TheEmperor

Reptile, You want to keep the # of surgeries as small as possible! It is surgery and there may be complications. Also, the healing period is difficult and you will look awkward or 4+ months until the new hair grows in. You will not want to go through this twice if you dont have to. There are some clinics that get 4000+ grafts on a fairly routine basis. If you accept that you will not have enough hair to cover the crown (which I believe is true in your case if you are only 30yo), then you might as well seek as large a first procedure as possible which will give good coverage in the front/top and connect with the sides. Its a numbers game. You need as many grafts as possible with as few sessions as possible. If your surgeon only gets 2500 in the first session, and then only 2500 in the second in an attempt tp cover your whole head, you will need a third procedure! If you get 4000 in the first, you will have the option to stop with a bald crown, or proceed for another 2500 to complete the crown. I have seen some bad results where a doctor attempts to stretch a small graft count over too large an area. The patiet still looks bald and only after the second fill in procedure does the result start to look acceptable. OTH, with your large area, if the doctor only plants 2500 in the front, it may look OK from the front, but not be well connected to the side hair and as a result look unnatural. I recognize that most doctors cannot perform these mega-mega-sessions, and they are not indicated for all patients, but you owe it to yourself to seek out one of the 5-ish docs who can routinely perform these large sessios.

I had a 4500 graft session and your balding area is larger than mine; you will need 6-7K grafts to cover it all, and that with not too great density. I would suggest not to touch the crown. Most patients can get at most 4500 grafts in a single session, which I would advise to cocentrate in the front and top. Also, I think there is some truth in the larger sessions splitting larger grafts to get 1's, but if your hairline has any 2's in it, it will look unnatural, especially if you have coarse hair as it looks like you do. If you go to your doc asnd get a 2500 graft session, that is only 250-300 singles by his admission and that is NOT enough to give a natural hairline. Therefore, clinics like H&W that may be splitting grafts smaller will get maybe 1000 singles from a 4500 graft session which will be enough to complete the hairline and look natural. Yes, hair for hair it will be more expensive, but for someone with coarse dark hair like yours, it is the only way to proceed, IMHO. If you cant get 4000+ grafts in your first session, then I would not proceed; it will look too thin and too sparse to do any good, and with only 10-15% 1's it will look pluggy as well.

Wantego, You are WAY ahead of the curve -- definitely a fast grower. You will be very happy. Your 3 month pics look more like my 5-6 month pics.

I had a large procedure and my scar is on the wider side. Coupled with the fine hair on the sides of my head, it can only barely be concealed with hair cut to one inch and even then I see a faint outline around my head. I most ceratinly lost the abilty to use clippers even on higher settings. I went to a top 5 doctor and got tricho. The scar was wide from the begining, right after taking out the staples. Scarring CAN be an issue. I lost the abilty to clip my hair, but I can still keep it short, but it is a loss. It makes going to the stylist very dicey because you need to tell them about it (well in my case its easy to see.) I am hoping te scar will not be as wide after the second procedure. I would say about 50% of guys are lucky and can still use clippers. But of the guys who have had strip procedure, you will notice very few of them use clippers. Wonder why? FUE would not have been an option for me due to potential yield issues. although the presence of the scar would really make me consider FUE if my loss was minimal. The problem with "minimal" loss is that it often progresses, so its difficult to make a blanket case for FUE. Maybe in guys who are 30 or older and have minimal loss. Everyone else needs the highest possible yield. Once you have had a HT, you will realize how precious every hair is. There are some FUE guys who have gotten close to strip yield, but then there seem to be a good number who havent and have needed touch ups. Neiter method is perfect. So if you are going strip, please be prepared to sacrifice the abilt to clip your hair. THe pencil thin scars CAN happen, but they are not as common as you might think.

