Dear Bold,

A hair transplant has a very large artistic element in it's application. It is very difficult to project an exact outcome even when knowing the surgical methodology of the physician you are consulting with. How is the doctor going to allocate the first 3500 grafts? I'm assuming that he is going to rebuild your hairline, corners and anterior third of your head in the first procedure.

The hairline and front is a very strategic in a HT procedure. The hairline frames your face and keeps the facial appearance symmetrical. OK. It appears you are heading towards an advanced Norwood class.

Did your doctor perform a miniaturization study? How dense is your donor hair per square mm? What is the laxity of your donor region (very important for size of procedure and safe donor incision closure)? How thick (fine, medium or thick) is your hair shaft diameter? Is your hair wavy, or straight when grown out? Another factor, Bold, is the contrast of color of your black hair on a lighter skin tone. All these factors play an important role in devising a surgical protocol for you.

The gold standard is to achieve approximately a 40% density of the transplanted area when compared to the donor density. This will give the appearance of very adequate density. Can that be achieved in your case? It is unknown without some of the general information requested above.

The surgery graft number recommended by this physician seems a very fair assessment given your presentation (pictures). The donor region appears good but donor density (hairs/sq mm), miniaturization and scalp laxity need to be determined. This will ultimately determine how far you can go. Remember, the donor scar must be as aesthetically pleasing as the newly transplanted hair! Ask the doctor if he can do a trichophytic closure after your last HT procedure.

Are you using finasteride?

As to receiving all the grafts you contracted for: we take the leap of faith to entrust a licensed health care professional to serve the patient in the the patients best interest. One would hope that the doctor wants the best outcome for you and will place all the grafts he can safely harvest.

Bold, try to look at patient pictures with a similiar presentation and a similiar number of grafts to get a ballpark estimate as to what you can expect. Remember that so many factors may be different like head shape and all the previous mentioned information or questions I asked above.

The surgery protocol, absent the above information, seems fair and appropriate.

Good Luck Bold. Please keep us updated on your information gathering and ultimate decision.

rich91403

Dear Bold,

You,re welcome and congradulations on selecting a surgical date. I've read your profile and our collective hearts go out to you with this hairloss situation and how it is impacting your life.

It appears you are practicing a very healthy lifestyle and please do not entertain the thought that you have done something wrong to negatively impact your hair. Mendelian genetics and being a male are probably the dominant causes of your hair expression.

The good news is that there is a solution for what ails you. You are taking a proactive step towards it's resolution so all is good. Now we have to be pragmatic and efficient in this moving forward process.

You are going to have a large surface area to cover. Placing 3500 grafts diffusely over the entire male pattern area "may" not satisfy the density you are seeking to offset the appearance of baldness. I agree with your foresightful thinking that a second procedure is probably going to be necessary. It is good that you have that in the back of your mind. If you are satisfied after the first 3500, then that is great. If you desire more density, then you have mentally prepared for that. The good news is two procedures may do it for you. I've had like seven! I lost count already!

Bold, I read on your profile that you are using two milligrams of finasteride per week. The doctors in the US and the clinical studies here have shown that 1mg per day is the effective dose (based on clinical trials). Maybe you can discuss this with your physician.

One other factor on your pictures. There appears to be a "crown edge" from the picture that shows the back of your head. This is a region of donor rim that still has characteristics of receding inferiorly. It appears to be solid and permanent hair but a miniaturization study should be performed to see how wide this "crown edge" is. Since you're making the big move, the boys here on HTN gotta look out for you. Just ask your doctor to assess and plan for the "crown edge".

Keep up the good diet and exercise program. I look forward to hearing about your progress and the positive impact it has on your life.

Rich (I'm a medical consultant for Dr Parsa Mohebi). I'm expressing my own opinion as a fellow hair loss sufferer.

Dear Bold,

I'm very glad to hear that you are confident and satisfied with your doctor's approach.

I am using finasteride daily without any negative effects. The recommended dose by the doctors here (FDA approved) is 1mg per day for hair loss as the effective dose. I believe that would be an appropriate dose for you per your doctor's approval. He seemed to recommend the 1mg per day and I believe that to be a responsible one.

The reason I had seven procedures is because the technology was so much different in the early eighties. Now, one or two procedures usually takes care of most patients. I was born too early!!!

Bold, you're very welcome for the response. I hope you get a great result and if I can be of any support along the way, I'd be honored to do so.