mattj

I can't say I can recall ever seeing a man with long hair who has the signs of traction alopecia.

Shera is correct and it most definitely isn't a myth. You may have noticed that women who tie their hair back tightly will sometimes be receding all the way around their hairline as well as around the back at the neckline. I see this often and feel like I want to warn the person that they're causing damage.

This doesn't mean you shouldn't tie your hair up at all. Just don't do it too tightly.

He had been dying his hair. I know that the change in hair colour is almost as dramatic as the transplant! I think the grey actually looks good.

This patient is 57 years old and he came to Dr Rahal to restore density behind and around a stronger front forelock area. This was achieved using the FUT method.

The patient came back a year later to address his crown. This gave us the opportunity to take the photos and also see how well the scar had healed. You can see this in the final photo which was taken shortly before surgery.

Surgery Type: FUT

Recipient Area Treated - 68cm

Total Grafts - 3611

Total Hairs - 7786

Recipient Graft Density - 53 grafts/cm

Recipient Hair Density - 114.5 hairs/cm

Graft Breakdown:

Single Hairs - 338 grafts

Two Hairs - 2375 grafts

Three Hairs - 894 grafts

Four Hairs - 4 grafts

Average Hairs Per Graft - 2.16

This patient was aged 21 and had had a NeoGraft procedure elsewhere. The previous surgeon had used large punches (we suspect at least 1.2mm), used multi-hair units in the hairline and the overall design was poor.

The goal of the repair was to remove the grafts that were placed too low (especially the multi-hair units) redesign the hairline and add density further back behind the previous work. He had lost hair since his previous surgery.

A 0.8mm punch was used to remove the hairline grafts as well as for the donor extractions. The zone of extractions avoided as much as possible the previous area of large punches to balance out the donor.

Post-op photos were supplied by the patient at 9 and 10 months.

Surgery Type: FUE

Recipient Area Treated - 37cm

Total Grafts - 1591

Total Hairs - 2830

Recipient Graft Density - 43 grafts/cm

Recipient Hair Density - 76.5 hairs/cm

Graft Breakdown:

Single Hairs - 513 grafts

Two Hairs - 917 grafts

Three Hairs - 161 grafts

Four Hairs - 0 grafts

Average Hairs Per Graft - 1.8

Nice to see your update. The next month should be when it all starts happening..

If you can find a natural opening into the subject, then it's worth raising it. But please be careful. It can be a sore point.

I am curious what really the difference between FUT and FUE is in terms of graft numbers.

 

I have been told to have a great donor area with dense hair. I am currently probably a NW 3 Vertex.

It's not horrible yet but I fear it will be eventually.

 

I really don't want to get a FUT scar because I'm worried about having to completely shave one day.

However if it means to have a lot more grafts available I'd reconsider.

I do think right now I'm at the top end of the grafts scale with a good donor area. But if I go completely bald I may need every graft I can get.

FUT will normally get more grafts in one go. The maximum number of grafts would be through a combination of both procedure types.

His hair characteristics definitely help. If he had fine, straight hair, he would have needed more grafts to cover an area of that size.

So an example of how it isn't 'one size fits all' in terms of how many grafts are needed to cover an area.

It is almost certainly male pattern baldness. It will be interesting to know how you and your twin brother do on the two different treatments.

This patient is age 35 and wanted to restore his hairline (including temple closure) and add density to his frontal zones. He opted for FUE. A great example of how good hair characteristics, together with skilled placement, can make the grafts cover a larger area with satisfying density. The patient also has above average donor density.

Surgery Type: FUE

Recipient Area Treated - 68cm

Total Grafts - 2728

Total Hairs - 6080

Recipient Graft Density - 40.12 grafts/cm

Recipient Hair Density - 89.4 hairs/cm

Graft Breakdown:

Single Hairs - 429 grafts

Two Hairs - 1344 grafts

Three Hairs - 857 grafts

Four Hairs - 98 grafts

Average Hairs Per Graft - 2.12

I don't think it's a good idea to draw any attention to a person's hairloss, even in a discreet, one-to-one situation. They might be incredibly embarrassed or insulted. But you can't even assume that it bothers them too much.

It would be much easier to approach the subject if you were open about your own HT

Well you haven't done any harm. That's the main thing.

What percentage of men use an electric shaver daily? I don't know the answer to that, but whatever the figure is, it's going to be about the same for HT patients. Some men shave their faces, some don't. It has no influence on the procedure.

Electric clippers/shavers can pull at hairs and snag them, especially if the blades are blunt or the battery is dying. That's why it isn't advised to use them on the transplanted areas.

I would say that going for the higher figure, or the maximum, is better to do with the first procedure and it makes more sense to do it that way. It's definitely possible to get a good result from a second surgery, though. A second surgery can add density to an already impressive first procedure.

200 grafts is an extremely small number. Unless you have a very small area to target then that kind of number won't make a difference. If you want to add density to your frontal third then you'll need a much higher number. You're probably looking at adding a zero to that number. As a second procedure, perhaps less.

I can see that your point is more about shedding and how to conceal that you've had a procedure. Transplanted hairs are much more resilient to shockloss than native hairs and in the vast majority of cases will start to grow back as any clipped hair will. Most surgeons will want to shave the area as that's the best way of going about it.

Shaving your face will have absolutely zero effect on your HT procedure. Zero. This isn't an issue at all.

I didn't realise you'd posted photos. I just took a look and I see a pretty good result. With your hair texture it looks even better and I can't see why you'd want to undo what has been done. I totally stand by what I already said.

Looks great. I'm guessing the dense hairline is obscuring thinning further back in the areas you want to target this time around.

I would say that the best way forward is to contact the doctors on your shortlist (one of whom I represent, and you're welcome to contact me directly) and search this forum for results posted by patients as well as by the clinics. This forum is a goldmine of information and it's easy to find.

Highly debatable whether you are ready for a transplant. I see some frontal loss but nothing major. If you were a lot younger then I'd be telling you to avoid a transplant, but if your loss is stable then I can see how you'd benefit with minimal risk. This is a tough one.

Great medical advice from the doctor above. As someone who has smoked and who seems to be sensitive to nicotine, I can say that there's a big difference between smoking only a couple a day and a full habit. There's a real difference in how the nicotine will affect the body. Just don't let 2 cigarettes become 20. It's easily done.

I would assume, from Oscarito's third paragraph, that a second surgery is financially out of reach. Which is understandable.

If there is a remote possibility of raising the funds for a second procedure in the future, then I would try and live with the result for now. Perhaps make use of concealers. Even a disappointing result might not be as bad or as detectable as you think. We are our own biggest critics, after all.

Bill has said it all and I totally agree. It is very rare but the surgeon was right to inform you. They were just being very thorough with their information, which may have scared you but can only be seen as a good thing on their part.

You don't look like a typical diffuse thinner, but most men with MPB will have some thinning beyond the obvious recession and bald spots. From what I see, you have a receding hairline in a typical Norwood 3 pattern and look like a before picture that would sit next to a photo of a fantastic hairline transplant. Pretty much every patient will have some miniaturised hairs left and they may or may not return after the procedure, but weren't really providing much coverage anyway. If Finasteride hasn't provoked any change in those hairs after 11 months then I doubt if it will at all.