The painful truth! How can I get help?

[Hairdude]

I would just get a transplant and get it done with. What is going to fall out is going to fall out, let it. I don't know what it costs for generic Finasteride, but I am sure over a 10 year period, it is cheaper and less hassle if you got a transplant now. Since your frontal hairline is not an issue, you should get excellent results with a transplant.

[Ragckr]

If I were you, I would start in on Finasteride as soon as possible. To be honest, a hair transplant is probably not the best idea to jump right into at your stage. It would most likely give you EXCELLENT coverage right now..............but what happens if those temples start to recede some? What happens when you now have a HT scar on the back of your head (cant shave your head anymore) and you cant donate more hair to the front because you used it all in the back?

In my opinion (based solely on countless hours of research, not a medical doctor here) I would hold off on a HT, and instead start right in on propecia. Give the finasteride a good chance and see what happens. Maybe it will fix the problem for you...........perhaps it will maintain what you have. If it turns out Fin. is maintaining what you have, then I would explore the possibility of a HT in the back. But only after you can for certain say that your frontal hairline is not moving.

Just my opinion there.

[PayDay]

Why go though the hassle and expense of a hair transplant until you need one? See how Propecia works and you can always use Dermatch to cover the thin spots. What if you need to restore your hairline someday? Save your grafts in case you really need them!

[Mark Baxa, MD]

I know that everyone here has an opinion. I can only state that as a MD [Medical Doctor] .... In my experience I would recommend what 'Payday' and 'Ragckr' have stated above.
First try the conservative approach .... That would be Finasteride!
A Hair Transplant can always be done at a later date if you still wish .... but it can not be un-done.
So why not try the 'Easy-Button' approach first!
In reference to the cost over ten years .... Well, you will know in the first 18 -24 months if the Finasteride has worked for you! If not, then you can consider the more invasive appproach .... That being a Hair Transplant.
Mark D. Baxa, MD

[Hairdude]

I made that statement assuming there is not excessive frontal recession. He is 48yo, so chances are that he is not going to recede too much in the front in the future. I guess trying FIN for 18 months is a reasonable less invasive approach, but he will have to be on it for the next 30+ years, and if he stops taking the medication it's going to fall out. If it were me, I would have the HT done, he seems to have good donor supply. Rather than "try" Finasteride for 18 months, I would have hair in 8 - 12 months and never have to worry about it. If he's too concerned about the scar, then go FUE. He can always get another HT later if he needs one. I think in the future, HT will be like getting braces for your teeth, if that hasn't happened already.

[Mark Baxa, MD]

