43 year old male looking to transplant

[Rocknroutlaw]

Thanks for all the helpful discussions on this forum.
After so much deliberating, I have decided to take the plunge in 2016.
I am unsure where I am on the Norwood scale. While the hair loss is undeniably horrific, my areas of baldness are not completely shiny-bald.... there are random live follicles with some actual visible (and growing) hair, and many baby-like strands which are neither visible nor growing in length.
Over the years, I have been using Regaine with limited or no success. I am currently more than halfway through a 6-months course of laser therapy, which seemingly has little to no effect at all.
FUE is the only viable option from what I can gather. I guess the question now is where do I turn, how many grafts, and what relevant questions should I be asking ?
My main goal is to have a decent job done. I am based in the UK and prepared to travel if there are clear benefits. Obviously the costs do play a major role in choices, but I am prepared to pay more if I have reasons to believe the results are likely to be superior.
Having read the success story of the forum members, I am quite keen to hear more from the likes of Swoop who had a positive experience with Dr. Hakan *********.
All opinions appreciated!
Thanks!

 

[follicle2001]

Couple of things:
At 43 and with your pattern, hair transplant is not a bad option for you. I would not rule out FUT and just run to FUE. Rather, I would consider both carefully and pick which one seems best for you. Lots of people read all about FUE on these boards and think it is the only way to go but FUT, just like FUE, has advantages and disadvantages that make it better for some people. Neither FUE nor FUT are magic, but both work so make this decision very, very carefully.

I cannot stress to you strongly enough the importance of choosing a good, experienced, reputable surgeon. Take a few consultations, see what sort of options are offered to you. You really need to be fully confident in this decision (surgeon, type of surgery, extent of surgery, fallback plan for potential future surgeries, etc) before you have a hair transplant. If you are 90% sure of your plan, you are better off to wait until you are fully confident of your decision.

 

[Rocknroutlaw]

That's good advice,thank you! I'll start contacting the surgeons who have been discussed here as a starting point. Unless you have better advise on some kind of recommended surgeon database?
Also does anyone have a ball park figure of the number of strands I'm likely to need, or my likely Norwood scale category?

 

[Illu2ion]

You can look at IAHRS.org if you want to look for surgeons, most surgeons on there are pretty reputable. Plus, you can see galleries of the surgeons on that site so you get an idea of the quality of their work. Be aware though, often the best results are posted in the galleries so you can't automatically assume that if the galleries has good results only it's a 100% indicator that it's a top notch surgeon. But you can get a pretty good idea. Don't only browse this site though, it's good to get your information from multiple sources (if they're good sources that is).

Also, some surgeons do mainly FUT, others mainly FUE and then there are surgeons who do both approx equally as much. It's important to take this in consideration, because if you're going for FUE, you'd want a surgeon that mainly or exclusively does FUE because he will have more experience with FUE than a surgeon that mainly does FUT or does FUE and FUT 50/50. This is common sense ofc, but it's just a reminder for you when looking for a surgeon.

I can't really help you with the number of grafts you would need... It largely depends on what result you're going for. If it's worth anything, in my experience people usually need a larger amount of grafts than they imagined for the result they want to achieve so don't be shocked if the amount of grafts (and thus the price) comes out a little higher than you would've thought. But really, the amount of grafts, expectations, price, etc are all things you would want to discuss with your surgeon. We (well not I but other hair transplant veterans) can give you a general idea of the number of grafts but that's about it.

 

[Swoop]

The first thing you should ask yourself is if you want a FUE or FUT. FUT is a bit more safe in terms of end results and has a slight edge in outcome overall due to less variability of damage to the grafts (hair follicles) and so may have higher yield. FUT will leave you with a linear scar though. I believe overall the edge is small for FUT over FUE assuming you pick a elite surgeon. But there is no scientific answer to this really. There are obviously many variables that come into play. In terms of maximum graft output a combination of FUT/FUE is the best option for long term planning.

