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

[4chanhrn]

3 minutes ago, TakeAction said:

Yeah it's far from insignificant.

I think people are too afraid of the scar because most people are not high norwoods and don't need extra grafts so they don't benefit much from FUT. But for those of us who are higher norwoods and need 6k grafts or more, there's a massive benefit.

I personally don't mind trading a linear scar for 3k extra grafts. My donor is quite good in the occipital region but not so great on the sides, so it makes even more sense to use FUT to get all of those thicker grafts. Most people have stronger occipital hair than temporal, but for me it's a pretty significant difference. I probably need about 6k total and I might not be able to get that with FUE alone, but I probably can with FUT.

I actually met a guy last year at brunch who had a haircut that exposed his FUT scar. It didn't look bad, and I brought it up later and we talked about transplants. Pretty thin and honestly I wouldn't have thought much of it if I didn't know about transplants. It wasn't some disgusting frankenstein scar, and if he had let his hair grow another two weeks it would've been covered.

We can always talk about worst case scenarios i.e. "what if the scar stretches" --> then you grow your hair out longer. Everything comes with some risk. Not everyone has the luxury of being able to do just FUE and get the result we want. And some people say "just use beard hair" which I don't agree with. Scalp hair is far superior in terms of appearance for obvious reasons. Beard hair is something I'd only use when I've maxed out FUT and FUE.

Like I've said before I wouldn't do FUT if I were a NW3 or even a NW4. But FUT has it's place, especially for high norwoods.

 

Yes, I completely agree. I also feel people's opinions are skewed because people look at select cases where great surgeons have managed to overharvest(not sure if this is the right word) from unsafe donor and still managed to make it look great. But it is risky for many reasons. And very expensive because you need to pay for the best.

One underrated thing about FUT is that it reduces overall area of the scalp, while the actual overall density remains the same. If you do FUT, you can always goto a Zarev or Pitella later. That option is completely open to you. You could also just get more FUEs.

Scar is a complete non-factor for me, but I understand why people would be concerned about it. Before I knew what transplants were and if I had looked at Joe Rogan's scar, I wouldn't have known or cared at all.

I am open to using beard/body hair. FUT+beard/body hair+FUE w/ Verteporfin can potentially give huge no. of grafts vs just doing FUE today and probably much cheaper?

[TakeAction]

7 minutes ago, 4chanhrn said:

Yes, I completely agree. I also feel people's opinions are skewed because people look at select cases where great surgeons have managed to overharvest(not sure if this is the right word) from unsafe donor and still managed to make it look great. But it is risky for many reasons. And very expensive because you need to pay for the best.

One underrated thing about FUT is that it reduces overall area of the scalp, while the actual overall density remains the same. If you do FUT, you can always goto a Zarev or Pitella later. That option is completely open to you. You could also just get more FUEs.

Scar is a complete non-factor for me, but I understand why people would be concerned about it. Before I knew what transplants were and if I had looked at Joe Rogan's scar, I wouldn't have known or cared at all.

I am open to using beard/body hair. FUT+beard/body hair+FUE w/ Verteporfin can potentially give huge no. of grafts vs just doing FUE today and probably much cheaper?

Yeah 100%, I never noticed Joe Rogan's FUT scar and I'd been watching MMA for years before I got into HT research and learned he'd had one. Not the end of the world.

And exactly no matter how good the technique, you simply cannot extract 100 percent of the donor from any subsection of the donor with FUE like you can with FUT. Unless of course you're just gonna leave a massive bald scarred area visible.

Yeah I think either way it'll cost a lot though. I will say, PIttella is 4-5 dollars per graft which is not much higher or the same as several of the surgeons you mentioned. Only thing is he has a massive waitlist of 1.5 years now and it's expanding fast. But with Pittella FUE + beard you probably will get full coverage in one session. He also uses a TON of grafts. You'd probably get 9k minimum from him.

Edited April 10 by TakeAction

[LeonBlack]

Example of a high Norwood with FUT x 2 for full coverage (me). Cost about 30k. Frontal half grown in, back half 3 months post op.  Small FUE shortly after for temples. Plenty of donor in the tank if needed, ie I progress to NW 7. 
 

I am super impressed by what Zarev/Pitella are doing, and acknowledge I have my biases….. but I think it’s still TBD if the FUE grafts taken from outside the conventional safe donor zone will stand the test of time. 

 

[4chanhrn]

4 minutes ago, LeonBlack said:

Example of a high Norwood with FUT x 2 for full coverage (me). Cost about 30k. Frontal half grown in, back half 3 months post op.  Small FUE shortly after for temples. Plenty of donor in the tank if needed, ie I progress to NW 7. 
 

I am super impressed by what Zarev/Pitella are doing, and acknowledge I have my biases….. but I think it’s still TBD if the FUE grafts taken from outside the conventional safe donor zone will stand the test of time. 

