Why I got rejected by 3 top tier clinics

[Rafael Manelli]

Have a look at this thread, it might give you an idea. 

[HappyMan2021]

4 minutes ago, Rafael Manelli said:

Have a look at this thread, it might give you an idea. 

exactly, good example. while i think the end-result in this case was quite exceptional/rare lol, this is a great example for OP to look at of a guy with zero MPB but successfully lowered the hairline. 

[Melvin- Admin]

The hairline you want is too aggressive IMO. You have a good head of hair, the pros outweigh the cons. There is no surgeon on earth that will give you a better hairline that what you already have. Your hairline looks perfectly natural and normal for a man of your age. Now, that is not to say you can't have surgery. But you're trying to be too aggressive. Most surgeons will not perform hair transplants that would appear juvenile because the likelihood of future balding in your 30s is high. 

[iKelia]

13 hours ago, Rafael Manelli said:

Have a look at this thread, it might give you an idea. 

13 hours ago, HappyMan2021 said:

exactly, good example. while i think the end-result in this case was quite exceptional/rare lol, this is a great example for OP to look at of a guy with zero MPB but successfully lowered the hairline. 

Thanks guys! This a great info. He indeed lowered his hairline. Me on the other hand want to cover the frontal corners without touching my temples. This will not lower the hairline which determined by central point but only lowers the corners to the same level as central point.  

[Rafael Manelli]

Hence you'll require fewer grafts than him. Maybe 2000.

[Fue3361]

17 minutes ago, iKelia said:

Thanks guys! This a great info. He indeed lowered his hairline. Me on the other hand want to cover the frontal corners without touching my temples. This will not lower the hairline which determined by central point but only lowers the corners to the same level as central point.  

Your case is much easier than mine.  Temples are the hardest part and the part that can make it look the most unnatural.  

I think you don't need a transplant and that it looks good already.  But you're 32, and you know what you want better than I do.  People told me I didn't need one, and I still got one.

You'd need fewer grafts than me, I used 3.3k  I'm sure you can pull off a great look with under 2500.  But I don't think under 2k grafts would work, because you really want it to be very dense, otherwise it will look off.  An aggressive, lower hairline, requires high density.  It just is what it is.

[iKelia]

13 hours ago, Rafael Manelli said:

Okay. I get what you mean. Are you sure this is the hairline you had before any loss? If so, if it looked natural before, it can look natural again. But it’ll take 2000 grafts, give or take.

Yeah, I'm certain I had it when i was 17 years old. I just want to restore it. I have learned some people called juvenile hairline and it's natural to lose it when you become an adult. However, I don't like the appearance it gives me now.  Few people commented i have a way to big forehead because of it.  



If restoring straight hairline aka. juvenile hairline with HT can't be permanent I wish to learn this beforehand from this forum.
I still don't understand why one clinic said it will last at least 15-20 years. 
Other in unison say minoxidil + finasteride is must have regimen post surgery till the end of life.   
Aren't they transplant highly resilient to DHT hair follicles which would make using finasteride irrelevant?  



 

[iKelia]

12 minutes ago, Fue3361 said:

Your case is much easier than mine.  Temples are the hardest part and the part that can make it look the most unnatural.  

I think you don't need a transplant and that it looks good already.  But you're 32, and you know what you want better than I do.  People told me I didn't need one, and I still got one.

You'd need fewer grafts than me, I used 3.3k  I'm sure you can pull off a great look with under 2500.  But I don't think under 2k grafts would work, because you really want it to be very dense, otherwise it will look off.  An aggressive, lower hairline, requires high density.  It just is what it is.

Your doctor did an amazing job! Can you still differentiate a native hair from transplanted one? Do they grow in correct direction? 
Do you still follow any post surgery medication regimen like cialis, minoxidil, finasteride? 

[NegativeNorwood]

10 minutes ago, iKelia said:

Yeah, I'm certain I had it when i was 17 years old. I just want to restore it. I have learned some people called juvenile hairline and it's natural to lose it when you become an adult. However, I don't like the appearance it gives me now.  Few people commented i have a way to big forehead because of it.  



