HT worth it, this far gone? Considering FUE, 1 consult under my belt, advice please? (Pics, history, consult notes included)

[jfally]

Hi there!

35 y/o male, thinning started when I was 31, so about 4 years ago.

For the last 2 years I've been taking Finasteride daily, caveat being I'd say I've been 75% faithful to the 'daily' part of it. Minoxodil I'll start, do for a few days, stop, start again a few weeks later, etc. So not ideal/strict usage of either, but MOST of the time, at least Fin has been coming in daily.

Clearly, my hair is escaping me. Crown moving forward, hairline running backward.

 

Family history on both sides = grandfathers totally bald or close to it.

I'd considered buzzcuts + SMP, but ultimately I don't love the buzzcut look (tho coming to terms with the fact that that may be 'it).

 

At this point, is FUE at all worth it, or is it a super temporary delay to the inevitable and a decade or two from now, I'm left with hair in odd spots, none in others, and a jacked up/depeleted donor area with no options left?

 

I've had one consult locally so far, they recommended FUE with 2200 grafts, 1600 going into crown/vertex, remainder going into temple/hairline area to increase density. I let them know I was almost shocked at how low those #'s were and consultant let me know that 1600 into crown (area I am MOST concerned with) is the max they could comfortably work in and feel confident they'd have most chance at viability, as a higher graft count into that area would mean all of them fighting for a finite amount of blood supply so paying for a bunch of grafts that ultimately wouldn't 'take'. (That's my rough translation anyhow)

I was told the goal for crown area would be to go from bald appearance to thinning appearance, but that a full coverage visual just was not possible at least from 1 transplant.

Open to honest thoughts, playing this journey as logical as possible and trying to keep emotion out of this whole thing.

Thanks in advance for any feedback/advice/thoughts!

 

[WhereIsMyMind]

Long story short... yes you can fix it but this is a very hard case. This means WAY MORE than 2200 follicles they quoted you, potentially several transplants and a long journey. Just want to get your expectations straight.

For me battling hair loss is always worth it even if it takes so much sacrifice, but this is personal decision you must take.

Edited October 26, 2022 by WhereIsMyMind

[Xanadu]

If it's worth it depends to a large extent on whether you can be regular with finasteride. You can bet your bottom dollar that all the great hair jobs you see actors having maintained for many years and decades is like that because they have been religiously on finasteride. If you are not consistent or even stop it, then you will be like the footballer Rooney and other who looked good for a bit and then was overtaken by MPB again.

 

If you will go on reddit you will more likely be the next Rooney rather than the next Ashton Kutcher. Even in here unfortunately the risk of developing nocepo is quite....well, present, due to several people scaring people every chance they get. It's a shame, but if you feel very sure that you have done the research and will not be tempted to blame a temporary sadness or lack of libido or the dishes not having been done (all things that can occur in life) on finasteride and stop taking it - then yes it's probably worth it. 

 

Edited October 27, 2022 by Xanadu

[Melvin- Admin]

You’re definitely not too far gone. You should try to be consistent with medication. What are your goals?

[jfally]

Thank you!

 

Goals would be as much coverage and density as possible front to back on top. 
 

Unlike many, my crown/vertex is what I’m most self-conscious about. 
 

Addressing that area is my priority. 
 

I’m really trying to get realistic opinions on how many procedures I’m looking at across how many years, which I realize is going to be largely guesses/estimates, but I’ve lurked on this forum for ages and finally decided I’d just put my pics up and ask outright. 
 

Melvin your videos and story are a huge source of inspiration for me, your journey has been long and arduous but results are the stuff of dreams. 

[jfally]

Here are a couple more pics that may also help. 

[Pbaird98]

Definitely need to stick with the med regime regularly, even if you decide MWF. Stick around here and research as much as possible. You’re absolutely not too far gone, but yes you will need more than the grafts already quoted. 
Which was the local clinic? It’s always good to consider travelling to get the right Dr/Clinic, where are you based? 

[jfally]

I’m in Va Beach. Local consult was at Washington Medical Hair Clinic. 
 

Definitely open to suggestions. 
 

I’ve reached out to a couple Dr Nader in MX as well as Eugenix in India for remote consults as well. 

[Al - Moderator]

At your consultation they suggested 600 grafts to beef up the front and 1600 in the crown. Looking at your pictures I would say I tend to agree with them. You still have a lot of hair in the front half, so you don't need too many there at his time. You say you are on finasteride, but you are sill losing hair, so we should assume the front hair will all be gone eventually. That means you will eventually need another 2500 to 3500 grafts in the front half at a later time, so don't put too many grafts into the crown right now. Save them for the front half.

