FUE consideration and advice needed

[daredevil]

Hi,

I am a 28 years old guy from London

Brief background - I had leukaemia when I was 9 and I lost all my hair as a result of chemotherapy. I also had radiotherapy around the top/crown area of my head. My hair has regrown since but it volume has half compared to before my treatment, especially around the crown area.

My hair has been thin (I wouldn’t call it bald) during my teenage years but now that I’m approach 30s I can see a very clear sign of baldness emerging. Neither side of my family has male pattern baldness so I suspect that my hair (or lack thereof) problem is largely due to the radiotherapy destroying my hair follicles.

I’ve been on minoxidil for more than a year and I have not seen an obvious improvement (it might have slower the rate of hair loss slightly). I have not taken finasteride on the advice on numerous doctors on the basis that one of the known side effect is breast cancer. As a leukaemia survivor I have an aversion of taking any medicine that might potentially cause cancer (better safe than sorry).

I am hoping for a FUE transplant but would be grateful for your advice:
1. Am I a good candidate for FUE?
2. Which Norwood stage is my baldness at?
3. How many grafts will I need?
4. Do I have to shave my hair to undergo the transplant? Is there an option for an unshaven FUE?
5. Could I wear hair pieces afterwards? Obviously I’d like to be discrete.
6. Is there a technique that uses hair from a third party or synthetic hair? I’m aware that other body hairs (e.g. chest hair/leg hair) could also be a potential candidate for FUE

Having been on this forum for a while I’m tending towards Dr. Hakan ********* - he seems to have quite good reviews. I am open to alternative treatment/method if that’ll help my situation.

Thanks a lot for your help

 

[Wolf Pack]

In light of your background, first confirm that you have male pattern baldness with a good doctor. finasteride will thicken up that crown or hold the fort so to speak. The risk of breast cancer is very low, even lower than gynaecomastia.

Transplants are good but there is only a limited amount of hair that can be moved. Usually it's not enough to replace all the potential hairs that can be lost on top. If you are destined to not go beyond Norwood 3V and have average donor hair - transplants could work. To determine your pattern of thinning see a transplant doctor in this country - free analysis or £70 for a consultation.

It looks like you're not a good Minoxidil responder so probably can discontinue it. If your hair loss is due to radiotherapy, it usually grows back? You do need to get this checked out and find out the CAUSE before you proceed further. If it's radio/chemo related than you can definitely just get a transplant and quit worrying.

They always shave the donor area, not necessarily the recipient area. Usually a clean shave all round is needed. Probably the worst part of a transplant (for me) but it grows back in a few weeks. At least we are not girls, it would take forever to get their length back.

 

[arfy]

You're a problematic case because you have diffuse thinning. It's considered preferable when a person has a distinct zone of hair loss to address. You still have a good amount of existing hair in your hairline and crown. If you transplant there, surgery can sometimes accelerate your hair loss (shock loss, or "telogen effluvium"). In some cases, the hair returns, but not always - it depends how "on the edge" that hair was, before surgery. Worst case scenario is when a guy gets a transplant, but ends up with less hair than he had before surgery. Responsible clinics will discuss this possibility with patients. If a doctor downplays the possibility of permanent shock loss, ask for a written guarantee (they don't give them). It's always hard to judge from photos, but your hair still looks pretty darn good. Seems like getting a hair transplant would be more of a "pre-emptive" decision, which is most usually not a good idea. Feel free to hang around and learn more, but I think you would be jumping the gun now, and in general, transplanting guys with your characteristics (diffuse hair loss in both the hairline and crown) comes with serious risks.

If you do decide to stop Minoxidil, you should think about tapering off your routine slowly over a period of weeks or months. I believe that quitting abruptly can sometimes lead to shedding. If you didn't respond at all, though, then you might not shed either. But better to be safe than sorry.

I agree with the recommendation to try Finasteride (or Dutasteride), it's less usually less risky than a hair transplant, in my opinion (things can go wrong with a hair transplant). You might even try a half-dose (every other day) to begin with. Discuss this with your doctor though, since you have additional concerns. It would be smart to keep your physician aware of what you're taking.