The good news is that you seem a very good candidate, at least in my opinion. I can't see your donor area but it seems strong, at least your sides do. Given your age you could do a big session and most likely achieve a result that will make you very happy. Although there are never guarantees with a hair transplant.

The most important thing is really to chose a ethical skilled surgeon. Here are some good videos of Lorenzo who is considered a skilled FUE only surgeon;

https://www.youtube.com/user/shubbapahte/video

Some cases might give you a idea of what you possibly could expect. Really you should start researching and find a doctor that you think is great.

Also what are your expectations?

 

[follicle2001]

One other thing: Be realistic. You will never look 18 again. Ever. Never. Ain't gonna happen.

Choose a hairline that looks age appropriate and natural for someone in their mid forties.

 

[Rocknroutlaw]

One other thing: Be realistic. You will never look 18 again. Ever. Never. Ain't gonna happen.

Choose a hairline that looks age appropriate and natural for someone in their mid forties.

Fair point. I would like to think I am being realistic in hoping for results similar to what Swoop is enjoying. I guess the consultants will let me know more concrete answers when they see me in person.
As I would like to continue wearing longer hairstyles (long at the back as well) and don't mind much thinner volumes at the back, I feel that FUE would be my choice. So far the feedbacks from email enquiries suggest my back/side donors are decent.
Another interesting thing was the idea grafting of beards on scalp, which would have been ideal for me given that I dislike facial hair on me anyway..but sadly I've been informed my beard doesn't have enough grafts.
So far Dr. ********* suggested 5000 grafts (Illu2ion's comment was spot on, it was much more than I had hoped) and it sounds promising.
Search goes on....and thanks for the comments so far.

 

[Pequod]

From the photos it looks like you have excellent donor hair so you can get a full head of hair back. It is really a matter of how much you have to spend and finding the right doctor. It may take 8000 grafts or more, but even 6000 could bring a lot back. You should also get on a medication that works like finasteride. Minoxidil does not stop hair loss. i would expect you to do the hair transplant's in multiple procedures like many of us do though.

BTW I think you can get more done at a lower price by doing FUT, it also has a higher chance of success for follicle survivability. Get a couple of exams from different doctors if you can.

 

[arfy]

From the photos it looks like you have excellent donor hair so you can get a full head of hair back.

I have to object to anybody who says that you can "get a full head of hair back". You're only moving hair from the back and sides to the top. You'll never have a full head of hair, because you can never restore the amount of hair that's been lost. Maybe that's a minor argument but it's important to be accurate about what hair transplant can achieve. Hair transplants don't result in a "full head of hair" - even the patient with 11,000 grafts has "see-through" hair in the sunlight (a different thread). Most guys don't even have 11,000 grafts in their donor supply, to begin with.

To the original poster, you should plan on spending more time researching hair transplants. You still have a lot to learn, before you can make an informed decision (I can tell you're a total newbie, because nobody ever refers to "strands"... as in "how many strands do I need?")

You say that you are inspired by Swoop's results, however unless you have the exact same characteristics as Swoop you are comparing apples and oranges. Your personal characteristics will be a huge factor in your potential results. You should look for examples of patients with the same characteristics as you (blonde hair, diffuse thinning). Both characteristics are less than ideal, and while that doesn't rule out a hair transplant, it means that your results will likely not be "knockout" results that certain other guys can achieve. Blonde hair is finer than dark hair (less coarse, smaller hair shaft diameter) which means that blonde hair doesn't cover as well as dark hair. You will need more grafts than other patients, to get a similar amount of coverage. The problem is that the donor supply is already limited, and basically nobody has enough donor hair to begin with. Diffuse thinners are at a higher risk of shock loss than guys with a distinct area of hair loss (and other areas with strong remaining hairs). The surgery can cause any "at risk" hairs to fall out... the trauma of surgery accelerates the life cycle of your hair. It's possible to end up with less hair after a transplant, than you had before. Or merely exchange the existing hair for transplanted hair (some guys are okay with this, as it means that their hair loss will never appear to progress any further).

