Opinion/advice as considering hair transplant

[andii]

Hi all,

First time posting here and hoping to receive some advice from other members as I am considering a hair transplant.

I have attached photos below of my current hairline.

I have spoken to several clinics with online consultations, namely with HDC (Cyprus), Dr. Yaman, Dr. Gur, Dr. Turan (all Turkey), and Dr. Arshad (UK/Leeds) and between them they have suggested a range of 2000-4000 grafts (most were moreso in the 2.5-3k range). (Note, my hair is and always has been quite fine)

A big concern of mine is using up too many of my donor hairs in a first procedure, and then being left with minimal available donors if a future procedure is required (which at my age of 29, I feel may be likely).

With this in mind, do members think that this range of donor hairs seems accurate, necessary along with leaving sufficient donor hairs if a follow-up procedure? 

Furthermore, what are people's opinions on the above surgeons? In particular for a case of fine, receding hair such as mine.

Please see further information on my hair loss pattern below -

I'm 29 now and first noticed my hairline receding at about 22/23, when I began to use minoxidil on and off until about 1 year ago when I got sick of the maintenance of it (and the greasy look it gave my hair), which in hindsight has resulted in much further loss.

About 1.5 months ago I began taking finasteride (1mg every 2 days), and thankfully have yet to experience any sides. 

 

Edited November 10, 2023 by andii

[andii]

To add to this -

In the event I proceeded with a hair transplant, I would much prefer if I could keep it (and more specifically the recovery) as private as possible.

Can anyone provide opinions/advise on receiving an unshaven (recipient area) transplant? I could happily hide or wear a hat for the first month or so, but after this I would prefer if it were possible for my native hair to cover up my current hairline, and hide the initial signs of a treatment. Does this sound feasible/like a good idea?

Thanks in advance all!

[LaserCaps]

There are several issues you're dealing with....And they're all concerning.

First, fine hair does allow for the most natural results.  It does take, however, many more grafts than someone with coarse hair.

Dark hair, light scalp results in tons of contrast.  You don't have that issue - so that's a good thing.  Whatever you add will give the illusion of more density.

Review the Norwood pattern and notice the progression.  As patterns advance, a number of things happen.  The hairline recedes, the corners become deeply recessed, the crown begins to expand.  Unfortunately the quality of the photos is not very good.  It's difficult to tell what exactly is happening behind the front.

There seems to be miniaturization throughout, including the sides.  This could be a function of your hair being too short and exposing the scalp.

You were on Rogaine but stopped due to getting tired of the regimen?  What's going to happen when you get tired of using Propecia?  My friend, you're playing with fire.

Donor limitation often drives this industry. There's typically not enough hair available to allow for fullness in the front, top and crown.  It's for this reason most doctors would consider working the frontal area to start with.  It's the area you see when you see yourself in the mirror.  It's also the area others see when they interact with you.  Now the crown.  

Think of the crown as a circle.  You fill it.  Because you've shown the propensity to lose, you'll continue losing.  You go on to lose all the hair around the island worth of hair and now you'll have created a target area and an unnatural pattern. When you look at this from the back, it looks like a "happy face."  We refer to this as "chasing the pattern."  Now you have to waste more grafts to keep that area looking natural while we could have been using those grafts in the very front, the most prominent area.

Retention of the native hair, in the overall scheme of things, is HUGE.  Propecia and Rogaine are considered to be the best meds for retention in the crown.  The problem, is a year later when patients see no visual change - not understanding - the meds are not intended for you to grow anything. They're to keep you from losing more.  If you look the same a year later, the meds did what they were intended to do.  Research PRP and Laser. When done correctly, these can help reverse miniaturization.

I'd encourage you to do all modalities and stay on them for a good year.  First to confirm you'll stay on them and second to assess their effectiveness.  It truly takes a full yer to confirm what exactly they'll accomplish.   A year later, based on the results, you can decide if the effort, time and expense are worth continuing. 

Lastly, be age and pattern appropriate.  Advanced patterns do not have a hairline in the middle of their forehead.  

[jjalay]

You have really fine hair and an average donor area. You have a small head and the surface to cover up is small to, in your case and considering your age and your hairloss stage i would not lower the hairline but i would fill in the temples and reinforce-add density to the midpart of the hairline. My guess would be around 2500 grafts for this.

Judging from the photos it is very likely that after a couple of years you may proceed to a higher NW, even NW 5 or NW 6 and your donor doesnt look sufficient for another fue procedure to cover such a big area. In this case you may want to consider an fut procedure combined with BHT to accomplish your goals.

From the doctors you have mentioned they are all good, i personally would consider HDC and fuecapilar.

Unshaven fue in the recipient area in nowadays and in your case completely reasonable and most of the clinics can offer that. BUt even if you shave your head i think after 4 weeks you wond have any visible signs of a hairtransplant.

