Rate my plan for reversing Norwood 7.

[Med]

I’m 30 years old and starting way too late on this journey, but here I am. I have just been prescribed oral finasteride 1 mg daily (which I might take 3 times weekly to avoid side effects), oral minoxidil 2.5 mg daily, and ketoconazole 2% shampoo. I will use these for a year to induce as much regrowth as possible. Then I will go to a hair transplant surgeon who does big cases and try to get 5000-6000 grafts in one mega session, focusing on aggressive restoration of the hairline/frontal scalp (FUT vs FUE). Then, a year after that, while still on the meds, I would go for my second surgery (FUE) with a surgeon who specializes in body hair cases. I will request that my remaining donor scalp units plus as many beard and chest units as possible be used to fill in density at the crown / mid scalp. I would shoot for another 5000-6,000+ units during this second case. I would continue the meds indefinitely.

 

Some questions/concerns:

1. FUT vs FUE for the first procedure? I  understand FUT may maximize donor grafts, but I worry about the resulting scar.

2. Are there good surgeons out there who will agree to do 5000-6000+ units in one session? I live close to Dr. Rahal in Ottowa, and I want to go to him for the first case. He only does FUE though.

3. Can 10,000+ grafts even restore me to Norwood 1 even if the meds give me no regrowth?

4. I am starting both minoxidil and finasteride at once, so I will never be able to tease apart which one is working and which one is not. Is that okay?

Thanks in advance! 😀

 

 

 

 

 

[Turkhair]

Do not bother with meds. If your hairloss is stable you have reached your final Norwood pattern. Meds will only do slight improvement at this stage and not worth it. 

Your plan is good but NW1 is ambitious, can only get NW2.

1. FUT is such a dated technique, I hate the ugly scar it leaves. Some people still prefer it but meh. You look good now but when you get old and your skin isn’t so nice, that scar going to be look hideous. Look at Joe Rogan, just hideous.

2. Zarev. Pitella. Eugenix

3. Sure if you’ve a massive beard and don’t mind thinned look behind hairline in some places (midscalp/crown). 12k grafts. 

4. Don’t bother and condemn yourself to a life of drugs. You’re too far gone 

[Fox243]

1 minute ago, Turkhair said:

Do not bother with meds. If your hairloss is stable you have reached your final Norwood pattern. Meds will only do slight improvement at this stage and not worth it. 

Your plan is good but NW1 is ambitious, can only get NW2.

1. FUT is such a dated technique, I hate the ugly scar it leaves. Some people still prefer it but meh. You look good now but when you get old and your skin isn’t so nice, that scar going to be look hideous. Look at Joe Rogan, just hideous.

2. Zarev. Pitella. Eugenix

3. Sure if you’ve a massive beard and don’t mind thinned look behind hairline in some places (midscalp/crown). 12k grafts. 

4. Don’t bother and condemn yourself to a life of drugs. You’re too far gone 

I would agree with all of this, but I would say even NW2 is too ambitious. I think NW2.5-3 is more reasonable

[Med]

12 minutes ago, Turkhair said:

Do not bother with meds. If your hairloss is stable you have reached your final Norwood pattern. Meds will only do slight improvement at this stage and not worth it. 

Your plan is good but NW1 is ambitious, can only get NW2.

1. FUT is such a dated technique, I hate the ugly scar it leaves. Some people still prefer it but meh. You look good now but when you get old and your skin isn’t so nice, that scar going to be look hideous. Look at Joe Rogan, just hideous.

2. Zarev. Pitella. Eugenix

3. Sure if you’ve a massive beard and don’t mind thinned look behind hairline in some places (midscalp/crown). 12k grafts. 

4. Don’t bother and condemn yourself to a life of drugs. You’re too far gone 

 

10 minutes ago, Fox243 said:

I would agree with all of this, but I would say even NW2 is too ambitious. I think NW2.5-3 is more reasonable

Thank you for the replies, guys. Even if I end up at Norwood 2-3, I would be happy. As for the drugs, that is a very good point. I am on the fence about taking them. I know the hair unit is unrecoverable if it has been >50% miniaturized, and I’m guessing mine are probably too far gone. But I have seen some progress pics online of “super responders” who get significant regrowth on the meds. That’s the only thing making me consider it. The hope would be to regrow as much as possible before the transplant so that fewer donor grafts need to be taken. I know it’s unlikely…But yes, I don’t love the idea of taking meds for the rest of life, especially since I want to have more children…I am very conflicted. I have the pill bottles here but haven’t started yet.

