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

[consequence]

Any ethical surgeon should reject you as a patient. Your mindset is a recipe for disaster.

[Sunset Dune]

10 minutes ago, consequence said:

Any ethical surgeon should reject you as a patient. Your mindset is a recipe for disaster.

100% agreed.

[mister_25]

10 hours ago, consequence said:

Any ethical surgeon should reject you as a patient. Your mindset is a recipe for disaster.

10 hours ago, Sunset Dune said:

100% agreed.

This comment is so ridiculous, gave me a good chuckle.

My attitude surrounding my hair is that I am unhappy with what the transplant has achieved because it does not meet the expectations that we’re reinforced by the doctor. And I want to resolve this issue with the best capabilities preferably earlier than later. This is the most common mindset people have on here. Are they all disasters waiting to happen?

What my “process” is before surgery, I will research, follow and do everything to make myself the best possible candidate. So far what I’ve done and what I am doing is;

• Stabilise my hair loss
• Three years Finasteride Usage
• Three years Minoxidil Usage (Almost one year of Oral Minoxidil)
• Changed diet and lifestyle to address overall health
• Will spend whatever money he needs on his hair, not going for budget options
• Actively converses on forums with regular users looking for advice
• Actually follows said advice
• Sees a therapist to address the mental side of it all

So someone that actively wants to do something about his hair, researches and does the informed decisions based on his research but is still unhappy because expectations aren’t met and still wants to meet those expectations by going through multiple surgeries is a “recipe for disaster”. You must be joking.
 

I am not the type of person that likes back and forth arguments, so instead I'll just ask you this respectfully. Don’t comment on my thread anymore. I don’t value your input enough to look past the condescending comments. 

 

 

Edited November 19, 2023 by mister_25

[Savemyhairline]

21 hours ago, mister_25 said:

.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.

 

 

Okay dude I need you to understand that is very NOT normal and you unfortunately have been exposed to evil. Frankly based on what you’re describing, these “people” deserve to get their a$$ beat. They were never your friends, and in a way you are lucky that this is what showed you that instead of down the line where you could have lost money or otherwise been screwed over.

 

I usually don’t condone violence but assuming these were non-disabled males, you would have been in the right to beat the s**t out of them. Consider looking into a martial art, I think that can also increase your confidence.

 

bald/balding guys may be the blunt  of the joke sometimes but not what you’re describing and certainly not by friends.

[mister_25]

1 hour ago, Savemyhairline said:

Okay dude I need you to understand that is very NOT normal and you unfortunately have been exposed to evil. Frankly based on what you’re describing, these “people” deserve to get their a$$ beat. They were never your friends, and in a way you are lucky that this is what showed you that instead of down the line where you could have lost money or otherwise been screwed over.

 

I usually don’t condone violence but assuming these were non-disabled males, you would have been in the right to beat the s**t out of them. Consider looking into a martial art, I think that can also increase your confidence.

 

bald/balding guys may be the blunt  of the joke sometimes but not what you’re describing and certainly not by friends.

True, I'm all the more better for having these people out of my life. It was a shock when its happened and the feelings are definitely lingering, but I am better without them then with them.

 

[jnyc97]

19 hours ago, consequence said:

Any ethical surgeon should reject you as a patient. Your mindset is a recipe for disaster.

Completely agree with this. 

[HappyMan2021]

As long as you remain committed to this false belief that a 22 yr old NW5 should only need a 'one and done' surgery, I dont think you will ever be at peace with this process. Your expectations do not meet the reality of this journey. 

Consider the recent NW2 Mwamba patient who is also around your age. He started from a MUCH better baseline spot than you did, and even he will need a 2nd (and perhaps more) procedures. 

Your 1st HT unquestionably brought progress to your situation. You will need a 2nd ht and i will go as far as saying you likely will need a 3rd ht too if you want a 10/10 end result. 

And the thing about this is it is all 100% NORMAL. Even NW2's and NW3's should expect multiple procedures. 

I definitely empathize with all your feelings and emotions. And i am sorry if you did not receive a fully transparent prognosis from Dr. Hasson before you embarked on this journey. 

