Do better doctors generally use less grafts?

[El Chacal]

Hi,

I am between NW4 and NW5 and considering a transplant, having previously stupidly ignored my hairloss.

Having sent my pics to 2 Turkish clinics. 1 quoted me 4500 grafts. The other quoted me 4500 grafts - if I first take fin for 6 months and get back to them then.

I am however willing to pay a little bit more to get better results, putting other countries in Europe on my radar.

I have sent my photos to a doctor who is rated maybe slightly higher than the Istanbul hair mills, and whos location would be easier for me to get to than Turkey.
This doctor said I would need 2500 grafts. Almost half what I was told in Turkey.

Is this more expensive doctor quoting me a smaller figure because he can do more with less? Or did he just misdiagnose me? I sent him the same pictures as the others.

2500 with him would still be a bit more expensive than 4500 in Turkey, but if I am paying more for similar results but to leave donor hair for future transplants I would consider it worth it.

For reference I have attached my picture below.

And if so, what clinics in Europe would best fit this mid level tier – more money, less grafts for similar result?

Thanks for any help.

 

[smokeybacon]

Your questions may be better asked to the Dr that quoted you 2500 grafts. They should be able to say why they did not suggest 4500 grafts. It is probable they could do 4500 if they wanted to, from the point of view of just doing it. So for me maybe they must have a good reason, maybe technically or quality reasons why.

 

[Bigmac]

A bit more information would be helpful. What area are all 3 clinics proposing to cover?
Are 4500 to go for full coverage, frontal 2 thirds and 2500 frontal third? Some clinics will be more cautious in their approach, taking into account your age and where they think your hair loss pattern will end.
Hair characteristics play a part in coverage, skill of the person doing the surgery, how they implant the grafts and so on.
This link will give you some information on donor and coverage issues. Donor hair and coverage
Have you a picture showing your donor?

 

[Ronnie]

That link is an extremely interesting and informative read, thanks Bigmac

 

[Bigmac]

You’re welcome Ronnie.

 

[El Chacal]

A bit more information would be helpful. What area are all 3 clinics proposing to cover?
Are 4500 to go for full coverage, frontal 2 thirds and 2500 frontal third? Some clinics will be more cautious in their approach, taking into account your age and where they think your hair loss pattern will end.
Hair characteristics play a part in coverage, skill of the person doing the surgery, how they implant the grafts and so on.
This link will give you some information on donor and coverage issues. Donor hair and coverage
Have you a picture showing your donor?

Thank you for your help.

I did not think to ask about the areas to cover. I supposed al clinics would quote me the prices needed to make it look like I have hair again, as naive as that may sound.

Does this picture show my donor area? Not sure if the hair needs to be short to properly see.

 

[Bigmac]

Your donor does look good in that picture but the doctor will establish this before surgery.
What are you wanting to achieve with a hair transplant?
Are you wanting FUE or FUT? Possibly both?
I think you need to ask the clinics to confirm what exactly they will do with the graft estimates they’ve advised.

 

[El Chacal]

Your donor does look good in that picture but the doctor will establish this before surgery.
What are you wanting to achieve with a hair transplant?
Are you wanting FUE or FUT? Possibly both?
I think you need to ask the clinics to confirm what exactly they will do with the graft estimates they’ve advised.

Thank you for the feedback.

Regarding what I want to achieve, I honestly just thought - I want to fill in as much hair as possible. Get the look those who had success stories manage. As I'm not sure myself what would look best and generally not been a person who focused too much on aesthetics, I thought the doctor will probably know better than me what would look good.

May I ask what should I be considering to achieve?

I have not yet thought whether FUE or FUT. The doctor offers both and havent weight up the pros and cons yet.

May I also ask as you seem a very knowledgeable person on these matters, based on the pictures I showed is 2500 grafts something that could realistically bring a successful result?

 

[Ronnie]

Hi

I‘m far from the expert in these matters having only started looking into this myself these last few weeks, but I have spent a lot of time absorbing information these last few weeks and I’m a solid Norwood 5, so this is my take on things, for what it is worth.