I think the two primary reasons for a strip procedure are 1) Damage during dissection, and 2) Damage during placement by techs Keep in mind that every follicle is cut out from the surrounding tissue under magnification. It is very exacting work and some % of them are going to die. Also, the placement of the grafts must be done without putting much force on them or they will be damaged and die. In my procedure there is a "line" up the middle. On the left the yield is good, on the right front, not so much. This follows the pattern that the technicians were working. (They usually have one on the left and one on the right and divide you head down the middle). Furthermore, the longer grafts are out of the body, the more likel they are to die. I suspect this is why crown growth is slowed/delayed, because they are placed often after 10 hours of being out of body. Perhaps techs are getting tired and rushing to get things done. I have also heard that dense packing jeopardizes the grafts. Its not clear to me if there is a lack of blood or if it is the tight handling which causes damage. IOW, the yield is almost entirely a function of the skill of the technicians. How good they are in dissection and placement without traumatizing the grafts.

I have given this some thought. I think even more vexing is how to determine the growth rate of transplanted hairs. To answer your original question, you can take close up photography in one or more pics and count the grafts. A small session of 2500 grafts spread over the entire scalp will no look like much.

Yes. Fine donor hair can make it harder to hide the donor scar. Also will make it much harder to achieve coverage. This should factor in to how much ground needs to be covered and how much donor hair there is.

Wallet.

Yes, look into a small FUE session. Should work very well.

Some of the Bosley docs are doing good work, dont worry about it. Just wait for it to grow in, you should be fine. It will take many months for it to all grow in.

Hi, I cant be sure, but my guess is that MPB is causing the hair loss and that is causing you stress. Also stress has been shown to accelerate hair loss, so that may be contributing. Look on the bright side; there are therapies that can help you now -- 20 years ago that was not true. Propecia can slow or stop loss and HTs can restore hair. My advice is to begin saving money, focus on school and getting a good job, then in another few years you may ave enough money for a HT, or find that the propecia has stopped your hair loss. You can also try shaving your head to see if you like how you look. Its a PITA, but its not the end of the world. If you absolutely need hair then you have options but it may be expensive.

Yes, my satisfaction is likely to improve as my result matures over the next few months. I'm not unhappy at this point, but I'm fully aware of what they mean by the "illusion of density". I did not know exactly what this meant until my results had grown out. The doctor used lateral slits to layer the hair forward. Laying on top of one another and growing forward, the hair can look like there is more there than there really is. If the hair is combed up or back, it becomes apparent how little hair there is. I was a NW5-6 temple points still in-tact, 4500 grafts in the front 2/3rds. I have a smallish crown area that was not addressed. I would like get a second procedure to slightly lower/broaden the hairline and smooth out some irregularity and connect better to the rim hair on the sides, also finish the crown. Certainly I would like more density, but im not sure that is possible with my other goals.

Ceasr, There are still some elements of the procedure that I'm not thrilled about. I am pretty sure the expected outcome was oversold, and im pretty sure I dont have 100% yield in all areas. And there are some issues with the hairline design that will need to be fixed in a follow up. Also, its quite clear that this is just an "illusion" of density and that hair will look almost invisible if combed the wrong way or in the wrong light. OTH, when combed and styled the right way, the hair looks respectable and I look much better than before. So the bottom line is that I guess overall Im happy that I look better, I'm not 100% happy for various reasons. Part of being happy is the realization of what they mean by the "illusion" of density. Some guys seem to get actual density, but unless you are planted at an outrageous density or have very thick hair, you will get coverage that will either look very bad or very respectable depending on lighting, hairstyle, photograph quality, etc. Good luck. Even thought they tell you about the doldrums, I think most patients have a right to be discouraged because its never really made clear what the final product is going to be. There is a crossover point where growth catches up and your expectations are reduced enough that you can feel happy about the procedure. Looking back at your before pics will put things in perspective. ------------- Ceaser, I'd like to add that it is my opinion that most posters who post pics are proud of their HT decision and post pictures that cast the work in a positive light. I took some 9 month pics that from some angles might elicit a "wow" response, but from other angles really show what is meant by the "illusion of density". When I go back and look at other people's pics, even the home runs, this is obvious to me.. My point is that you have a long ride ahead of you and not to lose faith. You picked one of the best docs and you result will eventually come together.