But i advise you to stop being hung up on that fact and understand that every single hair transplant doctor in the world - every single cosmetic doctor in the world - is part salesman and part of their job is selling you surgery and making the journey seem smoother than it may be in reality. 

To me and perhaps others in this thread, it just seems like you set impossibly high expectations/goalpost with your 1st surgery, when in reality I think your journey has actually been very standard/expected. 

The vast majority of ht patients dont realize until after their 1st surgery that this journey has many touchpoints and is never as simple or easy as 'one and done'

[asterix0]

These guys coming in gaslighting the OP and changing the subject has nothing to do with the fact that these results are subpar. Ad hominem the OP all you want, but OP has stuck his neck out with transparency of his whole journey and it takes courage to do that when you invest all this time and money into a procedure like this.

 

[BackFromTheBrink]

56 minutes ago, HappyMan2021 said:

As long as you remain committed to this false belief that a 22 yr old NW5 should only need a 'one and done' surgery, I dont think you will ever be at peace with this process. Your expectations do not meet the reality of this journey. 

 

That's not how I read his posts. I read it as saying that he expected to need multiple procedures. However, what he also believed was that through those surgeries he would have the capacity in his donor to give the illusion of a full head of hair.

He believes his first procedure did not give the yield that was promised, expected or required to meet that end goal. 

I'd tend to agree with him.

[consequence]

.

Edited November 26, 2023 by consequence

[asterix0]

31 minutes ago, consequence said:

No one's saying the results aren't perfect. They are an improvement however.

The basic point is this: OP is still a kid at the beginning of his life. He's not on maximum medical therapy with aggressive hairless at a young age. Getting another surgery without upgrading his rx regimen and when he's already had subpar results with one of the best in the world is just asking for trouble.

Plus he's unfortunately dealing with some pretty severe psychiatric issues it seems. If down the line he's in a place where he's blown out all his grafts and doesn't have a Colin Farrell level hairline, I worry that he might hurt himself. Mental stability is as much a prerequisite for successful procedure as an optimal medical regimen.

OP doesn't want to see this and there's nothing I can do about that. You get all sorts on these forums and the hyperneurotic 20 year old with advanced hair loss at a young age is a textbook personality I've seen dozens of times. He will regret the path he's taking now but ultimately not my monkey, not my circus.

And to the OP: You came on here looking for feedback, but became very emotional when it wasn't what you wanted to hear. I agree -- no more comments from me on your thread because, frankly, it's like talking to a brick wall. This is not a thoughtful approach to life that you've developed.

You will find a doc to cut you because someone's eventually going to say yes to free money. Will it be an ethical doctor? I don't think so. You'll have your procedure, and another middling result, and then you'll come on here and post about it how unfair the world is again. The exact same sequence of events. This Sysiphean wrestling back and forth will consume your 20s. I hope not, but I've seen your story so often it's a no-brainer at this point.

Either way, good luck. Remember it's just hair. Don't ruin your life over it. There is a time in the future where you will look back and be profoundly jealous of where you are right now.

Having a "not perfect" result is much different than a pretty much failed transplant.

I don't think his transplant failed, but looking at this pre-op and post-op photos, for 4000 grafts I don't see a lot of improvement. 

Have you gone under the knife yourself personally? What is your criteria for a successful transplant, 90% yield, 80%? Give a ballpark number. 

What do you think OP's yield was?

 

Edited November 20, 2023 by asterix0

[asterix0]

I would estimate OP got about 70% yield, but with long hair combed it really is difficult to say. I could absolutely be wrong. 

Edited November 20, 2023 by asterix0

[consequence]

6 minutes ago, asterix0 said:

I would estimate OP got about 70% yield, but with long hair combed it really is difficult to say. I could absolutely be wrong. 

When we throw around percentages, what are we even talking about? Percentage of the "illusion of density"? Percentage of scalp covered? Percentage of looking like you were never bald in the first place? What about results where 100% of follicles grow but they stay thin in caliber?

I don't know what percentage of his follicles grew, or to what caliber, but yes it is a fairly middle of the road result. This is why I think he should be careful with new procedures and maximize medical therapy first. 

