TheEmperor

Looks great before and will look even better. You seem to have taken a "where needed" approach to graft placement as opposed to the traditional #1 front #2 crown. Did Dr wong see areas that did not grow from previous surgery, or were those areas that were not planted in #1? Also it seems like the "core" of your front is at least partially native hair. Do you have more in the hairbank when/if that starts to thin? OT: it looks like you are 6' 6" in the pics based on where you are relative to the door. Are you very tall?

This is great. You might be able to strike a bargain with her. Any parts of her anatomy you would like enhanced? If you're ok with someone dictating how you should look, it should go both ways. If you are comfortable with how you look, then you shouldn't even consider HT.

Another thing to consider is that removal of the strip pulls down on the flesh and makes the bald area a bit larger. Look at the guys who have had many procedures and you will see that this is true. The bald spot is enlongated and runs farther down the back. Also, much of the surrounding rim hair supplements the hair on top and makes it look thicker. I have had the same experience as you and originally thought it was just because the hair was shaved down, but now that its grown back, the bald spot is a fair bit larger. This may also be because the doc planted into native hair on the sides, in which case Im still waiting for it to grow back. Good luck. If the yield is good, you could have a "home run" as you have a good bit of native hair.

I did _lots_ of research and was surprised by this as well. Each incision leaves a tiny divot. If you look closely at some other's pictures you will see the same thing. When the hair grows and the skin cycles, I have found that they are becoming less obvious months after the procedure. I wouldnt worry about it.

There was a patient of Dr Hasson a year ago who had diffuse thinnign in the crown and Hasson placed ~2000-2500 in the crown. The after results was nearly imperceptible. The problem when there is alot of native hair is that it is difficult to plant within the hair without damaging existing hair. Hair that does not return is thought to be "weak" bu you are left with replacing some hairs and losing others -- so the final result may not be what you are hoping for. It really comes down to your expectations. HTs do not restore native density and you do not look that thin to me. Good luck, but make sure your exectations are in line.

Yeah, some patients dont grow.

I met Friedman over 10 years ago when I first started researching HT. He was using mini grafts dense packed in the front, which I suppose was good for the time. I remember he showed me a bald guy and then whipped his portfolio open (dramatic effect) to reveal the new wall of hair he had built for this patient! I got the feeling he was trying to size me up financially when he asked me what kind of car I drove. He was the best of a few guys I met back then who suggested ~300-700 grafts (dont remember friedman's recommendation), but overall I got a negative vibe from all of them and decided not to move forward with HT. Only within the past few years have things been taken to the "next level." Not sure where Friedman ranks with today's best. I also remember his receptionist was uber hot. That is all I know.

Count yourself lucky! If you feel stubble that means a good number of hairs are growing and that should continue. I feel stuble in a couple isolated places but am waiting for large sparse areas to start growing in earnest.

itsaboutime, You state you are a NW4 and are 25. This could mean that you have a NW4 pattern starting, or it could mean you are slick bald in the crown with a little bit holding on in front. You need to understand that hair transplants are not generally successful in raising the density of areas that already have alot of hair in them. You say that zones 3 and 4 are pretty bad, but if they are at half original density, you may not be able to improve much upon this. At such a young age, I think ethical doctors would be hesitant to spend 6K grafts building your crown back to full density given that your front will likely disappear in the next 20 years. (Sorry for the honesty here.) Armani is the most agressive "give you what you think you want" HT on the planet. Rahal is well respected but he is also quite agressive. You might give H&W a look. Doctors Hasson and Wong have done 6-7K+ sessions on individuals with the right characteristics (london lad comes to mind). This many grafts might be required to give you the density tha a 25yo expects. Older guys who have gone completely bald are generally happy to see a bit of hair framing their face. There are many good choices but I would at least consult with H&W because they will either give you a huge session or turn you away if its in your best interest. Good luck! Hair loss at 25 SUCKS!

I didnt repond to your PMs because you asked me questions that I said I was not going to answer. I have mentioned that I have had a HT with a coalition doc but have no plans to document it online and would prefer to stay anonymous. However, I can certainly commiserate with many of the posters here because I am going through some of the same things (doldrums, etc). I am certainly curious about growth rates and am not far enough along to make any judgements, but just thought it would be prudent to count graft sites as opposed to the subjective appearance of hair and wonder if anyone else has done this?

