mahhong

Spanker - I agree, it is tough! Nobody can truly know, not with all the indicators and prognostics in the world. I've seen men start going bald in their late 30s and by their 50s they're NW5/6 and men start going bald at 25 and by 40 they're only NW3/4. It's a cruel thing because you may dodge the bullet or you may not. Joe - That's interesting about your father as well. I'll have to find out if my grandfather is still on the minoxidil but he has a lot more hair than my dad does, although their "pattern" is relatively similar. I'm hoping I'll be something around a 5A. I say "hoping" because I don't realistically see it being any better than that, but of course it has the chance to be worse! My back and sides have seemed to remain stable the last 3-4 years though, whilst the top of my head has thinned pretty noticeably. The current demarcation between miniaturized and non-miniaturized hair seems pretty stark at the moment though, so I'm hoping that remains relatively stable in the future. I think if I'm lucky enough to keep it that way my chances of a decent restoration would be good with a good doctor. It's too early to tell though, so it's a case of watching, waiting and planning!

Your observations about family history are really interesting. My maternal grandfather was the NW6/7. I haven't that many photos of him but I found a few of him aged about 26-27 and whilst he still has a head of hair (at least based on the angle of the images), it's clear it's in recession pretty deeply around the temples (not the corner of the hairline, the actual temples). My grandfather on my father's side has relatively minimal hairloss, although he did (maybe still does) take oral minoxidil for his heart - I have no idea what if any benefit this may give him. I'd put him in the NW4 category. His hair is thinner all over the top of the head but he still has decent density apart from a relatively small bald crown and a bit of recession, with a strong back and sides still, into his 70s. His son (my father) has more pronounced hairloss which is pretty much NW5. The two family lines probably couldn't be more different genetically speaking. My maternal grandfather was small (5'4 maybe) and very thin all his life, no matter what he ate or did. His frame was very slender indeed and his features quite pronounced; relatively big, pointed nose and ears etc. My father's side are stocky, bulky men, prone to put weight on easier and much broader physically. Interestingly I have a brother and we sound very much like you. I'm the stocky, slightly bigger one and he's a good 3-4 inches shorter than me and naturally slender no matter what he eats virtually. I definitely take more after my father's side! We're both losing our hair and I've been trying to monitor it a little bit to see how we differ through the process! My hairloss is starting to get pretty noticeable now but it seems (hopefully) relatively confined to a thin(ish) strip at the top of my head. It's definitely thinnest at the crown and hairline though I'm resigned that the whole top is on its way out, but my back and sides seem relatively high and had appeared to stay that way over the last 3-4 years, whilst the balding area has thinned pretty considerably (I can literally feel the margin where the hair becomes much bulkier and thicker when I run my hand through my hair). My brother (who is a couple of years younger) had much earlier and more pronounced thinning in his crown but his mid-scalp and hairline have held up longer, although it's clear they are thinning too. His "pattern" does seem to be more extensive than mine, though, with the hairloss seeming to extend further down the back and sides of his head. I probably will give finasteride another trial though I am fairly confident it won't pan out, so I'm trying to think about realistic hair restoration plans that don't include finasteride. That obviously limits the sort of density you can hope to achieve and makes planning a bit trickier, but it seems (at least to me) doctors are becoming more knowledgeable and understanding of what to look out for and how to identify and monitor patterns of hairloss. So I'm hopeful there might be a plan that will work and restore a good head of hair, though obviously not the head I once had! To be honest as long as it was a relative improvement on where I am now (without concealer) I'd be very happy; I'm still managing to just about hide the worst of it with a bit of concealer though it's becoming pretty clear around the hairline and crown now! Anyway thanks again for all your insight Joe, and congratulations on yet another superb procedure!

Thanks for your reply Joe, very useful! In regards to the continued thinning of hair without finasteride, would a second (and possibly further) procedures go some way towards offsetting this problem? I know so much is dependent on your physiology and available donor, but I'm assuming if you were able to get around 6,000 grafts in one session a second session of 2-3,000 grafts would be a relatively plausible proposition? This patients results are truly stellar! To be honest I'd be happy with more modest results as these look phenomenal. It's interesting to find people who seem, at least, to be dealing with relatively similar hairloss patterns. I'm of a similar age (a year or two younger perhaps) but I'd say my hairloss looked similar to his; perhaps not quite as pronounced in the thinning zone yet but well on the way. There is a range of hairloss history in our family; certainly one pretty severe NW6 into 7, someone who borders 5/6 and someone who is probably more 4 - it's hard to figure out where mine might be heading! At the moment though it seems I have fairly high non-miniaturized borders on the back and sides, so perhaps somewhere around that NW5 mark. Anyway thanks for all the thoughts on this!