If restoring straight hairline aka. juvenile hairline with HT can't be permanent I wish to learn this beforehand from this forum.
I still don't understand why one clinic said it will last at least 15-20 years. 
Other in unison say minoxidil + finasteride is must have regimen post surgery till the end of life.   
Aren't they transplant highly resilient to DHT hair follicles which would make using finasteride irrelevant?  



 

 

I know that fin + minox is necessary to avoid further hair loss (ie: different zones than the transplanted ones).

But I'm on the same boat, I think "juvenile" hairlines look better overall (number of grafts available for the future aside).

I'm very curious about what one of the clinics told you with regards to fin + minox and the possibility of experiencing hair "regrowth" (which I've seen many cases lately, some of them posted by professionals). Like, imagine being on meds for a year and recovering most of the juvenile hairline, only needing something like 300 grafts for refinement...wouldn't that be amazing? 0_0

Edited February 1, 2023 by NegativeNorwood

[Gatsby]

You have a very youthful face and a good head of hair. As Melvin has stated no surgery performed anywhere in the world would be able to mimic, let alone appear as natural as your hair is now. The hairline you have drawn is far too low. I would really encourage you to give both finasteride and minoxidil at least a full year before even thinking of surgery. Your donor area is DHT resistant but it is not DHT 'proof.' If you commit to surgery now you have no idea what the future holds but one thing you will committing to is a lifetime of surgery to chase that low hairline. There is good reason why surgeons know people back because they know from experience the outcome. I know this is not what you want to hear but for the reasons above I highly recommend that you stay on medication and avoid surgery. All the best!

[iKelia]

22 minutes ago, NegativeNorwood said:

 

I know that fin + minox is necessary to avoid further hair loss (ie: different zones than the transplanted ones).

But I'm on the same boat, I think "juvenile" hairlines look better overall (number of grafts available for the future aside).

I'm very curious about what one of the clinics told you with regards to fin + minox and the possibility of experiencing hair "regrowth" (which I've seen many cases lately, some of them posted by professionals). Like, imagine being on meds for a year and recovering most of the juvenile hairline, only needing something like 300 grafts for refinement...wouldn't that be amazing? 0_0

I know that fin + minox is necessary to avoid further hair loss
But does their usage still make sense if you have no history of hairloss in you family past the state you're in right now? 

-I'm very curious about what one of the clinics told you with regards to fin + minox and the possibility of experiencing hair "regrowth"
They didn't say it can regrow, only improve my condition(aka improve hair quality😞
-"Another one said that my hairline is only slightly accentuated, it might not even be operated on. And claimed I can possibly improve my condition by taking oral minoxidil 5mg along with finasteride 1mg. " 

I wish it could fully regrow.
I have a friend with Norwood 6, he's got good results after using mesotherapy. However, no full recover happened for him. On the other hand he never used minoxidil or finsteride. His current state after the course:   

 
(not me, don't confuse)

Maybe, I'll put a HT on hold and go for medications + PRP, PRL or whatever mesotherapy treatment. 
Frankly, the whole idea of becoming dependent on medications which have side effects just for aestetics is kinda repellent. 
I have put too much faith into HT because I thought it can do it once and forget. Subjectively my reasoning seemed solid to me, 
- I get transplanted a highly resilient to DHT hair follicles, hence I shouldn't worry about them post surjery; 
- I have no history of hairloss in you family past the state you're in right now; 

 

 

Edited February 1, 2023 by iKelia
removed personal photo i didn't plan to add

[Rafael Manelli]

There's nothing magical about a juvenile hairline. There's no reason it can't be restored. It won't be any more susceptible to falling out than a conservative hairline. The only reason to avoid it in my view is because you may continue to lose hair behind it. 

The clinic said 15-20 years AT LEAST. They're being cautious. Hair in the donor area can thin as well. Look at old men. Is their hair as thick as it was at 15? Rarely. Look at old Norwood 7s. Is their donor area thick? Not always. It can thin over decades. So can transplanted hair. You probably don't have DUPA though.

