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Advice before FUE consultation

J

JFR8

Valued member
Hi,

Thanks in advance for any advice and the threads here have been useful already.

I've been losing my hair since my mid 20's, so 15 years now. I tried Minoxidil, Nizoral and Propecia (or it might have been its predecessor) back then after seeing Belgravia. Unfortunately I suffered side effects from Propecia (some loss of libido and swelling of pecs) so stopped that after 6 weeks. I continued with Minoxidil (foam now) and Nizoral. Which seemed to slow things down. Up until 5 years ago, with selective haircuts I could live with what I had. In the last few years its got to the point where there's no hiding it. Perhaps the last year where I've started doing a lot of exercise and Whey protein have caused even more shed to get me where I am now.

I'd always shied away from a HT as I didn't want to risk a bad one and figured when the time came I'd just go for a grade 1 and be done with it (despite my OH not liking that look). But several of my cousins have recently had transplants with varying success, although none I would consider bad. So I've decided to take the plunge myself.

Moreover, I suspect we'll have a few more mini lockdowns, so hopefully I can hide away for some of the time post op. I wish I'd done it last year.

After lots of research I contacted the Maitland Clinic. They are a little more expensive then others, but I like a couple of things about them. Firstly all the key work is done by the surgeon, rather than clinicians. Secondly their literature came across as quite honest and realistic, without any hardsell or unrealistic examples. Thirdly they appear to focus on natural hairlines (hopefully counter any urge to go for a 20's hairline), to ensure donor hair is preserved for future top ups.

I've attached a picture which they returned with a rough idea of what they'd propose initially. Approximately 2k grafts. Not touching the crown. This is based on the pictures I sent them and conservative. As I understand it they'd want to examine how much donor hair I have and how my hair loss is likely to progress and only then consider the crown.

I noted on their site they do offer beard hair transplants. I have quite a dense bears from lower neck up. And, atleast to me, it is similar to the hair on my head. So I will be asking if thats a possibility for the crown. And if there are any negatives I should consider. I have read beard hair has different growth phases.

I'll stop there for now. Really I'm just looking for some advice. In terms of what I can realistically expect. Any other things I should consider. And if the Maitland Clinic is a good choice and if there are any other similar clinics in the UK I should consider.

1389320F-0DAE-4E5D-B1B8-D9DC80BEA86C.jpg


Thanks for bearing with me and any advice greatly appreciated.

If I could get back to what I had in my early 30's I'd be over the moon. I'm not expecting what I had in my 20's, I realise thats unrealistic.
 
Bigmac

Bigmac

Administrator
Staff member
Hi JFR8 and welcome to the forum.
You have a large balding area, the area marked out will benefit from 2000 grafts but I think you could do with more in that area. Donor dependent and the possibility of beard hair you may be offered more once assessed by the doctor. I have seen instances where lesser grafts, a more conservative approach produce great results. A patient has just posted a 2000 graft result with a similar area to your marked out here.
See here 2000 graft transplant
Having your hairline reconstructed with density behind it will frame your face, provide a younger look and overall confidence. I like where the hairline has been drawn, it will look good.

It’s a shame you suffered sides from some meds. You could possible try topical versions of Finasteride or oral minoxidil.
All the best.
Bm.
 
Raphael84

Raphael84

Valued member
I would agree with Bigmac in terms of graft numbers. You will find great examples on this forum to really get a sense of what 2000 / 3000 grafts can achieve in terms of coverage / surface area.
As you are considering a consultation, that would definitely be recommended and is the most effective step to allow your doctor to attain empirical data regarding your donor and thoroughly understand all aspects of your case.

An important understanding is that it is an "illusion" of density that should be the objective and there are many factors and considerations personal to each patient and their hair characteristics and calibre as explained in the below video.

Without knowing anything about your case or your donor availability, in most cases patients are able to extract significantly more grafts that mentioned before considering beard, but with a nice ratio of scalp and beard, beard can be very effective as a filler in the right patient. As you have detailed that your beard has similar quality and characteristic to your scalp hair, if coarseness, curl and colour are favourable it can be a very good supplement.

