win200

Yeah, I have a difficult time believing that a patient so young could lose enough hair on Avodart in such a short period of time to render the transplant a wash. That's just implausible. Yeah, Avodart can lose its efficacy over time, but that's a REALLY potent drug.

I've had good luck with Avodart. Propecia was mildly effective for me, but Avodart really slowed my loss down to nearly a halt. It's a potent drug, though, so it shouldn't be taken lightly. It really interferes with my sleep (it affects NO production in the brain, which has a direct impact on sleep), but I tolerate it. But for many people, it has an efficacy above and beyond Propecia.

That's a life-changing result right there. Hair loss is tough enough as a guy; could you imagine having that degree of loss as a woman? Brutal. She must feel absolutely incredible. Great outcome.

Just wanted to jump in and add something about the crucial importance of seeing real, in-person transplants before you pull the trigger. It's so, so important to get a sense of context--i.e., what a great transplant looks like, what an average transplant looks like, and what a bad transplant looks like.

I had surgery in June 2012, and was fairly disappointed when the results took hold. I was a NW 2 with pretty thick hair, and the transplant was definitely thinner than the hair behind it, which I wasn't expecting. I thought I'd gotten shoddy work, because my expectations were totally out of whack; I really thought I'd have a hairline that was pretty close to native density. I had the good fortune to meet Joe, and he told me that, on the contrary, my work was terrific. I was floored--I had no idea that relatively speaking, my outcome was top-notch. Because I hadn't done my homework. I think young guys with pretty full heads of hair like me are most susceptible to this; we see flash photography hairline pictures and think we can get a couple thousand grafts and go back to our teenage hairline with full density.

I've learned to be happy with my transplant and now think it looks terrific (and night and day better than I started with), but I should never have jumped without looking.

Ugh. Bosley strikes again. What a travesty. There was no way that yours was a 900 graft procedure; I'd guess 2,000, roughly, for good coverage. And you had diffuse thinning throughout your frontal third, which is a red flag for shock loss. She should have been extremely conservative about transplanting into that area.

To echo everyone else, go consult some other docs about a repair. Even if you have a terrible result, there have been some borderline-miraculous repairs. You're obviously suffering a lot, and there are caring docs that can probably help. Try to upload some 'after' pics and the folks here will give you constructive comments.

All I can say is that this guy must be one of the all-time great minoxidil responders.

I'd love to see a closeup of the hairline with no flash. That's a very small number of grafts for a really large surface area, and I have a hunch that these pictures don't display what's likely a thin graft dispersal. I tend to be aggressive about hairlines myself, but I think 2,500 is a more realistic number for that square centimeter area.

But... if the patient's happy, he's happy. Well done.

Let's be clear, guys: when I said 3,500 grafts, I meant *in addition to* the first procedure. We're looking at 1,500 to 2,000 for the follow up, for a TOTAL of 3,500 at the hairline. That's much different than 5,000. It's aggressive, but not crazy when taking into account my native honor, donor characteristics, etc. I've had two top surgeons take a look at me and both signed off on that approach, so I don't think anyone's proposing a crazy donor dump here. Aggressive, yes; crazy or unethical, no.

And I'm extremely finicky about my hair. I'm not obsessive. I could leave it as is and be happy, but dropping a hairline a bit would make me happIER, so I'm doing it. Honestly, I think 3,500 hairline grafts on a 32-year-old with extremely stable loss and a NW2 head of thick, dense donor hair is much less crazy than pretty much any procedure on a 23 year old. You don't have a crystal ball, but with my hair at my age, you pretty much know a NW7 probably isn't in the works.

I think your hairline looks better before drawing the outline of new the one on - something in between maybe.

Thanks! It's just the rough proposed hairline--we haven't sketched it out in person, so I'm sure it'll change a little. I'd to a perfectly straight hairline if I could, but the widow's peak is transplanted too low. I don't care for sloped hairlines much.

Man, I took a look at your recent pics... You have a killer head of hair with a really nice hairline as it is.

Thanks, Mickey! I don't disagree... I'm just particular and really fastidious about my hair. I talked with Dr. K a lot about such an aggressive strategy, because 3,500 in the hairline is a lot. Buuuut, he felt that with my native hair in the state it's in, plus the fact that I'm on meds, he felt comfortable proceeding and I trust his judgment more than anyone's.