One thing that is interesting to me is that most people make subjective judgements on their yield based on their overall look (or improvement), instead of counting actual growing grafts. A patient with coarse hair, densely packed into a small area could be quite happy, even if he gets a low yield (from FUE or otherwise). OTH, a guy with poor characteristics, and a modest number of grafts planted over a large area could have 100% growth yet be unhappy with his result. My observation is that each recipient site leaves a tiny divot and in the right lighting you can see which ones are growing hair and which ones are not. I have been taking close up photos to evaluate the % of hairs that are growing. I am still in the doldrums phase and would say that 10-20% of the graft sites have shown activity, but growth is not uniform. There are a couple areas with more activity than others. My observation is that as early as week 7 there were some new tiny hair shafts and that this trend has continued uninterrupted (slowly) over time. I would not say that there has been an "explosion" but rather a slow progression. I am obvisouly fearful that this will not continue or fill in some of the void areas. I am very interested to see what % of the grafts grow. The subjective evaluation of my yield is clouded by the fact I had a decent amount of diffuse native hair which is now longer than any grafts that are growing. The only way for me to evaluate growth rates is close up photography of hairline recipient sites (where there was very little native hair.) I think first hand graft counting (sampling) is the only way to know for sure what % has grown.

One thing that is interesting to me is that most people make subjective judgements on their yield based on their overall look (or improvement), instead of counting actual growing grafts. A patient with coarse hair, densely packed into a small area could be quite happy, even if he gets a low yield (from FUE or otherwise). OTH, a guy with poor characteristics, and a modest number of grafts planted over a large area could have 100% growth yet be unhappy with his result. My observation is that each recipient site leaves a tiny divot and in the right lighting you can see which ones are growing hair and which ones are not. I have been taking close up photos to evaluate the % of hairs that are growing. I am still in the doldrums phase and would say that 10-20% of the graft sites have shown activity, but growth is not uniform. There are a couple areas with more activity than others. My observation is that as early as week 7 there were some new tiny hair shafts and that this trend has continued uninterrupted (slowly) over time. I would not say that there has been an "explosion" but rather a slow progression. I am obvisouly fearful that this will not continue or fill in some of the void areas. I am very interested to see what % of the grafts grow. The subjective evaluation of my yield is clouded by the fact I had a decent amount of diffuse native hair which is now longer than any grafts that are growing. The only way for me to evaluate growth rates is close up photography of hairline recipient sites (where there was very little native hair.) I think first hand graft counting (sampling) is the only way to know for sure what % has grown.

Could the "X factor" be atypical hair follicle physiology that doesnt respond as well to typical planting depth or harvesting/cutting techniques? My doctor made several observations about the characteristics of my scalp and follicles. There could even be micro viruses or bacteria that the patients immune system is fighting at just the wrong time which causes poor growth. There are a few examples of patients who had almost non-existant growth and then went to a coalition doc and saw great growth on their 2nd and 3rd procedures. This has got to be one of the scariest and perplexing issues in hair transplantation for both patients and doctors. I watch the results and see a range of growth rates even from the best clinics. Guys like Bobman must have had great characteristics and 100% growth.

Pat, I hate to bring this up, but Beehner's yield study of "skinny" vs. "chubby" grafts. The chubby grafts actually had a yield higher than 100%, presumably because hairs that were in the resting phase were being transplanted in tact. I have to believe that the same will hold true for transplanting DFU's as opposed to skinny grafts of only 1 or 2. It seems that the less fine dissection that occurs, the greater the overall yield. The main advantage of the skinny grafts is that while the yield is lower, they can be planted closer together. However I believe that if a clinic wants the highest possible yield it would probably be from using all DFUs. This of course is not feasible because of the need for a natural hairline. So I'm really not sure what the differnce in density is going to be between a doc using all DFUs and one using skinny grafts trimed down to the smallest bundles possible. Thats why I suggest the only way to know is to look at results. If Mohamnd is getting dense, aesthetically pleasing results with his technique, the more power to him. Its a shame he doesnt meet the crieria for the coalition. I suppose the standards are to eliminate the majority who would not be getting good results sans microscope.