Solid results and very solid long term plan. Planning for you was very well done.

I think we are very similar cases. I think it would be actually better to lose existing hair before surgery so that I can start from clean slate.

Are you on medication now? I remember coming across your post on reddit thread that I had posted.

I think I'm going to do a consultation with Bloxham and look at what he says. 2 FUTs might be the way to go.

[LeonBlack]

9 minutes ago, 4chanhrn said:

Solid results and very solid long term plan. Planning for you was very well done.

I think we are very similar cases. I think it would be actually better to lose existing hair before surgery so that I can start from clean slate.

Are you on medication now? I remember coming across your post on reddit thread that I had posted.

I think I'm going to do a consultation with Bloxham and look at what he says. 2 FUTs might be the way to go.

Thanks. Im definitely happy with it thus far. 
 

re meds…. I am not. Used topical min for years and fin intermittently ( I know wasn’t optimal). Continued to progressively lose. Was so far gone pre HT that I didn’t see the point of indefinite meds. 
 

Edited April 11 by LeonBlack

[4chanhrn]

1 minute ago, LeonBlack said:

re meds…. I am not. Used topical min for years and fin intermittently ( I know wasn’t optimal). Continued to progressively lose. Was so far gone pre HT that I didn’t see the point of indefinite meds. 
 

Yea losing most of it pre HT I think is actually a blessing. I don't think NW6/7 needs meds if pros don't outweigh cons.

Low dose oral min may help you if youre comfortable taking it. It improved my hair a lot.

[Gatsby]

If you can tolerate Finasteride I would recommend taking it (I’m not a doctor). It will preserve your hair transplant and donor area. After all that money spent on surgery it’s a cheap investment. 

[4chanhrn]

Just now, Gatsby said:

If you can tolerate Finasteride I would recommend taking it (I’m not a doctor). It will preserve your hair transplant and donor area. After all that money spent on surgery it’s a cheap investment. 

I know. Have discussed it above. I've tried almost every variation and spoken to my derm, multiple doctors and their advice was not to take it because my body can't tolerate it. My body is very sensitive to 5AR blockers.

[Gatsby]

Oh if your body can’t tolerate it then that’s different. 👍

[4chanhrn]

11 hours ago, Gatsby said:

Oh if your body can’t tolerate it then that’s different. 👍

I'm going to try pyrilutamide(from grey mkt) soon. Although phase 3 trials failed, it did have hair count above baseline after a year, just not a lot above placebo. AAs seem better for maintenance vs regrowth so it could be decent for maintenance with much better side effect profile. IMO this might work as well as topical fin. If you look at trials for oral fin, the hair count over baseline wasn't too impressive either.

Kintor's investor presentation heavily stresses on much better safety/side effect profile. Ofcourse you can't have 100% because AAs don't selectively target ARs on scalp, but I think this might be as good as we may get for a while. It's also non steroidal, which is better as far as side effect profile is concerned

Edited April 11 by 4chanhrn

[LeonBlack]

8 hours ago, Gatsby said:

If you can tolerate Finasteride I would recommend taking it (I’m not a doctor). It will preserve your hair transplant and donor area. After all that money spent on surgery it’s a cheap investment. 

I do agree that would be the wise decision. Don’t intend to hijack this thread… But I acknowledge I have not made the optimal decision on that aspect. I used topical minoxidil for over a decade. definitely noticed I would lose more hair whenever I briefly stopped it. Hair loss nonetheless substantially progressed from Norwood 2 in my early 20s to I believe a 6 before my first hair transplant, as seen in my linked post.  I tolerated finasteride somewhat, not perfectly, but not terrible. It was stopped for one to two years at a time, directly before/after having each one of my kids. Perhaps that was misguided, but it made my wife feel safer. Frankly, don’t know that I saw a difference on it, even when steadily taking it for a year or more. Perhaps I could’ve switched to dutasteride, or if more recently,  added oral minoxidil. 

All that said… At the time of my first hair transplant, the only residual hair I really had was the miniaturized patch in the mid scalp.I asked my doctor his opinion. He did not think it was worth taking medicine for the rest of my life to preserve that small area that was already on its way out.

 

At this point, reasons I could think to take it would be preserving the lateral humps, and back of crown, just in case I was destined to go from a 6 to 7. Also, possibly prolonging the lifespan of my transplanted hairs. I have made the conscious, and perhaps unwise, decision to just let it ride, given all that. Several thousand scalp graphs left available via FUE, not even including my thick beard. 
 