The transplanted hair should last as long as it would have lasted in the donor. Usually that is a lifetime.

Finasteride (and to a lesser extent, minoxidil) are recommended not primarily to keep the transplanted hair, but to halt the progression of hair loss and minimise the need for more transplants. 

What do you think about these hairlines? 

[iKelia]

1 minute ago, Rafael Manelli said:

There's nothing magical about a juvenile hairline. There's no reason it can't be restored. It won't be any more susceptible to falling out than a conservative hairline. The only reason to avoid it in my view is because you may continue to lose hair behind it. 

The clinic said 15-20 years AT LEAST. They're being cautious. Hair in the donor area can thin as well. Look at old men. Is their hair as thick as it was at 15? Rarely. Look at old Norwood 7s. Is their donor area thick? Not always. It can thin over decades. So can transplanted hair. You probably don't have DUPA though.

The transplanted hair should last as long as it would have lasted in the donor. Usually that is a lifetime.

Finasteride (and to a lesser extent, minoxidil) are recommended not primarily to keep the transplanted hair, but to halt the progression of hair loss and minimise the need for more transplants. 

What do you think about these hairlines? 

The light one(turquoise) line is what I expect from HT procedure, thumbs up for the design :)
I will able to put up with finasteride for lifetime if it won't give me sides or will cost a fortune. I've already started 1mg on alternate days, so far, no side effects. 
Minoxidil - I would rather ditch if possible, because oral is too risky and topical is inconvenient to use on regular basis.  

How do think, the area above turquoise line can be regrowthed jsut with PRP + finasterid + minoxidil treatment? 

[Rafael Manelli]

1 minute ago, iKelia said:

The light one(turquoise) line is what I expect from HT procedure, thumbs up for the design :)
I will able to put up with finasteride for lifetime if it won't give me sides or will cost a fortune. I've already started 1mg on alternate days, so far, no side effects. 
Minoxidil - I would rather ditch if possible, because oral is too risky and topical is inconvenient to use on regular basis.  

How do think, the area above turquoise line can be regrowthed jsut with PRP + finasterid + minoxidil treatment? 

Definitely not. Meds can thicken thin hair but they will not regrow hair that receded into nothingness long ago. The only way to get hair where you want it, is a transplant. 

If I were you I'd go to a top doc and get it sorted. It will feel empowering and you'll feel great to have your hair back. 

If your family history really stops at Norwood 2 or 3, I'd personally go for it. It's a good sign. Fin is just another layer of safety. If it thins despite fin you can just switch to dutasteride. 

I still think about 2000 grafts will be required. 

Don't bother with minoxidil if it bothers you. It's not as powerful as fin anyway. If you need it later, you can reconsider.

If the worst happens, and you become Norwood 6/7, despite all the precautions and odds, you can just get a partial hairpiece which will fit snugly behind the transplant and disguise itself easily. That's in a worst case scenario. It's good to prepare for the worst. But the odds are in your favour by the sound of it.

[Rafael Manelli]

Just curious if you prefer the turquoise or the red? 

[NegativeNorwood]

52 minutes ago, iKelia said:

I know that fin + minox is necessary to avoid further hair loss
But does their usage still make sense if you have no history of hairloss in you family past the state you're in right now? 

-I'm very curious about what one of the clinics told you with regards to fin + minox and the possibility of experiencing hair "regrowth"
They didn't say it can regrow, only improve my condition(aka improve hair quality😞
-"Another one said that my hairline is only slightly accentuated, it might not even be operated on. And claimed I can possibly improve my condition by taking oral minoxidil 5mg along with finasteride 1mg. " 

I wish it could fully regrow.
I have a friend with Norwood 6, he's got good results after using mesotherapy. However, no full recover happened for him. On the other hand he never used minoxidil or finsteride. His current state after the course:   

 
(not me, don't confuse)

