Diffused hairloss is worse than a norwood 6

[Henry]

A lot of hair transplant surgeons will turn you down if you're a diffused thinner (even if you've stabilized it with meds) a norwood 6 on the other hand can have an illusion of a full head of hair that you can style, in 2 years with hair transplant. So living a life of diffused thinning is arguably worse because you have no choice but to just stare at your thin hair or just accept it and go bald.

Edited November 29, 2022 by Henry

[Henry]

(This is just nonsense i want to write, i know it's not true. It depends on on the person really)

[Melvin- Admin]

Diffuse thinning is arguably worse to transplant because of the high chance of permanent shock loss. It can be done, but it’s difficult.

[Curious25]

Weird post, considering you’ve later contradicted yourself? 
 

A restored NW6 is effectively a diffuse thinner. 
 

Diffuse thinners can be perceived as more fortunate, as they tend to be more likely to experience regrowth as well as stabilisation on meds. 
 

There is also no reason as to why a stabilised diffuse thinner can’t expect to receive a good hair transplant result under the hands of a competent surgeon.

[ticker]

I was also rejected by 1 surgeon due to diffuse thinning. The reason was donor even though it looks good there is a thinning and no guarantee those grafts will survive along with shock loss on native hair. So overall cosmetic benefit will not be there so you might end up looking worse or just look how your are pre - HT. So for diffused thinners the recommendation is only meds but i am going with another surgeon.

[Curious25]

If your donor is substantially thinning also, then this is DUPA - which is different to diffused thinning in a typical Norwood scale pattern. 
 

Totally different scenario. 

[ticker]

Got it. So which is worse? Dupa or diffused thinner non dupa? Looks like dupa but wondering why surgeons operate on a dupa patient?

[Curious25]

7 hours ago, ticker said:

Got it. So which is worse? Dupa or diffused thinner non dupa? Looks like dupa but wondering why surgeons operate on a dupa patient?

DUPA, because the patient doesn’t have a stable donor. 
 

Any good surgeon who can identify DUPA would be very reluctant to perform surgery, and it may only be a consideration if the patient is able to prove that it has stabilised from using medication for a sustained period of time. 

[Al - Moderator]

There are so many variations of hair loss. It's not that a diffuse thinner can not have a transplant, but if certain characteristics are present than it may be much harder to get a good result.

[Henry]

On 11/26/2022 at 11:50 PM, Curious25 said:

Weird post, considering you’ve later contradicted yourself? 
 

A restored NW6 is effectively a diffuse thinner. 
 

Diffuse thinners can be perceived as more fortunate, as they tend to be more likely to experience regrowth as well as stabilisation on meds. 
 

There is also no reason as to why a stabilised diffuse thinner can’t expect to receive a good hair transplant result under the hands of a competent surgeon.

Yeah but transplanted norwood 6 have an illusion of density even if it isn't really, mathematically. Also those transplanted hairs grow longer, so you can style them however you want to make it look thick, diffused thinners on the other hand cannot grow their hair as long because of minitiurization (even with medication sometimes) so they're stuck with a thin looking hair. 

[Curious25]

7 hours ago, Henry said:

Yeah but transplanted norwood 6 have an illusion of density even if it isn't really, mathematically. Also those transplanted hairs grow longer, so you can style them however you want to make it look thick, diffused thinners on the other hand cannot grow their hair as long because of minitiurization (even with medication sometimes) so they're stuck with a thin looking hair. 

I agree - but it’s important to remember what hair transplant surgery is - so between a diffuse NW6 with thin hairs like you mention, and a restored slick NW6 who has a better illusion of density because of the stronger and strategically placed hairs . . . Which one has more hairs on their head?
 

The former , as their donor is untouched. 

 

So even if medication merely just stabilises these weak hairs as they are, once they get a restorative surgery from a skilled physician, given all variable factors equal for arguments sake, their illusion will ultimately be the superior one, because of the support these native hairs will additionally provide. 
 