I’d suggest very strongly that you need to get a few face to face consultations with reputable surgeons locally for you to better understand your own situation. I’m sure your donor area could yield enough grafts to fill in most of your thinning bits and I suspect that’s what the clinic quoting 4,500 grafts is intending to do. The clinic quoting less grafts is possibly adopting a longer term strategy.

In my case, I’ve already had my expectations managed that I won’t achieve full coverage. I’m actually fine with that, I’m 46 and greying a bit, so I don’t need to look 25 again. My expectation is now to restore my hairline, but the one I had at 35 (mature and slightly receding) and not my younger, flatter one, and then to fill the space backwards to achieve the illusion of hair from the front. I’m expecting to still have an exposed crown.

I‘m still to have a face to face consultation, but did have a very useful call with a top UK clinic and they suggested 2,000 grafts for me in the first instance. The thing to possibly get your head round is that this might not be your only surgery. In my situation, I’m Norwoord 5 but I could continue to lose some hair at the sides which could leave me with bald strips. I suspect the advice to go for 2,500 grafts is to preserve donor hair to then be able to fill in any further balding down the line. I guess in 5 years time, if I’m stabilised and don’t have bald strips, maybe I’d choose to fill in some of the crown with the spare donor hair.

You certainly seem to be in a better position than me, but I’d advise you to take your time and not rush into anything. My feeling is that (some of at least) the ‘hair mills‘ in Istanbul might not have your best long term interests at heart and be more likely to just give you what you want now and not be too concerned about advising you of the best long term strategy. This is something I’ve given a lot of thought to and I kind of see the whole process a bit like this:

What are your hopes and expectations? These may well change once you have the surgeons input.

What is your starting point? This possibly isn’t how you are today, it might mean a year on meds to test your tolerance to them, to try and thicken or regrow anything you can and to understand how stable your condition is.

The surgeon to then evaluate you and suggest the correct strategy going forward, this might include suggesting a more conservative hairline, only aiming for partial coverage, how many donor grafts to preserve based on how much of your remaining hair not be in a safe zone etc.

The surgical skill, ability to extract a and implant follicles in the cleanest way, with the best chance of survival.

The artistic skill, the create a convincing hairline, to lay the implants in the correct orientation and angle, to layer density appropriately in different areas of your head to best achieve the illusion of overall density, to create a convincing crown and to achieve an overall natural look.

The more I understand on all this, the more convinced I am that I’m uncomfortable going down the cheaper route, as I’ll never be convinced that those last 3 points are being properly considered. I think that is perhaps an area where you get what you pay for. If I was younger, more fashionable and had grafts to spare, I’m sure I’d be more cavalier and take a punt on them, but I only realistically have one shot at this, if they make a mess of it then I’m out of options, I have to give myself the best chance of success from the outset. I’m not sure what your view is on your own situation?

I‘d strongly advise getting your head around your own situation before making any rash decisions. I’ve learned a tonne of information in a short space of time from the likes of Bigmac and it will hopefully stand me in good stead. Another point to note is that there are several very well respected clinics in Istanbul who aren’t ‘hair mills’ at all and might only do one procedure a day. There are links to many of these on this forum and you can see patient feedback in the patient section too. I’m considering these as an option for me, they are more expensive, but still a lot cheaper than top UK clinics.

Cheers and good luck.

 

[smokeybacon]

Ronnie mentions some very good point. It is important to listen to the Dr and their approach to your hair transplant. But, with many options open to you do not automatically assume that one Dr has your best interests over another simple because their plan fits with ideal scenario. Something like the hairline design is very important. Fine line between being too aggressive for your age and looking natural. So, for me discussing the hairline design would be important. Including aspects mentioned above like hair direction etc.

Personally I am not into these very large FUE procedures, after reading a lot over time it seems they have become more popular. But as somethings do not change, like hair and skin I have my doubt if they have got more popular because of skill of demand. Damaging your healing and hair growth potentially. I think you are doing everything right and taking time and getting knowledge. So good luck with your research.

 

[Bigmac]

Thank you for the feedback.