[Turkhair]

43 minutes ago, Med said:

 

Thank you for the replies, guys. Even if I end up at Norwood 2-3, I would be happy. As for the drugs, that is a very good point. I am on the fence about taking them. I know the hair unit is unrecoverable if it has been >50% miniaturized, and I’m guessing mine are probably too far gone. But I have seen some progress pics online of “super responders” who get significant regrowth on the meds. That’s the only thing making me consider it. The hope would be to regrow as much as possible before the transplant so that fewer donor grafts need to be taken. I know it’s unlikely…But yes, I don’t love the idea of taking meds for the rest of life, especially since I want to have more children…I am very conflicted. I have the pill bottles here but haven’t started yet.

You will get good regrowth with fin/min combo but start with the knowledge that once you get a hair transplant and those regrown hairs are transplanted to your front, stopping medication isn’t an option without severely affecting your results.

The other better option in my opinion is get a HT without drugs. Then even if you start medication, your transplant won’t be dependent on drugs. What also makes this option possible for you is you seem to be stabilised at your current loss. Not everyone stays like this and progresses even farther, for them transplant without medication isn’t even a possibility. 

[AB2000]

This is what Dr. Pittella did with a similar patient using 12k grafts.  He does large sessions, and it looks like he did this surgery over three days:

 

 

 

[mr_peanutbutter]

if i was you id get a comsultation with dr.zarev or pitella.

 

you should be able to spend 50k usd though

[Gatsby]

Trust me. Meds will ‘definitely’ make an improved difference even if you are Norwood 7 as I am/was. You want to keep your hair in the anagen phase as long as possible if using more than one donor source. 5mg a day of oral minoxidil has achieved this for me and has also thickened all of my scalp (especially in the donor) and beard hair. I also take 0.25% topical Finasteride every night also. You want to prevent the lateral humps and bottom crown from dropping more than it has into the coronet. I would only recommend Dr Sethi, Dr Pittella and Dr Zarev for a Norwood 7. There is a big difference between Norwood 6 and Norwood 7 and that’s where these three doctors excel. Wishing you all the best! 

[Rahal Hair Transplant]

@Med,

Generally speaking, those with a advanced Norwood 7 classifications will not have enough donor hair to restore a completely full looking head of hair, especially with high density.

Even if you have exceptionally dense donor hair, you still have to consider supply versus demand. There is only so much supply and demand for hair is so much greater than the supply available.

Essentially, you would have to harvest every single follicular unit in the donor area and move it to the top and even then, full coverage and density would not be achievable. It would also be unethical to perform such a procedure.

That said, if you do have the donor for it,  an experienced surgeon may be able to re-create a conservative, age-appropriate hairline with some mild density and then taper back as far as possible. You may be able to get as far as the mid scalp region but covering the crown won’t be likely.

Also keep in mind that non-surgical solutions are not proven to grow hair in completely bald areas.  What they might do for you is preventing you from losing any more hair and even reverse the miniaturization process for those hairs that are not yet fully destitute.  But based on the photo you presented, it doesn’t look like you have much if any natural hair left on top of your head.  Thus, don’t be surprised if your non-surgical treatment regimen doesn’t do anything to bring back any of the previously existing hair on top of your head.

I hope this helps.

Rahal Hair Transplant

Edited September 11, 2023 by Rahal Hair Transplant

[mrmane85]

Consult with Dr Pittella and see what he thinks is possible. I'm sure you can both come up with a very good strategy on how to tackle your situation 

Edited September 11, 2023 by mrmane85

[Med]

2 hours ago, mrmane85 said:

Consult with Dr Pittella and see what he thinks is possible. I'm sure you can both come up with a very good strategy on how to tackle your situation 

On 9/10/2023 at 12:38 PM, AB2000 said:

This is what Dr. Pittella did with a similar patient using 12k grafts.  He does large sessions, and it looks like he did this surgery over three days:

15 hours ago, mr_peanutbutter said:

if i was you id get a comsultation with dr.zarev or pitella.

you should be able to spend 50k usd though

Thank you for the recommendations. Impressive work. I will look into getting consults.
 

 

On 9/10/2023 at 11:58 AM, Turkhair said:

You will get good regrowth with fin/min combo but start with the knowledge that once you get a hair transplant and those regrown hairs are transplanted to your front, stopping medication isn’t an option without severely affecting your results.

The other better option in my opinion is get a HT without drugs. Then even if you start medication, your transplant won’t be dependent on drugs. What also makes this option possible for you is you seem to be stabilised at your current loss. Not everyone stays like this and progresses even farther, for them transplant without medication isn’t even a possibility. 

