I need your advice?

[mandg]

Age: 30
Meds: Propecia (3.5 yrs)
Hair loss began: Age 22.

Considering the following Docters for FUE:

Hasson and Wong in Vancouver,
Dr. Feller in NYC
Dr Lindsey in VA (Feller Medical)
Please feel free to make a recommendation!!

My questions:

1. My goal with HT's (FUE) is to keep a step ahead of the impeding loses and hopefully in about 5 years have a thick full head of hair again. Is this possible?

2. Do you recommend placing grafts on the scalp area where good hair is still growing - such as the center front? Some people on the boards have said it will cause good hair to fall out.

2. How many grafts would I need to restore my hairline in the frontal region? How many to restore the crown? I was thinking around 2000 to 3000 for the frontal region?

Your help is greatly appreciated! Thank you.

[StressedToTheBald]

I have very similar hair loss.
How do You range on Norwood scale - 4 or 5 ?

[mandg]

I have very similar hair loss.
How do You range on Norwood scale - 4 or 5 ?

Between a 3 and a 3v... I think.

[StressedToTheBald]

Between a 3 and a 3v... I think.

Many thanks for the answer. Then I'm surely not 5. I'm either late 3 or early 4. I have receding hairlines, same as You, and balding in the crown, same as You. Not sure density wise, its hard to tell, I might somewhat worse but not too much.

I think You are right regarding the number of grafts.. it could take around 2000 grafts for the front, and probably similar for the back.. to achieve good density.

I too would only go for FUE, thats if I could afford it..
As for the details.. surgeon would know best, maybe ask Dr. Cole - he is much focused and mainly does FUE.

Its hard to predict I guess, even with transplant, what would happen to the rest of the DHT non-resistant hair.. Your question in that sense in a excellent one - would it make sense to implant hair even in these places, it would be like acting in advance, just in case. Trouble however is - even if this is done - You'd then need way many more grafts and the cost of the procedure would sky rocket as well.

[StressedToTheBald]

Forgot to ask.. You used propecia for 3,5 years with no results ?
I myself am against propecia. Don't know which is worse - that it carries significant side effects or that it doesn't even work with so many people.

[mandg]

Thanks for the tip!... I will check out Dr Cole. I've actually read some posts about him, he seems reputable.

Its hard to predict I guess, even with transplant, what would happen to the rest of the DHT non-resistant hair.. Your question in that sense in a excellent one - would it make sense to implant hair even in these places, it would be like acting in advance, just in case. Trouble however is - even if this is done - You'd then need way many more grafts and the cost of the procedure would sky rocket as well.

Propecia or no propecia - I'm headed for a 5V. Without an HT, I will be there by 45. I like the idea of being preemptive and placing grafts where hair exists so long as there is enough donar hair to cover everything. I'm not rich but I really value my self confidence.

I'd like to get all the work done at once rather than breaking it up over a ten or fifteen year period. When all is done, I'm thinking it will take 4 procedures to cover the frontal and crown region. The big question is... Do I wait for the area to go completely bald?

[mandg]

Forgot to ask.. You used propecia for 3,5 years with no results ?
I myself am against propecia. Don't know which is worse - that it carries significant side effects or that it doesn't even work with so many people.

Its hard to say... I started taking it over three years ago and haven't stopped.

[StressedToTheBald]

Thanks for the tip!... I will check out Dr Cole. I've actually read some posts about him, he seems reputable.



Propecia or no propecia - I'm headed for a 5V. Without an HT, I will be there by 45. I like the idea of being preemptive and placing grafts where hair exists so long as there is enough donar hair to cover everything. I'm not rich but I really value my self confidence.

I'd like to get all the work done at once rather than breaking it up over a ten or fifteen year period. When all is done, I'm thinking it will take 4 procedures to cover the frontal and crown region. The big question is... Do I wait for the area to go completely bald?

It may or may not be, with some people I guess it progresses down the road, for others its slower or remains pretty much the same. I'm not absolutely sure even about my own case.. I think my baldness hasn't gotten any worse.. I believe I'm not any worse today than I was a few years ago.. but then again, its hard to be sure, and its hard to predict what will happen in the next few years.

I understand, selfconfidence is a big thing. Baldness has killed my selfconfidence to a very good degree.

Donor hairs are limited as far as I know, although I still fail to understand why as we all have plenty of hair sideways.. anway, If You need at least 2000 for the front and 2000 for the crown, its a question how much there would be left to increase density elsewhere.

It would be more straightforward if Your areas was completely bald, then it would be easier to know where You stand and results couldn't be compromised later in the future. The trouble is, if You can wait or even if thats gonna happen at all. I'm not sure even the surgeon would be able to predict if You'll eventually end up completely bald.

Some seem to claim that for extensive hair loss, only FUT can be a solution. Regardless of the answer, due to scarring etc. I personally would never do FUT.

[StressedToTheBald]

Its hard to say... I started taking it over three years ago and haven't stopped.

