Beginner needing hair transplant advice (QUESTIONS + PICS ATTACHED)

[patefa5345]

Hi guys,

I'm a total newbie and I don't really know a lot about hair transplants. I've got a lot of questions and been trying to research the best I can, but it seems difficult to get truthful and unbiased answers. I'm hoping this is a better forum to get helpful and honest answers.

I'm 44 years old. I'm attaching photos. As you can see, my hairline is M-shaped and it has pretty much always had this shape even since I was a child. Obviously it has receded some over the years, but I don't really feel I have much of an active hairloss going on.

What I am wanting to achieve is fill those bald sides and get more of a straight hairline across, without that widow's peak. I am also thinking I might want to bring down the hairline slightly. I always wear my hair so that it covers my whole forehead, all the way down to my eyebrows. I'm hoping that adding more hair in the front through a transplant will give me more fuller and thicker looking bangs. I think I have plenty of hair to harvest from the back? Now on to my questions:

1. Besides the hair transplant, I am planning quite extensive invasive surgery on my face like a facelift and necklift. I am also considering a brow lift. This involves an incision starting above the ear level following the hairline up the forehead to the next ear. I am thinking that these procedures should be done BEFORE the hair transplant? I have a consultation with a surgeon soon, and of course I will ask there, but I thought I'd ask here as well.

2. The hair clinic in my area which has the best reputation uses the FUE technique. I have also heard of DHI transplants and I understand these are the more costly transplants. Is a particular technique more suitable for certain people, maybe depending on the severity of their hairloss or quality of hair or something else? Is one technique more superior than the other in terms of final results? Has one a lower failure rate?

3. I have a problem that my hair gets really greasy fast. I just washed my hair yesterday and I think you can tell that in these photos I took today and uploaded to this post (especially the one showing the back of my head), my hair is already greasy looking. After 2-3 days it looks really bad and beyond 3 days my scalp will itch unless I wash it. I understand it's very important to not touch the new grafted hairs after a transplant, for like several weeks. So I assume I won't be able to wash my hair for a couple weeks? How is this usually solved for people with greasy hair? Should I ask them to shave my head after the transplant?

4. How many gafts approximately do you think will be needed to achieve the goal I explained earlier?

5. I have been considering going to Turkey for my transplant and I have read that I should stay away from so-called hairmills with non-doctors doing the transplants. The biggest reason for going to Turkey is hopes of a better result. It's difficult to research the clinics in my home country, and I don't really trust them. If I will go to Turkey, other than a good doctor it's also important that whoever I'll go to is responsive and easy to communicate with. I read multiple times about one of the popular doctors, that he / his secretary wouldn't return messages / e-mails and it was difficult to get a hold of them. I don't want a doctor like that. Do you have any suggestions who I should contact? The doctor's skills, reputation and good reviews, as well as good communication whenever I have a question, is what matters the most! Price comes second.

6. If the hair transplant is successful, once the transplanted hair starts to grow, will it be as strong as the rest of my hair, or will it be weaker / break off more easily? Can transplanted hair stand being washed like once every other day, or maybe even every day?

7. After the hair transplant, do I have to be on some kind of medications / supplements (temporary or like long term) or receive some type of treatments? Some clinics mention that if you do a hair transplant at their clinic, one or more PRP treatments are included. Is that necessary for me?

8. My last question isn't really transplant related, but I wanted to also ask if there are any types of products that can increase hair density in the areas where I don't really have any hair loss? To get an even thicker looking hair. I read that 99.9% of all products are basically worthless and don't do what they claim, at least not to such an extent that it will be noticable. Do you know if this is true or is there something that truly works?

Thanks for reading. Please try to answer as many of my questions as possible and also if you have any additional suggestions, feel free to add those too.

Edited January 17 by patefa5345

[LaserCaps]

Glad you found this forum.  Lots of experience and people who can help guide you along.  First thing to realize, this is not a regulated industry.  Any doctor can do this.  All they have to do is read up on the subject and be in business the next day with zero experience.   

1.  Any planned cosmetic surgery should be done before.  Imagine a patient doing an eyebrow lift which will have a direct impact on the hairline.  You'd be better served by doing transplants after the fact.

2.  Most clinics today will use FUE.  FUT involves surgery.  (I'd venture to say, if you were to call clinics in Turkey, none do FUT).  FUT is still a viable harvesting technique and one you could contemplate doing since you seem to keep your hair on the lengthier side.  You could exhaust all FUT, (always re-excising the original scar so as to keep the area as clean as possible with only one scar), and then move to FUE.  You could actually put FUE grafts on to the scar.  By considering both FUT and FUE, this would give you access to your entire donor area. (It's always suggested - when doing FUT - to avoid weightlifting that affects the neck for 6 months as this will cause your scar to widen.  Thus, if you're a weightlifter or keep your hair shaven in the donor, a high and tight haircut, FUE would be preferable.  But let's discuss FUE as, it seems, is the approach you're considering.

