Dr Hasson | November/December 2022 | 3872 FUE Grafts | 22M

[mister_25]

On 10/12/2023 at 7:15 PM, mister_25 said:

.

Here are my Questions:

• How many grafts do you think I have?
• How many grafts do you think I need to achieve a "illusion of density" in the frontal third?
• How many grafts do you think I need to achieve a "solid set of hair" in the frontal third that matches my original goals?
• How many grafts do you think my crown needs judging by the 9 Month photos previously posted?
• How can my yield be better on a second surgery, what are some methods that doctors could do to up the chances of better yield

Hey guys, really stressed here, I have asked these questions before, and I really need answers as I am not receiving clear answers.

 

Also @Chrisnorequested a middle part picture, so I am including it here

This photo shows how the growth actually is, in all the photos I presented before I take them in the absolute best positions, in the correct lightings and angles to showcase what it can look like at its absolute best. This is what it looks like if I comb it forward or a middle part it.

I am aware that the illusion of density applies less in these angles and conditions, but if you look at any other procedure with similar area covered and similar graft count regardless of fine hair or not it should be better than this.

To me, it’s about the same as pre-op in the worst conditions. You can see on page 1 of a photo I took in similar lighting, similar camera angle

 

I need help guys, what do I do? I am having trouble communicating with the clinic so i have to wait a while for a response. I feel like my potential and one chance of having the hair I wish I had has been taken away from me.

Edited October 15, 2023 by mister_25

[Chrisno]

You should seek the input of a hair restoration surgeon. You should get in-person consults, and I think you should start with Dr. Hasson as he was your surgeon. That is my recommendation and input for you moving forward. We are not surgeons or medical experts on this forum, hence why you are getting varied input on your case. One person could tell you 1000 grafts is adequate, while another could tell you 4000. No one knows before you have had in-person consults. Your case is difficult, that's why I would say online consults wouldn't give you any answers or conclusions.

If I were to guess, your mid-scalp is losing native hairs. I can't find a reason why your transplanted hairs would suddenly fall out.

Melvin should be able to assist in getting in touch with the clinic.

[mister_25]

56 minutes ago, Chrisno said:

You should seek the input of a hair restoration surgeon. You should get in-person consults, and I think you should start with Dr. Hasson as he was your surgeon. That is my recommendation and input for you moving forward. We are not surgeons or medical experts on this forum, hence why you are getting varied input on your case. One person could tell you 1000 grafts is adequate, while another could tell you 4000. No one knows before you have had in-person consults. Your case is difficult, that's why I would say online consults wouldn't give you any answers or conclusions.

If I were to guess, your mid-scalp is losing native hairs. I can't find a reason why your transplanted hairs would suddenly fall out.

Melvin should be able to assist in getting in touch with the clinic.

Midscalp seems to be a bit stronger thanks to Oral Minoxidil, I’m having a better time concealing the weak points before pre-op. I’ll attach a photo, which you can compare to your own leisure

I like your idea of a in person consultation to some degree, it’s getting more reinforced as a good measure the more I think about it. What I’m thinking on doing is I’ll see what the other online consults say, I am interested in seeing which clinics accept me or reject me first and I may select one for a online consult, and then a in person consult. If I had a preferable doctor to give me a in person consult I think Couto would probably be a great call.

I am asking these questions because it is appropriate to do so, I expect somewhat accurate responses because at the end of the day I am asking hair transplant related questions on a forum on the topic of hair transplants and hair restoration rather than reddit, my GP, real self, google or whatever other unreliable source. This forum literally has surgeons and representatives active on here and is made for patients by patients. 
 

I will wait for a reply from H&W after the weekend.

[ThePerseverantWarrior]

On 10/11/2023 at 6:26 AM, mister_25 said:

Its more than just dating. I've been treated differently depending on what social circles I am in by people I once thought of as my friends.

Also even if my balding had no effect on my dating life such as covering up with fibers. The insecurity and lack of confidence associated with my hair loss surely will.

It is a big personal issue for me on multiple fronts. I'm not expecting for my hair to come back and all the damage to be  undone to my mental health and relationships, but I just want to feel a sense of normalcy and not have "balding early 20s" as my defining physical trait.

I am taking your advice, I took it the first time around. I've started to see a psychiatrist and I've returned to my diet and my hobbies as past times. But thats all they are now, past times. They no longer serve as a sense of fulfilment to me.

I am treating it as a work in progress, it's just what I was told to expect and what I expected myself is such a mismatch to reality. It's gotten me anxious for any future surgery because if I yield poorly the first time around, what's to say it won't happen again?

I was told two surgeries were needed, but I can't realistically see my goals being met if my growth the first time around is the standard that's set for me. It's looking like 3 to 6 possible surgeries at this rate and I'll be 26-30 by the time its all over.

I don't want my 20s to be remembered as me hating myself for a insecurity that I fought with everyday with all my effort and it still wasn't enough.

I completely echo your sentiments. The lack of confidence, insecurity and the related emotional/mental tolls that early balding takes on men is the key issue. And this damage is much harder to undo. 

Being in a fairly similar boat as you, all I can tell you is that you should probably take another shot at a HT procedure. What do you have to lose, since your present condition isn't gonna improve on its own anyway? If things work out, you will at least spend the 2nd half of your 20s in a much better frame of mind. 

The best way to tackle this situation is to think as less about it as possible, and that will only happen when you know your hair doesn't look abnormal/unnatural. So probably you should give it another shot. You don't look too far from your goals. One good procedure should take you there

[ThePerseverantWarrior]

6 hours ago, mister_25 said:

Midscalp seems to be a bit stronger thanks to Oral Minoxidil, I’m having a better time concealing the weak points before pre-op. I’ll attach a photo, which you can compare to your own leisure

I like your idea of a in person consultation to some degree, it’s getting more reinforced as a good measure the more I think about it. What I’m thinking on doing is I’ll see what the other online consults say, I am interested in seeing which clinics accept me or reject me first and I may select one for a online consult, and then a in person consult. If I had a preferable doctor to give me a in person consult I think Couto would probably be a great call.

I am asking these questions because it is appropriate to do so, I expect somewhat accurate responses because at the end of the day I am asking hair transplant related questions on a forum on the topic of hair transplants and hair restoration rather than reddit, my GP, real self, google or whatever other unreliable source. This forum literally has surgeons and representatives active on here and is made for patients by patients. 
 

I will wait for a reply from H&W after the weekend.

Are you on 2.5 mg oral minoxidil daily?

[mister_25]

8 hours ago, ThePerseverantWarrior said:

Are you on 2.5 mg oral minoxidil daily?

