40-yr old male considering HT - your advice is appreciated

[randomhair]

hi all, 

40-yr old indian male here with a modestly receding hairline and balding crown (pics attached). I've been lurking on this forum as i've started to consider a hair transplant and finally decided to join today. There's a lot of useful information but i have to admit given all the choices and how permanent the process is it's a bit overwhelming to narrow down a doctor. As you can see from my pics, I'd probably classify my case as a NW3. I have thin straightish hair and have not been taking any medication for hair loss so far but have been considering oral minoxidil.

I've narrowed down the following doctors based on the research i've done on the forum: Dr(s) Bicer, Dogan Turan, Kaan Pekinar, and Luis Nadar. 

I would greatly appreciate any guidance the experienced members can give on who i should reach out to for consultations. I'm looking for a high quality doctor but the upper bound of my budget is around 12-14k. Also, any advice on whether a no-shave transplant could work for me and if so, which doctor would be best equipped for this procedure?

Thank you in advance!

[mr_peanutbutter]

are u on meds?

what norwood are ur older relatives?

[Spring15]

Your loss doesn't seem aggressive - good sign. Out of your choices I would recommend Dr Pekiner - I personally went with him, Dr Nader is quality as well, Dr Turan I've heard good things, Dr Bicer has been producing mediocre results recently if I'm honest

[Mike10]

medicaton is recommended because of hair loss in crown, preferrably Finansteride.

[duckling]

No shave is definitely an option for you. If you are not on meds then please consult doctor and start to see if you can improve the crown area. Reason being that you can delay the crown area for next treatment and focus on just hairline for now. The doctors you mentioned are great and can give you a nice hairline and with the density you have in midscalp , sides you are going to look like a nw1 at age of 41-42 ( the time by which the transplanted would have grown).

The money you have , i would have gone with pekiner for the hairline but Dr turan also i saw give a good hairline for a patient who was same norwood as you ( so he didn't have to be conservative with grafts put in hairline). I have also seen one case of dr bicer where she did around 2000 grafts but the results are pending so i can't comment until i check the final result.

[Doron Harati]

 Great donor, need to check how deep you can have a procedure over the frontal area, need many single grafts to make your result homogenous with your existing hair.

[randomhair]

Thanks to all for your thoughtful suggestions!

@mr_peanutbutter: I am not on meds. My father has a very aggressively receding hairline but my uncle on my mothers side has a balding crown. 
 

@Spring15: Thanks. Seems the wait for Dr Bicer is quite long now. Did you get a no shave transplant? Also was the focus on the crown or the hairline. 
 

@Mike10 noted Mike. Always a bit weary of medication but I will be consulting a doctor soon. May I ask why finensteride versus say minoxidil? Thanks

@duckling I will consult with both Dr Pekiner and Turan. Thanks for the suggestions. And will look into medication. You suggest I just skip the crown and only focus on hairline?

@Doron Haratithanks. Yes fortunate to have good density in the donor area. 

[Mike10]

1 hour ago, randomhair said:

Thanks to all for your thoughtful suggestions!

@mr_peanutbutter: I am not on meds. My father has a very aggressively receding hairline but my uncle on my mothers side has a balding crown. 
 

@Spring15: Thanks. Seems the wait for Dr Bicer is quite long now. Did you get a no shave transplant? Also was the focus on the crown or the hairline. 
 

@Mike10 noted Mike. Always a bit weary of medication but I will be consulting a doctor soon. May I ask why finensteride versus say minoxidil? Thanks

@duckling I will consult with both Dr Pekiner and Turan. Thanks for the suggestions. And will look into medication. You suggest I just skip the crown and only focus on hairline?

@Doron Haratithanks. Yes fortunate to have good density in the donor area. 

I think oral Minox can be an effective treatment no question. However, Finansteride is the more proven treatment long term. Unfortunately, hair loss is a life long  progressive comdition and that is especially true for people  with crown loss (even when you are 40). I believe  takiing medication is personal choicebut it become more relevant when undegoing a HT

Edited April 9, 2023 by Mike10

[duckling]

@randomhair minox and finasteride will help you with crown. If not fill them up enough, it might atleast slow the progression there. 

You will eventually want transplant there but if there are still some hairs which can be saved or regrown then you will have to use less hair on crown in first transplant. They say crown to be a black hole as it will eat up lot of grafts and still from some angle it will look thin (because its a whirl.. so hair will be spread out so even with hair it looks little empty, but in frontal part the hairs will overlap each other and make illusion of higher density).. so people want to use less grafts on crown and more on front and then mid-scalp.. reason is that people see your face then your frontal hair (hairline) will define your look.. and hide lesser density mid-scalp and then mid scalp can be used to hide a crown with lowest density.

By the way this approach is used for people with higher grade of baldness ,  as the donor hair are limited so it has to be used in best way to hide all the scalp and not make your donor look depleted. You have a great head of hair at age of 40 in my opinion. If you haven't been on meds and have this hair then your loss was less aggressive. You can surely try with meds before transplant to see if you can go down one norwood grade or hold on to your norwood grade before the HT and also it will help you after HT.