[asterix0]

59 minutes ago, consequence said:

When we throw around percentages, what are we even talking about? Percentage of the "illusion of density"? Percentage of scalp covered? Percentage of looking like you were never bald in the first place? What about results where 100% of follicles grow but they stay thin in caliber?

I don't know what percentage of his follicles grew, or to what caliber, but yes it is a fairly middle of the road result. This is why I think he should be careful with new procedures and maximize medical therapy first. 

% of how many grafts grew successfully after the conventionally understood period of time to evaluate a result, i.e. 9-12 months after the transplant. 

I dont think they can grow but stay thin in caliber, can you give some examples of that? A graft can thin over time however in some patients. 

[Stewie]

I think tbh looking at what you had done and where you're at, it looks like pretty much most of it has grown and you have carried on losing hair at the same time. As for your hang ups going bald so early I am not the only one on here but mine started falling out at 17 and I was a NW6 by 21 and was shaving it since 20 until a few months ago when I finally let it grow after 3 surgeries of 3000, 3000 and 4544, and even with all that its still thin, thats the reality of losing hair and put less back to cover what's gone. Like others have mentioned its never a one and done, you have options to move forward to address what's concerning you, but one thing I would say is your young and don't maybe rush into to many procedures until you know its all calmed down and stabilised. And I have always had the piss taken out of me and my bald head, some things you can't help, everyone has something and people are quick to pull on the things they know trigger you to get a rise, thats all that is.

[mister_25]

To answer some of the comments

I think it’s 70-75% Yield overall, the crown met my expectations fully and I have no issues with the results for my crown as of this first procedure. Frontal third is like 55-65% what I imagined it to be. 

I lost some native hair at the very front of the hairline that contributed a small amount, but ultimately they were very weak and deep in the miniaturisation phase. The rest of the hair that I would have lost made up almost 0 coverage and would only grow a couple of millimeters in the course of three years, this is especially obvious in the right corner.

I have not seen any regression since I started finasteride, you can take a look at my Finasteride thread and you can see where I started from and where I was pre surgery, I may of temporarily shedded due to stopping topical minoxidil but it looks like that has grown back as of now.

I definitely have hang ups on balding early, I do want to say that I am going to therapy for this, that’s about all I can think of to address that problem, if anyone else has any advice on this I’m willing to listen.

I’m not getting any surgery in 2024, I’m aiming for 2025 or 2026. Partly because I am taking time on considering my options, I also want to address my areata within this time and perhaps transition into Dutasteride. Is that a reasonable approach?

I don’t exactly know what to say anymore about people criticising me over my expectations. I did the sensible thing when looking for answers, asking my surgeon. If you think I’m childish, delusional, mentally unstable, brick-wall, gullible, hyper-neurotic, circus monkey, whatever you want to label me fine. But I only put my trust in my surgeons words, was I wrong to hold on when he reaffirmed my expectations and goals as attainable?

I want to also put emphasis on the fact that while the general consensus is that my result is “subpar”. Dr Hasson describes it as “excellent and the result he was looking for”. There is most certainly a mismatch to what the majority here believes the result is, and what the doctor believes the result is. It is also does not match what I was told or implied.

Overall though, I am adjusting my expectations into something less due to my limited donor capacity that I was only recently made aware of. I am probably going to have to live with a somewhat bald crown because I probably want to use all my remaining grafts bolstering the front. This is very disheartening for me because I was led to believe that it would be full along with the rest of the balding zones after all my surgeries.

I just want to say, that in no way am I rewarded for this post and the transparency I provide. I think it’s quite obvious that I shared how vulnerable I am about my hair, and my emotions associated with it. Anyone can go back looking on this thread and see I asked questions over and over again that usually devolve into tirades that aren’t much to do with the question itself. It’s whatever though because at the end of the day, receiving new questions like do I have fine hair or coarse led me to search the answer and narrow down factors that I had against me and for me. I just don’t appreciate when the topics falls outside the realm of hair.

