What shall I do? Hair transplant or Minoxidil only? (photos)

As you are probably already aware, the Norwood 6 to 7 levels are considered to be the most severe stages of male pattern baldness. Although you may be noticing some fine hair growth, it is quite unlikely that this will result in the density and coverage that you would find to be most ideal. At my practice, the Dr.U Hair and Skin Clinics in Los Angeles, we offer body hair to head transplant for severe baldness, since at the Norwood 6-7 stages, the amount of head hair remaining on the scalp would be insufficient for producing significant improvements in coverage.  As opposed to depending on Minoxidil, this is a far more reliable approach for achieving desired forms of improvement

The little bit of peach fuss type hair growth you are seeing from the Minoxidil is all that will happen. These hairs will not turn into full terminal hairs. You should do some Hair transplant consultations to see if you are a candidate for the procedure. It does appear from the photos that you have a very large area of hair loss and a smaller area of available donor hair. There is a good chance you do not have enough donor hair to get coverage over the entire area of hair loss.

Hair restoration is like a train...there are many cars and they are all headed in the same direction. The closer you are to the engine the faster you will reach your destination (i.e. the caboose is the last t pull in).
There are a number of modalities available ranging from supplements, topical therapies, medical therapy (Rogaine/Propecia) and PRP.
Patients may try one intervention at a time beginning with the least involved and add or replace as they see results. Each has positives and negatives and not all will be equally effective.
Hair grafting is the final and most definitive solution, however this should be delayed until you have reached a stable hair pattern. This is due to the fact that the grafted hair is permanent and if you have not reached a stable pattern you can expect further losses and the need for more grafting to avoid the appearance of a double hairline (grafted hairline followed by losses and the receding natural hairline).
With regards to your specific question, I would forego hair transplant until you have stabilized. Otherwise, you may be committed to further grafting in the future as your pattern evolves. That being said, you demonstrate a fairly advanced pattern which can be limiting with regards to options. Minoxidil is not going to be a definitive solution. Hair grafting may also be of limited utility (limited donor sites).
As always, discuss your concern with a board certified plastic surgeon (ABPS) with experience in hair restoration.
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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