By the way if you choose not to use meds due to risk of sides , then please do crown HT. With your slow hairloss maybe without meds also you can keep your results for some years.  

[Rahal Hair Transplant]

@randomhair,

Given your age and hair loss pattern, you do appear to be a good candidate for hair  transplant surgery. That said, however, you may first want to try nonsurgical solutions such as finasteride and minoxidil to see how well they do for you.  If you are a good responder to the medication, it may even reverse some of the miniaturization and could thicken your existing head of hair without the need for surgery.

There’s certainly a lot of information here but I agree that it can be a bit overwhelming and even difficult to put everything in order in terms of steps to restore your hair.

So that said, this is what I would do in your position.

1. Learn about the pros, cons and potential side effects associated with nonsurgical treatments such as finasteride and minoxidil. Consider trying finasteride for at least a year to see if you are a good responder to the medication. You may also want to add minoxidil into the mix which has a synergistic effect when used in conjunction with finasteride.  It could also simulate even more hair regrowth.

2. While you are using nonsurgical treatment, research and learn everything there’s to know about hair transplant, surgery and the doctors that perform it. Learn to differentiate between an outstanding surgeon, a good surgeon and one that is less than reputable.  This should include viewing countless before and after photos and videos presented on this forum and others by real patients and clinics.

3. Take monthly photos showing multiple angles of your hair in order to monitor the progress of finasteride and minoxidil. You can compare any of these monthly photos to see any noticeable differences month to month.

4. If after one year of using nonsurgical solutions you determine that you still want to proceed with hair transplant surgery, begin narrowing down your selections of a doctor based on the research that you have been doing while using nonsurgical solutions.  Below, I presented steps on selecting the best surgeon for you when that time comes.

Note - Given the fact that you are 40 with relatively minimal hair loss, you could opt to undergo hair transplant surgery sooner, but I do think it’s wise to consider nonsurgical solutions at the very least to slow down or stop the progression of male pattern baldness.  Surgical hair restoration is great for restoring hair but it does nothing to stop androgenetic alopecia from continuing.

——

Rahal Hair Transplant 

How to Select an outstanding hair transplant surgeon. 

1.  Start by looking at the surgeons recommended by this community, in particular the Coalition of Independent Hair Restoration Physicians.  Surgeons recommended by this community have met a demanding set of standards and are approved based on meeting those high standards.  Many online hair surgeon memberships don’t have any criteria other than to pay a membership fee.  Furthermore, physician members of the coalition have met an even higher and more demanding set of standards and have proven to be amongst the best of the best in the profession.

2. Now even amongst a list of outstanding surgeons, not all surgeons are created equally. Therefore, while it’s tempting to select a surgeon based on price or location, try to avoid this as many individuals travel great distances to undergo surgery with an elite surgeon they are most impressed with. Thus choose a surgeon based on their proven ability to produce outstanding results rather than because of cost or location.

3. Narrow your selection down to 3 to 5 surgeons you are most impressed with.  You can do this by using this discussion forum and others to view examples of patient results posted by both the clinic and their patients.  Speak with and meet with real patients in person if possible. If not, video chat works pretty well.

4. Come up with a list of consult questions to ask each surgeon/clinic you are considering. I’ve created several different posts on this forum with good questions to ask doctors.  If you need help coming up with a list of good questions, please let me know.

5. Consult with each doctor you are considering and ultimately, choose the surgeon you feel can best meet your goals.

I hope this helps  

Rahal Hair Transplant 

Edited April 10, 2023 by Rahal Hair Transplant

[randomhair]

You all are super helpful. 

@mike10, 

@duckling

i booked an appointment with a dermatologist and will perhaps start medication. 

I’ve also reached out to two of the doctors I listed above. Any other recommendations for high quality doctors given my hairline? Thank you again.

[A_4_Archan]

13 minutes ago, randomhair said:

You all are super helpful. 

@mike10, 

@duckling

i booked an appointment with a dermatologist and will perhaps start medication. 

I’ve also reached out to two of the doctors I listed above. Any other recommendations for high quality doctors given my hairline? Thank you again.

The doctors you mentioned are good in that budget range...if your budget is around 3.5 to 4 euro per graft than you can look at dr de freitas(excellent hairlines and he may be your best bet)  and dr pittela/pinto/ferreira(all of them are somewhat equally skilled and you can choose according to your personal preference) and dr mittal from uk who is an emerging star and producing great results and priced around 3 euros..

This is just my opinion and there may be other doctors who are good and you can do your research ...

[randomhair]

On 4/10/2023 at 8:20 AM, Rahal Hair Transplant said:

@randomhair,

Given your age and hair loss pattern, you do appear to be a good candidate for hair  transplant surgery. That said, however, you may first want to try nonsurgical solutions such as finasteride and minoxidil to see how well they do for you.  If you are a good responder to the medication, it may even reverse some of the miniaturization and could thicken your existing head of hair without the need for surgery.

