TheEmperor

hair_care, Check out my blog. I was considered a slow grower and I would say 99% of my hair had sprouted by month 7. The progress you see after this time is lengthening and thickening of the hair. As your hair lengthens and thickens, your look will improve. That said, pictures can be deceptive. I would take more accurate shots that are combed like your before pics. I think it is best to be realistic and plan your next steps than to hope that you will get more hairs after 7 months. I honestly have never seen a patient "pop" late hairs. What happens after month 7-8 is lengthening and thickening.

Chest hair to the crown might work. I think there are a very small number of patients and doctors who have an opinion on this. Contact Dr. Umar, he is the guy doing it.

Is your chest hair of the same quality as your head hair? If your chest hair is coarse and curly, it may not be good for your head unless your head hair is the same. I think there is only one FUE doctor who advocates the use of body hair, and it is mostly used in repair cases. I wouldnt bank on using any of your body hair unless your head hair is thick and wiry. As you know, being a NW3 at a young age makes futue loss unpredictable, so it is difficult to plan where to reconstruct the hairline. Point of comparison, my hair started thinning at around age 22, but it wasnt clear what my NW pattern was until I was around 30 years old. Then it took another 10 years for the remainder of the hair to disappear.

I have a Hair, Nail, and Skin supplement that I bought that has 3mg per pill. They recommend 3 pills per day, so 9mg daily. I think that is 900ug. This probably does nothing, but thought I would give it a try along with MSM.

I think the distinction is that in stick and place, the techs (not the doc) are making the majority of incisions right before they place the grafts. The alternative is for the doc to make all the incisions by himself, and then have them filled by techs over the coming hours. Do you trust the techs to control design, transection, and angulation?

Buy a pill cutter.

Some docs get around 15% 1 haired grafts. Other docs get closer to 30%. That is a huge range. I dont thinnk it all has to do with physiology, but the way the grafts are cut.

Good is subjective. There are things you can pick up on about the HT. I wish you the best of luck with your HT, but being honest, one of the things I "see" about your HT is that Cooley placed the grafts over a fairly large area that had diffuse (yet still strong) hair. Not saying that you will be unhappy, but cases similar to yours, where HT hair is placed into significant hair often produce a "is this it?" reaction. This is probably due to a combination of further loss and unavoidable transection of hairs. Of course the HT hair is permanent so its a step in the right direction. So while I have seen some great results from Cooley, and your hair will probably look very good, it may be a case where your expectations are not met. SO to answer your question, there are things you can "see" before everything grows out. There are probably many more things docs can pick up by looking at each others work.

Bill, I have had two procedures with Dr. Wong -- my second procedure less than 10 days ago. He is one of the best doctors in the field; you have chosen wisely. I think you have realistic expectations, except that graft counts of 6-7K, while possible, are not the norm. I believe "average" session sizes for H&W are 4-5K. 4500 Grafts will typically provide coverage to the front and/or top. View my blog to see how Dr. Wong chose to place that number of grafts. As I am 20 years younger than you, I did not deem my result complete, so I returned for a second procedure for 2000 grafts which will add density and some coverage to the crown. However, I _could_ have stopped at 4500 grafts as the way the grafts were planted connected with the sides and provided coverage on top. Had the grafts been dense packed farther forward, the work would have required a second procedure. It is a balancing act. At your age, you may well decide that 4500 grafts gets you a very complete look (although perhaps with a bald crown.) Most men of 60 years have thinner, receded hair which looks quite natural. My hair characteristics are fine, so my density will not be as great as someone with very coarse hair. Keep that in mind when viewing my photos. The primary reason to choose H&W for an advanced norwood restoration like yourself is the number of grafts they can pull in a single session. They are capable of 6-7K sessions and average 4-5K. Other megasession clinics seem to average 3-4K with around 4K being the maximum. So your chances of a "one and done" restoration is much greater with H&W. Good luck.

So is it correct to say that tightness does not necessarily mean a bd scar? My scalp is still very tight 10 days post op from my second procedure and I am very concerned the scar will be bad.

Hi! I just found this thread and found it very interesting. I am a patient of Dr. Wong and my hair quality may be close to yours. I believe your observation is correct -- that the 2s, 3s and 4s placed more centrally account for more perceived density on the top than in the hairline. Even if it appears post operatively, that more grafts were placed in the front. It may also be that small 1-hair grafts are not as hardy as larger grafts. If a patient has a large number of grafts focused in the front 1/3, there are alot of multi hair grafts in the front which translates to significant density. But the photos of the incisions may not show this. In photos, it is difficult to see the distribution of grafts. I have returned to Dr. Wong for a second procedure with hopes to thicken the front and top. Check out my blog to see my growth progress. I would say that you are 1-2 months ahead of my growth from #1. Good luck.

