Need advice for a repair plan

[coinflipdrifter]

Hi all, 

I’ve posted in the past - but I’m looking for community support on a seemingly uphill battle. A bit about my HT experiences:

- I had a 2200 FUT with Dr. Wasserbauer in 2015 that rendered little results. I thought it had been a complete botch, but further surgeons confirmed that she had transplanted behind what we had planned for and thus, I’m balder than I had originally thought. I was 23. She shouldn’t have operated on me given at this point I only had slight recession. 

- 10 months ago, I had a pretty terrible 1250 graft FUE with Dr. Ben Paul in NYC. While he’s one of the kindest Dr.’s I’ve ever met, he took a far too conservative approach, ended up doing less grafts than we had agreed upon (which was supposed to be up near 2000), and thus I look like the below. In short, the density is horrendous for the space it’s supposed to cover, it doesn’t blend, and he replaced bald spots with diffuse, see through fin spots. It wasn’t looking great before hand - but this diffuse thin has really, really destroyed my self confidence. 

- I also can’t take Fin. I get full blown sides. I’ve switched from oral to topical - but my libido and ED haven’t subsided in the slightest. It has me spooked. I’m also taking oral minoxidil, using Niz. and Propidren.

- I recently met with Dr. Hasson - who thought I had roughly 4000k FUE grafts left (which, honestly, this feels generous). He’s also fairly confident I’m destined for Norwood VI town.

- I’ve set up consults with Nadimi, Bloxham, Dorian, and Cooley. 

Before I get to my questions, see below for the current state of things:

 

Left side. It’s noticeably thinner than the right side here. 

 

Right side:

 

Left Side - from a different angle

 

Awkward front pulled combover to cover the diffuse thinning: 

 

Pre-2nd HT, about a year ago. 

 

My questions are as follows:

- Has anyone ever done a third repair? I’m really feeling disheartened by the lack of content I’m seeing around about the viability of something like this. 

- What is your estimate for # of grafts needed for such a repair?

- If I try and get 2k grafts in the front with a reputable surgeon, will a remaining 2k grafts be enough to have to (eventually) cover the crown? 

- Is beard-to-hair transplant a viable solution here for density? I know you’re not supposed to use beard hair in the front … but I have too thick beard and would get rid of it in a heartbeat if it meant I could fix this issue. Has anybody had experiences with this type of transplant before? 

- Is getting another surgery at 12-14 months too aggressive? Honestly, this is ruining a huge chunk of my life (especially dating) and I want to feel like I’m reasonably in control of this. 

Thanks for your input in advance. I appreciate this community immensely.

- CFD

 

 

Edited March 22, 2023 by coinflipdrifter

[BaldReaper]

your hair looks great, you dont need an ht

[FUT4000]

You're consulting with all the right docs for sure. 

[coinflipdrifter]

@BaldV - I appreciate the kind words - but the camera isn't doing this justice. It's extremely see through (and it doesn't help that I'm pale). In person, it looks like I'm diffusely losing it. 

[Melvin- Admin]

Your hair looks pretty good. Are you looking to lower your hairline or fill it in? 

As for medication, if you’re not doing well on topical fin, you might wanna consider dutasteride. The molecular weight makes it harder to go systemic. 

[Silent123]

Hey man, your hair looks very good already, though I do understand wanting to have a little more density. I think a small touch up would complete your goal. We can be our own worst critics in life, often our imperfections we tend to focus on heavily, even though no one else even notices.... 

[Berba11]

Honestly as I scrolled down toward the photos I was expecting some total horror show from what you described. Instead I was met with a bunch of photos of a bloke who has hair that 90% of dudes would be envious of. 
 

All HT’s will have areas of weakness. Your “weaker” areas just look like totally normal, natural thinning at the absolute worst. If you’d posted this thread as a “here are my 12 month post-op results” thread, I think everyone would have said you’d had a home run. 
 

What you’re asking for isn’t a “repair”. There’s nothing to repair. What you want is a minor touch up for density, though frankly you don’t need it. 

[coinflipdrifter]

Appreciate the kind words, guys, and sorry for the late reply. Been on a torrid work travel schedule. 

 

Took a few snaps this morning in better light. This shows more what I'm talking about. There isn't nearly enough density in the front for me to actually style it without everything pushed forward - especially on the left. @Berba11 @Silent123

 

@Melvin- Moderator - I'm not trying to lower given the half-burned donor supply (but I'd love to fix the temples). Sides seem to slowly (emphasis on slowly) subsiding so it could be depression, etc. I'm shedding like nuts still and I can't tell if it's the oral min, the topical fin, or what. 

 

 

[Berba11]

21 minutes ago, coinflipdrifter said:

Appreciate the kind words, guys, and sorry for the late reply. Been on a torrid work travel schedule. 

 

Took a few snaps this morning in better light. This shows more what I'm talking about. There isn't nearly enough density in the front for me to actually style it without everything pushed forward - especially on the left. @Berba11 @Silent123

 

@Melvin- Moderator - I'm not trying to lower given the half-burned donor supply (but I'd love to fix the temples). Sides seem to slowly (emphasis on slowly) subsiding so it could be depression, etc. I'm shedding like nuts still and I can't tell if it's the oral min, the topical fin, or what. 