 

@consequence I am always grateful to comments that tell me the truth of the matter, rather than buttering me up with falsehoods that I would like to hear. However basic flat statements like “Any ethical surgeon should reject you as a patient, your mindset is a recipe for disaster” is a largely unhelpful statement, what am I as a HT patient who is mid way in his journey am supposed to get out of that? You didn’t give reasoning as to why it would be a recipe for disaster, and I am unsure on how my mindset is a issue considering people had reiterated to me constantly that my approach and mindset was not a issue before hand. 

And the closing comment of “it’s just hair” is diminishing of what I put in. I put in time and energy researching, waiting for the procedure, waiting for the results to unfold, time working hours at my job, financial resources towards the procedure, efforts to conceal the ugly duckling phase by dodging social outings. All for the promise that I could greatly rectify the thing that bothers me most, and a “middle of the road” or “subpar” result is obviously not what I am looking for. So no it’s not just hair, it’s years of effort, hard work, insecurity, confidence issues and more. 

I like many other people, do not want to be labelled as a “hyper neurotic, brick-wall, unthoughtful, mentally unstable circus monkey” who also is destined for a middling result that won’t last after asking the poster to leave my thread alone from their input.  I’m not sure where you got “unthoughtful and brick wall” from considering I literally got a dutasteride prescription per your own advice. Also when you say “no more comments from me on your thread because, frankly, it's like talking to a brick wall.” You do realise you posted two comments in response right?

Just to clarify, the reason I was hesitant to begin dutasteride is I’ve seen cases on r/Tressless of people switching from finasteride to dutasteride and losing hair fast because it did not work for them. I don’t think it is as simple as 70% DHT reduction to 90% DHT Reduction. Regardless, any decision about my hair and scalp I proceed with absolute caution and always research first. 
 

I am a week away from the one year mark, so my result is practically finished. I’m not entirely sure if I want to continue updating this post for reasons that should be fairly obvious. And you all know how I feel about my transplant anyways.

Out of all surgeons, regardless of location and budget, can anyone tell me who you would go too if you were me and why you would go to them? So far my list has been narrowed down to Couto, Ferreira, Konior and Ahmad for a second surgeon.

Edited November 21, 2023 by mister_25
Grammar

[Savemyhairline]

Op, imo you really need to be assessed under a microscope and only under a microscope, by a professional. Nobody here can tell exactly what happened just by looking at your pictures. I think it’s worth flying back to H&W or at least some top end surgeon for in-person evaluation. Maybe you did continue losing hair, maybe you didn’t, we can’t know for sure. 
 

it is a bit concerning how, according to you, Dr. Hasson described this as an “excellent” result, as I think we can all agree it is not. But I won’t read into that too much. You are very young and spent a ton of money on this, and have finite grafts, so I understand your worry for sure. But before rushing into scheduling another procedure, I think you need to know for sure what exactly is going on. 
 

Konior is unbelievably expensive and IIRC you don’t want FUT, but he does seem to get impressive results with relatively few grafts. There was a case recently here however where he very much underestimated the grafts required and the patient required a second surgery, nobody bats 100. Before scheduling an appointment at all, I think your scalp needs to be assessed thoroughly now that you are 1 year post op, just my 2 cents.

 

if you are happy with your crown at this point though, that is definitely a good thing and I’m happy for you.

[mister_25]

8 hours ago, Savemyhairline said:

Op, imo you really need to be assessed under a microscope and only under a microscope, by a professional. Nobody here can tell exactly what happened just by looking at your pictures. I think it’s worth flying back to H&W or at least some top end surgeon for in-person evaluation. Maybe you did continue losing hair, maybe you didn’t, we can’t know for sure. 
 

it is a bit concerning how, according to you, Dr. Hasson described this as an “excellent” result, as I think we can all agree it is not. But I won’t read into that too much. You are very young and spent a ton of money on this, and have finite grafts, so I understand your worry for sure. But before rushing into scheduling another procedure, I think you need to know for sure what exactly is going on. 
 

Konior is unbelievably expensive and IIRC you don’t want FUT, but he does seem to get impressive results with relatively few grafts. There was a case recently here however where he very much underestimated the grafts required and the patient required a second surgery, nobody bats 100. Before scheduling an appointment at all, I think your scalp needs to be assessed thoroughly now that you are 1 year post op, just my 2 cents.

