ManinSpace

Difficult to tell to be honest, like Newhair says there does appear to be some minaturisation but its not definate, we have no way of knowing if your hair is naturally fine etc, so that in a way, is a good sign as the back of your head does not look bad, I knew people your age at school who were completely bald by your age. Still, Its worth you keeping an eye on it with photos every 3-6 months under same natural light conditions, do not use flash as you have fair hair and flash makes it look thinner. Obviously you have options if the thinning looks like it progressing such as minoxidil, nizoral and finesteride, the last of which is the best but also it affects your hormones and thus is not advised for younger people so the longer you can stay off it the better, but on the flip side, its easier to get hair back the sooner its lost and much easier still to prevent it going in the first place. I would say keep an eye on it over the coming months and then consider your options, maybe post more pics as you take them but give it a few months, people will be honest with you here. best of luck

Thanks for that Kira thats very considerate of you. I read that with interest and then browsed the site, you have a number of results on patients similar to me who used in the region of 1200-2000 grafts, That would make the whole difference to me and i like your clinics approach in that Dr Arocha appears to generally create hairlines which look nice and strong now but that will also be age appropriate down the line, that is very important to me. When im 50 I dont want to look like Im trying to be a skater boi! I am certainly feeling more prepared and researched so thanks, like you say in your article, its a lifetime decision so everything that helps make that decision is sincerely appreciated.

Thats part of the the problem, so many good Drs to choose from now, each with their own ideas and styles and with Dr Arocha producing work like this its getting even harder Thanks again

Thanks for the response Matt J. I appreciate you outlining the areas that are the considerations for a candidate. I guess I just dont understand how dr Rahal can dense pack NW3's like Cappelli into NW1's (i disagree with you cappelli in that i believe from your pictures your design looks distinctly NW1 to me) using up half a patients donor supply, increasing the surface area and still ensure that he has enough to last in the bank for another minimum 40 years of ageing (sorry dont know how old you are). Im not at all insinuating he cant, i just simply dont understand how he does it but other drs advise so strongly against this practise. Who knows, maybe they just cant do it as well. I would love to understand simply because I find Dr Rahals designs so eye catching. Again, no offence meant, no impropriety suggested, just a very curious man in search of answers.

Thanks Kira, I was in the process of booking one for June but just in the last few days I have decided to postpone for several reasons. Ever since I discovered this hidden world of HTs last year ive been like a child in a sweet shop and was charging into this decision and i wasnt 100% sure where i was going. I still have not completely satisfied the voices between agression and conservatism with my hairline design... I was planning on going conservative and touching it up if i felt the need but then a voice in my head is now saying go and get it densly packed up the front all in one go!. Im trying to reason with that second voice as i am approaching 30 and it may just be me going through an early mid life crises and i dont want to end up with the equivilant of a flash new sports car and younger woman on my head if that makes sense!! Im also lucky in that meds are working well for me in my thinning areas and have only been on them for 9 months so im tempted to give them another year or so to mature etc. Thanks again for asking, i look forward to seeing more results from Dr Arocha.

New hair indeed i deleted my message as in the time i wrote it i had two new messages and i felt the discussion had been exhausted. Once again, i understand all that, your telling me stuff i already know. I do appreciate it and i am sure Dr Rahal is fantastic, i think ive been clear that i am trying to remain neutral, im just wanting to know in the same way that some drs can explain their conservtism in general, non case specific terms I would like a general understanding of a more aggresive dr in the same way. Im perfectly aware that HTs are largely case specific, but there are fundamentals that each dr goes through whether conservative or aggressive, i have seen the conservative case, i would like to hear the more aggressive case (im not really comforatable with this word aggresive by the way, i feel it is a little emotive but i mean it in a neutral but descriptive way) I have no doubt that if i were to speak to Rahal in person he could tell me why he thinks he can be more aggressive on me but I already know im a good candiate for this kind of proceure, i am also on meds and have good family history, so im actually less interested in my specific case and more the general attitudes and approaches of Drs like Rahal. I persist with doing this in the forum as it is the discussion that interests me, the dialectical method so to speak that you get within a public forum. Thanks again, saw your avatar new hair, to me, Seinfeld is the best show in history by the way.