Regarding what I want to achieve, I honestly just thought - I want to fill in as much hair as possible. Get the look those who had success stories manage. As I'm not sure myself what would look best and generally not been a person who focused too much on aesthetics, I thought the doctor will probably know better than me what would look good.

May I ask what should I be considering to achieve?

I have not yet thought whether FUE or FUT. The doctor offers both and havent weight up the pros and cons yet.

May I also ask as you seem a very knowledgeable person on these matters, based on the pictures I showed is 2500 grafts something that could realistically bring a successful result?

2500 will give you a fuller look to your frontal third with a decent hairline.

You should know what you want to achieve. You want to fill in as much as possible. 2500 grafts spread out over your thin areas won’t do too much but concentrating it to the frontal third should make a nice difference. Would you be happy with that?

 

[El Chacal]

Hi

I‘m far from the expert in these matters having only started looking into this myself these last few weeks, but I have spent a lot of time absorbing information these last few weeks and I’m a solid Norwood 5, so this is my take on things, for what it is worth.

I’d suggest very strongly that you need to get a few face to face consultations with reputable surgeons locally for you to better understand your own situation. I’m sure your donor area could yield enough grafts to fill in most of your thinning bits and I suspect that’s what the clinic quoting 4,500 grafts is intending to do. The clinic quoting less grafts is possibly adopting a longer term strategy.

In my case, I’ve already had my expectations managed that I won’t achieve full coverage. I’m actually fine with that, I’m 46 and greying a bit, so I don’t need to look 25 again. My expectation is now to restore my hairline, but the one I had at 35 (mature and slightly receding) and not my younger, flatter one, and then to fill the space backwards to achieve the illusion of hair from the front. I’m expecting to still have an exposed crown.

I‘m still to have a face to face consultation, but did have a very useful call with a top UK clinic and they suggested 2,000 grafts for me in the first instance. The thing to possibly get your head round is that this might not be your only surgery. In my situation, I’m Norwoord 5 but I could continue to lose some hair at the sides which could leave me with bald strips. I suspect the advice to go for 2,500 grafts is to preserve donor hair to then be able to fill in any further balding down the line. I guess in 5 years time, if I’m stabilised and don’t have bald strips, maybe I’d choose to fill in some of the crown with the spare donor hair.

You certainly seem to be in a better position than me, but I’d advise you to take your time and not rush into anything. My feeling is that (some of at least) the ‘hair mills‘ in Istanbul might not have your best long term interests at heart and be more likely to just give you what you want now and not be too concerned about advising you of the best long term strategy. This is something I’ve given a lot of thought to and I kind of see the whole process a bit like this:

What are your hopes and expectations? These may well change once you have the surgeons input.

What is your starting point? This possibly isn’t how you are today, it might mean a year on meds to test your tolerance to them, to try and thicken or regrow anything you can and to understand how stable your condition is.

The surgeon to then evaluate you and suggest the correct strategy going forward, this might include suggesting a more conservative hairline, only aiming for partial coverage, how many donor grafts to preserve based on how much of your remaining hair not be in a safe zone etc.

The surgical skill, ability to extract a and implant follicles in the cleanest way, with the best chance of survival.

The artistic skill, the create a convincing hairline, to lay the implants in the correct orientation and angle, to layer density appropriately in different areas of your head to best achieve the illusion of overall density, to create a convincing crown and to achieve an overall natural look.

The more I understand on all this, the more convinced I am that I’m uncomfortable going down the cheaper route, as I’ll never be convinced that those last 3 points are being properly considered. I think that is perhaps an area where you get what you pay for. If I was younger, more fashionable and had grafts to spare, I’m sure I’d be more cavalier and take a punt on them, but I only realistically have one shot at this, if they make a mess of it then I’m out of options, I have to give myself the best chance of success from the outset. I’m not sure what your view is on your own situation?