I wish you the best.
 
J

JFR8

Valued member
Thanks for the response.

I’ve had the initial video call with David which was informative and confirmed much of what I’d already read. He also answered my questions wrt to beard hair, which I’d hoped could be used for the crown area.

But Maitland probably wouldn’t want to do that and he suggested looking into a clinic that specialises with using beard hair. They would if suitable use beard hair to supplement along with regular donor hair.

My beard hair, atleast to me appears quite similar. It’s straight, similar thickness. More white hairs on my beard, but that’s acceptable to me as I don’t mind going grey. It’s losing my hair that bothers me.

I’ve read about oral Minox but unlikely to go down that route. There’s a history of cardio vascular disease in my family, so despite being healthy myself I don’t think it would be a goood idea.

Im considering trying topical Finasteride. But reading some mixed messages. Some suggest over time it does build up systemically, which would in my case lead to the same side effects. But since the side effects weren’t permanent I could give it a try and see how I go. Are there any reliable suppliers in the Uk?

After my initial consult with David, I’m going to book the face to face with Dr Ball. At the very least I’d get a good idea of where I stand wrt my donor area. How my hair loss is likely to proceed. For the sake of £100 it seems worth it. Just a pity it appears I’ll have to wait several weeks to get an appointment.
 
Bigmac

Bigmac

Administrator
Staff member
It’s good to hear that David explained everything to you, especially in regards to the use of beard hair. Meeting the doctor in person would give you a better idea what can realistically be achieved and help you decide on how you want to proceed.
I won’t use oral minoxidil for the same reasons, cardio vascular disease runs in the family. You could try a lower dose of Finasteride, see how it goes and then slowly increase it if no sides.
 
J

JFR8

Valued member
It’s good to hear that David explained everything to you, especially in regards to the use of beard hair. Meeting the doctor in person would give you a better idea what can realistically be achieved and help you decide on how you want to proceed.
I won’t use oral minoxidil for the same reasons, cardio vascular disease runs in the family. You could try a lower dose of Finasteride, see how it goes and then slowly increase it if no sides.

Im eagerly awaiting my appointment now. Unfortunately there was nothing until Nov, but keeping an eye out for cancelations. It would be good to know definitively (or atleast as close to) where I stand wrt donor hair.

Finasterside I’m still dithering over. If I do try it again I’m thinking I’ll go a low topical dosage and see how I get on. Given the sides showed quite quickly, I’m hesitant to take a pill which will deliver it all systemically.

Im hoping, perhaps foolishly, it will be easier to strike a balance between effectiveness and minimising it going systemic by using it topically where I need it’s effect.
 
Bigmac

Bigmac

Administrator
Staff member
There are plenty of guys who use a lower dosage of topicals and see the benefits. If you could prevent future loss or slow it right down, then that would be good for you.

While you wait for your appointment it’ll give you time to research and see how you react to the topical. Once you know you have X number of grafts available, you can plan accordingly.
 
J

JFR8

Valued member
Are there any reliable sources that will ship to the UK? Preferably somewhere that offers lower doses aswell.
 
Raphael84

Raphael84

Valued member
Hopefully somebody will be able to help you out and point you in the right direction to be able to source in the UK.
In our experience, Brexit has complicated the process for our patients and with additional tax and courier charges, purchasing and shipping medication from the EU has become very expensive.
 
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H

hopeful

member
A very interesting post which I have enjoyed reading.
I am hoping to have One or Two consultations.
What are folks advise on questions a client should ask the Drs during consultation?
Thanks
 
J

JFR8

Valued member
A very interesting post which I have enjoyed reading.
I am hoping to have One or Two consultations.
What are folks advise on questions a client should ask the Drs during consultation?
Thanks

From my research, some key ones are:

1) What is the extent of your safe donor area (how many hair do you have to work with).
2) How they estimate your loss will progress.
3) Who will do the work, Dr or Tech (remove grafts, prepare grafts, place grafts)
4) What yields they achieve (although hard to verify)
5) Ask for examples similar to your condition (hair loss, type of hair, type of donor, etc).
6) Check online on this forum and others for prior patients and peoples opinions. But i'd still take everything with a pinch of salt. Its still the wild wild west, so suspect patients with great results are sometimes encouraged/incentivised to post. And some clinics probably have their own people posting.