 

if you are happy with your crown at this point though, that is definitely a good thing and I’m happy for you.

I actually had a appointment with my trichologist on the 9th to get a microscopic examination, but apparently the person that does it at the clinic had a sick day or a hangover or something. So I was unable to get it done which was the main reason I went there. Also I would probably visit my next surgeon before I get the transplant for a in-person consult, I feel like its the safest and will give me the most educated approach for my situation. My next appointment is in January so I'll try again for the examination.

I should also note that when I visited my trichologist I asked him just by eyeballing it and examing it if there was ANYTHING of concern at all in the transplanted/balding zones. And he said no, the only concern I have right now is the Areata in the donor.

I mean, right now I wouldn't mind having a transplant that underestimates the amount of grafts I would need if I was told that it was possibility and the yield was fine. It would just mean that I would have to wait for another transplant. Right now my attitude is donor maximization more than anything else. I need my next 2000 grafts to look like 2000 grafts.

I am happy with what the crown achieved in the first procedure, but I would still really want to get it filled in some more.

As for the front, even though it’s not ideal, It’s something to work with. I’m just stuck with the same hair style that I used pre surgery with no flexibility.

 

Edited November 21, 2023 by mister_25

[Savemyhairline]

6 minutes ago, mister_25 said:

I actually had a appointment with my trichologist on the 9th to get a microscopic examination, but apparently the person that does it at the clinic had a sick day or a hangover or something. So I was unable to get it done which was the main reason I went there. Also I would probably visit my next surgeon before I get the transplant for a in-person consult, I feel like its the safest and will give me the most educated approach for my situation.

I mean, right now I wouldn't mind having a transplant that underestimates the amount of grafts I would need if I was told that it was possibility and the yield was fine. It would just mean that I would have to wait for another transplant. Right now my attitude is donor maximization more than anything else. I need my next 2000 grafts to look like 2000 grafts.

I am happy with what the crown achieved in the first procedure, but I would still really want to get it filled in some more.

 

Yes definitely get an in person assessment even if you have to spend several hundred on flights etc you really need to know what exactly is going on and why this didn’t look like 3.8k grafts. Several hundred is a hell of a lot less than several thousand on a procedure that potentially isn’t planned correctly, in the future.

That’s what I meant by the crown, that is a victory in and of itself even if it’s not at the final point you want, at least we know your body accepted the grafts well enough.

with only potentially 2k grafts remaining, careful and methodical are two words that describe how your path needs to be.

 

so try and get ideally multiple opinions, with your age and history I think you need to be extra cautious here and have definitive answers as to what is going on with your scalp.

[Chrisno]

This has become a very long thread, and a difficult case. I thought I'd take the time to give my insightful input and provide some (perhaps) valuable input for the OP. But firstly I want to say that I think a lot of the posters in the recent pages of this thread do not contribute to the discussion, which should be to help OP with his situation. Hair loss is difficult - that's why we are all here on this forum - so let's treat each other with respect.

@mister_25 I have gone through your entire thread in detail the last few days. I have read all posts, and looked again (and again, and again) on all the photos you have provided. Firstly, I want to say that threads like these are what contribute to this forum, in which it lets everyone learn the struggles, and realities, ups and downs and positive and negatives of what to expect from a hair transplant. And secondly, I want to say thank you for providing your journey for others to learn from, in such detail and sharing your thoughts and struggles.

Below a summary of how I perceive your situation, my (non-professional) conclusion to you case, and my advice moving forward:

1. You have aggressive hair loss at a young age, and are heading to a high NW
2. Medication is slowing down your hair loss, but you are still losing ground
3. Overall your procedure was good, but could perhaps have been better
4. You need to plan for the long run - forget about your 20s.
5. You need a thorough in-person evaluation of your procedure
6. You need a proper in-person (medical/expert) evaluation of your scalp
7. You need a high NW specialist HT surgeon down the line

1. You have aggressive hair loss at a young age
Without a doubt, you are heading for a high NW. Even with medication. Medication slows it down, but eventually the little DHT still left in your system (along with testosterone, which is also an androgen) gradually chips away at your hair. You could try switching to Dutasteride. Most likely it will halt your hair loss better than Finasteride, but as you mention you are taking a risk in switching. This is because Dutasteride blocks even more DHT so that your testosterone will increase even more than on Finasteride. Some people have hair follicles that are sensitive to testosterone increases, and this is why a few people can experience an increase in hair loss when switching from Finasteride to Dutasteride.