I think first and foremost we should be chosing based on results regardless of how they are achieved. A doctor using a microscope could be overcharging patients or could have a poor staff transecting grafts. A piece of gear will not overcome problems. I know one of the very highly regarded Doctors on this Site, Dr. Beehner, has been producing excellent results throughout his career and for most of it (very possibly _still_) was a proponent of using micro grafts internally for greater density! Are we calling these double FUs now? Graft for graft I must say that his results look very dense. I'm not usre if he has migrated to using exclusively FU megasessions. Isnt this argument similar to Pat's "Dividing a pizza into more pieces does not make the pizza bigger"? I know for a while he was defending some of the docs who were not getting uber-sessions and claimed that this was because they were not dissecting the grafts as small. That on average, their grafts had more hairs. Count hairs, not grafts! So there seems to be some debate as to what actually constitutes a FU. If didffernt clinics are getting more one's than others, then what consitututes a "FU" seems arbitrary. So there seems to be a continuum. We've got doctors like H&W getting excellent results doing uber-sessions. When their average hair counts are examined, it seems that they are getting proportionally more 1's than (say) a doctors like Shapiro and Epstein, who are _also_ getting excellent results. Then youve got Dr Mohamand who is perhaps using primarily double FUs with specailly trimmed 1's for the hairline and getting excellent results. I think everyone needs to chose based upon their needs. H&W are an excellent choice because of their consistency, dense packing, and large session sizes. Are you paying more per hair? Very possibly, but you know that going in. Maybe a doctor like Shapiro who has stated he likes to use double FUs in some patients for additional density is abetter choice. His sessions may not be as large on average, but possibly the value is higher and the cost per hair is lower. Then you've got Dr. Mohamand who is using morse double Fus, showing density and refined hairlines, coupled with large sessions. Possibly there is some graft wastage, but his cost per hair is the lowest. On the other end of the spectrum, you've got FUE dos who are possibly wasting grafts, are considerably more expensive, but do so without a donor scar and an easier healing process for the patient. This comes dwn to a fundamental argument that has not been answered for me: Density vs. graft size. On one hand doctors who trim lots of small skinny grafts claim they can more densely pack. On the other hand, doctors using double FUs claim they can get higher hair density. If its the same number of hairs, then why would double FUs provide greater density? But the pictures and some docs seem to support this notion. . .

I must say that his work looks very good and those grafts look good too. And he sounds intelligent and appears to have good credentials and considers his patients best interests. In his part of the world, the microscopes may be relatively much more expensive than in the USA. I'm guessing your average pakistani earns 1/10th of what an american earns, and his prices probably refelct this. Microscopes will increase his overhead but may not improve his results much if at all, so it may be in the best interest of his patients to continue with his current methods, but this disqualifies him from the coalition on a technicality. My advice for the doctor is that his work appears excellent and that will advertise for itself. There are many internet formus that discuss hair loss and hair transplantation.

If your doctor is not too concerned about the progress and thinks things are fine, why dont you post some more pics and let us know who did the work. Also, was is FUSS or FUE?

I forgot to mention that you should most definitely talk to your wife about the situation.

I dont think anyone has asked this yet. . . Is this FUSS (strip) or FUE? If it was FUSS/strip, how is the scar healing? Do you have any scar pics from postop and six months so we can see the healing progression.

This is a very scary time -- I am a bit behind you and wondering where everything is. Even though they say 3-5 months, with many of the online posters you can see good growth in their pics in the month 3 or 4 time frame, then by month 9 they are absolutely hairy. Hopefully you will be ok. I have heard of slow growers, but if nothing has happened in 6 months you may need to adopt some realism (as opposed to hopefulness) and come up with a contingency plan. My understanding is that most of the top docs guarantee growth -- will replace grafts that did not grow and in some cases may refund the costs if there is no growth. Of course if there is no growth, do you want to return to te same clinic? If you dont have any growth and the doctor does not respond adequately, I would start shopping your pics around and see what other docs have to say regarding the yield.

