mahhong

Great write-ups by Bill and Dr. Beehner!

I think if you go down the hair transplantation route you have to be prepared for the fact that, whether you take drugs or not to slow down hairloss, you are in your lifetime likely going to have to commit to at least 2 hair transplants or at very least be willing to prepare for that likelihood. I understand that every procedure is rightfully planned to look natural and stand up on its own, but hairloss is a progressive thing and the drugs are really designed to slow that progression down to a point that it will not be noticeable over a moderate timespan of say 5-20 years. Accepting that multiple procedures are a distinct possibility is the same as accepting all the other realities about hair transplantation; the density, the coverage, the limitations.

As Dr. Beehner points out, the problem (and it's very hard to accept for most of us) is that hair transplantation cannot be about going back but moving forward. There is a tendency to think of a HT as recapturing how you looked years ago, but in reality you are having to design a new plan for your hair that can look as good as possible. Men in their 20s and 30s do want to look like their non-balding peers, but in the majority of cases that is not a good starting point for your restoration journey.

I think you have to start the journey knowing it will probably never end. Propecia and minoxidil can work wonders, but over the course of decades they are very unlikely to keep you stable and that will mean using HTs to replace what is going missing. That might mean two or three large procedures of 2000+ grafts in the course of your lifetime, or maybe 4/5+ procedures that have more specific or modest aims.

This is something I am having to think about, since my hair is thinning and I found finasteride to give me moderate side effects that I do not believe were psychosomatic or worry related. At nearly 29 I still have some hair on top which, with concealer, can look pretty full, but the time is coming up in the next 2-4 years where I don't think that will be the case. It's tough to know what to do; on the one hand I don't want to lose my hair and want a HT to deal with, but on the other hand I don't want to commit unless I know the results will be acceptable and look good. I'm quite content with the idea of having 2+ procedures over the course of the next 5-10 years and using a lot of my donor to deal with the problem, providing I can be sure it's not a journey I can't finish as I want!

It's all about research, preparation and commitment I guess. I think most men have the opportunity to gain a good head of hair again using HTs, as long as you plan and understand. If you're heading for a severe NW6/7, you have to be very frank about it and what you can achieve. If it won't give you the hair you desire, it is a bad choice to make a go of it. I have a feeling I'm heading towards NW5 - so still a pretty advanced balding pattern, but hopefully with the right doctor and the right plan there is a good future on the horizon. I'd rather wait a while longer though and try as best as possible to make sure the possibility of an NW6/7 is unlikely. Without propecia the need for detailed analysis and planning is even more paramount and I really have to think about what can be achieved and how best to go about it.

Anyway, yeah, in short the work of HT doctors constantly amazes me. But the real work seems to be at the beginning, when doctor and patient do their utmost to analyse the situation and come up with a crystal clear, realistic, contingency-calculated plan that will provide results everybody is pleased with. I think a lot of patients still hear what they want to hear and regret it. You have to be very frank I guess, but the options and techniques available now are more successful than ever, and I think if you choose the right surgeon and come up with the right plan, the majority of men will find a path that suits them and that transforms them.

I think Lorenzo is right in the sense that, unfortunately, 22 is too young to really say whether lowering the hairline is something you might be able to do. You do look to have a strong head of hair but there is unfortunately no way of knowing whether MPB will be in your future or not. Do you know what your family history is like? Are any males in your family bald? This won't tell you for certain whether you will or won't go bald, but I think in honesty what the trichologist meant is that you are not currently exhibiting any signs of MPB. No doctor could confidently tell you won't develop MPB in the future - be that in 2 years time, 10 years time, 20 years time etc.