Between military service and public engagements there is no way he'd have time to have a HT and heal up without it being noticed, or without compromising his duties. Add to that the fact it'd be so noticeable and the media/public scrutiny and I don't know whether it'd even be worth his while! Plus, and I'm just speculating here, my suspicion is he couldn't have such a procedure justifiably paid for through the tax system, meaning although it sounds ridiculous, he might have to pay for any sort of cosmetic surgery through his plain old wages. I know it sounds ridiculous to say a Prince couldn't afford it and I'm sure theoretically he could afford it many times over; but none of that wealth is his and the public would be pretty incensed if they found out William had a HT via their finances. Overall I think there's just too much complication to get it done in the near future. Maybe after military service though...

I think you'll find that is the sort of results they are aiming for to be honest. There has become a misconception that all these current medical trials are researching "the cure". Replicel would see results on a par with finasteride as positive; it would essentially be propecia minus the lifetime commitment, cost and potential side effects (though no doubt may involve its own set of side effects or specific issues). That's obviously disappointing but this is how medicine and medical research works I guess. We're just not going to go from 0-100mph straight away. These techniques are in their infancy and the first stage is really just to make them as effective as their competitors in the marketplace. If Replicel can offer an alternative to finasteride, that would be deemed worthy of a place in the market. To us that might seem disappointing, but to investors it's proof the product can compete. That's why we need to lower our expectations somewhat with Replicel and Histogen and all these other "on the horizon" medical ideas. I have no doubt in the next 10 years some of them will become new products in the fight against hairloss, but they'll just be another string in the bow. This is what doctors mean when they tell you not to refuse hair transplantation and current medical treatment in the hope of a future magic bullet. It isn't going to work like that; evolution, not revolution unfortunately.

I'd hazard a guess the majority of men on these forums are on propecia. There are millions of men worldwide on the drug and the reported 2% of men that report side effects is probably about right, give or take. Side effects should cease after taking propecia if you find they are intolerable. Some men also report their side effects diminish after a few weeks/months on the drug. There is a very tiny minority of men who claim to have persistent side effects after discontinuing the drug but this is not scientifically supported. In short, you will read stories of men who claim propecia is still causing problems weeks, months or even years after stopping it but there is no accurate, verifiable report of this really happening in the peer reviewed scientific literature. It would probably be the case that most men suffering sexual dysfunction during and/or after taking the drug are experiencing other problems such as stress or other physiological issues. I took propecia in two stints, for about 3 months and about 8 weeks respectively. I had moderate side effects both times, which caused me to stop taking the drug, but they resolved pretty soon after I discontinued. I'd go to a GP or hair restoration doctor and get a prescription (with their consent of course) and give it a go. If you do notice any problems talk it through with your doctor or, if you are worried, discontinue the drug. I would hazard a guess that the legend surrounding finasteride is far more of a problem than the finasteride itself. If you do find it intolerable, stop taking it and you should find yourself back to where you were within a week or so.

Yes, the rewind case is a decent one for 2,000 grafts , but as other poster have pointed out the hairline is very high indeed. That's not to say it is bad or wrong because each case is its own thing, but it's clear this guy has opted for coverage and a very high, fairly sparse hairline over density. It really does all come down to personal opinion. If you trust the doctor and have seen results you like with similar grafts and feel you can replicate them then go for it, although as most people have said make sure you've done your research, spoken to a range of doctors and come up with the best route forward based on the facts of your specific case. There are lots of things to consider. For example, more important than number of grafts would be the number of hairs. Some men are lucky to have more 2 and 3/4 follicular units than others, meaning 2,500 grafts on one man will look very different on another. Add to that hair diameter, contrast with scalp and all the other variables and it's not as easy as to look at one man's procedure and say "mine will look like that", although of course you can get some idea of what you might be able to achieve. It does come down to a personal decision. You sound happy with your doctor and the plan you have constructed with them and if that's the case and you feel you've done your research, go for it. I think most people would just be concerned that you won't mention the doctor's name despite the fact, with the exception of a few very dubious doctors, this is a public forum where any doctor's name can be mentioned freely. There are still hacks out there and whilst I'm not suggesting your doctor is sub-par, if you can't mention their name something seems amiss. Whatever you choose to do best of luck with it! Every case is different and so in theory there's no reason you couldn't have a successful outcome; just make sure you've researched and made your decision based on facts and you'll be fine, I'm sure!