2. Medication is slowing down your hair loss, but you are still losing ground.
This is evident by your pictures. See below two photos of the area of concern you have highlighted; your forelock. Photo 1: post op. Photo 2: post op day 4. Photo 3: middle part at about 10.5 months [photos at the bottom of this post]. You can clearly see from your post-op photos that you were implanted sparsely in your forelock area. This was not a wrong decision by your surgeon, you had existing hair there. However, at 10 months-or-so you complained that you were losing hair in this area, and that the area is now weaker than before. You claim transplanted hairs have fallen out, but to the contrary I think your native hair is progressing further. There is no reason your transplanted hair have fallen out. It is your native hair that is continuing to thin.

3. Overall your procedure was good
I firmly believe your procedure was good. You have a much better hairline. The result look completely natural, and no one will ever suspect you have had a transplant. That in itself is a success. I do not believe for a second another surgeon would have gotten you a higher yield and more density. I do not believe other surgeons could "make more with less grafts) as others in this thread have pointed at (which is a statement that in itself is absolutely absurd in my view, but which I won't go into here).

Now, did it meet your expectations? No, because it looks a bit thin due to two reasons:

• Your yield is probably not in the high 90% range (which is what Dr. Hasson consistently delivers). Is that the doctors fault? You went to arguably one of the best hair transplant surgeons in the world - the answer is simple, it is not the doctors fault. I think it is your physiology more so than anything else. Some people have better yield than others, it's just the laws of nature which we are all humbled by. See point 6 for more input on this.
• You are losing the hair just behind the transplant, which makes everything appear thinner. As an example, I have thick dense hair (100 FUs per cm2) and when I take a 1x1cm of my hair and comb anything else completely flat, that section is a bit see-through simply because it does not have hair behind that that blocks the light.

4. You need to plan for the long run - forget about your 20s
You are losing hair fast and are heading to a high NW. You need to realize that whatever you do now - in your early 20s - will have a big impact on your options for hair restoration later in life. You absolutely need to plan for the long run. Do not 'spend' anymore grafts before you have a better understanding of where you will end up eventually. Absolutely do not get a procedure in 2025 or 2026 with one of the surgeons you have listed. You fail to think long term. There is a high probability you will end up as a NW6 or NW7. Imagine this: if you were a NW6 or NW7 right now, would you go to Couto? Would you go to Konior? No. You would go to a high NW specialist. More on that in point 7.

This next paragraph you can skip if you do not want some honest advice and feedback on your life situation. Keep in mind that it's based on my understanding of your social and work life situation solely from your online forum posts - so I might be completely wrong.

You keep circling back to the statement that you want to have hair in your 20s and to feel your age. I understand that. However, while you may think your 20s is the most important decade of your life, I am here to tell you that you are wrong - like most 20 year-olds. Forget your 20s. Plan for your 30s. That's when things get fun and exciting - if, and only if, you set up your life for success. That means working hard in your 20s to get an education with good grades, get a good paying job, climb the ladder. That's where your focus should be right now; to set up your future life for success. In your 30s you could have financial freedom, a nice apartment/house, a young girlfriend (or boyfriend). You will be more mature, and you can make better decisions about what you want to do with your hair. If you continue down the path you are on now, which is obsessing over your bad hair as a 20 year-old, I can almost guarantee you that your 30s will be much worse than your current situation when you realize you didn't spend your 20s setting up your life for the future.