To that extent lowering your hairline may be tricky. I would go and see a reputable hair restoration doctor as they can do a proper analysis and make a more informed decision with you, but lowering a hairline is a very risky procedure. If you started to go bald at some point in your future after lowering your hairline, you'd be in big trouble to be frank, because you'd have to have further procedures to deal with that balding and you'd also be looking at a larger number of grafts because of the lowered hairline. As I'm sure you know, we only have a limited amount of donor hair and it's usually not enough to get full density or anything close to it back in the balding area (unless your balding is very minimal). To that extent HTs are rarely used to sculpt or lower someone's hairline unless there is a high degree of certainty they won't bald or the balding will be very minimal. That certainty usually comes from family history and from your age. If you're 35 and have no hairloss, it's a good bet you won't suddenly develop major hairloss (though still just a bet), but at 22 the honest truth is nobody can know.

There is another factor here that you already know about, and that is that really this is to do with your perception of your hair and not your hair itself. I would be concerned that in addition to the risk of lowering your hairline from a long-term perspective, there is also the psychological perspective to consider. I'm not sure that lowering your hairline, even if it could be done, would easily eliminate your problems with your perception of yourself. You look perfectly fine to me and I can guarantee that 99.9% of other people that have seen you with the wind in your hair or when it's slicked back would never in a million years think "man, that guy has a high hairline".

I know this is about improving your own perception of yourself and, to that extent, I do understand that what I've just said doesn't really matter. I also read you've tried counselling and feel that hasn't improved the situation. But a hairline lowering procedure is risky at the best of times and if it was to be miscalculated and you started to bald naturally through MPB, the consequences could be disastrous unfortunately. Just something to consider; make sure you see a good and honest doctor. You'd probably find some hack out there who'd do whatever you want for a fee - PLEASE don't let them persuade you to go ahead by appealing to your emotions.

In short, I honestly think that most reputable doctors would be very reluctant to perform a hairline lowering procedure. I know that's not what you want to hear, but I do think that's the answer you'll get and for good reason. I would urge you to see a good doctor though (any of the recommended doctors on these forums would help you and give invaluable advice). Only they will know whether this is feasible and they will only know after a thorough examination - but my opinion is that nobody will perform a surgery like this at the age of 22.

I have no knowledge about any sort of forehead reduction/excision procedures so couldn't comment on them. There is a Doctor on these forums called Dr. Lindsey that is both a great hair restoration doctor but also deals more generally with cosmetic surgery and I've seen many interesting special cases from him that deal with hair restoration in specific or unusual circumstances. I am not saying he could definitely help but he might be worth looking up on the internet in more detail!

Anyway, best of luck with finding a solution to this! I know these sorts of words mean little to you given your perception of things, but you really don't have an unnaturally high forehead.

Yep, definitely don't do that! Unfortunately, there are no magic cures yet; there are some very good options, but using somebody else's follicles isn't one of them!

As TakingThePlunge says, in theory it's possible but it'd be like any other organ donation (it would literally just be organ donation). You'd have to take anti-rejection drugs and there is always a chance you could have major, life threatening problems if these didn't work. People who have life saving operations such as liver transplants or heart transplants use anti-rejection drugs because the risk of doing so outweighs the guarantee of serious health problems or death otherwise. Hair is a cosmetic and non-health related thing though, meaning that it would be both reckless and unjustifiable to take the risk.

I can't believe people can post such nonsense and sell it as a real procedure. That's actually a death warrant if it goes wrong enough! Even if it was possible the price they're quoting is crazy. If you wanted 15,000 grafts (which would be a very good head of hair and more than you could hope to achieve via genuine methods) it'd cost $105,000! And you'd still probably be about 10,000 grafts away from absolute normal density!

Anyway, in short, stay away! And from anybody else claiming miraculous, full restoration cures. We've all been tempted, but absolutely nothing like this exists. If it did, it wouldn't be a secret!

People go bald in vastly different ways. Some thin diffusely in the entire balding area, some recede very gradually, so that the hair in the crown may stay thick right into their 30s and 40s.

