Should I get a hair transplant now-or wait? (photo)

It is important to assess the patient history which includes family history Norwood scale, speed of ongoing hair loss and response to non-surgical treatment. For patients who are experiencing ongoing hair loss, hair transplant can still be performed but we have to plan out the management wisely such that at the end of the final hair loss process, the final hair appearance will look natural. With this group of patients, I often start with oral minoxidil +/- finasteride to help keep their current hair.
Based on your photo, I estimate at least 2000 to 2200 grafts to cover both hairline and crown.

Dear captaingrooveThanks for the question. Before all, your current physical and mental health condition should be fine. Your donor site which is the back of scalp should have adequate supply of hair to extract and this amount should be enough to restore an acceptable large portion of the bald area with a desired density. Your expectation with the result should be realistic. I wish you all the best.

Photos cannot determine if you would be a good candidate for surgery.  You need an examination and the doctor needs to understand your goals and expectations.

Hi captaingroove, thank you for posting your question on realself.comIt is not too early for you to get a
transplant. I would prefer that you start early. Often patients who think the
hair transplant is the only way to improve their hair begin to quickly learn
that adding hair doesn't mean the rest of your hairs will behave. Treat your
hair restoration as an investment. Protecting the optimal results of a hair
restoration is half the battle. Look at what you are willing to do. Find a routine that will become as normal as
brushing your teeth. Often this sounds like a downer, but my patients feel the
results are so spectacular they want to keep it that way. Your donor area looks
good, so you can probably do multiple procedures. Why do this if you can
prevent it? Consider if you did a procedure today. The
permanent hairs grow. If our concern of the remaining hairs being lost in an
advanced male pattern continues, what would it look like? I design your hair
restoration to look like a natural pattern of male hair loss. With this in
mind, if you lost more hair, you would not feel forced to do another procedure
to fix something that looks sectional or man-made. Find a hair restoration
practice that understands your biggest concern and addresses it fully to your
satisfaction. Find a board certified in hair restoration practice that is
results oriented. Best Regards,Bernardino Arocha, MD, FISHRS

This is a fantastic question captiangroove. Based on your photos, it appears that around 2000 to 2500 follicular grafts would be needed to optimally correct your current loss pattern. Unfortunately, in  patients genetically predisposed to male patterned hair loss, they will continue to lose hair in the typical spots like your photos exhibit (the frontal/temples/top/vertex/crown) in a progressive manner over time. The only way to slow the rate of loss is through nonsurgical prescription (Propecia), over the counter (minoxidil) and injection therapy (PRP). Before undergoing any hair transplant, make sure that you're using 5% minoxidil foam twice daily over all affected areas, and if tolerated taking prescription Propecia which blocks the hormonal stimulus for hair loss, as directed by a physician. PRP scalp injection treatments are also potentially a good option for you. In this in-office awake procedure a blood sample is taken and the platelets and growth factors are isolated, concentrated and then injected into the scalp near the hair follicles to support and stimulate their growth. Several PRP injections separated by 6-8 weeks can slow and potentially reverse some hair loss. 
Again though, in patients genetically predisposed to hair loss, it is a progressive and inevitable process without hair transplantation to replace the lost follicles. The timing of hair transplantation should not have a significant effect on the future rate of loss in the areas of concern. Additionally, it is important to understand that the hair follicles transplanted are harvested from the lower rear portion of your hair-bearing scalp, which is a privileged area. The follicles in this area are special in that they are not sensitive to the hormonal cues that cause hair follicle loss on other parts of the head (this is why you'll rarely if ever see someone who is naturally bald on this part of the scalp unless they shave the area). After transplanting the follicles elsewhere on the scalp to replace the lost follicles, they maintain this hormone resistant quality and should be permanent. After transplant though, the native follicles in those areas will continue to be lost over time causing the appearance of progressive loss. This can be corrected however, with repeated transplant procedures.
I always leave it up to my patients, but universally optimize the medical management of hair loss first. Afterwards, the patient and I decide whether to proceed immediately or in the future with transplantation. My preference usually though, is that staged smaller transplant procedures over time are superior to waiting until further hair loss occurs and then perform a much larger and more complicated procedure with a more dramatic before/after change. This approach gives a more gradual correction of the hair loss which patients often desire.
The most important thing you can do now, is to find a local plastic surgeon that performs the Follicular Unit Extraction/Follicular Unit Transplant (FUE/FUT) procedure, and discuss in person with them how to best proceed. Best of luck!

You didn't mention your age but the most important thing to do now is stop the loss of more hair and protect the existing hair.This can be done with adjuncts such as Minoxidil ,Finasteride ,PRP and/or Low Level Laser Light.

A great first step would be an online consultation. Often you can submit photos to top hair restoration surgeons for a complimentary evaluation. This should help lead you in the right direction. Having multiple consultations with different doctors cannot hurt. 

I advise you to have a FUE operation of 3500 grafts. The doctor will  determine frontal hair line and debade with you to decide level of new hairline. No need to wait for loosing more hair. Hair transplantation would cover all bald spot in one session of operation and you would have a good, successfull result .ıf you loose more you can get a second session in future.

Thank you for the post. This question you can only answer. If it bothers you enough, it would be a good time to have your scalp restored. If it doesn't bother you, then you shouldn't. From the reflection of the mirror, it does show you a good donor region. When it comes to hair restoration, and graft count you need to know and understand 3 key points to make your decision safely. 1. Surface Area Size being covered, 2. Density being used per 1 cm square by the clinic 3. Understand what natural density starts with 1 cm square. This will help in your decision making. Best wishes. 

Very clever use of the mirror in your first photo- shows the crown nicely.  Whether you should get a transplant now or wait depends on how much the hair loss bothers you.  If it bothers you enough that you want it fixed, there is no reason not to proceed.  Be sure to go to a qualified hair transplant surgeon who will design your hairline with future hair loss in mind so that as your hair continues to thin the transplanted hair will not look unnatural.  I always hate to estimate graft numbers based on a few photos, but from what I can tell 3500 is a very large number for what you need done.  1400 should give you a decent hairline, perhaps increasing to 2000 or 2400 to include the top of your head, but I'd have to see you in person to say for sure.You still have a fair amount of native hair left.  Also discuss with your surgeon ways to maintain your hair and prevent further loss, such as platelet-rich plasma (PRP), minoxidil (Rogaine), laser and finasteride (Propecia).