I just took a trip down memory lane. Looked at my pics from each month. 2 months -- Nothing visible. Didnt really expect much 3 months -- Maybe some new vells hairs and some of the native hair had started growing back. 4 months -- Very little to show. Starting to get anxious 5 months -- Feeling very much behind curve. Anxious. Anxious. Depressed. 6 months -- Scrappy thin hair, enough to lose the hat. When carefully styled did not look retarded, but see through, se through, allmost invisible. Starting to have serious doubts because I had heard you have 50% at 6 months and doubling what I had in my minds eye did not give me confidence. 7 months -- Same as above. Maybe more than before, but scutinizing lack of growth, Uneven growth, some patches with more apparent hair. Anxious and depressed. Still havingdoubts. 8 months -- Hair quality is wirey and diesnt seem to be growing at same rate, need to cut it once every two weeks to keep it looking ok. Careful styling routine makes it look ok. 8.5 months. -- Looked at my before pics. Wow, something has happened. . . 9 months -- I really dont look bald anymore. Maybe this was a really good decision. Maybe there will be more to come! I'd say that somewhere around 8.5 months it came together enough to look respectable, and then at 9 months, I'd say I realize that it was not a failure and made a significant improvement in my look. I'm not sure if new hairs sprouted, but DO NOT UNDERESTIMATE THE THICKENING AND MATURATION of the new hair! A 20% increase in diameter represents a 50% increase in hair mass. So mild increases in hair diameter may not be visible to the naked eye, but overall will have a significant effect on your overall look. At some point everything comes together. Months 3.5-8 are the hardest because you have an expectation based on what you see from some of the fast growers.

Most people can only safely get 4000-4500 grafts in one session. If you have a fully bald head, it is best to concentrate the grafts in the front and midscalp rather than putting them in crown. I have seen some docs make poor decisions and spread smaller numbers of grafts (2.5-3K) ove the entire scalp and it does not make much of a cosmetic difference; you want to avoid doing this. If the doc can get 5-6-7K, then you may be able to cover the entire scalp depending on how bald you are.

I think you can have decent coverage w/ 7500 grafts, but some people want more than just decent coverage, and why not go for as much as you can if you can afford it. If you are stripped out with 7500 grafts and hair greed strikes, I would think it prudent to save precious follicles for repair when hair recedes more. Being that close to the edge one should exercise extreme caution. Having only 7500 grafts indicates a NW6/7. I believe most 4/5s have closer to 9-10.

I think this is one of the less mentioned risks of HT. If you read the forums there is an underlying theme that the hair is differnt sometimes. Most people it is close enough that it does not bother them. In my case, I am 90 months out and have fairly straight hair. The transplanted hair is a bit differnt, but it was layered forward with the lateral slit so I dont have the problem of it standing up. However, after a certain lengt of about 2 inches the hair begins to curl. This may go away in time. If a person has a wave to their hair naturally and the follicles are rotated randomly, this is bound to create some texture or directional problems. I think it is unavoidable.

OK, this may be a stupid question, but how can you get 7500 grafts and not have at least decent (mature) coverage? Was there poor planning or poor yield in this case? I had always heard that the number of grafts required was 1000 x norwood classification, so a NW6 would need 6000 grafts.

I am sory to hear and thank you for sharing. I have had my first megasession and was planning to finish with a second, although I am fully aware that something like this could happen. Te sides on my head ar already thin and the whole thing could fall apart if I loose more native hair or the transplant hair starts shedding.

Sounds like you are on the treadmill of small sessions. Dont screw around, go to one of the top 5 and get a 4K+ session. Only then will you feel like you have made progress and are winning the battle

I agree with all this. You have to look beyond the hairline to the overall design to include the supporting hair. Even hair that is 100% native density, you will see "into" it quite a bit and even see scalp under certain circumstances. HT docs have shown the ability to plant at very high density in the hairline, but given the overall pattern of loss, do you really want full density in the hairline? And if not, how does the hairline look from differnt angles, when the hair is moving, combed different directions, etc? The answer of course is the use of ultra refined grafts, exclusively 1's in the hairline as much as possible, and proper balance with other areas of head. Everything works together. Check out H&W for examples of this.

