mattj

This 37-year-old man came to Dr Rahal a wishing to restore his hairline and frontal zone. Dr Rahal designed a hairline with mild adjustment of the temporal angles, adding density without dropping the front.

The patient now has many more styling options available to him, and with only 2005 grafts used he still has plenty of donor in reserve.

Surgery Type: FUE

Recipient Area Treated - 42cm

Total Grafts - 2005

Total Hairs - 4330

Recipient Graft Density - 47.73 grafts/cm

Recipient Hair Density - 103.1 hairs/cm

Graft Breakdown:

Single Hairs - 315 grafts

Two Hairs - 1104 grafts

Three Hairs - 537 grafts

Four Hairs - 49 grafts

Average Hairs Per Graft - 2.16

This hairline that you drew is a more sensible position. Closing the temples and strengthening the front will make a world of difference.

https://imgur.com/a/D3ZeR

Have a read about the hair growth cycle. The telogen phase is when the follicle rests after the hair is shed and this dormant stage lasts approximately three months. After a follicle is transplanted, more often than not it enters the telogen phase and this is why the hairs will begin to grow at around three months after surgery.

I wore a beanie at two weeks, although I was careful when putting it on not to brush it against the grafted area. One on, the minor pressure will be around the circumference of your head (forehead, sides and back) and shouldn't interfere with your grafts.

Put it on starting from the back, stretch over the top of your head giving that area a wide berth and then release onto your forehead.

But: ask your doctor before doing any if this!

I walked the streets of Ottawa, Canada after my FUE procedure, wearing only a surgical cap, and the February temperatures of -15C (or perhaps even lower) did no harm to my result.

The water can add a small amount of body to each hair strange. Not as much as styling products, but a little.

I happened to take a few photos of my hair after a shower yesterday, simply because I haven't specifically photographed my hair for a while now.

I find wet hair useful for closely examining the density and looking further back beyond the transplanted hairline to see how even everything is. I was pleased with what I saw.

Agreed, the result looks good. What was Dr. Rahal’s assessment of this patient’s donor hair quality? Fine, average, ideal?

Average thickness and straight, so not quite as idea for coverage as thicker, wavy/curly hair.

FUT would normally be the best way forward for loss of the kind that you have, but of course you have to consider whether you want to opt for that surgery type. It would be worth trying out a complete buzz down and also thinking about what SMP could do to cover the area in combination with that kind of short cut.

It's hard to be sure based on these photos, but I don't see any significant change, if any. Your hair characteristics will work in your favour, just as they did for the patient example you gave.

I still think you should opt for a slightly higher hairline than the one you drew. It's the sensible way to go and most doctors would agree.

I like the hairline shape that you drew, but I think you need to aim for something a bit more conservative. It would take a lot of grafts to lower your hairline that much and you need to keep future loss in mind. You could still have basically the same design, just higher up, and it would still look youthful.

1800 grafts wouldn't even be close to enough to cover what looks to be a very large balding area. Some men who lose hair at the crown have quite a narrow balding zegna near while others, like you, unfortunately have a wide expanse of bald scalp and this requires a large number of grafts to fill. It is well established that crowns at the best of times need a high number of grafts to give adequate coverage.

It would be a good idea to take some more photos from other angles. Sometimes the balding zone extends downward into the donor area and it's not clear if that's the case with you.

I can't be 100% certain so I wouldn't want you going back to your doctor to complain purely on the basis of what I've said, but it doesn't look like 2800 grafts to me.

I asked and the patient had been on Fin for years prior to surgery. Of course there is the possibility of further loss, but I would say that in this case he would have more hair than when he began, even if all native hair was lost.

This is an especially stunning result for a patient with diffuse loss.

It can be hard to determine when the loss started even if, like me, your loss is more of the frontal recession kind rather than diffuse. I was blissfully unaware for several years before I noticed. It creeps up on you. As you look like you're following in your father's footsteps it's worth asking. If my pattern matched a family member I would interrogate them for all the info I could get

I understand your aversion to cosmetic concealers. I wouldn't want to feel dependent on them.

There's no way that you need 5000 grafts. There is not enough bald space to put that many grafts! It's possible that they were speaking of hairs rather than follicular units - a follicular unit contains on average 2 hairs, with some being single hairs and with the occasional 4 hair unit. It's important to clarify this.

Are you applying anything to the area at all? Saline spray?

I would expect some redness to remain at 7 weeks and some shockloss is common. Looks like your hair covers it so I agree that you should just give it time to fully heal and not stress too much. You're probably looking at months before any major difference so there's no point checking it daily.

You still have a lot of hair left in both areas of concern. Basically no reputable doctor would want to lower your hairline, as it's actually in a good position already. It looks like your father's hair hasn't receded very much and his pattern looks very similar to your own. I would (cautiously) use him as a guide as for how your hairloss might progress. It would be worth asking (if you haven't already) at what age his hairloss began to see if his age of onset matches yours.

I'm not convinced that you should opt for surgery for the crown area yet as there is still a lot of hair remaining. Have you tried experimenting with concealers? I know they aren't a substitute for real hair, but I've seen what they can do and I think you could totally conceal the loss with very little product.

I think your current plan to address your hairline is a sound approach. Just strengthen it a bit.

Here is another patient with a diffuse pattern. He had 3025 grafts via FUT.

There's also a video for this patient.

This patient had diffuse thinning throughout his frontal zones. He received 2553 grafts via FUT, which is a number on the lower side for the size of the treated area, but his existing hair made all the difference.

Strategic shaving (like the mohawk) can work in some cases. Some cases will be easier to hide than others, for example a small hairline procedure might be easy to conceal by keeping the top long. In most cases, I think an all over buzz cut is more tidy and makes the surgery less conspicuous within a shorter time.

I should have been clearer. He had the FUT procedure first and then the FUE several years later to add some density to the very front. The higher number of grafts needed to cover the large diffuse area meant that the hairline couldn't be planted to a high density first time around.

It is true that this patient has good donor. I wouldn't say that he is a unique case, but I agree that not every patient with extensive loss will have the donor supply to achieve this result.

This looks like an unusually pronounced example of a common phenomenon known as 'valleys', for obvious reasons. It sometimes happens shortly after surgery and I've never known it to impact upon the success of the procedure. In time it'll go and you shouldn't* notice any sign of that pattern in the final result.

*I say "shouldn't" rather than a more confident "won't" because there is always the chance that you'll be unlucky, but I really don't think you should worry. I've seen patients with your issue many times.

You do need those sorts of numbers but I don't think your scalp donor alone will supply it, so yeah, you'll have to go down the route of alternative donor sources like beard hair to get the coverage you need. It will be quite a commitment in time and money.