NARMAK

OP, i do apologise but i should have replied directly too and point out a slightly flawed part of what you said. Having "more grafts" is a luck of the draw if such a thing even exists. We all have a finite donor area but the difference is that depending on donor quality, some people are considered a poor candidate, some average, some good and extremely few may be considered an excellent candidate. Some of this depends on things we can try control like for example taking medication to block DHT with Finasteride. If genetically we're lucky and our hair loss isn't aggressive, then that DHT blocking will help good responders for many, many years to come. The main goals to slow or halt hair loss through blocking DHT. Usually a good candidate has a generally good donor area with no signs of retrograde alopecia around or thinning there as well as a usually higher calibre of hair in thickness rather than being more fine. Density is a tricky concern because some have average of 80 follicular units in a square CM but could be thin hair and it doesn't look as good as say somebody with the same number but thick hair follicles. Similarly a person with 100+ follicular units with fine hair might look as good as somebody with around 80 FUs but with thick hair. So that's why it's always called "Illusion of Density" when they try to match your native hair by following a rule of thumb around 50% of the original density. Medication will be your best weapon to hopefully slow and halt hairloss leading to less grafts needed for any hair transplant. On average we have 6K grafts and if possible, it wouldn't cover all your head if you went slick bald at whatever age to Norwood 7. So no, getting more grafts so you can get a hair transplant earlier isn't a thing. Being on medication, proving you slowed/stopped hair loss for a few years and being around 25+ would probably put you in a better position as being a good candidate with realistic expectations.

As a guess, that works but i do think the way OP phrased it, he wants an in depth analysis to see hair calibre and how much miniaturised hair there are that could benefit from medication etc. I do wonder, that even though you might not go to these other hair transplant places for a procedure, maybe getting a free or reduced price consultation could answer some of those more technical burning questions.

Getting a diagnosis for hair loss isn't exactly the easiest in most developed countries imo and not everybody will even consult with hair transplant clinics for assessments if they're in their early teens/20s because they can't afford it. As i said above, by the time you notice it, usually 50% is already lost and you're playing catch up. There's nothing wrong with being more pro-active imo around hair loss. There's no significant proven scientific study that says taking Finasteride will stifle any meaningful development of a biologically born male for example. If i could do back, Finasteride 1mg 3x a week at 18 would easily be what i'd have done and probably increased to everyday after 3-6 months if no side affects

Unfortunately the "ultimate cure" doesn't exist yet for hair loss and until then, we can only use what we have. Finasteride and Minoxidil have been around for 25+ years and we only now have other treatments trying to get approved and they don't seem to work that much better. They just work differently. The biggest game changer could be Stemson Therapeutics clone hair grafts if they can pass and get to human trials soon then to market. It would solve the finite donor issue but that doesn't mean it will be cheap or that you won't have to find a clinic that can do a good job making them look natural when you get a hair transplant. Personally i hope i can see it happen in my lifetime and maybe any kids i have that are 20+ could benefit from it circa 2030 onwards but for myself, i can only use what we have and how well it works isn't 100% the same. We can only try.

OP, as a young guy you need to understand that hair loss is progressive and if you can't take Finasteride because you got side affects then Minoxidil and other stuff as mentioned can help but they're not going to stop the underlying cause which is DHT like Finasteride is designed to. Nothing else on the market except maybe the topical Finasteride which usually has a lower side affect profile probably could help you in that respect. Overall i would strongly urge you to consider researching more about hair transplants because right now your understanding is at a very early stage regarding high grafts etc. Hair Transplants create an "Illusion of Density" which is that usually they rely on a rule of achieving approximately 50% of the original density you used to have to make it visually look similar. However sometimes even then the density could be less if its smartly designed and placed. This is done because if you ever had aggressive hair loss and needed up a Norwood 5 or greater in your 30s, it's gonna require a lot of grafts to cover the entire areas and even give it an illusion of density. Circa 6K grafts is what the average donor has in a candidate. Now, sometimes you can split these grafts up smartly and make triple hair grafts a single and a double for example, but again this depends on your donor and how many doubles, triples, quads etc. it has and its still not 100% ideal. Maybe you're part of the lucky generation that might get hair clone grafts but you'll still probably be in your late 40s to 50s when they actually become a reasonable price and even then you might think its expensive. You should probably wait a bit longer till you 25+ and tried some kinda of treatment to maintain your hair loss and do research. Also save up!

