Please Review My Condition

[Shlenz]

Hi,
I'm 26 years old, started loosing hair when I was 18.
I'm taking Minoxidil for the last 7 years and started Finasteride 1y and 3 months ago, my hair condition is the same as it was when I started Finasteride.
I've consulted with a lot of clinics, most of them reject me as a patient claiming that I'll lose a lot of hair in the following years and that a HT might look ridiculous because I'll definitely need a 2nd session but won't have enough donor hair for it.

Please help me, what are you thoughts?

[davidn]

it looks like you have retrograde alopecia and it unfortunately is very clear that you will be a norwood 7. Shaving your head might be your best option. Else, after consulting with a gp, you could upgrade your medical regimen to dutasteride and you might wanna add oral minoxidil.

[jjalay]

You have very aggresive hairloss,nw7, and retrograde alopecia. Shaving your head might be the best option you have.

[baddecisions]

The doctors you had consultations with are right and ethical, do not have a hair transplant, it would be a huge mistake. Just like @davidn said, you may consider upgrading your regimen to dutasteride and oral minoxidil. Good luck.

[Bucky O Hair]

If you have the money, then go with Dr. Munib Ahmad or Dr. Tsvetelin Zarev.

Both docs manage to do extremely well with limited grafts and have pretty much zero transection due to their technique.  They also use the smallest punches and leave virtually no scars (so you can opt to shave it all off if you need to in the future).

Considering the cost, this many not be a good use of funds (if it just leads to you having hair for a few years before you shave it off anyway due to further loss as a NW7).  

But if you're going to get one either way, I wouldn't go to any other clinics for your case.

[Dr. Wipawan Vathananai]

Hello Shlenz,

From the photos, it appears that you are experiencing aggressive hair loss from the front to the crown. I can see a significant amount of miniaturized hair. You mentioned taking minoxidil. May I inquire about the dosage you are currently taking?

For management, I highly recommend oral medications such as dutasteride at 0.5 mg/day and oral minoxidil at 2.5-5 mg/day for at least 12 months to preserve your existing hair and slow down further hair loss. Additionally, it might be beneficial to consider some blood work to rule out anemia, thyroid disorders, vitamin D deficiency, and iron deficiency.

Regarding hair transplant surgery, while you may not be the ideal candidate, there are still options available, particularly with a conservative hairline approach. If you opt for a single procedure with a high number of grafts, it would likely involve a combination of FUT & FUE and FUE techniques (aka COMBO). I also noticed that you have some amount of beard hair so thhe beard might be able to provide around 600-1,000 grafts from the photos. However, it is advisable to continue the medications for at least one year before undergoing a hair transplant, as this may reduce the number of grafts required.

In summary;

1. Combo (FUT + FUE)

2. Beard-to-scalp FUE

I don't usually recommend chest hair as a donor since the survival rate is not that good.

Please note that this is only a rough estimation from the photos.

 

Best,

Dr. Wipawan Vathananai (Wunny)

Hair transplant surgeon and Dermatologist

BHI Clinic, Bangkok, Thailand

[SuperHans]

I have to chime in with the others and say that shaving would be the best option, though if you've not tried dut/oral min - give that a go for 12 month and see where you're at. 

Perhaps shave and jump on dut/oral min at the same time, if you see improvement then start considering HT, if you don't you'd have already taken the plunge. Imho the shaven look is always better than patchy balding. 

Check out the Baldcafe YouTube channel, shaving is never as bad as you think it is going to be, it's just hair. 

All the best. 

 

[Shlenz]

On 4/1/2024 at 8:56 AM, Dr. Wipawan Vathananai said:

Hello Shlenz,

From the photos, it appears that you are experiencing aggressive hair loss from the front to the crown. I can see a significant amount of miniaturized hair. You mentioned taking minoxidil. May I inquire about the dosage you are currently taking?

For management, I highly recommend oral medications such as dutasteride at 0.5 mg/day and oral minoxidil at 2.5-5 mg/day for at least 12 months to preserve your existing hair and slow down further hair loss. Additionally, it might be beneficial to consider some blood work to rule out anemia, thyroid disorders, vitamin D deficiency, and iron deficiency.

Regarding hair transplant surgery, while you may not be the ideal candidate, there are still options available, particularly with a conservative hairline approach. If you opt for a single procedure with a high number of grafts, it would likely involve a combination of FUT & FUE and FUE techniques (aka COMBO). I also noticed that you have some amount of beard hair so thhe beard might be able to provide around 600-1,000 grafts from the photos. However, it is advisable to continue the medications for at least one year before undergoing a hair transplant, as this may reduce the number of grafts required.

In summary;

1. Combo (FUT + FUE)

2. Beard-to-scalp FUE

I don't usually recommend chest hair as a donor since the survival rate is not that good.

Please note that this is only a rough estimation from the photos.

 

Best,

Dr. Wipawan Vathananai (Wunny)

Hair transplant surgeon and Dermatologist

BHI Clinic, Bangkok, Thailand

Hi Dr. Wipawan Vathananai,
Thanks for you response.
Can you please explain how the combination of FUE and FUT might be better than just FUE?

[Bucky O Hair]

18 hours ago, Shlenz said:

Hi Dr. Wipawan Vathananai,
Thanks for you response.
Can you please explain how the combination of FUE and FUT might be better than just FUE?

It's not.

Many on here think that you can extract more hairs by going the FUT route, then go with FUE afterward.

This may be the case, but only in cases where you have a lot of scalp laxity to be able to extract a lot of grafts from your FUT (many do not have this).  Otherwise, it will be an insignificant amount and you'll be left with a visible scar.

Since you are potentially headed for a NW6 or NW7, it's totally not worth putting a linear scar on the back of your head in case you want to trim down your hairs and pull off an ultra short hairstyle in the future.

 

 

 

[Dr. Wipawan Vathananai]

19 hours ago, Shlenz said:

Hi Dr. Wipawan Vathananai,
Thanks for you response.
Can you please explain how the combination of FUE and FUT might be better than just FUE?

Extracting the donor area with FUE alone will decrease the donor area density to the point where it looks unnatural. FUT, on the other hand, preserves donor area density, allowing us to extract some grafts around the FUT with FUE. However, you will need to wear your hair at least 2 cm long to cover the linear scar, depending on your surgeon's technique during the FUT procedure. Everything has its advantages and disadvantages.

Regarding scalp laxity, most people's scalps have enough laxity to be harvested by FUT if they have never undergone any scalp surgery.

If you're not ready to proceed with FUT yet because you prefer to continue wearing short hairstyles, then consider doing some FUE from the scalp and beard hair (under the chin) area. After that, continue with medications and let's see if you're happy with the result.