 

[ticker]

Here is my confusion. I had an in-person consultation with Dr Couto few months back and he rejected my case saying I have DUPA by doing micro scopic evaluation. His Jr Doctor said atleast my frontal areas can be transplanted if not crown but Dr C said he wont operate due to DUPA and only medication is the option for me. I had an in person consultation with Dr Konior and Dr Sethi and they are good to operate on me  but they didn't do any microscopic evaluation of my donor and in their opinion DUPA is not a Blocker for HT. Other elite surgeons who saw my photos also they are ready to operate as long as I take medication. So can I ignore Dr C's assessment as every other elite doctor is ok to perform HT on me even though they didn't do microscopic evaluation? If a DUPA patient shouldn't get HT then why other doctors think I am a good candidate as opposed to Dr C's assessment?

 

[Henry]

3 hours ago, Curious25 said:

I agree - but it’s important to remember what hair transplant surgery is - so between a diffuse NW6 with thin hairs like you mention, and a restored slick NW6 who has a better illusion of density because of the stronger and strategically placed hairs . . . Which one has more hairs on their head?
 

The former , as their donor is untouched. 

 

So even if medication merely just stabilises these weak hairs as they are, once they get a restorative surgery from a skilled physician, given all variable factors equal for arguments sake, their illusion will ultimately be the superior one, because of the support these native hairs will additionally provide. 
 

 

True, it would have to be a very skilled physician though, they are expensive or usually requires you to travel overseas. The diffused thinner would have a much harder time of looking for a skilled surgeon.

Let's say an average skilled physician operates on both people, i would argue the slick norwood 6 would have a better result, the diffused one might have permanent shock loss and at least 30 percent of grafts transplanted not growing, the diffused thinner might end up with exactly the same density or even less density.

 

 

[ticker]

2 minutes ago, Henry said:

True, it would have to be a very skilled physician though, they are expensive or usually requires you to travel overseas. The diffused thinner would have a much harder time of looking for a skilled surgeon.

Let's say an average skilled physician operates on both people, i would argue the slick norwood 6 would have a better result, the diffused one might have permanent shock loss and at least 30 percent of grafts transplanted not growing, the diffused thinner might end up with exactly the same density or even less density.

 

 

Does implantation "technique" really matters along with skilled physician to avoid the permanent shock loss for diffused thinner? Like going with DHI and Not pre-made slits for diffused thinner as the slits are less wide?

[Henry]

6 minutes ago, ticker said:

Here is my confusion. I had an in-person consultation with Dr Couto few months back and he rejected my case saying I have DUPA by doing micro scopic evaluation. His Jr Doctor said atleast my frontal areas can be transplanted if not crown but Dr C said he wont operate due to DUPA and only medication is the option for me. I had an in person consultation with Dr Konior and Dr Sethi and they are good to operate on me  but they didn't do any microscopic evaluation of my donor and in their opinion DUPA is not a Blocker for HT. Other elite surgeons who saw my photos also they are ready to operate as long as I take medication. So can I ignore Dr C's assessment as every other elite doctor is ok to perform HT on me even though they didn't do microscopic evaluation? If a DUPA patient shouldn't get HT then why other doctors think I am a good candidate as opposed to Dr C's assessment?

 

The reason i can think of (and this is just based on my logic and research which absolutely means nothing next to a doctors opinion) is that dr. C probably doesnt have the patience for the amount of work needed to pick and choose every single graft that contains healthy, unminitiurized hairs. Or another reason maybe is that once the other doctors examine you under the microscope, they would say the same thing and would decline operating on you as well. I would suggest on doing in person consultation everytime and requesting to get your scalp checked under the microscope.

[Henry]

7 minutes ago, ticker said:

Does implantation "technique" really matters along with skilled physician to avoid the permanent shock loss for diffused thinner? Like going with DHI and Not pre-made slits for diffused thinner as the slits are less wide?

I would say a skilled surgeon can decide if they can perform a successful surgery on you or not, regardless of the technique. What matters is the skill of the surgeon. Not the technique. Just my opinion.