I apprecite your input and shall cease asking the same questions. I still feel maybe im not explaining myself very well as i dont seem to be understood but i dont know how else to word it. Edited to say i dont really disagree with anything either Capelli or new hair say, its just that almost all of it was taken as read. I sincerely appreciate your attempts to understand and help.

Once again Capelli thanks for the extensive response. By extensive I did not mean that as in an offensive sense, so forgive my poor selection of words, I simply meant your loss was apparent and is far enough on the way that had you not addressed it with a HT and meds then there is reason to suspect from the level of miniaturisation and diffusion that appeared to be occuring in your pre op pictures that it would continue through at least 1 more NW scale in your lifetime. I did not mean any offense I can assure you so my apologies on that. I have only consulted with 2 Drs as I have researched for around a year and these were the 2 whom fulfilled all my criteria. Having consulted with them I was satisfied with both proposals but i have decided to put the breaks on and am delaying my procedure. As stated, I have a good head of hair, I am regrowing much more than anticipated on meds and am happy enough to recede as I get older, so im now thinking that I dont need to address this with such haste, it is my opinion that the longer you can go without having a HT the better as for me, it is a last resort. I fear because of my responses to you my concerns are taking over the thread so i wonder now if you and I should stop discussing this?. You keep telling me things I know and presuppose i do not understand the things you say, but I think it is you who is not quite understanding me. My questions remain totally unsatisfied so if anyone else feels they can address them it would be appreciated. I dont mean that in a rude sense Cappelli, its just we have both made our points and are going around in circles. I hope that doesnt appear rude, everything you say is valid and are interesting points of discussion, but they are not answering my specific points. You assume i am a conservative charecter but this is not true, i am happy to change tact, indeed i would love to, if i see evidence that it is totally viable in the long term to do so. Admittedly the conservative argument is easier to make, I want to hear how valid the aggressive argument is and so far all ive got is 'pack it and see'. I remain convinced there is more to it than that, but if it really is as simple as that then that is certainly not satisfactory for me. One final thing, I need to be clear im not accusing Dr Rahal of any impropriety or not operating a duty of care, I have no reason to suspect this, Im simply asking how he is doing so. You say 'the doctor plans for the future' but that is a little abstract, im asking for something more procedurally concrete, how is it planned for, what is the protocol?! How much donor is sufficient contigency? How does donor density affect the decision to dense pack? The effect of Hair characteristics? Whats the maximum you could lose on top without being compromised by a heavily harvested donor from a dense packing in the hairline etc?. How do you balance a densely packed frontal region of 75 fus per cm with an area behind that will likely thin as you age particularly into old age into something less than that? What will the aesthic appearence be of a denspe packed linear frontal hairline and thinning and possibly emergence of a bald spot on the crown? What happens if the recession continues in the lateral temple region and they seperate from the rest of the hair and there is not enough donor to address this and the top? I feel these are all vastly important considerations and there must be more to it than hope fot the best and it varies for each patient. Of course it does, but there must be some be some basic procedural considerations? Thanks again

Thanks again for your input Capelli, but this is the exact opposite of how a medical procedure should work. For me, it is simply not a good enough argument to say ill worry about it tommorow so long as its good today. Obviously, its fine for a patient to think that way, this is normal, but a Dr has a duty of care and thus should be doing all he can to prevent problems down the line. Im not saying Dr Rahal doesnt, I have no idea of how he is planning to manage this patient or yourself. Im simply asking, how does he plan for the future when especially in cases like yours, he has designed a very low hairline and total temple closure using up 4500 grafts in just the frontal section when you already have extensive hair loss? Its all well and good to say ive left enough in the bank, but have you? You were already suffering a pretty extensive amount of loss, you now have A NW1 hairline so you have used up thousands of grafts largely packing totally bald areas of your head over half of it is now gone and you have a vast surface area remaining to cover with your remaining donor, how will that work down the line if your crown goes which it appears it may well considering how much loss youhave already experienced?. I think it is reasonable to ask for an answer that isnt simply, hope for the best. If that genuinely is the best answer Im going to get then i will simply go away from this discussion and let everyone get on with admiring the work. However Im hoping someone will be able to provide a better argument than that which you present. I dont mean this with any malice and i appreciate your trying to address my point. I have consulted with two Drs, neither recommended this level of procedure and one categorically stated it was not in a patients long term interests to close the temples. I have much less recession than this patient too. Im a 28 NW2 with thinning in small areas to the sides of the hairline, density of 80FU/cm medium hair charecterstics. I would be an ideal candidate for this procedure and like you, i have been tempted. However the reason i persist asking the same questions is that i havent recieved a satisfactory answer. The Drs I have spoken to and also various clinicians on the forums who suggest a conservative approach make a considered and convincing case for their approach. All im asking is that Drs who are more aggresively inclined also provide their case. If the best answer is pack it in the front and wait and see, then obviously i have my answer, but i actually believe that its a little more considered than that, at least, i sincerely hope it is.