[andii]

I have attached some better resolution images below -

[andii]

On 11/10/2023 at 6:12 PM, LaserCaps said:

There are several issues you're dealing with....And they're all concerning.

First, fine hair does allow for the most natural results.  It does take, however, many more grafts than someone with coarse hair.

Dark hair, light scalp results in tons of contrast.  You don't have that issue - so that's a good thing.  Whatever you add will give the illusion of more density.

Review the Norwood pattern and notice the progression.  As patterns advance, a number of things happen.  The hairline recedes, the corners become deeply recessed, the crown begins to expand.  Unfortunately the quality of the photos is not very good.  It's difficult to tell what exactly is happening behind the front.

There seems to be miniaturization throughout, including the sides.  This could be a function of your hair being too short and exposing the scalp.

You were on Rogaine but stopped due to getting tired of the regimen?  What's going to happen when you get tired of using Propecia?  My friend, you're playing with fire.

Donor limitation often drives this industry. There's typically not enough hair available to allow for fullness in the front, top and crown.  It's for this reason most doctors would consider working the frontal area to start with.  It's the area you see when you see yourself in the mirror.  It's also the area others see when they interact with you.  Now the crown.  

Think of the crown as a circle.  You fill it.  Because you've shown the propensity to lose, you'll continue losing.  You go on to lose all the hair around the island worth of hair and now you'll have created a target area and an unnatural pattern. When you look at this from the back, it looks like a "happy face."  We refer to this as "chasing the pattern."  Now you have to waste more grafts to keep that area looking natural while we could have been using those grafts in the very front, the most prominent area.

Retention of the native hair, in the overall scheme of things, is HUGE.  Propecia and Rogaine are considered to be the best meds for retention in the crown.  The problem, is a year later when patients see no visual change - not understanding - the meds are not intended for you to grow anything. They're to keep you from losing more.  If you look the same a year later, the meds did what they were intended to do.  Research PRP and Laser. When done correctly, these can help reverse miniaturization.

I'd encourage you to do all modalities and stay on them for a good year.  First to confirm you'll stay on them and second to assess their effectiveness.  It truly takes a full yer to confirm what exactly they'll accomplish.   A year later, based on the results, you can decide if the effort, time and expense are worth continuing. 

Lastly, be age and pattern appropriate.  Advanced patterns do not have a hairline in the middle of their forehead.  

Thanks for your detailed reply. I have attached better resolution images which will hopefully help to shed some further light on the extent of my thinning/miniaturization.

From these images, do you think there may be miniaturization on the side donor areas? If this is the case, I would imagine this would be quite damaging to the number of suitable donor hairs I have available. How many would that possibly limit my donor area to?

Furthermore, how does the crown look? Personally, I don't believe I have had much hair loss in the crown area (for now), but understand it is certainly an area to be mindful of for future thinning.

Regarding minoxidil and finasteride - using the topical minoxidil really wasn't suiting my fine hair type and was leaving it looking a lot greasier than I would desire which lead to me eventually getting sick of it (although I agree this hasn't done me any favours in hindsight). With this in mind, I am planning to start using oral minoxidil. Do you have any opinions/experience with this drug? Ideally, I will not have any drastic side effects from this or finasteride, which I hope will lead to me keeping the majority of my remaining native hair.

Do you have any experience or opinion on Dr. Yaman (Turkey)? When speaking with his patient advisor, they advised perhaps up to 3500 grafts may be required, given the possibility that I may need further procedures, this sounds like quite a lot. Would you think a lower number is more appropriate/sufficient? Although, they also mentioned that a final amount will be decided during the consultation the day before the surgery, and that they will aim to provide the max without overharvesting the donor area.

Thanks again for your input

[andii]

On 11/10/2023 at 6:12 PM, jjalay said:

You have really fine hair and an average donor area. You have a small head and the surface to cover up is small to, in your case and considering your age and your hairloss stage i would not lower the hairline but i would fill in the temples and reinforce-add density to the midpart of the hairline. My guess would be around 2500 grafts for this.

Judging from the photos it is very likely that after a couple of years you may proceed to a higher NW, even NW 5 or NW 6 and your donor doesnt look sufficient for another fue procedure to cover such a big area. In this case you may want to consider an fut procedure combined with BHT to accomplish your goals.

From the doctors you have mentioned they are all good, i personally would consider HDC and fuecapilar.

Unshaven fue in the recipient area in nowadays and in your case completely reasonable and most of the clinics can offer that. BUt even if you shave your head i think after 4 weeks you wond have any visible signs of a hairtransplant.

Thanks for your reply. I agree that it is likely best to focus more so on filling in the temples and adding density to midpart of hairline, rather than lowering it.