5mg daily

[consequence]

Switch to oral dutasteride, add on ketoconazole and give it a year. You've had improvement, see what meds can do.

With how rough psychologically this has been for you, I'm not sure getting another surgery is a good idea. Hair transplants are not for the faint of heart.

[HappyMan2021]

3 hours ago, consequence said:

With how rough psychologically this has been for you, I'm not sure getting another surgery is a good idea. Hair transplants are not for the faint of heart.

i agree. 

the emotional and mental toll of surgery is not brought up enough...

even for people who have great results, it can be a very stressful and anxiety-filled process

[mister_25]

 

7 hours ago, consequence said:

With how rough psychologically this has been for you, I'm not sure getting another surgery is a good idea. Hair transplants are not for the faint of heart.

I don't really have a choice, hair loss has damaged my social life and destroyed my confidence. My options are either struggle and try to restore my hair or live a miserable twenties by giving up.

 

I am past the 11 month point, I will be withholding information about my communications with H&W until the 12 month point. 

 

I have been communicating with other surgeons. General consensus is that I have 2000 grafts left and I have to choose between fulfilling my front or crown.

And to answer the question, Dr Hasson said that my hair was Coarse and Wavy, so any misconceptions about my hair being fine contributing to the less than stellar result should have their answer.

Edited November 6, 2023 by mister_25

[ThePerseverantWarrior]

5 hours ago, mister_25 said:

 

I don't really have a choice, hair loss has damaged my social life and destroyed my confidence. My options are either struggle and try to restore my hair or live a miserable twenties by giving up.

 

I am past the 11 month point, I will be withholding information about my communications with H&W until the 12 month point. 

 

I have been communicating with other surgeons. General consensus is that I have 2000 grafts left and I have to choose between fulfilling my front or crown.

And to answer the question, Dr Hasson said that my hair was Coarse and Wavy, so any misconceptions about my hair being fine contributing to the less than stellar result should have their answer.

You have "2000" grafts left? Generally, at your age, people do have 7000-8000 grafts available that they can harvest without damaging donor area's visibility. 

 

Have you got a trichoschopy done through your donor area?

[jnyc97]

14 hours ago, consequence said:

Switch to oral dutasteride, add on ketoconazole and give it a year. You've had improvement, see what meds can do.

With how rough psychologically this has been for you, I'm not sure getting another surgery is a good idea. Hair transplants are not for the faint of heart.

I agree with this. Your mental mental health is concerning and age, if you have only 2k grafts left you should wait

[Zinedine]

On 10/15/2023 at 1:45 PM, Chrisno said:

You should seek the input of a hair restoration surgeon. You should get in-person consults, and I think you should start with Dr. Hasson as he was your surgeon. That is my recommendation and input for you moving forward. We are not surgeons or medical experts on this forum, hence why you are getting varied input on your case. One person could tell you 1000 grafts is adequate, while another could tell you 4000. No one knows before you have had in-person consults. Your case is difficult, that's why I would say online consults wouldn't give you any answers or conclusions.

If I were to guess, your mid-scalp is losing native hairs. I can't find a reason why your transplanted hairs would suddenly fall out.

Melvin should be able to assist in getting in touch with the clinic.

This! I would do what @Chrisno is suggesting here. Go and talk with your surgeon, no one better than Dr Hasson, one of the best HT doctors, to follow up and see what could have happened... But of couse, you could always go for new consults if you feel that way... hope all goes great.

[splitting hairs]

Hi Mister_25,

I actually think that you have got significant improvement.  Dealing with a hair transplant is an emotional roller coaster at any age, so I can't imagine what it's like at 22.  

Give it the full 12 months.  Dr Hasson is one of the World's best surgeons.  H&W are a reputable clinic and will always stand by their work.  

Also, you were an evolving NW5, so 3800 grafts isn't going to give you total coverage.  You will need a second procedure.  

It may also be worth considering switching from finasteride to dutasteride, as you have an aggressive type of hair loss at a young age. 

Good luck! 

[asterix0]

10 hours ago, mister_25 said:

 

I don't really have a choice, hair loss has damaged my social life and destroyed my confidence. My options are either struggle and try to restore my hair or live a miserable twenties by giving up.

 

I am past the 11 month point, I will be withholding information about my communications with H&W until the 12 month point. 

 

I have been communicating with other surgeons. General consensus is that I have 2000 grafts left and I have to choose between fulfilling my front or crown.

And to answer the question, Dr Hasson said that my hair was Coarse and Wavy, so any misconceptions about my hair being fine contributing to the less than stellar result should have their answer.

OP I think your donor area was pretty good, I stand by that and anyone who says otherwise is trying to blow smoke to be honest.

To me this is a sub par result and if anyone here does enough research, this clinic unfortunately is resting on past laurels, has recently tried to overpack areas that many other elite clinics could do with 33% less grafts, and get better yields from the looks of it.

This site has the more recent results and these threads are available for us to see, I won't like them here as I don't have time presently but someone else can look at the last 3-4 years or so and post links if they like.

I heard that they are not doing 1 patient a day anymore, seems to be trending to the hair mill direction with minimal surgeon involvement in the extraction/incision phases.

You did everything right OP in my opinion, did your due diligence, unfortunately the clinic didn't serve you properly and you probably could have gotten a similar result in Turkey for 1/10th the price.

As for next steps, I recommend you consider FUEgenix in the Netherlands, some of the Spanish doctors with longer waiting lists, perhaps Dr. Feirreira in Portugal. 

Edited November 6, 2023 by asterix0

[mister_25]

This will be a long post, it will serve as addressing some comments I want to reply to, what I am doing, thoughts on doctors I am consulting with, and a small description of my hair at 11 months in.

5 hours ago, ThePerseverantWarrior said:

You have "2000" grafts left? Generally, at your age, people do have 7000-8000 grafts available that they can harvest without damaging donor area's visibility. 

 

Have you got a trichoschopy done through your donor area?

I've had my donor examined at my current trichologist three-seperate times (Once during my donor shockloss at about two months in, and twice during my areata checkups at the 7/8 month mark). I've also had Doctor Hasson previously operate on my donor before. In-fact I am going in for a third Areata checkup next week making it the fourth time this trichologist has examined my donor. Just for full context, this trichologist I currently visit was recommended to me by a notable forum member who is very knowledgeable about the hair transplant situation going on in my country.

I have retrograde alopecia, so I have a reduced donor zone. If I can only get 2000 grafts out it would make me only able to harvest about 5900-6000 grafts in total. Doug once told me that if someone's retrograde alopecia were to take up 20% of the donor, then they would probably only get 5500-6500 grafts out of their donor. I was expecting this to be honest.

