Revisiting the Hair Transplant question/decision after coasting along for over a decade using Toppik

[WhamHair]

Hello All,

So it has been over a decade since I’ve been on this forum. I am headed towards being a NW5. I used to be a regular on this forum in my late 20s as I battled the crippling loss of self-confidence that came from balding in my crown area (but my hairline seemed quite OK – I am actually quite OK with it now too). I discovered Toppik on here and it worked on my crown area. I did not think it would get me by for almost 11 or 12 years but I am at the point to where I think it is running its course in terms of being an effective concealer and the serious decision of getting a Hair Transplant cannot be put off anymore. These days all it takes is the wind or wearing my bike helmet and the gaps in my crown show. I am paranoid about unsavory changes in weather or people leaving the windows open while driving on the freeway. Each container of Toppik no longer lasts for a month like it used to. It’s a shame that this is an issue because with Toppik, I do look younger than I actually am – but there is a part of me that feels like I am being incredibly deceptive due to the use of Toppik. I have attached some photos to give you a sense of what my head looks like with and without Toppik (only one of the photos is a glimse of what my hair looks like with Toppik). For context, I am close to 42 years old now. 

Prior to using Toppik as my cosmetic crutch, I did do an in-person consultation at Dr Konior’s office. I did not meet Dr Konior. I only met his assistant. Since I was in my late 20s at the time, they did not seem too keen on jumping the gun with the surgery – especially since there were signs that my hair loss had not stabilized. I totally respected their decision. I was uncomfortable by Dr Konior’s assistant insisting that I would have to take Propecia to minimize shock loss. I’d rather have a bald head than risk some of the unsavory side-effects of Propecia (that in worst case scenarios can be long-term) – especially since I have had testosterone issues even without using any of this.

While I think I’d be happy with a better hairline, it doesn’t bother me nearly as much as the gigantic sinkhole that is my crown area. As you can see, there is very little hair on it. Even if I get half of that covered, I would be ecstatic. Now I realize that in general, hair surgeons prefer working on the hairline first and then the crown via a subsequent surgery.

In view of the above, my questions are as follows:

a.       Have any of you started with the crown and have had success with that approach?

b.       I see many folks that have pointed out Eugenix. They seem to have locations in both Mumbai and Gurgaon. Are the standards of work comparable in both locations?

c.       Did any of you get by doing this without shaving your head completely?

d.       Did any NW5 folks on here have any success without the use of Propecia?

e.       I checked out the following link for hair surgeons: https://hairlosslearningcenter.org/coalition-physicians . Are these the only recommended surgeons. I remember Radha Rani used to be highly recommended and she did not show up in this list. Any reason why?

f.        For those of you using Toppik as a concealer, did you have to stop using it for a while after having  your hair surgery?

 

Any input with regards to the above would be super helpful. Thank you in advance!

Edited September 4, 2023 by WhamHair

[Gatsby]

Can you share pics with your scalp unhidden by your comb over? It's just so we can see exactly what is going on and to give you the best advice. 👍

[WhamHair]

4 hours ago, Gatsby said:

Can you share pics with your scalp unhidden by your comb over? It's just so we can see exactly what is going on and to give you the best advice. 👍

Photo 2 is without the combover but if you would like another one without it, I can upload it here. Not an issue. Thanks so much!

[Turkhair]

Without medication, it’s just a recipe for disaster. Finasteride doesn’t have any long term sides, it’s just an internet myth.  

Your donor looks good and your loss isn’t that far gone yet. 

Good luck 

[hairman22]

29 minutes ago, Turkhair said:

Without medication, it’s just a recipe for disaster. Finasteride doesn’t have any long term sides, it’s just an internet myth.  

Your donor looks good and your loss isn’t that far gone yet. 

Good luck 

Yes it can have long term side affects for some people.

I have met a few in real life & had some issues myself 6 years off the drug. Its a small minority but honestly you shouldnt speak on the drug as you are unable to be subjective about it and you are not that informed on the topic

I really dont know why people who are are lucky to have no side affects are so defensive & just dismiss anyone with side affects.