Maybe, I'll put a HT on hold and go for medications + PRP, PRL or whatever mesotherapy treatment. 
Frankly, the whole idea of becoming dependent on medications which have side effects just for aestetics is kinda repellent. 
I have put too much faith into HT because I thought it can do it once and forget. Subjectively my reasoning seemed solid to me, 
- I get transplanted a highly resilient to DHT hair follicles, hence I shouldn't worry about them post surjery; 
- I have no history of hairloss in you family past the state you're in right now; 

 

 

 

It doesn't happen to everyone, but there's lots of people who experienced hair "regrowth" with minoxidil, finasteride and microneedling. This is one of many, reposted by William Rassman:

https://baldingblog.com/5-months-on-minoxidil-and-finasteride-photo/

I'm writing regrowth in between commas because I don't know the exact term, like ie: they may still have miniaturized hair that the meds helped growing out and making visible. I'm not knowledgeable enough tbh.

I think trying for a few months and see what happens wouldn't hurt, the side effects are rare (reportedly less than 2% of people get them) and they even stopped in people who continued the treatment according to studies.

If I were to got a HT, I would definitely hop on fin and minox just as a cautionary measure. I wouldn't like to suffer more hair loss and need a second (or third or fourth) transplant, and if I needed it I would like it to be a small one, of course.

 

 

[iKelia]

4 minutes ago, Gatsby said:

You have a very youthful face and a good head of hair. As Melvin has stated no surgery performed anywhere in the world would be able to mimic, let alone appear as natural as your hair is now. The hairline you have drawn is far too low. I would really encourage you to give both finasteride and minoxidil at least a full year before even thinking of surgery. Your donor area is DHT resistant but it is not DHT 'proof.' If you commit to surgery now you have no idea what the future holds but one thing you will committing to is a lifetime of surgery to chase that low hairline. There is good reason why surgeons know people back because they know from experience the outcome. I know this is not what you want to hear but for the reasons above I highly recommend that you stay on medication and avoid surgery. All the best!

6 hours ago, Melvin- Moderator said:

The hairline you want is too aggressive IMO. You have a good head of hair, the pros outweigh the cons. There is no surgeon on earth that will give you a better hairline that what you already have. Your hairline looks perfectly natural and normal for a man of your age. Now, that is not to say you can't have surgery. But you're trying to be too aggressive. Most surgeons will not perform hair transplants that would appear juvenile because the likelihood of future balding in your 30s is high. 

-"no surgery performed anywhere in the world would be able to mimic, let alone appear as natural as your hair is now."
Do you mean on a micro level? Like unnatural density or directions? 

- "The hairline you have drawn is far too low."
-"Now, that is not to say you can't have surgery. But you're trying to be too aggressive."
I don't plan to lower my hairline which determined by central point, the last living hair at the center(blue cross at the image) or alter the temples. I want to refine frontal corners by lowering them to the same level as my central point(blue cross at the image). Is it still considered aggressive? 

 


Also I expect HT to fix asymmetry between left and right sides: 



-"You have a good head of hair, the pros outweigh the cons"
What are the cons if I will be in hands of a great surgeon?

-"Most surgeons will not perform hair transplants that would appear juvenile because the likelihood of future balding in your 30s is high. "
Why this would happen if I have no history of hairloss in my family past the state I'm right now?  

-"There is no surgeon on earth that will give you a better hairline that what you already have."
I used to have juvenile hairliine in my 17-s  like the next guy has: 


But after puberty period kicked in, my frontal corners receded. This give me appearance I don't like, it enlarges my forehead when looking at profile projection. 
I just wanna lower my front corners to the central point level to straighten up the hairline when you look at my face from the front.  

-"I would really encourage you to give both finasteride and minoxidil at least a full year before even thinking of surgery."
Can it regrow already minituarized hairs from 16 years ago on front corners? 

-"If you commit to surgery now you have no idea what the future holds"
Can't I rely on my family history? 

-"Your donor area is DHT resistant but it is not DHT 'proof.'"
I can put up with using finasteride for lifetime. 

