TheEmperor

I'll get some pics up soon. I was trying to take pictures of the hair that I was talking about. The one where the 2mm of the tip is normal, and the rest of the shaft is fine. While finding that hair, I found a couple other hairs that seemed to be influenced by the HT#2. The other hairs grew thick for about 5mm, got fine (probably 3-4 weeks after surgery), and then gradually got thicker. I got a pic of one of these, but I believe I lost the other one. Anyway. There is evidence that a second transplant can tax existing transplant hair. There seem to be three possibilities. 1) Transection or other damage, causes hair to fall out and it is never seen again. 2) Partial damage, causing hair quality to diminish temporarily. 3) Partial damage, causing hair quality to diminish permanently. I have very close up pics from after the procedure showing grafts/cm2, so I should be able to track growth rates.

Here is an interesting link I found comparing growth rates of chubby vs skinny grafts. http://hairtransplantion.blogspot.com/search/label/Chubby%20graft I am in the dumps right now because I seems the overall hair quality has declined from the first procedure. I have less hair now than I did 6 months into my first, and I am only four months in. I should have more hair. It appears that while some of the new hairs are growing very fine, they may have caused other hairs from previous transplant to give up. The study shows that smaller divided and skinny grafts grow at much lower rate. I am sure there is variance from patient to patient.

wb280 I am not a doctor, but this is what I have noticed: Prior to any procedures, I had a decent amount of native "bridge" hair connecting the two sides. Dr. Wong planted down one side of this (left side), and left the right side largely alone. In the second procedure he planted more hairs into the area he had planted before. (Both procedures focused on left side.) To my surprise, after the first procedure, the side of the bridge that he had planted into had less hair than the native side. I believe what is happening is that the hair was angled forward using lateral slit, and no attempt was made to preserve the native hair. THe belief may have been that this hair would be falling out in the next few years anyway, so it made sense to plant into this area, knowing it would damage native hair. In another five years, this area may have more hair than the other side. Or it may not. So my answer to you is that it is possible to plant within hair without destroying it, if it is angled EXACTLY the same way as it was originally. However, as you have been reading these boards, the "illusion of density" achieved with hair transplants is accomplished by planting the hairs at a more forward angle so that they layer on themselves. Other doctors have different strategies for creating density, but honestly, when I have seen patients with significant native hair planted into, it is largely a zero sum gain. However the new hair is supposed to be permanent, and depending on your hair quality, there may be a cosmetic improvement. I would say it depends on how much native hair you have. I would probably not consider it until your native density is around 40% or less of original. I cant make a call on your case without seeing pictures.

I do not believe he told me these things in confidence. It is obvious that he has an incredible amount of experience. He has done thousands of patients. The patient he was telling me about was probably an outlier. My point is that there is lots of variation in outcomes, and I would not be surprised if for some reason, hairs that had been transplanted stopped growing 8 months later. Maybe not all of them but some of them. Like I said, I can see one hair that was immediately knocked down in quality, from thick to thin. The tip (2mm) is thick, and all new growth from the procedure onward is very fine. I wonder if this hair will survive for the long term? It does not seem to be recovering. There will be know way to know if it continues to grow long term. My gut feeling is that any damage to a hair will impact it in the long run. If a large % of hairs are "slightly" damaged, then they could grow for a bit and then stop growing some time in the future. Given the fine nature of my tranplanted hair, I am very worried about this. I can only hope that it is a very small % of hairs that were damaged. I only see ONE instance of this, and it happens to be in the front. I will get a picture of it. I might like to add that Hassson and Wong are leaders in HT, but they have been in business for what, ten years or so? So even though they have had thousands of patients, they have not been able to track anyone for 20 years. So its really unknown territory. A person whose transplanted hairs are thick and vigorous probably does not need to worry. Someone whose transplanted hairs are fine has to think about the outcome. Doctor Wong used a very large zone of 1's and a conservative hairline. I suspect he did this in anticipation of the possibility of these hairs going away.