2,500 in the frontal third will give you a very, very light 5 o'clock shadow, possibly. It comes down to personal opinion, but the question becomes whether the cost and the surgery itself become worth it. That is to some extent a personal decision but you have to be realistic and understand you're going to look like you have a very thin smattering of shaved hair in the front of your head. So, less "5 o'clock shadow" and more just a sparse sense of a hairline. This might look fine; I don't recall seeing a case exactly like this but I have no doubt there are people out there who have had it done. Why only 2,500 though? Is it a financial thing? A doctor's recommendation? Don't go rushing into a procedure with the first doctor who tells you he/she is happy to perform one. 2,500 will give some cosmetic difference but it will be small and conservative with a high likelihood you'd want further surgery. Also, regarding the doctor, I haven't checked the forum T+Cs in detail recently but I'm pretty sure almost any doctor is mentionable here. I personally wouldn't trust a doctor that was so dubious his name was banned on a forum! I hope this doesn't sound overly negative as I don't know the details of your case apart from what you've said, it's just a case of raising issues or ideas you may not have thought of to make sure you're prepared as possible for any decision you take. Another possibility that may be worth considering is scalp micropigmentation (SMP). This is essentially a tattooing of the scalp to look like buzzed hair. It can be combined with FUE to create a more pleasing look in some cases. It has its drawbacks and its not cheap, but some people have had it done and are happy with their results. I know Dr. Rassman and NHI do it so you might want to research them if it's something you're interested in.

Who told you that you couldn't use his/her name? I'm pretty sure you can mention any doctor by name on these forums and, if they have asked not to be mentioned here, I would take that as very suspicious indeed. 2,500 won't really do anything worthwhile for you. If you're NW6, even if you don't touch the crown, I don't really see how you're going to get get 20g/cm2 unless you pretty much just do the frontal half very lightly. This would give you very, very light coverage but wouldn't really do much cosmetically and for the cost/surgery involved seems ultimately not to be worth it. More than that it just sounds like your doctor hasn't really come up with a solid plan with you and made you understand the limitations and practicalities. I'm a bit confused about the BHT thing. Unless you've had lots of work done in the past or have some other particular problem you should have at very least something around 4-5,000 hair grafts in your donor reserve (on your head) - most men have around 6-8,000. If you were going to have a second procedure it shouldn't have to be BHT and it seems a bit weird your doctor would recommend that above using the head donor up first. Can't imagine any plan that involved such a conservative first surgery followed by a BHT when there should still be donor left being a good one. 2,500 might give you some light coverage in the frontal third, but it would be pretty scant to be honest. I don't know, but I don't think you'd be happy with the money you spent compared to the result you got. Add to that the fact other clinics seem to have said the same thing and the fact it appears the doc doesn't want to be named and is suggesting BHT. The doc shouldn't be banking on you "coming back" - you should have a proper, effective plan worked out with them that you're happy with and that makes sense. It's hard to say what density you "should" have transplanted as it depends on so many factors. If you imagine the average person has somewhere between 75-100g/cm2 in a non-balding head and you can see 20 is, at best, around a quarter of your hair back. I'm no expert but I would say people usually start around a minimum of 25g/cm2, especially around the hairline, where it's not uncommon to see 35-50+. It just sounds, to be honest, like there's too much uncertainty to consider it seriously. You need a complete plan which takes into account future balding, if you're on meds, hair type, donor density, goals, ambitions, realistic outcomes, potential multiple surgeries etc. It sounds like this doctor is telling you "try 2,500 and come back if you want more". That's not going to cut it. I'd say listen to some of the other clinics ahead of whoever this doctor is. I'm really dubious about doctors that don't want to be named at the best of times personally! Add to that the fact the plan doesn't sound wholly convincing and I'd say steer clear.