I recommend that you spend a good amount of time reading various forums (beware, IMO some people are "plants" who are there to drum up business for the doctors). Meet with several doctors purely for informational purposes. Ask about the risk of shock loss (and if the doctor says that there is no risk, ask if he will guarantee that in writing, and see what they say).

You will certainly find doctors who are eager to get you into the chair, and you may very well be pleased with the results (everybody has different expectations of success, however most guys have high expectations). In my opinion, you are not an ideal candidate and you should know that in advance of any decisions you make regarding surgery, because it's a big commitment that is basically impossible to completely undo (for most people).

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Hmm, upon further review, maybe your hair isn't blonde (only dyed blonde). Anyway, hair caliber is an important factor. If your hair is fine, that is not as desirable as having coarse hair. Everything else I said, I still maintain.

 

[Pequod]

I have to object to anybody who says that you can "get a full head of hair back". You're only moving hair from the back and sides to the top. You'll never have a full head of hair, because you can never restore the amount of hair that's been lost. Maybe that's a minor argument but it's important to be accurate about what hair transplant can achieve. Hair transplants don't result in a "full head of hair" - even the patient with 11,000 grafts has "see-through" hair in the sunlight (a different thread). Most guys don't even have 11,000 grafts in their donor supply, to begin with.

The grafts will be addition to what he already has, he is not entirely bald on top. If he went on finasteride he might even get some of it back along with the hair transplant. Compared to what he has now it will seem like a full head of hair assuming he gets the right doctor and he has excellent hair follicle survival. It will cost a lot of money though, no way around that.

 

[Rocknroutlaw]

From the photos it looks like you have excellent donor hair so you can get a full head of hair back. It is really a matter of how much you have to spend and finding the right doctor. It may take 8000 grafts or more, but even 6000 could bring a lot back. You should also get on a medication that works like finasteride. Minoxidil does not stop hair loss. i would expect you to do the hair transplant's in multiple procedures like many of us do though.

BTW I think you can get more done at a lower price by doing FUT, it also has a higher chance of success for follicle survivability. Get a couple of exams from different doctors if you can.

Thank you for your views, that's encouraging to know. I would like to remain realistic and have a decent hairline and volume, but certainly have no expectations of the appearance of an 18 y.o..
I have ordered Propecia, will continue to use Minoxidil, and possibly RU in conjunction. I have got the caffeinated shampoo/conditioner from clinic which I will continue with. Anything else obvious that I should consider?

- - - Updated - - -

I have to object to anybody who says that you can "get a full head of hair back". You're only moving hair from the back and sides to the top. You'll never have a full head of hair, because you can never restore the amount of hair that's been lost. Maybe that's a minor argument but it's important to be accurate about what hair transplant can achieve. Hair transplants don't result in a "full head of hair" - even the patient with 11,000 grafts has "see-through" hair in the sunlight (a different thread). Most guys don't even have 11,000 grafts in their donor supply, to begin with.

To the original poster, you should plan on spending more time researching hair transplants. You still have a lot to learn, before you can make an informed decision (I can tell you're a total newbie, because nobody ever refers to "strands"... as in "how many strands do I need?")

You say that you are inspired by Swoop's results, however unless you have the exact same characteristics as Swoop you are comparing apples and oranges. Your personal characteristics will be a huge factor in your potential results. You should look for examples of patients with the same characteristics as you (blonde hair, diffuse thinning). Both characteristics are less than ideal, and while that doesn't rule out a hair transplant, it means that your results will likely not be "knockout" results that certain other guys can achieve. Blonde hair is finer than dark hair (less coarse, smaller hair shaft diameter) which means that blonde hair doesn't cover as well as dark hair. You will need more grafts than other patients, to get a similar amount of coverage. The problem is that the donor supply is already limited, and basically nobody has enough donor hair to begin with. Diffuse thinners are at a higher risk of shock loss than guys with a distinct area of hair loss (and other areas with strong remaining hairs). The surgery can cause any "at risk" hairs to fall out... the trauma of surgery accelerates the life cycle of your hair. It's possible to end up with less hair after a transplant, than you had before. Or merely exchange the existing hair for transplanted hair (some guys are okay with this, as it means that their hair loss will never appear to progress any further).