5. You need a thorough in-person evaluation of your procedure
I've said this before: you need a thorough in-person evaluation of your procedure. And you should first fly to Vancouver to have Dr. Hasson inspect your results and have his evaluation of i) your yield, and ii) the speed of which you are a losing hair. After consulting with Dr. Hasson, if you for any reason feel you need a second opinion, you should seek out another surgeon if this would give you any comfort / closure. In that case, you should see a high NW specialist.

6. You need a proper in-person (medical/expert) evaluation of your scalp
Based on your photos it seems your scalp is red. A red scalp at almost 12 months is not normal after a hair transplant, and could be indicative of an underlying scalp issue, which again could explain you losing native hair while on Fin&Minox and/or having bad yield (or a combination of both).

7. You need a high NW specialist HT surgeon down the line
When you are ready for surgery(forget about your 20s, plan for your 30s) you must see a high NW specialist. You should consult with the likes of Zarev and Pittella. Do you research on NW6+ cases to evaluate who you want to have your procedure with

--------------------------------

This has been a long post, so to summarize: you need to wait for your next HT until your early 30s. It would be a big mistake to get another procedure in 1-2 years from now, as you are evidently losing ground fast. You need to be in the hands of the highest skilled high-NW-specialists when the time comes.

Ps. I am here for support and advice. Feel free to PM me if there is anything you want me to elaborate on, share with me etc. The struggle is real, I know, having had a HT myself.

Picture 1: Sparsely implanted (and rightfully so) in the forelock and mid scalp among existing hair:

Picture 2: post op day 4

 

Picture 3: losing ground in the forelock and mid scalp:

[Sunset Dune]

OP I know exactly where you’re coming from, I spent my entire 20s alone I never had a girlfriend, I was never in a relationship and I didn’t have any friends (still don’t have any of those things as a matter of fact) you could  say I wasted my 20s but I’m also not very social or outgoing either. Sure my hair loss didn’t start as early as yours did or wasn’t as aggressive but it still started in my 20s nonetheless. I was 25/26 when I noticed the first signs of hair loss, my hairline started receding very rapidly between ages 26-28 and I also had thinning on my crown at the same time. I have thick hair so even with my front thinning I was able to “hide it” when my hair was longer but that was a disaster with wind and rain. I finally met a girl for the first time that I really liked when I was 29 and she rejected me because of my receding hairline. 
I also went to H&W for a transplant this year and at 7 months my hair still isn’t where I want it to be. I’m just going to focus on myself and plan it out for the long term hopefully my 30s will be better. 

[GeneralNorwood]

I just looked through yours thread now.

 

So basically your hairloss pattern was something like this: 

 

 

Hasson wanted to close the deal in 2 operations, that would 6000 grafts total. But after first surgery ~4000 grafts, it doesn't look like extra 2000 grafts will do the job. 

 

The planning was poor in my opinon. Implanting 900 grafts into the crown, where the needs of this area are much greater, was a bad idea. Now the effect is that the front is still balding and the crown is also balding. It seemed a much better idea to focus on the frontal third and midscalp, so the final look after first HT would be more appealing.

 

2900 grafts were implanted for the pretty big area in the front. It wasn't enough. I didn't see detailed information how much grafts per cm2 were implanted in different areas though. 

If I were you, I'd forget about dr Hasson as he didn't put much care in your case.

 

Get in touch with doctors from the "new school of HT". That is Zarev, Pittella, Ferreira*.  Doctors that see in average donor not 5000-6000 grafts, but 10000+. 

 

* Bruno Ferreira is more conservative then Zarev or Pitella, but he often sees in patients around 9000-10000 grafts in donor, cause his extraction zone is large too compared to classical. 

[jjalay]

Any updates on this?

[Sunset Dune]

Update?

[mister_25]

Nothing much really to share, But I'll try to do a small simple update;

I'm consulting with other doctors and I have a in person consult booked in 2025. Second Surgery most likely will take place in 2026 (Probably Q4 of 2026). I am attempting to get more in person consults scheduled around the same time so that way I can have a small trip around Europe of consulting with various doctors in person about my capabilities.

The spot that had shedded behind the hairline has improved over the past two months, but still will need to be addressed in a second procedure. Otherwise, the hair situation is the same, maybe slightly better or so.