Regardless, what Dr Hasson told me at the clinic when he had finished operating on me, and what he is telling me now contradict each other.

Dr Hasson told me that if I opted for a conservative hairline (which I did), that I would be able to address the frontal third, and the crown whilst also having grafts saved for future hair loss, whilst also achieving my goals after the second procedure. Now Dr Hasson has told me that I will have to "choose" between the frontal third or the crown.

If I'm looking at every bit of information confirmed about my donor, this is what I can list that concerns my donor.

• Average Density (From Dr Hasson) and "Average at best density" (From Dr Konior), Seems to be Good Density (From my Trichologist)
• Average Characteristics (From Dr Hasson) Coarse and Wavy Hair (From Dr Hasson)
• Retrograde Alopecia
• NW6/7 Potential

 

2 hours ago, jnyc97 said:

I agree with this. Your mental mental health is concerning and age, if you have only 2k grafts left you should wait

When you say wait, how long are you talking about? The options that I am very impressed by have spots probably around some time at the end of 2024 or the middle of 2026. Is that a sufficient wait?

I am very confused by people telling me to wait because of my mental health. The reason why I am miserable is because I have blatantly obvious hairloss now. Isn't my best interest for my mental health actually addressing the problem? It seems counter-productive to me.

 

 

And to really reiterate, the whole idea of "focus on other avenues of your life" to "distract myself of my hair loss" doesn't work for me. I have acted on this forums advice both publicly and privately. I see a therapist now, I actively go to gym more consistently with a stronger sense of routine and discipline, new and improved diet that I find is giving me better results and even progressed at my job. I do not feel better or fulfilled in the slightest. 

I hate myself for my hair loss, my whole purpose in the past three years of my life is to rapidly improve myself in every conceivable way, especially since I lost almost all of my social circles and friendships because of my rapid and sudden hair loss. All my earnings are put towards funding future procedures, gym membership, psychiatrist appointments, flights, food that fits under my diet and accommodation. It is all to address the one insecurity that makes me feel less about myself and has made others treat me as if I am less.

1 hour ago, Zinedine said:

This! I would do what @Chrisno is suggesting here. Go and talk with your surgeon, no one better than Dr Hasson, one of the best HT doctors, to follow up and see what could have happened... But of couse, you could always go for new consults if you feel that way... hope all goes great.

I am not sure if I would get a second procedure with Dr Hasson or H&W. I will say that I have a scheduled phone call with Dr Hasson and after that phone call I will make up my decision and post all the input I have received from the clinic and my collective honest experience. 

Also a thing worth noting. Due to my Areata, Dr Hasson has said that he wants to delay my second procedure to November 2024, the reason for this is that he wants one year without active areata before performing a proecedure.

 

1 hour ago, splitting hairs said:

I actually think that you have got significant improvement.  Dealing with a hair transplant is an emotional roller coaster at any age, so I can't imagine what it's like at 22.  

I am not saying that there was no significant improvement, because in its own way there clearly is. I cannot describe this procedure as a failure or a success when you look at hair transplants objectively. But the miss match from expectation and reality is devastating.

I asked the doctor at the very start. In fact its in the opening paragraph of the original post "are my expectations reasonable and achievable" here is the exact quote

On 12/9/2022 at 7:25 PM, mister_25 said:

I asked Dr Hasson if my goal was realistically attainable and I described that as "A head of hair that is uniform when wet, meaning it can look thinner and scalp can show but not patchy and still quite good, and when dry and in harsh lighting if someone was to rummage their hand across my hair/scalp randomly they would not see any thinning/weak points what so ever" From memory he believes this is attainable.

My expectation, that I had reinforced on Day one post-op. Does not line up with reality. 

1 hour ago, splitting hairs said:

Also, you were an evolving NW5, so 3800 grafts isn't going to give you total coverage.  You will need a second procedure.

3800 was not enough to address my balding, I have stated multiple times I was and I am still aware of this. I always knew, from the very beginning that I would need two procedures. My problems do not arise from this understanding.

What I was told, was to meet my goals I will need to do two two personalized surgeries. The first surgery would address the frontal third and add some coverage to work with in the crown (3872 grafts). The second procedure would boost that crown to the satisfactory degree and boost the mid-scalp by reinforcing the weak point. At no point did Dr Hasson indicate to me that my frontal third would be insufficient in a first pass. (This quoted second procedure was somewhere in the 2000 range. Getting me to a grand total of something around 5872)

Yet again I'll say it plainly. The reason why I am unhappy is the frontal third is weaker than what the doctor reinforced in my expectations.

1 hour ago, splitting hairs said:

It may also be worth considering switching from finasteride to dutasteride, as you have an aggressive type of hair loss at a young age. 

I have not seen any hair loss at all since I started Finasteride/Minoxidil at the beginning of February 2021. No hair loss at all for almost three years. My regime works and I do not want to risk changing one item for another. However, I do not mind adding something on top of another. This is the regime I was thinking off if I were to progressively bald again or If I can reasonable add more stuff without risking side effects

• Finasteride 1mg a day (currently taking)
• Oral Minoxidil 5mg a day (currently taking)
• Topical Dutasteride once a day
• Saw Palmetto once a day (currently taking)
• Ketoconazole maybe twice a week?

 

 

May as well say what my hair is like now at 11 months in terms of improvements;

The hairline seems to have improved in terms of how "natural" it is, the weak point that I deemed as "unnatural" at around the 8/9 month mark has softened up due to the hairs maturity. But it still stands out to a degree.

The hairs seem thicker, but as for "amount of hairs" there doesn't seem to be much improvement.

Crown seems to show more improvement, and even in poor conditions (example I am referring to is bedhair where my hair was all over the place) it is a significant increase in coverage/density.

In the plainest and simplest terms my hair right now has two states based on two major conditions

• Without direct light, I look like a NW2 with visible early signs on transitioning to NW3. This only applies outside of a top-down angle and frontal tilt.
• With direct light, there is a obvious mismatch in density between the transplanted hairs and the native forelock. And all those transplanted areas are very see through. It looks like I have hair in the NW2 area, but I am "rapidly approaching NW4, skipping the NW3 process"

As for the consults, here is a update

Konior - The difference between communicating with a Clinic (like H&W/Rahal who I consulted with) and a Doctor directly is night and day difference. I feel like I am getting personalized emails straight from the source itself. Konior seems rather straight forward and explains his reasoning and gives honest input. He told me that due to the information I provided (which he said is not entirely accurate due to lower resolution photos) is that I have up-to 2000 grafts and that would be pushing the upper limits of my donor capacity, and that he would transplant the best 1000-2000 I have in the frontal third to boost the density.