Carra, I wouldn't discount what you are saying as a possibility. I have noticed some peculiar things after two HTs, and I wouldn't be surprised if it was an early cycle. My feeling is that the HT hair starts out very fine and vellus and then progresses to its normal diameter and strength. It is not unreasonable to assume that a hair which starts growing may not "recover" and after several short months may give up the ghost. I have read that hairs which are damaged during HT will come in at a finer character. Dr. Wong said something scary to me during my 2nd surgery, which was that he had a patient who kept going back for touch ups every three years because his transplanted hairs were not surviving long-term. It was not clear if this was because they were not DHT resistant, or if it was some unique quality of this patient. The message here is that transplant hair is not _always_ permanent, and this is not usually discovered until some time down the road. I wonder if Dr. Wong was trying to indirectly tell me that it was a good possibility in my case? Time will tell.... That said, it may also be a normal shed cycle, or at Future mentioned, the surrounding native hair gave up the Ghost. I can tell you for FACT that transplanting into an area will damage native hairs in the area. One hair in the front was shaved down to 2mm prior to my 2nd procedure. After the procedure, that hair continued to grow, but at a MUCH FINER diameter. I can see the hair is thick at the tip and very fine through its length. That tells me that the act of transplanting into hair, in my case hair that was from a former transplant, can damage the existing, growing follicles. This does not necessarily kill them, but it may decrease their diameter or quality. The point here is that I believe you.

I'm not sure if its shockloss. I think one of the effects of strip removal is stretching of skin in vicinity of scar. Thus the hair around the scar is thinned out. The scar looks normal and is only 2-3mm. That is par for the course with strip.

TC17, I believe you are suggesting that FUE is an option for an advanced Norwood, as long as he is willing to accept less grafts overall. I'm not sure how many less grafts. If transection rate is minimal, then sure, everyone should get FUE. If a graft is killed for every graft harvested, then it may be another story. I think Bill assumes that the advanced NW patient wants to get as many grafts as possible. I think if the patient only wants a "less is more" or frontal forelock, he will be better served by FUE. If the doc goes crazy and attempts to rebuild a full hairline with FUE, that is where the problems begin.

I agree with TC17 and with Bill (to an extent). Another factor that is not discussed (and I know Joe at H&W disagrees with), is what _exactly_ is happening to the rest of your scalp when a few cm of strip is removed? In my personal experience as a (once) NW5a, the skin is pulled down and back. If you pull down the skin above your neck, you will see the skin on your forehead move up. The flesh slides along the surface of the skull. Strip removal has the effect of making the bald spot larger. For someone who is a NW1-3, this probably doesnt matter. But for someone in the NW4-5 range, baldness that is not visible from behind or the sides, will become more visible. Someone who is a NW6-7 , this probably doesnt matter as much as baldness on the sides and back is already visible from normal viewing angles. I'm still unsure if FUE yield is the same as strip. If indeed only half of patients are good candidates for FUE, due to yield issues, then performing FUE without diagnostics would be tantamount to malpractice. Yet I know at least one FUE clinic that has switched to doing it exclusively. I think the current situation with FUE is that it is a gamble. That said, if growth with FUE is good, a "less is more" look could be accomplished in the front with 3K grafts. The patient can buzz the sides and everything will look in proportion. The reality of strip surgery is that the sides must be kept longer which means that the top must also be longer to look correct, and it comes out looking like some variation of a comb-over. FUE might also allow a doctor to hand pick healthy follicles in an individual whose hair quality is not uniformly good.

If you feel you got good growth with FUE, then keep going with it. If you got poor growth, then what is to stop that from happening again? You will run out of hair before the front is completed to your satisfaction. And when it thins out behind, you will look like a freak.

You actually have alot of hair right now. You will not be able to get that much hair with hair transplants. I think your situation is pretty good overall. I would experiment with Toppik, dermatch, couvre, and styling putty/gels. I HONESTLY believe that you have enough hair that with correct styling, it will not look like there is loss until your late 20s. At that point, you will be a good candidate for HT.

You guys some advice: If you have a specific question for a specific doctor, contact the doctor directly. If you have questions about how much another member paid for his procedure, contact the member directly. Airing personal questions publicly is bad form.

Please direct your questions to the doctors. I am just repeating what I have been told or discovered reading thousands of posts.