 

 

 

[4chanhrn]

13 hours ago, LeonBlack said:

I do agree that would be the wise decision. Don’t intend to hijack this thread… But I acknowledge I have not made the optimal decision on that aspect. I used topical minoxidil for over a decade. definitely noticed I would lose more hair whenever I briefly stopped it. Hair loss nonetheless substantially progressed from Norwood 2 in my early 20s to I believe a 6 before my first hair transplant, as seen in my linked post.  I tolerated finasteride somewhat, not perfectly, but not terrible. It was stopped for one to two years at a time, directly before/after having each one of my kids. Perhaps that was misguided, but it made my wife feel safer. Frankly, don’t know that I saw a difference on it, even when steadily taking it for a year or more. Perhaps I could’ve switched to dutasteride, or if more recently,  added oral minoxidil. 

All that said… At the time of my first hair transplant, the only residual hair I really had was the miniaturized patch in the mid scalp.I asked my doctor his opinion. He did not think it was worth taking medicine for the rest of my life to preserve that small area that was already on its way out.

At this point, reasons I could think to take it would be preserving the lateral humps, and back of crown, just in case I was destined to go from a 6 to 7. Also, possibly prolonging the lifespan of my transplanted hairs. I have made the conscious, and perhaps unwise, decision to just let it ride, given all that. Several thousand scalp graphs left available via FUE, not even including my thick beard. 

You're not hijacking the thread. It's a good discussion to have. I don't think you need finasteride. I feel it's a good thing for you to lost the hair more susceptible to DHT before you started your journey. I wish the same happened to me lol. Then I can start from a clean slate.

I feel planning for you was really well done so you don't need meds as much as others. I'm really impressed.

I've filled out Dr. Bloxham's consultation form looking at your case. Do you know what sort of wait time I would be looking at for Dr. Bloxham(or for other clinics)?

Also I started Pyrilutamide today.

[LeonBlack]

14 minutes ago, 4chanhrn said:

You're not hijacking the thread. It's a good discussion to have. I don't think you need finasteride. I feel it's a good thing for you to lost the hair more susceptible to DHT before you started your journey. I wish the same happened to me lol. Then I can start from a clean slate.

I feel planning for you was really well done so you don't need meds as much as others. I'm really impressed.

I've filled out Dr. Bloxham's consultation form looking at your case. Do you know what sort of wait time I would be looking at for Dr. Bloxham(or for other clinics)?

Also I started Pyrilutamide today.

Sorry, but I’m not sure what his wait time is like. For my most recent, I specifically requested a date that was about six months out (working around my schedule and holidays) and it was open. I did not look into first available. 

[4chanhrn]

23 minutes ago, LeonBlack said:

Sorry, but I’m not sure what his wait time is like. For my most recent, I specifically requested a date that was about six months out (working around my schedule and holidays) and it was open. I did not look into first available. 

Got it, thanks.

[Bucky O Hair]

On 4/10/2024 at 4:49 PM, TakeAction said:

Don't get me wrong, if I were a full blown NW7 I'd go to Pittella. I mostly agree with you. But I don't think it's true that a patient would be lucky to get only 1000 more grafts with FUT.

Assuming a strip 25 cm long and 1.8 cm wide most patients can get 45 cm^2 in their first strip, with around 75 FU/cm. That first strip can easily yield 3000+ grafts, and the vast majority of patients who don't have abnormally bad laxity can get a second strip of similar caliber.

Conservatively most patients can get 5000 or more lifetime FUT grafts (with two strips).

Most surgeons won't take more than 50 percent of the donor, so that entire area would only have yielded 2500 grafts with FUE only. So the average patient can easily get another 2500 or more grafts by combining FUT and FUE.

 

 

I guess it's just a matter of what % difference will the FUT give you (with a good surgeon) over strictly doing FUE.

I've seen NW7s on this site pull off 10,000 grafts with Zarev and end up with a nice looking head of hair that they wear (with short sides and back).  

If you did FUT first (then decide to go to Zarev), then I assume this would this mean you could get 12,000 total grafts.  Is a 20% increase worth it to lose the ability to wear your hair short on the sides and back?

I think people underestimate how important it is to wear your hair short on the sides and back, and how it creates the appearance of more volume on the top of your head.   You would lose this with a scar.  Then again, I have seen some great SMP in the scar (@gatsby being one of them) so this would mitigate any scar visibility as well. 

It's just a difference of opinion.  The most important thing is to go to a good surgeon (regardless of your strategy) and to not let money and travel time be a significant factor in your decision (even though it's hard not to).

 

 

[krusher7]

Hey @4chanhrn ... I was a NW 5/6 in a similar type scenario of hair loss like you. Do a mega session with Hasson & Wong in Vancouver. You won't regret it!

Edited April 12 by krusher7

[LeonBlack]

9 hours ago, Bucky O Hair said:

 

I think people underestimate how important it is to wear your hair short on the sides and back, and how it creates the appearance of more volume on the top of your head.   You would lose this with a scar.  Then again, I have seen some great SMP in the scar (@gatsby being one of them) so this would mitigate any scar visibility as well. 

