Potential Hair transplant evaluation from current hair condition. (with pics)

[ChefP]

Hi 

I have posted here before but I'm uploading pictures for the forum to evaluate my current hair loss condition and what treatments I could have. I have consulted a few Dr's already and have had some options presented but would love the collective wisdom and evaluation from this forum to help. 

Those are so far:

H&W 4500 grafts FUT recommended. ( They can do FUE but said FUT in my case maximises donor area for future ops)

Dr Nakatsui 3500 grafts. Either FUT or FUE

So some context:

I'm 43 year old male.

Been using topical Minoxidil (5%) Finasteride (0.1%) foam for 4 months.

Used to take oral Finasteride but I think the recommended dose of 1.25mg daily was to high as caused some libido side effects. Nothing some coaxing doesn't fix. TMI. 

Just started back on oral Finasteride but this time will take 3.5mg per week on alternative days. (seen YT vid from Hair docs in Oz recommending this). Thinking of combing the foam and pills at the same time.

 

Never had a hair transplant before. My hair is fine. My Father has very little hair left on top but has on the sides and back he is 73 now. Mum's side some have hair some not as much.

At everyone tagged below from previous topic FUE VS FUT, thought it would be easier to reply on this new topic, as have pics now to show you. 

 

@Rahal Hair Transplant @Z-- @mr_peanutbutter @Bucky O Hair @Vann @AlexMeister21

 

I've attached some pics that show the front, back, sides and top view. Sometimes I'll have my hair a little shorter on the back and sides but this is generally the style and length I've been using with my current head of hair. 20 years ago I would slick it up a little and style it. Would be nice to get back to those days again...

 

I'm looking to get a transplant done, all being well in the next few months. 

 

Appreciate all the help and information you all provide. 

 

Thanks so much.

 

[Hazy]

FUT is a good idea if you have significant hair loss in the family (NW 6 or 7) since yes technically you can harvest more efficiently, BUT, you have to be OK with leaving your hair roughly the length in the back it is now or maybe a bit shorter. It's really surgeon and patient dependent on how the scar turns out, some people just make wider scars due to collagen laxity or tight scalps, some surgeons just make big scars because their technique needs work. I'd probably recommend going with a FUE since it's easier to hide and you don't have to worry about the scar, honestly it's a tough decision since you're trying to predict your future hair loss (or future hair loss breakthroughs).

4,000 grafts would get you started covering the front and bridge, but I would leave the vertex of the scalp for last or a later procedure. At that number you might be left with a 5cm circumference circle on the vertex that isn't touched, but they may be able to fill around that somewhat in the first procedure (outside of the circle first). 

One thing going for you is you have a good looking donor right now, the trick will be finding a good medical therapy to STOP further hair loss. If you can do that then you can transplant to good results. 

[mr_peanutbutter]

do you have good scalp laxity? cab you do that?

 

 

it looks like you are heading to at least norwood 5 and you are going for a higher graffcount in your upcoming procedure so going with fut isnt the worst idea. remember that you can get like 1.000 and more additional grafts to transplant over lifetime if you go with fut + fue combo (given your laxity is at least normal)

 

you could contact hattingen for a second fut opinion

Edited May 17, 2023 by mr_peanutbutter

[Vann]

Plan to do both. Consider the worst possible outcomes and see what your surgeon recommends. 
 

if you plan to do FUT first, consider options that would potentially go ear to ear. Then when you get checked on site you can always switch to FUE depending on your donor and scalp.

If you go FUT first you can probably get 2-3k grafts additional over your lifetime. There’s a reason some people remain doing FUT.

Nonetheless, I would say consider doing FUT first and if your surgeon says you have >7k grafts personally I would do FUT. However if you have way more than 7k grafts available you could probably cover enough with fue. 

Edited May 17, 2023 by Vann

[Bucky O Hair]

I would avoid FUT at all costs...but I'm an "FUT hater".   

I just don't think it's ever worth it to put a linear scar on the back of your head.  You'll never be able to cut your hair short on the sides and back, and you lose the 'opt out' where you can just clip your hair short all over (if you ever progress to a NW6 in your senior years). 