Glad to hear all of the doctors are good. HDC initially suggested 3000 grafts, potentially rising to 4000 if they deem the donor area suitable, with Yaman saying up to 3500 with the same cavaet. I am a bit concerned with using this amount of grafts for a first transplant, at a relatively young age, so I hope that both doctor's have my best interests in mind regarding the probability of needing to hold on to donor hair for future transplants.

Dr. Yaman's advisor also mentioned that he does not perform the implantation himself, instead the "Yaman implanter" is used (something he patented and has been using for 2 years, according to his advisor) by team members who have been trained by Yaman. Is it commonplace in highly rated clinics for this step to be performed not by the main doctor? I am curious as to how reputable this "Yaman implanter" is

[jjalay]

35 minutes ago, andii said:

Thanks for your reply. I agree that it is likely best to focus more so on filling in the temples and adding density to midpart of hairline, rather than lowering it.

Glad to hear all of the doctors are good. HDC initially suggested 3000 grafts, potentially rising to 4000 if they deem the donor area suitable, with Yaman saying up to 3500 with the same cavaet. I am a bit concerned with using this amount of grafts for a first transplant, at a relatively young age, so I hope that both doctor's have my best interests in mind regarding the probability of needing to hold on to donor hair for future transplants.

Dr. Yaman's advisor also mentioned that he does not perform the implantation himself, instead the "Yaman implanter" is used (something he patented and has been using for 2 years, according to his advisor) by team members who have been trained by Yaman. Is it commonplace in highly rated clinics for this step to be performed not by the main doctor? I am curious as to how reputable this "Yaman implanter" is

Between those two clinics i would chose hdc. Better results, and better to go with a clinic where the doctors makes the slits himself. This is very important step for the angulation of the grafts and the overall natural look of the hair transplant.

[LaserCaps]

52 minutes ago, andii said:

Thanks for your detailed reply. I have attached better resolution images which will hopefully help to shed some further light on the extent of my thinning/miniaturization.

From these images, do you think there may be miniaturization on the side donor areas? If this is the case, I would imagine this would be quite damaging to the number of suitable donor hairs I have available. How many would that possibly limit my donor area to?

Furthermore, how does the crown look? Personally, I don't believe I have had much hair loss in the crown area (for now), but understand it is certainly an area to be mindful of for future thinning.

Regarding minoxidil and finasteride - using the topical minoxidil really wasn't suiting my fine hair type and was leaving it looking a lot greasier than I would desire which lead to me eventually getting sick of it (although I agree this hasn't done me any favours in hindsight). With this in mind, I am planning to start using oral minoxidil. Do you have any opinions/experience with this drug? Ideally, I will not have any drastic side effects from this or finasteride, which I hope will lead to me keeping the majority of my remaining native hair.

Do you have any experience or opinion on Dr. Yaman (Turkey)? When speaking with his patient advisor, they advised perhaps up to 3500 grafts may be required, given the possibility that I may need further procedures, this sounds like quite a lot. Would you think a lower number is more appropriate/sufficient? Although, they also mentioned that a final amount will be decided during the consultation the day before the surgery, and that they will aim to provide the max without overharvesting the donor area.

Thanks again for your input

Your hair is long enough on the sides but you can still see through and see scalp.  That's concerning. 

The crown is the weakest point we all share due to the whirl.  The hair grows away from the point exposing the area.  Rely on a medical regimen to help you retain.  If you end up with a thinning crow, that's perfectly normal.  

Yes, I think moving to oral Min would be a great idea.  Take a pill and walk out the door.  Less labor intensive.  

It's often not what you need but what the doctor estimates he can harvest from the donor at any one time.  In a case similar to your own, 2000-2500 grafts.  So, how do you get from this to 3500?  You could do a max procedure, (FUT and FUE over two days), or you can split grafts. 

A follicular until can have from 1-5 hairs.  You could take a 5-hair graft and convert into 5) 1-hair grafts.  This would result in a diffused and unnatural look.  Lastly, you could over harvest.

You typically want to take every 7th.  Take one, you have the other 6 to cover. If you take every other one, you'd be left empty areas.  And while I am exaggerating, spreading the harvest is a much better approach.  This would allow for you to return for additional procedures if need be. 

[andii]

On 11/13/2023 at 6:35 PM, LaserCaps said:

Your hair is long enough on the sides but you can still see through and see scalp.  That's concerning. 

The crown is the weakest point we all share due to the whirl.  The hair grows away from the point exposing the area.  Rely on a medical regimen to help you retain.  If you end up with a thinning crow, that's perfectly normal.  

Yes, I think moving to oral Min would be a great idea.  Take a pill and walk out the door.  Less labor intensive.  

It's often not what you need but what the doctor estimates he can harvest from the donor at any one time.  In a case similar to your own, 2000-2500 grafts.  So, how do you get from this to 3500?  You could do a max procedure, (FUT and FUE over two days), or you can split grafts. 