Julius, Dr. Wong said just what I said he did, but you should probably call them and report back here, rather than trying to bait an altercation. I believe that Wong is conservative in his approach. He expressed that if you dense pack too much, there is risk of nothing growing. Ultimately, when it came time for the procedure, I left the question of density to his judgement. Regarding "one pass procedure", I though I was going to have something closer to Bobman's result. Obviously results vary. Even if all of the grafts had grown, I would probably have still required a second pass. I think the goal is to get an area done in one pass, but I am evidence that this approach does not always pan out. Not saying that H&W are bad or negligent, only that things do not always work out as planned. The question of yield vs density is a very good one to ask. My opinion is that they plant at a relatively high density. If everything grows, they get a home run. If everything doesnt grow, or if hair quality is poor, they go back for a second pass. If they didnt attempt a one pass procedure, then patient would be guaranteed to have two procedures, so it is a calculated risk. If they dont go crazy with dense packing, then a good percentage will grow, so even if (say) 500 grafts dont grow, that will not destroy the patients prospects overall. You should also ask why people only have typically 7K grafts in the bank. This was not apparent to me before the surgeries. ( It is interesting what removing 2-3cm of skin does to the rest of the scalp. You will only know once youve had procedures.) Another question you should ask is why patients often report reduced yield in 2nd, 3rd procedures. As I watch my #2 grow out, it is curious that the areas that had poor yield before are showing delayed/less growth now. I can only assume it has something to do with the hidden scar tissue that SMG mentioned. Another question you should ask is about graft size. Looking through results you will see many of the most impressive results are repair patients who had minis or larger FUs. Larger FUs create more scarring (larger incisions), but contain more hairs. If there is a ratio of scarring to hairs, the larger grafts are superior. Also, chubby grafts require larger incisions, but have shown greater yield. Skinny grafts create less scarring/smaller incisions and can be placed closer together. Also ask whether the quality (thickness) of transplanted hairs can be influenced by cutting techniques. I have read that grafts which are damaged in cutting will often grown but at a finer caliber. I suspect chubby grafts receive less trauma. I signed up for Dr. Wong's approach to HT based on the "one pass approach" and large graft counts, but given that I needed two passes anyway, I think I would have gotten a better result going to a clinic that uses chubby grafts, and/or double FUs with medium session sizes. I truly belive that 3000+3000 is going to be better than 6000 or 4500+1500. (of course, after only getting 3000, you will not be close to finished, so getting a very large first procedure will get you closer to your destination, so sacrificing yield for faster results is probably in most peoples best interest.) Smaller session sizes afford the doctor more freedom in choosing better hair, and he can respond to the results of prior procedures better. You will see a trend that often guys who have say 3-4 medium-small sessions get more density than the guys who try to get it in 1-2 megas. That does not speak the naturalness. I think the skinny graft+megasession provides more natural results, but potentially compromises yield and hair quality. Julius, keep doing you research and listen to what various doctors say. There is NOT one right approach.

More that one reputable doctor has stated that if they dense pack, they run the risk that nothing will grow. I know Dr. Wong said this to me when we talked about my plans for #1. That said, there is evidence that the top docs DO dense pack, despite there being a chance for poor growth. It must be a calculated risk. There are many good examples where this strategy pays off. We call them "home runs". In my case, after #1 I noticed that some areas in the hairline seemed to have less grafts growing than internally (behind the hairline), despite originally being planted at higher density. My conclusion was that the front of the hairline was dense packed and didnt get the hoped for yield. Most of the grafts behind the hairline seem to have grown. However, given what I have heard about dense packing, and the fact that they put 4700 grafts in such a small area on Phil, leads me to believe that IF there is a yield problem, that dense packing may be the culprit. If it turns out there is a problem, I'm sure they will stand behind their work. Phil looks better than I did at 6 months, but not by much. Given the number of grafts I would expect more impact. I think in the next couple of months he will have a better idea of overall yield. I (personally) think most grafts have sprouted by month 8.

4700 in that small an area should be really dense. I think in 2 more months you will have a better picture of the yield. I have a suspicion that when docs dense pack, they are rolling the dice. If there is a 70% chance all of them will take, its an acceptable risk, knowing that if you get half yield, you can return for another procedure. Beyond a certain density, grafts start to fail. Maybe a blood supply issue, or transection of neighboring grafts. Honestly, I think you will need another pass. Hopefully you have some styles that work better than what you show in the pics. Product is your friend. Good luck.

It may be related to scar tissue, but I dont know. I would recommend a little bit of chemical tanning. There are some good ones that look real. Just apply a bit in the area and apply a bit more each day until it matches.

Thats not entirely true. Unless your hair is thick/coarse, you will need to keep you hair at least 1" on sides and back to hide the scar. It is not invisible. I need to keep my side hair 1.5" to hide it without styling products. Some people brag about being able to clip sides short, but you will notice the majority of HT patients keep their side hair long-ish, and never buzzed.