Ahmad - No update, I need to provide more information on my part.

Ferreira - Not taking online consultations, but I have been placed on the waiting list when they arrive.

Bisanga - Rejected as he does not take patients under the age of 28-29.

Pinto - Not taking assessments

Couto - Not taking assessments, I have been told when to contact them when they are available to book one.

 

So far after researching additional options, the doctors that I am leaning towards the most are Konior and Couto so far. This can be subject to change.

 

 

[asterix0]

Also, you have a very thick beard. This can definitely be utilized in your midscalp and crown, and you can save the best grafts in your donor area for your hairline. 

You can probably get 3000 grafts from your beard. 

[mister_25]

10 minutes ago, asterix0 said:

OP I think your donor area was pretty good, I stand by that and anyone who says otherwise is trying to blow smoke to be honest.

Honestly, I don't know. All the mixed feedback really adds a massive element on confusion and is actually detrimental to the way I process my decisions.

I've been told by you and others, publicly and privately that I have "good/great characteristics and donor" but also been told by others that it looks like I have DUPA and I actually have poor donor. How can you not be confused when two different groups give the exact opposite opinions. I especially started getting confused when I was told that I have fine hair by one group and coarse hair by the other. It infact still has some hold of doubt on me, in spite of the doctor saying that I have coarse and wavy hair.

10 minutes ago, asterix0 said:

This site has the more recent results and these threads are available for us to see, I won't like them here as I don't have time presently but someone else can look at the last 3-4 years or so and post links if they like.

Its not a 3-4 year thing. I checked every single result. The post-procedure photos that came into question started around March 2022 but were minimal concern until the final results came in around December 2022. Now in 2023 I am seeing alot more people express concerns about H&W. 

I don't want to bag on the clinic that I am still considering, but the most I will ever say is that before my transplant, I actively searched for bad hair transplant results with H&W and I could only find three posts that were rather public that spoke negatively about them from either experience, or result. Now when I search it I see multiple reddit threads and other cases, probably including my own.

13 minutes ago, asterix0 said:

As for next steps, I recommend you consider FUEgenix in the Netherlands, some of the Spanish doctors with longer waiting lists, perhaps Dr. Feirreira in Portugal. 

Considering Couto, Ferreira and Konior the most, looks like this line of thinking is probably right so far.

3 minutes ago, asterix0 said:

Also, you have a very thick beard. This can definitely be utilized in your midscalp and crown, and you can save the best grafts in your donor area for your hairline. 

You can probably get 3000 grafts from your beard. 

Here is the thing, I did not want to have to rely on beard grafts. I am not opposed to getting beard hairs implanted in my scalp, but I would be very cautious because my beard is very different than my scalp. My scalp hair is dark brown, almost black whilst my beard is red. On top of that my beard hair is very wiry and unruly whilst my scalp hair is wavy. Its very different characteristics and if I transplant my beard hair and it is "unable to adapt to the scalp characteristics" its going to look very unnatural and very poor.

I'll PM you a case that shows what I am fearing as I do not want to publicly shame the user for his poor result.

 

 

[BurnieBurns]

35 minutes ago, mister_25 said:

This will be a long post, it will serve as addressing some comments I want to reply to, what I am doing, thoughts on doctors I am consulting with, and a small description of my hair at 11 months in.

I've had my donor examined at my current trichologist three-seperate times (Once during my donor shockloss at about two months in, and twice during my areata checkups at the 7/8 month mark). I've also had Doctor Hasson previously operate on my donor before. In-fact I am going in for a third Areata checkup next week making it the fourth time this trichologist has examined my donor. Just for full context, this trichologist I currently visit was recommended to me by a notable forum member who is very knowledgeable about the hair transplant situation going on in my country.

I have retrograde alopecia, so I have a reduced donor zone. If I can only get 2000 grafts out it would make me only able to harvest about 5900-6000 grafts in total. Doug once told me that if someone's retrograde alopecia were to take up 20% of the donor, then they would probably only get 5500-6500 grafts out of their donor. I was expecting this to be honest.

Regardless, what Dr Hasson told me at the clinic when he had finished operating on me, and what he is telling me now contradict each other.

Dr Hasson told me that if I opted for a conservative hairline (which I did), that I would be able to address the frontal third, and the crown whilst also having grafts saved for future hair loss, whilst also achieving my goals after the second procedure. Now Dr Hasson has told me that I will have to "choose" between the frontal third or the crown.

If I'm looking at every bit of information confirmed about my donor, this is what I can list that concerns my donor.

• Average Density (From Dr Hasson) and "Average at best density" (From Dr Konior), Seems to be Good Density (From my Trichologist)
• Average Characteristics (From Dr Hasson) Coarse and Wavy Hair (From Dr Hasson)
• Retrograde Alopecia
• NW6/7 Potential

 

When you say wait, how long are you talking about? The options that I am very impressed by have spots probably around some time at the end of 2024 or the middle of 2026. Is that a sufficient wait?

I am very confused by people telling me to wait because of my mental health. The reason why I am miserable is because I have blatantly obvious hairloss now. Isn't my best interest for my mental health actually addressing the problem? It seems counter-productive to me.

 

 

And to really reiterate, the whole idea of "focus on other avenues of your life" to "distract myself of my hair loss" doesn't work for me. I have acted on this forums advice both publicly and privately. I see a therapist now, I actively go to gym more consistently with a stronger sense of routine and discipline, new and improved diet that I find is giving me better results and even progressed at my job. I do not feel better or fulfilled in the slightest. 

I hate myself for my hair loss, my whole purpose in the past three years of my life is to rapidly improve myself in every conceivable way, especially since I lost almost all of my social circles and friendships because of my rapid and sudden hair loss. All my earnings are put towards funding future procedures, gym membership, psychiatrist appointments, flights, food that fits under my diet and accommodation. It is all to address the one insecurity that makes me feel less about myself and has made others treat me as if I am less.

I am not sure if I would get a second procedure with Dr Hasson or H&W. I will say that I have a scheduled phone call with Dr Hasson and after that phone call I will make up my decision and post all the input I have received from the clinic and my collective honest experience. 

Also a thing worth noting. Due to my Areata, Dr Hasson has said that he wants to delay my second procedure to November 2024, the reason for this is that he wants one year without active areata before performing a proecedure.

 

I am not saying that there was no significant improvement, because in its own way there clearly is. I cannot describe this procedure as a failure or a success when you look at hair transplants objectively. But the miss match from expectation and reality is devastating.

I asked the doctor at the very start. In fact its in the opening paragraph of the original post "are my expectations reasonable and achievable" here is the exact quote

My expectation, that I had reinforced on Day one post-op. Does not line up with reality. 

