Looking for Opinions Based on the Feedback I got for a HT

[baam14]

Hey guys, I’ve been lurking on this forum for a few months, doing my research to get a better idea of what to expect and what to look for in a doctor/clinic. I’m a Norwood 4/5, started off losing hair in the crown before getting decreased density in the frontal area. I’ve been on minoxidil for about four and a half years, started taking fin in February, as well as starting PRP treatments that month, and continuing with it bimonthly at the moment. It’s during this time I’ve reached out to these forum recommended doctors with my pictures while I was in my shedding phase. I’ve seen appreciably improvements in density personally and in the pics taken at the clinic I got for PRP treatments.

I’ve shot out a consultation form for about 15 - 20 doctors and I’m looking for some input from the feedback I’ve received for the course of action.

Dr. Bicer – Will need 4000 grafts, starting from the hairline and working back. Most likely will need a second procedure but will reevaluate a year after the first.

Dr. Camacho – Will need two procedures. Can do 3000 grafts for either the front area or the crown and wait a year to see how the donor recovers before deciding how much to do for the other area of focus

Dr. Turan – He recommended I be on medication for 9 – 12 months to see the full effect before evaluating my case. I will be in touch with his assistant in November to see what he says then.

Eugenix – Will need 2000 – 2200 for the front, 1700 for the crown

Dr. Devroye – Will need 1000 – 1500 for the front, 2000 for the crown

Dr. De Freitas – Will need 3000 for the front during the first procedure, a lesser amount though unspecified for the crown in a second procedure

Dr. Laorwong – Will need 2000 in the front, 2000 in the crown, can do in one procedure.

Dr. Pathomvanich – 2000 in the front, 2000 in the crown. Recommended a blend of FUE and FUT ( FUE 1500 – 2000 grafts, FUT 2000 – 2500 grafts)

Dr. Nader – He was unsure if I would be a good candidate for a transplant based on my pictures and recommended I go see a hair clinic in my city (Toronto) and report to him what they say. This led me to get an evaluation by Dr. Rahal’s team.

Dr. Rahal – His assistant is the only one on this list that saw me in person so I put more weight on his assessment. Keep in mind I saw him in April when I was just starting to turn the page on my shedding phase so take that as you will. His assistant did think I was a good candidate for a transplant. There were a few points he made to emphasize the point, though by now I’ve mostly forgotten the details for the bigger picture. He mentioned if I had a pronounced dip from the back of the crown then that would have been a sign this procedure may not produce the results I want long term. Either way, he said if I wasn’t a good candidate he would have rejected me as they wouldn’t want a poor result advertised from his clinic.

He noted my donor was on the thinner side in terms of individual hair thickness, with a sample from the back he took measuring at 49 microns. Now based on the follicular level pictures I’ve had taken at the PRP clinic I go to, I know my donor hairs have a wide array of thickness, so I want to believe he just sampled a thinner hair, but I’m likely average thickness at best. In his assessment he said I’d need to do two procedures. In the first we could do 3000 grafts for the front, and in the second a year later do 2000 – 2500 grafts for the crown.

There were a few other doctors who responded though I got a sketchy feeling or the responses were too far apart for me to feel like I could effectively organize a procedure with them. There were others who I have yet to hear back altogether.

My shortlist from who I’ve heard back from is Nader, Turan, Camacho and Laorwong. I chose these four because I like their work, consistency of results and they’re mid tier in terms of pricing. While price is not really an obstacle here and I’m willing to pay for a quality surgeon, a $20k+ transplant from the recommended list looks to be very similar quality as one I can find for half the price, so personally I think doctors who charge that much are excessive.

Nader would be my number 1 but ever since his response to my consultation form he hasn’t replied to any of my emails and I’ve sent several, one every week or so. I don’t want to make a final decision until I hear back from Turan, and I don’t mind waiting, especially as I want the medication to take full effect. I don’t plan on doing this until the first half of next year, though I’m open to waiting longer if it’s necessary.

Since my visit to Dr. Rahal’s clinic I’ve settled with the idea of needing two procedures to have the best results. However Dr. Laorwong’s proposal of doing it in one is very attractive to me, although I don’t mind splitting it in two procedures a year apart either if it’s what’s best for me.

Do you guys believe it’s possible, either in one session or spread on in two sessions in two consecutive days, and still get great results?

Let me know what you guys think may be the best course given my case, if you recommend a specific doctor or anything else you think may be important for me to know.

Thanks for taking the time read through this.

