Estimad 6300 grafts, norw.6, curly dark hair, what to do ... ? (photos)

[siphna]

Hello I am 27 years old, last year I want to Dr. Bisanga, Lupanzula and Muresanu.

At the time, I had a short haircut (buzzed to 1 cm) so my donor area didn't look as full as it does now, because I have curly hair with good coverage

Bisanga: Did not want to do a HT on me, without at least putting me on minox. Oral + fina + prp, he didn't like my donor area

Lupanzula: was hesitant, he wanted to wait and see finasteride/minox effect, I took 6 months of finasteride and minox, but I had ES, and it did not seem to particularly slow down or have any significant effect on the hair loss

Muresanu: He warned me that I was a big norwood, but that my donor area was not bad ! and he said if I am motivated we could try, he estimated roughly 6300 graft

I did Minox & Topical fina for 6 months at 2.5% (large dosage) very assiduously: I had side effects (ejaculations with very very little sperm, and peaks of anxiety / depression, I'm already subject to it with or without finasteride, so I decided for my safety not to continue any medication.

For the moment, I use TOPPIK, and honestly nobody notices anything (see photo), I do not have crazy expectations for the transplant, if I have a result where I must continue to use a little bit of toppik, I don't mind just aiming for something okay

I hesitate between the transplant, and (worst case scenario) a hair system, what do you think? And for the transplant do you think it's better to focus on the frontal 1/3 and at worst to use a hair system later on for the posterior vertex? Or distribute the graft evenly and use toppik?

Thanks to those who take the time to help!

 

[Bully]

Fut surgery might be the way to proceed without the use of Finasteride. The hair taken from the occipital area will be the strongest and most resistant to DHT and allow a big transfer of grafts for your first transplant which may yield a result that will make you very happy. Your curly hair will help with coverage and density.

 

[siphna]

Fut surgery might be the way to proceed without the use of Finasteride. The hair taken from the occipital area will be the strongest and most resistant to DHT and allow a big transfer of grafts for your first transplant which may yield a result that will make you very happy. Your curly hair will help with coverage and density.

You mention the "first HT", with DR.muresanu we discussed this last year, he advocated FUT+FUE combined to maximize grafts.

You would do separate procedures ? Like a year or two between them or what ?

 

[Bully]

I was thinking you could have a big strip of like 5000 grafts for your first one. This might be enough and provide a result that you are happy with. The grafts from the strip zone are safer than fue grafts taken from a wider area.

 

[Techno1]

While I tend to agree on the strip surgery option you require help for your depression first and foremost. Once that has been achieved you’ll be in a better position that allows you to think more clearly about your hair. Right now, you can manage with the toppik.
Finasteride has been linked to depression, not sure about the oral minoxidil. A possible lower dosage could be suitable provided your healthcare professional deems it safe to use with any other medication you may be on.
Your donor looks in good shape from your pictures. Did the examinations say it is miniaturizing?

 

[siphna]

Examinations showed slight miniaturization in the donor, something like 5% or 7% I don't remember the number Dr.Muresanu told me.
But I am guessing we all have at least some degree of miniaturization in the donor due normal aging etc. It doesn't mean it's going to progress any further, and we have no way of predicting the rate

 

[Techno1]

Are you prepared to roll the dice and risk it with the small percentage of miniaturization? 0.5mg of Finasteride could reverse this.

 

[siphna]

Yes I am willing to try, even if it gives me 10 / 15 years of peace, there are multiple solutions like hair systems, and maybe in 10 years hair cloning (I know it's optimistic), but I prefer that rather than putting a medication in my body for years and years

Doesn't everyone have a sligh degree of miniturization in his donor area ? I am sure people don't have 0% miniturization no ?

 

[Techno1]

Indeed, most people will experience miniaturization throughout the entire scalp during their lifetime. You make a valid point regarding having “peace of mind” for a number of years, then turning to an alternative if you have to.
You’ll be choosing Hattingen Hair, right?

 

[siphna]

Yes Hattingen, they have alot of experience about FUT

 

[Prohairclinic]

Fut surgery might be the way to proceed without the use of Finasteride. The hair taken from the occipital area will be the strongest and most resistant to DHT and allow a big transfer of grafts for your first transplant which may yield a result that will make you very happy. Your curly hair will help with coverage and density.

Finasteride yes, but nowadays it is possible in a lotion form with virtually no risk of sides.

Yes, curly hair is very good for achieving a better illusion of density.

FUT. 5000 grafts Unsure. How do you know this patient has enough laxity? Nobody, including surgeons, would be able to know this without examining the patient. Even if he has good laxity, will he have 5000 grafts in a single session, unknown. How will the scarring turn out? Unknown.

My advice would be to use a combination of multiple therapies such as Finasteride or Dutasteride (liquid forms), Minoxidil, PRP treatment, microneedling. Then, re-evaluate in about 12 months. If you respond well you will see a nice improvement and you will likely achieve a better result. If you don't stabilize your hair loss it will very likely degrade more and you will need follow-up hair transplants every couple of years.

Without trying to turn this into a FUT vs FUE debate, I would dig deep into FUT and FUE before making a decision.

 

[siphna]

Hello, thanks for your comment, a few clarification :

- I did use 6 month of topical finasteride gel from farmacia parrati (2.5% which is pretty high concentration) and I DID have side effects, extremely reduced ejaculation volume, and mood swing. No loss of libido tho and no erectil dysfonction. But still I chose to not stay on medication for the rest of my life, I'd decided the hair I was going to save with finasteride I'll just use some more Toppik instead. I did a DHT blood test after my 6 month finasteride use, and my serum DHT was very low compared to baseline

- I consulted last summer Dr.Muresanu at hattinghen clinic, switzerland, and he said my scalp laxity is good

- He suggested something around 4500 fut in one session

- I m currently doing microneedling, but I am aware that my hair loss is inevitably going to degrade, that's why I want to plan a strategy that takes into account : my curly hairs, the use of toppik, and a possible future hair system for the posterior part to optimize hair distribution during surgery. It's not ideal, but I'll choose the burden of a hair system and medium/low density over a full bald head

 

[Prohairclinic]

Ok, the gel is indeed a very high dosage. We use a very different kind of mixture and far lower concentration. Maybe it is worth to switch and try again. We also measered some patient blood level and could not find anything abnormal.

Have you also considere hair pigmentation? If you are ok with shaving the hair short it is a very good option when performed by skilled hands of an hair pigmentation artist.

 

[siphna]

Hey @Prohairclinic I sadly didn't yet got the courage to shave my head and try the shave look aha, but I know I must ...

 

[Bully]

Is it better to start on Fin or Dut?