Looking for some early pre-HT feedback

[MAL87]

Hi all, this is my first post so be gentle. I'm fully decided on finally getting a transplant this year and want a little user input based on clinic feedback I've received. 

So far, I've reached out to HLC Ankara, Eugenix and Dr. Gur in Turkey and will likely reach out to a few more. One of the reasons I'm lookin for feedback is because Eugenix preliminarily graded me as Norwood III (although we have a first video consult this weekend), but I feel like I'm almost definitely a NW V, or late state IV. Neither HLC or Gur have graded me yet, but HLC said they could transplant 4,000-5,000 grafts, with about 1,000 coming from my beard. And since I'm aware that Gur usually maxes out around 4k grafts, thats about in line with HLC. 

I think my main questions are as follows: 1) What would you grade me based on the pictures I've sent to the clinics, 2) Since I absolutely know I will need two procedures for max coverage, is it wiser to take, say, a conservative approach with Gur (choosing his VIP package) and go for about 3500-4k grafts, or go with Eugenix who will likely get more grafts out of me for better immediate coverage, then go back for the rest? I'm also going to choose a conservative hairline because I'm not tryin to be Brad Pitt over here.

[Hazy]

Hello,

1. Norwood 5, maybe heading towards a 6 depending on your family history.

2. You have a decent amount of thinning on the sides and the vertex bald spot is fairly low. I think if they get 3,000 from the donor area at once that would be impressive, they would need to stay fairly narrow in the back to avoid the thinning vertex or retrograde alopecia. Definitely do two procedures, maybe 2,500-3,000 grafts at a time. In the mean time you should be on finasteride oral and minoxidil oral (or topical) as your doctor sees fit, maybe you can recover some of the thinning. Microneedling once a week wouldn't hurt (1.5mm depth).

While it would be super great to get 4-5K grafts at a time you need to consider:

• Grafts don't live forever outside of the scalp and need to be implanted relatively soon, the timing depends on the holding solution they use
• Planting grafts too close together runs the risk of compromising the blood supply and losing some grafts

Because of this, it's likely better to do two reasonably sized procedures (2,500) than one MEGA procedure. I'm curious to see what others think.

[MAL87]

2 hours ago, Hazy said:

Hello,

1. Norwood 5, maybe heading towards a 6 depending on your family history.

2. You have a decent amount of thinning on the sides and the vertex bald spot is fairly low. I think if they get 3,000 from the donor area at once that would be impressive, they would need to stay fairly narrow in the back to avoid the thinning vertex or retrograde alopecia. Definitely do two procedures, maybe 2,500-3,000 grafts at a time. In the mean time you should be on finasteride oral and minoxidil oral (or topical) as your doctor sees fit, maybe you can recover some of the thinning. Microneedling once a week wouldn't hurt (1.5mm depth).

While it would be super great to get 4-5K grafts at a time you need to consider:

• Grafts don't live forever outside of the scalp and need to be implanted relatively soon, the timing depends on the holding solution they use
• Planting grafts too close together runs the risk of compromising the blood supply and losing some grafts

Because of this, it's likely better to do two reasonably sized procedures (2,500) than one MEGA procedure. I'm curious to see what others think.

Thanks for the input. That's fairly in line with what I was thinking

[BearsFan88]

Did Gur propose filling your frontal area but not lowering your hairline? That’s what he recommended for me. My hair similar to you 

[MAL87]

6 minutes ago, BearsFan88 said:

Did Gur propose filling your frontal area but not lowering your hairline? That’s what he recommended for me. My hair similar to you 

Gur is actually the only one who hasn't gotten back with a proposal or plan, but I'm hoping he can by this weekend. 

However, Eugenix provided the following attached plan, which I'm not opposed to.

Either way I go, I'm planning for a conservative hairline, which I know Gur is usually good for

[duckling]

Honestly if your beard is good then i would have had no worries going with eugenix plan. 2.7k-3k scalp grafts and rest beard mean you rough have same amount of scalp grafts for next sitting and if beard is still good then you get upwards of 8k grafts. 
 

if you think your beard and scalp donor is not that good (probably get a trichoscopy locally ) then gur will use those decent sized grafts conservatively.  And his hairline i am sure will not be this lower. ( it is actually not that lower but gur may give higher hairline considering your future grade)

[BackFromTheBrink]

I'd say your loss is similar to mine (Norwood 5). Fortunately I didnt have retrograde so managing my donor wasn't as tricky.