I‘d strongly advise getting your head around your own situation before making any rash decisions. I’ve learned a tonne of information in a short space of time from the likes of Bigmac and it will hopefully stand me in good stead. Another point to note is that there are several very well respected clinics in Istanbul who aren’t ‘hair mills’ at all and might only do one procedure a day. There are links to many of these on this forum and you can see patient feedback in the patient section too. I’m considering these as an option for me, they are more expensive, but still a lot cheaper than top UK clinics.

Cheers and good luck.

Thanks for all the information and help Ronnie.

Ive seen your thread and it seems we are thinking along the same lines with our approach - good doctor that can do it right rather than just getting it done cheap.

I'm ok with further transplants down the line, though my aim is to get a decent result now for a few years, even if I understand further coverage may be needed down the line.

I would like to get it done in spring however. I want to have a good result for my early 30s, and will consider future transplants, SMP or maybe even hair systems in a couple of years when further hairloss spoils the result.

May I ask, would you have any advice on clinics to go for the consultation? And have you narrowed down which clinics you will like to go to when you do your transplant?

 

[El Chacal]

2500 will give you a fuller look to your frontal third with a decent hairline.

You should know what you want to achieve. You want to fill in as much as possible. 2500 grafts spread out over your thin areas won’t do too much but concentrating it to the frontal third should make a nice difference. Would you be happy with that?

Thanks for the feedback.

Yes I would be happy with that. If the front was strong I think I could potentially use concealers on the back.

 

[Bigmac]

Have you considered hair loss medications? You could respond well and make some great improvements, especially around the crown.

 

[El Chacal]

Have you considered hair loss medications? You could respond well and make some great improvements, especially around the crown.

Have considered fin including in the past, but always decided against out of caution. Not the immediate sides so much as the potential even if unlikely for some effect decades later. I'm the kind of health conscious nut who doesn't even touch a grain of sugar,

However after hearing about it recently, might consider topical fin.

Min, I was bought some bottles by someone, forgot about my hairloss and used for a few months when they were a couple of years past expiry date. Sounds stupid I know. Didnt do much. From memory I read min loses its effect after a couple of years so if I had used it when it was bought (2014) i would have long lost my gains from it by now?

Would there be others? From my research anything else, other than dut (Fin XL) would not have much of an effect.

And the aim of the medication would be to preserve the results of the transplant? I have heard some say it can improve the transplant, taking it before, is there wisdom to that?

 

[El Chacal]

Ronnie mentions some very good point. It is important to listen to the Dr and their approach to your hair transplant. But, with many options open to you do not automatically assume that one Dr has your best interests over another simple because their plan fits with ideal scenario. Something like the hairline design is very important. Fine line between being too aggressive for your age and looking natural. So, for me discussing the hairline design would be important. Including aspects mentioned above like hair direction etc.

Personally I am not into these very large FUE procedures, after reading a lot over time it seems they have become more popular. But as somethings do not change, like hair and skin I have my doubt if they have got more popular because of skill of demand. Damaging your healing and hair growth potentially. I think you are doing everything right and taking time and getting knowledge. So good luck with your research.

Re your second paragraph, are you saying that FUE damage healing and growth when compared to FUT? Or are you referring solely to the large 4000 Graft transplants at cheaper hairmills?

 

[Bigmac]

Taking it before can be very beneficial. It also helps your donor stay strong.
I’ve been on Finasteride since 2005, very slight Gynaecomastia which is not an issue. I believe it’s still effective.
Topical solutions are being made by various doctors or chemists with promising results. I’ll be collating the data and posting it shortly.
Only you can decide if you wish to use anything. Your hair loss could stay as is but you never know. For these reasons it’s good to have a strategically placed transplant that would stand alone if you were to lose more hair.

 

[Ronnie]

Thanks for all the information and help Ronnie.

Ive seen your thread and it seems we are thinking along the same lines with our approach - good doctor that can do it right rather than just getting it done cheap.

I'm ok with further transplants down the line, though my aim is to get a decent result now for a few years, even if I understand further coverage may be needed down the line.

I would like to get it done in spring however. I want to have a good result for my early 30s, and will consider future transplants, SMP or maybe even hair systems in a couple of years when further hairloss spoils the result.