As for why this happens, it's still not totally understood. In regards to DHT though (based on what I thought I knew, so I could be wrong) it is that hair follicles are genetically determined to be sensitive to DHT and to respond by becoming inflamed and slowly choking the hair. DHT in and of itself couldn't be the lone cause, because all men create DHT yet not all men go bald. If it was due to "elevated" levels of DHT, then it would be a much more measured case of simply bringing those levels down to "normal" parameters, which is unfortunately not how it works.

It's a complicated chain of events that scientists still don't fully understand. The follicles become inflamed and damaged and this causes the hair they produce to gradually weaken, thin and the cycles to become shorter. DHT is involved in this, with follicles genetically susceptible to the effects of DHT being effected, but DHT is just one part of what is probably a complex chain of events. There is brand new research that an enzyme called Prostaglandin D2 is also involved in this chain of events, but exactly how and why is not understood yet.

In regards to how HTs figure into this, you're right that it's not wise to pack your donor hair into the visible balding areas because there is a chance you will continue to bald further in your lifetime and you don't want to get to the point where you don't have enough donor to deal with it. This is one of the central dilemmas to hair transplantation and the planning you do with your doctor. Drugs can slow down or perhaps even halt the balding for a period of time (years, perhaps decades), meaning that doctors can transplant into the frontal third with more confidence the remaining hairs will stay and not thin drastically in a short space of time.

A good doctor shouldn't let you pack large amounts of hair unless they are very confident your balding won't get out of hand. It's also based on things like available donor, bulk analysis and miniaturization testing. But if there is even a remote chance you will be higher on the NW scale, a doctor should only really transplant as if that was going to happen, meaning they won't put 4,000 grafts upfront just because you're not balding in the back at the moment. They'll estimate the donor reserves you have and base it on that; so (for argument's sake) if you have 6,500 grafts comfortably available they might suggest 2,500 in the frontal third, but if you're fortunate enough to have say 9,000 grafts, they might be happier putting 3,500 up there. My point is; whether your hairloss has stabilised or not and whether you're on drugs or not, doctors should still analyse the possible worst case scenario and plan with that in mind. If you have a small family history of minor balding, you're 40 and you have great donor, then maybe the doctor will consider being a bit more aggressive with your procedure. But if you have a larger or more severe history of balding and you have other factors against you, chances are a doctor will be conservative and start with coverage and acceptable density with the view to maybe taking a second pass to add more density if the hairloss continues to be stable.

There is unfortunately no exact science with hairloss, even with all the research and drugs available! That's why you have to be realistic, be vigilant, and find a good doctor!

Seeing a professional like Rahal is the best thing you can do and they will offer better advice than any of us can.

Generally speaking early twenties is too young to consider a HT, especially if you're not on propecia. Dr. Rahal will almost certainly recommend you get on that drug; if you're unwilling that's your choice of course, but it would be very unlikely a doctor would consider a HT at such a young age unless there was evidence your hairloss had stabilised, which it is very unlikely would not happen soon without medication.

If you're unwilling to use propecia or find side effects to be a problem the other alternative is to maybe wait for a few more years and see where your hairloss ends up. If it appears to stabilise at some point in the future due to natural genetics then maybe a HT could be considered, but that would be very dependent upon things like how bald you were, available donor etc.

As you probably know those who bald young and aggressively tend to end up with a larger balding pattern (though this is not always true). To that extent your options may be relatively limited but again, a doctor like Rahal will be best placed to answer this.

Ultimately though I would say a HT would be difficult for you at the moment, especially without meds. Finasteride is generally safe though as someone who suffered side effects myself (temporary) I do understand your concerns. I would still suggest giving it a go though, as will any hair doctors you visit I reckon. It's your best chance at your age to stall your hairloss and, maybe then, a doctor could consider if a HT might be suitable.

Dr. Rahal is a great doctor; his advice will be very useful indeed.