Cheers

[Rahal Hair Transplant]

@baam14,

I think it’s good that you’re doing your research and speaking to several physicians you are impressed with to garner their input in terms of what they think is best for your situation. As a representative of Dr. Rahal, an educated patient and from someone who’s been in the field for over 15 years, I am inclined to agree that a two session pass would likely be ideal for your case.

Now, clearly I don’t have all of the information about your case but having worked with Dr. Rahal in someway for the 15 years I’ve been in the profession, I have complete faith in his assessments and doing what’s best for each patient individually.

Furthermore, you did state that you only just started finasteride in February so I think it’s probably good to spread things out while you give finasteride a chance to reach its full level of efficacy. That way, you can minimize the potential of permanent shock loss to any miniaturizing hairs that may actually thicken and become terminal by using finasteride.

At the end of the day, you have to determine what’s best for you.  But one thing that has always impressed me about Dr. Rahal is that he takes his time to tailor a custom hair restoration plan that benefits each patient over the long term and not just immediately.  I’m sure you like the idea of getting everything done at once. But keep in mind, the best hair transplant procedures and hair restoration plans take into consideration all risks and work to remediate and minimize as many of them as possible in conjunction with the physicians/clinics skill and experience.

I hope this helps.

Rahal Hair Transplant 

 

[A_4_Archan]

@baam14I guess something around 2k grafts would be fine if you go for a conservative hairline ...so number of grafts depends on that plus your hair thickness and the size of area to be covered...i had a surgery with dr laorwong and i had 3611 in one session...am just at 2 and half month post op so can't tell you about the results but donor area is completely healed and it is now same as it was before surgery and there are lots of baby hairs all over the transplanted area so i think they will all grow soon...you can check out journey of @Jamos1982  he has a surgery of more than 4k grafts in one session and his growth is awesome at 5 months

[Bucky O Hair]

Yea, you're always going to get a wide array of estimates between doctors.

Depending on size of your head (area of baldness being treated), it's usually a safe bet that the front half will always need around 3,000 grafts and another similar amount in the crown.   Obviously this changes based on how much native hair (and you seem to have quite a bit left), so you will need less hairs to be transplanted.

But it's always good to plan for the worst case scenario, and ask yourself the "WHAT IF" questions...like what if my hair continues to fall out and I become a NW6/7 patient.

 

Some other questions to think about...

1. - Did you find out how many estimated "lifetime grafts" you have in your donor?  Will you be able to have extract 6,000 (or more) grafts in your life for future transplants?

2. - Are you prepared to get more than two hair transplants in your life?  (in case your hairloss doesn't stabilize and you have to chase the loss) 

3. - Are you comfortable wearing your head buzzed down in case any future loss makes it look too thin to wear it grown out?

 

You're doing good research.  You seemed to have done the most important work already.  

So long as you have a Plan B in case the drugs don't work that well and you continue to lose native hairs. 

 

[baam14]

7 hours ago, A_4_Archan said:

@baam14Iguesssomethingaround 2kgraftswouldbefineifyougoforaconservativehairline ...sonumberofgraftsdependsonthatplusyourhairthicknessandthesizeofareatobecovered...ihadasurgerywithdrlaorwongandihad 3611 inonesession...amjustat 2 andhalfmonthpostopsocan'ttellyouabouttheresultsbutdonorareaiscompletelyhealedanditisnowsameasitwasbeforesurgeryandtherearelotsofbabyhairsalloverthetransplantedareasoithinktheywillallgrowsoon...youcancheckoutjourneyof@Jamos1982  hehasasurgeryofmorethan 4kgraftsinonesessionandhisgrowthisawesomeat 5 months

@A_4_Archan All I'm looking for is to maintain the hairline I've got, more or less. My right side is more receded than my left, and I just want my left side mirrored onto the right. So technically lowering but not a significant amount. I've been following your journey and it's looking good so far. It's a lot of grafts you had done and still more to do. Did you ever consider doing an FUT or a blend of FUT/FUE to maximize the number of grafts you could use in a lifetime?

And @Jamos1982 does have impressive results. I'll be looking more into his journey and others who do these large sessions

Edited July 13, 2023 by baam14

[baam14]

6 hours ago, Bucky O Hair said:

Yea, you'realwaysgoingtogetawidearrayofestimatesbetweendoctors.

Dependingonsizeofyourhead (areaofbaldnessbeingtreated), it'susuallyasafebetthatthefronthalfwillalwaysneedaround 3,000 graftsandanothersimilaramountinthecrown.   Obviouslythischangesbasedonhowmuchnativehair (andyouseemtohavequiteabitleft), soyouwillneedlesshairstobetransplanted.