Artas, Neograft, Smartgraft are robotic type techniques.  These use a much larger punch as it's easier to extract  with O than with o.  These will leave circular type scars in the donor.  Think of honeycomb.  Manual systems use a much smaller punch.  As long as the punch is smaller than a .9mm, it'll leave a micro-scar which is not detectable.  DHI is an FUE method using an implanter.  More often than not this involves shaving the top of your head which, in my view, is more of a negative.  Leaving the hair long on top allows the doctor to decipher the angle and direction of the aperture.  Once the new hair comes in, it'll match angle and direction of what you have.  

Let's go back to - "any doctor can do this."  Think of the FUE manufacturer.  Their job is to sell equipment.  Do you think they care who they sell the equipment to?  And not only will they sell the equipment, they'll send techs with it.  People with no medical experience.  A disaster waiting to happen.  It's not uncommon to hear, "the techs did the work, the doctor was nowhere to be seen."  Perhaps that was a good thing, he has no experience either!  So, who do you trust?  Review the list of suggested surgeons and do your research.

3.  It's important you keep the area clean.  Post op instructions will be given to you outlining a modified washing technique.  Get baby shampoo which contains no alcohol.  Put in on the tips of your fingers.  Tap the area gently, not rubbing.  Get a cup of water and pour to the back of the hand and let the water trickle down.  Others will suggest pouring shampoo and water on a cup, mix, and pour unto the area.  Do not let the water from the shower hit the transplanted area.  This could dislodge the grafts.  (Visit with your favorite hair dresser.  They can help you address the greasy look issue).

4.  Unfortunately you're holding the hair up with your hand and it's impossible to tell what pattern you're thinning into.  It does seem, however, you've receded the hairline, the temporal areas, and the area behind the hairline.  How far back?  difficult to tell by the angle of the photo you've submitted.  Review the Norwood chart and notice the progression.  The important thing to understand, you can identify a pattern by the way the hair is being lost.  Take a pattern 5a for example.  Grab a pencil and cover the figure.  You can have hair but, if you can see through, you should be able to idenfity the pattern you're thinning into.  Always be pattern appropriate.  A class 6 would never have a hairline in the middle of the forehead.  (There are engineering principles that apply to all of us universally.  Research the Rule of Thirds.  This should give you a basic idea where your hairline ought to be).  You can also think about it this way....18 is long gone, 80 is coming.  Imagine being 80 YO in a happy home with a hairline of an 18 year old.  Not good.  In regards to numbers, 1500-2000 follicular units is a common range for a case similar to your own.  A lot will depend on how far down you come. Bringing hairlines down take many, many grafts.  (Keep in mind, hair typically grows forward at an angle.  You'll now have bangs which will make it look as if you have a much lower hairline.  Stay conservative.  You can always add and tweak.  You can't ever remove.  Well, you could - but it would leave scars in the middle of the forehead. 

5.  Has been addressed.

6.  Testosterone is what drives guys.  This gets broken down to DHT which we know is an irritant to the follicle.  This affects the horizontal area but not the vertical.  If we know the hair in the donor is permanent, it'll be permanent wherever it's placed.  It's the best hair you have!  But this does not preclude you from losing more native hair.  If you've shown the propensity to lose, you'll continue losing.  What are you currently doing to mitigate the progressive nature of this condition?

7.  Propecia, Rogaine, PRP and Laser are the modalities we typically refer to when dealing with this debilitating condition.  The mechanism of action of each is totally different and there's synergy when combined.  Propecia and Rogaine are considered to be the best meds for retention towards the crown.  PRP and Laser, when done correctly, can help reverse miniaturization.  Just be under the supervision of a physician.

 

 

 

[TorontoMan]

1. Should be discussed with both surgeons 

2. There are two main transplanting methods, FUE and FUT. DHI from how I understand it is a method within FUE, so its just a way that they perform it. Looking at this is not nearly as important as choosing a reputable hair transplant doctor, with many years of experience, results and user experiences, like the ones posted here so you came to a good place. Many times things like DHI are a marketing tool, that make the clinic sound more advanced when in reality it doesn't mean much. 

3. Your hair is likely getting greasy from sebum production, which could be induced from DHT. Before considering a hair transplant, you should have a better consideration for medication. Hair loss is progressive, and while your hair has held up very well into your 40s, it will only continue to miniaturize over time if unaddressed. The only two proven and FDA approved hair loss medications are finasteride and minoxidil, finasteride being the more important one as it reduces the hormone DHT which is mainly responsible for miniaturization. Finasteride and minoxidil will help to prevent further hair loss which will also aid in a positive transplant result. At the same time it is likely that finasteride will hellp reduce sebum production and your hair will feel less greasy. 

