25 yo male seeking advice on SMP, medication, HT & future course of action in general

[ThePerseverantWarrior]

Hello everyone! This post might be a little long.

I am a 25 year old male from India, suffering from hairloss since I was 19! By 23, I was a NW 4V diffused thinner. Even my sides (particularly right side) were affected by alopecia.

I have undergone 2 hair transplant procedures since 2021, wherein 6500+ grafts (maybe a bit more) were implanted on my frontal area, crown and temples. It's been 8 months since my 2nd HT. I am quite satisfied with my hairline, and the difficult crown has also improved a fair bit. However, my goal of sporting a headfull appearance still eludes me. The upper half of my frontal third, and the mid-scalp, look pretty thin and stand out from the transplanted zones, more so when my hair isn't combed over and held steady in a particular position. 

I have been on 1mg oral finasteride for the last 18 months, and I was on topical minoxidil for 3.5 years before switching to 2.5mg oral 2.5 months back. Also take multivitamin tablet and have tried PRP. I haven't experienced any significant improvement via medication. Frankly, I'm not even sure if my baldness has been completely stabilised via these medications. The only thing I'm sure about is my baldness hasn't rapidly progressed for the worse. 

Now I'm wondering how should I hence pursue my still unfulfilled goal of sporting a headfull appearance. Putting hair fibres & spray (and hence dreading the wind!) is becoming increasingly frustrating. I don't want to get another hair transplant, since my genetic baldness seems rather aggressive and I want to preserve my donor for the future (donor still looks pretty healthy and undetectable though). So I have a 2 point plan in my mind, but not without concerns that I would love to have your inputs on : 

1) Add oral dutasteride in my regime, since I don't seem to be responding to finasteride very well. However, my clinic wasn't very supportive of this, and they in fact wanted me to lower my finasteride dosage as long term exposure to these drugs, they said, could lead to side effects in the future ("You shouldn't take chances with your sexual health", the doc said!). Any inputs on this? Should I add dutasteride, or tread more cautiously? 

2) Use SMP to fill up the thinner areas on my head and hence get a more fuller look. However, my concern is that some areas of my scalp are a little too thin to be naturally camouflaged via SMP. I'm afraid the contrast between my hair & SMP dots may stand out when my hair isn't properly combed & lights are harsh, thereby defeating the very goal of achieving a natural headfull look. Any advice here? 

Thanks for patiently reading this far. Hairloss is the biggest challenge I've faced in my quarter life, and the battle still seems uphill. Would love to hear the perspective of more experienced folks on how I should proceed hence. Thanks!

PS: The pictures below have been clicked after shampooing, so my hair here looks as best as it can. 

 

 

 

[ThePerseverantWarrior]

@EvoXOhio would really appreciate your inputs wrt my chances with SMP. 

I'm considering it super seriously, and won't mind keeping longer hair if that helps with the illusion better. 

[A_4_Archan]

I can understand how frustrating this is for you...You can consult another doctor regarding medication ....there are many people over here who are on dutasteride so they can give their opinions regarding that...if you didn't face and side effects from finasteride and you have tolerated it well thn i guess you can try dutasteride after consulting a doctor ....i don't think so that each and every person would face side effects and even if you face it thn you can stop it ....i agree with your decision that you need to preserve your donor for the later stage and try to stabilise your hairloss significantly before planning your next surgery ....there are few smp artist over here and few patients who have undergone smp and they can give their feedback about this...

@hairthere can give some suggestions on smp on this particular case...

 

[ThePerseverantWarrior]

9 minutes ago, A_4_Archan said:

I can understand how frustrating this is for you...You can consult another doctor regarding medication ....there are many people over here who are on dutasteride so they can give their opinions regarding that...if you didn't face and side effects from finasteride and you have tolerated it well thn i guess you can try dutasteride after consulting a doctor ....i don't think so that each and every person would face side effects and even if you face it thn you can stop it ....i agree with your decision that you need to preserve your donor for the later stage and try to stabilise your hairloss significantly before planning your next surgery ....there are few smp artist over here and few patients who have undergone smp and they can give their feedback about this...