Honestly, i earn money and that's ridiculous imo to pay to get Oral Minoxodil. I would rather pay for an entire year or two worth of topical Minoxidil for that amount. OP, i do believe your right temple does look a bit worse than your left and taking Finasteride pre-emptively shouldn't really affect you overly negatively at a low dose. I don't take the same stance as some on here because technically by the time you actually realise about most hair loss, you're already at about a 50% loss. I feel being pre-emptive is better but Finasteride can inhibit DHT and the function it can offer towards production of certain masculine development like beards etc. so it's a double edged sword That said, if i could go back in time, i would definitely have started around 18-21 myself. I think i haven't lost a lot and visually it doesn't seem to be much but i have a sneaking suspicion i did lose some density and that's where usually you don't see things as obviously imo.

Firstly the fact that you're on medication is a great step because you recognised the potential hair loss progression and pre-empted it at much as possible. The largest concern atm is your age and that maybe you haven't fully researched enough to inform yourself on what that would mean long term if your hair loss did progress even whilst on Dutasteride and Oral Minoxidil. In fact, the Oral Minoxodil has only been 2 months. That's barely enough time for a single hair cycle, so you need to give it 12 months. Right now, the best thing for you genuinely imo is to give oral minoxodil 12 months and maybe add Nizoral or a 2% ketoconazole shampoo into the mix and also add Microneedling with a derma pen at 1-1.5mm into your regimen. Save up and basically keep an eye on your hair loss progression from now till around 25. If you can prove you haven't got worse and stayed the same or improved it will be a good sign to top clinics to consider you for a hair transplant as it shows you halted/stabilised your hair loss. Right now, genuinely even at 20 years old, your hair loss hides a lot betted than mine did just by a simple styling. I completely lost the triangle temple points by 17/18 and you still have yours so it frames well and the styling can hide the right temporal loss. I would honestly ask you to manage things with medication and add what i said. Just take your time and save up.

I'm honestly going to go another route since i think the others have already touched on clinics/doctors and pricing. Looking at your hair loss situation, your donor doesn't look particularly strong in that picture either due to lighting or possibly because you might have retrograde alopecia and it's just not that area but over your ear that makes it seem that way too. I would probably recommend you to increase your dosage to 1mg every day of Finasteride as soon as you are able to in order to block the maximum DHT that medication allows because at only 25, it does seem like your hair loss is getting a bit more aggressive. Early intervention is the best defence imo. Also, add in Nizoral or a similar 2% ketoconazole shampoo and i would honestly say Microneedling at 1-1.5mm with a derma pen 1x a week could help a lot to stimulate blood flow and those struggling hairs. That said, with your shorter hair it's difficult to asses but Minoxidil can IF you stick to the routine probably make a huge difference. Just be aware, once you start these treatments, they need to be used indefinitely. The SMP probably makes it a touch harder to tell fully your native hairline and where it is but that's probably a credit to the SMP being done well enough to blend more naturally.

I would honestly urge you OP to get some medication like Finasteride and it could help save some of your hair. I'm also going to recommend if you want to use Nizoral 2% ketoconazole shampoo and add Microneedling in, that can help too. Possibly you look like you would honestly benefit from Minoxodil and might be best off using both Finasteride and Minoxodil because of how much thinning it looks like you have in the midscalp. It will probably be best to wait 12 months using Finasteride, Minoxodil, Microneedling and Nizoral before going through any hair transplant. You can do your research and save up for the best place.

Good going on making the guide. Hopefully will help a lot of folks wanting to show off their results and now wanting to drown their threads with pictures.