The problem is there is no way to know if you will be one of the ones to have an adverse reaction to it. I sure would not want to take that chance becuase once the damage is done in most cases it is lifetime. There have been enough bad side effects from this drug to warrent ads on TV asking people to contact their law firm it they were a vicitm of Propecia. If they didn't think they had a case against the product and enough people to file lawsuits they would not be spending large sums of money trying to locate the victims. In case you don't know this, anything topical penetrates the skin and goes in the body, so this could have the same side effects of a pill. In fact many times topical solutions are better than a pill because it doesn't have to pass through the stomach and risk being destroyed or reduced by the stomach acid. How may times have we seen drugs recalled because after they are "tested"and FDA approved they have terrible side effects that caused death? There has not been enough research to prove this is safe which is why I said I'll believe it when I see it. I hope it turns out to be the magic bullet.

I understand as I was one of the men to have side effects from finasteride on the two occasions I trialled it. They were moderate but persistent sexual side effects that disappeared on both occasions within about a week of stopping the drug.

I don't think your belief that once the damage is done in "most cases it is lifetime". Millions of men take finasteride and a few thousand report side effects, of which the overwhelming majority see a cessation of those effects after stopping the medication. Yes, there are some men who claim permanent side effects, but the evidence this is true is not forthcoming. If it was some kind of epidemic you'd be seeing literally tens or hundreds of thousands of men taking the pill and having major problems. This does not happen. And the men who claim it has ruined their life, whilst nobody can as yet prove one way or another, often don't make compelling cases for their claims.

The reason there are TV ads and lawsuits is because there is money to be made in them. This is not uncommon right across the medical world, unfortunately. It does nothing to prove finasteride is dangerous or its side effects are more common. I'm not suggesting these claims are lies because the jury is literally still out, but here's the thing. If finasteride was as dangerous as some claim, it would not be some covered up secret. There would be a great number of very vocal users whose lives were destroyed. Whilst there is a number of people claiming that, in the scheme of things it is not a great number.

I wouldn't say that "many" people had ill effects from Propecia. Millions take it, only thousands get ill effects, most of them on the milder end of the scale.

Even though this is far from ready and not even proven I would also counter that the science from this doesn't seem as "invasive" as the mechanism by which finasteride works. This is apparently being looked at as a topical solution like minoxidil, targeting a very specific protein. Finasteride targets a very common receptor that converts testosterone into DHT, and anything to do with the hormone system is always likely to produce potentially far reaching effects on the body.

I don't think it's quite worth getting excited about, but as someone pointed out the science is improving and so are the results. If this is a more simplistic but more effective upgrade to finasteride with less room for side effects, I'd see that as a massive step up, even if it wasn't "the" cure.

Hi guys

 

Well, when I was about 18 people would joke, like 'You're going bald', and other ill-judged remarks. You see, when I was still 18, I had wild hair, and it was my pride. I had no reason to believe I would ever lose my hair, there is no history of hair loss in my family. Alas, it's happening. Now 21, my hairline has made the dreaded 'M', and the crown is balding. I have reached the point at which I am no longer willing to sacrifice my life, so of course, I am looking for the right surgeon, the right technique, and what my expectations should be. 3 years, and my self-esteem is destroyed. I can only look in the mirror in darkened rooms, so I can delude myself into thinking I still have a full head of hair, and it is unthinkable I'll allow a picture of myself to be taken.

 

My life really is devastated. I was brimming with confidence, perhaps even arrogant, and now I am so insecure that should someone even mention my hair, whatever comment they made will reverberate in my mind for the full day. I understand that many feel people my age shouldn't even be considering a hair transplant, that they should wait until they are older and their condition has progressed into a more predictable paradigm, and so is thus more manageable for the surgeon, but I've lost three years of my life, and I refuse to live in incubation until my youth is gone. It's not that I want to make the choice to have a procedure which could very well fail, and require me in ten years to spend yet another ?5-6000 I don't have repeating the procedure- it's that I have no choice. It's that the choice is between a life of constant misery, unable to interact socially with anyone because I'm crippled by paralysing self-consciousness or a procedure that might just give me my youth back.