@hairthere can give some suggestions on smp on this particular case...

 

Thanks a lot for you inputs. I am actually in the process of consulting another doctor and may add dutasteride onto my regime should I get favourably advised. 🤞

[A_4_Archan]

2 minutes ago, ThePerseverantWarrior said:

Thanks a lot for you inputs. I am actually in the process of consulting another doctor and may add dutasteride onto my regime should I get favourably advised. 🤞

Yeh thats nice..and who was the doctor you had surgery from?

[ThePerseverantWarrior]

5 minutes ago, A_4_Archan said:

Yeh thats nice..and who was the doctor you had surgery from?

1st surgery was from Dr. Manoj Khanna of Enhance Clinic, Kolkata in September 2021. 3500+ grafts via FUT. I chose him primarily because back then, I was borderline paranoid about "preserving" my donor as best as possible and hence wanted an FUT (just foolish 23 yo things 😅). He was the most experienced FUT surgeon I could find in India. Results were pretty average though.

2nd surgery was 3000 FUE grafts from QHT regrow Haridwar in August 2022. Mostly the crown was addressed (only 100 grafts were placed in a rather bald crown in the 1st surgery), some density was added in the hairline-frontal area and a bit of temple work was done too. Pretty happy with the result. 

I had a good donor. It still looks pretty full and undetectable. Maybe it can yield 2000 more grafts. But that's for the future

[A_4_Archan]

Great..yeh actually at that time dr khanna was a famous surgeon bt he never produced good consistent results ...it was just all hype...i dont knw abt qht clinic though I have seen their insta and youtube adds few times....actually imo its good that you have gone for fut in 1st surgery and thts why evn aftr 2 surgeries your donor is still healthy and not over harvested ...from your donor it seems that you will have 3k grafts easily available...so your future is well secured...just contact a good surgeon and i wish you can stabilise your hairloss..

[EvoXOhio]

2 hours ago, ThePerseverantWarrior said:

@EvoXOhio would really appreciate your inputs wrt my chances with SMP. 

I'm considering it super seriously, and won't mind keeping longer hair if that helps with the illusion better. 

I think SMP could work for you, but only if your hair loss is stabilized. If you’re not sure if it is, I wouldn’t get SMP. 

[ThePerseverantWarrior]

46 minutes ago, A_4_Archan said:

Great..yeh actually at that time dr khanna was a famous surgeon bt he never produced good consistent results ...it was just all hype...i dont knw abt qht clinic though I have seen their insta and youtube adds few times....actually imo its good that you have gone for fut in 1st surgery and thts why evn aftr 2 surgeries your donor is still healthy and not over harvested ...from your donor it seems that you will have 3k grafts easily available...so your future is well secured...just contact a good surgeon and i wish you can stabilise your hairloss..

Thanks. 

I think my donor "looks" more full than it actually is (thanks to FUT) so I'm not sure if 3k+ grafts will be feasible. 

Given a chance, I would probably redo my 1st transplant, probably preferring a good FUE clinic over Dr. Khanna. I also regret not getting on finasteride earlier and trying it at least for a year before deciding on my surgery.  

Let's see how the future unfolds 🤞

[ThePerseverantWarrior]

33 minutes ago, EvoXOhio said:

I think SMP could work for you, but only if your hair loss is stabilized. If you’re not sure if it is, I wouldn’t get SMP. 

Thanks. 

My journey with medication has actually been a little strange. 5 months after starting finasteride in 2021, my mid-scalp and crown had improved dramatically, so much so that I was contemplating that I may not need another transplant! However, I had a massive shed thereafter and lost all that progress. No recovery yet. 

In Jan-Feb this year, my hairfall seemed pretty much stable. But a couple of weeks after switching to oral minoxidil, I started experiencing increase shedding and that hasn't stopped yet. Now I'm afraid that if I start dutasteride, I might experience more shedding! 

The only positive takeaway is that if I compare my current scalp pictures with those of June-July last year, it doesn't appear thinner as such. 