Fantastic result Joe! Out of interest are you able to tell us the age of the patient and whether he is on any medical regime or not? I'm curious because I have very similar hairloss to this but have been unable to tolerate finasteride unfortunately. Also, another question related to this patient (who I am using as a sort of test case for myself based on his photos!). There seems to be a relatively clear differentiation between the visually obvious miniaturized and non-miniaturized zones. Do you anticipate potential further loss in the non-miniaturized areas or do you think it's safe to say his relatively high back and sides native hair will remain as they are with or without medication? I know nothing is certain in this world but I figured the doctor would have a good inkling based on his history and physiology. Hope this wasn't too many questions and thanks again for showing this case; great work!

I don't think it's a typo. I may be wrong but in the photo that shows the pen marking out the transplanted area you can see a portion of the area to be transplanted right at the back already has a relatively good amount of native hair. This might mean that the hairline could take the majority of grafts and that could gradually be reduced as the native hair starts to enter the picture. The net result may be that a good 10-20cm2 of that 93cm saw only a smattering of grafts. I could be wrong, but that's how it looks to me. Plus this guy's characteristics means he can get a lot of coverage with relatively minimal density and still have it look great. Looks like it may be something like mid-40g/cm2 in the hairline with a gradual phased reduction of that density into the native area. Just proves how much artistry and design come into the planning of a good HT! Great result! Really nice.

Best of luck with your surgery jimmybald! One question I did have though; has Dr. Panine seen you in person and/or performed any kind of miniaturization/bulk analysis of your hair or had a look at your donor area and made any estimations of available donor? I think Dr. Beehner raised some great points and, whilst you've found a good, reputable doctor to do your surgery and hopefully achieve your goals, I think you need to try and plan as best as possible for future loss. I'm sure Dr. Panine will be able to go through all of this with you but I'd recommend discussing thoroughly what the plan might be for your future if your balding progresses. My personal instinct is that surgery like this can only be effectively performed if part of a 'Master Plan' that tries as best as possible to take into consideration all aspects of your hairloss and ambitions and tries to create contingencies for any future loss. If you've had 1800 on the temples and now let's say 2500 in the crown, that's 4300 FUs of your donor used up. That's a good chunk of your donor change and potentially over 50% of your donor hair gone. If Dr. Panine has agreed to perform the surgery I'm sure you'll be looked after and a careful idea of your future planned out. I'm just saying these things to make sure you have all the information you can have. Happy growing after the procedure!

Hi dragonfly, There will be a lot of factors in determining your hair transplant. Firstly, no good doctor would ever transplant at 90g/cm2 or anything like it. I think about 65g/cm2 is the most I've ever seen, maybe a bit more in some very select cases. If it really is just a hairline lowering procedure (I'll explain more below) then there is a chance you could get the higher end, densely packed procedure done. But I think a reputable doctor would be unwilling to go much above 60, maybe 70. That, however, should get you truly stellar results with the right surgeon. There is much more to it though; shaft diameter, contrast between hair and scalp etc. Some men can have 45g/cm2 and look better than others with 55 or 60g/cm2. It is not just the amount of hair that will make the difference. The other major concern is your age and goals. As you probably know, you have a finite amount of donor hair and it's notoriously difficult to know how far you will bald. If you're 35 with only a tiny bit of hairline recession that bodes well, but if you're 22 or something, you could potentially be in for major baldness in the future (let's hope not, but it is possible!). Family history and a thorough examination can help ascertain where you might be headed, but it is impossible to know definitively where your hairloss will end up. As you can guess, this will have a major impact on the density you can transplant at. If there is even a moderate risk of serious further balding in the future, you will be looking at a hairline of more like 30-50g/cm2 instead of the 60 mark. If you're a suitable candidate for top-end dense packing, however, you should find that a good doctor will restore your hairline in such a way that it should be by and large undetectable under even the most unforgiving of lights. That will require you to have very minor loss though. If there is any chance of future balding, you will have to be a bit more conservative in your goals. That's not to say you couldn't still have great results. The number one thing that you've said which is positive; you're considering a top doc. Make sure you do, because they will be honest about what you can achieve and do the best work if you're a suitable candidate. I say this because there will be some hack out there that promises you completely natural, full density results. You might be able to get something that looks that good, but a top doc will be honest with you if you can't. Make sure you hear the truth and make a decision based on that; there is a lot of snake oil about!

