Need advice - Suggest plan and which doctor to consult with (NW5/6)

[4chanhrn]

On 4/13/2024 at 6:00 PM, Bucky O Hair said:

Yea, my issue with H&W (when I had my consultation with them last year) was the high graft estimate.  They always seem to give very high estimates.

Their estimate was double what I got quoted from Munib and Konior. 

I'm not sure why this is the case, and (like you) I am trying to be efficient and maintain a long term plan (that doesn't involve exhausting my donor).

Don't you think I need atleast 4000-4500 for front/midscalp? Bloxham said in total would need 5000-7000 grafts with 2 procedures.

I'm going to consult with more doctors and see what their opinion is. Different opinions are always good.

 

On 4/13/2024 at 6:00 PM, Bucky O Hair said:

Since you seem to want to stick to USA/Canada for your procedure, I would email Konior to see what he has to say.  He communicates directly will all patients, so you'll get feedback from an actual doctor (and not a sales rep).

I'm open to other locations if the price/quality of surgeon is much better. Not strictly restricting myself to North America.

I'll contact Konior, thanks.

Edited April 15 by 4chanhrn

[4chanhrn]

On 4/13/2024 at 6:26 PM, LeonBlack said:

I have seen a few 5K+ from HW on this forum. I don’t think I’ve ever seen over 4K from Bloxham here, or his YouTube videos. my strip goes from here to ear, actually a bit past the ears. Couldn’t be any longer. Only way is to take a wider strip.  perhaps some patients have the scalp laxity for that and/or a they use a different closure technique to maintain a thin scar without too much tension leading to stretching. On my second FUT, he used internal sutures, in addition to the usual staples, to maintain a thin scar. That one was just under 3K.
 

If he said he could’ve safely gotten me 5k+ on a single procedure, I would’ve paid and done it. Granted full coverage needs 6-8k+, so needs 2nd procedure either way for high Norwood. Larger was not advised for me. 

That makes sense. I was always curious about discrepancy in numbers. I've asked it to Bloxham as well.

I know we've been spoilt by 10k graft transplants, but 4k was a big transplant just few years back.

Also can you tell me how long you had to spend in NYC? I'm guessing till the staples are removed? I'm wondering how much would the hotel costs come to.

Edited April 15 by 4chanhrn

[LeonBlack]

8 hours ago, 4chanhrn said:

Don't you think I need atleast 4000-4500 for front/midscalp? Bloxham said in total would need 5000-7000 grafts with 2 procedures.

I'm going to consult with more doctors and see what their opinion is. Different opinions are always good.

 

I'm open to other locations if the price/quality of surgeon is much better. Not strictly restricting myself to North America.

I'll contact Konior, thanks.

Konior top notch….. but 35k/procedure 

[LeonBlack]

8 hours ago, 4chanhrn said:

That makes sense. I was always curious about discrepancy in numbers. I've asked it to Bloxham as well.

I know we've been spoilt by 10k graft transplants, but 4k was a big transplant just few years back.

Also can you tell me how long you had to spend in NYC? I'm guessing till the staples are removed? I'm wondering how much would the hotel costs come to.

2 nights.  I stayed on Long Island near where his office was. Procedure Friday. Stayed Thursday and Friday night, drove home Saturday. 

Edited April 15 by LeonBlack

[4chanhrn]

20 minutes ago, LeonBlack said:

Konior top notch….. but 35k/procedure 

Yea, I know. He's pretty low down on my list(because of his price) and I'm not completely sure I can afford him but it doesn't hurt to ask.

[4chanhrn]

22 minutes ago, LeonBlack said:

2 nights.  I stayed on Long Island near where his office was. Procedure Friday. Stayed Thursday and Friday night, drove home Saturday. 

That's not too bad. How much longer do you think you'd need to fly and how did you get the staples removed?

[LeonBlack]

18 minutes ago, 4chanhrn said:

That's not too bad. How much longer do you think you'd need to fly and how did you get the staples removed?

I drove for all of mine so not sure on that end. I would think fine to fly the day after procedure.  Staples, you can get removed at home. PCP, urgent care, etc. 

[4chanhrn]

15 minutes ago, LeonBlack said:

I drove for all of mine so not sure on that end. I would think fine to fly the day after procedure.  Staples, you can get removed at home. PCP, urgent care, etc. 

Got it, thanks!

[Bucky O Hair]

17 hours ago, 4chanhrn said:

Don't you think I need atleast 4000-4500 for front/midscalp? Bloxham said in total would need 5000-7000 grafts with 2 procedures.

I'm going to consult with more doctors and see what their opinion is. Different opinions are always good.

 

I'm open to other locations if the price/quality of surgeon is much better. Not strictly restricting myself to North America.

