Good response to meds, but still have diffuse thinning. Is next step a HT? (pics attached)

[jakos]

hello!

These are my before pics from 1 year ago:

 

After being on fin for 10 months and topical min for 6 months, I had good response (i assume mainly thanks to min) and many miniaturized hairs came back to life. 

But still overall density is far from ideal. I´d say hairline and frontal part is looking good, but especially when you look from above, and look at the crown, you can see the thinning pretty easily.

 

Current pics:
 

With all these developments, do you think a HT is the next step? I would love to increase density overall, with some touch on crown (maybe 500 grafts?) But do you think there are some risks with it, like the operation hurting native hairs?

As diffuse thinning is a pain, i would want to go with a conservative approach.

Or maybe since meds are working, should i level up on those and go with dut / oral min? 

Would love to hear your opinions.
 

Edited May 9, 2023 by jakos

[Gatsby]

I takes up to two years to reap the full benefits from finasteride and one year for minoxidil. I would stay on the drugs longer and ensure that your stabilization maintains (and your hair may even improve more as you are a great responder). I'm not a doctor but switching to oral minoxidil with your doctor will likely benefit your hair more. You 'might' even get away from needing surgery. Have a look at some of @Viney's results from meds. All the best!

[Rahal Hair Transplant]

@jakos,

You are definitely a good responder to medication as finasteride and minoxidil typically are pretty good at helping men retain their existing hair but it’s a lot rarer for individuals to thicken up as much as you have.

As far as the next step, hair transplant surgery could be an option for you although diffuse thinners are a bit more complex.  Ultimately, there is a delicate line between transplanting enough hair and too much hair that could cause potential permanent shock loss to miniaturizing natural hairs.  That’s not to say that it’s impossible to find this line, but it does take a surgeon with a great deal of skill and experience. Going to a less experienced or skilled physician could result in a net loss of hair instead of a net gain which is ultimately what anyone undergoing hair surgery wants.

How do you consulted with any surgeons yet? If not, I do suggest researching all surgeons are considering and ultimately choose a surgeon with a proven track record of producing I’ll send her results rather than simply going to  surgeon strictly based on location and price.

I hope this helps 

Rahal Hair Transplant 

[Sunset Dune]

Your front/hairline seems to be okay but despite being on meds your crown is still very problematic and you are losing hair at the back of crown so your headed toward stage 6 so you will need a transplant regardless 

[jakos]

hello!

things look same with no significant improvement or worsening. i came to think that i can benefit from having a HT to improve density through my thirties.

i was advised by a doctor not cover my entire scalp in one operation for density enhancement, since according to him coverage of a large area hinders recovery and survival rate of grafts. this is why 2 HTs sound better for me. one for front/mid, and one for mid/vertex (though not sure about the areas)

however, i have some issues, and would really appreciate thoughts on those;

1) fortifying the hairline will surely improve the looks, but i think my hairline at this point is fairly low, and i have concerns about "committing" to this current hairline considering the potential progression of hair loss
2) considering this, do you think increasing density starting from maybe 2 cm's above the hairline makes sense? maybe covering entire front and midscalp for improving density
3) my vertex is the worst looking part, but it is the vertex, so not so much visible. i think covering it in a 2nd HT makes more sense. would you agree? i also want to incorporate beard hair there. something like 500 body hair and 1000 scalp hair

 

[THE GAME]

Your hairloss pattern is exactly what i had , i was 32 when i looked like you by 45 i was a norwood 6 . Also i was a hyper responder to fin and minoxidil. I developed side effects after 12 months and discontinued the use of fin which sent me back into hair loss.

 

i would not add hair to your hair line , i would however plan with the surgeon that you will be a norwood 6 . Zarev talks about planning for final norwood stage by knowing what your total donor is . 
 

watxh Zarev’s interview with Melvin it will give you a better understanding of what is coming and how to plan surgically.

Edited December 9, 2023 by THE GAME

[Al - Moderator]

I think your hair line looks good right now. There's no reason you can't start the transplant behind your natural hair line. You can always go back later and create a new hair line if you want/need to. I would just fill in the midscalp for now and see where that gets you. Don't use up too many grafts because it looks like you could turn into a NW 6 or NW 7 if the meds stop working at some point or if for some reason you need to stop taking them. 

Edited December 9, 2023 by BeHappy

[jakos]

7 hours ago, BeHappy said:

I think your hair line looks good right now. There's no reason you can't start the transplant behind your natural hair line. You can always go back later and create a new hair line if you want/need to. I would just fill in the midscalp for now and see where that gets you. Don't use up too many grafts because it looks like you could turn into a NW 6 or NW 7 if the meds stop working at some point or if for some reason you need to stop taking them. 

yes i have a very conservative approach. i know every graft counts so need to find a balance between improving appearance now and reducing the donor bank

 

though i am thinking should i prioritize midscalp or vertex first?

Edited December 9, 2023 by jakos