Firstly i think this has been a deeply divided thread in the community and there's been many strong opinions voiced. In some cases perhaps people have not chosen the best wordings or mentioned things in the best phrasing. Ultimately i've said i think we need to come together as a community and try to get a good resolution between patient and clinic. Eugenix are of course highly trusted on here because of the personal experiences of individuals who have felt a successful outcome thus far in their journeys. However, OP has now reached out to the clinic and the clinic is saying their piece. Hopefully there will be a middle ground and positive outcome. Eugenix via Melvin's post have offered to count the implanted grafts and check the survival rate and i believe it was explicitly mentioned any grafts that would not have grown will be re-done. I believe OP classed this as a "touch-up". If possible and the donor allows, perhaps OP would be willing to have an additional procedure to add density but whether this is with Eugenix or somebody else will be seen in time. You cannot as individuals perhaps fully relate unless you have gone through a procedure the emotional hesitancy to so soon return for a further hair transplant when results may have not reached the planned fruition due to complications etc. I think Eugenix will be the first per their post to admit the complexity of repair cases vs a virgin scalp may have led to this outcome, however once an evaluation has been done. If the majority of the grafts yielded, then i think it's only fair for them as the clinic to perhaps review their original planning for the procedure as possibly not having the desired outcome and use it as a learning experience for future patients. No clinic is perfect and anybody even highly rated probably has had a poor patient result at least once even with efforts taken to reduce any such risk. I hope we can all as i've said previously pull together as a community and learn from this.

OP, you probably didn't research well enough or misunderstood the role of medication like Finasteride. Finasteride inhibits DHT to slow or stop hair loss progression where DHT is usually the primary cause of androgenetic alopecia. So the fact you were on it for 6-10 months and didn't see a progression of hair loss means the medication is actually doing its job. In fact, a long term Japanese study showed it still being effective in individuals 10 years later and helping mildly with regrowth. However, for regrowth to be possible you really should be using Minoxodil in combination with Microneedling to boost the results even further. Both Finasteride and Minoxidil/Microneedling work on different mechanisms of action and as such work synergistically to boost your hair restoration efforts. You could possibly still start Finasteride again with the above routine and throw in a ketoconazole 2% shampoo like Nizoral to further help. If you do have any issues with Vitamin deficiencies then that being address alongside any scalp issues such as inflammation, dandruff, seb derm etc. will all improve your scalp and hair regrowth. The scalps like a field. You need to ensure its fertile land in the best condition for hair to grow.

I would say if you're not averse to it, H&W with an initial FUT procedure and future strip for a potential second before switching to FUE might benefit you the most long term. Your donor area looks weak to be frank. It's very patchy in that above picture maybe exaggerated by lighting but indicates retrograde alopecia and that would make it even tougher. As you said, H&W have their track record and imo with the potential future progression, FUT is probably better for you to start with alongside the fine hair and possible donor issues long term.

I think that's a bit harsh bud, but hopefully @AJ_HThimself can post what resolution he's looking for. That said, i think there's enough information in this thread for people to form a picture of events. I think this thread does have some learning points both from a patient and clinic perspective. I've talked about not trying to blame anybody here but as a person who went through previous bad experiences i'm sure in a small way you can relate to the emotional hesitancy OP may be having felt he did his research and that his expectations were realistic for an adequate illusion of density based on the clinic quoted grafts for the frontal hairline. Giving it the full 12 months to fairly assess and now fully confirming the end results fell short of perhaps the expectations set. Perhaps i think OP can share more details of their before photos from when the first procedure happened that required repair. If the frontal area was all transplanted hair, then as we all agree generally, this hair won't fall out and be affected by DHT and so any repair would slot in between.

Thanks for sharing Melvin. Looking forwards to the updates. I personally never bought into the LLLT shtick but that was probably cause of those snake oil hair combs and whatnot with low strength diodes, not the more stronger lasers that the research was actually done on. I also think it's supplementary hair growth you can achieve but i strongly believe just like Minoxidil, if you don't block the root cause (DHT), then LLLT and Minoxodil will eventually show itself as becoming more ineffective as hair loss progresses. If i would personally rank things for cost and efficacy in hair restoration i think my list would be: 1) Finasteride/Dutasteride 2) Minoxodil/Microneedling combination or solo 3) Nizoral shampoo 4) LLLT, PRP etc. I'd probably say depending on where you go, PRP and these laser caps probably cost the same. Very much a maximisation purchase, not something on a lower budget and probably worth it for most.

Thanks a lot for providing an update and hope everything goes well for you settling into a new country and making it all work! Your hair does look great grown out but 100% appreciate you taking the time to tell potential patients things to watch out for. I wanted my temples to be completely reconstructed and i will definitely be looking to discuss this a lot more in depth with the clinic and try ensure there's adequate density and symmetry between the two sides. I usually keep my hair at a Grade (guard?) 4 and above on the sides and back with a scissor blend towards the top. I just feel a medium long hairstyle is versatile and gives you styling options. Might as well show off the fruits of that sweet, sweet hair transplant when the time does come lol Thanks again and all the best for the future!