 

 

Same difference. Looks pretty good. You can’t seriously tell us that you can’t style that in multiple different ways. Get a better barber!

[Melvin- Admin]

50 minutes ago, coinflipdrifter said:

Appreciate the kind words, guys, and sorry for the late reply. Been on a torrid work travel schedule. 

 

Took a few snaps this morning in better light. This shows more what I'm talking about. There isn't nearly enough density in the front for me to actually style it without everything pushed forward - especially on the left. @Berba11 @Silent123

 

@Melvin- Moderator - I'm not trying to lower given the half-burned donor supply (but I'd love to fix the temples). Sides seem to slowly (emphasis on slowly) subsiding so it could be depression, etc. I'm shedding like nuts still and I can't tell if it's the oral min, the topical fin, or what. 

 

 

I feel like Dr. Cooley would knock this out of the park.

[coinflipdrifter]

Hey guys, 

Consult update here.

I met with Dr. Bloxham today in Great Neck. I can't speakly highly enough of his surgical intelligence and demeanor. That said, he pitched a very, very different approach to the repair comparative to Dr. Hasson. 

• He immediately identified density as a problem and agreed it need to be fixed sooner rather than later. I know a lot of you had mentioned that it looks fine (which, much appreciated) - but the pics aren't doing anything justice here. It's really, really thin in the front and it looks diffuse on only the left. 

 

• Dr. Bloxham recommended a second FUT with a target of 2k-2.5k grafts in a dense pack approach in the front. While I'm not necessarily against another FUT, I am apprehensive about any situation that would worsen my scar. Also, I'm definitely thinning in the mid scalp and crown... so any splurge in grafts here is a risk. 
  • @Melvin- Moderator - I did a few searches, but do you have any good references of multiple FUT results? Bloxham was confident in this approach (and I know he's a bit of a detractor of FUE) but it's not something I had heard of as popularized. 

 

• He was confident I had about 4500 - 6000 FUT grafts left. As you can imagine, this is a relief. He also mentioned that my FUE donor supply was 'patchy' from the previous procedure so hence the FUT recommendation. 

My question for the group - Hasson was pretty anti-FUT and Bloxham is very gung-ho about this. How would you suggest I rationalize this? I really do want to maximize donor area for the inevitable crown work - but I don't really know which approach is safer. My gut is saying go FUT to maximize donor yield... but I do worry about yet another botch and then dealing with a noticeable scar (my current one is very, very small). 

I have consults setup with Cooley and Nadimi in the coming two months before I decide between Hasson, Bloxham, and those two. Thanks again for all your input. 

 

- CFD

 

 

 

Edited April 11, 2023 by coinflipdrifter

[Melvin- Admin]

The problem with FUT is that scars are unpredictable. Dr. Hasson used to be one of the best FUT surgeons in the world. But he’s transitioned to FUE because the unpredictability of the scar. 

I think FUT maximizing grafts is a bit outdated. You see cases like @HugoX and @Zoomster these guys achieved insane number of grafts using just FUE. I myself have had 9k grafts, and I’m no outlier. 

FUT makes sense if you wear your hair long and want something cheaper. But I don’t believe in the maximizing grafts. I’ve stopped thinking like that since more surgeons have been achieving high numbers of grafts using FUE. There’s also a problem with stripping out, because the scar could stretch as your scalp gets tighter. Overall, it’s not the best approach in my opinion.

[coinflipdrifter]

Appreciate the quick reply @Melvin- Moderator!

I think what I'm most worried about is that I'm fairly confident I need at least 2k grafts to fix the frontal band and first half of the mid scalp (Hasson and Bloxham both floated this number) and Hasson thinks I only have about 4k FUEs left. That's not much leftover for the continued recession (and I can't really take oral fin). 

2k FUEs doesn't feel like it's enough to cover the remaining midscalp and crown, no? 

 

[Melvin- Admin]

54 minutes ago, coinflipdrifter said:

Appreciate the quick reply @Melvin- Moderator!

I think what I'm most worried about is that I'm fairly confident I need at least 2k grafts to fix the frontal band and first half of the mid scalp (Hasson and Bloxham both floated this number) and Hasson thinks I only have about 4k FUEs left. That's not much leftover for the continued recession (and I can't really take oral fin). 

2k FUEs doesn't feel like it's enough to cover the remaining midscalp and crown, no? 

 

You have a lot of hair left. I don’t think you’ll need much hair in the immediate future. There’s no guarantee you can get multiple strips either. CosmeRNA is coming out in the next few years. There’s also Xyon topical dutasteride Dr. Hassons formula which I take, no sides. You should consider getting on some form of medication before getting any further surgery, whether it be FUT or FUE.

[coinflipdrifter]

2 minutes ago, Melvin- Moderator said:

You have a lot of hair left. I don’t think you’ll need much hair in the immediate future. There’s no guarantee you can get multiple strips either. CosmeRNA is coming out in the next few years. There’s also Xyon topical dutasteride Dr. Hassons formula which I take, no sides. You should consider getting on some form of medication before getting any further surgery, whether it be FUT or FUE.

Great. I'm on topical fin and oral min right now - and still on the climb back from oral fin sides. I'll reach out to Hasson about the topical duta. No idea what CosmeRNA is but I'll look into it.