Getting FUT in NY - need help deciding between doctors

[rel1422]

I am almost 30 yrs old and have been losing my hair for about 10 years. For the first few years I didn't know better and did not do anything about it, but finally went on Finasteride when I was about 24. I tried Rogaine foam and oil but it was too greasy and didn't fit with my lifestyle/routine. I assume that the finasteride has helped me keep some of what I have, but I have still lost a lot on the crown and in the front, and am at the point where I am ready for a HT procedure.

I have done a bit of research online and on the forums (there is WAY to much content out there to read everything) and have had in-person meetings with 4 doctors in NYC: Bernstein, Wesley, Dorin and Mollura. Their recommendations and proposals all differed slightly. I am having a difficult time making a decision.

Mollura - ruled out because I do not want to have any procedure at Bosley/Hairclub

Bernstein - recommended 2500 grafts. 1500 in front, 300 middle, 700 in the back area. The hairline he drew was not too aggressive and not too conservative. I liked it the best. The only drawback was the cost, which was significantly higher than the others.

Wesley - recommended 2200 grafts, but ONLY IN THE FRONT/MIDDLE. I really want to fill in the bald spot in the back, and Wesley seemed to be the most conservative about this. The other 3 doctors had no qualms whatsoever about doing the front and back in the same procedure. Furthermore, the hairline that Dr. Wesley proposed was the most conservative. He took a lot of time to explain things to me and the passion he has for his work is clear. I may go back to see if he would consider doing more grafts and filling in the back, because otherwise I really would be leaning towards Dr. Wesley.

Dorin - recommended 2500 grafts, 1800 in front and 700 in the back (pretty much the same as Dr. Bernstein). While the amount of grafts was the same as Bernstein, the hairline Dr. Dorin drew was MUCH more aggressive/lower down on my forehead. It was easily the most aggressive hairline of all the Dr's. He also seemed the most concerned with shock loss. He also said that in areas where there is no existing hair, the transplanted hair will only be 1/3 as thick as natural density, so my natural question was why not raise the hairline and increase the density in the recipient area. I don't think I really got a good answer to that question. Anyway, I was just concerned about the aggressiveness of the hairline and high aversion to shock loss.

Can anyone add any thoughts / provide any insights here? Im pretty much ready to schedule this thing, just need to make the decision!

[Rekoj]

Why can't you please post the Cost you were quoted ? Please ?? Im in the same boat you are accept im not in NY but Im trying to get an idea of cost in general ???

[gillenator]

rel1422,

It's good that you pursued multiple opinions and IMHO, three out of the four docs that you consulted with are talented and reputable. I agree with you in not considering any of the large hair clinic chains for the obvious reasons.

A couple of things. I do not believe that any of the recommendations are cut in stone so-to-speak especially considering the placement of your hairline and the proposed density levels. But since the majority of the docs are proposing an initial graft level of roughly 2500, then that is probably based on taking a strip that is appropriate for your present laxity and donor density. They undoubtedly are evaluating a strip that is not too wide so that you end up with a thin strip scar, rather than risking a wider than desired scar if the strip was taken too wide in order to harvest more grafts. Not sure how long the strip specimen would be but probably would go across the entire donor (occipital) zone.

If you want to do both areas to start with, both crown and frontal zone, then the graft count is not as optimal to work with considering both recipient areas, something you already appear to know. You can always raise the proposed hairline to increase the frontal zone density and lower it a tad bit in a future procedure. I did that myself in my own case. Yet not knowing the exact dimensions of both surface areas to cover, it's hard to estimate how the grafts should be distributed and can be a bit subjective for any of the docs you are considering. Remember, these are estimates which can be fine tuned later.

Another thing. All too often we hear about docs "not" discussing the apparent risk of shock loss. Many guys can be frightened by the real possibility of it and I for one believe that it should be discussed 100% of the time when the possibility exists so that it does not come as a surprise when or should it occur. Also, some docs will make a point to discuss it if the patient shows diffused thinning or advanced sigs of miniaturization because that is the native hair that is mostly at risk of shock loss. And the weakest hair may not grow back once it is shocked. That is critical to be aware of and to also plan for it because you want your restoration to be done in a way that keeps the level of trauma to a minimum.