The 2% is the one usually recommended as part of the routine. Nizoral is mildly effective as an Anti-Androgen at best but studies that did involve the Ketoconazole i think showed 2% as being effective enough to opt for it.

Tbh with you, i'm expecting some shock loss around the frontal hairline where the hairs are more fine but i just hope it is more temporary than permanent because they still give a decent visual cover. Almost SMP like i guess in some ways. Thanks for replying. I'm going to consult with the clinic on the day as i want the best outcome but if it technically is possible i feel like it's going to be a lot easier to get through the ugly duckling phase with the longer native hair able to mask it i guess. Plus the donor area after a month plus should grow back well enough to just look like a low grade short cut.

Looking at this picture where they have the lines drawn for a proposed hairline, do you think i could get away with just shaving the donor area and leaving the top normal? I feel like the main hair transplant is going to be done in areas where there's not a lot of hair and any density added behind wouldn't be a lot of the grafts. I have made my peace with shaving down the whole area if needed, but recently just thought i've seen cases where the hair up top was left when a new frontal hairline was being built.

I think OP is looking to establish in the context of hair transplants specifically what due diligence/homework needs to be carried out from a patient PoV. Like do we specifically need to know our hair calibre, our density per cm/2. Our current Norwood Scale rating etc.

Wow, that's a sharp spot there lol Definitely not a great first post to get caught with your pants down on

You need to stay on Finasteride and probably add in Microneedling 1x a week at 1-1.5mm and use Nizoral shampoo with 2% ketoconazole. You could if you were willing to keep the routine up start applying topical Minoxidil just to the frontal hairline area and Microneedling there to try get regrowth. It's not 100% guaranteed to be up front. The bottom line is like you probably but even worse i had my temple points completely recede and it aged me. You still look to have yours and the frontal hairline loss doesn't seem to have significantly altered things at present. So stick with Finasteride and maybe add the rest and see how you get on till you're 25. If you can prove you haven't lost any further then you could probably get away with asking for a more youthful lower hairline from where you area providing you realise the risk. That said, usually asking for a hairline like you had at 14/15 probably won't age as well when you turn 50 and that's important because you will spend more time looking older than younger and you don't want to look like a weird old man with a kids hairline either.

I would also like to confirm how legitimate this information is tbh. Sounds pretty good if true.

The replacement of hair planted isn't the issue here i believe for OP. It's that at month 8 he felt no need to raise the issue of density as 4 more months worth of growth was expected to evaluate a new enough 99% final result. Now at month 12 the final result is visible and the density doesn't seem to adequately create the illusion of density expected. So there appears to have been a miscalculation on the requirement of grafts. I do think the onus falls moreso on a clinic to either adequately estimate the required grafts given hair calibre etc. or when they have had a candid conversation with a patient, for them to make an informed decision on whether to proceed if it was explicitly mentioned the density will not be where it should be.

Melvin, the clinic themselves in the very screenshot you posted state "We still have time. The front looks good" and specifically aligns with the OP stating he was at month 8 and had a total of 4 more months to have the frontal hairline mature. A timeframe with which it is unfair to assume a final result as a patient which is exactly what OP has stated in their replies here. The touch up is for the midscalp and the OP has not raised any further complaints regarding that. The OP has simply stated they are now over 12 months and the agreement of offering sufficient density to the frontal hairline as expected after allowing the additional 4 months to get to a final 12 month result has not yielded the desired additional growth, maturity or density OP had expected based on clinical assessment. I'm trying to give a fair shake to OP and the clinic here. I'm sure others can also draw their own conclusion. You are certainly right that "He said, she said" is not something that can be really addressed but now i will raise something that has been mentioned. A document amounting to more or less an NDA for OP. Can you please address where you stand on this aspect if it is the case whether for this or any other clinic recommended by this forum as well as generally behaviour that any clinic would try to get a patient to sign. Clearly that wasn't a standard patient surgery consent as we know OP had a midscalp procedure which we are calling a touch up but he wouldn't have had it if he didn't sign for surgery.