[ticker]

Well I met Dr K and Dr Sethi :). They looked at my donor and said I am a good candidate. Why would they send me back home and during surgery day they will decline saying microscopic exam says your donor is not good compared to when we looked at you without microscopic exam. 

[ticker]

On 11/26/2022 at 9:23 AM, Melvin- Moderator said:

Diffuse thinning is arguably worse to transplant because of the high chance of permanent shock loss. It can be done, but it’s difficult.

@Melvin- Moderator - The whole point of medication like finasteride and dutasteride is to avoid permanent shock loss along with retaining native hairs correct? so I am wondering why if a patient have diffuse hair loss and on medication and maintain good donor is not a good candidate for HT? Please advise.

[Henry]

34 minutes ago, ticker said:

Well I met Dr K and Dr Sethi :). They looked at my donor and said I am a good candidate. Why would they send me back home and during surgery day they will decline saying microscopic exam says your donor is not good compared to when we looked at you without microscopic exam. 

I'm just thinking of scenarios here, I've read cases of people getting sent home during surgery day for various reasons like scalp inflammation that wasn't detected on their initial consultation. 

[Curious25]

20 hours ago, ticker said:

@Melvin- Moderator - The whole point of medication like finasteride and dutasteride is to avoid permanent shock loss along with retaining native hairs correct? so I am wondering why if a patient have diffuse hair loss and on medication and maintain good donor is not a good candidate for HT? Please advise.

Correct - if hair is stabilised by medication, permanent shock loss is pretty much a non issue, given surgical skill and execution is sound. 
 

In response to your dilemma between the DUPA assessment from Couto, yet the positive assessments from Sethi and Konior, I would explain to the latter two that another surgeon claimed to have found evidence of DUPA from a microscopic examination, and ask for them to do the same, so you can confidently count it out as not being an issue. 
It may well also be a possibility as was mentioned by Henry, that you are potentially a trickier than conventional case, and one Dr doesn’t have the desire to operate, whereas others might. 

All three are proven docs in the field. 

[ticker]

2 hours ago, Curious25 said:

Correct - if hair is stabilised by medication, permanent shock loss is pretty much a non issue, given surgical skill and execution is sound. 
 

In response to your dilemma between the DUPA assessment from Couto, yet the positive assessments from Sethi and Konior, I would explain to the latter two that another surgeon claimed to have found evidence of DUPA from a microscopic examination, and ask for them to do the same, so you can confidently count it out as not being an issue. 
It may well also be a possibility as was mentioned by Henry, that you are potentially a trickier than conventional case, and one Dr doesn’t have the desire to operate, whereas others might. 

All three are proven docs in the field. 

Yes and I trust these doctors however another confusion is Eugenix will not implant my midscalp and other doctors do not touch my crown in the first sitting

So confusion within confusion. Thats why my question regarding Implantation technique. All the doctors whom I reached out and they said they do only frontal and mid scalp in first sitting they use DHI method. Eugenix is the only clinic who refused to touch my mid scalp as there are native hairs in diffuse pattern and they will use pre-made slits. They will address hairline and Crown where I lost most of my hair. H&W is exception they use lateral slit technique (guess pre-made slits) but they will do dense pack on my frontal and midscalp and touch crown in 2nd sitting. I was expecting Eugenix will address all areas as they are known for high NW cases however due to "diffuse" thinning they are being careful not to touch my mid-scalp. If that's the case I am not sure why other doctors are addressing my frontal and mid-scalp areas. So its not easy to take a decision for "diffused" thinner compared to Slick NW6 patient as different doctors have different approaches/techniques and at the end of the day its patient responsibility.

Budget, wait list and country is not an issue for me however it seems over research is also a problem and I am not able to take a decision whether to go for HT and if I go with HT whom should I go ? 