I had 3100 grafts to cover the frontal third (and a few reaching back to the vertex) and did not lower the hairline.

I planned to wait to see how the donor recovered and whether finesteride helped with regrowth before a potential second surgery.

I think a similar approach would work well for you. 

[MAL87]

9 hours ago, duckling said:

Honestly if your beard is good then i would have had no worries going with eugenix plan. 2.7k-3k scalp grafts and rest beard mean you rough have same amount of scalp grafts for next sitting and if beard is still good then you get upwards of 8k grafts. 
 

if you think your beard and scalp donor is not that good (probably get a trichoscopy locally ) then gur will use those decent sized grafts conservatively.  And his hairline i am sure will not be this lower. ( it is actually not that lower but gur may give higher hairline considering your future grade)

I've got a pretty strong beard, so that's not a concern, fortunately. After my video consult with Eugenix, they upgraded the amount of grafts from 4200 to around 4500-4700. 

I might update their hairline design to be a bit more conservative so I can save those grafts for the scalp.

[MAL87]

8 hours ago, BackFromTheBrink said:

I'd say your loss is similar to mine (Norwood 5). Fortunately I didnt have retrograde so managing my donor wasn't as tricky.

I had 3100 grafts to cover the frontal third (and a few reaching back to the vertex) and did not lower the hairline.

I planned to wait to see how the donor recovered and whether finesteride helped with regrowth before a potential second surgery.

I think a similar approach would work well for you. 

Yeah I'm not sure I need to lower my hairline much from where it would be, based on my currently non-existent hairline. 

I actually just hopped back on finasteride yesterday (and will be on minoxidil next week) in hope that I can strengthen the donor area, but also because the docs think that I can get some regrowth in the mid-scalp.

I think I'm leaning fairly heavily towards Eugenix at this point.

Edited May 20, 2023 by MAL87

[BackFromTheBrink]

That sounds sensible. They seem to get good yields, and make excellent use of beard and body hair. Given you're likely to need 5-6k grafts for total coverage, I suspect that may be necessary in your case. That said, with careful management of your donor area there's  every chance you'll be able to get a good result from them.

[BearsFan88]

How much was eugenix charging you??

[MAL87]

5 minutes ago, BearsFan88 said:

How much was eugenix charging you??

I'm planning to go with the Premium package with Dr. Das, which would be $2.54/graft. I really wish I had gotten in before they updated their plan pricing, but it is what it is.

But the pricing is also why I'm still waiting to hear back from Dr. Gur, because I would go with his premium package where he does the work for like half the price of Eugenix.

Edited May 20, 2023 by MAL87

[BearsFan88]

To be honest, you don’t need premium package with Gur.  He makes incisions.  His techs are well trained to implant.  You never see a bad case from him with his standard package.  
The problem you’ll run into is the same as me.  He will propose around 3200 grafts or so for $3,000eu, and we both need much more than that.  So with gur it will be a two trip transplant at least one year apart 

im leaning gur because I want the peace of mind of having my entire front done, before I burn up a bunch more grafts. Plus, he’s half the price so I can basically go twice and pay roughly the same. 

[MAL87]

5 minutes ago, BearsFan88 said:

To be honest, you don’t need premium package with Gur.  He makes incisions.  His techs are well trained to implant.  You never see a bad case from him with his standard package.  
The problem you’ll run into is the same as me.  He will propose around 3200 grafts or so for $3,000eu, and we both need much more than that.  So with gur it will be a two trip transplant at least one year apart 

im leaning gur because I want the peace of mind of having my entire front done, before I burn up a bunch more grafts. Plus, he’s half the price so I can basically go twice and pay roughly the same. 