Even though docs will tell you that you will get more hairs out of an FUT procedure... I find that people rarely get exact numbers from these docs.  

It always seems to be some "to be confirmed" amount, that relies on things like 'scalp laxity' and ensuring you do some weird 'laxity exercises' and things like that.  If you can get an ACTUAL estimate from these docs on how many ADDITIONAL follicles you'll receive from an FUT procedure over and above an FUE procedure (without them tapdancing around the subject) then you can make an informed decision.  But if they're just going to say that it's more, and not actual tell you how much more...then just go for FUE.  But even if you do get more from the FUT...it would have to be A LOT more in order to make it worth putting a linear scar on your head (IMO, getting an additional 500 to 1000 more hairs is totally not worth it).  

Again, I'm biased against FUT, but I'm sure if you surveyed this board the vast majority opts for FUE over FUT in almost every scenario.

 

Re: your hair...

You seem to have very good donor hair, and you have a good amount of native hairs left on top of your head.  Your native hair shafts in your forelock looks pretty coarse too, and doesn't look miniaturized either (which is good).  The estimates provided by your two docs are probably accurate (somewhere between 3500 and 4500 should be good) and that will give you full coverage (front to back) in conjunction with your existing native hairs.  H&W are pretty world renown.  I don't know too much about the other doc, but they're on the recommended list here so I'm sure they're fine too.

 

 

[ChefP]

@Hazy The scar is a concern alter in life for sure. Right now I"m back on oral Finasteride and will combine with the foam to see how it affects my current hair. 

@mr_peanutbutter So I tried pinching my scalp like in that pic and I can't do it that much. I can a bit. When I spoke with H&W they said I would need to do some stretching for it.

@Vann that's a good point to see total amounts of grafts available. Will speak with the doctor. I think one of the issues I have with FUT is the downtime healing from a piece of my scalp being cut out and the then pain afterwards with healing etc. I've seen Dr Nakatsui is good at minimizing scars in his patients. 

@Bucky O Hair I've got the same fears for FUT scars as well. It's all the what if's down the road with hair loss in senior years. Although you might loose hair having the big scar seems like an issue. Pricing is obv more for FUE. One good thing about FUE at Dr Nakatsui is he does all the extraction and also implantation himself, I believe.  

[AlexMeister21]

Just from my personal experience, I would go for FUE. I really regret getting FUT and know I'm going to regret it even more in my senior years unless I am able to significantly reduce my scar. My case is a bit of an outlier though as I went to a poor doc. H&W seem like they produce okay scars for the most part. Are you planning on consulting with more docs? You look like you have a good donor area and a good surgeon could make the most out of your donor with FUE.

[shiba1985]

On 5/16/2023 at 8:13 PM, ChefP said:

Hi 

I have posted here before but I'm uploading pictures for the forum to evaluate my current hair loss condition and what treatments I could have. I have consulted a few Dr's already and have had some options presented but would love the collective wisdom and evaluation from this forum to help. 

Those are so far:

H&W 4500 grafts FUT recommended. ( They can do FUE but said FUT in my case maximises donor area for future ops)

Dr Nakatsui 3500 grafts. Either FUT or FUE

So some context:

I'm 43 year old male.

Been using topical Minoxidil (5%) Finasteride (0.1%) foam for 4 months.

Used to take oral Finasteride but I think the recommended dose of 1.25mg daily was to high as caused some libido side effects. Nothing some coaxing doesn't fix. TMI. 

Just started back on oral Finasteride but this time will take 3.5mg per week on alternative days. (seen YT vid from Hair docs in Oz recommending this). Thinking of combing the foam and pills at the same time.

 

Never had a hair transplant before. My hair is fine. My Father has very little hair left on top but has on the sides and back he is 73 now. Mum's side some have hair some not as much.

At everyone tagged below from previous topic FUE VS FUT, thought it would be easier to reply on this new topic, as have pics now to show you. 