I'll contact Konior, thanks.

 

Was Bloxham's estimate of 7000 for the front/midscalp only?  Not including the crown?

If he is excluding the crown from that estimate then I would have to say that is way too much, and will probably exhaust almost all (if not all) of your donor grafts.

I was in the same boat with you re: my crown in that I thought I would need at least 3500 grafts (or more)...and this is what the tech-heavy clinics were quoting me at.  But I was surprised when the doctor-only clinics were quoting me at 2000 grafts.  I thought that was way too low and couldn't possibly be true.

I decided to go with Dr Munib, and the jury is still out on my results (I'm not even 4 weeks postop on my crown) but the coverage looked great before it shed. 

I'm beginning to really question the "low" transection rate that all of these clinics claim to make.  There's no real way to confirm if a clinic has transected 5% or 20% of the grafts they take out (because you won't really be able to count each newly implanted graft to confirm this).  You just have to take their word for it.  In my case, if my crown results turn out to be as good as everyone else's here (with half the graft count) then I am convinced that most tech-heavy clinics are removing more than is needed and are just transecting tons of grafts along the way.  

 

 

 

 

[4chanhrn]

5 minutes ago, Bucky O Hair said:

Was Bloxham's estimate of 7000 for the front/midscalp only?  Not including the crown?

If he is excluding the crown from that estimate then I would have to say that is way too much, and will probably exhaust almost all (if not all) of your donor grafts.

I was in the same boat with you re: my crown in that I thought I would need at least 3500 grafts (or more)...and this is what the tech-heavy clinics were quoting me at.  But I was surprised when the doctor-only clinics were quoting me at 2000 grafts.  I thought that was way too low and couldn't possibly be true.

Bloxham said I'll need 2 FUT surgeries of 2500-3500 for full coverage front to back. He said he wants to start with 1 FUT aiming for "as much as possible".

He included crown in that estimate and I should still have enough grafts to do FUEs later after that if I really need those grafts/have more loss.

12 minutes ago, Bucky O Hair said:

was in the same boat with you re: my crown in that I thought I would need at least 3500 grafts (or more)...and this is what the tech-heavy clinics were quoting me at.  But I was surprised when the doctor-only clinics were quoting me at 2000 grafts.  I thought that was way too low and couldn't possibly be true.

I decided to go with Dr Munib, and the jury is still out on my results (I'm not even 4 weeks postop on my crown) but the coverage looked great before it shed. 

I'm beginning to really question the "low" transection rate that all of these clinics claim to make.  There's no real way to confirm if a clinic has transected 5% or 20% of the grafts they take out (because you won't really be able to count each newly implanted graft to confirm this).  You just have to take their word for it.  In my case, if my crown results turn out to be as good as everyone else's here (with half the graft count) then I am convinced that most tech-heavy clinics are removing more than is needed and are just transecting tons of grafts along the way.  

That's very interesting. I would love to see your results.

 

[Al - Moderator]

Bloxham tries to limit the width of the strip so there's not too much tension. A thinner strip will generally give you a lower chance of scar stretching. Hasson & Wong like to push the limits of how wide a strip they can get for higher NWs that could use more grafts.

 

 

[Melvin- Admin]

I would NOT recommend strip. If you’re going to do this, I would look at the big 3 Zarev, Sethi, Pittella. These are the surgeons doing large cases with the biggest Norwood 6 portfolios. 

Keep in mind, this will not be a cheap endeavor. 

[Bucky O Hair]

3 hours ago, Melvin- Admin said:

I would NOT recommend strip. If you’re going to do this, I would look at the big 3 Zarev, Sethi, Pittella. These are the surgeons doing large cases with the biggest Norwood 6 portfolios. 

Keep in mind, this will not be a cheap endeavor. 

BOOM!

The administrator has spoken, and he is in full alignment with Bucky O'Hair!

#neverstrip

[4chanhrn]

18 hours ago, Al - Moderator said:

Bloxham tries to limit the width of the strip so there's not too much tension. A thinner strip will generally give you a lower chance of scar stretching. Hasson & Wong like to push the limits of how wide a strip they can get for higher NWs that could use more grafts.

Thank you. I asked Bloxham and got a similar response.

11 hours ago, Bucky O Hair said:

BOOM!

The administrator has spoken, and he is in full alignment with Bucky O'Hair!

#neverstrip

15 hours ago, Melvin- Admin said:

I would NOT recommend strip. If you’re going to do this, I would look at the big 3 Zarev, Sethi, Pittella. These are the surgeons doing large cases with the biggest Norwood 6 portfolios. 

Keep in mind, this will not be a cheap endeavor. 