Well, judging by the pictures, unless You started as Norwood 5 or 4 those 3 years ago, that would be a proof that it worked to a degree. This way, I don't see You regained full density like in those advertising before/after pictures, even though You've been on the drug for much longer ! Those pictures showcase 1+ or 2+ years of treatment and supposedly very much increased density after that time.

[Tracy C]

I need your advice?

Age: 30
Meds: Propecia (3.5 yrs)
Hair loss began: Age 22.

Hi mandg,

You need to be aware that Propecia is more for maintaining what hair you still have than for growing hair back, though for some people it can allow hair that can grow back to grow back. To conclude that Propecia is not working for you based on lack of regrowth is not accurate. If you haven't gotten any worse, the medication is working for you. If you are not experiencing negative side effects from Propecia, you should continue using it. Though you may want to consider going to a generic to save money.

Propecia blocks the hormone that triggers hereditary hair loss - but it does nothing to stimulate hair follicles that can grow hair to start growing hair. Rogaine is a growth stimulant. Rogaine stimulates hair follicles that can still grow hair to start growing hair again - but Rogaine does nothing to block the hormone that triggers hereditary hair loss. These two medications do two different things. When used together, they help each other.

You are currently a NW3 with the beginning of NW3v. I do not know how long you have been at that stage. I bet it has been at least three years though. However, if it has been longer than five years, you will not likely see appreciable benefit from using Rogaine. If it has been less than five years, you may see appreciable benefit from using Rogaine.

Concerning your questions about hair transplant surgery, you need ask the doctors those questions. Certainly do not listen to StressedToTheBald. He is heavily misinformed and will likely steer you down the wrong path. You can find the most truthful information about treating hereditary hair loss at this link.

http://www.americanhairloss.org/

[John P. Cole, MD]

Tracy C, you seem well tuned to hair loss and treatments. I've been seeking answers you have for years without success. Thanks. You know that many people have perceptions about hair loss and hair treatment that lacks scientifically conclusive data. Stressed is not more right or wrong that you are so the more appropriate path is to simply state your perspectives without challenging someone whom you cannot conclusively adversely confront.

Mandg, you are 30 and very potentially going to a class 6. No one can say for sure without evaluating the mid-scalp for miniaturization, but i'd say it is likely. How long will it take you to get there? I don't know. Look for a family history. In the abscense, it is impossible to tell. Hair loss goes in stages. It accelerates. Stabilizes. Stalls. Accelerates. No one knows if the stall is due to medication. We certainly like to think it is medication. No one likes to waste their money or take unnecessary risks.

How many grafts?

Look, treatment is very individual. The things you need to look at are hair density, follicular density, hair diameter, curl/wave, area of loss (present and potential), desired personal goals, and trichoimetric surface area. Here's the tricky part. Find someone who can give you this information. Good luck!

Patient donor capacity determines potential results. It's not magic. If you don't have the proper size and number of bricks, you can't build the house that someone with more substantial building elements can achieve.

Currently, your mid-scap looks good. I can't say when you will loose it, but i suspect it will happen. perhaps not, but it is probable. thus, be careful with what you do in the crown and be careful how low you build your hairline.

If your trichometery is greater than 90, I think you can be much more aggressive than if it is 60 to 70. A trichometry of 90 suggests higher diameter, higher follicular density, and hair hair density. The number of grafts in the front depends on the hairline location you desire. Lower spells more grafts. Crowns always eat up more grafts because the hair grows in 360 degrees back there, which means there is less shingling affect in the crown area. One always needs more hair in the vertex to make it look full.

Let me give you an example. A patient with a hair diameter of 82 and trichometer of 92 had 1400 grafts in the frontal area. The resulting trichometery showed a 62% to 76% loss in the front and top respectively compared to the donor area, yet the patient looked totally full. in other words, the 50% loss rule does not apply. What applies is individual characteristics. Only someone who evaluates these variables and understands them can give you an interpretation of what you can expect based on your donor area, recipient area, goals, and anticipated hair loss.

I'm really not sure where you are headed, but it could be significant. Therefore, i would certainly encourage you to either do nothing or to seek medication or FUE. I'd steer clear of a strip procedure simply because your situation can get a whole bunch worse over time and only God knows for sure where you are headed.

The photos suggest you might be worse off or better off. Hard to give a recommendation based on them. Don't be upset. Poor photo quality is very common and even with good photos it can be hard to tell.

[Tracy C]

Tracy C, you seem well tuned to hair loss and treatments.

I pay attention.

I realize you likely do not have the time to spend enough time here to see what StressedToTheBald has been doing in this forum. He has been doing more harm than good and I am not the only person who knows that.

[John P. Cole, MD]

Tracy C, I spent a good bit of time tending forums at one time. I am the first to admit that I don't spend much time there any longer. What I can tell you is that I have skimmed here and there the past few days. I think i will tag along for a bit of time because there are multiple perspectives valuable to the decision making process.

