32yo thinking of getting HT only on the crown — suggestions?

[tshep]

Hi everyone,

I'm 32 and I've been experiencing (or at least noticing) HL since I was about 22. I've been taking finasteride for about 4 years now, and I think it's done a lot. Unfortunately I have the impression that the HL has gotten worse lately despite finasteride, although to be honest I'm not completely sure about it. I've never tried Minoxidil as my dad said that he tried when he was young and it gave him palpitations and I'd rather not take the risk. Also, I don't find topical medications very appealing.

In any case, the idea of HT has always been at the back of my mind, and I'm thinking about it more seriously now. The only aspect of my HL that I'd really like to fix is the crown. As long as the hairline doesn't recede further, I'm happy with it as it is. Ideally I'd like to keep the hair relatively short as in the pictures, with little to no styling, but without the "hole" on and around the crown.

I've attached some photos, I'd like to hear what you guys think and what you suggest! In particular:

1. Do you think it makes sense to have HT for the crown only?
2. I've read that HT for the crown is very delicate, especially at my age. Is that true?
3. How many grafts do you think I might need?
4. Does my donor area look good?

Thanks for your help!

[Z--]

I think there's signs of thinning in the front. Assuming you lose the front, where would your hairline to be?

At 32 and Norwood 6-7 pattern, I wouldn't worry. Most of the hair has fallen out, but I think what's more concerning is the severity of the dip in your crown. Crown will take more than 4,000 imo. Prob 5k.  And your donor is limited mate (not sure about quality - you need a doctor to asses). I would be very cautious focusing on your crown for first go. You probably need 2-3 surgeries and can't afford to have a bad doctor waste your grafts.

Think about doing the front half first and then the the back half in a second procedure.

[asterix0]

The problem is, from your pictures it looks like you are heading to norwood 7, so the assumption you have that the front will stay as it is, is not a good one. You will almost certainly also lose the front as your age is only 32.

In that case, since your donor is limited, you want to keep as much as possible for when you lose the front. 

I would recommend you buzz your head at this point and hold off on a transplant.

[HappyMan2021]

Agree the crown work alone will 2 surgeries minimum. 

Due to the severity of crown loss there is nothing really simple or "open and shut" about your case.

Think long and hard if you are ready to commit to this journey, because you will be looking at multiple surgeries

[mr_peanutbutter]

get smp for the crown and buzz everything. that would look the best imho

[WhereIsMyMind]

I wouldn't give up as others suggested tbh. IIts definetely still in the fixable territory esp. if your hairloss is stabilized for so long, and you have money and enough commitment to go for it. Of course it's a difficult case that would need at least 2 or 3 HTs though.

In this same forum there is many cases of people with similar HL who went full transplant route and are happy about it, starting with the site admin, so idk why is everyone so discouraging lol

I agree that you should have some coverage on the front first, and then use whatever is left on crown though. If HL progresses focusing on crown you will regret 100%.

Do you have any decent beard for BHT potentially? I doubt you can reach full coverage without it. Also having a slightly longer hairstyle would help giving illusion of density with less.

Edited October 24, 2022 by WhereIsMyMind

[tshep]

Thanks a lot to everyone! Your feedback is so bad that I'm almost happy: there's no way I have the money for 4-5000 grafts at the moment, so I can at least stop thinking about HT for a few years 😅

As for the recommendation of shaving: I've been trimming the hair very short for about 1y a few years ago. It was not too bad, but the problem is that I have a big bump on the side of my crown that is quite visible and pretty ridiculous when I have very short hair. You can kind of see it in the picture below. I don't know how it'd look completely without hair, but I guess pretty bad. Anyway, once I started taking finasteride I had quite a lot of regrowth and so I decided to go back to the barber, and honestly I've been quite a lot happier about my hair ever since (and my gf is as well). So I'd rather stick with a short but not fully buzzed haircut for now.

...Which brings me to new questions about alternatives:

1. Do you think that Minoxidil could improve the situation? And oral Minoxidil would work just as well (provided I manage to get a prescription)?
2. SMP seems quite nice, but would it make sense for a haircut like mine or you need to buzz completely?
3. Also, I think SMP would be quite visible from close distance (say, someone standing behind you while you're seated). Is that true?
4. Do you think it'd be worth having a visit with a HT clinic to ask about these questions? There's a good one in the city I live (it's among the HTN recommended ones).

Thanks a lot again!

[GoliGoliGoli]

I'm curious what everyone's thoughts on the benefit of crown work is in general. Put differently, is a surgeon really ever able to put enough grafts into the crown to provide coverage that provides a satisfactory illusion of density in all lighting?. Or is it always going to look pretty darn sparse? Are people going for crown work pretty much destined to marginal improvments? I know all HT is essentially a marginal improvement compared to when you were 17, but I think ya'll know what I mean. 

I know these things come down to hair type, quality of surgeon etc, but generally speaking I'm interested in peoples thoughts on whether crown work is really "worth it". I personally am fine with my hairline but am considering getting my crown worked on but I don't want to go through it all if I'm still going to have a decent bald spot on top. 

[splitting hairs]

I think that it's clear you have a very aggressive hair loss pattern.  I would switch to Dutasteride for 1 year and then look into a transplant.