 

[daredevil]

Thank you for both of your replies.

I suppose belgrave hair clinic is a no-go judging from the general comments/reviews they have on this forum. Crown clinic is a good bet? Hanson and Wong offers online consultation for free - is that good enough?

 

[arfy]

You could certainly do an online consult with Hasson & Wong - they are somewhat new to FUE (so not the most experienced) but you're just talking, right? They have lots of experience with hair transplants, and only the FUE harvesting method is different. But overall, most of the "rules" are still "the rules" if you know what I mean. FUE is an advancement, but it doesn't usually change who is a good candidate versus who is not (maybe in some specific rare cases, but generally not, in my opinion). I think you should get their opinion.

I think it makes sense to talk to a variety of people, but understand that in some cases, they will all tell you something different. (Do nothing, do a small transplant, do a large one, etc). If a doctor advises you to do nothing, you should really listen. It's obviously much easier for a doctor to encourage you to go forward (and then they can make a profit from you.) If a doctor advises you against a transplant, it's significant.

 

[daredevil]

So Hasson and Wong has come back to me.

They estimated I would “need 3000-3500 grafts of which 2000-2500 would be used to address the hairline and frontal area”. They expect to use “1000 grafts into the crown to provide better density here this will not give high density and there will be scalp still visible but there would be an improvement”. This can all be done in one session by the FUT method.

Does this sound reasonable?

3500 grafts seem a bit excessive. I’m not too bothered by my hairline and the frontal area but I’d rather have more hair around the crown area.

Not too sure why they offer the FUT method instead of the FUE one. Any ideas? I would probably go back and ask why…

 

[FWIW]

that is really excessive estimate based on your hairloss imo

 

[kbarnes]

My advice will be do few consultation with professionals , based on your medical history and other complications, we might not be able to provide solutions. But looking at this picture above, doesnt look like baldness to me

 

[azurapose]

Good candidate

It seems you are a good candidate for FUE/FUT

 

[Pequod]

I don't think you can have a 3000 graft FUT or FUE and be discrete unless you are able to take a week or two off on vacation to have it done. There is the chance of facial swelling that happens and also the loss of some hair depending on the procedure you have done. If they add to the front hairline it will be visible for at least a few days until the scalp improves.

The problem for you is your density seems low and so you probably have less grafts to access for hair replacement. Is the hair on the back of your head as thin as the top and front? If it is then this is an issue for you. i agree 1000 to 1500 grafts could help your crown.

You could just do a 1500 graft FUT on the crown and leave the rest alone. They can put the grafts in around the current hair length. With an FUT you don't have to cut any hair if they do it right.

 

[arfy]

It seems you are a good candidate for FUE/FUT

I disagree. I would advise this person not to get a hair transplant, he still has tons of hair left, his thinning pattern is less than ideal, and his goals don't correspond with careful future planning.

The reason Hasson & Wong didn't recommend FUE is probably because they are more experienced doing strip surgery, and save FUE for particular cases which call out for it. Also, regarding the large H&W estimate, they are advocates of the approach that "the first transplant grows the best" (and yield is reduced with every surgery after that). Also, the risk of shock loss is real, and the idea of just adding a few new transplanted hairs here & there, mixed among your regular hair, is mostly a fantasy that newbies have. It almost never seems to go that way in reality. I suspect that H&W are trying to avoid trading in your original hair for transplanted hair. The patient will probably not be happy with just sprinkling in some grafts here and there, patients like to see density in the hairline.

The idea that you want a transplant mainly to address the crown, while showing diffuse thinning in the front, is a big red flag to me. The crown is the last area of priority when planning how to use your donor supply, but you want it to be an important point of your first procedure. To get a better crown density than what you have now would require a lot of grafts - I don't know why Hasson & Wong recommended only 1000 grafts there - possibly to appease you. If any large general area on your head "only" needs 1000 grafts, you probably don't need a hair transplant to begin with. You seem to be a marginal candidate at best, and marginal candidates shouldn't get hair transplants in my opinion.

However, you'll certainly find plenty of clinics eager to do it, and lots of anonymous guys on the internet urging you to "go for it!"