Everyone's body is different & they can react differently to any drugs in general

[hairman22]

You need a big budget. Because you can get a good result donor seems decent but you need alot of grafts & an excellent doctor.

Zarev,Sethi or Pittella as they are the only 3 who can extract the grafts needed with seems like it would be at least 7k maybe more but we all dont know your hair thickness so just a guess.

 

[Turkhair]

1 minute ago, hairman22 said:

Yes it can have long term side affects for some people.

I have met a few in real life & had some issues myself 6 years off the drug. Its a small minority but honestly you shouldnt speak on the drug as you are unable to be subjective about it and you are not that informed on the topic

I really dont know why people who are are lucky to have no side affects are so defensive & just dismiss anyone with side affects.

Everyone's body is different & they can react differently to any drugs in general

You’re reading things from my post that haven’t been said 

 

[WhamHair]

2 hours ago, Turkhair said:

Without medication, it’s just a recipe for disaster. Finasteride doesn’t have any long term sides, it’s just an internet myth.  

Your donor looks good and your loss isn’t that far gone yet. 

Good luck 

honestly, I am willing to have a less-than-ideal transplant instead of taking on any risks associated wit Propecia. I realize what a gamble that is but it's the preferable gamble for me. I appreciate the comment on the donor. I agree that the loss at least in the front is not terrible but the crown really is pretty bad - which makes me wonder if any doctor would touch the crown first.

[WhamHair]

1 hour ago, hairman22 said:

You need a big budget. Because you can get a good result donor seems decent but you need alot of grafts & an excellent doctor.

Zarev,Sethi or Pittella as they are the only 3 who can extract the grafts needed with seems like it would be at least 7k maybe more but we all dont know your hair thickness so just a guess.

 

I guess the question here is whether any of these would start with the crown. Of course, in an ideal world, I would love full coverage but honestly, even if I can get half that crown covered, and use Toppik for the rest, I'd consider that a win at this point. 

[A_4_Archan]

@WhamHair

As you are reluctant to take finasteride which i think is your personal decision and i appreciate this because you are willing to accept nature's call than to induce drugs in body which unfortunately many of us aren't strong enough to accept 

Finasteride ofcourse can help to slow down ,stop or reverse hairloss but even without that its not that everyone will surely get fully bald...evryone is destined to be at a certain NW grade...there are so many people who are nw3 stays same thought their life and there are many who keep on loosing and get to nw7...so no one can say if you are surely going to loose whatever you have or not....

Now generally frontal part is given more importance because its the part which will frame you face well plus its most noticeable when people interact with you or you see yourself in the mirror....

So when you go for a HT for your crown you should look for low density work and even use beard/body grafts to cut down the scalp donor grafts and this way you can preserve more scalp donor grafts for fufure if you loose hairs on your frontal part....

I have seen one such approach from HDC clinic where they did crown work first... @Doron Harati can show you this 

[Bhumik Shah MD]

In my opinion your goal to address the crown and not the hairline is very reasonable. Your expectations also seem to be in line with your situation. 

At 42 you have lost majority of what you are going to lose. You are still going to continue to lose some more hair over the next 2-3 decades, if you don't take finasteride, but most likely it will be a small percent. Planning something conservative will keep you looking natural as you age. 

You should be able to use toppik 2-3 weeks after a transplant without any issues. You will have to discontinue using it temporarily while the surgical wounds heal. 

If you don't want to shave, you should consider FUT. You would be a good candidate for it, as long as you are ok with a scar. 

[Turkhair]

1 hour ago, WhamHair said:

honestly, I am willing to have a less-than-ideal transplant instead of taking on any risks associated wit Propecia. I realize what a gamble that is but it's the preferable gamble for me. I appreciate the comment on the donor. I agree that the loss at least in the front is not terrible but the crown really is pretty bad - which makes me wonder if any doctor would touch the crown first.

