Please have a look and let me know what you think (Thinning crown and temples)

[davidmcvicker]

 

Hey all, I am starting the research process for a potential HT, particularly my crown and temple areas. I am 36M and have been noticing thinning in my hair for several years and am now wanting to do something about it.

Medications: currently I use topical 5% min daily and a weekly derma stamp with a 1.5mm stamper. I have an appointment with a dermatologist in about two weeks and am going to suggest prescriptions for oral min/and dut, as I took fin in the past and didn’t feel like I got much result after two years.

I know the crown is a more difficult and time consuming area to get results but as you can see, it’s truly the one glaring area of missing hair on my head. I am not looking to have a procedure done right away, I'd like to follow the guidelines and be on oral dut and minox for at least a year before making any commitments. 

Any feedback/advice/criticism would be great. Thanks!

[Berba11]

Forget about putting your hairline where that green line is. That’s off the spectrum aggressive and will look weird as hell tomorrow, let alone in another 30 years time. 
 

Everything else you’ve posted sounds fine: take your time, try to improve/slow hair loss and address the biggest problem area (crown) further down the line. A small, conservative enhancement to the hairline would be fine I’m sure - your donor looks good. 

[Gatsby]

@davidmcvicker if you feel you received no benefits from Finasteride do you mean your hair loss continued? How long were you on Finasteride? If your hair loss didn’t improve but your hair loss remained stable then the drug is working. Just curious. Yes as @Berba11 stated that green hairline would look regretful and would also waste too many grafts that you could benefit with keeping. All the best. 👍

[davidmcvicker]

19 minutes ago, Berba11 said:

Forget about putting your hairline where that green line is. That’s off the spectrum aggressive and will look weird as hell tomorrow, let alone in another 30 years time. 
 

Everything else you’ve posted sounds fine: take your time, try to improve/slow hair loss and address the biggest problem area (crown) further down the line. A small, conservative enhancement to the hairline would be fine I’m sure - your donor looks good. 

Hah! Thank you, yeah, I just want even across where it is now while filling in the temples, but the crown is my main focus. I am going to see where I am at in the beginning of 2025 after being consistent on meds for a year. 

I appreciate you taking the time to comment!

Edited April 2 by davidmcvicker

[davidmcvicker]

5 minutes ago, Gatsby said:

@davidmcvicker if you feel you received no benefits from Finasteride do you mean your hair loss continued? How long were you on Finasteride? If your hair loss didn’t improve but your hair loss remained stable then the drug is working. Just curious. Yes as @Berba11 stated that green hairline would look regretful and would also waste too many grafts that you could benefit with keeping. All the best. 👍

I think its probably safe to say I ended the medication regimen too prematurely, however I dont feel like my hair got better nor worse, just stayed the same. I now understand thats the medication working which is why I am going to begin the regimen again for a much longer, more patient period. 

Thanks for the comment!

[Bucky O Hair]

The crown is a tricky, and you will notice that many of the top docs on here have some solid frontal work but no good crown examples (which should be a red flag when doing your research). 

Also, even with the good crown docs...there seems to be a massive variance in terms of graft estimates.  Some clinics will tell you that you need 3500 grafts, but then you will also get some quotes below 2000 grafts.

I recently did my crown and I have an almost identical hair type as you.  I did a lot of consultations with many of the top clinics before I went forward with my recent crown HT.

I narrowed my list to H&W, Zarev, Konior, and Munib Ahmad.  I ended up going with Munib.  Results look great so far.   

 

 

 

 

 

 

 

[davidmcvicker]

6 hours ago, Bucky O Hair said:

The crown is a tricky, and you will notice that many of the top docs on here have some solid frontal work but no good crown examples (which should be a red flag when doing your research). 

Also, even with the good crown docs...there seems to be a massive variance in terms of graft estimates.  Some clinics will tell you that you need 3500 grafts, but then you will also get some quotes below 2000 grafts.

I recently did my crown and I have an almost identical hair type as you.  I did a lot of consultations with many of the top clinics before I went forward with my recent crown HT.

I narrowed my list to H&W, Zarev, Konior, and Munib Ahmad.  I ended up going with Munib.  Results look great so far.   