3800 was not enough to address my balding, I have stated multiple times I was and I am still aware of this. I always knew, from the very beginning that I would need two procedures. My problems do not arise from this understanding.

What I was told, was to meet my goals I will need to do two two personalized surgeries. The first surgery would address the frontal third and add some coverage to work with in the crown (3872 grafts). The second procedure would boost that crown to the satisfactory degree and boost the mid-scalp by reinforcing the weak point. At no point did Dr Hasson indicate to me that my frontal third would be insufficient in a first pass. (This quoted second procedure was somewhere in the 2000 range. Getting me to a grand total of something around 5872)

Yet again I'll say it plainly. The reason why I am unhappy is the frontal third is weaker than what the doctor reinforced in my expectations.

I have not seen any hair loss at all since I started Finasteride/Minoxidil at the beginning of February 2021. No hair loss at all for almost three years. My regime works and I do not want to risk changing one item for another. However, I do not mind adding something on top of another. This is the regime I was thinking off if I were to progressively bald again or If I can reasonable add more stuff without risking side effects

• Finasteride 1mg a day (currently taking)
• Oral Minoxidil 5mg a day (currently taking)
• Topical Dutasteride once a day
• Saw Palmetto once a day (currently taking)
• Ketoconazole maybe twice a week?

 

 

May as well say what my hair is like now at 11 months in terms of improvements;

The hairline seems to have improved in terms of how "natural" it is, the weak point that I deemed as "unnatural" at around the 8/9 month mark has softened up due to the hairs maturity. But it still stands out to a degree.

The hairs seem thicker, but as for "amount of hairs" there doesn't seem to be much improvement.

Crown seems to show more improvement, and even in poor conditions (example I am referring to is bedhair where my hair was all over the place) it is a significant increase in coverage/density.

In the plainest and simplest terms my hair right now has two states based on two major conditions

• Without direct light, I look like a NW2 with visible early signs on transitioning to NW3. This only applies outside of a top-down angle and frontal tilt.
• With direct light, there is a obvious mismatch in density between the transplanted hairs and the native forelock. And all those transplanted areas are very see through. It looks like I have hair in the NW2 area, but I am "rapidly approaching NW4, skipping the NW3 process"

As for the consults, here is a update

Konior - The difference between communicating with a Clinic (like H&W/Rahal who I consulted with) and a Doctor directly is night and day difference. I feel like I am getting personalized emails straight from the source itself. Konior seems rather straight forward and explains his reasoning and gives honest input. He told me that due to the information I provided (which he said is not entirely accurate due to lower resolution photos) is that I have up-to 2000 grafts and that would be pushing the upper limits of my donor capacity, and that he would transplant the best 1000-2000 I have in the frontal third to boost the density.

Ahmad - No update, I need to provide more information on my part.

Ferreira - Not taking online consultations, but I have been placed on the waiting list when they arrive.

Bisanga - Rejected as he does not take patients under the age of 28-29.

Pinto - Not taking assessments

Couto - Not taking assessments, I have been told when to contact them when they are available to book one.

 

So far after researching additional options, the doctors that I am leaning towards the most are Konior and Couto so far. This can be subject to change.

 

 

While the concerns people have of mental health do come from a place of good intentions, I understand the frustration that hair loss very much is the sole driver of it all. It makes sense you want to be proactive as possible.

Sorry if this was already stated but you you be open to FUT?

Edited November 6, 2023 by BurnieBurns

[mister_25]

25 minutes ago, BurnieBurns said:

While the concerns people have of mental health do come from a place of good intentions, I understand the frustration that hair loss very much is the sole driver of it all. It makes sense you want to be proactive as possible.

Sorry if this was already stated but you you be open to FUT?

No as of now, for multiple reasons.

• Getting a FUT really ruins the bald look and the buzzed look in my opinion. In spite of me desperately wanting hair I also wants options for shaved heads.
• I don’t think it’s necessary unless I go into 6/7 territory. 
• Beard hair in my opinion is a better alternative for my case.
• From what I’ve seen, filling in a FUT scar with SMP or grafts is very difficult to achieve something that looks satisfactory on shorter cuts.

I would only consider a FUT after I’ve exhausted all options or I enter a territory where I have noteable loss in the 6/7 areas. If I am low on donor with only 2000 grafts than donor preservation is just as important as restoring the front and crown.

And if I do get a FUT, I would probably get it with Konior.

 

 

[consequence]

With the aggressive nature of your hair loss at a young age, there's a strong possibility that you've lost underlying native hair as well during your recovery, contributing to the loss.

Do not consider further surgery until you maximize medical therapy. This means oral dutasteride, oral minoxidil and keto 2% shampoo. Then reassess after a year. Otherwise you're pouring sand into a bucket with a hole in the bottom.

I don't think you should consider strip unless you're sure you'll never want to shave your head. This is very hard to know at such a young age.

[mister_25]

3 hours ago, consequence said:

With the aggressive nature of your hair loss at a young age, there's a strong possibility that you've lost underlying native hair as well during your recovery, contributing to the loss.

Do not consider further surgery until you maximize medical therapy. This means oral dutasteride, oral minoxidil and keto 2% shampoo. Then reassess after a year. Otherwise you're pouring sand into a bucket with a hole in the bottom.

I don't think you should consider strip unless you're sure you'll never want to shave your head. This is very hard to know at such a young age.

Any native hair that I have lost would of been too weak to survive the surgical process anyway. They were extremely thin in diameter and the only area that loss was visible in is on the left side hairline.

I am practically maximising already. I am on two DHT blockers, high dosage of oral minoxidil for 10 months, I mean I can add ketoconazole but I’ve already stabilised with no visible regression for almost three years. I am absolutely certain that as of now, that doctors and myself consider my situation stabilizied. 

Why would I risk changing Finasteride for Dutasteride when finasteride works for me? If I swap to dutasteride and it’s not as effective for me and I start to thin again, I’m creating more problems down the line. 
 

I will probably add new medication, but waiting another year? Probably not. All I do is wait and I hate it. I’ll wait for doctors but not this.
 

My goal is to restore it with the best ability, precautions and methodology as well as early as possible. 

[consequence]

Fin is DHT 70%, Dut is DHT 95% And eventually there's a decent chance you would regress even with dutasteride. But that's where I would start.

The amount of psychological distress the recovery process has caused you, when you've really had a significant improvement, is very concerning. And that's coming from me, a neurotic.