Doctors will do what you tell them to do. The reason others have front/midscalp done first is because the best grafts are used there. But if you instruct your doctor you only want crown he will only do crown or start with crown first. 

[WhamHair]

3 hours ago, A_4_Archan said:

@WhamHair

As you are reluctant to take finasteride which i think is your personal decision and i appreciate this because you are willing to accept nature's call than to induce drugs in body which unfortunately many of us aren't strong enough to accept 

Finasteride ofcourse can help to slow down ,stop or reverse hairloss but even without that its not that everyone will surely get fully bald...evryone is destined to be at a certain NW grade...there are so many people who are nw3 stays same thought their life and there are many who keep on loosing and get to nw7...so no one can say if you are surely going to loose whatever you have or not....

Now generally frontal part is given more importance because its the part which will frame you face well plus its most noticeable when people interact with you or you see yourself in the mirror....

So when you go for a HT for your crown you should look for low density work and even use beard/body grafts to cut down the scalp donor grafts and this way you can preserve more scalp donor grafts for fufure if you loose hairs on your frontal part....

I have seen one such approach from HDC clinic where they did crown work first... @Doron Harati can show you this 

Thanks so much @A_4_Archan for the reassuring message. I agree that for the long term, the frontal section is far more important. Currently, the crown is the larger issue and as a single guy (that is trying to change this aspect of my life), the sparseness in my crown is a huge hit to my self-confidence and my reliance on Toppik is excessive to this end. Honestly, until yesterday, I did not even know beard/body grafts were an option. Had I known this earlier, I would not have gone through 5 rounds of laser hair removal from my back. I didn't even think this was an option. It most certainly wasn't 10 years ago - which is the last time I was on this forum until this past weekend. I think the low-density approach for the crown makes sense because I do foresee a scenario in which I need a hairline job in the future unless something miraculous happens and it stays as it is. Honestly, even what I have right now is a miracle considering that I started visibility losing hair at the age of 26 - almost 16 years ago. Friends of mine that started at the same place that I did are completely bald so I am actually quite grateful for what I have right now under the circumstances. Will definitely reach out to @Doron Harati for a perspective on this. Thanks once again for the super supportive message! 

[WhamHair]

2 hours ago, Bhumik Shah MD said:

In my opinion your goal to address the crown and not the hairline is very reasonable. Your expectations also seem to be in line with your situation. 

At 42 you have lost majority of what you are going to lose. You are still going to continue to lose some more hair over the next 2-3 decades, if you don't take finasteride, but most likely it will be a small percent. Planning something conservative will keep you looking natural as you age. 

You should be able to use toppik 2-3 weeks after a transplant without any issues. You will have to discontinue using it temporarily while the surgical wounds heal. 

If you don't want to shave, you should consider FUT. You would be a good candidate for it, as long as you are ok with a scar. 

It feels super validating to hear this. Thank you so much. My hair loss pattern is somewhat of a miracle given that I started visibility losing hair at 26.  Most friends of mine that started at the same place have far less hair than I do. Honestly, hair loss affects me more now than I think it will 2-3 decades down the line. But then again, I do believe that it makes sense to look at the long-term when planning this. Good to know that I can use toppik 2-3 weeks after a transplant. I don't mind shaving. I just want to understand the trade-offs of shaving versus not. Obviously, I would prefer a minimal scar. I also need to give myself a refresher on the difference between FUT and FUE. It's been ages since I've had to look at that. Once again, thank you so much for the message.

[WhamHair]

2 hours ago, Turkhair said:

Doctors will do what you tell them to do. The reason others have front/midscalp done first is because the best grafts are used there. But if you instruct your doctor you only want crown he will only do crown or start with crown first. 

I wouldn't mind a little done for my hairline but yes, I would like to improve the coverage in my crown area since it takes very little (e.g. wind, water etc.) to mess up what felt like an iron-clad concealer strategy with Toppik until recently.  This is helpful though. Thanks so much. 