BummedinCA, Sorry to hear you're not happy so far but as many have pointed out (even though you said you already knew), it is way too early to evaluate where you'll be. Without seeing photos and knowing who your doctor is it's hard to offer complete feedback but, another aspect of your post I found puzzling is your concern that the density was "nowhere near" your native hair. Hair restoration cannot and will not replace your locks on a hair-for-hair basis. This is particularly true at 29 years of age, where you're likely still balding (propecia and minoxidil will halt but indefinitely stop your loss). Most men, even with moderate or minimal balding, will only look to replace 30-60% of the hair they lost (60% at the very top end, really). And the higher end of that scale is only really suitable for patients who are older and/or show signs their hairloss has truly stabilised and is very unlikely to progress. Those with higher density restoration also tend to get that far over multiple surgeries across a span of time. Grown out, at around 30-50% of density restored, your hairline should look natural and the transplanted hair will blend with the native, higher density hair. The discrepancy between the two will look harsher under strong lights or similar circumstances, but to all intents and purposes your hairline should look restored. If you were looking for more density then this is likely something you'd look to achieve in a second pass, and this should have been discussed as part of your ambitions in consideration with other factors like eventual balding pattern, available donor etc. In short, if you weren't aware of these realities and limitations, either your doctor has failed to inform you of what hair restoration can achieve or you haven't researched thoroughly enough and developed a complete plan that takes into account all of the considerations and limitations. At 29 years of age your doctor was right to be conservative and plant hairs at a relatively lower density. Most men will be lucky if they have 7-8,000 grafts and there is the chance if you bald further you may need all of them to deal with the increased balding one day. I'm sorry if this comes off a bit contrary to what you were saying (I didn't mean to be blunt or antagonistic if it feels that way), I'm just trying to highlight that the procedure you've described sounds pretty normal and your concerns about a multiple surgeries are something you should have been aware of. Most men will need multiple surgery across their lifetime; there is a chance you won't but you're likely to be in a different position at 39, 49, 59 etc. I'm not suggesting you will need to have lots of surgery or anything like that; I'm just saying you can't ever truly have a procedure and just assume that's going to be it. You have to be aware that further surgery might be necessary to deal with continued loss. Anyway, what you have described sounds normal and if the surgeon was reputable I'm sure the eventual results will be acceptable or better. If the surgeon was not reputable or did not make you aware of how things will be then that is a concern. Whatever the truth, you have to wait at least 9-12 months to see how this first procedure turned out. If you can tell us who the surgeon was and post photos we would be better placed to offer constructive advice, but there's no way you can know this is the worst decision you've ever made yet and, if it is, it will be for factors that should have been clear to you prior to deciding on surgery.

I think it's all very exciting stuff, but what you posted above shows why we shouldn't be too quick to believe this is going to be on our shelves or in surgery in the near future. All sorts of treatments/surgery/scans etc. technically put patients at higher risk of developing cancer, so the first thing will be to statistically analyse what the extra risk will be and, if too high, research ways in which that risk might be lowered. Stem cell/cloning research is truly exciting and is going to be the revolution of our time, but this is the prevailing problem with it; altering and growing cells is potentially dangerous and we still don't know the full story about what we're doing. I have no doubt scientists will be able to overcome all these barriers, but with, you guessed it, time! Ultimately I wouldn't hold out hope that the "cure" is near yet, even though the science behind the cure is currently being researched. These things do take decades to really come into their own; by the time you've developed stuff, trialled it, re-developed and researched problems, found a way to bring the product to the market and given the product a few years to really penetrate the market and become common within the medical skillset you're probably looking at at least a decade before anything being talked about now is ready for us; with some treatments a lot longer even. That's just the way things work. In the meantime I'm sure there will be improvements and additions to the drugs/techniques available, but propecia, minoxidil and HTs are going to be with us for a long time yet and I wouldn't hedge your bets too much on a replacement as successful as any of them for at least a few years, potentially a decade or more.