Sure those with more experience will suggest many other questions. But those are the obvious ones, to me atleast.

And unfortunately this is definitely not a service you want to shop around and make price paramount. You only have a limited number of donor hair, you want to ensure they are used to best effect. And god forbid you don't want to lose them due to botched removal/handling/placement. Moreover, avoid anyone that gives you the hard sell.
 
H

hopeful

member
From my research, some key ones are:

1) What is the extent of your safe donor area (how many hair do you have to work with).
2) How they estimate your loss will progress.
3) Who will do the work, Dr or Tech (remove grafts, prepare grafts, place grafts)
4) What yields they achieve (although hard to verify)
5) Ask for examples similar to your condition (hair loss, type of hair, type of donor, etc).
6) Check online on this forum and others for prior patients and peoples opinions. But i'd still take everything with a pinch of salt. Its still the wild wild west, so suspect patients with great results are sometimes encouraged/incentivised to post. And some clinics probably have their own people posting.

Sure those with more experience will suggest many other questions. But those are the obvious ones, to me atleast.

And unfortunately this is definitely not a service you want to shop around and make price paramount. You only have a limited number of donor hair, you want to ensure they are used to best effect. And god forbid you don't want to lose them due to botched removal/handling/placement. Moreover, avoid anyone that gives you the hard sell.
JFR8
Thanks for taking time to reply .
I really appreciate it. I want to make sure I come away from any consultations with the correct information.
many thanks
 
J

JFR8

Valued member
JFR8
Thanks for taking time to reply .
I really appreciate it. I want to make sure I come away from any consultations with the correct information.
many thanks

NP and best of luck with your search.

You do have to be careful, as IMO parts of the HT world really are akin to the wild wild west :/

Don't make budget your priority. IMO an aesthetically bad transplant is not the major concern, ultimately I could still shave it which is my last resort plan. But wasting limited donor and risking obvious scarring are not something you can do anything about after the fact.
 
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H

hopeful

member
NP and best of luck with your search.

You do have to be careful, as IMO it parts of the HT really are akin to the wild wild west :/

Don't make budget your priority. IMO an aesthetically bad transplant is not the major concern, ultimately I could still shave it which is my last resort plan. But wasting limited donor and risking obvious scarring are not something you can do anything about after the fact.
Thanks for the sound advise .
Much appreciated
 
J

JFR8

Valued member
I've had my Consult with Dr Ball.

Firstly it was £100 well spent. I spent roughly an hour talking to David and Dr Ball. Going through history, my hairloss, non surgical options and most importantly condition of my donor and prospects of FUE surgery. It was also useful to see the proposed hairline drawn on my scalp and get a visual idea of what a first surgery would deliver and where I could go from there.

(NB: Apologies if my terminology is off, recalling from memory as haven't got the report back yet, so filling in some terms myself).

So the good news is my Donor is healthy and I have 5-6K grafts before any need to go into using beard hair/etc. Density of 65-70 back and sides (slightly lower on sides then back). Predominantly 3-4 follicles per FU (follicular unit) and they are closely packed together in the FU which makes extraction of the FU easier.

The fact there was little sign of miniaturisation in the follicles and there were so many 3-4's gave him confidence my Donor was safe, although ofcourse there are no certainties. The only negative was my right lower temple (the bit above that sticks out into the forehead) was more diffuse then my left. I think it's always been that way as I used to have my hair long and tied back until I was ~12. But it could mean my temples are susceptible to future hair loss.

The initial proposal was ~2k grafts in an area roughly similar to the picture in my first post. Given I have lots of FU 3-4's he felt that should give good coverage. And since the follicles are tightly packed in the FU's, extraction should be easier, so possibly go further if things are proceeding well during the day. Then wait to ensure they come in as expected and place another ~2k in a second surgery, hopefully being able to do something about the crown.