 

 

 

 

 

That's awsome! I appreciate the insight and advice! Do you mind sharing your experience? I just looked at Munib website and social media and it is definitely top notch work, I have to imagine it did not come cheap. 

[Bucky O Hair]

15 hours ago, davidmcvicker said:

That's awsome! I appreciate the insight and advice! Do you mind sharing your experience? I just looked at Munib website and social media and it is definitely top notch work, I have to imagine it did not come cheap. 

Yea, none of the docs I listed are cheap.  I think H&W were the cheapest, but they also usually go really high on the graft count for your crown (3-4K) which could use up too much of your donor and you will want to save it for the future.  They are also a technician-heavy clinic, so that's also why they are cheaper.

Munib, Konior, and Zarev do all their work on their own...so you're paying for an actual surgeon doing everything.  They may have an assistant there cleaning the grafts (after the doc extracts them) but everything from extraction to incision to insertion is all the doctor's work (which is very rare to find).

Munib and Zarev are the top-2 docs in the World.    

Konior shared some good photos with me, but I think the other two just do some mind-blowing stuff (plus I hear that Konior is retiring soon).

 

My experience with Munib was great.  He responds to all emails, and he'll just end up just interacting with you on Whatsapp (send you photos and videos of similar cases).  He'll do a video consultation with you, and then you have the option to book.  He's pretty in-demand, so you'll probably be waiting for over a year.  

The session wasn't too long (maybe 7am to 1pm).  He has a medical office in the Netherlands in a nice little town.  His approach is pretty laid back and casual (he won't send you dozens of waivers or documents to sign like some other docs on here do).  You just book a hotel nearby and walk over to the clinic.  His work is pretty clean and I was out in the town eating at restaurants and cafes the next day, and I didn't look like a bloodied-up Frankenstein monster.  Just clean work, no bandages needed.

I think both Munib and Zarev use a similar method for extraction, and it results in pretty clean work.  

In my case, I have larger than normal sized hair follicle bulbs...which would likely result in a high transection rate.  If I went to a Turkish hair mill (or even a technician-heavy clinic), I would probably lose half my grafts from transections...so I'm glad I broke the bank and went with Munib, lol.

I'll post a collection of photos and sequence them by month when more time passes.  But i just attached a photo of me three days postop while I was still in the Netherlands.  Most people thought I just had a funky hairstyle and didn't really give me a second look while I was there.  

 

 

 

 

 

[Dr. Wipawan Vathananai]

Hello davidmcvicker,

Your donor area appears to be in great condition in the photos. However, the hairline you've drawn seems a bit too aggressive 😅 For the frontal area, I suggest simply filling in the receding temples for now. It's advisable to preserve donor hair for potential future hair loss.

Regarding medication, many people anticipate thicker and denser hair after taking oral finasteride, but typically it doesn't work that way due to its mechanism of action. Normally, testosterone is converted into dihydrotestosterone (DHT) by the enzyme called 5alpha-reductase. It's the DHT that causes hair miniaturization in male androgenetic alopecia (AGA).

There are two types of the enzyme 5alpha-reductase: type 1 and type 2. Finasteride inhibits the function of type 2, whereas Dutasteride inhibits both types, resulting in a greater reduction in DHT levels.

Primarily, AGA progression is slowed down by inhibiting hair miniaturization with either finasteride or dutasteride, but neither can significantly increase hair shaft thickness. Therefore, if you're expecting denser and thicker hair, you may not see significant changes. Essentially, these medications slow down AGA. It's worth noting that discontinuing finasteride might lead to increased hair loss. Considering your hair loss isn't particularly aggressive, you could either continue with finasteride or consider switching to dutasteride.

Regarding graft estimation, I would roughly estimate around 1,000-1,500 grafts for the crown since you still have some existing hair there. I'd aim for a density of 15-20 grafts/cm2. For the frontal area (if it concerns you), approximately 1,200-1,500 grafts should suffice, aiming for 50 grafts/cm2.

I recommend trying oral minoxidil at 2.5 mg/day on Mon-Wed-Fri, or daily if you can tolerate it, along with either finasteride or dutasteride for about a year before considering a hair transplant.

I hope this helps.

Best,

Dr. Wipawan Vathananai (Dr.Wunny)

Hair transplant surgeon and dermatologist

BHI Clinic, Bangkok, Thailand