I only just noticed Joe had replied as I was typing this message! I think the other reason is about the confidence of the individual doctor. H+W have been studiously building their grafts per session record and it would appear they have the experience and confidence to try for that little bit more in certain patients. A lot of doctors are more reserved in what they are willing to try for various reasons. It takes an outfit like H+W to push the boat out before others are willing to wade that far. There are lots of great doctors but being a pioneer is an entirely different endeavour. H+W have the background, experience and ambition to be those pioneers I guess. It's wonderful when the results justify those efforts and I think we can all agree this patient proves that many times over! It's much the same in any other field; many wonderful surgeons but only a handful make it their profession to go further.

Very nice! Really great density and naturalness.

I agree this looks like top class work! Especially for the relatively few number of grafts used. Good stuff indeed!

This is a great result! Even though 7000 grafts sounds (and to some extent is) a lot, this guy is pretty much somewhere between a NW6/7 and that makes even 7,000 grafts a precious commodity. I think the hairline looks fine; it's age appropriate and is certainly an improvement on the starting position!! Joe, out of interest, do you know if this guy has any donor hair left? I'm just curious because of the extent of his balding and what you've managed to achieve despite that fact. I wondered if there was even more left in the bank for any further work if needed or wanted.

Sounds theoretically plausible, but I'd recommend telling this story to your doctor and maybe getting it looked at because prostate enlargement at that sort of age is very rare and there are other things it could or could have been. If the symptoms have abated that's obviously good news and may in fact point to what you feel has happened. Out of interest was there any reason you didn't get this examined at the time, prior to taking finasteride?

I don't think so. That scar looks to be at least 3/4" - 1" away from the nearest area of miniaturization. The patient also looks to be at least in his mid-to-late thirties, but more likely into his forties or beyond. The margin between miniaturized and non-miniaturized hair appears to be pretty stable and with his age you would assume fairly confidently there will be no major continued hairloss in his future below the apparent stable region. Add to that the fact he is more likely on propecia and I would say all that makes up for a pretty thorough reasoning that this guy is unlikely to see thinning down to the scar. No doubt there will be continued miniaturization on top in the clear balding area, perhaps even a little bit around the margins. But if he got 9,000 grafts in his first session you can pretty safely bet between the remaining FUT and any potential FUE there is another 4-7,000 grafts worth, which should see him in good stead if he does need further work. My father has hairloss similar to this, with the exception of a bit more loss around the crown, and he looks the same at 53 as he did at 33. I'm no doctor, but I think it usually becomes clear whether the margins between thinning and non-thinning hair have stabilised and surgeons as experienced as H+W have seen enough scalps to know when the chances of progression between the stable/unstable zone are high and when they are low.

Yeah I've done this too! When I do that it's pretty clear, at least at the moment, what areas are clearly balding and what areas aren't. I have a lamp in my house and, for some reason, even though it's not that bright a light, it really exposes the thinning areas! It's horrible; but I think because it's a stand lamp and not a light it's literally about an inch from your hair, and I think the colour of it exposes the scalp more easily.

Looks great! Joe, do you know if he is on any medication? I presume he is!

There are a few out there (check the section of this forum dedicated to hairloss medicine) but in honesty I'd be careful. Blocking DHT is what causes some people to have side effects, not finasteride specifically. To that extent stuff like Saw Palmetto (probably the most famous "natural" DHT blocker) are just as likely to cause you problems - the only difference being they're not as well trialled and not FDA recommended for hairloss treatment. As previous poster said generic proscar is your best bet; much cheaper. If you're dead against finasteride there are other touted DHT blockers (such as Saw Palmetto) but they're poorly documented because they're not strictly for hairloss; there is no common consensus on dosage or statistics on side effects, so in essence I'd say they're even riskier than finasteride. Finasteride will remain your best bet. It is the blocking of DHT that has the potential to cause sexual problems, so any blocking of DHT has the slim but clear risk of doing the same. There isn't any way to get around that unfortunately, whether you take herbal supplements or any other type of drug. The only difference with finasteride is we know the statistical likelihood of these side effects (around 2%) because they've been thoroughly studied in pretty large numbers.

It looks like something from one of his films with Spielberg! I don't think he has anything to worry about, the lucky sod! Like Brad Pitt, he was blessed with nice hair and no hairloss. I notice in some photos he does seem to have a bit of thinning right in the centre of his hairline, but I don't think it's going to be progress much. Having said that, I guess he's a mere mortal like all of us and he has the money to try anything!