Need advice on where to go from here - Repair or throw in the towel?

[ALittelTeal]

I made the mistake of getting a 1275 graft FUE "dense pack" done in December 2021. I regret not having done more research and finding this community prior, but hindsight is 20/20. The procedure was a botch job while my hair loss accelerated. (Honestly, it felt like my hair loss had stabilized when I went in for the FUE, but the procedure trauma must have kick started it again).  For context, I am 29 years old, on oral minoxidil, LLLT, ketocanozole 2%, and started microneedling once a week or every other week. I started Xyon Dutasteride and worked my way up to every other day, but decided to discontinue as I had blood labs done that showed my serum DHT had dropped 50%. I was def experiencing some mental sides, and as someone who had prior finasteride sides, decided to immediately discontinue. Unfortunately, I had to end in the midst of a VERY bad shed caused by the dut and my hair has never been worse lol. I think the sparsity is exacerbated by 1.5mm microneedling that I was doing with a Dr. Pen that had far too many blades and I went over the same areas way too many times. 

Recognizing that 5ARs are not for me, I am torn on what to do from here.  My hairline is a disaster courtesy of the prior doc. I would not like to rehash that terrible decision and instead focus on next steps. I initially had a repair lined up with Mwamba for over the summer, but put that on hold after an in-person consultation I had with Bisanga. Bisanga told me that I had thick donor supply (75-90 FU/cm2 around the sides and back), but that there was >30% miniaturization going on in the upper back donor region which gave him pause. He said to continue with medication and see if that worked before opting for another procedure. As I said, I will no longer be continuing. 

My choices as I see them are 1) Buzz my hair short, and just shave down the mis-angled, pluggy transplanted hairs to the skin when they are around the hairline/once they become unruly. Problem is that there is still some cobblestoning along the hairline. Or 2) Go for another transplant with a reputable surgeon for a repair and start the "chase". I had consultations with Nadimi, Bisanga, Mwamba, H&W, Konior, and Shapiro among others and they all landed on 1800-2250 grafts for the frontal zone. Since this dutasteride shed has done a number to my existing hair, as you can see from my pictures below, that estimate has likely only gone up by 500-1000 if none grow back. I am resigning myself to the fact that if I go the surgical route again, I am basically a guarantee for needing another 1-2 more procedures after that. There is baldness on my mother's side of the family, and my older brothers seem to have stopped at NW4s. Even if I have continued miniaturization, I still probably have 5-6k solid grafts to pull from.

In a perfect world, I will opt for Option 1 and just give up on chasing this hair dream. I look forward to a day of not thinking about it constantly, and I believe that I have more than enough other things going for me in life that I should be fine without hair. On the flip side, I won't be able to shave completely bald because of the prior FUE, and I don't quite know how bad the hairline is going to look if I run a 6-8 guard over it. Maybe it's such a disaster that going the surgical route is the logical next step.

Either way, would love to hear the input from the community.  First two pictures are from a doc visit 13 months after my FUE (Jan 2023). Last pictures are me today....you can see how badly things have deteriorated lol. For the purposes of this conversation, and my mental health, I kindly request that we keep the topic of conversation as forward looking as possible and not get wrapped up in just how bad the first FUE went. I will happily address that in private messages or perhaps another thread. In none of my consults did the docs say that my scalp was damaged, no signs of scaring alopecia, and couldn't think of a clear reason why the first FUE failed but just that it had. 

 

 

 

[duckling]

I say fight as your opponent "AGA" seems less aggressive.

you have used just little over 1k grafts. no need to worry about it. ( as you said forward looking is better)

your current situation is honestly quite good for a 29 year old. you dont seem to have aggressive AGA so you can make do without DHT meds as you have decided not to take them going forward. Oral min , ketocanazole and microneedling should help you enough . LLLT is probably not needed.

The doctors you have consulted are quite good and any of them can give you a great result. konior if you can get then maybe he can give best hairline. but others are quite good too.

look if no one in your family is norwood 4+ then it means less chance of you going there. you can make do without meds too if you reach max norwood 3,4 . you can  get additional procedures to fill in.  if you end up at norwood 5+ then it becomes tricky without meds but if you have body or beard hair to give then its fine. not ideal but fine.

Edited June 1, 2023 by duckling

[consequence]

You've already had FUE so there's probably not much harm in trying again if you are patient. Your hair isn't that bad though.