[WhamHair]

I was also wondering if someone could help me with regards to the recommended surgeons. Are they just the ones listed in the link that I referenced in my original post or are there others. I remember Dr Radha Rani being somewhat of a big deal 10 years ago but I don't see her showing up in this list. I am curious as to why. Any input here would be super helpful. Thank you once again! 

[GoliGoliGoli]

I got crown work exclusively for my first and so far only HT. I am also not on finasteride.

If you're going to go the non-fin route, I think it's fine as long as you have a very strong donor and enough money to spend on future HT's. The thing about crown work though is that unless you have a ton of 3/4 hair grafts density will probably be fairly sparse so you need to go into it with proper expectations of what can be achieved in a single session. You also have quite a large spot to cover (Probably like 3 or 4 times the spot I had to cover). You're a fairly difficult case I think it's fair to say. 

Two good videos below on the topic. 

 

[WhamHair]

5 minutes ago, GoliGoliGoli said:

I got crown work exclusively for my first and so far only HT. I am also not on finasteride.

If you're going to go the non-fin route, I think it's fine as long as you have a very strong donor and enough money to spend on future HT's. The thing about crown work though is that unless you have a ton of 3/4 hair grafts density will probably be fairly sparse so you need to go into it with proper expectations of what can be achieved in a single session. You also have quite a large spot to cover (Probably like 3 or 4 times the spot I had to cover). You're a fairly difficult case I think it's fair to say. 

Two good videos below on the topic. 

 

Thank you so much for this. I don't even mind if the entire crown is not covered. Even if half can be covered, I'd consider that a massive win at this point. I have taken it for granted that I will require multiple transplants - 2 at a bare minimum and that is OK. As for the 3/4 hair graft density, that is something the hair surgeon should be able to assess during a consultation right?

[GoliGoliGoli]

2 minutes ago, WhamHair said:

Thank you so much for this. I don't even mind if the entire crown is not covered. Even if half can be covered, I'd consider that a massive win at this point. I have taken it for granted that I will require multiple transplants - 2 at a bare minimum and that is OK. As for the 3/4 hair graft density, that is something the hair surgeon should be able to assess during a consultation right?

Yea they'll be able to assess that during consult. 

It sounds like you've got proper expectations which is really the main thing. If you're fine with a sparse crown that will actually be good because it will help alleviate any concerns of you developing a "bullseye" pattern as your loss continues. Basically further loss will just cause a diffuse look across the whole area, not a super dense bullseye  surrounded by a "moat" of baldness. 

[WhamHair]

2 minutes ago, GoliGoliGoli said:

Yea they'll be able to assess that during consult. 

It sounds like you've got proper expectations which is really the main thing. If you're fine with a sparse crown that will actually be good because it will help alleviate any concerns of you developing a "bullseye" pattern as your loss continues. Basically further loss will just cause a diffuse look across the whole area, not a super dense bullseye  surrounded by a "moat" of baldness. 

Thanks a ton. I think I have a sparse crown now and all I'd like is that the area of that sparseness be decreased by 50%. Because for the long run, the hairline bit is far more important. The ultimate victory for me would be keeping the hairline I have now with a smaller area of crown sparseness. Anything above this is just icing on the cake! 

[jjalay]

On 9/4/2023 at 4:22 AM, WhamHair said:

Hello All,

So it has been over a decade since I’ve been on this forum. I am headed towards being a NW5. I used to be a regular on this forum in my late 20s as I battled the crippling loss of self-confidence that came from balding in my crown area (but my hairline seemed quite OK – I am actually quite OK with it now too). I discovered Toppik on here and it worked on my crown area. I did not think it would get me by for almost 11 or 12 years but I am at the point to where I think it is running its course in terms of being an effective concealer and the serious decision of getting a Hair Transplant cannot be put off anymore. These days all it takes is the wind or wearing my bike helmet and the gaps in my crown show. I am paranoid about unsavory changes in weather or people leaving the windows open while driving on the freeway. Each container of Toppik no longer lasts for a month like it used to. It’s a shame that this is an issue because with Toppik, I do look younger than I actually am – but there is a part of me that feels like I am being incredibly deceptive due to the use of Toppik. I have attached some photos to give you a sense of what my head looks like with and without Toppik (only one of the photos is a glimse of what my hair looks like with Toppik). For context, I am close to 42 years old now. 

