Caution on getting hair transplant

[Recession1]

I wanted to share my experience not to throw any surgeon under the bus, but to help others before getting a hair transplant. I am 35 years old and am on dutasteride 2.5 mg and oral minoxidil 5 mg daily… yes I know very aggressive. I started to recede at 23 years old and would say i am NW 3 now. I visited 2 renown surgeons that members of this forum speak very highly of. Both of them said I have awesome donor hair and no miniaturization and I would be an awesome candidate for surgery. I was excited but in the back of my mind I was skeptical because I felt like my donor when short looked very thin and I felt that the top of my head changed texture and thickness in the last 2 years. I decided to book surgery for the end of this year due to “experts” saying I was a great candidate with no miniaturization. With doubts in my mind and feeling that my donor has been thinning for many years I started to research DUPA. I came across Dr. William Rassman who coined the term DUPA along with Dr. Bernstein. I reached out to Dr Rassman who had me order a densometer and microscope and we set up a zoom call. He had me clip 20 hairs in a small circle in my donor and the hairs measured in density from 30-90 which reflected that I have a high percentage of hairs in the donor that are miniaturizing. I also shaved a small circle and took pictures with microscope that showed over 20% miniturization which classifies DUPA. Also I have miniturization on top of my head that wasn’t initially  spotted. Dr. Rassman stated it is Dupa and would have been a disaster to move forward with surgery as my transplanted hair would thin and my donor would also look thinned out. I would have been in a bad spot because I would then have to shave my head and would have scars in donor and recipient areas. What I am getting at is I think a lot of surgeons are great artists and surgeons but at the end of the day they either don’t know how to spot miniaturization in the donor or just turn a blind eye to it to turn you into a patient. When hair is long in the donor it may look great as you can see in my pictures but that doesn’t tell the whole story. Attached are pictures of my donor long which appears to be fine but under a microscope is not fine. Very disappointed but thankful I didn’t move forward with procedure. 

[YodaHead]

Very interesting.

I wonder why most HT surgeons don’t spend much time in actually examining the scalp and/or “requiring” certain tests be conducted to rule out such issues. 

[Recession1]

Hard telling… I think sometimes we put surgeons on a pedestal and give them all the credit and talk about how “ethical” they are. At the end of the day they perform surgery to make money… I think we hear about surgeons who turn people down and then we think how “ethical” they are but in reality they know they can’t achieve short term cosmetic improvements with certain patients which would tarnish their reputations. In a case like mine with the current state of my donor they know they can get great results in the short term to promote business but would be a nightmare in 5 years and beyond and claim that I have just further thinned. The doctors even told me that my donor was so great that they would almost allow me to go as low as I want with a hairline. Then I hear from Dr Rassman that I have Dupa which is the worst donor you can have. Makes no sense 

[Eli_Avdikian]

Indeed very lazy and reckless on the part of the surgeons who accepted you. But I also wonder whether you saw them for a consultation in their clinic, where they could potentially examine your donor area under a microscope, or you just corresponded via email. 

[jjsrader]

There are many surgeons that examine your scalp w/a densomiter & take their time in a personal consultation - sounds like you went to top surgeons that don't bother, regardless...

Edited March 27 by jjsrader

[Recession1]

13 minutes ago, Eli_Avdikian said:

Indeed very lazy and reckless on the part of the surgeons who accepted you. But I also wonder whether you saw them for a consultation in their clinic, where they could potentially examine your donor area under a microscope, or you just corresponded via email. 

I went to the surgeon twice…. After the first time I was apprehensive because I felt that my hair was thinning so had him look again to make sure and he still thought things were fine. So yes, 2 in person visits! He was annoyed that I questioned him and said if he didn’t like me he would drop me as a patient because he thought I was hard to please…. In reality I was the one who had the right to question him because I ended up being right and he either didn’t care that my donor was thinning or doesn’t know how to diagnose Dupa.  Both times he would throw his high mag glasses on and comb my hair around for about 10 seconds and say it’s fine. Again, my post isn’t to degrade surgeons… I think there are wonderful ones it’s mainly to caution people to get multiple opinions from doctors that know what they are looking at and make sure they don’t have Dupa or thinning donors.  

[DermMD]

I am a board certified dermatologist. I do not do hair transplants, but discuss them with patients often. I feel compelled to write a strong disagreement here with Dr. Rassman, and the assessment.  If you had true DUPA, it would show even with long hair. The photos attached of your hair being wet are still not consistent with DUPA. My assumption is your overt concern for DUPA, when your hair is the way it is swayed a statement from him. A concern for DUPA with your volume of hair is a giant red flag when doing cosmetic procedures, and personally would scream do not proceed, as any physician would not be able to meet your expectation. You have zero deficiencies in hair density of your crown, occipital, parietal, posterior vertex and temporal scalp, and no evidence of DUPA. This can not be magically hidden. And as a expert in dermoscopy (trichology is a component of this field), I would not anticipate the donor density having any true deficiencies as you're stating. Also, the test he instructed you to do is garbage. If you really want to have a true assessment, see a Board-Certified Dermatologist, or hair transplant surgeon using something like Fotofinder (no COI, just a good product for dermoscopy).  