Beyond that you should be aware that with how advanced your hair loss is at a young age means there's a good chance you're going to end up at a high Norwood and be left with only transplanted hairs on your head down the line, and even those can fall out depending on harvest site and where your Norwood is going to take you eventually. That's despite avodart and whatever CB RU PRP you try. You're just on fin, which means that point will most likely come sooner for you. You need to plan for the long term, not just your 20s. Hair restoration is a marathon not a race.

Either way, good luck.

Edited November 8, 2023 by consequence

[Sunset Dune]

You have very aggressive hair loss at only 22 it’s very unlikely your hair loss has fully stabilized with meds. Finasteride can lose efficacy and may not be sufficient enough for someone with aggressive balding such as yourself. You definitely should consider “upgrading” to dutasteride and you may start seeing more visible hair growth within a year of daily use. Given your aggressive MPB you may want to use topical and oral dutasteride together at the same time.  

It’s irrelevant what some people “think” of H&W, they are still one of the best HT clinics in the world and Dr. Hasson is an elite surgeon, a few results you might have seen online doesn’t change that fact. 

Your head looks better compared to pre-OP, the results will continue to improve it can take up to 18 months for some people but given your case you already know you  needed a second procedure. You should have the second procedure with the same clinic, Dr. Hasson is already familiar with your case and I’m more than confident you will get the results your seeking.  
 

I only trust two surgeons in entire North America, that’s Konior and Hasson, if you decide to go to Konior for a second transplant your result won’t be that much different and he uses less grafts so actual density won’t be as much as Hasson.
As for FUT, I wouldn’t recommend it unless you’re fine with having a linear scar on the back of your head for the rest of your life. Don’t ever think about shaving your head in the future regardless if you get an FUT or not, that sort of attitude is just submitting your loss to MPB.  

The only thing that surprises me here is why Dr. Hasson didn’t focus only on the front instead of using extra grafts for the crown unless you specifically requested this. You did all your due diligence before getting a HT but the only mistake you made was asking for grafts in both the crown and front which will decrease over all density, had you only received grafts on the front you would have had a better aesthetic improvement.  Medication can improve the crown on its own buts it’s much more difficult to improve the front on meds if you are that far gone. 
 

Definitely add Keto shampoo into your regimen but don’t start it until at least month 12 post op. You don’t want to take any risk damaging the grafts since Keto can be very harsh on the scalp.  
 

I personally wouldn’t add beard hairs to the scalp unless you have no other choice, beard hairs will never look as “natural” as actual scalp hairs. 
 

Your frustration is understandable but this whole idea about “looking your best in your 20s” is nonsense you will care about your looks just as much when you’re 40. You might spend your 20s alone fighting hair loss but if you discipline yourself by working out focusing on yourself and focusing on work and earning lots of money (for yourself and hair transplants) you will prevail in the end and you can start a brand new life by the time your 30.

Edited November 8, 2023 by Sunset Dune

[curiou]

@mister_25, I feel your pain. Considering everything, including your mental problems. I am sorry.

I'll be strictforward: IMO your result isn't worth the price. I'm sorry for that. There is an improvement, but it is slight. 3872 grafts should have covered your spots perfectly. IMO Hasson should offer you a free touch up if you're dissatisfied in month twelve.

I would like to come across as a friend and try to give some words of advice, if you look for this kind of support. I've been there: self-hate and self-contempt due to hair problems is one common that we share. My HT wasn't perfect either. It was enough to make "terrible" go to "will do", but if I get in a wrong light, I still feel myself like an ugly. 

So:

1. Try to style your hair another way. You have that "slicked back" look and it shows thin hairs in the front line. Maybe you could try side part. Should cover the spots. Should mask front: side-parted hair looks fuller.

2. Do not try Duta in desperate attempt to improve your situation. I suspect you have severe depression due to failed expectations (and it is not your fault, man. It was the clinic that failed to deliver in your case) AND finasteride. Changing to Dutasteride might worsen your mental condition.

And I should say one thing that might you may not like, but I ask you to give it a thought: your social life worsened not only because you're feeling bad about your hair, but also due to your depression. Depression part what does it most. It is not your fault: people love you when you're up, but no one gives a flying f*** if you're down. If your "friends" left you in the dark - they're not your friends. F*** THEM. If someone have the audacity to publically discuss your hair when you're not proposing that topic - they're rude and obnoxious people. F*** THEM. You deserve better.

3. Try to reduce your Fin dosage to 0.5-0.2 mg daily. Or exclude Saw Palmetto. When someone advices to use DHT blockers, it is rarely mentioned that by blocking 5-a-reductase it blocks the synthesis of neurosteroid Allopregnanolone(ALLO). When ALLO is deficient in your brain, it may cause depression.

4. With slightly reduced Fin dose, add palmitoylethanolamide(PEA).  It should increase ALLO level in your brain.  There is one problem though: when you're on Fin, ALLO synthesis is very, very low and PEA impact will also be mitigated. But I think it is still worth to try. Here is some links to read. 

 https://neuroendocrinology.org/a-potentially-new-treatment-for-post-finasteride-syndrome/

 https://pubmed.ncbi.nlm.nih.gov/21554431

To close mental part: it won't be easy, it requires many factors for you to start getting out of this. To me it was combination of p.1,2,3,4 and therapist.

5. I read that you're fixed your diet. It is very good to hear. Maybe you could visit a gastroenterologist: your stomach affects your hair and skin more than you think. If there is some chronic problems, make appropriate changes to your meal plan. Skin/hair will improve.

6. Ketokonazole works in combination with p.5 as a prophylactic. Use it a 2-3 times a week. Wash your hair each 2-3 days.

7. Consider other doctors who could fix your problem. Save your money little by little for a good option. I could recommend Konior, Pekiner, Couto, De Freitas, Ferreira. Maybe it is Hasson who should fix it, but if you don't trust him anymore, it is up to you. 

8. If p.1 doesn't work and it looks terrible to you, you could shave your head to 0.6-1cm and rock some rugged shaven-bearded lumberjack look as well. It'll help when you're waiting for you second surgery.

9. I was addicted to fibers some time, but it is like a drug. If you use them, use them deliberately for special occasions. Not everyday.

10. Trust your feelings. If you feel that your result doesn't satisfy you - don't settle and don't listen to cope from the others. Fight. Every age is worth it: 20's, 30's, 40's. You deserve to be happy about your looks. But remember: a beatiful box is just a box, if it is empty. Try not to forget about more meaningful things that fill your life. Remember yourself.

As you see, I vouch for a complex take on the problem. You have a very different journey ahead of you, but I believe in you. Why? Because you took the chance to improve when you got your 1st HT. There is fight in you. Don't give up. I wish you all the best.