That being said, getting hair restoration requires a bit of thick skin to deal with all the ups and downs of recovery. You probably don't want to hear this, but you seem to have a little bit of psych component mixed in. Shaving your head and leaving hair restoration behind in general might give you some peace there and avoid another emotional roller coaster, it's not totally unreasonable.

[HappyMan2021]

@ALittelTeal can you clarify what the problem(s) are a bit more clearly? Maybe you can add arrows and comments to your photos as well. Right now in your photos I am just seeing "messy hair" but not explicitly seeing anything that is botched.

Who is the doctor who botched you? A repair can be anything from a 'simple' 2nd pass touch up to needing 4 or more repair surgeries. Getting botched is a very serious matter because the repair journey is super lengthy. It is rare to get a 'one and done' repair job. 

Whether you decide to pursue the repair journey depends on 1) the extent of damage 2) what your end goal is 3) your commitment to the process and 4) $$$ at your disposal

I am a repair patient myself and honestly wouldn't fault any botched person for throwing in the towel, shaving, accepting baldness, etc.

For reference, my own repair journey has spanned multiple years, multiple surgeries, excruciating patience and discipline needed, traveling across continents, over $50k spent - AND I am still not fully repaired yet 🤷‍♂️

1 hour ago, ALittelTeal said:

Recognizing that 5ARs are not for me

I am sorry to hear this. I wou;dn't advise a newcomer to get a hair transplant without being on Fin/DUT, let alone a repair patient. 

I would hate for you to have to suffer through tens of thousands of dollars, multiple repair surgeries just for your native hair to fall out. 

Edited June 1, 2023 by HappyMan2021

[consequence]

9 minutes ago, HappyMan2021 said:

I am sorry to hear this. I wou;dn't advise a newcomer to get a hair transplant without being on Fin/DUT, let alone a repair patient. 

This is a good point. Maybe to put it differently, it's probably not a good idea to get a transplant until your hair loss has stabilized for some time and this is less common unless you're on fin/dut. Like buying the lowest water front apartment in Venice -- there's a good chance your investment is going to get flooded.

[ALittelTeal]

My fear is that as my hair loss progresses, the few transplanted hairs that did take and are difficult to style will standout much more and it will be obvious that I had a crappy FUE done. 

 

The below photo is from July 2022, 7 months post FUE

 

The next two from November 2022 show how thin the hairline is a little more clearly 

 

[ALittelTeal]

6 minutes ago, consequence said:

This is a good point. Maybe to put it differently, it's probably not a good idea to get a transplant until your hair loss has stabilized for some time and this is less common unless you're on fin/dut. Like buying the lowest water front apartment in Venice -- there's a good chance your investment is going to get flooded.

Yeah, I am aware of the fact that it's going to progress and why I referred to it as a "chase". My initial thought was that I could really pack the front with a proper FUE, and then as the thinning progresses behind it I would do another procedure when fibers no long do the trick. My hairline is so thin now that fibers don't work. 

If and when my crown goes, my thought was I could either 1) live with that 2) hair system or 3) Maybe have a few hundred hairs left to transplant. I can grow very, very thick facial hair. 

[ALittelTeal]

22 minutes ago, HappyMan2021 said:

@ALittelTeal can you clarify what the problem(s) are a bit more clearly? Maybe you can add arrows and comments to your photos as well. Right now in your photos I am just seeing "messy hair" but not explicitly seeing anything that is botched.

Who is the doctor who botched you? A repair can be anything from a 'simple' 2nd pass touch up to needing 4 or more repair surgeries. Getting botched is a very serious matter because the repair journey is super lengthy. It is rare to get a 'one and done' repair job. 

Whether you decide to pursue the repair journey depends on 1) the extent of damage 2) what your end goal is 3) your commitment to the process and 4) $$$ at your disposal

I am a repair patient myself and honestly wouldn't fault any botched person from throwing in the towel, shaving, accepting baldness, etc.

For reference, my own repair journey has spanned multiple years, multiple surgeries, excruciating patience and discipline needed, traveling across continents, over $50k spent - AND I am still not fully repaired yet 🤷‍♂️

I am sorry to hear this. I wou;dn't advise a newcomer to get a hair transplant without being on Fin/DUT, let alone a repair patient. 

I would hate for you to have to suffer through tens of thousands of dollars, multiple repair surgeries just for your native hair to fall out. 

@HappyMan2021 I would say my goal is to have a NW 2.5/3 hairline that's at least thick and can be worn in a style that exposes my hairline. 

 

How advanced was your hairloss and what about your second and third procedures still needed fixing?

