Advice on going with crown or front hairline as priority for transplant

[zxc]

I am 32 years old with family history of baldness and I have been losing hairs slowly in the last 4-5 years mainly in the crown region and now in mid-scalp section. I am now thinking of getting hair transplant. Below are the current options I am considering which was given to me.

Option 1 by Pioneer Advanced Hair Transplant Centre Bangalore with in person meeting: 3000 +/- 200 grafts to be removed from my donor. ~2500 for crown area and rest in mid-scalp, nothing for the front hairline. I did mention my preference of hair density would be crown > mid-scalp > front hairline and even the Dr also mentioned this would be his recommendation as I have average quality donor and to focus mainly on crown and mid-scalp. He also mentioned even after transplanting 2500 grafts in crown, it would be slightly better than my current mid-scalp area look/density wise.

Option 2 by Eugenix based on online pics shared: Got the initial evaluation and have attached the image with their plan (one in black t-shirt).

 

The confusion I am having is:

1. Will Eugenix initial plan of ~1500-1700 for crown result in lower density at crown? Since Dr at Pioneer mentioned even ~2500 would still result in slightly better than my current mid-scalp, I am looking for opinion from this forum how would the ~1500-1700 look after a year of growth based on my baldness level at crown?

2. Currently my order of preference for HT density wise is crown > mid-scalp > front hairline. But is this the right way of thinking to focus more on crown? Because I did read in some posts here to not place too much focus on crown as it is kind of black hole but again this answer could be relevant to that specific posts and person's hair loss at crown. Based on my hair loss wanted to check if I should slightly change my order of preference? My main goal is not to have 1 or 2 patchy areas after 1 year of HT, rather have good density at crown and mid-scalp region. But I am not sure if am putting too much priority on crown?

3. When I checked with Eugenix if mid-scalp will not be receiving any hair transplant, their response was "our plan is to focus on the frontal and crown areas for treatment. It is possible that the mid-scalp may see improvement with medication in the upcoming months".  Is it fine for me to depend only on fin to maintain current mid-scalp hair? What if I have severe side affects of fin and I need to stop taking it, wouldn't this result in losing my mid-scalp hair and result in baldness in between crown and front? (I will be asking this question to Eugenix while also looking for unbiased answer from this forum).

 

With above 2 options, I am confused between which one is better. With Pioneer it is mainly centered around my preference but with Eugenix I feel they have good reputation and what if their plan makes sense and my thinking around preference is not right. So looking for some answers/advice for my above confusions.

 

 

Edited November 22, 2023 by zxc

[Shadman]

1 hour ago, zxc said:

I am 32 years old with family history of baldness and I have been losing hairs slowly in the last 4-5 years mainly in the crown region and now in mid-scalp section. I am now thinking of getting hair transplant. Below are the current options I am considering which was given to me.

Option 1 by Pioneer Advanced Hair Transplant Centre Bangalore with in person meeting: 3000 +/- 200 grafts to be removed from my donor. ~2500 for crown area and rest in mid-scalp, nothing for the front hairline. I did mention my preference of hair density would be crown > mid-scalp > front hairline and even the Dr also mentioned this would be his recommendation as I have average quality donor and to focus mainly on crown and mid-scalp. He also mentioned even after transplanting 2500 grafts in crown, it would be slightly better than my current mid-scalp area look/density wise.

Option 2 by Eugenix based on online pics shared: Got the initial evaluation and have attached the image with their plan (one in black t-shirt).

 

The confusion I am having is:

1. Will Eugenix initial plan of ~1500-1700 for crown result in lower density at crown? Since Dr at Pioneer mentioned even ~2500 would still result in slightly better than my current mid-scalp, I am looking for opinion from this forum how would the ~1500-1700 look after a year of growth based on my baldness level at crown?

2. Currently my order of preference for HT density wise is crown > mid-scalp > front hairline. But is this the right way of thinking to focus more on crown? Because I did read in some posts here to not place too much focus on crown as it is kind of black hole but again this answer could be relevant to that specific posts and person's hair loss at crown. Based on my hair loss wanted to check if I should slightly change my order of preference? My main goal is not to have 1 or 2 patchy areas after 1 year of HT, rather have good density at crown and mid-scalp region. But I am not sure if am putting too much priority on crown?

3. When I checked with Eugenix if mid-scalp will not be receiving any hair transplant, their response was "our plan is to focus on the frontal and crown areas for treatment. It is possible that the mid-scalp may see improvement with medication in the upcoming months".  Is it fine for me to depend only on fin to maintain current mid-scalp hair? What if I have severe side affects of fin and I need to stop taking it, wouldn't this result in losing my mid-scalp hair and result in baldness in between crown and front? (I will be asking this question to Eugenix while also looking for unbiased answer from this forum).

 

With above 2 options, I am confused between which one is better. With Pioneer it is mainly centered around my preference but with Eugenix I feel they have good reputation and what if their plan makes sense and my thinking around preference is not right. So looking for some answers/advice for my above confusions.

 

 

Well, in my opinion if you’ve good density in the frontal part you can certainly cover up mid zone with minimal density. Good density in the frontal portion will change your appearance completely. Moreover, mid portion can be improved with medicine. And my opinion is for the crown, the type of result Eugenix can offer you with 1700 grafts some other indian clinic might not even achieve that with 2100 grafts. Because Eugenix has higher graft survivality. But during the planning you can discuss further with the Dr if anything more can be done.