I think my genetic baldness is quite aggressive and medication isn't being able to keep up with it properly 🥲

[duckling]

I dont think you need smp. For now good hair length combined with proper combing of hair should hide a lot of thin areas. SMP is used when you want to cut hair short. At these length SMP wont help in most situations which you mentioned.

For medications i will say keep faith in oral min, I have read few posts where they said that from month 5 onwards the growth was visible.

Finasteride even if not getting you new hair will atleast have helped you with keep your hair. Sure you should have started fin before HT (atleast 1 year).

And FUT and manoj khanna hype wave was tough to escape (even i thought for sometime that i will get it done from him as it showed that he has done celeb HT's like harsha bhogle). When you google best FUT surgeon in india then his name comes up. Why didn't you pick medispa though ? Suneet soni is also very popular in many pages for FUT in india. 

[duckling]

2 hours ago, ThePerseverantWarrior said:

1st surgery was from Dr. Manoj Khanna of Enhance Clinic, Kolkata in September 2021. 3500+ grafts via FUT. I chose him primarily because back then, I was borderline paranoid about "preserving" my donor as best as possible and hence wanted an FUT (just foolish 23 yo things 😅). He was the most experienced FUT surgeon I could find in India. Results were pretty average though.

2nd surgery was 3000 FUE grafts from QHT regrow Haridwar in August 2022. Mostly the crown was addressed (only 100 grafts were placed in a rather bald crown in the 1st surgery), some density was added in the hairline-frontal area and a bit of temple work was done too. Pretty happy with the result. 

I had a good donor. It still looks pretty full and undetectable. Maybe it can yield 2000 more grafts. But that's for the future

your hair is very thick ? as after 2 surgeries also it seems to look full. FUT has surely helped but after this much grafts i have seen slightly depleted donor even in FUT +fue cases in suneet soni's youtube page. 

[ThePerseverantWarrior]

41 minutes ago, duckling said:

I dont think you need smp. For now good hair length combined with proper combing of hair should hide a lot of thin areas. SMP is used when you want to cut hair short. At these length SMP wont help in most situations which you mentioned.

For medications i will say keep faith in oral min, I have read few posts where they said that from month 5 onwards the growth was visible.

Finasteride even if not getting you new hair will atleast have helped you with keep your hair. Sure you should have started fin before HT (atleast 1 year).

And FUT and manoj khanna hype wave was tough to escape (even i thought for sometime that i will get it done from him as it showed that he has done celeb HT's like harsha bhogle). When you google best FUT surgeon in india then his name comes up. Why didn't you pick medispa though ? Suneet soni is also very popular in many pages for FUT in india. 

Actually a combover provides me a headfull kind of appearance only if it's held steady in a particular way with hair spray, and that's very difficult to maintain. One gust and my scalp stands exposed. That's why I have to use hair fibres + spray. And that's honestly getting too frustrating and I can't keep doing it. I need something more permanent. 

SMP actually works well in two extreme cases : buzz cut appearance AND long hair with minor thin areas on the scalp. I feel my case is somewhat close to the 2nd scenario. Basically, whenever the contrast between existing hairs and smp dots isn't too stark, it works. @EvoXOhio please correct me if I'm wrong. 

Yes I plan on continuing taking oral minoxidil for the foreseeable future if I don't get any side effects. I've read that several people who didn't respond as well to finasteride achieved better results on including dutasteride, so I'm inclined towards trying that. But fear of long term side effects is also playing on my mind. 

I don't recall if Dr. Soni featured prominently as an FUT specialist in my research back then. That fact that I lived in Bengal and Dr. Khanna's clinic was quite close by also tilted my decision (and also my dad's decision) in his favour (obviously I know now that it was a stupid reason). But yes, Dr. Khanna is way overhyped. Now I know at least half a dozen FUE clinics in India which provide better results than Khanna at half his price! 

[ThePerseverantWarrior]

48 minutes ago, duckling said:

your hair is very thick ? as after 2 surgeries also it seems to look full. FUT has surely helped but after this much grafts i have seen slightly depleted donor even in FUT +fue cases in suneet soni's youtube page. 