After inspecting my donor, he felt I was in a good place given the amount I have and the area of loss. But still emphasised my expectations should be to get a good result on that frontal area. And whilst he felt I should have donor for the crown, I shouldn't set my hopes on it until after the results of the first surgery came through.

He said I'll likely lose what I have left on top (probably obvious) and likely my sides will drop a bit more. But with my donor and my beard hair as a backup, which is good quality (straight, similar coarseness, more whites but I can live with that), I should have enough in reserve to address that when the time comes. He appreciated why I was apprehensive about Fin, but if I was prepared to try a lower dose, I may be able to hold onto whats left on top and maintain the sides for longer.

I'll leave it there, but obviously quite happy as I was apprehensive my Donor may not be suitable. I have been considering consulting with Bisanga as well. My slight concern is recent news of lockdowns across Europe. Ideally i'd like to get going as soon as possible, I wish I'd done it last year when I was locked in doors anyway. I suspect socialising will be curtailed at points this year as well, so it seems a good time to get it done and get through the ugly duckling phase.

Appreciate any thoughts/comments.
 
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H

hopeful

member
I've had my Consult with Dr Ball.

Firstly it was £100 well spent. I spent roughly an hour talking to David and Dr Ball. Going through history, my hairloss, non surgical options and most importantly condition of my donor and prospects of FUE surgery. It was also useful to see the proposed hairline drawn on my scalp and get a visual idea of what a first surgery would deliver and where I could go from there.

(NB: Apologies if my terminology is off, recalling from memory as haven't got the report back yet, so filling in some terms myself).

So the good news is my Donor is healthy and I have 5-6K grafts before any need to go into using beard hair/etc. Density of 65-70 back and sides (slightly lower on sides then back). Predominantly 3-4 follicles per FU (follicular unit) and they are closely packed together in the FU which makes extraction of the FU easier.

The fact there was little sign of miniaturisation in the follicles and there were so many 3-4's gave him confidence my Donor was safe, although ofcourse there are no certainties. The only negative was my right lower temple (the bit above that sticks out into the forehead) was more diffuse then my left. I think it's always been that way as I used to have my hair long and tied back until I was ~12. But it could mean my temples are susceptible to future hair loss.

The initial proposal was ~2k grafts in an area roughly similar to the picture in my first post. Given I have lots of FU 3-4's he felt that should give good coverage. And since the follicles are tightly packed in the FU's, extraction should be easier, so possibly go further if things are proceeding well during the day. Then wait to ensure they come in as expected and place another ~2k in a second surgery, hopefully being able to do something about the crown.

After inspecting my donor, he felt I was in a good place given the amount I have and the area of loss. But still emphasised my expectations should be to get a good result on that frontal area. And whilst he felt I should have donor for the crown, I shouldn't set my hopes on it until after the results of the first surgery came through.

He said I'll likely lose what I have left on top (probably obvious) and likely my sides will drop a bit more. But with my donor and my beard hair as a backup, which is good quality (straight, similar coarseness, more whites but I can live with that), I should have enough in reserve to address that when the time comes. He appreciated why I was apprehensive about Fin, but if I was prepared to try a lower dose, I may be able to hold onto whats left on top and maintain the sides for longer.

I'll leave it there, but obviously quite happy as I was apprehensive my Donor may not be suitable. I have been considering consulting with Bisanga as well. My slight concern is recent news of lockdowns across Europe. Ideally i'd like to get going as soon as possible, I wish I'd done it last year when I was locked in doors anyway. I suspect socialising will be curtailed at points this year as well, so it seems a good time to get it done and get through the ugly duckling phase.

Appreciate any thoughts/comments.
Sounds like you had a good experience in your consultation. I presume magnification was used to check your donor area ?
 
J

JFR8

Valued member
Sounds like you had a good experience in your consultation. I presume magnification was used to check your donor area ?

Yes thats correct. They had a digital telescope that they used to go through the sides and back. Checking for any scalp issues and quality of the donor area.