[BackFromTheBrink]

I agree. You are norwood 5 (or close to getting there).

Before deciding what to do I'd jump on finesteride. That should slow/stop the midscalp bridge that when gone would take you to NW6. If you can tolerate it you may make ground in the midscalp and crown.

I'd  plan on 2 smaller procedures (hairline and then crown). However, it may be possible with a single large procedure.

The hairline will frame your face and will be what most people see most of the time. If you favour the crown and cannot tolerate meds you will end up with a strong crown but still effectively appear balding to most.

Edited November 22, 2023 by BackFromTheBrink

[son2]

My case is extremely similar to yours. Bald crown, severely thinned midscalp and front. First, get on meds, finasteride especially, to save the midscalp and front and prevent progression to NW6-7. I've had ~3200 grafts just for the crown this year, and it filled really nicely. And will be doing another for the midscalp and front in a couple of weeks. Around 3000 grafts. This should give me a pretty nice illusion of density. I suspect a similar graft requirement for you too.

[zxc]

3 hours ago, Shadman said:

Well, in my opinion if you’ve good density in the frontal part you can certainly cover up mid zone with minimal density. Good density in the frontal portion will change your appearance completely. Moreover, mid portion can be improved with medicine. And my opinion is for the crown, the type of result Eugenix can offer you with 1700 grafts some other indian clinic might not even achieve that with 2100 grafts. Because Eugenix has higher graft survivality. But during the planning you can discuss further with the Dr if anything more can be done.

Thank You for the opinion and pointer on Eugenix. 

[zxc]

2 hours ago, BackFromTheBrink said:

I'd  plan on 2 smaller procedures (hairline and then crown). However, it may be possible with a single large procedure.

 

This is something very similar to what Eugenix has proposed. But if i go ahead with HT and then start on fin for mid-scalp but get to know I cannot tolerate it and stop it, with the current plan of  ~1500-1700 at crown and 2000 at front, after a year of growth for transplanted hair do you think with my existing hair state I would get into baldness patch in between crown and front? My only option at this point would be another HT for mid-scalp? 

And if I start fin now and get to know I cannot tolerate it what would my options be? My donor area seems average so wondering will I be able to have transplants for all 3 areas - crown, mid-scalp and front - with front being important to appear not balding and would have to accept some patchiness at mid-scalp or crown without taking fin? Or better to give up on HT if fin poses a problem?

 

Edited November 22, 2023 by zxc

[zxc]

1 hour ago, son2 said:

My case is extremely similar to yours. Bald crown, severely thinned midscalp and front. First, get on meds, finasteride especially, to save the midscalp and front and prevent progression to NW6-7. I've had ~3200 grafts just for the crown this year, and it filled really nicely. And will be doing another for the midscalp and front in a couple of weeks. Around 3000 grafts. This should give me a pretty nice illusion of density. I suspect a similar graft requirement for you too.

As you mentioned your case is extremely similar to mine, do you think ~1500-1700 grafts at crown wont give much density and still the scalp will be visible?  Taking graft survivability into account as well as pointed by Shadman above 

[zxc]

3 hours ago, BackFromTheBrink said:

hairline and then crown

 

If front hairline and crown has to be done in 2 different procedures with a year apart, you are mentioning if I can tolerate fin get hairline first and then crown next? 

[BackFromTheBrink]

2 hours ago, zxc said:

If front hairline and crown has to be done in 2 different procedures with a year apart, you are mentioning if I can tolerate fin get hairline first and then crown next? 

As much as you probably won't want to hear this, the first step is medication. It'll let you know if you can tolerate it, strengthen existing miniaturised hairs before the transplant and let you see whether you can achieve any regrowth.

After 6-12 months (depending on your patience) you will then be able to plan and make an educated decision.

If it were me, I would start with the front and midscalp. I'd go to a clinic that can use body hair and mix that into the midscalp to preserve grafts.

In a later surgery I'd do the crown. If you are looking for full coverage, you will need more than the 1700 grafts you were quoted and could need double that (depending on expectations, regrowth and the source of your donor hair for that procedure).

[Shadman]

5 hours ago, zxc said:

This is something very similar to what Eugenix has proposed. But if i go ahead with HT and then start on fin for mid-scalp but get to know I cannot tolerate it and stop it, with the current plan of  ~1500-1700 at crown and 2000 at front, after a year of growth for transplanted hair do you think with my existing hair state I would get into baldness patch in between crown and front? My only option at this point would be another HT for mid-scalp? 

And if I start fin now and get to know I cannot tolerate it what would my options be? My donor area seems average so wondering will I be able to have transplants for all 3 areas - crown, mid-scalp and front - with front being important to appear not balding and would have to accept some patchiness at mid-scalp or crown without taking fin? Or better to give up on HT if fin poses a problem?

 

I think you can proceed with the original plan of Eugenix. And also start the medications. After a year, depending on your condition you can take a decision whether you'll go for another procedure or not. And if you're unable to tolerate oral fin you can for the topical. Before that give oral fin a try