Yup I've been told at both the clinics that my donor hair is pretty thick and healthy. Although unfortunately, I don't see much of it's effect in the transplant, as most of the transplanted hairs grow curly and wavy beyond a certain length

Edited April 23, 2023 by ThePerseverantWarrior

[EvoXOhio]

19 minutes ago, ThePerseverantWarrior said:

Actually a combover provides me a headfull kind of appearance only if it's held steady in a particular way with hair spray, and that's very difficult to maintain. One gust and my scalp stands exposed. That's why I have to use hair fibres + spray. And that's honestly getting too frustrating and I can't keep doing it. I need something more permanent. 

SMP actually works well in two extreme cases : buzz cut appearance AND long hair with minor thin areas on the scalp. I feel my case is somewhat close to the 2nd scenario. Basically, whenever the contrast between existing hairs and smp dots isn't too stark, it works. @EvoXOhio please correct me if I'm wrong. 

Yes I plan on continuing taking oral minoxidil for the foreseeable future if I don't get any side effects. I've read that several people who didn't respond as well to finasteride achieved better results on including dutasteride, so I'm inclined towards trying that. But fear of long term side effects is also playing on my mind. 

I don't recall if Dr. Soni featured prominently as an FUT specialist in my research back then. That fact that I lived in Bengal and Dr. Khanna's clinic was quite close by also tilted my decision (and also my dad's decision) in his favour (obviously I know now that it was a stupid reason). But yes, Dr. Khanna is way overhyped. Now I know at least half a dozen FUE clinics in India which provide better results than Khanna at half his price! 

You are correct. SMP has 2 use cases - for someone who shaved their head bald and wants to have the shaved head look, and for people with longer hair who have decent hair coverage with some thinning and they want to have the illusion of a full head of hair. Mine is the latter. Here is a pic: https://imgur.com/a/oVKVz5Z

Edited April 23, 2023 by EvoXOhio

[duckling]

18 minutes ago, ThePerseverantWarrior said:

Yup I've been told at both the clinics that my donor hair is pretty thick and healthy. Although unfortunately, I don't see much of it's effect in the transplant, as most of the transplanted hairs grow curly and wavy beyond a certain length

wavy hair will help you in fuller appearance though. But managing them and styling them is very tough. I had naturally curly hair in childhood and now have wavy hair so it helps me in coverage. Maybe after a while you will get used to it. 

[duckling]

31 minutes ago, ThePerseverantWarrior said:

Actually a combover provides me a headfull kind of appearance only if it's held steady in a particular way with hair spray, and that's very difficult to maintain. One gust and my scalp stands exposed. That's why I have to use hair fibres + spray. And that's honestly getting too frustrating and I can't keep doing it. I need something more permanent. 

SMP actually works well in two extreme cases : buzz cut appearance AND long hair with minor thin areas on the scalp. I feel my case is somewhat close to the 2nd scenario. Basically, whenever the contrast between existing hairs and smp dots isn't too stark, it works. @EvoXOhio please correct me if I'm wrong. 

Yes I plan on continuing taking oral minoxidil for the foreseeable future if I don't get any side effects. I've read that several people who didn't respond as well to finasteride achieved better results on including dutasteride, so I'm inclined towards trying that. But fear of long term side effects is also playing on my mind. 

I don't recall if Dr. Soni featured prominently as an FUT specialist in my research back then. That fact that I lived in Bengal and Dr. Khanna's clinic was quite close by also tilted my decision (and also my dad's decision) in his favour (obviously I know now that it was a stupid reason). But yes, Dr. Khanna is way overhyped. Now I know at least half a dozen FUE clinics in India which provide better results than Khanna at half his price! 

no worries. whats done is done and as he was prominent name then obviously parents will tell you to go with them.

For FUE i think you might have had to choose from eugenix, hairfree hairgrow, tejinder bhatti , qht , poswal etc. 

hairfree hairgrow is so much advertised though . especially from "born creator". He is a youtuber and you might know him.

Edited April 23, 2023 by duckling

[ThePerseverantWarrior]

4 minutes ago, duckling said:

no worries. whats done is done and as he was prominent name then obviously parents will tell you to go with them.