15 hours ago, Gatsby said:

Trust me. Meds will ‘definitely’ make an improved difference even if you are Norwood 7 as I am/was. You want to keep your hair in the anagen phase as long as possible if using more than one donor source. 5mg a day of oral minoxidil has achieved this for me and has also thickened all of my scalp (especially in the donor) and beard hair. I also take 0.25% topical Finasteride every night also. You want to prevent the lateral humps and bottom crown from dropping more than it has into the coronet. I would only recommend Dr Sethi, Dr Pittella and Dr Zarev for a Norwood 7. There is a big difference between Norwood 6 and Norwood 7 and that’s where these three doctors excel. Wishing you all the best! 

Thank you for the replies. I do get the appeal of transplant without meds, but the problem is that I can't be sure that my hair loss has stabilized. The photo does not show it clearly, but I do have miniaturized hairs all throughout my scalp. It is not hairless like my palm. I can't say what percentage miniaturized they are. I am thinking of taking only finasteride 1 mg and forgoing minoxidil on second thought. It might be a myth, but I have read claims online of minoxidil inducing premature aging of the face (eye bags, wrinkles, etc). It has sketched me out a bit to the point where I am planning on just using rosemary oil and microneedling with 1.5 mm needles once a week instead. I am leaning towards taking the fin though. If I am transplanting DHT resistant hairs on my scalp, shouldn't they survive later on once my alopecia has "burned out" if I choose to go off fin (not that I would necessarily)? Also, I think fin would improve my skin, which is another reason I want to take it, as I do have some back acne. I wouldn't mind being on fin long term and then just stopping it for a month or two before conceiving children.
 

 

9 hours ago, Rahal Hair Transplant said:

@Med,

Generally speaking, those with a advanced Norwood 7 classifications will not have enough donor hair to restore a completely full looking head of hair, especially with high density.

Even if you have exceptionally dense donor hair, you still have to consider supply versus demand. There is only so much supply and demand for hair is so much greater than the supply available.

Essentially, you would have to harvest every single follicular unit in the donor area and move it to the top and even then, full coverage and density would not be achievable. It would also be unethical to perform such a procedure.

That said, if you do have the donor for it,  an experienced surgeon may be able to re-create a conservative, age-appropriate hairline with some mild density and then taper back as far as possible. You may be able to get as far as the mid scalp region but covering the crown won’t be likely.

Also keep in mind that non-surgical solutions are not proven to grow hair in completely bald areas.  What they might do for you is preventing you from losing any more hair and even reverse the miniaturization process for those hairs that are not yet fully destitute.  But based on the photo you presented, it doesn’t look like you have much if any natural hair left on top of your head.  Thus, don’t be surprised if your non-surgical treatment regimen doesn’t do anything to bring back any of the previously existing hair on top of your head.

I hope this helps.

Rahal Hair Transplant

Dr. Rahal,

Thank you very much for your reply. I live just a few hours drive from your clinic, and I was planning on filling out your hair loss history form soon for a consult. I am very impressed by your frontal hairline work, which I consider the most important part of a hair transplant. The proposed strategy of re-creating a hairline with density tapering as far as possible is precisely what I want out of the first surgery, acknowledging that coverage of the crown is unlikely. Then, later on, I could perhaps FUE some body hair to add density to the crown and adjacent zone. The photo I posted does not capture it, but I do have miniaturized hairs throughout my scalp. I am hoping they are not too far gone and can be revived, thus reducing the number of grafts I will need in my transplant. I am hoping to have the surgery ~10 months from now.

Thank you,
Med

 

[Turkhair]

9 minutes ago, Med said:

…

 

At the end of the day you’ve to live with it and it has to be the plan you want.

 

[A_4_Archan]

Consult dr pittela and plan it out..i would say keep reasonable expectations...imo nw 2.5/3 with decent density is good rather thn nw 2 with poor density 

[Med]

On 9/12/2023 at 8:31 AM, A_4_Archan said:

Consult dr pittela and plan it out..i would say keep reasonable expectations...imo nw 2.5/3 with decent density is good rather thn nw 2 with poor density 

I just submitted my consult request for Dr. Pittella. I am also on the waitlist for a consult with Dr. Zarev, but it’s in September 2026. Then I would have to wait additional time for the actual surgery after that. I think Zarev is the best in the world for my case, but I don’t know if I should wait 4 years to get the procedure. Is Zarev that much better than Pittella that it would be worth waiting?