 

@Rahal Hair Transplant @Z-- @mr_peanutbutter @Bucky O Hair @Vann @AlexMeister21

 

I've attached some pics that show the front, back, sides and top view. Sometimes I'll have my hair a little shorter on the back and sides but this is generally the style and length I've been using with my current head of hair. 20 years ago I would slick it up a little and style it. Would be nice to get back to those days again...

 

I'm looking to get a transplant done, all being well in the next few months. 

 

Appreciate all the help and information you all provide. 

 

Thanks so much.

 

you have never had a hair transplant before? this will be your firsT?

[ChefP]

@AlexMeister21 sorry to hear that Alex. I read an article somewhere about hiding the scar with micro dot tattoos or something like that. Is that something your able to do? Heard it works really well to bend in scars etc.

 

Dr Nakatsui is a student of H&W he trained under him for the lateral slit technique. But scalp laxity for me is an issue. 

 

I was concerned 3500-4000 FUE at once was to much harvesting. Wouldn't it make sense to split that? 

[ChefP]

@shiba1985 yes first time.

[AlexMeister21]

8 minutes ago, ChefP said:

@AlexMeister21 sorry to hear that Alex. I read an article somewhere about hiding the scar with micro dot tattoos or something like that. Is that something your able to do? Heard it works really well to bend in scars etc.

 

Dr Nakatsui is a student of H&W he trained under him for the lateral slit technique. But scalp laxity for me is an issue. 

 

I was concerned 3500-4000 FUE at once was to much harvesting. Wouldn't it make sense to split that? 

For my case, SMP would help but my scar would still likely be an issue since it's so wide. I recently had beard grafts put into it, but I am still expecting the scar to be a problem. If you have a good scar from H&W or another doc, then you can get SMP and camouflage it pretty well. However, you would have to redo your SMP after every four years or so since the ink is not permanent and fades within time. Of course, if you're willing to keep your hair at the length it is now, then you wouldn't need to get SMP.

3,500 - 4,000 is possible for one session of FUE, but yes it is a bit much and would probably be better to split. There are great FUE docs like Mwamba, Freitas, Couto, etc. You also seem like you can grow a beard as well and those can act as backup grafts if you need them. But if you are fine with keeping your hair at a certain length and want some extra grafts, then FUT is fine as well.

[ChefP]

@AlexMeister21 where did you get beard grafts put in? I do have a full beard and wonder if that can be potential donor hair down the road? 

I think i'm booking in for FUE and if I can swing it financially i'll do 3500-4000 grafts at once if not then just do 1500-2000 first. 

 

I"ll look at those docs you mentioned also.  

[mr_peanutbutter]

if you have good scalp laxity id go with fut

contact hattingen in switzerland

[ChefP]

@mr_peanutbutter been told it's not enough laxity and have to do those stretching exercises....

[AlexMeister21]

On 5/31/2023 at 12:37 PM, ChefP said:

@AlexMeister21 where did you get beard grafts put in? I do have a full beard and wonder if that can be potential donor hair down the road? 

I think i'm booking in for FUE and if I can swing it financially i'll do 3500-4000 grafts at once if not then just do 1500-2000 first. 

 

I"ll look at those docs you mentioned also.  

I got beard grafts put into an FUT scar. If you have a full beard, then you could probably get an extra 2,000-4,000 grafts from there .

Edited June 1, 2023 by AlexMeister21

[A_4_Archan]

If you are sure that you would keep the same length on back than you can consider fut...i think it can give advantage of around 1k-1.5k grafts...if your donor is dense and if lifetime availability is around 7k than i think fue would be fine..actually i was also confused between this two...bt i keep my hair very short at the back so i have chosen fue..you can go for h&w or hattingen for FUT...

This days surgeons like zarev,pittela ,Eugenix are handling high nw cases with only fue very well..you may check them out...

[ChefP]

So A little update for this post. I'm going forward with FUE. 

Have spoken with some additional clinics:

Eugenix
Dr Freitas. 

Both recommend 3000 grafts. Dr Freitas does not have availability until Nov 2024. Am speaking with Eugenix now going over their packages. 