For FUE i think you might have had to choose from eugenix, hairfree hairgrow, tejinder bhatti , qht , poswal etc. 

hairfree hairgrow is so much advertised though . especially from "born creator". He is a youtuber and you might know him.

I did my 2nd HT at QHT. But yes, all these clinics provide better results than Khanna, and most of them are cheaper. 

However, if I get my 3rd HT (hopefully no earlier than 5-7 years), I'll prefer either Dr. Sethi of Eugenix or an overseas clinic (Dr. Ferreira, Zarev, Pinto, Hasson and suchlike). Unfortunately, India is yet to reach the global gold standards of hair restoration surgeries. 

God be willing, I'll also have the financial resources to afford overseas clinics by then ✌️

[duckling]

1 hour ago, ThePerseverantWarrior said:

I did my 2nd HT at QHT. But yes, all these clinics provide better results than Khanna, and most of them are cheaper. 

However, if I get my 3rd HT (hopefully no earlier than 5-7 years), I'll prefer either Dr. Sethi of Eugenix or an overseas clinic (Dr. Ferreira, Zarev, Pinto, Hasson and suchlike). Unfortunately, India is yet to reach the global gold standards of hair restoration surgeries. 

God be willing, I'll also have the financial resources to afford overseas clinics by then ✌️

save up for next 5-7 years and then do. This is probably your last HT so get it from the best. Hopefully in india we would have more good surgeons by that time so it would be more affordable to do here. Else there is always option of going outside with the saved money.Good luck. By the way how much did khanna and qht charge per graft? if isnt not confidential then please tell. In india i have seen people charge 20-50 rupees and eugenix's lowest one starts at 75 and bhatti think charges 120. So just wanted to compare prices.

[ThePerseverantWarrior]

5 minutes ago, duckling said:

save up for next 5-7 years and then do. This is probably your last HT so get it from the best. Hopefully in india we would have more good surgeons by that time so it would be more affordable to do here. Else there is always option of going outside with the saved money.Good luck. By the way how much did khanna and qht charge per graft? if isnt not confidential then please tell. In india i have seen people charge 20-50 rupees and eugenix's lowest one starts at 75 and bhatti think charges 120. So just wanted to compare prices.

Khanna charged me INR 65-70 per graft iirc. QHT was INR 30 per graft, and better results. 

Dr. Khanna is grossly overrated and overpriced 

Btw, I also hope the verteporfin will become more mainstream in another 5 years time, and safely allow maximum utilisation of donor

Edited April 23, 2023 by ThePerseverantWarrior

[duckling]

11 minutes ago, ThePerseverantWarrior said:

Khanna charged me INR 65-70 per graft iirc. QHT was INR 30 per graft, and better results. 

Dr. Khanna is grossly overrated and overpriced 

Btw, I also hope the verteporfin will become more mainstream in another 5 years time, and safely allow maximum utilisation of donor

wow he took a lot compared to some popular fue clinics. fingers crossed for verteporfin. scarring maybe gone.

[ThePerseverantWarrior]

@duckling @A_4_Archan

I had a trichoscopy done. Turns out I have ~2000 grafts left in my donor (without harming its visual appeal) and ~1500 beard grafts under my chin  Donor hair is pretty thick. 

So that's the reserve for future 

[Gatsby]

SMP can make your results look better or worse. It just depends. I've had SMP and then I had two surgeries with Dr Sethi as a Norwood 7.

[ThePerseverantWarrior]

10 hours ago, Gatsby said:

SMP can make your results look better or worse. It just depends. I've had SMP and then I had two surgeries with Dr Sethi as a Norwood 7.

How can it make my results worse? If it's done in a botched manner?

[Kamran10]

On 4/30/2023 at 11:33 AM, ThePerseverantWarrior said:

How can it make my results worse? If it's done in a botched manner?

Hi dude . I saw that you mentioned the name of QHT clinic in India and it seems you have done procedure there . What is your overall experience ? Do you recommend them for NW 6 ? I have seen they produced some impressive result on high Norwood . Have you met dr Ankur ? 
 

Thanks,