[mr_peanutbutter]

you could also consider h&w

https://hassonandwong.com/hair-transplant-photos/?_sfm_norwood_scale=type_6-%2C-type_7&_sfm_number_of_grafts=0+11000

[Bandit90]

Sensible plan doing FUT then FUE then BHT, but not always necessary to do this and you find that most of the surgeons who specialise in high norwoods dont even offer FUT.  i'm sure if your willing to give up your beard, to support FUE in your donor then there is probably a good cosmetic improvement to be had. You need a doctor who specialises in high norwoods and confident on transplanting beard hair - which narrows it down to Eugenix and Pitella.  

Edited September 15, 2023 by Bandit90

[GeneralNorwood]

1 hour ago, Bandit90 said:

Sensible plan doing FUT then FUE then BHT, but not always necessary to do this and you find that most of the surgeons who specialise in high norwoods dont even offer FUT.  i'm sure if your willing to give up your beard, to support FUE in your donor then there is probably a good cosmetic improvement to be had. You need a doctor who specialises in high norwoods and confident on transplanting beard hair - which narrows it down to Eugenix and Pitella.  

Generally, most of the clinics in the world offer FUE, because it is easier to perform. 

However H&W offer FUT, same for Hattingen and even Eugenix can do FUT (i asked them about it). 

 

On 9/12/2023 at 3:48 AM, Med said:

If I am transplanting DHT resistant hairs on my scalp, shouldn't they survive later on once my alopecia has "burned out" if I choose to go off fin (not that I would necessarily)?

 

 

When you do FUT for first surgery and you get 5000-8000 grafts, you harvest 100% grafts from area that is very resistant to DHT. It is not possible for FUE, because with this technique you harvest 50-60 % and then you have to expand extraction zone and extract from areas that are  less resistant to DHT. Extraction zone for FUE is way bigger then for FUT. 

 

@Turkhair

I don't think Joe Rogan's example is valid to critique FUT technique. As i remember he had 2 or 3 FUT procedure and they were a failure. The growth was poor and he finally decided to shave it off. The scar doesn't look good too. But all of this is rather because of the clinic he went to, not because of the method. I can show you examples of clinics that deplet the donor and growth is tragic with FUE method. Does it mean that FUE is bad? No. 

Edited September 15, 2023 by GeneralNorwood

[Melvin- Admin]

Are you willing to spend tens of thousands of dollars? This will not be cheap, and it will take a long time, years. Is that something you’re willing to embark? It looks like you already shave. Might be best to keep shaving.

[jakos]

On 9/10/2023 at 5:51 PM, Turkhair said:

Do not bother with meds. If your hairloss is stable you have reached your final Norwood pattern. Meds will only do slight improvement at this stage and not worth it. 

Your plan is good but NW1 is ambitious, can only get NW2.

1. FUT is such a dated technique, I hate the ugly scar it leaves. Some people still prefer it but meh. You look good now but when you get old and your skin isn’t so nice, that scar going to be look hideous. Look at Joe Rogan, just hideous.

2. Zarev. Pitella. Eugenix

3. Sure if you’ve a massive beard and don’t mind thinned look behind hairline in some places (midscalp/crown). 12k grafts. 

4. Don’t bother and condemn yourself to a life of drugs. You’re too far gone 

i disagree. i think starting medication is essential because;
1) you might be hyper responder. you can't tell this without trying. who knows, maybe minoxidil will regrow substantial amount of hair, even in your high nw case
2) transplanted hair will not be immune to DHT. it would be a shame if you undergo these surgeries only to find yourself in a situation where your transplanted hair miniaturizes

 

 

[HairFunk]

If I was you - I'd consider 2 FUE procedures up to 5,000 grafts staged 4-6 months apart (front 3000 grafts, crown 2000 grafts) and have a super high and receded hairline and keep your hair short. Think Statham from Lockstock & 2 Smoking Barrels. 

Then have full SMP to add the illusion of density and repopulate your donor region 6 - 8 months after your final FUE. 

Keep you hair short

If you still wanted more (most men do) you could always have a final FUT strip 1500 - 1800 grafts and grow your hair our a little longer, possibly FUE the scar with 200 - 300 grafts / SMP

[mrmane85]

On 9/15/2023 at 4:29 AM, Med said:

I just submitted my consult request for Dr. Pittella. I am also on the waitlist for a consult with Dr. Zarev, but it’s in September 2026. Then I would have to wait additional time for the actual surgery after that. I think Zarev is the best in the world for my case, but I don’t know if I should wait 4 years to get the procedure. Is Zarev that much better than Pittella that it would be worth waiting?