Once again, thanks for your input but your response was anecotal evidence and your own personal biases. Whilst your opinion is appreciated, these are not what im looking for. Im after a medical vindication of the approach taken here on this patient being in the the long term interests of the patient vs a conservative approach. For me, it is precisely your argument that you want to enjoy hair today and not worry etc that concerns me. Say for example in 20 years time significant dangers are found with long term finesteride use, if a dense packed forehead is being supported by a drug that was to cease to be in circulation, all of a sudden aggresive hair restoration would start to look an inadvisable practice. Now I know this is unlikely, but the recall of a drug is certainly not without historical precedent. With this in mind it is simply my belief that ones donor must be used with extreme caution. In that context, I am asking sincerely if there is any evidence that the approach on this patient and others like him is viable in the long term both medically and aesthetically? Hopefully you can see how your post did not answer my questions. Thanks again.

Travis- you just need to have a long look through and educate yourself, there are many pros and cons but if you want to fast track why not start a thread on that topic and people will gladly help you out Cant decide- thanks for addressing my question. I still believe the hairline is a little unnatural in so much as mens hairlines beyond their childhood are generally not so linear, if i saw this man in the street i would suspect a HT because it is so perfect, Im not sure if perfection is a criticism, but I am certainly a little wary of it. Something that I dont understand is that Armarni was crucified for packing grafts into the front, Im not sure how when Dr Rahal does it, it is more ethical? This is not an attack, it is simply not clear to me how it is different, I would actually quite appreciate someone like Matt J to address my question if he finds the time. The reason i am so forceful in asking is that having spoken to a few drs and clinicians and I get wildly varying opinions about what is good procedure. Why do other doctors recommend a much more cautious approach? For instance, I have much less recession than this patient, yet I was assertively warned by a world leading surgeon not to change my hairline to this degree. I suspect were i to consult with Rahal he would be able to achieve this look for me, thus there seems to be a procedural distinction. My point becomes, why do some Drs such as Rahal see lateral hairlines and lowering into bald areas, increasing the surface area that a finite donor must cover practical and and some other world leading surgeons do not? I genuinely dont understand the differing modus operandi amongst such well regarded Drs and I would love to see the logic explicated. The truth is, if i could see it rationalised i would consider it myself, who wouldnt want elvis hair like this gentlemen if it is practical in the long term?!!

Thank you for answering newhair but ideally im after some discussion thats not just based on opinion, though i do appreciate your input. Im curious to know how anyone can know how its going to look considering how relatively brief history of transplants of this efficiency are. It is simply unknown as we havent seen young men with dense packed hair in the front grow out to that age yet and thus i always feel that a natural conservative approach is better. There are so many variables, this man may diffuse, not now, but in 30 years time, causing density discrepencies, obviously the threat of further loss etc but its not just simply that which concerns me. There is also the simple fact that you dont even see many 16 year olds with hairlines like that, and thus, I feel whilst looking spectacular, it is already unnatural looking and if its like that now, how unnatural is an 80 year old going to look with a thick NW1? Even if I was 80 i still wouldnt put an NW1 on my head, it wouldnt be age appropriate. Like I said Im not looking to stir up nothing, I am just genuinely curious about the matter. I am not as knowledgeable as many here so that is why I am asking.

I absolutely love this look on this guy and its obviously a fantastic turnaround for such a small amount of grafts as well, Dr Rahal is undoubtedly a very proficient surgeon, but can someone explain to me please why this is not going to look silly when the patient reaches say, 50, 60 maybe even 90 years old? Im not having a pop or anything, I am just ignorant and I genuinely dont understand how this can age well.