-"but one thing you will committing to is a lifetime of surgery to chase that low hairline"
Doing it once will be sufficient. I don't want to lower my central point(the last living hair at the center), just straightening the shape by lowering front corners. 



 

[iKelia]

34 minutes ago, Rafael Manelli said:

Just curious if you prefer the turquoise or the red? 

Turquoise is fine. I'm gonna be conservative 

[TommyLucchese]

19 hours ago, iKelia said:

Thank you ! Unfortunately, I won't be able to find any quality photos with head profile from 16 years ago we didn't have digital cameras that time ( 
   
Center point for me is a point where the last fully grown living hair follicle of mine sits. I use it as a base and draw horizontal line across it to make my face appear like it's having somewhat straightish hairline. Because that's how I perceive myself being of the age when i was young.  
Also a couple friends of mine have a straight hairline when looking at their face from the front and I quite enjoy the look. 

     

That is a very excellent frontal hair piece. This is confirmed by how he looks in the pics where he's holding his newborn daughter from a few years ago, with the complete recession that he had in the early 2000s. He's held on to his hair very well but it's nothing like how he appears when he's working.

I can see why you would want a surgery. Seems like a 1,500 FUE could work well for you, but the doctors know more than me. Maybe try to schedule an in-person consultation so they can assess your donor and everything?

[Rafael Manelli]

"no surgery performed anywhere in the world would be able to mimic, let alone appear as natural as your hair is now."
Do you mean on a micro level? Like unnatural density or directions? “
 

He just means even the best transplant is not perfectly equal to natural hair. The density will be less than original hair, but that’s okay because you only need visual density aka high opacity. And the hairs at the very front will not be as super fine and soft as in a natural hairline. But it can be close enough.

- "The hairline you have drawn is far too low."
-"Now, that is not to say you can't have surgery. But you're trying to be too aggressive."
I don't plan to lower my hairline which determined by central point, the last living hair at the center(blue cross at the image) or alter the temples. I want to refine frontal corners by lowering them to the same level as my central point(blue cross at the image). Is it still considered aggressive? “
 

It’s aggressive by surgical standards because you’re young and the hairline you want is your original hairline. At first I thought it was too low by aesthetic standards too, but that may have been due to the angle of the photos. 


“Also I expect HT to fix asymmetry between left and right sides”

That can be done. But nobody’s hairline is completely symmetric.


-"You have a good head of hair, the pros outweigh the cons"
What are the cons if I will be in hands of a great surgeon?”

the cons are any surgery has risks. Not just hair. Any surgery. Although the odds are in your favor.

-"Most surgeons will not perform hair transplants that would appear juvenile because the likelihood of future balding in your 30s is high. "
Why this would happen if I have no history of hairloss in my family past the state I'm right now?  “

family history is reliable but not guaranteed. Genetics are more complicated than you may think.


-"There is no surgeon on earth that will give you a better hairline that what you already have."
I used to have juvenile hairliine in my 17-s  “

Surgery can give you this hairline. It’ll just be a little less dense and not quite as natural looking to the trained eye. But it will have visual density and appear near natural with the right surgeon.

-"I would really encourage you to give both finasteride and minoxidil at least a full year before even thinking of surgery."
Can it regrow already minituarized hairs from 16 years ago on front corners? “
 

it’s not going to regrow hairs that have miniaturised to the point where they look like bald skin. The only way to get to the turquoise line is surgery.

-"If you commit to surgery now you have no idea what the future holds"
Can't I rely on my family history? “

to an extent, it’s a good predictor but it’s not absolute.

-"Your donor area is DHT resistant but it is not DHT 'proof.'"
I can put up with using finasteride for lifetime. “
 

thinning of the transplant is the last of your worries. If you continue to recede and thin, the nw7 (donor) zone will be the last to go. You’ll have ample warning.  Fin is primarily to protect the native hairs behind the transplant, not the transplanted hairs, those hairs are tough as nails.