This is why some docs will not increase the level of density too high when there is neighboring hair that is diffusing or weak hair within the recipient area. The higher the level of trauma, the higher correlating level of shock loss can be. Again, I admire that this factor was taken into consideration and to prepare patients of the possibility, ahead of time.

Also, anytime the patient is starting with a bald surface area, there are only so many grafts to work with considering you desire coverage in two separate areas. It's not that the density level in your crown could not be increased but obviously that will leave fewer grafts for the frontal zone. In addition, the crown can potentially take up to 50% of one's available scalp donor so prudent management of one's limited donor is imperative. As you know, MPB is progressive and your crown will continue to open up and your frontal zone will continue to lose. Would you rather have a more restored hairline and frontal zone or a more dense crown? That is something we all have to consider for ourselves as individuals but I can tell you firsthand that my own frontal zone is far more important to me than my crown. And many guys feel the same way because we interact facing people more often than not.

Lastly, you stated that you are continuing to lose in the crown in spite of being on low dose finasteride long term where finasteride is supposed to be the most efficient. This could also be why your graft count is being considered on the conservative side because there will be further loss there in the future. And you don't want to be caught in a long term situation of having to commit more and more donor to that area. You said you are continuing to lose in the front as well so again, prudent management of your finite donor supply is critical.

BTW, what Norwood class are you at present and how advanced is the hair loss in your family history?

Wish you the best in your decision making process and continue in your research because it will provide you more and more information to base any decisions from...

[rel1422]

Gillenator - thank you for your thoughtful response. These are all points that I discussed with the doctors. I ended up choosing one of the doctors and have the procedure coming up in the next 1-2 months. One of the docs classified me as NW5... I have thin coverage over the back of crown but not completely bald and then thicker in the middle and thinner again up front with recessions into the temples.

I have one more question that I hope folks can weigh in on - I am planning to return to work on Day 17 after the surgery. How bad will the redness be in the front around the hairline/on my forehead and in the temples? I plan on using a concealer in the back/crown but I know that wont work to mask the redness in the front. Is there anything you can do to cover the redness if there is any on the forehead/temples (makeup, etc.)??

I havent seen any pictures of an FUT on Day 17... would be great if someone can share a link if they know where to find them.

[tercex11]

rel1422, everyone differs so there is not way to know for sure. In my case I went back after 10 days and was not very red, but by about 30 days I had gotten much more red and it looked like I had a sunburn on my scalp. Nobody at worked asked, but I figured I way say I had gotten too much sun if asked. Someone on here suggested that I only shower with cool water, which did seem to help over time, but I would say I was at least a bit red for two months.

[gillenator]

rel1422,

If you are a good healer, there should not be any visual problems within the recipient area. In other words, there should not be any lingering redness by day 17 post-op. The recipient incisions are very small and not very invasive so the healing of these micro-incisions heal very quickly for most people. Aside from the healing, some individuals can be a tad bit collagen deficient and then the post-op redness can linger for awhile. You won't know until you get there.

There are some quality make-up products and I always recommend the granule based higher quality options that are not creams but a powder base that is used for foundation. You can mix the base to match your skin tone to a perfection. It's very popular with women.

Should there be lingering redness that exceeds 30 days or so, then there are topical cream steroids that can greatly diminish the redness. Your doctor can explain that when you have your procedure.

Congrats on your upcoming procedure and best wishes to you my friend.

[whoa45]

Hi rel1422 ,

Can you say who you ended up choosing and why? If you prefer, I can PM you if you don't want to say publicly.

Gillenator, where is the PM function, I can't seem to find it?

Thanks!