Otherwise, I'm getting good at using fibers and have gone out without a hat a couple of times with confidence (with fibers of course). Fibers make me look like I am just "beginning to thin" because of the weak point on my left side hairline, but otherwise with fibers I can pull off a NW2 look pretty well. The issue with fibers for me is that the fibers tend to fall out of the hairline after a couple of hours, so it's something that I'll have to apply in the hairline about 2-3 times a day. The crown and midscalp retain the fibers very well, and I've even seen them stay in for up to three-four days at a time using a hair-spray.

Fibers have been absolute godsend on my confidence, I even received one compliment about my hair with them in that really made my week to be honest. If anyone is in a similar position, would highly recommend them. It gives me "breathing room" or even "momentary bouts of confidence and higher self esteem".

I somewhat expected this from before the surgery, but during windy days my crown hairs blow upwards and get exposed, because of this I've grown my hair out into a bun to keep the crown hairs in the spot I want them, so that it doesn't get exposed. This works pretty well so far. But it is the only hair style that really works, I am very limited in the styling department. I will for the next couple years be known as "that guy who has his hair in a bun"

I had a brief visit with a Dermatologist who has a stake in the HT industry and has trained under a surgeon, and I asked him out of curiosity how much donor he thinks I have left (Asked this a while ago) he said around 3000 grafts but it would be a inaccurate assessment.

 

Right now, since I am in this "waiting" period where my hair will remain stagnant for around 3 years before a second surgery. I am going to put my time, energy and focus onto other aspects about myself that I can improve during this timeframe. Fitness, Diet, Skincare, Teeth, Hands-on Skills and Social Skills as examples, I can always improve and make/create new defining positive features that overpower my primary negative feature (my hair), which will ultimately be getting addressed when the time calls for it. 

I got this idea from reading a comment that @Der3k7 posted that really stuck with me about being a "self improvement monk" and coming back "levelled up". Don't know why but the nerd in me really took that in lol. So because of this comment, I am not "worrying" as much about my hair in the sense that there is nothing I can do now but there will be things I can do then, I put my time and energy on something that I can do as of now (like hitting the weights at the gym)

 

As for various comments that I never got back to, I'll address some things that I would like to say.

• I've been really closely looking at my hair since I started Finasteride/Minoxidil back in the beginning of 2021. I've been monitoring it closely under multiple directions, angles, and conditions. I can say with confidence that I have not seen any additional thinning, the only areas that I have lost were very weak miniaturized hairs in the hairline that probably got shock-lossed out from the surgery, but they provided such minimal coverage that it does not weigh on me at all.
• I asked the doctor for a small amount in the crown to help with covering up, I do not regret this as before my crown was very bald to the point it was a unavoidable baldspot unless I had my donor hairs covering it. Now it looks like a thin spot (that is somewhat covered) without fibers and is filled in (to a much stronger degree, but not fully) with fibers. Before I don't think even fibers would do anything as it was that weak.
• I apologize if I did not react well about the comments about "forgetting about my 20s, plan for your thirties". I am slowly coming around to the idea that the reality of improving myself especially pertaining to hair is a slower process, and by the time I am in my late 20s (28/29) I can properly reap the rewards from the cautious approach. I am planning to get a second hair transplant nearing the end of 2026 if I can (which will make me almost 27) and that way the one year point for my second surgery will be when I am 27 but almost 28. 
• Thank you for all your suggestions on different surgeons, I have narrowed my list down to three-four potential surgeons that I look on more favorable than others. I am grateful

As a additional closing remark I will make, I am over one year on oral minoxidil, and I have not seen as much of a change in my balding areas, but it feels like my donor is almost as thick as what it was before surgery. Dr Hasson after the procedure told me I had alot of Donor hair in the telogen phase that he wanted me to address by starting Oral Minoxidil, could be a placebo but I think that it worked out with what he was saying as II cannot see or feel a difference in donor density.

I probably wont be replying to this thread very often. There is something about commenting on this thread that "unbottles" and makes all the repressed feelings and sentiments I have about my hair come out. I hope you can understand.