[HappyMan2021]

33 minutes ago, ALittelTeal said:

How advanced was your hairloss and what about your second and third procedures still needed fixing?

I am only a NW3. But my first HT had over 1000 badly angled grafts.

How many bad angles do you have? Or is your issue really just lack of density?

If your only issue is lack of density, perhaps all you need is a 2nd pass. Im not even sure I would call lack of density to necessarily be "botched", moreso just a poor result. 

[Gatsby]

Hey @ALittelTeal. Your donor looks strong. Also I don't see your transplanted hair as bad (if at all) as you do (and I have looked quite hard) from the pics. It looks natural. However one thing I want to add is that if you have any thoughts of shaving your head or wearing a hair system down the track then I definitely would not suggest a hair transplant/s. As you say it is like 'chasing' and by that I mean like chasing a tiger by the tail and the cost of doing so (financially/psychologically) can destroy the benefits in some people. I don't know if you are one of those people. But this does not dismiss you having surgery but something to seriously consider before pulling the trigger. The best thing about a hair transplant is that it is permanent. The worst thing about a transplant is that it is permanent. You are doing all the right things asking questions and taking your time. All the best!

[baldfighter]

Doesn't look like a botch job at all. Can you post pre-op photos?

[A_4_Archan]

Doesn't look like a botched job and though its not looking that good bt it is looking average and not worst....its more of a lack of density than bad angles i guess...you have got good donor so you can go for 2nd surgery if your hairloss gets stabilise and only you can know if its stabilised or not...as you mentioned 5ar inhibitors are not for you than you need to give more time to see how aggressive your hairloss is cause if it is aggressive than you will keep on loosing native hairs and you will be chasing hairs forever...cause minoxidil will not stabilise your hairloss....so take you time...imo when someone has side effects from meds or don't wanna take meds than the best thing is to wait for more time and let the hairloss progress and let it get stable naturally so that you will know the exact situation and than plan your surgery accordingly ..and the other option is that just go for a small session and try to preserve as many grafts as you can for future loss...if the hairloss continue you can again go for a small session ...both have its downside..in one scenario you have to wait so long and in another one you may have to go through multiple surgery if hairloss continues ..and the last option is to shave it off and it may suit you and you may like that look than you be relaxed forever...so the last option is worth trying before any other option...

[RTC]

Depending on how you approach it, just know that you're in for years of  operation, ugly duckling phase, shock loss, growth, and repeat.

It's draining man. Sometimes 'good enough' is good enough and it takes discipline to stop there.

[ALittelTeal]

These are the pre-op pics (Dec '21)

 

Edited June 2, 2023 by ALittelTeal

[ALittelTeal]

And these are today. As far as the prior transplant, the yield was clearly just low. The angles as best I can tell aren’t terrible. Not perfect and still can be difficult to style along with the native hair, but that is likely to be the case with any FUE. Appreciate the comments from everyone so far, definitely goes to serve as a good reminder to me that my scrutiny of it is far higher than others

[Melvin- Admin]

I have to agree with what others have mentioned, you need to treat the hair loss first. Perhaps get back on the dutasteride and lower the frequency. You can also try CosmeRNA which doesn’t reduce DHT. You need to be on some sort of anti androgen, otherwise you’re fighting a battle without any weapons.

[mr_peanutbutter]

„My choices as I see them are 1) Buzz my hair short, and just shave down the mis-angled, pluggy transplanted hairs to the skin when they are around the hairline/once they become unruly. Problem is that there is still some cobblestoning along the hairline. Or 2) Go for another transplant with a reputable surgeon for a repair and start the "chase". I had consultations with Nadimi, Bisanga, Mwamba, H&W, Konior, and Shapiro among others and they all landed on 1800-2250 grafts for the frontal zone.“

 

since you already started id continue. since the scars and the transplanted hairs are already there you dont have the option of balding „naturally“ anyways.

[ALittelTeal]

2 minutes ago, mr_peanutbutter said:

Since you already started id continue. since the scars and the transplanted hairs are already there you dont have the option of balding „naturally“ anyways.

This is a fear of mine. On one hand, the yield on the first pass was so low that there may not be that many unruly hairs to take care of. On the other hand, there is still a little bumpiness to the skin where some of the implants happened. I know I can wear my hair as short as a 2 guard on the sides and back, but I don't know how "normal" the top of the head would look at that length and if it's something that I could manage around. Either way, it's something that I am unlikely to know until I ever just do it and get a buzzcut