#neverstrip seems to be the consensus and in an ideal world I should be going for a Zarev, Sethi or Pittella, but if one does not have the access to elite surgeons that have worked on NW6/7(I'm not sure you can even book Zarev. Sethi and Pittella would be like 1-1.5 yr wait away and expensive. $5/graft for 6000+grafts adds up quickly), then wouldn't FUE exhaust donor completely if I somehow progress to NW7 vs doing FUT first? That is really my concern. FUT leaves you with lot of grafts in the bank as an insurance policy+Verteportfin could end up giving more grafts down the line.

 

I've been tempted by someone like Nader, who's cheap and excellent(I think I can be persistent in contacting him). There are other good FUE surgeons as well. But worried about FUE not leaving enough in the bank for later. The scar doesn't bother me. What do you think? Here's a good large case Nader handled: 

 

Edited April 18 by 4chanhrn

[mr_peanutbutter]

2 hours ago, 4chanhrn said:

Thank you. I asked Bloxham and got a similar response.

#neverstrip seems to be the consensus and in an ideal world I should be going for a Zarev, Sethi or Pittella, but if one does not have the access to elite surgeons that have worked on NW6/7(I'm not sure you can even book Zarev. Sethi and Pittella would be like 1-1.5 yr wait away and expensive. $5/graft for 6000+grafts adds up quickly), then wouldn't FUE exhaust donor completely if I somehow progress to NW7 vs doing FUT first? That is really my concern. FUT leaves you with lot of grafts in the bank as an insurance policy+Verteportfin could end up giving more grafts down the line.

 

I've been tempted by someone like Nader, who's cheap and excellent(I think I can be persistent in contacting him). There are other good FUE surgeons as well. But worried about FUE not leaving enough in the bank for later. The scar doesn't bother me. What do you think? Here's a good large case Nader handled: 

 

just consult with docs who offer both such as hattingen, dr path, medispa or h&w

personally i wouldnt do strip due to the risk of stretching, nerve damage etc but i also see that you can get a few more grafts out if you combine fue + fut

 

btw joe rogan strip scar definitely hasnt stretched, so even though he had to shave he isnt a worst case scenario. 

[Melvin- Admin]

11 hours ago, 4chanhrn said:

Thank you. I asked Bloxham and got a similar response.

#neverstrip seems to be the consensus and in an ideal world I should be going for a Zarev, Sethi or Pittella, but if one does not have the access to elite surgeons that have worked on NW6/7(I'm not sure you can even book Zarev. Sethi and Pittella would be like 1-1.5 yr wait away and expensive. $5/graft for 6000+grafts adds up quickly), then wouldn't FUE exhaust donor completely if I somehow progress to NW7 vs doing FUT first? That is really my concern. FUT leaves you with lot of grafts in the bank as an insurance policy+Verteportfin could end up giving more grafts down the line.

 

I've been tempted by someone like Nader, who's cheap and excellent(I think I can be persistent in contacting him). There are other good FUE surgeons as well. But worried about FUE not leaving enough in the bank for later. The scar doesn't bother me. What do you think? Here's a good large case Nader handled: 

 

The idea that you can get maximum 6,000 grafts is antiquated. There are several men who’ve had 9k+ from FUE that look good. @Bandit90 @captaincalico @Gatsby @mtb@HugoX these are just a few. 

FUT doesn’t leave you with more grafts. You’re removing the grafts, so those grafts are gone. It will leave you with a scar that you may need to add grafts to afterwards. Remember you need optimal density to conceal a strip scar. Getting subsequent FUEs reduces density, which Will w post the scar. 

I will add hattingen to the mix. I love Nader, but high Norwoods isn’t something he does often. Hattingen certainly do more high Norwoods. 

[BurnieBurns]

1 hour ago, Melvin- Admin said:

The idea that you can get maximum 6,000 grafts is antiquated. There are several men who’ve had 9k+ from FUE that look good. @Bandit90 @captaincalico @Gatsby @mtb@HugoX these are just a few. 

FUT doesn’t leave you with more grafts. You’re removing the grafts, so those grafts are gone. It will leave you with a scar that you may need to add grafts to afterwards. Remember you need optimal density to conceal a strip scar. Getting subsequent FUEs reduces density, which Will w post the scar. 

I will add hattingen to the mix. I love Nader, but high Norwoods isn’t something he does often. Hattingen certainly do more high Norwoods. 

I have to disagree with FUT not leaving you with more grafts as a blanket statement.

It depends on the patient, their hair characteristics, baldness pattern, and scalp laxity. Also what hairstyles they prefer.

As someone with fine hair, average donor density, NW6 with slight retrograde loss on the lower back and sides, I was estimated by some top docs as having just over 3k scalp grafts available after already having one small initial procedure of 900 grafts. After then it would start looking too thin. 
 