THIS IS POSSIBLY ONE OF THE MOST IMPORTANT QUESTIONS TO ASK! You need to be prepared for a possible extended awkward period after your procedure. Things can look normal fast for some people, but there are variables beyond your control that you might want to plan for. Shock loss can occur in the donor area and recipient areas. This is the temporary loss of other wise good hair. If they plant into diffuse hair, much of that may be lost, plus most of the best docs require shaving the top. So on top you may go from having diffuse coverage, to a red, bald area with thousands of tiny divots from each graft. These divots make the area appear rough. Most of the redness fades in 1-2 months, but there may be lingering redness that wont be covered until the hair starts to grow somewhere between months 3-5. Also around the donor scar, native hair can fall out from the trauma, leaving a bald area around the scar. You very likely will not be able to buzz it down, but if you keep it cut short it will hide the scar. It really depends on your hairstyle and transplant procedure. In my case, I used to buzz the sides down and had some hair on top. After the procedure, the doc had shaved the top and I had shock loss around the scar so I could not cut it shorter than 2" without the red scar showing through. Now I can cut it to 1.5". On top, diffuse hair was replaced with a bald, red, rough area. I am over 3 months out and I still do not look normal, but I have seen gradaul improvements over time. The donor scar is less red so I can cut the sides a bit shorter. The roughness on top is less noticeable. Some new hair has started to show. The shock loss around the scar is still a concern although I have been reassured it will grow back. Consider all these factors.

Given that Pat explained his side of it (with his spin), I think it would be fair for you to express your opinion. Besides explaining that you were removed from the coalition, his post painted you in a negative light. I was actually surprised to see him airing his dirty laundry. It seemed unprofessional if not slanderous. As I am constantly reminded, web sites are not "open" and they are not democratic. They are owned by a single individual who imposes his views and can deleted posts as he sees fit. I like to think of Web forums as coffee houses where our freedom of speech is NOT protected. (Imagine being escorted from a coffee house for expressing a view counter to the proprietor's. Probably not legal. Not a big fan of "moderated" web sites but as far as hair loss web sites go, this is probbly the better of the two.)

I think an average person has 80,000-100,000 total hairs. So if you are a NW4, then that means about 1/4-1/5th of your hair is missing, which at native density would be around 20,000 hairs. An average graft has 2.2 hairs, so to attain full density would require 9000 or so grafts. However, to attain "half density" or the ammount necessary to trick the eye into believing there is not loss, would be around 4500 grafts, which is right in line with the "1000 x Norwood classification" to get the nuber of grafts you need. In practice they plant a slightly receded hairline with great density in the front and less behind it, so 3000-3500 in only the frontal third will probably look very thick with maybe some thinngin in the crown.

I agree 100%! Great story to exemplify this... Recently I heard on the radio, this girl had posted on a dating site that she was only interested in men who made at least 500K a year and were looking for a serious relationship to get married. Her justification for this (what she brought to the table) was that she was both young and very sexy. Well, she got a response. A gentleman who was a stock broker for J.P. Morgan (and happened to leave all of his contact info for her) said that he feels that the terms of her agreement were unfair. He said, that while it is true that she is *currently* young and sexy, she is a depreciating asset while he is an appreciating asset. With time, her looks will fade. By the age of 30, she will no longer be "young" and not nearly as "sexy". On the other hand, he will not only continue to make money, but with all certainty will make even *more*. His net-worth, will continue to grow. While she, viewed as an "asset" will continue to depreciate. He further justified his position by stating that, under her current terms she is bringing to the table her youth and sex appeal in EXCHANGE for his money. He further stated that the likelihood of him losing his money is very rare, but if *IF*....IF, he ever loses his money, she will most assuradly leave him. As that is the sole reason why she wanted him. But, make no mistake about it, she WILL lose her youth and sex appeal, then if he decides to leave her, she will have earned 50% of his net appreciation. He ended with: I could not agree to this arrangement under your terms, but perhaps a lease shall suffice? Oh, it was CLASSIC! I heard about that! Do you have a link?

You need to look at the big picture. With the exception of hairloss, men get better with age. Much of that comes with improved career, stabilty, money. In terms of "market fair value" women cannot say the same, they are a depreciating commodity. A fresh faced 21 year old will often look tired and haggard by the time she is 30. She'll be able to cover it with makeup, but make no mistake. The root of hair insecurity is the women. Will you be able to connect? Score a hot babe? (or even an average one?) At a young age, all you have are looks -- there has been little time to save money or build your career. While 25K seems like alot at 21, when you are 30 or 40, that is a much smaller sum. I would recommend saving as long as you can with the knowledge that the women who are rejecting you now because of hairloss will be begging to have you in another 10 years. Save for the HT.