 

 

 

I agree, regarding the effect of keeping it short on the sides… Except, don’t forget that with a properly placed FUT scar, you can fade it down below as low as you want. I go from a three over the scar down to a 1. Also, being mindful of age and profession. Not all lend themselves to keeping the sides buzzed up tight all the way

[4chanhrn]

18 hours ago, krusher7 said:

Hey @4chanhrn ... I was a NW 5/6 in a similar type scenario of hair loss like you. Do a mega session with Hasson & Wong in Vancouver. You won't regret it!

Thank you. Your results look really good. Currently consulting with H&W. I have a call planned with their consultant on Monday. Dr. Wong is world class surgeon. There's no doubt about it. I'm hoping they can help me more with long term planning and I wish I could talk to the doctor directly.

[LeonBlack]

18 hours ago, krusher7 said:

Hey @4chanhrn ... I was a NW 5/6 in a similar type scenario of hair loss like you. Do a mega session with Hasson & Wong in Vancouver. You won't regret it!

Probably what I’d do if lived around there. 

[4chanhrn]

31 minutes ago, LeonBlack said:

Probably what I’d do if lived around there. 

For me they are just 4 hr drive away. They are quoting me 4000-4500 grafts for first 1/2 to 3/4 scalp w/ FUT and it comes to 16.3-17.9k USD w/ taxes.

Bloxham wants to do 2500-3500 grafts for 14-16k USD(plus flight/hotel costs?) for as much as possible starting from the front. Plus another FUT procedure later down the line if required.

H&W is cheaper but I liked Bloxham's planning better. He was also very good answering questions and putting effort into the consultation. I'm looking for a long term plan to address my hair loss(especially because I'm not on a 5ARI) vs a 1 time procedure. I have a call with H&W consultant on Monday to ask questions but it would have been nice if I could talk to the doctor directly.

Currently for me both are viable options. I'm taking my time to decide who to go with. I'll be consulting with other doctors as well.

Edited April 13 by 4chanhrn

[LeonBlack]

2 hours ago, 4chanhrn said:

For me they are just 4 hr drive away. They are quoting me 4000-4500 grafts for first 1/2 to 3/4 scalp w/ FUT and it comes to 16.3-17.9k USD w/ taxes.

Bloxham wants to do 2500-3500 grafts for 14-16k USD(plus flight/hotel costs?) for as much as possible starting from the front. Plus another FUT procedure later down the line if required.

H&W is cheaper but I liked Bloxham's planning better. He was also very good answering questions and putting effort into the consultation. I'm looking for a long term plan to address my hair loss(especially because I'm not on a 5ARI) vs a 1 time procedure.

Currently for me both are viable options. I'm taking my time to decide who to go with.

Same as mine. Planned to do “as much as safely possible” on first. Ie max size strip while minimize stretching risk. Got ~3800. Wasn’t sure I’d ever want to do crown…. Til 6 months later when I saw how good front looked and accentuated my bald crown.  Always very responsive via email with questions and concerns pre and post op. 
 

travel time with days off work (if production based), hotel, airfare, etc do jack up the price though

Edited April 13 by LeonBlack

[LeonBlack]

1 minute ago, LeonBlack said:

 

 

Edited April 13 by LeonBlack
Double post

[4chanhrn]

3 hours ago, LeonBlack said:

Same as mine. Planned to do “as much as safely possible” on first. Ie max size strip while minimize stretching risk. Got ~3800. Wasn’t sure I’d ever want to do crown…. Til 6 months later when I saw how good front looked and accentuated my bald crown.  Always very responsive via email with questions and concerns pre and post op. 

Do you know why Bloxham's numbers(how much he can extract) from 1 session are much lower than H&Ws? I'm just curious.

Edited April 13 by 4chanhrn

[Bucky O Hair]

4 hours ago, 4chanhrn said:

For me they are just 4 hr drive away. They are quoting me 4000-4500 grafts for first 1/2 to 3/4 scalp w/ FUT and it comes to 16.3-17.9k USD w/ taxes.

Bloxham wants to do 2500-3500 grafts for 14-16k USD(plus flight/hotel costs?) for as much as possible starting from the front. Plus another FUT procedure later down the line if required.

H&W is cheaper but I liked Bloxham's planning better. He was also very good answering questions and putting effort into the consultation. I'm looking for a long term plan to address my hair loss(especially because I'm not on a 5ARI) vs a 1 time procedure. I have a call with H&W consultant on Monday to ask questions but it would have been nice if I could talk to the doctor directly.

Currently for me both are viable options. I'm taking my time to decide who to go with. I'll be consulting with other doctors as well.

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).

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).

 

 

[LeonBlack]

19 hours ago, 4chanhrn said:

Do you know why Bloxham's numbers(how much he can extract) from 1 session are much lower than H&Ws? I'm just 

 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. 

Edited April 14 by LeonBlack