Need Advice Please (photos)

[aj6543]

I started losing my hair around age 23 (now I am 27), and immediately started taking propecia. It seems to have stopped or slowed the hair loss, but nevertheless, the damage was significant. I have diffuse and I am a NW3.

I went to see a reputable doctor recently, and said I have very good donor area, thick hair and lots of hair. He believes most of the current hair I have- minus a strong widows peak- will fall out in 4-5 years. He gave me two options:

1. Do two procedures. The first, 2000 grafts to fill the temples and recreate hairline, and build around the widows peak that is strong and has not suffered diffuse. And down the road do another 2,500 grafts when the rest of the mid scalp hairs fall out.

2. Wait until all the hair falls out and do one procedure.


Does it make sense to do option one? I think the plus is that a nice hair line can be reconstructed for the time being. For now I can manage the hair loss because i can push my hair down and hide it well.

[Spex]

Make sense to go with the most conservative option in my opinion ie just address where is required now.

Pics not the best so difficult to give you a truly honest opinion.
SPEX

[CIT_Girl]

I would advise putting off any type of procedure for as long as possible. However, since you seem to have an understanding that hair loss is a lifelong procedure and have talked through a long term plan with the physician, I don't believe a small procedure would be a bad idea. The front of the scalp and hairline are, in my opinion, the most cosmetically important areas- you just want to make sure the physician doesn't lower your hairline too aggressively (which could deplete your donor supply prematurely or look unnatural as you age).

[mattj]

Are you saying that the damage was done before you started taking Propecia, including the diffuse hairloss, or have you lost more hair since you started treatment?

[aj6543]

Matt I mean that I started to late on propecia.

I just don't want to have to spend 10k and then spend another 10k for a second procedure. Plus I think it makes more sense to wait. Wouldnt it be easier to just do one large session? What are the pros and cons for each option?

[mattj]

If Propecia is working for you then it's not certain that you'll lose everything, and especially not within that time frame. Even without drug intervention, hairloss can be slow and unpredictable. How did the doctor determine that you will lose the rest of your hair within 4-5 years? I'm not saying that he's wrong, but did he explain his reasoning?

That leads to the main factor against waiting. You don't really know how long you'll have to wait. Five years could pass and you might not be any worse off than you are now.

If you are not so unhappy that you feel you have to get a transplant immediately, then waiting is not a bad idea. It's never a bad idea to hold off from getting a transplant. So many guys with MPB want to rush into it and get everything fixed yesterday, but if that isn't your state of mind then good for you.

Regarding the money aspect. One large procedure will likely cost near enough the same as the two smaller procedures spread out over time. There will probably be some savings to be made as with larger procedures doctors tend to reduce the price per graft, but you're still looking at spending more money in one go.

It looks like you probably have plenty of styling options available to you. The temple recession isn't too bad, and that strong forelock gives you options at the front while also helping to hide the thinning behind it. Looking again at your photos, I see the third one shows that you can actually hide your hairloss pretty well.

[gillenator]

aj,

Anything you can do to hide, disquise, cover the loss is a good thing because as was said by many in this thread, "a hair transplant should be one's last resort".

I wanted to add a couple of things. One of the downsides to doing it all in one procedure is that the amount/volume of sustained loss of natural hair to accomodate the placement of another 2500 grafts is surmountable, meaning, that significant additional loss would be necessary to place those extra grafts (surface area). Over time, that area of additional loss would become fairly noticable. Chances are you will pull the trigger before that would happen.

Another downside that rarely anyone brings up is the fact that literally no one documents nor publishes their respective yields from 4500 plus mega-sessions. WHY?! In a majority of the cases they would see that the yield begins to significantly drop! And the patient is the big part of "We"! Many would begin to demand partial refunds.

Another risk in doing it all in one setting is that if you're not happy with the final result of 4,500 grafts, you're already committed. If you do it in two procedures and you are not happy with the first result of 2,000 grafts, I doubt you will go back to the same doc!

If it were me, I would break in down into two sessions, option one.

Best wishes to you AJ on your final decision!

[aj6543]

The doctor made his conclusion after looking at my hair and then asking about my family hair loss. I told him about my father who seems to have very similar hair loss. He is in his sixties and is not completely bald, but little hair and mostly a forelock. (Also, I have a older brother who is 30, his hair loss pattern his different. He has thinning, but no hair loss in the temples and his hair loss has not progressed.)

Also, another doctor wants to shave my head to add 2,500 grafts to build the hairline and thicken the hairs behind the forelock.

[aj6543]

Can anyone provide their input on my last comment?

A second doctor, has a different approach to my hair loss. They want to build around the forelock and put hairs in the thinning area behind the forelock.

Both doctors are very good but have two different methods of dealing with my hair loss. What is the best option?

[mattj]

I think both approaches are good. I actually thought you were talking about having grafts placed behind the forelock originally. Your hair in that area looks to be of a density that you could go either way - leave it or strengthen it. To strengthen it could extend the time before you would feel like you need the second procedure.

[Carzar555]

I would experiment with very short hair cut options first. You need to know if you might be happy with a short hairstyle before you end this option with a strip scar. You may end up with a wide scar even in the care of the best doctor. It depends on your healing characteristics. You are young and may change your mind. Very short haircuts are always in and make your thinning harder to notice. You have a lot of hair still so I would wait, experiment with hair length and make the decision after 4-5 years. You may be surprised and keep more than you think with Propecia.