However, due to very good scalp laxity and no desire for short hairstyles, I’ve received nearly 9k grafts total from FUT between Dr Jerry Wong and Dr Ron Shapiro. 
Scar is on average 3mm wide and can get good filling in from 250 grafts. I even still get around 2k more scalp FUE in future while still looking full.

I researched extensively and consulted with many of the clinics listed here, including Eugenix.
Ultimately by doing both methods, I upped my graft bank from 4K to 9k!

I understand I’m a very specific case and many if not most candidates are be better candidates for FUE only. But I believe that for the right patient hoping to maximise yeild , even in 2024, strip is worth at least considering. 

 

 

[Bucky O Hair]

Does graft count matter as much as the doctor implanting them?

I've seen cases on here where a doctor (like Zarev) is able to pull out 8-10K grafts from patients that would normally be quoted as only having about 6K lifetime grafts from other doctors. 

I've also experienced a high degree of variance between doctors for my own crown procedure...and the range in estimates was pretty high (from 1,750 to 4,000).
I went with Dr. Munib and got 1,750 grafts (and the jury is still out on the results) but the postop photos look just as good (if not better) than any 3k-4k crown session.

Are we simply putting too much emphasis on total graft count? 
 

[mtb]

Yeah, I never felt like I got a good enough explanation of why FUT then FUE yield more grafts. I can see the argument from a coverage and planning standpoint but once grafts are moved they're moved. I've had 12k grafts moved FUE and no one can tell when looking at my donor area. Only I can tell when I've slept on it weird or something. However, I did go the the best FUE-scalp hair-only surgeon in the world. He's the only one I can recommend for that number of grafts. I'm sure I could still get an FUT and it would be covered just fine, not that I'll ever need to. 

[Melvin- Admin]

1 hour ago, mtb said:

Yeah, I never felt like I got a good enough explanation of why FUT then FUE yield more grafts. I can see the argument from a coverage and planning standpoint but once grafts are moved they're moved. I've had 12k grafts moved FUE and no one can tell when looking at my donor area. Only I can tell when I've slept on it weird or something. However, I did go the the best FUE-scalp hair-only surgeon in the world. He's the only one I can recommend for that number of grafts. I'm sure I could still get an FUT and it would be covered just fine, not that I'll ever need to. 

Traditional wisdom was that you would “strip out” then go for subsequent FUE procedures. But the problem with this is that the strip scar can stretch after multiple strips, plus you need high donor density to conceal a strip scar. I don’t think this is the best approach. Obviously, your approach is best, second best would be a mixture of scalp + beard. I would put strip +FUE third. 

[davdoff23]

On 4/10/2024 at 9:13 PM, bigmistake said:

I'm currently 30, your hair loss is very similar to mine when I was 27, I am now NW6-NW7, your hair can still be revived with dermarolling + oral minoxidil + topical finastride. You can almost become a NW2. 

Don't get a HT without Fin. 

May I ask why should one not get a HT without Fin?

[4chanhrn]

On 4/18/2024 at 1:06 AM, mr_peanutbutter said:

just consult with docs who offer both such as hattingen, dr path, medispa or h&w

personally i wouldnt do strip due to the risk of stretching, nerve damage etc but i also see that you can get a few more grafts out if you combine fue + fut

 

btw joe rogan strip scar definitely hasnt stretched, so even though he had to shave he isnt a worst case scenario. 

That's a good idea. Waiting for a reply from Hattingen.

On 4/19/2024 at 12:29 PM, Melvin- Admin said:

Traditional wisdom was that you would “strip out” then go for subsequent FUE procedures. But the problem with this is that the strip scar can stretch after multiple strips, plus you need high donor density to conceal a strip scar. I don’t think this is the best approach. Obviously, your approach is best, second best would be a mixture of scalp + beard. I would put strip +FUE third. 

I was watching your podcast with Hattingen. Dr. Muresanu says the jury on FUE(especially for high NWs) is still out because you need to harvest from outside traditional safe donor area and FUEs are a relatively new procedure so we haven't seen how the patients would age with them, especially if donor starts to thin. I guess this would be even more of an issue with people not on fin and young. People getting these large FUEs seem to be either on fin or much older(and have stabilized pattern/donor for long time) or both.

I'm thinking 1 strip+FUEs with beard/graft after that.

4 hours ago, davdoff23 said:

May I ask why should one not get a HT without Fin?

Hair loss can progress beyond initial pattern. Your hair loss will just end up naturally how you will lose hair. If you don't plan for it correctly or take that into account then your HT can look weird later. Fin can put the breaks on or help you keep hair that you started with.

During consultation I got told that most likely I'm NW6. Although there are some areas of weakness, if I was a NW7, I would have been there by now so should be planning like a NW6.

 

Edited April 23 by 4chanhrn