 

https://www.fotofinder-systems.com/technology/hair-consultation/

[asterix0]

I would get another opinion, I am not a doctor but your photos do not show signs of DUPA. It looks like you have a healthy donor area to me, and particularly with such a strong medical regimen I would not worry about your donor thinning. 

[Otis james]

This is all very odd. As a poster has said, could it be that you seem particularly obsessed with having DUPA that the doctor decided you weren’t a good candidate, emotionally, for him? I don’t wish to sound rude, and I know nothing, but your hair looks tremendous in the donor area… 🤷🏻‍♂️🤷🏻‍♂️

[laverita]

Yes I don't see DUPA here. Keep in mind also a percentage of hair will be also in the Telogen phase naturally when measured and really I cannot see DUPA in these photos.  These experts you saw in person, what density readings did they give, how many hairs per FU and what was the miniaturisation measured? To have none is the other impossible end of the scale and even a healthy scalp has them...if they were experts then I assume you got some real verifiable data and not just opinion? 

By all means see others but make sure you get real data.

[Melvin- Admin]

I didn’t know Dr. Rassman was still practicing. With all due respect, to the legends you’ve mentioned did you see any other practicing surgeons? 

I believe after multiple threads, regardless, you probably shouldn’t have an HT. 

[Gatsby]

I’m not a doctor but there is no evidence of DUPA in the photos you have posted @Recession1. Actually can you post blocked out pics of your hair front on? I can’t even imagine you being a Norwood 3 by those pics either? 

[Berba11]

Quite apart from not looking remotely like you have DUPA, the crown and midscalp that we're able to see in these pictures looks flawless - the envy of anyone. You may well experience a little thinning all over in time, but possibly not enough to actually need surgery (or multiple surgeries) and certainly not enough to be alarmed by DUPA. Of course, we're limited by photos alone, but a recommended surgeon that you saw in person twice also confirmed you don't have DUPA...

[Eli_Avdikian]

In OP's defense, there are some documented cases (see Dr. Lorenzo's YouTube channel) of "hidden" DUPAs that don't appear to the naked eye. However, if OP wishes to substantiate his claims, he can provide us with some microscopic images.

[Berba11]

19 minutes ago, Eli_Avdikian said:

In OP's defense, there are some documented cases (see Dr. Lorenzo's YouTube channel) of "hidden" DUPAs that don't appear to the naked eye. However, if OP wishes to substantiate his claims, he can provide us with some microscopic images.

I don't think anyone should be hasty in ruling out the possibility, but as far we know, one surgeon says he has it, and another says he doesn't. Eye test looks like a superb head of hair...

I'm also not sure how qualified many of us would be in looking at microscopic images of the OP's hair. If I were him I'd be doing a round of in-person consultations to get multiple views on the matter.

[shiba1985]

I agree with the dermatologist above. You don’t seem to have DUPA. Trying to categorize a miniaturized follicle can be tricky and depends on ethnicity. A strong hair in Caucasian may be the same size as a miniaturized hair in a Hispanic. It is not an EXACT science as some people may think of it. 
 

if you stayed on the stabilization regiment, phenotypically you seem to be an excellent candidate for hair transplant. 
 

But you seem to be an obsessive type personality and a worrier. Partial knowledge sometimes is worst than no knowledge: 

 

Better to leave good enough alone instead of aiming for perfection. 

[Hairboy67]

Based on the pictures submitted, I don't see where you even need a transplant. What am I missing here?

[Al - Moderator]

You are 35 years old with no signs of thinning anywhere that we can see, yet you think you have DUPA. Why would you think you have DUPA?

 

[mr_peanutbutter]

17 hours ago, Eli_Avdikian said:

In OP's defense, there are some documented cases (see Dr. Lorenzo's YouTube channel) of "hidden" DUPAs that don't appear to the naked eye. However, if OP wishes to substantiate his claims, he can provide us with some microscopic images.

the video was interesting, thank you

 

i agree with some others, that op seem very neurotic and hence might be not a good candidate for that reason alone

 

getting a hairtransplant is understanding that it wont be perfect especially as time continues. with age every donor thins, even in men who dont really suffer from mpb. and once senile alopecia hits even women go bald to a certain degree. but if you worry how your hair looks with 83 then ht isnt the best decision.

 

however would be interested in the microscopic images

 

 

[lunch_owl]

Honestly, your hair looks so good that it made me think that it looks like a wig