Prior to using Toppik as my cosmetic crutch, I did do an in-person consultation at Dr Konior’s office. I did not meet Dr Konior. I only met his assistant. Since I was in my late 20s at the time, they did not seem too keen on jumping the gun with the surgery – especially since there were signs that my hair loss had not stabilized. I totally respected their decision. I was uncomfortable by Dr Konior’s assistant insisting that I would have to take Propecia to minimize shock loss. I’d rather have a bald head than risk some of the unsavory side-effects of Propecia (that in worst case scenarios can be long-term) – especially since I have had testosterone issues even without using any of this.

While I think I’d be happy with a better hairline, it doesn’t bother me nearly as much as the gigantic sinkhole that is my crown area. As you can see, there is very little hair on it. Even if I get half of that covered, I would be ecstatic. Now I realize that in general, hair surgeons prefer working on the hairline first and then the crown via a subsequent surgery.

In view of the above, my questions are as follows:

a.       Have any of you started with the crown and have had success with that approach?

b.       I see many folks that have pointed out Eugenix. They seem to have locations in both Mumbai and Gurgaon. Are the standards of work comparable in both locations?

c.       Did any of you get by doing this without shaving your head completely?

d.       Did any NW5 folks on here have any success without the use of Propecia?

e.       I checked out the following link for hair surgeons: https://hairlosslearningcenter.org/coalition-physicians . Are these the only recommended surgeons. I remember Radha Rani used to be highly recommended and she did not show up in this list. Any reason why?

f.        For those of you using Toppik as a concealer, did you have to stop using it for a while after having  your hair surgery?

 

Any input with regards to the above would be super helpful. Thank you in advance!

Can you post some pictures of the donor area too? You seem to have thick hair but from these pictures it"s really hard to tell.

[WhamHair]

2 hours ago, jjalay said:

Can you post some pictures of the donor area too? You seem to have thick hair but from these pictures it"s really hard to tell.

For sure. I'll have this posted in about a day or so. I need to do a whole updated set of photos anyway for these hair surgeons. Been a little derailed this week because I had to get two root canal procedures done - but yes, I'll have this posted by tomorrow at the latest. 

[asterix0]

Your hairline will soon disappear as well without medication, I would say probably in the next 5 years if I had to guess. 

You will need to budget a lot of money to do this properly, of course you can roll the dice at a low cost clinic, but considering how many grafts you need, I would advise you not to do this.

The problem is, the clinics you need to go to will have at least a year long waiting list.

[WhamHair]

9 minutes ago, asterix0 said:

Your hairline will soon disappear as well without medication, I would say probably in the next 5 years if I had to guess. 

You will need to budget a lot of money to do this properly, of course you can roll the dice at a low cost clinic, but considering how many grafts you need, I would advise you not to do this.

The problem is, the clinics you need to go to will have at least a year long waiting list.

I would rather spend more and do it properly given that the donor supply is finite. I have definitely factored in a long waiting list - which is why I am trying to lock down a strategy in the next couple of months. That way, I am not starting this process when it becomes urgent. 

[WhamHair]

2 hours ago, asterix0 said:

Your hairline will soon disappear as well without medication, I would say probably in the next 5 years if I had to guess. 

You will need to budget a lot of money to do this properly, of course you can roll the dice at a low cost clinic, but considering how many grafts you need, I would advise you not to do this.

The problem is, the clinics you need to go to will have at least a year long waiting list.

Not sure if this counts but I did take some homeopathic meds many years ago. Not sure what that does but I honestly didn't think I would have the hairline I do at this point. Cannot confirm if there is any correlation here at all.