Edited November 17, 2023 by curiou

[mister_25]

12 hours ago, curiou said:

'll be strictforward: IMO your result isn't worth the price. I'm sorry for that. There is an improvement, but it is slight. 3872 grafts should have covered your spots perfectly. IMO Hasson should offer you a free touch up if you're dissatisfied in month twelve.

Dr Hasson thinks the results are excellent so I think the offer of a free touch-up or refund is off the table if they were to say that. 

Also the doctor said I have coarse hair, and when you look at any hair transplant material, coarse hair transplants are always fuller than medium or finer hair transplants. This was also discussed on this thread if you go back a couple of pages.

11 hours ago, curiou said:

1. Try to style your hair another way. You have that "slicked back" look and it shows thin hairs in the front line. Maybe you could try side part. Should cover the spots. Should mask front: side-parted hair looks fuller.

I've tried by combing in all sorts of ways, my hair falls flat against the skin because of the very little volume, no matter how I part it. Slick back looks the most natural because the hair naturally gets pressed closer towards the scalp anyway. I have to live with the weak hairline for now. Its "passable" as long as I'm not in direct lighting.

 

12 hours ago, curiou said:

2. Do not try Duta in desperate attempt to improve your situation. I suspect you have severe depression due to failed expectations (and it is not your fault, man. It was the clinic that failed to deliver in your case) AND finasteride. Changing to Dutasteride might worsen your mental condition.

I'm probably going to "test" dutasteride by starting on Fin 6 times a week and Dut 1 times a week, and slowly over the course of a year work my way up to 7 days usage. I got a prescription for Oral Dutasteride now but I havent ordered any.

You nailed it on the head about the failed expectations, All these people downplaying by saying you still "got a significant improvement" fail to see the reality of the situation. Regardless its a significant improvement, or even if this is somehow 100% growth. The doctor told me, in person, at his clinic after I directly asked him "Are my expectations achievable, and reasonable" and he said they were, this is what I set in my mind as my expectation due to his response, this is what was reinforced into me. 

I will say without a doubt the peak of my self hatred was about 1-2 months into minoxidil usage when I had shed all my hair from minoxidil. And in-spite of the disappointment that was my hair transplant, I don't nearly hate myself as much as I did back then. 

My point is, I don't think I am suffering Finasteride induced depression. Pretty sure its body image based and how I was treated during that.

12 hours ago, curiou said:

And I should say one thing that might you may not like, but I ask you to give it a thought: your social life worsened not only because you're feeling bad about your hair, but also due to your depression. Depression part what does it most. It is not your fault: people love you when you're up, but no one gives a flying f*** if you're down. If your "friends" left you in the dark - they're not your friends. F*** THEM. If someone have the audacity to publically discuss your hair when you're not proposing that topic - they're rude and obnoxious people. F*** THEM. You deserve better.

My social life worsened on both ends, one side from my depression affecting my on my confidence to say witty things, joke or to mingle and share personal matters and opinions without being judged/rejected. On this end this was entirely on my behalf because the simple answer is if I didn't care about my body image whatsoever then It wouldn't affect this at all. But the other side was and is completely outside my control and it genuinely changed how I was treated. When I went NW3 but still rather thick and full hair, I was still mocked, excluded, a topic of gossip, a example of "what not to be", etc. When my balding progressed into NW4, I straight up was mocked relentlessly, whenever I had a small disagreement with my "friends" they would just say "I don't have to listen to someone who's balding at 20". That's the type of life I lived for a while, at the end of the day. I felt and was treated as "less". I don't have that type of life now, but I carry that with me.

Unlike what everyone says, your personal image matters. If I didn't shower and I smelled horrible, then gossip about me smelling bad and being unhygienic would exist, I would also be excluded more often due to this, who wants to invite someone that smells bad to a bar or club? Same thing with receding/balding, or acne, or fat or anything else society deems "defective, undesirable, unattractive"

And the reality is, they probably weren't worthy of being my friends anyway which you are 100% correct on. Regardless some of them removed me from their life, I removed some of them from my life, they are gone now but doesn't mean the damage isn't done.

Everyone is the sum of their life experiences, observations, anecdotes. When I went from a non balding man to a balding man, I was simply treated horribly or even ignored and rejected completely by some groups of people that I called my peers and friends. I can change the state of my hair by struggling with everything I have by exhausting a significant amount of my savings, funds, time and energy. But at the end of the day, I cannot change the fact that I was treated horribly by the closest of my peers all because I was balding. That's a part of who I am now, that's something I will have to live with and probably will never go away.

12 hours ago, curiou said:

3. Try to reduce your Fin dosage to 0.5-0.2 mg daily. Or exclude Saw Palmetto. When someone advices to use DHT blockers, it is rarely mentioned that by blocking 5-a-reductase it blocks the synthesis of neurosteroid Allopregnanolone(ALLO). When ALLO is deficient in your brain, it may cause depression.

I won't adjust finasteride dosage because its working for me how it is, I might be swapping to dutasteride over the coarse of the year. But excluding Saw Palmetto is probably going to happen if I switch to Dutasteride.

12 hours ago, curiou said:

5. I read that you're fixed your diet. It is very good to hear. Maybe you could visit a gastroenterologist: your stomach affects your hair and skin more than you think. If there is some chronic problems, make appropriate changes to your meal plan. Skin/hair will improve.

I'll research into it, but I will probably try it because if it improves my hair then it simply improves my life. That's literally what my life boils down to. But the reality is, I am not made out of money. I exhaust huge financial resources into my hair already as it is and every time I add things like "Personal Trainer, Therapist, Gym Membership, Nutritionist" I just get further away from the future hair transplants.

 

12 hours ago, curiou said:

7. Consider other doctors who could fix your problem. Save your money little by little for a good option. I could recommend Konior, Pekiner, Couto, De Freitas, Ferreira. Maybe it is Hasson who should fix it, but if you don't trust him anymore, it is up to you. 

I am leaning towards Konior/Couto the most out of the ones you have listed here. As for Dr Hasson, he has offered a phone call to me but I told him that I want to wait until I hit 12 months, the reason I said this is whenever I had a issue, H&W would just tell me to wait, I do not want to hear that again at 11 months as the reason why my result isn't where I wanted it to be.

12 hours ago, curiou said:

9. I was addicted to fibers some time, but it is like a drug. If you use them, use them deliberately for special occasions. Not everyday.

I just got fibers and tested them for about a day, fibers get my hair going from a 55-65% to about a 90% of where I want to be. Its a good intermediate solution but at the end of the day, it doesn't make me look I'm not balding. My hairline is just too thin, and to high to look like someone at the age of 23. Still I feel like that when I have fibers in, my hair looks "average" and won't give anyone any negative or positive thoughts on it so thats the biggest win I can ask for.