That's pretty much my conflict, too. But I'm also totally impatient and want more grafts upfront that lead to a lighter second operation 😬

[BackFromTheBrink]

1 hour ago, BearsFan88 said:

To be honest, you don’t need premium package with Gur.  He makes incisions.  His techs are well trained to implant.  You never see a bad case from him with his standard package.  
The problem you’ll run into is the same as me.  He will propose around 3200 grafts or so for $3,000eu, and we both need much more than that.  So with gur it will be a two trip transplant at least one year apart 

im leaning gur because I want the peace of mind of having my entire front done, before I burn up a bunch more grafts. Plus, he’s half the price so I can basically go twice and pay roughly the same. 

Thats the thing though - you'll both need two procedures, unless you go for a gigasession, and that's not a great idea unless you have a fantastic donor. If you have a bad result for a single 3000 graft procedure it will leave you with option, unlike a much larger surgery.

As I said, I feel my 3100 grafts made a massive difference, so it's not as if you'll need to wait for 2 years before seeing results.

Edited May 20, 2023 by BackFromTheBrink

[MAL87]

7 minutes ago, BackFromTheBrink said:

Thats the thing though - you'll both need two procedures, unless you go for a gigasession, and that's not a great idea unless you have a fantastic donor. If you have a bad result for a single 3000 graft procedure it will leave you with option, unlike a much larger surgery.

As I said, I feel my 3100 grafts made a massive difference, so it's not as if you'll need to wait for 2 years before seeing results.

Do you have a link to your results that I can take a peek at?

[BearsFan88]

9 hours ago, BackFromTheBrink said:

Thats the thing though - you'll both need two procedures, unless you go for a gigasession, and that's not a great idea unless you have a fantastic donor. If you have a bad result for a single 3000 graft procedure it will leave you with option, unlike a much larger surgery.

As I said, I feel my 3100 grafts made a massive difference, so it's not as if you'll need to wait for 2 years before seeing results.

Thanks for helping. I want to go get 5,000 grafts so badly.  But honestly feel the 3000 or so grafts that gur, HLC, and Nader proposed me with a return visit would be the smartest and safest bet 

[Bucky O Hair]

14 hours ago, MAL87 said:

Yeah I'm not sure I need to lower my hairline much from where it would be, based on my currently non-existent hairline. 

I actually just hopped back on finasteride yesterday (and will be on minoxidil next week) in hope that I can strengthen the donor area, but also because the docs think that I can get some regrowth in the mid-scalp.

I think I'm leaning fairly heavily towards Eugenix at this point.

 

You are very obviously a NW5 (heading to NW6 or NW7) similar to me. 

As a NW5 myself, I recently ended up doing a 3200 FUE procedure on the front half, and I plan to do one in the crown at a later date...but man, that Eugenix plan does look tempting.  I wish I had transplanted hairs in my crown (it's so exposed now that I've buzzed my head for this first HT procedure) but apparently it's the 'safer' route, lol.   

In terms of your future hairline, I would do the hairline about 8cm above your glabella.  

It's conservative enough that you're about 1cm above where a more aggressive hairline would be (so you save a lot of grafts) but at the same time, you're not doing some overly conservative hairline (which takes all the fun out of getting a HT in the first place).

 

 

 

 

 

Edited May 21, 2023 by Bucky O Hair

[BackFromTheBrink]

13 hours ago, MAL87 said:

Do you have a link to your results that I can take a peek at?

You can see the details here.

Its thickened up further since then and I'm much happier with my hair after the procedure.

I'll probably get a much smaller second  procedure for the crown now that we know how much impact finesteride had on recovering hairs.

 

I 

[MAL87]

8 hours ago, BackFromTheBrink said:

You can see the details here.

Its thickened up further since then and I'm much happier with my hair after the procedure.

I'll probably get a much smaller second  procedure for the crown now that we know how much impact finesteride had on recovering hairs.

 

I 

Those are impressive results man. Hard to believe that was achieved with only 3100 grafts. 

Kinda gets me thinking that maybe I should divide the 1700 grafts they're planning for the crown to share with the mid-scalp. Maybe like 1000 for the crown and the rest mid-scalp.