May I ask, would you have any advice on clinics to go for the consultation? And have you narrowed down which clinics you will like to go to when you do your transplant?

Hi

As regards clinics, my approach was to set aside a weekend to do lots of research. My starting point was the list of clinics at the bottom of the pages of this website, I spent time browsing each of their websites and took notes of clinic locations, approximate costs etc and just my general thoughts. I then went off to read customer feedback posted on this and other similar websites. Wider reading highlighted a few more options, but I’d say this alone gave me a much improved understanding of clinics I‘d be willing to put my faith into and made me better appreciate the risks I’d be taking if I prioritise cost as the determining factor. Cost most definitely is a factor, but for sure I won’t be going anywhere for a procedure unless I have the utmost faith in their desire to achieve the right long term outcome for me and also that their surgical and artistic skills are well documented.

Im still a long way from any procedure and this list is very much a work I progress, but I’m currently considering 4 clinics, each fitting a different criteria:

Farjo Institute. This represents a highly regarded UK clinic. I haven’t selected it over other UK clinics based on reputation, rather location, it is 5 miles from where I live. I’ve no reason to believe they are better then other top UK clinics, but also no reason to believe they are any worse, so them being so near is a massive bonus in multiple respects. They are also only a 10 minute walk from my place of work.

Dr Bicer. This represents a very well regarded Turkish clinic. I’ve literally not come across anything negative about Dr Bicer’s work, so I’d really seriously consider going here.

BHR Clinic. This represents a top European clinic. This just kind of grabbed my attention in a similar way to Dr Bicer, Dr Basinga seems to get lots and lots of positive feedback.

Eugenix. This is very much the wildcard, but was chosen due to them having a good reputation with higher Norwood cases. The key thing that counts against them is their location. They are the opposite of Farjo in that respect, getting there seems to be almost the equivalent of travelling to Australia and I’d be slightly concerned about getting an upset tummy. In terms of intangibles, such a long journey time to such a distant place and nervousness about getting an upset tummy, they are all just things that I think I’d like to do without and which wouldn’t be good in terms of optimal conditions for recovery. This is very much a personal view as lots of people seem to have gone their and got great results. In my case, given the extent of my condition and age and hair quality etc, I’m just not convinced they are any better set up to give me a good result than any of the other options.

Hope this is helpful. I’d just stress again that I’m very early in the process still and this is by no means a definitive final list, more clinics could easily come into consideration as I learn more.

Cheers and good luck

 

[El Chacal]

Taking it before can be very beneficial. It also helps your donor stay strong.
I’ve been on Finasteride since 2005, very slight Gynaecomastia which is not an issue. I believe it’s still effective.
Topical solutions are being made by various doctors or chemists with promising results. I’ll be collating the data and posting it shortly.
Only you can decide if you wish to use anything. Your hair loss could stay as is but you never know. For these reasons it’s good to have a strategically placed transplant that would stand alone if you were to lose more hair.

Look forward to seeing your data.

I would actually like to have the transplant in the coming months since the doctor already offered dates there. That would be too short to get any effects from fin, topical or otherwise I suppose. It should not be too much of a hindrance to in that case start the fin after the transplant should I go ahead?

The strategically placed transplant would be an area of my head (the front) predominantly of transplanted hair so the further hairloss would then be that which occurs behind?

 

[smokeybacon]

Re your second paragraph, are you saying that FUE damage healing and growth when compared to FUT? Or are you referring solely to the large 4000 Graft transplants at cheaper hairmills?

Not particularly compared to FUT as very different techniques. I think large FUE sessions can be harmful. The hairmill types you can see online bad donor healing, shock loss etc, some I am sure get one procedure and that´s it because the donor is gone. It was only a few years back for many clinics to say around 2500 to 3000 FUE in a session. When Turkey started offering all these large graft numbers, many seemed to follow suit. Commercially I assume not to lose out, to compete. I am sure instruments have improved and allowed for more grafts to be extracted but I do not see to the extent 50% or so more for instance can be removed. The reasons before cannot all be wrong a few years later. It is likely if you have a big session any real damage will not be known until another FUE is needed.