12 hours ago, curiou said:

10. Trust your feelings. If you feel that your result doesn't satisfy you - don't settle and don't listen to cope from the others. Fight. Every age is worth it: 20's, 30's, 40's. You deserve to be happy about your looks. But remember: a beatiful box is just a box, if it is empty. Try not to forget about more meaningful things that fill your life. Remember yourself.

Thank you for this.

My problem is that I don't get the same fulfillment out of my hobbies that I used to get before hair loss. I associate my hair loss as "losing my youth" and the reason I say this is because I went from "freshly graduated from highschool with no balding" to "heavily balding" in the span of a year. I work so hard with all the financial and other resources I have just to offset this, its ruined my perception on enjoying the present, I only care about the future and I consider the present "lost" to me. 

12 hours ago, curiou said:

You have a very different journey ahead of you, but I believe in you. Why? Because you took the chance to improve when you got your 1st HT. There is fight in you. Don't give up. I wish you all the best.

The thing is, I don't know if I am able to achieve my goals anymore.

The assessments about my current donor are about 2000 grafts, which isn't enough to address my level of hairloss in my opinion.

On top of this, because of the stress that my hair growth was slow and the responses of the clinic were practically just "wait", I developed alopecia areata from stress. My trichologist straight up told me, that he does not think I am a good hair transplant candidate anymore due to my areata. He is very against it, but he also says that I can't back down from future transplants because I'm already in deep. He never said it but I'm pretty sure he implied im in a really sh*tty situation.

At the end of the day, can I expect significant improvement? Yes. Can I expect my goals to be achieved? I don't know, my goals were to just have decent-hair that can pass off as my age. "My Age" refers to whatever age I am at.

On 11/9/2023 at 8:56 AM, Sunset Dune said:

It’s irrelevant what some people “think” of H&W, they are still one of the best HT clinics in the world and Dr. Hasson is an elite surgeon, a few results you might have seen online doesn’t change that fact.

The world runs on what people think of each other, and this is no different than what people think of H&W or any other clinic/surgeon for that matter.

If enough people "think" on this website that Asli Tarcan is a upstanding clinic that provides the best results, than word of mouth will make it known that they are a "upstanding clinic that provides the best results" even if they are grossly wrong. The reason I picked Dr Hasson of H&W is that I "thought" he was "the best and most capable choice for my situation and case". 

To generalize, people are filled with "individuals" who each have their own personal anecdotes that they willingly go out of their way to share them, and in less common cases even explain them, this happened many times with Clinics like H&W to the point that many people associate H&W as a elite clinic due to their consistent excellent results, the same thing can be undone if people believed there is a new trend where they stopped caring for their practice and their results suffer as a result. If a large group of people come out and say it, then its worth considering and addressing.

On 11/9/2023 at 8:56 AM, Sunset Dune said:

I only trust two surgeons in entire North America, that’s Konior and Hasson, if you decide to go to Konior for a second transplant your result won’t be that much different and he uses less grafts so actual density won’t be as much as Hasson.

Konior in my case said that he would do something between 1000-2000 grafts (depending on how much I get placed into the hairline) and that he would select the strongest 2000 hairs/grafts that I have in my donor for the best coverage. After my donor has healed he can then assess how much I have remaining.

 

On 11/9/2023 at 8:56 AM, Sunset Dune said:

I personally wouldn’t add beard hairs to the scalp unless you have no other choice, beard hairs will never look as “natural” as actual scalp hairs. 

Can you elaborate on this? 

 

On 11/9/2023 at 8:56 AM, Sunset Dune said:

Your frustration is understandable but this whole idea about “looking your best in your 20s” is nonsense you will care about your looks just as much when you’re 40. You might spend your 20s alone fighting hair loss but if you discipline yourself by working out focusing on yourself and focusing on work and earning lots of money (for yourself and hair transplants) you will prevail in the end and you can start a brand new life by the time your 30.

I care about how I look now, and the "near future" which is my 20s. 30s, 40s, 50s, 60s even 70s and 80s I am going to care what I look like from before, now and until I die.

The reason I put emphasis on 20s, is that very rapidly after I turned into a adult, I went bald which is associated with aging and a undesirable attractive trait. You are only young once, and I want to look good in my physical prime and at the height of my youth. Is that really nonsense?

I already actively do what you are saying about building myself up finaicially and discipline wise. If anything, your comment just reinforces that its proabably the best thing I can do outside of addressing my hair. But this does not address the present where I am miserable now, only the future which may or may not have my hair goals met.

For the past 3-4 years, I've been obsessed in self improvement, I began gym, self care, reading self help books, dismantling bad habits and assembling good ones, and improving my discipline in ways that apply to all aspects of my life. I can improve in all these aspects and become "better" or "more" than the average person in these ways, but at the end of the day the one way that I am "less" than others overpowers my thinking. Its unhealthy, and I cant change it after years of on and off therapy and so far months of consistent therapy. 

On 11/8/2023 at 11:06 AM, consequence said:

You need to plan for the long term, not just your 20s. Hair restoration is a marathon not a race.

On 11/8/2023 at 4:14 AM, consequence said:

Do not consider further surgery until you maximize medical therapy. This means oral dutasteride, oral minoxidil and keto 2% shampoo. Then reassess after a year. Otherwise you're pouring sand into a bucket with a hole in the bottom.

I am aware that I need to plan for the long term, that much is obvious and because of your comments I have gotten a prescription for Oral Dutasteride. But the whole idea that hair restoration is a marathon and not a race isn't 100% accurate.

If I keep playing the waiting game like I have been doing this whole time, I'll be 30 by the time everything is addressed. Whilst I may live to the ages of 80 or so on, I am not young forever. I want to look the best I can for the longest amount of time, and early is better because my youth wont last forever. 

 

Small Update now that I am 11.5 months in

My previous Areata patch is about 90% filled in, it took a good 1-2 minutes in the office to expose it in a way that was slightly visible. However I developed another one that is smaller than the previous one, my trichologist explained that since I reacted very positively and well to the injections the first time around that this weaker patch is all but guaranteed to really fill in, which is a good thing but still a pain in the ass that I have to go through this a second time.

Because I developed this second areata patch, I have more of a understanding of "what causes" my areata loss. I see a very similar circumstance/situation/pattern on the weeks leading up to when I first discover these patches and that is excessive stress to when it hits boiling point.

I don't want to elaborate in detail because I find this topic in particular very embarrassing to share publicly, so if anyone is interested in this they can send me a private message and i'll elaborate as long as they keep it private.

Outside of that, Not much really to report on, if anything there is slight improvements but not in growth or amount of hair on my head.