In hopefully addressing the original question ..... And to just add a friendly comment for Hairdude. I understand your concern about HT verses Finasteride, however as in the 'real-world' of Medicine & Surgery, we do generally try the less invasive techniques first [i.e. for a fracture we place a cast on the broken limb ... before considering just going to the operating room to insert a rod into the cortex of the bone //// In cardiology we prefer medications to control BP or decrease lipids, before angioplasty and placement of a stent ~ or ~ taking the patient into the O.R. to do a open-heart bypass graft].
I understand that this is just dealing with 'hair' ... But I still like to advise my patients on ALL options available and if they are a candidate for medication [i.e. Finasteride], then I will offer it.
However, as you pointed out ... definitely some patients are best just going directly to HRS [Hair Restoration surgery] ... However, I do still like to educate the on all options and create a viable plan for them.
I discuss these facts with my patients and new consults everyday.
Two comments that I think are important [and may shock the HT community] .. First, Finasteride is pretty effective at lowering DHT, thereby it does take 18 -24 months to really see the full benefit of the medication. Most men will take it for years [which is not a bad thing, considering it is also very effective for maintaining prostate health and lowering your risk for BPH and Prostate Cancer]. Then when and if you do decide to stop taking Finasteride .... Your hair does NOT just fall out! Instead, the DHT will have to build up again [over 18-24 months] before you will then 'start' at that point to have progressive thinning and the hair loss that you may of had many years earlier ... but it will take time and 'start' from the point in which you stop taking the medication.
Secondly, [and I am sure this will get alot of comments], FUE is NOT a new or wonderful or fabulous procedure! I only advise it when my patients have had extensive HRS [usually the old plug method of the 60's & 70's] and therefore have alot of scar tissue and limited donor supply! Then FUE has a good place for HRS. On that note, I feel that ALOT of Doctors & clinics tout the FUE as a 'Scarless Procedure' ... ONLY for 'Marketing' and 'Revenue' for their office!!
FUE is NOT a Scarless procedure .... instead you just have hundreds of small punch holes which WILL leave hundreds of little round scars!!!
Even in the best of hands [i.e. The Surgeon] ... FUE is a BLIND procedure that leads to transected grafts and alot of WASTE of good donor and follicles!
So do not be mis-lead on this point!
FUE does have a place ... and I use it only in very select patients.
FTU [Follicular Transplant Units] are in 'my' opinion ... still the Gold Standard!
I would also add [and I am sure that this will stimulate discuss] ... That the 'New' rage of "Ultra-Refined FTU's" .... Is just a 'finer' type of FTU ... and therefore is again just another marketing tool to stimulate office/clinic revenue!
I can say all of the above, because I have been doing HRS procedures for MANY years and I have pretty much seen it all .... Plus, I am successful enough that I do NOT rely on all the 'B.S.' marketing Hype that unfortunately plagues the field of HRS.
When it [HRS] is done correctly, it can and is a fabulous and life changing procedure .... any of the above [i.e. Ultra-refined FTU, FUE or even FTU's] in the wrong hands can leave the patient wishing they had never done anything at all!!
I see many unfortunate patients everyday ... who now have limited donor, many scars or round FUe punch holes .... still in need of repair work.
I could go on, but enough siad.
Sorry for the long 'rant'
In closing, i would just ask the members of this forum to choose wisely and always look at the Doctors work .... and above all, get educated on all the options.
I hope this puts this matter to rest.
Best Regards, Mark D. Baxa, MD

[Hairdude]

Dr. Maxa,
My apologies if I offended you or anyone, that is not my intention. I only had the strip method, so I can't comment on the FUE other than what I have heard or seen. I also know that it is not for anyone. I was unaware of the high amount of transected grafts - so your rant is welcome and educational. I am in my early thirites and HT has changed my life. I am only voicing my opinion as a satisfied patient and for me I just don't want to take any meds for the next 50 years, again that is for me. Thank You.

[Someguy]

Thank you all for the responses. Say if I were to get a HT, how would I pay for it. In other words, would he do 400 hairs until I could pay for the next 400 hairs ect? Or would he do it all at once.

If a HT is permanent, I wouldn't mind going that route. However, I can't afford it. I will look into the other methods as well.


By the way, when you say a HT causes a scar what do you mean?

There is a Dr. Feinberg by me in Englewood NJ. He looks very good from the little I know. Does anyone know about him?

I can't believe I'm discussing this. I never thought I would have a spot on my crown. The days of denial are over.

[the B spot]

FUE is certainly not a scarless procedure. However, by using .8 .9 and 1.0mm punches tailored to the patient, once can minimize the "potential" scarring and be left with no visible scarring.

Of course, as you continue to take from the donor, there may be gaps or some white dots that effectively give the donor a moth-eaten look that renders the argument moot---it is the doctor and patient who must be judicious and forward looking when advising and performing this procedure.

We have found FUE to be a great adjunct to our clinic. Instead of turning away certain patients we can help them instead of slapping a strip scar on them and forcing them to wear longer hair forever. These patients have options for their future.

Also, those who need a 4-500 graft touch-up in the temples, or those who cannot deal with a strip scar, FUE is an excellent alternative.

FUE elicits very strong opinions--there are those who oversell it, over-hype it, and put patients at risk both short and long term. Then there are those who either cannot perform the surgery properly or will not invest the time it takes to get really good at FUE who will not support FUE as a first option and a great one at that. There doesn't seem to be a middle ground, for some reason
Take Care,
Jason

[Someguy]

I went to get a free consultation today from a Dermatologist who does hair transplantations. He said I would only need around 800 grafts if I remember correctly and it would cost me a little over 4 grand. I guess I can go for that.
I can't afford it now...