[BackFromTheBrink]

50 minutes ago, MAL87 said:

Those are impressive results man. Hard to believe that was achieved with only 3100 grafts. 

Kinda gets me thinking that maybe I should divide the 1700 grafts they're planning for the crown to share with the mid-scalp. Maybe like 1000 for the crown and the rest mid-scalp.

Thank you. I still find it surprising that Dr Arshad got the density given the number of grafts used.

Remember though, it was a result for surgery and finesteride. I suspect I was fortunate enough to have a really good yield, a high hair to graft ratio, intelligent planning and a good response to the medication.

The crown is a black hole for grafts. I've seen 3k and upward used for just the crown and it still leave scalp showing. 

I suspect a thorough analysis of your donor area would influence the plan significantly. One of the reasons for recommending finesteride is that it would slow down loss, but also improve donor and recipient (so you should have more donor capacity,  reduced demand for grafts and reduced shock loss).

Have you thought about what you're looking for? For example, if you had to have a weaker area, where would it be?

I took the approach that framing my face was more important. After that, I'd rather my midscalp was dense.

If I had to, I'd settle for an age appropriate look where my crown was starting to thin (think Frank Lampard).

I'm now hopefully I can tackle the crown too. I'm at the point where it bothers me enough to consider another procedure but those around me (including my hairdresser) think I should be thankful for the hair I now have and leave it alone!

Front (in bright sunlight)

Vs crown 

Edited May 21, 2023 by BackFromTheBrink

[BearsFan88]

How much did you pay for the 3,200 grafts ? 

[BackFromTheBrink]

12 minutes ago, BearsFan88 said:

How much did you pay for the 3,200 grafts ? 

I paid for 3000 grafts. They charge £3/graft. 

[MAL87]

1 hour ago, BackFromTheBrink said:

Thank you. I still find it surprising that Dr Arshad got the density given the number of grafts used.

Remember though, it was a result for surgery and finesteride. I suspect I was fortunate enough to have a really good yield, a high hair to graft ratio, intelligent planning and a good response to the medication.

The crown is a black hole for grafts. I've seen 3k and upward used for just the crown and it still leave scalp showing. 

I suspect a thorough analysis of your donor area would influence the plan significantly. One of the reasons for recommending finesteride is that it would slow down loss, but also improve donor and recipient (so you should have more donor capacity,  reduced demand for grafts and reduced shock loss).

Have you thought about what you're looking for? For example, if you had to have a weaker area, where would it be?

I took the approach that framing my face was more important. After that, I'd rather my midscalp was dense.

If I had to, I'd settle for an age appropriate look where my crown was starting to thin (think Frank Lampard).

I'm now hopefully I can tackle the crown too. I'm at the point where it bothers me enough to consider another procedure but those around me (including my hairdresser) think I should be thankful for the hair I now have and leave it alone!

Front (in bright sunlight)

Vs crown 

I'm glad I just hopped on Fin. I tried it for a few months, I think, about 8-9 years ago but got spooked by the side effects. I don't know how much 2-3 months is going to help pre-op, but it's better than nothing. 

And it's hard to decide which area I would be comfortable leaving weaker, but I'm thinking it might be mid-scalp. It's where I have the most hair up top, currently, so maybe Fin and Minoxidil can help. My crown has been probably my biggest sore spot, since even when I shave my head that's the most glaring hole. 

At this point, I think I like Eugenix's plan of giving me a strong hairline and covering the crown, then going back to fill the crown and mid 8-12 months later. Like, looking at your crown, I would totally be satisfied with that for now.

Edited May 21, 2023 by MAL87
Spelling

[BackFromTheBrink]

Sounds like a plan. My advice would be to make sure the planning on the day is done collaboratively and that you're entirely happy with the approach before going ahead.

They'll only really know the hair diameter, hair/follicle ratio and general health of your donor when you're examined in person.

At that point, you can plan with more certainty and make sure that your preferences are understood and catered for.

Eugenix are by all accounts an ethical and skilled team. However, I have seen people comment that planning has seemed less patient involved than is perhaps desirable, so it'll be up to you to take some control over that on the day.

Edited May 21, 2023 by BackFromTheBrink