Sorry, I very much disagree with the statement that there is only one "right" hairline for a patient. And even the great docs miss the mark sometimes. There are so many variations and possibilities. I would say to pick a doc whose hairlines you like. You will notice stylistic trends in patients from one doc. The same patient goes to two differnt top docs and will get two differnt hairlines. Once the hairline is on your head and grown out you will realize it was man made and imperfect. That said, I have heard from a reliable source and believe that the 4000+ megasessions provide the softest hairlines because the doc has the greatest number of 1's to use in reconstructing the front. The ability to "see into" the hairline without detecting any plugginess is more important IMO than the wall of hair approach that you see some docs planting.

It's kinda pathetic obsessing about hair, thats exactly why we get HT to begin with, so that we dont have to obsess. I fully admit that I come here out of boredom and morbid curiosity, to compare my results with others. When I provide advice I kid myself that its some altruism in helping others. I'm happy to lend my insight but Im really here because im bored and (somewhat) dissatisfied. If I really was over the moon I'd be preaching like an evangelist or gone from here. Once you spend the price of a new car on your head you usually feel like talking about it. OTH, HTs really do work and if you can plant enough grafts in a small enough area you may get the result youre looking for. I'm still not out to 12 months from my first and I will need another procedure. In some ways it worked out well, but in other ways didnt meet my expectations. I expect the result to get better slightly in time, but really im still just planning and thinkig about where to put more grafts and which doctor I think would do the best job for #2. I must add that some mornings, after carefully styling my hair, I think its a marvel that im not bald and that i look better. Also think that some women react better to me. All in all though, the problem has just changed. When before I had no hair, now I have really thin hair. Pick your poison.

I had a 4000+ megasession 9 months ago which has mostly grown in and looks decent. This required shaving the remaining native hair which was not very much. I wore a hat after the procedure for a long time. The first 3 months your scalp will be rough and red; until hair grows in to cover the work you will look really awkward. Most of my remaining native hair did not keep growing, so there was nothing to hide the work until the new hair grew in. If you have alot of native hair surounding the work, then you may look relatively normal in a month when that hair has grown out, but that hair will most likely experince shock loss; only expect half of it or less to start growing back immediately. I had always known I would need a second procedure. While I am happy with my decision to bite the bullet and get as large a procedure as possible, which requird shaving, I dont think I will be able to shave again for the second procedure. This means I will only be able to address the bald crown and will just have to live with the coverage and hairline I got from the first procedure. Everyone's circumstance is differnt. If you are already a cue-ball, shaving is not a deal breaker. If you have very diffuse coverage, I would recommend shaving before the pricedure to get everyone used to the look. If you have siggnificant native hair and shaving it off will impact your look, then you probably shouldnt be considering a HT. If you only need dense pack hairline and dont want to address the rest, the ngo to alexander. If your remaining hair is thin and you know it will be gone within 3-5 years, you probably want to bite the bullet, shave and get it replaced with a megasession. The down time is no picnic, but I am glad I did it, although there is no way in hell I can fit shaving the front down into my schedule now. Good luck.

I would consult with some of the clinics that can do large megasessions, H&W, Rahal, Feller, Shapiro all do 4000+ sessions. With your degree of loss, you will need to get 4000 grafts to start. Most patients cant get more than 4000-4500 in a single session so you may not be able to finish the crown in the first procedure, but 4K grafts in the first half or 2/3rds will make a significant difference. The down sides of HT are these: * Cost. I advise saving and paying in cash when you are financially stable. * Healing Time: Your scalp will be red and rough until the new hair grows in at 5-6 months. Your appearance will be awkward for a long time. Also, you will ont be able to do any physical exertion in first couple of months after surgery. *Strip Scar: I advise a strip procedure for you because you need large coverage and density and strip provides the best results. However you will have a strip scar which will limit your abily to cut your hair short. This varies by patient. *Lowered Expectations: You need to understand that your final look will not be full density. If you are content to not be bald with thin hair, HTs will work for you. Some people have fuller looking results than others. Depending on your donor characteristics, you can always throw more grafts at the problem.