There’s certainly a lot of information here but I agree that it can be a bit overwhelming and even difficult to put everything in order in terms of steps to restore your hair.

So that said, this is what I would do in your position.

1. Learn about the pros, cons and potential side effects associated with nonsurgical treatments such as finasteride and minoxidil. Consider trying finasteride for at least a year to see if you are a good responder to the medication. You may also want to add minoxidil into the mix which has a synergistic effect when used in conjunction with finasteride.  It could also simulate even more hair regrowth.

2. While you are using nonsurgical treatment, research and learn everything there’s to know about hair transplant, surgery and the doctors that perform it. Learn to differentiate between an outstanding surgeon, a good surgeon and one that is less than reputable.  This should include viewing countless before and after photos and videos presented on this forum and others by real patients and clinics.

3. Take monthly photos showing multiple angles of your hair in order to monitor the progress of finasteride and minoxidil. You can compare any of these monthly photos to see any noticeable differences month to month.

4. If after one year of using nonsurgical solutions you determine that you still want to proceed with hair transplant surgery, begin narrowing down your selections of a doctor based on the research that you have been doing while using nonsurgical solutions.  Below, I presented steps on selecting the best surgeon for you when that time comes.

Note - Given the fact that you are 40 with relatively minimal hair loss, you could opt to undergo hair transplant surgery sooner, but I do think it’s wise to consider nonsurgical solutions at the very least to slow down or stop the progression of male pattern baldness.  Surgical hair restoration is great for restoring hair but it does nothing to stop androgenetic alopecia from continuing.

——

Rahal Hair Transplant 

How to Select an outstanding hair transplant surgeon. 

1.  Start by looking at the surgeons recommended by this community, in particular the Coalition of Independent Hair Restoration Physicians.  Surgeons recommended by this community have met a demanding set of standards and are approved based on meeting those high standards.  Many online hair surgeon memberships don’t have any criteria other than to pay a membership fee.  Furthermore, physician members of the coalition have met an even higher and more demanding set of standards and have proven to be amongst the best of the best in the profession.

2. Now even amongst a list of outstanding surgeons, not all surgeons are created equally. Therefore, while it’s tempting to select a surgeon based on price or location, try to avoid this as many individuals travel great distances to undergo surgery with an elite surgeon they are most impressed with. Thus choose a surgeon based on their proven ability to produce outstanding results rather than because of cost or location.

3. Narrow your selection down to 3 to 5 surgeons you are most impressed with.  You can do this by using this discussion forum and others to view examples of patient results posted by both the clinic and their patients.  Speak with and meet with real patients in person if possible. If not, video chat works pretty well.

4. Come up with a list of consult questions to ask each surgeon/clinic you are considering. I’ve created several different posts on this forum with good questions to ask doctors.  If you need help coming up with a list of good questions, please let me know.

5. Consult with each doctor you are considering and ultimately, choose the surgeon you feel can best meet your goals.

I hope this helps  

Rahal Hair Transplant 

Thanks Dr Rahal

[randomhair]

15 hours ago, A_4_Archan said:

The doctors you mentioned are good in that budget range...if your budget is around 3.5 to 4 euro per graft than you can look at dr de freitas(excellent hairlines and he may be your best bet)  and dr pittela/pinto/ferreira(all of them are somewhat equally skilled and you can choose according to your personal preference) and dr mittal from uk who is an emerging star and producing great results and priced around 3 euros..

This is just my opinion and there may be other doctors who are good and you can do your research ...

Hi @A_4_Archani will do some research on DR De Freitas. Thanks for the recommendations

[Rafael Manelli]

You look like a strong candidate to me. 

[randomhair]

thanks. Can someone guide me on what the best way to contact Dr Pekinar's office is? Their website has very little information. 

[randomhair]

Quick update: went to the doctor and was prescribed finasteride and oral minox (initial dose of 2.5mg doubling to 5mg if no side effects). Started today so let’s see how it goes 

[randomhair]

Another update. No side effects from meds so far it seems. No response from Dr Pekinar’s office and am still waiting on some consultations but two docs that have gotten back estimate I’ll need 2,500-3,000 grafts. 

[randomhair]

Thank you all for your guidance. I've decided to go with Dr De Freitas. The wait time is around a year but I think its worth it given the quality of his work.

Separately, definitely seems I'm experiencing side effects from Finestaride. Finding it difficult to fall asleep and semen quality has gone down. 

[Spring15]

10 hours ago, randomhair said:

Thank you all for your guidance. I've decided to go with Dr De Freitas. The wait time is around a year but I think its worth it given the quality of his work.

Separately, definitely seems I'm experiencing side effects from Finestaride. Finding it difficult to fall asleep and semen quality has gone down. 

He is world class, good choice. If the finasteride sides are too much wait to see how cosmeRNA turns out

[randomhair]

I’m thinking of starting topical finestaride, perhaps the side effects will be minimal 

[Happyhead]

I had a similar reaction to oral fin. I’ve now been on topical fin for a little over 3 months; it’s definitely more tolerable.