A follicular until can have from 1-5 hairs.  You could take a 5-hair graft and convert into 5) 1-hair grafts.  This would result in a diffused and unnatural look.  Lastly, you could over harvest.

You typically want to take every 7th.  Take one, you have the other 6 to cover. If you take every other one, you'd be left empty areas.  And while I am exaggerating, spreading the harvest is a much better approach.  This would allow for you to return for additional procedures if need be. 

Thanks for this info.

Hypothetically, if I were to receive a hair transplant in the near future using 2,500-3000 grafts and several years down the line would require a touch-up/follow-up procedure in the crown/top of the hair, would it be anticipated that a procedure such as this would require fewer grafts than an initial hairline/frontal procedure? As perhaps it would not require being as densely packed as a hairline/frontal? I understand that each case is different, but just trying to gather as much information as possible on the subject.

 

[LaserCaps]

Forget the crown.  Concentrate your grafts in the front and area right behind the front.  If you're going to be thin, be thin back in the crown.  (The meds tend to be more effective in that area.  And, it's normal to have hair in the front with a thinning or even an empty crown.  

The crown can truly eat your lunch.  We refer to this area as the black hole of hair restoration.  It all has to do with the whirl.  Let me illustrate.

Grab a piece of paper and a pencil.  Draw a dot.  Draw an intersecting cross right on the point.  Let's assume this is procedure #1.  Turn the paper ever so slightly in either direction and draw another cross.  How many crosses would you need to fill the entire circle?  You could actually put your entire donor in the crown and still look thin.  You then go on to lose all the hair in the front and you'll have nothing to fix it with.  What's worse, you'll be questioning the doctor, "Why did you put all my donor in the crown when now have nothing left for the front and still look bald?" Remember, it's the front people see when they converse with you.

You also have to deal with the doctor.  How was he trained?  Where did he learn to do this?  Many doctors are under the impression grafts compete for blood supply and feel the need to leave a separation in between grafts.  They'll explain they're placing a foundation to which you can add grafts in the future.  So, you do the first procedure and it leaves you with a thin result.  You return a year later to do more grafts and achieve a bit more density.  You might even require a third and a fourth visit to achieve desired density.  Eventually you run out of donor.  

My suggestion to you is to rely on a medical regimen to help you retain as much of the native hair as you can.  Do all modalities and give them a year.  Based on the results you can then decide how best to deal with the situation.  

 

[andii]

On 11/13/2023 at 6:26 PM, jjalay said:

Between those two clinics i would chose hdc. Better results, and better to go with a clinic where the doctors makes the slits himself. This is very important step for the angulation of the grafts and the overall natural look of the hair transplant.

Thanks. Although I believe that Dr. Yaman also makes the slits himself? From speaking with his patient advisor, they informed me that "Dr.Yaman will be with you all the day until we finish and he will make incisions drawing the hairline consultation and opening the channels which is the most important because of the directions by himself". They also mentioned "In the operation there are 3 major steps of the surgery which are incisions step, extraction step and implantation step. Incision step is the first step of the operation and it's performed with sapphiere blade by Dr. Yaman. I also confirm that your consultation, hair analysis, hairline design, local anesthesia and incision steps are completed by Dr. Yaman himself too. "

As far as I can make out, Dr. Yaman performs all of the crucial/most important parts himself. Is this an accurate comment?

[jjalay]

With slits i meant the extractions too, at hdc the doctor does the extractions of the grafts too. Ant they use microscopes. Anyway i would prefer hdc, yaman had some poor results lately. Do your research in this forum before you decide.

[Jupiter_]

 

4 hours ago, andii said:

Thanks. Although I believe that Dr. Yaman also makes the slits himself? From speaking with his patient advisor, they informed me that "Dr.Yaman will be with you all the day until we finish and he will make incisions drawing the hairline consultation and opening the channels which is the most important because of the directions by himself". They also mentioned "In the operation there are 3 major steps of the surgery which are incisions step, extraction step and implantation step. Incision step is the first step of the operation and it's performed with sapphiere blade by Dr. Yaman. I also confirm that your consultation, hair analysis, hairline design, local anesthesia and incision steps are completed by Dr. Yaman himself too. "

As far as I can make out, Dr. Yaman performs all of the crucial/most important parts himself. Is this an accurate comment?

Indeed Yaman does the slits and all the crucial parts of the surgery by himself and he cares a lot about his patients. Between HDC and Yaman, i would select Dr Yaman since i like his results more as they look very natural plus he has much better price. Also HDC uses forceps to implant the grafts which might damage the grafts. Its better to use implanter when grafts are inserted as its more safe.

Edited November 21, 2023 by Jupiter_