 

[Curious25]

I thought Eugenix ‘invented’ DHI 

[ticker]

They invented DHT method which is kind of DHI. I had same confusions but after talking to various doctors and doing research DHI is where there wont be pre made slits. Extractions will be done first and then Implantations with implanter pens which will do slits and place grafts in 1 shot. DHT is slits will be made first then extractions and implantation simultaneously which is little different than traditional pre-made slits where slits will be done first, extractions and then implantations. The difference between DHT Eugenix vs other pre-made slits is the grafts outside body is minimal in Eugenix method. I might be wrong here but I have to wrap around these techniques multiple times and finally settled on this understanding  Regardless of methods I was told its Doctor that what matters and their results but Not technique. My intention is not to derail this topic but I was looking for some sort of confidence from community to which doctor I have to choose. To make it simple I settled on 3 doctors who agreed to do HT on me even though I am a diffused thinner and I am having difficulty which one I have to choose . Dr Defrietas, Dr Nadimi and Dr Sethi. Dr C Rejected me otherwise he was my 1st choice. I waited 4 years to have an appointment with him and I got rejection in 20 minutes..lol

[Melvin- Admin]

On 11/29/2022 at 2:03 PM, ticker said:

@Melvin- Moderator - The whole point of medication like finasteride and dutasteride is to avoid permanent shock loss along with retaining native hairs correct? so I am wondering why if a patient have diffuse hair loss and on medication and maintain good donor is not a good candidate for HT? Please advise.

Someone on medication and with a good donor is a good candidate. But we’re talking generalizations here. Even someone without medication could be a good candidate, granted they’ve lost enough hair. 

[Bandit90]

8 hours ago, ticker said:

They invented DHT method which is kind of DHI. I had same confusions but after talking to various doctors and doing research DHI is where there wont be pre made slits. Extractions will be done first and then Implantations with implanter pens which will do slits and place grafts in 1 shot. DHT is slits will be made first then extractions and implantation simultaneously which is little different than traditional pre-made slits where slits will be done first, extractions and then implantations. The difference between DHT Eugenix vs other pre-made slits is the grafts outside body is minimal in Eugenix method. I might be wrong here but I have to wrap around these techniques multiple times and finally settled on this understanding  Regardless of methods I was told its Doctor that what matters and their results but Not technique. My intention is not to derail this topic but I was looking for some sort of confidence from community to which doctor I have to choose. To make it simple I settled on 3 doctors who agreed to do HT on me even though I am a diffused thinner and I am having difficulty which one I have to choose . Dr Defrietas, Dr Nadimi and Dr Sethi. Dr C Rejected me otherwise he was my 1st choice. I waited 4 years to have an appointment with him and I got rejection in 20 minutes..lol

Not to derail the thread, but would like to chime in about my experience getting rejected from docs. I was rejected from H&W, after an in-person consult from Dr Wong, he took a ten-second look at my hair and said “no transplant” for me, going on to say that if I did one I would like “an old man with floppy hair”, I was then ushered very quickly out the door. The feeling of rejection is not nice, especially if you had your heart set on that doctor. At this point for me, I lost all hope in the hair loss journey, as I saw H&W as the holy grail for advanced norwoods. But I have since learned that some doctors just do not like challenging cases for various reasons and especially when they have the luxury of picking and choosing patients due to high demand. This doesn’t mean that you aren’t a candidate for surgery, it just means that the doc doesn’t feel comfortable taking your case on. I know there is a lot of respect for doctors who reject patients, as this is perceived as highly ethical as opposed to taking their money. But I do get the impression, they can also reject out of just not needing to take on difficult cases, due to an abundance of demand from low-risk patients.

I have a whole lot of sympathy given you waited for four years, and were very quickly told no. But you have mentioned some world-class docs you have had consults with and are keen to take on your case. I know you request confidence from the community, and without trying to beat the Eugenix drum too hard, as both a complex case (NW 7, Retrograde Alopecia, Fine & Light Hair) and as a Dr Sethi patient, I can first hand vouch that he thrives off challenges and  likes to challenge the status quo. So I’m confident he would excel in a case of treating diffused hair loss.