Atif, Overall, you will need more than 3500 grafts. That is a good number for a starting surgery, but it will likely not get you where you want to be. Your pattern looks like a NW6, with thinning down the back. This may be the photograph and the way your hair is cut. As a point of reference, I had considerably more hair than you at age 29, and you can see where I am 10 years later. I think my loss pattern is more favorable than yours (does not go far down in back). My guess is that for a "complete" restoration, you will need 7K grafts over the next 10-15 years. It is very easy to get a doctor to say what you want to hear. If you are not a raving lunatic and appear to have realistic expectations, they will tell you that you are a good candidate. You need to understand what this means. It means that (if you are willing) that they will have the ability to perform multiple surgeries on you to improve your position, until either A) You are satisfied, or B) You run out of grafts or money. Your ability to reach condition "A" depends on your degree of loss. I cannot imagine a scenario where a 29yo who is a NW 6 will be happy with the amount of coverage and density that they will be able to give you. Certainly not with 3.5K grafts. If they give you a hairline that you are happy with now, there is a very good chance that in the next 10-15 years the remaining loss will be severe enough to leave you looking odd. Only proceed if you have 40 K cash, are willing to undergo 3 or more surgeries, and are going to be happy with a significantly receded hairline. H&W are probably you best bet for getting it done in only 2 procedures. I'd like to add that subsequent procedures are smaller. If they only get 3500 in the first, a typical follow up might be 2K, and a third procedure would be 1.5K. Average person only has around 7K grafts available. Do the math on the cost of 3 surgeries for 7K grafts total. Also, keep in mind that surgeries are not always a slam dunk. You will have a scar that you need to style around. And the new hairline may not look perfect, may not even look good or natural and may require daily styling to make it look good. Lots of things can go wrong. Your head is shaved now, and if that is a look you are reasonably comfortable with, I urge you to keep it. Going from clean shaven to permanent "bad hair day" (that you spend a load of money on), may not be in your best interest.

While we're on the subject, I was shocked that the change password dialog is NOT secure http. It would be very easy for observers to hack user's passwords. I would not expect this from an OTS solution, but this site has a "home grown" feel, and not in a good way. I know it is alot of work to switch forum software, but I think you made a bad decision with this package and should consider switching to something more secure and less buggy. I have the same problem with it not remembering passwords. And after logging in, it takes me back to the main page, not the thread i was reading, so I need to find the thread again if I want to respond. Up until two days ago, pages were not loading. I'm not going to help debug this mess, I will recommend that you find a better package.

If you are in your 20's I would say its very risky. If you are in your mid/late 30s, I would say you can get a nice improvement.

The site is so clunky now that I didn't spend much time analyzing it. Half the time I cant even get into the forum to post.

Yeah, that is annoying too. And sometimes pages dont load.

I have received email telling me that I have received a PM from other user. When I log into read my messages, there is nothing new there. Has anyone else experienced this? Also, my HT blog has not received any new comments since the second procedure, which is odd given that I got a steady trickle of messages before. I have disabled my blog for the time being.

This is probably one of the MOST important questions you should be asking. The "technical" aspects of the HT must be understood, the limited donor supply, vs area to be covered.. they are very important too, but the hairline is what you and everyone else will be looking at the rest of your life. I am waiting for my second HT to grow out, and improved density may change how I feel about the hairline. The problem is that the hairline is not anything that ever occured on my head through any stage of hairloss, and as such, it looks unnatural to me in some regards. Its not that it looks pluggy, just that there does not seem to be a harmony with the shape of my forehead. When I was loosing hair (diffuse), I still had a "hairline" up until about 3-4 years prior to the procedure. The new hairline is a good 1-1.5cm higher than the receded hairline I had, so it does not fram the same way. THere are lots of men who have deep temple recession and thinning in the front. But not alot of men who have somewhat deep temple recession, frontal hairline recession, and overall thinning. Its hard to explain, but I have never seen this pattern on natural thinners. At least not my nationality. I am always carefully styling the hair down over the hairline and temple areas to balance out the look to my eye. In the doctor's defense, given the thinness of the transplanted hair, had he gone any lower, it probably would have been a disaster. But the hairline does not match what I thought was possible with my original degree of loss. It is a hairline appropriate for a 55yo man. That said, having reviewed the forums for a long time, most doctors have a "signature" hairline that they plant. Only a small handful of docs seem to stray far from their pattern (and of the ones who do, I more often see "what were they thinking" results.) I would recommend trying to identify each doctors "signature" or "pattern" and then decide if you think that would look good on you. As opposed to going to a doctor with a differnt style and trying to conform them to your vision. If you are a NW 4 or greater, I think what you should be hoping for is a hairline that is not detectable as a HT. Drop any illusions of the hairline looking "good". The new hairline, if you are lucky, will reverse you to some earlier stage of hairloss. What you dont want is some doctor's "creative vision" stamped on your forehead. Go for innocuous and natural. Make no mistake, hairline design is no joke and even the best get it wrong more than they would have you believe. Lots of pictures dont show the posters face, and its very hard to gauge how things look in proportion to the face, from all angles.

I think most people have 60-70% hairs popped through by month 5, but the result will not look nearly complete, until hair all pop and they lengthen/thicken.