-"but one thing you will committing to is a lifetime of surgery to chase that low hairline"
Doing it once will be sufficient. I don't want to lower my central point(the last living hair at the center), just straightening the shape by lowering front corners. “
 

What he means by committing to a lifetime of surgery, is he thinks you’ll keep losing hair and need more transplants to fill it in.

[iKelia]

3 hours ago, TommyLucchese said:

That is a very excellent frontal hair piece. This is confirmed by how he looks in the pics where he's holding his newborn daughter from a few years ago, with the complete recession that he had in the early 2000s. He's held on to his hair very well but it's nothing like how he appears when he's working.

I can see why you would want a surgery. Seems like a 1,500 FUE could work well for you, but the doctors know more than me. Maybe try to schedule an in-person consultation so they can assess your donor and everything?

Thanks man! 

"with the complete recession that he had in the early 2000s"
Do you mean he had a HT after 2000s? 

[MisterBreakfast]

Why are you being denied by good hair resto surgeons? It's because your expectations have to align with what is possible.

Why is what you want not possible? 

• You are asking for hair to be implanted where it is clear from a trained eye that your Frontalis muscle is. There are many problems with this, but the most being that if you make an expression your hairline will move. This will make you look like "lego man".
• You have a dense hairline already.  Eyeballing it from these few (poor) photos it looks to be at least 160-180 hair per cm2.  Surgery can not match the density you already have.
• Surgery is capable of MAYBE 120hair per cm2. If you put that next to natural hair density in a VERY visible location of vertical forhead (which is what you have indicated, it will look VERY different, obvious, and very bad.
• No good surgeon will transplant you hair into anything below the 45% angle your scalp makes with your forehead.  You are drawing a hairline on the 90 degree vertical. 

 

If you want to learn about hairline placement, go to Youtube and watch the Eugenix video about hairline placement (a simple search will turn it up). 

 

Another note, some of the men you are using for reference photos have a classically feminine hairline.  This is extremely rare in nature.  As a matter of fact it is typically the result of either: a poor result from a hair transplant, hormonal imbalance, or traction allopecia.

 

 

[iKelia]

1 hour ago, MisterBreakfast said:

Why are you being denied by good hair resto surgeons? It's because your expectations have to align with what is possible.

Why is what you want not possible? 

• You are asking for hair to be implanted where it is clear from a trained eye that your Frontalis muscle is. There are many problems with this, but the most being that if you make an expression your hairline will move. This will make you look like "lego man".
• You have a dense hairline already.  Eyeballing it from these few (poor) photos it looks to be at least 160-180 hair per cm2.  Surgery can not match the density you already have.
• Surgery is capable of MAYBE 120hair per cm2. If you put that next to natural hair density in a VERY visible location of vertical forhead (which is what you have indicated, it will look VERY different, obvious, and very bad.
• No good surgeon will transplant you hair into anything below the 45% angle your scalp makes with your forehead.  You are drawing a hairline on the 90 degree vertical. 

 

If you want to learn about hairline placement, go to Youtube and watch the Eugenix video about hairline placement (a simple search will turn it up). 

 

Another note, some of the men you are using for reference photos have a classically feminine hairline.  This is extremely rare in nature.  As a matter of fact it is typically the result of either: a poor result from a hair transplant, hormonal imbalance, or traction allopecia.

 

 

Maybe it's 2D effect of the photo but frontal corners doesn't have 90 degree vertical. The green line is not my drawing, it's corrected design from ASMED - Dr. Koray Erdogan, Turkey clinic. As I learned they are valued as a respectable clinic on this forum. 


 

[Melvin- Admin]

Have you researched who’s actually top tier? 

[thetdog666]

57 minutes ago, iKelia said:

Maybe it's 2D effect of the photo but frontal corners doesn't have 90 degree vertical. The green line is not my drawing, it's corrected design from ASMED - Dr. Koray Erdogan, Turkey clinic. As I learned they are valued as a respectable clinic on this forum. 


 

Looks way to aggressive.  Think what it will look like when you start losing behind it