4. My estimation would be somewhere between 1500-2500 max. That would also be best discussed with a reputable surgeon. 

5. I don't have experiences with transplants in Turkey, mainly because I avoided the idea of going to Turkey when I was doing mine. There have been countless poor results posted on here and other forumns of botched turkish jobs. Not to say that there aren't good clinics in turkey, but you have to be very selective, and this forumn is a better research tool for a good clinic. It is very important you do not try to cut corners with your research or finances when choosing a clinic, relatively there are very few clinics worth going to for really good results. Don't make the mistake of saving money as your priority when choosing, this is a very delicate numbers game, and you want to use your grafts optimally, spare your donor and avoid getting a result you're left disappointed with. 

6. The quality of the hair itself remains the same, it doesn't become more brittle or anything along those lines. You can treat like how you would normally. 

7. As mentioned above, you should be on finasteride and minoxidil if you want to slow the progression of any further hair loss. Make sure to research more into these two. Both are very capable of increasing the density and thickness in your hair because they could work to reverse miniaturization. However, your hair won't get thicker than what it was organically, because hair thickness is determined by our genetics. So you can potentially restore some of your hair to its original state, but you cannot exceed that density. Note that these hair loss medications mentioned are better at halting further hair loss than they are at regrowing. 

[patefa5345]

On 1/17/2024 at 4:43 PM, LaserCaps said:

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Thank you so for replying and all the information. I really appreciate it. So a manual type system would be preferable to a robotic one, as the manual types leave a smaller scar. I will ask about which type the hair clinic uses when I go for my consultation on Jan 22.

I understand this industry is not always well regulated and like you explained anyone can claim to be good at it but not necessarily be so. I get it that there are a lot of unserious practitioners in Turkey but a lot of people from all over the world seem to travel there for transplants so it's a little easier to research those clinics than it is in my tiny country where there are hardly no reviews of anything (same is true for cosmetic procedures in general).

However regardless of where I'll end up going, I think this consultation in my country may be worth going for because I can get someone to physically examine my hair and tell me if I'm a good candidate and how many grafts I'd need etc.

And sorry about the photos, I'll take new ones with better angles later and post those along with what was said at the consultation next week (if you don't mind), because I'll probably have more questions then. I'll also look up that chart system you mentioned.

Actually, I wouldn't mind having the hairline of an 18-year old when I'm 80. Weird, I know. But all this I'm planning on having done to myself (and I have given this a lot of thinking), the facial surgeries, the hair transplant, and so on, is to emulate the looks of someone much younger than my true age. Up until now I have spent over 10K on facial fillers, laser procedures and botox and when I don't hold my hair up like I did in those photos you just saw and when my hair is newly dyed and my face is freshly plumped up with fillers, people often mistake me for being half my age, believe it or not. I need more long lasting results, these temporary solutions are expensive and don't stay very long. My goal is to look younger, as young as possible as a matter of fact. I understand surgeries have their limitations, but given the fact that I have somewhat of a youthful look already (at least that's what I've been told), I think there is at least potential for me achieving my dream look.

I don't know what my DHT levels are, but I have been confirmed with low testosterone levels (around 15-16 pmol/l). SHBG levels were high, 132. I don't have any plans on treating my testosterone with injections etc. If I have low testosterone levels, do I still need PRP-treatments and those other medications mentioned?

I don't really think I am really actively losing much hair. I had those high arches even when I was young. The only thing I've noticed is that my hair is sort of brittle and breaks off easily sometimes but I think that is more connected to me bleaching it (planning on stopping this) and over washing it due to the hair becoming oily and looking like crap.

 

On 1/17/2024 at 4:47 PM, TorontoMan said:

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Hi there and thanks for much for taking the time to respond and all the information, appreciate it so much.

I don't know my DHT levels but I've been confirmed to have low testosterone levels. Could sebum production still be the cause even if my testosterone levels are low?

I don't really have much of any active hairloss going on, my hairline receded many years ago and I've had that window's peak even since a child. The hairline probably has receded somewhat over the past 20 years but not to any great extent. It's looked this way for many, many years. Will finasteride and minoxidil still be needed you think?

About Turkey, I'm not considering going there to cut costs. I was thinking that going to one of their reputable doctors, I could end up with a better final result. Of course it's nice to save money too, but that wouldn't be my primary reasons for choosing Turkey. I live in a small country and it's difficult to research the clinics as there is really not much feedback or reviews available.

 

 

 

[patefa5345]

Well, I went in for the consultation and I didn't really feel right about the place. Like when I brought up my greasy hair and concerns of damaging the newly grafted hairs, she said oh just be careful and don't touch it for the first couple nights, after that it's OK. Then I asked who would be doing the transplant and they told me their staff are kind of like trained nurses. I feel it would be no difference than going to one of those hairmill clinics in Turkey then. And this supposedly is one of the more reputable clinics in my country. I don't think there are any clinics here that uses real surgeons.

Also, I think for the price they quoted me, I think it would be roughly the same as if I was to have the transplant with Dr. Pekiner in Istanbul and I believe the chances of the whole thing being successful.