Bottom line is that I want a flatter hairline--I've never liked the widow's peak, which was not part of the plan with my prior surgeon, and I want the density beefed up in the dead-center area. Plus, I want stronger temple points. And seeing as though I have the donor supply and native hair to support that, I'm gonna do it. YOLO...

I've shifted gears and bit and am now looking strongly at Dr. Konior for a second procedure. I just updated my blog with details and new pics:

Hair Restoration Journal for win200 - Consult with Dr. Konior

I love Dr. Gabel's work--always so clean. And he's such a nice guy; I've met him on a few occasions.

How old are you, BTW? I think it's always interesting to gauge surgical approach against a patient's age.

Wow--that's a lot of grafts in a small area! The result should be a knockout. Do you mind sharing your age and whether you're on medications? The work looks super clean. I haven't seen much from Dr. Panine, but this looks impressive from this early stage.

I use Kevin Murphy hair putty called Night Rider. Thick stuff with great hold, and really keeps my hair looking dense. It has a matte finish.

It could be lighting but it appears that you have a nw 4 to 5 pattern developing. Was this discussed? You choose a great doctor but it does seen aggressive for the pattern you seem to be developing. I think you should be pretty choosie with where your future grafts are placed.

Really? I'm not sure I see the NW4/5 pattern emerging. Are you talking about some of the scalp exposed under the wet hair? It seems pretty full to me... there's always going to be some scalp showing with wet hair.

I'd take Konior's opinion seriously. He's about as careful as any other doctor out there. Did all of these guys examine you in person? I would imagine Konior did given that he detected miniaturization in your donor. If Konior did see you in person, and Rahal did not, I would be extremely careful about proceeding. The surgeon who's seen you in person is always going to have the best read on the situation.

Looks like a very nice result, but would be helpful to see the 'after' without wet hair.

IMO I do not think you should even considering having a procedure, some temple recession is totally normal, especially for your age. I would be surprised if any would even think that you had any hair loss if you did not mention anything to them.

And I'm not even sure if this counts as temple recession. There's no rounding there.

Oh, man. I mean, you're probably in the top 5% in terms of heads of hair for your age. That is a killer, low, dense hairline. I totally get wanting to tweak the corners, but considering that you're starting off in such a great position, and that things can and do go wrong in transplants, I think it's crazy to play with fire. Even if nothing "goes wrong," the results may not totally match your native hair, the density drop may be detectable, etc. Shock loss could kick in. I normally say people should just go for it, but you're so golden right now that I would just walk away and buy an expensive toy instead.

Agreed. This is a somewhat unique case, and that bald patch is a lot to fill with enough density to match the surrounding areas. Plus, he's 37 and his loss looks pretty stable, so this isn't some 20-something using an undue volume of grafts.

And the result obviously looks killer.

We understand you, we're just saying that doing what you're proposing would be incredibly stupid nonetheless. If you were 30 it would be another thing, but you're proposing a game of Russian roulette. At 19, I would be shocked (and horrified) if any reputable surgeon agreed to give you that hairline. Any surgeon that would agree to do this for you probably isn't very good, and the odds that you'd be appalled by the outcome would be pretty high.

So: we understand where you're coming from, but that doesn't mean any of us think it's not a crazy idea.

I mean, what everyone else said. It would be one thing if you were 30 and your hairline had literally never budged, but you look much younger than that. It's possible that that's just your natural, non-MPB hairline, but that's also a hairline that could be in the early process of receding. The hairline you're proposing is very, very extreme. If you have even moderate hair loss, it would be a catastrophe.

Also, transplants aren't perfect. You can't get original density. Sometimes the donor hair isn't a perfect match for the characteristics of the native hairline hair. You can get shock loss, etc.

Bottom line: your hair looks great. Give it a few years. If you do have MPB and your hairline moves, you can get a realistic transplant then. At this point, you'd be firing blind and could end up with a disaster on your hands. Also, it's kind of a moot point, because no decent surgeon would do what you're asking. Give Rahal or Konior a ring in 2018 if it's still bothering you.

Complete knockout. No one but a seasoned NW spotter would ever guess that this guy has lost hair. What a mane! I'm guessing he's a little lucky in that he appears to have great donor characteristics--thick, coarse, wavy hair.

That is a LOT of area covered. Nice work.

Getting a bit repetitive now! I'll probably wait until 12 months until the next update.

The temple points make this. I'm probably getting a procedure with Dr. K in October, and one of the things I'm focusing on is temple points. They make such a huge, huge difference. Subtle, but huge.