There is no such thing as not having time. There is not making the time. I stopped making time for forums because i found them distasteful because so many people can be quite rude. I'm going to make a bit of time now only to voice a different perspective. I certainly hope to avoid hurting anyone because at the end of the day no one is necessarily wrong.


Now, let's take stressed. He seems to be concerned about medication. What's wrong with that? Do you know that class action lawyers are starting to snoop about finasteride? Their radar comes on for a reason. I'm not saying it's right or wrong. I'm just saying that Columbus was sure the world was not flat. Don't condemn a guy just because he may sound off irrational fear that stirs petulance. He may turn out to be right. No one knows for sure at this point. I can honestly say that i have no idea whether the vast majority of my patients have responded positively to propecia. i can say that about 1 in 1000 had a noticeable response. How do you measure that risk to reward?

[Tracy C]

I can honestly say that i have no idea whether the vast majority of my patients have responded positively to propecia. i can say that about 1 in 1000 had a noticeable response. How do you measure that risk to reward?

I think at this time it would be very appropriate to ask you to describe what "noticeable response" means to you.

I also think it would be very appropriate for the other doctors to share there numbers and assessments as you have here.

What StressedToTheBald is doing is fear mongering. Fear mongering is not a good thing under any circumstance.

[John P. Cole, MD]

I wouldn't say it is fear mongering. i'd say it is a personal concern. He's not alone. Do you have any idea how many patients I see who refuse to take finasteride, minoxidil or any other prescriptions medication? Honestly, more of my patients refuse to take medications.

Let's look at smoking. Fifty years ago 50% of people smoked. Americans became wealthy selling nicotine. then someone discovered a cause and effect to cigarettes. Now what is the world like?

What is a noticeable response? More hair! How can you evaluate similar coverage? You can't. someone with fine hair and a low density can loose a very small degree of hair diameter and look significantly thinner, while someone with coarse, dense hair might loose much more hair diameter and still look full as a tick. Does it mean that someone is responding to finasteride because they look the same for 10 years? No, not really. Some people look the same for 40 years and then start loosing hair. Some stabilize off mediation for over 10 years and then accelerate off medication. you really don't know.

Tracy C, i really like hearing your perspective because i have to admit that i make mistakes. Unless someone challenges me to re-evaluate my opinions, I might continue to make mistakes. Sometimes a challenge gives me a AHA moment. So....keep it up.

I really don't know you well. I'm not sure if you know me. In North America there were three physicians who promoted FUE back in the early days of 2002-3. They included Robert Jones, Alan Feller, and myself. Between the three of us, i'd say that the vast majority of people who do a great deal of FUE learned from us. Over the years, i've probably done more FUE than anyone else and certainly more FUE grafts than anyone else. Over the past 10 years I've promoted FUE over strip surgery because i think FUE is far superior to strip surgery. There are many physicians who do not agree with me. Physicians are notorious for their sluggish acceptance to change, not that this is a bad thing. Despite adversity to FUE, i continued to promote it and improve it. Today over 22% of all hair restoration surgeries are done by FUE and the total percentage of FUE cases increases annually. In other words, adversity does not limit my interest in something that i consider superior. Adversity would similarly not limit my personal consideration of those things that i don't necessarily agree with. I simply continue to state those features that i feel one benefits from FUE.

I'm not going to tell someone that he is wrong for having a strip procedure. I will simply state why i feel FUE is superior when properly performed. Similarly, i'll never put a gun to a patient's head to tell him that he needs to take propecia. If competitive blocking of 5 alpha-reductase worked so well, everyone would respond to decreasing DHT. the fact is that most don't have any noticeable response and you can't properly evaluate a lack of response. Gather all the opinions of all the doctors you know and challenge them to give a more positive response to finasteride. The best they can do is tell you that the 5 and 10- year data shows that over that time span you have more hair on medication than off. Now, how do you determine more hair? Any time you want, I'll send you a photo of hair. You count what you see and i'll tell you how wrong you were. You can't count hair in a photo. It's really absurd to state that a medication grew more hair. Wasn't that the response to laser treatment that was sent to the FDA. You can't count hair in a photo. it's impossible. It's ridiculous.

I'll give you an example. Recently when the editor of the "Hair Transpalnt Forum", Bill Reed was in my office i told him i'd try my best to extract a single hair graft. Try as i may, every graft I thought might be a single turned out to be two hairs. Why did it do it? Because i wanted to show him that natural singles were rare. WhY show it was rare? Because most strip surgeons make 20% of their grafts single hair graft and that number simply does not exist. What's the point? if I'm looking at individual grafts with 6X loops and can't tell if a graft is one hair or two hairs, how can a photograph from a lower magnification do better? It can't. Thus, don't worry about the concerns about someone over medication especially when it really is almost impossible to note a positive response in most individuals. If you come across a large body of physicians who have seen a "positive response" to finasteride, i'd sure like to hear their commentary because in over 20 years of treating hair loss, i've not seen anything close to such a confirmatory response to any medical treatment.