These are excellent questions and quite valid. All the doctors have differnt approach to hairline and hair angulation. If they are different than your original hair, it will look different. You also must be concerened with yield and density. If the hair is not planted at a high density and/or the yield is not good, then the hair will be much thinner than your original hair. I struggle with a hairline that is much higher than my original one, but I also know that there is not enough hair to reconstruct the original hairline. A hair transplant is a compromise to get you to look better than you do, but it will only mimick your original look with varying degrees of success. The only guys who get really stunning results are the guys who are low norwoods and have grafts dense packed in the front. However, the only guys who should be having this kind of procedure are 35 years or older.

Based on these small photos and my experience as a "slow grower", I would say that you will require another pass. I think most of the hair will have sprouted by month 8. The additional density and lengthening will add to the overall result, but I would not expect many new hairs to appear.

I think its difficult to make a logical argument without facts to back it up. I believe hte claim that FUE will not provide as many grafts is because of inevitable transection of surrounding grafts and Feller's claim of the "scarring matrix" that forms in the donor after significant FUE removal. OTH, at least 10% of follicles in a strip removal are in dormant state and will be forever lost. The bottom line is results and cost. I havent seen any impressive NW5-6 conversions with FUE. Period. I have seen many from strip. That said, being a strip patient, I am aware that the strip removal has its own problems. I totally understand someone making a logical argument for FUE. At the end of the day, can anyone point to complete NW5-6 conversions via FUE?

Thank you. I am not expecting any miracles from #2 and have resigned myself to the probability of a thired. However, if the scar is thin and everything grows well, it should make a good "strategic" difference in the areas that looked thin and I may be happy enough to stop. Ultimately I would LOVE to be able to lower the hairline slightly, but realize that is easier said than done...

About ten months after the first surgery I was going to schedule for #2, but decided to live with the result for the time being. Because I could still feel the scar healing, I decided not to do scalp exercises. I wanted to keep the scar small. I scheduled for #2 in December and did the exercises for a couple months before hand. I was able to generate laxity over where I was initially. Something I learned is that the size of the scar greatly impacts the number of grafts. Given that my scar was 2-4mm (figure an average of 3mm along the length), and 30cm long, that represents approximately 10cm^2 of tissue without hair. If each cm2 has 90 FUs (or is that hairs?), then I got ~900 less FUs. SO if the scar had been pencil thin, I may have gotten closer to 3K grafts. I may have been able to generate more laxity had I done the exercises for a longer period of time, but devoting 30-60minutes a day to wrenching on your scalp is time that could be spent doing something else, like a normal all-body workout. My first strip was 1.6 cm wide and netted approx 4500 FUs. Doing the math shows that my native density is somewhere around 93 FU/cm2.

He looks 10 years younger!

Do you have any pics?

Did this get resolved on HTN? Is Epstein still a member? I remember the long thread about a year ago where his membership was in question at HTN. It makes me cringe when I pause to think of the long term hardship a wasted 5000 grafts will cause. Some large % of those grafts did not grow; depending on your Norwood class, this will impact your ability to have a good restortion. Adding to that the downtime and financial considerations, it is quite scary. I'm sure after a second round of no-growth with the same doctor, things are very touchy. I doubt Epstein ever acknowledged a lack of growth, only that he was providing the second procedure gratis to help you out. If a doctor actually admits a _mistake_ was made, it opens up a can of worms from a legal perspective. I have never met a doctor (in any field) who was able to admit he made a mistake. This has unfortunate implication on the patient's ability to receive proper care. The original doctor, in essence, is arguing against the patient and unethical treatment from a doctor will really drain a patient. emotionally. I hope your situation gets worked out.

Do you think running risks stretching the scar? Post op instructions say I can workout 2 weeks after, but I dont want to take any risks.