There seems to be a lot of positive outcomes and cases for Eugenix so I am hopefully there. I'm also taking oral Finasteride 5mg a week split up. So that should help the crown. 

So that's all for now and appreciate any advice anyone has on these 2 clinics. 

All the best. @A_4_Archan @AlexMeister21 @mr_peanutbutter @Bucky O Hair @Vann @shiba1985 @Hazy

[A_4_Archan]

@ChefP Yeh eugenix is good and you can go with package in which dr arika bansal or dr das does the incisions ..both have produced very good results. And if budget is a non issue thn ofcourse sethi is the best...but i would say if you are just choosing them because of the date availability issue with de freitas than you are doing wrong thing..

Never let this waiting period/your convenience be a factor in choosing your surgeon ...this is a lifetime procedure and you have to go with one you like the most...and with the one whom you most comfortable with....

Good that you are on medication and if you react well and tolerate it well than you will surely gonna get benefits of it on crown...and the main benefit will be that it will help in slowing down or halting your baldness progression ...plus you can add topical minoxidil to your regime as of now if you wish to....

[ChefP]

@A_4_Archan thanks for the advice. I understand it's a lifetime decision but if you're going to have multiple procedures over your lifetime when do you start? Are you saying Dr Freitas is the better choice? Am confused a little.

I'm taking topical minoxidil with finasteride in the formulation the last couple of months. I think it's to early to make a full assessment of results.

Kibd regards

[A_4_Archan]

2 minutes ago, ChefP said:

@A_4_Archan thanks for the advice. I understand it's a lifetime decision but if you're going to have multiple procedures over your lifetime when do you start? Are you saying Dr Freitas is the better choice? Am confused a little.

I'm taking topical minoxidil with finasteride in the formulation the last couple of months. I think it's to early to make a full assessment of results.

Kibd regards

Yeh you can start now and your age infact is one of the prime factor to make you a good candidate of HT..but am just saying that you have been handling your situation since so long and waiting for a bit more for a doctor you like the most isn't gonna be any issue...so i would say keel aside the date issue and just select one on basis of whose work you like the most..as i said earlier eugenix is good and you can go with them but if you liked de freitas more and just turning him down as you need to wait a bit long than don't do that and wait for him....

If you ask me i would say both are good and i just tend to like de freitas a bit more due to the hairline work which he has almost mastered.....though you won't go wrong with either of them so look at more and more results from both of them ...they both have published so many results and you will got so many patient posted results on both ..look at them and than go with the one whose results you like and not me or other people like....this things are subjective and you may get two opinions abt it so better choose your favorite one rather than choosing mine or someone else's favorite one...😊

 

[ChefP]

@A_4_Archanoh right that makes sense. Gotcha. Ok yeah for sure im going through all the transplants that have been posted on this site by both Dr's/clinics.

Lots to read and digest. In the end for sure I'll go with the one that seems right for me. Thanks man.

[A_4_Archan]

28 minutes ago, ChefP said:

@A_4_Archanoh right that makes sense. Gotcha. Ok yeah for sure im going through all the transplants that have been posted on this site by both Dr's/clinics.

Lots to read and digest. In the end for sure I'll go with the one that seems right for me. Thanks man.

Thts better...you welcome brother and best of luck and keep updating ...

[AlexMeister21]

10 hours ago, ChefP said:

So A little update for this post. I'm going forward with FUE. 

Have spoken with some additional clinics:

Eugenix
Dr Freitas. 

Both recommend 3000 grafts. Dr Freitas does not have availability until Nov 2024. Am speaking with Eugenix now going over their packages. 

There seems to be a lot of positive outcomes and cases for Eugenix so I am hopefully there. I'm also taking oral Finasteride 5mg a week split up. So that should help the crown. 

So that's all for now and appreciate any advice anyone has on these 2 clinics. 

All the best. @A_4_Archan @AlexMeister21 @mr_peanutbutter @Bucky O Hair @Vann @shiba1985 @Hazy

Nice. I personally prefer Freitas as I think he's a very good surgeon and a safe bet.