This is an example of one procedure to create a hairline that would not be appropriate for many men, especially younger men. This man is only 34 years old. I would be reluctant to graft this low a hairline in most men under age 40 and reluctant even then if their crown were more than minimally balding. This case, in my opinion, shows that ???black and white??? rules are fine for some and certainly make life easier for all involved (but leave some patients with the verdict of ???not being a candidate??? for whatever concerns their aesthetics had them visit the surgeon for in the first place). This gentleman is very smart and understands the consequences of future balding in the crown which, if extensive, could result in there not being enough donor hair to keep up a natural distribution of hair on his scalp. He states, however, that he has complete confidence that there is no crown balding on either side of his family. His crown (see photo) both with regular and 30X photography shows no evidence of male pattern balding. I agree with his assessment that the risks of insufficient donor hair are sufficiently small that surgery would be a reasonable option. He is not taking finasteride and would prefer not to. The absence of miniaturization or loss of density in the crown makes it reasonable not to use finasteride at this point. He can revisit this issue if miniaturization appears in the crown. A surgical plan should not be devised that requires a person to use ( with successful results) medicines for the rest of his life.

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William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians

This is an example of one procedure to create a hairline that would not be appropriate for many men, especially younger men. This man is only 34 years old. I would be reluctant to graft this low a hairline in most men under age 40 and reluctant even then if their crown were more than minimally balding. This case, in my opinion, shows that ???black and white??? rules are fine for some and certainly make life easier for all involved (but leave some patients with the verdict of ???not being a candidate??? for whatever concerns their aesthetics had them visit the surgeon for in the first place). This gentleman is very smart and understands the consequences of future balding in the crown which, if extensive, could result in there not being enough donor hair to keep up a natural distribution of hair on his scalp. He states, however, that he has complete confidence that there is no crown balding on either side of his family. His crown (see photo) both with regular and 30X photography shows no evidence of male pattern balding. I agree with his assessment that the risks of insufficient donor hair are sufficiently small that surgery would be a reasonable option. He is not taking finasteride and would prefer not to. The absence of miniaturization or loss of density in the crown makes it reasonable not to use finasteride at this point. He can revisit this issue if miniaturization appears in the crown. A surgical plan should not be devised that requires a person to use ( with successful results) medicines for the rest of his life.

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William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians

Looks superb, and the documentation is really great for getting a feel for the result! You've given this guy a flawless head of hair. There was a prospective patient with a very similiar situation (more receeded temples) who stumbled onto the forum recently; I'll definitely refer him to this case.

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*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

The work does look amazing Dr. Reed, great result. Would you please elaborate a little on what you meant where you said that "A surgical plan should not be devised that requires a person to use...medicines for the rest of his life."?

Very natural, great job, I am sure this patient is happy.

1301 grafts?

Thank you, TC17, for the compliment. You ask that I elaborate on " a surgical plan should not depend upon the successful use of medicine". I'll try not to be too verbose, but I think it's an important point to be clear about since male pattern balding is a progressive condition and since medication can stop the progression and even regrow some hair mass. A key question is if a person and his surgeon decide upon a pattern of grafting that addresses only his current pattern of hair loss or do they limit themselves to a more conservative pattern that can be created with the donor that remains and the amount of balding present in the distant future after balding has progressed for several decades. At times the decision is probably based upon the present degree of balding and larger amount of donor area because the person says he is going to take finasteride for the rest of his life. This is probably a false premise since how does he know he can take finasteride that long and that it will be effective? The "90% of people that have their balding arrested" is based upon a study that followed patients only five years. The informal nine year followup with this group of patients suggests the progression of balding is still arrested then and theoretically the progression will probably stay slowed down (although we, men and women, all lose hair over our entire scalps to some degree) after nine years. Nevertheless, the stakes of balding more than surgically planned can result in a social discomfort that is worst than the balding that had him decide on surgery. So I'm opposed to making a surgical plan whose success of having enough donor depends upon taking medications for the rest of ones life. Please feel free to follow up with questions if I'm not clear. I find a common misunderstanding of inquiries that I get from HTN is about this point. Young men in their twenties don't seem adequately clear on how bald they may go and what this means. I don't want to rain on any parades or enthusiasms about the refined techniques that have arisen in the last 15 years, but that is not a very long followup period and we have not yet begun to see the results of poor surgical planning whether it be because the person planned to take finasteride for the rest of his life or for some other reason. Male pattern balding is patient!

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William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians

Looks incredible Dr Reed. Im highly impressed

Dr. Reed,

Thank you for your reply. Just to clarify, is the gist of your post that you always look at what the patient will be in the future when transplanting? If so, how do you predict the final pattern with any accuracy?

Yes, grafts. Sorry for the typo.

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William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians