Surfarosa

Happy - here it is.....

Hi Happy - already started it but no response yet. Feel free to be the first to get it going !

Dr. Simmons - at what age do you feel that you can start making the "call" on predicting the extent to which a patient will lose their hair? I know this is a question that can have many answers with the usual caveats but you intimate above that it becomes easier to make a prediction thus you must have something in mind. I have been losing my hair since my late teens, been on meds for 10+ years and feel at 36 I should be able to have an idea of where I'm destined. In my early 20s my fear was that I would follow my father's advanced MPB route. However, as I have not (he was completely bald by my age) I often wonder where I might end up or when I might have a pretty darn good idea.

Scottish guy - all in all are you: a) Glad that u had the procedure ? b) Regret it ? c) Go back & forth ?

I have always thought that a telogen–anagen ratio or some other metric pertaining "rate of hair-loss" or "stability" is absolutely critical for this science to have any real credibility. This IMHO should be an absolute in what Coalition doctors should be measuring and recording without exception. Current stability is such a critical component (though it can change for various reasons) even if it's just a snapshot in time. If the technology is there (see Talizi's post yesterday) it should be part of the gold standard for sure. I also think full "standardized" reports should be given to patients before surgery and after 12 months. The goal = Scientifically objectifying HT surgery. i.e. you had this many FUs harvested successfully. They were placed in these regions at these densities. The survival rate was estimated at x %. You have xxx of FUs left in your donor area that could be used with a further xx via FUE. Then you can take your report to another doctor if you decide to have further work done elsewhere (or your current doctor disappears) or to seek a second opinion. This would eliminate so much of the conjecture and subjective opinion that plagues this field of surgery. As your history is a critical indicator of your destination with this condition, how can we not demand this ? I think this step forward as a standard would be awesome for us patients & would elevate this community. It would really make doctors have scientifically comparative results and elevate the bar beyond what really is just opinions about photos for most patients and potential patients. What do others think ? I think Pat & Bill as patients and experts in the field are more than qualified to draft a standardized report that their Coalition doctors could debate modify and agree upon.

Dude - we can all take pics that look fu*$ing terrible & I'm glad u only have 4 weeks to deal with the last bad images of your melon. Think of it this way - you came to terms with what you have now and you are OK ! From here on in (apart from post surgery blues) it is onwards and upwards. in 6-7 months from now you will look better than you have for years and it will be permanent. Even if you have a follow-up surgery it will never be where you are today again. Crack a beer you are going to be fine my brother ! Sending you positive vibes all the way !

I have always thought that a telogen–anagen ratio or some other metric pertaining "rate of hair-loss" or "stability" is absolutely critical for this science to have any real credibility. This should be an absolute in what Coalition doctors should be doing without exception. Stability is such a critical component (even though it can change for various reasons) even if it's a snapshot in time. If the technology is there it should be part of the gold standard for sure. Doctors could then say that you have become less stable than 3 years ago - we need to change your medications up etc etc .... I also think full "standardized" reports should be given to patients before surgery and after 12 months. i.e. you had this many FUs harvested successfully. They were placed in these regions at these densities. The survival rate was estimated at x %. You have xxx of FUs left in your donor area that could be used with a further xx via FUE. Then you can take your report to another doctor if you decide to have further work done elsewhere (or you current doctor disappears) or to seek a second opinion. This would eliminate so much of the conjecture and subjective b/s that plagues this field of surgery. As you history is a critical indicator of you destination with this condition, how can we not demand this ? I think this step forward as a standard would be awesome for us patients & would elevate this community. It would really make doctors have scientifically comparative results and elevate the bar beyond what really is just opinions about photos for most patients and potential patients. What do others think ?

Taliz - I love the use of the high tech mathmatical approach and the demonstration of density via actual counts and awesome pics. It still shocks me at how the docs are still so "rule of thumb" and approximating this stuff. HT is such a quantitative game yet all the discussion focusses mainly around the qualititive (and equally critical) dimension. Thank you for such an interesting and progressive post.

6 months is not long enough. Some people bloom later. Pictures would help but you need to keep the faith. Only at the 12 month mark can you make a yield call. Hang in there brother. I was the same for a FUT 1500 procedure.

Any quick input on this one fellas ?

I also fully believe that some of us have really impacted our thought patterns by thinking about this issue so much. These forums are without question a double edged sword but we are blessed certainly with this one thanks to Bill & Pat. We have gotten so used to reducing our world & our problems down to the hair on our head that it is very difficult to move on. The big missing part of our psychology is "acceptance" - that's what our bald brothers have over us and they are richer for it. Would we had gotten there quicker if we had just resigned to the cards we were dealt = impossible to answer. I personally wanted the time to get to the "well established" man stage before I felt I could deal with the acceptance part. And on a positive note, I am almost there - so it may have worked for me. Another thing is that I feel you obsess just as much post HTs as before. Now you have the "can anyone tell" angle which is quite scary. You wonder how far your hair loss will go still only with the added dimension of work & scars underneath that could be revealed.....

I think this is a great thread. I'm not at all surprised that you did not feel confident after your first procedure. 2000 graphs if you are losing hair still is not really going to give you a cosmetic bump only make you not as a bad as you would be without it and also set a base line up for future work. Sad but true. I was the same with my second procedure and went straight in for my third as soon as I could. I have a total of about 3000 FUGs. My first procedure was only 500 FUG but it made me so happy as it meant the all important corners were full when styles easily. As my 2nd brought the hairline forward it was very sparse. The 3rd pulled it all together. I hope your 2nd (& its way too early to make that call bro) gets you there. I used to wear my hat all the time - now I wear it only when I am nervous and want to avoid the stress. But I can style my hair quickly and leave the house without feeling those old horrible feeling we have all had (or we wouldn't be here). Keep the faith & start working on the next critical part of your restoration - the internal part.

I just heard that whilst a flash makes the hairline look great in photos, it actually make shots of the crown look much worse. Is this true ? That would suggest to me that flash shots of your crown and top of head - for the purposes of chronicling progression of thinning or the effectiveness of medical treatments - would be the most critical & accurate as the light is always a) harsh and b) the same.

The 2 middle pictures were taken in the last 2 weeks. The 2 outside pictures were taken almost 9 years ago.

According to Dr. Rassman the earlier you start on Fin the better (that it is more effective before extensive thinning has occurred). That being said I found that after 10 years it started to lose its efficacy & switch to Avodart. Avodart is great if you don't get side effects (I did not get any) as its a more powerful DHT inhibitor. No one really knows the long term impact of inhibiting DHT in the body. I attached crown shots almost 9 years apart that have been treated only with Minox, Fin and Avodart.

I think the question really is - "if he was a NW 5, 6 or 7 would the doc place the hairline in the same exact design?" If the answer is yes, then it makes no difference as he will end up in the same spot at some point in his future. I have heard doctors refer to the "safe zone" as anything in the area that would be worked on given an advanced case of MPB. I got turned down in my very early 20s and I'm very, very glad that I did but for 3 different reasons: 1. It gave me time to research, learn and find a great doctor 2. My expectations for what I wanted and what could be done converged more 2. Techniques improved greatly from micro graphs to ultra refined FUG & trichophytic closures

I do hope my contributions are welcome. At least I'm sticking pictures up for people to use / analyze. What I think of them is not even that important but pictures (at least ones taken in the right conditions) beat options 100 to 1 in my view. Just trying to help the cause my brothers. I'm certainly not putting pictures of myself online for fun.

Dude - thanks for the kick up the ass, I really do dig your candor. I just was surprised by the difference once I followed the instructions to take picture outside without a flash. A point you have made relentlessly. I like how may hair looks Epileptic!! I would never style my hair brushed back - it falls forward naturally. I have never worn my hair back. I was simply trying to add to this thread with real examples of what CopaSurfer is trying to achieve. Sticking a camera up close to any part of us is never a great look dude. In the name of progressing this thread, I gave myself a little shock - that's all ! I'm still super happy with my results as people don't tend to stick their face in mine to look at my roof ! My HTs have given me years back. I really hope you get the results you are looking for - I'm sure you will. I'm sending good vibes your way. Sorry if I offended or sounded hair spoiled brother. I'll try to stop being a girl .... Good stuff - made me smile ear to ear .....

And here is the non MPB area I referred to. This shows that my non MPB area is really quite fine too. As EpSkeptic highlighted it's the balance between the 2 zones (transplanted zone & non-MPB zone) that is a critical factor in a natural result. This pic cheers me up as it shows that I can make any area on my head look thinning even if it is not. My transplanted zones are very, very close to my transplanted zones. As I said - I have even seen this under the only real view - the microscopic camera. Dr. Feller - I would be very interested in your comments.

This pics shows a hairline close up with a flash. If we could get results that looked as good as they do with a flash it would be awesome! I wonder what the naked eye really sees? I guess it too depends on the lighting. I'd like to think it does not just see the harshest versions we can create.

One of the best hairlines I have seen ! Great candidate though - most with his starting point would likely not take the risk of a HT.

Bumble and Bumble Surf Spray guys ! It's the best. Blow dry or natural dry. Does not weigh the hair down or clump it. Gives you that great textured salty feel you get when you get out of the ocean and let you hair dry in the sun and breeze. I've tried every thing & now I just use my B&B Surf Spray. You can also use it on top of a thickening cream. Just dry the hair with the thickening cream till its almost dry at the spray and finish.

Sometimes when you are trying to prove a point you do something that you instantly regret (like taking these pictures). My goal was to find the harshest, most unflattering conditions possible to show brother CopaSurfa what he might expect from bringing his hairline forward. Most people have commented on how natural my results are (in conjunction with comments about see thru-ness and thinness). These pictures are the most brutal I can take - it took some experimentation to get this level of unflattering contrast. I really hope the naked eye sees a better version than this!! I think it does...... I have never seen my hairline appear like this & it was quite disturbing to me. I kinda wish I did not have these images in my mind. But I am committed to sharing with this community and that means the absolute truth which in terms of photo analysis I think means to include the absolute worst too. What do you guys think? I'm thinking of buzzing to a #4 for a break from styling - does anyone think that would not look natural ? A very bummed out SurfaRosa

Ha ha - nice analogy Doc. Thanks guys, you have made my decision for me ! I'll be building my website soon so you guys can see the work done on the hood !

The non MPB area comparison is so key as it gives you the baseline. It's the only real comparison you can make as it's comparing you to you vs. you to a picture of you in different conditions, or worse, you to another dude online via a picture analysis!! What's interesting is that if you have a super dense non-MPB area and a naturally low hairline (all sounds great right?), then you are potentially up for a harder task. Also, remember that the removal of donor reduces the density of the non MPB area thus helping the convergence of transplanted areas to the non-MPB areas. I had scalp analysis today with the microscopic camera which was really cool. My non-MPB area is in the 80s and my transplanted area in the high 70s (I was pleased with that). Only when you use the microscopic camera and take pictures with it to count and compare can you do this real analysis. A hairstylist friend of mine looked up close with a comb and water etc and concluded that my back and sides were less dense than the transplanted zones. Camera said = "wrong!" ! I thought my hairline was not as dense on both sides = wrong! Just different hair direction on one side. Just proves that even the trained eye can be deceived by hair length, growth direction, light etc etc .... I could have stayed and played with that dam camera all day ! Dam you OCD