Butit'salwaysgoodtoplanfortheworstcasescenario, andaskyourselfthe "WHATIF" questions...likewhatifmyhaircontinuestofalloutandIbecomeaNW6/7 patient.

 

Some other questions to think about...

1. - Didyoufindouthowmanyestimated "lifetimegrafts" youhaveinyourdonor?  Willyoubeabletohaveextract 6,000 (ormore) graftsinyourlifeforfuturetransplants?

2. - Areyoupreparedtogetmorethantwohairtransplantsinyourlife?  (incaseyourhairlossdoesn'tstabilizeandyouhavetochasetheloss) 

3. - Areyoucomfortablewearingyourheadbuzzeddownincaseanyfuturelossmakesitlooktoothintowearitgrownout?

 

You'redoinggoodresearch.  Youseemedtohavedonethemostimportantworkalready.  

SolongasyouhaveaPlanBincasethedrugsdon'tworkthatwellandyoucontinuetolosenativehairs. 

 

@Bucky O Hair To answer your other points:

1. I've bee given an estimate of 21,400 overall donor grafts, and told that no more than a third should be taken to avoid overharvesting, so 7,133 lifetime grafts.

2. It looks like I need two just to doing the work that's required, and I'd still have a decent amount to do a touch up in the future. Also, I'm open to doing body hair grafts, and any beard grafts from my neck. I'm keeping Eugenix and other clinics that do BHT in my back pocket for that

3. I'm 30 now, and honestly if this keeps me with a full head of hair for another 15 - 20 years I can live with buzzing my hair or shaving and doing SMP if my hair is too far gone at that stage in my life. I just want to look young while I'm still relatively young. I"ll blast myself with whatever medication I can find and tolerate to achieve that goal

Given what I'm working with in terms of my age and estimated lifetime grafts, do you think an FUT or a blend of FUT/FUE would be a better bet for long term success?

Edited July 13, 2023 by baam14

[NikosHair]

• Wait a full year on Fin.
• Assess if you have made or lost ground.
• If your meds have not improved your condition, consider increasing the dose and including Dut. (I would bring in the big guns earlier than a year, but your call)
• Is there hair loss in the family? It's a pretty accurate predictor of your destination (unless you respond well to the meds).
• Don't fixate on graft counts/sessions (as you have seen by the range of responses, it means very little).
• Try to find cases with similar hair characteristics and independent results. 

[A_4_Archan]

@baam14 good that you don't wanna lower your hairline and just want it to be in sync with the other side ....including FUT ofcourse increase lifetime availability of grafts and i even thought about that as i know i will be short of grafts in future but i keep my hair very short on the back so i didn't go with that plus i have a plan B...if i don't achieve desired results (density) or if my native hairs keep falling than i would just do a FUE where i will spread whatever grafts available or may be over harvest a bit plus will take most of the beard grafts and spread them all around the scalp and thn do smp to make it look more dense and keep buzzed look...

If you don't keep your hairs too short on back and ready to keep them long than you can surely consider fut ...

Edited July 14, 2023 by A_4_Archan

[Bucky O Hair]

13 hours ago, baam14 said:

@Bucky O Hair To answer your other points:

1. I've bee given an estimate of 21,400 overall donor grafts, and told that no more than a third should be taken to avoid overharvesting, so 7,133 lifetime grafts.

2. It looks like I need two just to doing the work that's required, and I'd still have a decent amount to do a touch up in the future. Also, I'm open to doing body hair grafts, and any beard grafts from my neck. I'm keeping Eugenix and other clinics that do BHT in my back pocket for that

3. I'm 30 now, and honestly if this keeps me with a full head of hair for another 15 - 20 years I can live with buzzing my hair or shaving and doing SMP if my hair is too far gone at that stage in my life. I just want to look young while I'm still relatively young. I"ll blast myself with whatever medication I can find and tolerate to achieve that goal

Given what I'm working with in terms of my age and estimated lifetime grafts, do you think an FUT or a blend of FUT/FUE would be a better bet for long term success?

I'm probably the worst person here to ask about FUT since I'm very anti-FUT, ha ha.

To me, it's never worth putting a linear scar on the back of your head, simply because it will interfere with my "Plan B" of being able to buzz my head and opting out of all this if the hair becomes too thin when I am older.

FUT benefits are also very "case by case".  If you have high laxity in your scalp, then you may be able to get more grafts out of it.  My only question is..."how many more grafts?".

Will the doctor be able to tell you exactly how many more lifetime grafts FUT will get you over FUE?

and if so, is it worth putting a linear scar on the back of your head for, say, an additional 1000 lifetime grafts?  So instead of 7,000 grafts you end up getting 8,000?  (like a 15% increase in density)