[rel1422]

Thank you to Gillenator and Tercex for the info. I had the procedure done and I think it went very well, but obviously still need to wait ~12 months too see the final result. The redness lasted more than 17 days, but I am using concealer and its helping a bit (but doesnt completely mask it).

Im so happy with everything that assuming the results are good, I want/need to go back for a 2nd procedure in 12 or 18 months to increase the density without lowering the hairline any further. My thinking is that I will do a 2nd FUT but this time with trichophytic closure, and then if I needed any additional procedures down the road (or wanted to fill in the scar) I would then do FUE's. Does that make sense / is there any downside to doing 2 FUT's and then switching to FUE?

Hi rel1422 ,

Can you say who you ended up choosing and why? If you prefer, I can PM you if you don't want to say publicly.

Gillenator, where is the PM function, I can't seem to find it?

Thanks!

Whoa45 - I honestly could not decide between the 3 doctors mentioned above because I trusted that they would all do a good job. I ended up going with the doctor who had availability that worked best with my work/vacation schedule.

[Hicks]

Do a search for for FUT and FUE. I "THINK" I read they did a study and the doing FUE had a different type of scarring because the FUT might of made the scalp tighter. Please don't take this as gospel. Maybe someone else can chime in about this. Either way it is worth exploring and something to ask the doctors.

Are you taking brand Finasteride i.g.Proscar? I hear generic finasteride is not as effective as brand but that could be rumors as well.

I'm in the same boat. Try to increase density or lower the hairline. I am hoping some PRP sessions help with the diffused thinning. Dang hair takes forever to grow.

8.5 months out is when my HT started to fill in. I'm 10 months out and I HOPE density kicks in some more.

Best of luck and keep us posted!

OK I just reread your post about FUE after another FUT and hairline. my mistake. ignore

[rel1422]

I just typed a very long and awesome reply and then lost it so Im going to make this shorter -

I went to one of the above 3 docs at 24. They said too early for HT but to get on Minox and also prescribed 5mg generic finasteride to split into 1.25mg doses. I took the finasteride on avg 4 days a week from age 24 - 29. I say 4 days on average over the period bc sometimes I would forget to take, would be away from home without it, or would be off of it for a week or two between prescriptions. There was one or two periods when I was off it for a couple months. Different dermatologists and doctors refilled the finasteride prescriptions over the years and nobody ever asked or mentioned anything about switching to name brand. Never really did the Minox at all. Never noticed side effects from the finasteride. Have a very dry scalp but almost 100% sure that has nothing to do with finasteride. I reign that in by alternating with prescription Ketaconazole shampoo and Neutrogena TGel every day and it seems to work.

I got serious about a HT, spent 20 mins online doing research and found this website, and then went back to same doc (as well as the others) at age 29 a few months ago. He thought the finasteride likely helped, probably more in the crown and more towards the bottom/back of the head, but I still had experienced a lot of loss in that 5 or 6 year span and my hairline had receded a lot (so the doc was right to advise not to do the HT at 24). He said to actually increase the dosage of generic finasteride to 2mg daily. None of the docs said it was too early for a HT this time around :-)

A few questions -

1. Are there any drawbacks of doing FUE after 1 or 2 FUT's, and what are they?

2. Should I consider switching to brand name propecia and why? If so, what dosage?

3. If I stick with generic finasteride, should I increase dosage from 1.25mg daily to 2mg daily as long as I dont see any side effects? This seems like a lot because I see people here saying 0.25mg or 0.5mg quite often. But then again people take a full 5mg pill so I know 2mg is not going to kill me? I guess Im just a little confused and uneducated on this one.

4. Can i continue to alternate Ketaconazole and TGel daily? Is washing my hair 6 days a week with these shampoos in an effort to fight dry scalp increasing my hair loss? Will it have an effect on the results of my HT?

5. Should I try Minox again and how could it / would it potentially help me? Is it available in pill form or anything besides foam and liquid?

Thanks in advance. I am going to ask all these questions to my HT doc too but want to hear what everyone has to say.

[Still pretty long.]