- Need to tame down my expectations because my donor is not great.
- With BHT I can compensate for my slim donor that won't yield much more than 6K follicles.
- The only way I will ever have a covered crown area is with a high-norwood type transplant procedure. Having a great hairline will take away from this too.

Since my priority is to have a good hairline, and have a crown that is "good enough to not seem bald" to go along with it, I think I will procceed with Freitas for the 1st HT to restore the hairline (probably 2.5k-3k grafts max?) and that will leave me 3-3.5k left in donor + 1-2K from BHT to save my crown with dr Zarev/dr Mambwa or any high NW surgeon in a 2cnd or even 3rd HT. 

My hairloss has been actually reversing a few norwoods since medication so I think its somewhat safe to assume it will at least mantain for >10 years. Im not planning to ever stop Dut or OM, and will hop on better drugs if they appear. 

Again, am I being delusional this should give me great results unless im unlucky?

Edited August 8, 2022 by WhereIsMyMind

[SeanT1]

I think you'd do well sir.

The crown is known to be a difficult area for a transplant to have success.  But it's certainly doable.

Anything you do SHOULD be an improvement in theory.

I personally got SMP for density work after my transplant to help give the illusion of fuller hair.

Try an online consultation with some clinics and see what they think.

Edited August 8, 2022 by SeanToman