I hope so for your sake, I know the frustrations of a high hairline but otherwise strong head of hair, you dont want to buzz it (why should you with 80% of it up there) but a wet and windy day is the enemy! If it comes through as expected for you, then you are going to have a great looking head of hair. You already had a great head of hair, its just some of it wasnt where it should have been Nice of the doctor to show those errant hairs the right direction!

Best of luck Jaywalker! I absolutely love your hairline design, when that comes through that should look fantastic. Glad your happy with how its going and still much more to come I have a similar hairloss situation as youin that i am only receding, so i will be watching your results with enthusiasm. Reinforcing that hairline must be a nice feeling! All the best

Thank you Dr Konior for taking the time to send such a detailed respond, It is very helpful to see the processes behind the decision laid out so clearly. I find the temple regions to be an interesting point of discussion and I have mixed opinions about whether or not to get mine closed, but I will probably err on the side of caution and not address them. This is an absolutely fantastic result and i must say one of the best I think I have seen. I imagine he must be ecstatic with his new look.

That looks fantastic. What is the consensus regarding this patients decision to close the temples as he has. Is the hair behind it in the lateral region considered safe as it as receded so far?

Jealous of your hairline

That woman is fit as, hair or not! I could care less if she was shaved bald or put a wig on, that woman is fine. If anything, at least shed understand what its like, I could probably relax around her!

Thanks for your response and welcoming me to the forum. This time exactly one year ago I had not the first clue about hairloss treatments and HT's. After a few weeks research I immediately got on the big 3 that i first heard of here and now after a year of lurking and researching Ive joined as Im hoping to embark on a FUE HT this year having been estimated around 1500-1800 grafts through various consultations. Im truly grateful to this forum as it has relieved at least half of my anxiety just to know that there is something that can be done and that i can recieve advice from so many experts. People like you, the coalition Dr's and their representatives who maintain a presence on these forums play such an invaluable role in communication. Hairloss is an amasingly psychological condition, we all have physical flaws that make us less than perfect so to speak but there is something about hair loss which is uniquely distressing. I first noticed mine was receding when i was 16. 12 Years later I am lucky that it has been so incredibly slow that with creative styling, no one would even know. Nonetheless, everyday without fail for 12 years I have looked in the mirror and been unhappy with my slowly disappearing hairline. Its not like most other issues in that it also gets worse every day and until last year, i presumed irreversibly so. For 12 years, if the day begins and it is raining or windy, then the day starts under a severe cloud. That is a long time to be worried about something!. Provided the op goes to plan my otherwise contented life will genuinely be turned around and I will owe a debt of gratitude to all the contributers on the boards. Your profession is genuinely changing peoples lives for the better day in day out, so you and your team have every right to feel satisfied at the end of your working day!. Thanks again and keep up the good work

Thats fair enough, its all relative and if he is 100% satisified then who can blame him, it looks much better! Personally if I had success like that I simply would not have been able to resist a second time around!. However, to have restored so much hair and a nice frame with so few grafts, well he must be on top of the world right now. It never ceases to amase me what a difference restoring a few thousand grafts can do for someones aesthetics and from that, their life in general. I know I would feel a lot more enthusiastic about the mornings with a little less forehead staring back at me in the mirror. Its like one of those timers with the sand in them staring back at you every day reminding you that your youth is diminishing, only its got a leak so its going too fast. Resetting the clock like this guy has done is something I cannot wait to do!

I didnt read the bit where you wrote of your loss. My condolences as well and I am pleased for you that Dr Devroye and his team were understanding.

Hairline is looking nice, work looks tidy, Im wondering do you have any preop pictures to compare? All the best, you picked a great doctor so every reason to suspect you will get a nice result

Well that is certainly very interesting, and I am even more jealous now!. You obviously dont feel it inhibits the quality of the work and it looks great in this case. Amasing to me how different surgeries can have such different outlook on this, as shaving the head is a serious inconvenience, especially if like me you frequently have to address large audiences. I wish I could afford the extra that it costs to go to America as I would be straight over to you! Dont fancy doing me a deal and making me your 'UK representative do you' Haha anyway, keep up the good work, SMG are my personal favourite clinic worldwide.

Phenomenal result for the amount of grafts, absolutely love his hairline design, this is the pattern in which i am receeding, though im in my late twenties and not so far receded in his preop condition. Still with his new hairline i am now officially Jealous!