Just returned from my second hair transplant. Dr. Wong was friendly and professional and we were able to come up with a good plan of attack for #2. There was a consensus that the front could use more density. He also seemed to be in tune with my desire to thicken the top on the side of the part. Approximately 1500 grafts were placed in these areas, with an additional 500 or so in the crown. Dr Wong softened up the jaggies in the hairline by adding additional grafts. He also used calipers to measure from the corner of my eye to the points of intersection between sides and top. He found that my right side had receded more and he used some grafts to balance things out. It was good to see Joe again. (He is probably the one responsbile for my mad HT journey. Anyone remember his early blog entries? I followed all his updates on the internet while my hair slowly disappeared through the years. ..) One of the options Dr. Wong gave me was in the harvesting of the strip. He said that instead of excising the old scar completely, he could take the new strip up to the edge of the old one. The new scar would be wider, but given that I am plsnning to return for a third session, this would maximize the graft count in #2. I decided to excise the old scar, because I did not want to take any risks with scar visibility. He measured the old scar at between 2-4mm, so this might have "sacrificed" 500 or so grafts, but I know I would not be happy with a wider scar. As it was, we got 2037 grafts, which brings me to around 6500. Not much was different between this surgery and the last. THe actual strip excision and surgery took a good 2+ hours. Because there were fewer grafts, I was only in the chair until 3pm or so. Surprisingly my face has swelled a bit more this time than last. I am currently 3 days post op and the incision pain is starting to go down. Sleeping the first few nights after the surgery is not comfortable. THere appears to be less redness in the recipient. This may be because of the special shampoo I was given this time, or perhaps the grafts were not packed as tightly, thus less trauma. Going through customs was a breeze -- they didnt even have me remove my hat! Going into Canada, they asked me the purpose of my visit. "Hair transplant surgery." "What?" "Here..." I showed them the custom letter provided by Hasson and Wong and they ushered me through. (As a point of comparison, I was detained in customs for 3 hours for HT#1. Make sure to print out the customs letter!) On the way back into the USA, I told the guy I had a Hair Transplant and he said alot of people are getting that done. None of the security guys asked me to remove the black ball cap. None of them even looked at me for more than a few seconds. Painless. I am hopeful that the additional grafts in the front and top will improve density and contribute to the illusion of density. I also hope to have more options in styling. I cant say if I will be "finished" after this procedure, but I feel I am a few steps closer. 6500 grafts is a good chunk, although my hair quality is fine, so I will probably always want more. I will say that things generally look more balanced and "correct" to my eyes now. I would like to thanks Dr. Wong, his staff, and Joe for a great experience! (Check out my blog for updated pics.)

Hair is like money, you never have enough of it. Your 8 month pics look great. Wait til the 12-14month mark and then decide if you want more hair in front. You cant make the decision now because it hasnt grown in. If you have the money and want even more hair, you can always do that.

I recently had a second HT with Dr. Wong to address the hairline density. The focus of the first procedure was coverage, but the density did not turn out as much as I expected. This is largely because my hair quality is fine and my donor laxity is on the low side of average. If you look through the H&W website results, and focus ONLY on the NW5 and NW6 guys who are completely bald, you will get a good idea of what can be accomplished in one (4500 grafts) or two (7000 grafts) sessions. Some of the results are more impressive than others, and I would say this is largely a function of how thick the donor hairs are. Patients with coarse hair get better results. I would say that the hair that was planted was very natural, and grows in a realistic direction. The primary issue is that there is/was not enough hair moved. Hopefully the second session will fix that. The scar is between 2-4mm. By keeping the hair at 1.5" it can easily be hidden. Some patients get thinner scars and have coarse hair which hides the scar better. They can clip to a #3 or #4. I am sharing this so you can get a realistic picture of the wide range of results possible.

Everyone's circumstance is differnt. THere are some cases of NW6s who have had stunning transformations. I believe much of your success depends upon your age, your donor characteristics, and your ability to halt further loss. If you are in your 40s, the outlook is much better than if you are in your 20s. Some extremely bald men have a frontal forelock planted which looks natural and removes the cue ball look. I think that at least that will be an option, but you should post pics or send them to doctors to get accurate feedback.

If it is still inflammed one month after surgey, my guess is that it has become infected. Skin wounds noremally heal much faster than that, although there will still be redness for up to months. I am not a doctor, so you should go see Beehner or an emergency room doc. First course of antibiotics dont always work, afaik. It could also be something like a fungal infection. THey could take a culture to find out. Do you sleep on the back of your head or wear a hat? You migh consider sleeping on your side or front and gently cleaning the area a few times a day. Maybe dab some neosporin ointment on it. I think you need to avoid touching it. I am not a doc so you should probably go see a GP and find out for sure. Youve not going to die, and I would say that you probably wont be able to tell you had it done when everything settles down. Good luck.