Main metrics of interest were density, how many follicles per follicular unit and any signs of minaturisation. Plus quality of the follicles (i.e. coarseness, wether they were straight or curled, etc). From what I understood the fact a lot of my FU's carried 3-4 hairs each and none showed obvious signs of minaturisation gave confidence. I presume thats because if my donor were susceptible, the FU wouldn't be able to service 3-4 hair follicles (i'm not an expert but an educated guess). Also because they were all tightly packed within the FU, it means less chance of damage during extraction and a smaller punch is needed so smaller scars.

I'm giving myself a few days as I dont want to jump into anything. But think I'm quite likely to go ahead with FUE in the near future.

Given the relatively small cost, I'd advise getting a consult if you have access to a decent surgeon nearby. Either way, it's nice to know where you stand.

If not, I have a cheap digital scope I grabbed of Amazon for my Daughter for her Birthday. As part of playing with that, we'd actually examined each others hair/etc. It was actually not far off in terms of magnification/image to what the clinic used. Obviously not the same quality, but you could probably use something like that to have a look for yourself. Just remember you're not a specialist, so don't draw any firm conclusions, but might temporarily quench any curiosity.
 
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H

hopeful

member
Yes thats correct. They had a digital telescope that they used to go through the sides and back. Checking for any scalp issues and quality of the donor area.

Main metrics of interest were density, how many follicles per follicular unit and any signs of minaturisation. Plus quality of the follicles (i.e. coarseness, wether they were straight or curled, etc). From what I understood the fact a lot of my FU's carried 3-4 hairs each and none showed obvious signs of minaturisation gave confidence. I presume thats because if my donor were susceptible, the FU wouldn't be able to service 3-4 hair follicles (i'm not an expert but an educated guess). Also because they were all tightly packed within the FU, it means less chance of damage during extraction and a smaller punch is needed so smaller scars.

I'm giving myself a few days as I dont want to jump into anything. But think I'm quite likely to go ahead with FUE in the near future.

Given the relatively small cost, I'd advise getting a consult if you have access to a decent surgeon nearby. Either way, it's nice to know where you stand.

If not, I have a cheap digital scope I grabbed of Amazon for my Daughter for her Birthday. As part of playing with that, we'd actually examined each others hair/etc. It was actually not far off in terms of magnification/image to what the clinic used. Obviously not the same quality, but you could probably use something like that to have a look for yourself. Just remember you're not a specialist, so don't draw any firm conclusions, but might temporarily quench any curiosity.
I have already had a couple of consultations and one more hopefully before the year is out.
Like yourself I am keen to move forward with a procedure in the very near future. It’s no secret that Dr Ball is a top surgeon so in my opinion a good place to get a consultation. Is he the only Dr in England you are considering ?
l
 
J

JFR8

Valued member
I have already had a couple of consultations and one more hopefully before the year is out.
Like yourself I am keen to move forward with a procedure in the very near future. It’s no secret that Dr Ball is a top surgeon so in my opinion a good place to get a consultation. Is he the only Dr in England you are considering ?
l

I'm happy to hear other recs, but in the UK he seems to be the best option.

I'd consider mainstream Europe, which is where Bisanga comes in. There are a couple of other possible options, but he stuck out to me for people with considerable hair loss already.

I wont consider Turkey/etc. I'm sure there are lots of great surgeons out there, but I feel I have more recourse going with mainstream Europe. Also in the very unlikely eventuality something goes wrong, i'd feel safer being treated in the UK or even Belgium/etc.

US is out of the question due to logistics, particularly in the current climate. I really don't want to end up stuck somewhere far away from home if there's a lockdown/etc. Also healthcare is expensive, so if there was a serious issue it would be costly should I need urgent treatment. Perhaps the clinic would foot the bill, perhaps you can indemnify against such eventualities, but I don't feel like adding further research to my task :)

My mind set is it's a one shot deal. So I'm not massively price driven, which rules out going second tier clinics or outside of mainstream Europe.
 
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