I recommend that you spend a good amount of time reading various forums (beware, IMO some people are "plants" who are there to drum up business for the doctors). Meet with several doctors purely for informational purposes. Ask about the risk of shock loss (and if the doctor says that there is no risk, ask if he will guarantee that in writing, and see what they say).

You will certainly find doctors who are eager to get you into the chair, and you may very well be pleased with the results (everybody has different expectations of success, however most guys have high expectations). In my opinion, you are not an ideal candidate and you should know that in advance of any decisions you make regarding surgery, because it's a big commitment that is basically impossible to completely undo (for most people).

- - - Updated - - -

Hmm, upon further review, maybe your hair isn't blonde (only dyed blonde). Anyway, hair caliber is an important factor. If your hair is fine, that is not as desirable as having coarse hair. Everything else I said, I still maintain.

That is very helpful, thank you. I will bring all the above-mentioned to the discussion table with consultants.

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In my late forties, I know how difficult it is to regrow hair. However, there is definitely hope, because I started finasteride this year (used Minoxidil for 20+ years, however). Adding an anti androgen, like Propecia, would probably significantly increase regrowth. I didn't use finasteride until January 2015. Once I added that I actually started seeing hair on my temples (my Norwood level is three). And I'm talking about going from an island (Norwood 4, with a little vertex baldness as well, mostly receding hairline), to gaining two centimeters (both sides, two more than I had in 2014). Also, I am still gaining on my right side (another centimeter/hairline which is more difficult than vertex). And it is significant. My left side has always responded better to minoxidil. However, more hair is growing above my eyebrow on both sides.

I had to know if it was my concentrated minoxidil or finasteride (30% from Jan - Oct 2015/ with .5mg liquid (.05 ml) combined. So I cut the minoxidil in half (15%), and doubled the finasteride. Now, I have more regrowth than before.

Unfortunately you will have to take care of the DHT sensitive hair you still have. So unless you kill the DHT sensitive follicles you have left, you will have to take finasteride.

We have less testosterone then we had in our twenties. So, you probably don't need 1mg of Propecia daily (if you decide to go that route). But I highly recommend finasteride.

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Also, it thickened my strands on top. My hair is very similar to yours. It's wavy (curly hair actually has a flat texture (bends more), has nothing to do with thickness, round hair texture is straight hair). The only difference is mine is darker and shorter than yours. But if I grew it longer, it probably would be the same shade as yours.

Thank you for your reply. I have ordered Propecia 1mg, and am considering taking it once every second day.
I'll consider using a higher % Minoxidil too (currently on 5%).
RU is probably on the cards too.
Meanwhile I'll continue learning on hair transplant.
Any thoughts ?

 

[espana]

Hi!

I'm glad to have read your post. I'm 38, had my first transplant at 24 in 2001 and second one in 2009 at 32 years. I have been happy with the results but the last 2 years the hair has been shedding in the non transplanted areas. I never would consider taking any drugs orally. I have just tried minoxidil on top, but I doubt it helps.

The first one was FUT in Belgium, the second one FUE in Copenhagen.

I am considering a 3rd one to help cover up and increase density, and am also looking for a good surgeon. Preferably in Paris where I live, but I really don't mind traveling to the other side of the world for a better result. I might use the same ones as before or someone else if the results can be better; so I look forward to hear if you found any good ones.

My problem is that I don't trust any of the amazing before/after pictures, I think they're always photoshopped or that the guy wasn't even really bald to start with ;-)

In the mean time, I have been able to cover it up quite well using a concealer, you might want to give that a shot first, given the fact that you still have loads of hair left. I use toppik and am very satisfied. If you'd like to swap some pics, let me know in pm.

Best regards from Paris