I don't think so. I would rate Zarev 10/10 and Pittella 9-9.5/10. For me I would go with Pittella if it meant waiting for 4 years. Who knows what Zarev will be charging in 4 years. 4 years is a long time, but completely up to you. They are both outstanding choices. 

[Med]

On 9/15/2023 at 1:01 PM, Melvin- Moderator said:

Are you willing to spend tens of thousands of dollars? This will not be cheap, and it will take a long time, years. Is that something you’re willing to embark? It looks like you already shave. Might be best to keep shaving.

I am definitely prepared to pay tens of thousands of dollars. I am not in a crazy rush either. I would just like to have hair by age 35, so I have a solid 4 years to make it happen. Thankfully I have a round head that looks decent shaved in the meantime.

On 9/15/2023 at 2:30 PM, HairFunk said:

If I was you - I'd consider 2 FUE procedures up to 5,000 grafts staged 4-6 months apart (front 3000 grafts, crown 2000 grafts) and have a super high and receded hairline and keep your hair short. Think Statham from Lockstock & 2 Smoking Barrels. 

Then have full SMP to add the illusion of density and repopulate your donor region 6 - 8 months after your final FUE. 

Keep you hair short

If you still wanted more (most men do) you could always have a final FUT strip 1500 - 1800 grafts and grow your hair our a little longer, possibly FUE the scar with 200 - 300 grafts / SMP

Not a bad idea. I definitely like the Statham look. It works for my physiognomy. Nevertheless, I am still drawn to the idea of going to one of the mega session masters like Zarev or Pittella for 10-12K grafts.

 

On 9/15/2023 at 2:15 PM, jakos said:

i disagree. i think starting medication is essential because;
1) you might be hyper responder. you can't tell this without trying. who knows, maybe minoxidil will regrow substantial amount of hair, even in your high nw case
2) transplanted hair will not be immune to DHT. it would be a shame if you undergo these surgeries only to find yourself in a situation where your transplanted hair miniaturizes

 

 

I just hopped on oral finasteride. I am praying I am a hyper responder. No minoxidil for me though because I read it can cause premature facial aging/wrinkles. Hair is no good with a wrinkly face.

20 hours ago, mrmane85 said:

I don't think so. I would rate Zarev 10/10 and Pittella 9-9.5/10. For me I would go with Pittella if it meant waiting for 4 years. Who knows what Zarev will be charging in 4 years. 4 years is a long time, but completely up to you. They are both outstanding choices. 

Thanks for the reply. If I go with Pittella, I will just need to negotiate the hairline with him. I have noticed in his recent work he tends to taper the hairline to a midline point. I am hoping for more of a rounded forelock area. I am sure he could accommodate my request?

 

 

 

[AB2000]

57 minutes ago, Med said:

Thanks for the reply. If I go with Pittella, I will just need to negotiate the hairline with him. I have noticed in his recent work he tends to taper the hairline to a midline point. I am hoping for more of a rounded forelock area. I am sure he could accommodate my request?

 

Whoever you do wind up going with please do share your results here down the line.

[jakos]

11 hours ago, Med said:

I just hopped on oral finasteride. I am praying I am a hyper responder. No minoxidil for me though because I read it can cause premature facial aging/wrinkles. Hair is no good with a wrinkly face.

Wrinkles thing is BS IMO.

Anyway, you can always start and see for yourself. There is a good chance that you hyper respond to minoxidil and get sizeable regrowth. That happened to me. Good luck with finasteride.

[mrmane85]

On 9/17/2023 at 6:29 AM, Med said:

I am definitely prepared to pay tens of thousands of dollars. I am not in a crazy rush either. I would just like to have hair by age 35, so I have a solid 4 years to make it happen. Thankfully I have a round head that looks decent shaved in the meantime.

Not a bad idea. I definitely like the Statham look. It works for my physiognomy. Nevertheless, I am still drawn to the idea of going to one of the mega session masters like Zarev or Pittella for 10-12K grafts.

 

I just hopped on oral finasteride. I am praying I am a hyper responder. No minoxidil for me though because I read it can cause premature facial aging/wrinkles. Hair is no good with a wrinkly face.

Thanks for the reply. If I go with Pittella, I will just need to negotiate the hairline with him. I have noticed in his recent work he tends to taper the hairline to a midline point. I am hoping for more of a rounded forelock area. I am sure he could accommodate my request?

 

 

 

I'm sure he can come up with a design that you are both happy with. He seems like a perfectionist so will take his time in making sure you are satisfied before proceeding. 

If you have a zoom consultation you can speak with him about this and see what he says. He may have examples of other hairline designs he has produced.