 

[MisterBreakfast]

I'd say you can address this, but you have to get serious about taking medication.  If you can't religiously stay on it, then I would just forget about it and shave your head when the time comes.

It may sound harsh, but the reason I'd put it this way is that if you can't stop the hair loss, if you get a transplant anyway, then you will be left with a strange looking island at the crown area when the rest falls out. I'm sure you probably don't want that.

I'd say you have an area about the size of 60cm2 that needs to be addressed, and it looks like your existing native density is about 40 ish per cm2 (NOT MEDICAL ADVICE ofc, get these numbers checked by a professional).  If these numbers were your case, you could see that you would need roughly 2600 grafts.  This would bring you to your existing density, which is thin, but way better than what I got for sure : P.

Keep in mind, the crown is the hardest area to transplant, so you will never go back to looking like you did in high school.  That being said, a transplant should give you good aesthetic results as long as you are reasonable about what you can expect from a transplant.

[jfally]

I really appreciate everyone taking the time to reply.

I 100% am committed to the meds being a non-negotiable daily thing.

I've been in that mode for the last 6 mos, for full disclosure working toward best advice possible, I felt it right to call myself out in terms of meds-compliance when making this post, first few months I 'forgot' some days and 1 day forgetting turned into 2-3, etc. 

But yes, meds are a must, only wished I'd committed and stayed regimented to them sooner.

I do have realistic expectations and I totally realize my glory-days head of hair, in all it's Frodo flowing gloriousness, are behind me. And that at this point 'thinning' is best case for the crown appearance. That's a huge upgrade from it's current state and with a few well placed fibers I can then shore up even more, so I'm okay with that.

I live in Va Beach, VA, if anyone has recommendations for FUE specialists anywhere in this area (say anywhere on the east coast), that'd be great. 

Eugenix hit me back and their graft estimates are def higher than my local consult here, they seem to do amazing work, the travel logistics + the cost of the travel would bring them basically up level to or even above some places stateside.

[MazAB]

You got plenty to work with to come out in the green and reset to a NW Zero my friend. Just about finding the right clinic and making sure that you set your goals and expectations accordingly. Best advice I can give you, get the best home care regimen for stopping the progression (ie, FInasteride, Minoxidill). Then find the right clinic without having cost or distance be the factor. 

Follow my Journey with Eugenix and Dr Arika Bansal!

[jfally]

18 hours ago, MazAB said:

You got plenty to work with to come out in the green and reset to a NW Zero my friend. Just about finding the right clinic and making sure that you set your goals and expectations accordingly. Best advice I can give you, get the best home care regimen for stopping the progression (ie, FInasteride, Minoxidill). Then find the right clinic without having cost or distance be the factor. 

Follow my Journey with Eugenix and Dr Arika Bansal!

Thank you. That’s the mission at this point, the right clinic for my situation. 

[jfally]

Update 5 weeks later:

I've been letting my hair grow and religiously using Min AM and PM daily, and have been on daily .5mg Dutasteride as well.

Wanted to grow my hair out more for the first time in years to see what it actually looks like longer, and how the thinning/balding areas look with more length.

 

In the meantime, I've been in touch with Dr Nader and plan to book a procedure with him soon as I hear back again, likely to be in April or May of 2023 at this point as he's booked out til then.

When I wrote to him using his online form, I submitted the original pics in this post plus a few other angles his form requests, and this was the treatment plan suggested:

"Based on this information, the donor area might be limited, and we would not recommend  extracting a large amount of grafts in one visit. This is what Dr. Nader recommends: based on the photos you sent, an average of 2,500 to 3,000 grafts for the crown and mid area, and if possible around 1,000 grafts in the hairline to reinforce it, while not moving it down. Then wait 12 to 15 months and evaluate if the donor area has healed properly and see if we can perform a procedure to increase the density in the crown area or hairline if needed."

 

That sounds pretty solid to me and is in line with lots of other posts I've been seeing in all my research.

Here's current pics that give more insight into my current state of affairs, again, main goal is to get my crown a whole lot thicker and beef up the frontal hairline however we can.

I will forever stay religious to the meds, before and after the procedure.

[jfally]

Also, potato quality images here, but in 6 weeks of faithful med regimen I do think I see at least a 5% ish difference so needless to say, kicking myself for not having been doing this for the last 5 years now.

 

[Etownone]

I've been to Nader 3 times.   

He's great,  and affordable too.   

Stick to the medications always buddy.  I stopped my medication after being very satisfied with my HTs and I had a huge setback. 

Maybe you should look into oral minoxidil cause the topical is a huge pain in the butt.