 

I'm a law student, and I can't afford to doubt myself. I need to be confident in my appearance and my ability to project an image I want to. I don't want to be the guy that always says 'You know, I really can't go out this weekend, guys, sorry, it's just, uh, I have work I need to do', I need this procedure, and it's a crying shame that it isn't available on the NHS. An instant cure for my depression.

 

That's just a little background I feel I should provide before posing my questions. I feel it's important one understands quite how disaffected I've become as a result of this condition, although I doubt very little that this is at all different to how many of you, too, feel.

 

1) I'd like to ask, with consideration to how life-chaning this has been for me, whether you believe it is wise, or advisable, to pursue an operation at this point?

 

2) Due to financial constraints, being a student, it'll be a long time before I have enough money to pay for the procedure, so I ask, do you believe the strip method (as it is the cheaper option) is good enough?

 

3) Can I expect, if I press the surgeon in this direction, for him to restore my hairline into a low position? I ask this because I know it is generally advised that the hairline be maintained higher, in case of future hair loss. But as I'm sure you all know, the younger the patient, the more demanding they tend to be, as their teen hair is very fresh in their mind. I am no exception to this rule.

 

4) Do you recommend any surgeon or clinic for which I should be saving?

 

5) Finally, with such varying before and after pictures, can you all give me an idea of what to expect? Should I expect to have a near fully-restored head of hair, near that of someone my age without this condition, or will I always be noticeably thin on top?

 

Thanks guys, in advance.

Sorry to hear about your hairloss; you're not alone here though!

There are some things you need to know and think about before making any real decisions. The first of them is the frank reality that, at 21, you're very likely too young for a reputable surgeon to be willing to give you a transplant. You could in theory have many more years of balding ahead of you unfortunately and that makes transplanting hair risky.

Far and away your best bet at the moment is medication; finasteride and minoxidil are the two proven medications. Go to the doctor, discuss your problems and concerns, and they will almost definitely prescribe you these (they are not free, unfortunately, but don't have to be terribly expensive either). In young people these medications can halt, slow down and even reverse some hairloss for years, perhaps even decades.

I'm sure you already know this so I'm sorry if I am telling you stuff you understand, but the problem with transplants is supply and demand. You will only have a certain amount of donor hair to use for transplants but the amount of balding could be minor or could be quite severe. Hair transplants are unfortunately not about replacing all the hair you've lost; even in the best cases of good donor/mild balding doctors will only look to put about 60/70% of your hair back (this would give you a full looking head of hair, however). Most men, though, don't have the luxury of minimal balding/great donor and so have to settle for impressive but lesser results; perhaps only 30-50% of their hair back, or just a frontal hairline restoration and no/minimal crown work.

Because there is only limited donor hair you can see why low, juvenile hairlines are a problem. The lower the hairline, the more bald area to cover, and the fewer grafts/cm2 you can hope for. A good doctor will design a hairline that will look natural but also produce a good density, in other words compromising between what you want and what you have to do it with.

A hair transplant won't give you all your hair back and possibly not even half of it, but that doesn't necessarily mean it has to look thin and obvious. With medication you can keep much of your hair and perhaps get a transplant a few years down the line that can beef up your hairline and that should let you have a good head of hair for a while. If you need another transplant further down the line that's usually possible to add additional density or touch up thinning areas but, as always, you will never have enough hair to replace all the hair you lose - so you can't have unlimited transplants even if it was financially possible.

So, to summarise, you're probably too young to have a transplant and medication is your best choice for halting/slowing hairloss and perhaps regaining some hair back.Finasteride can in some cases cause sexual dysfunction (it did for me unfortunately) but the stories about it being "irreversible" are much more contentious. There is no scientific evidence that this is true and even though that doesn't necessarily mean its not true, the fact is millions of men take finasteride and only a tiny handful claim long-term negative effects; none of which have been scientifically verified to my knowledge. I tried finasteride twice, had sexual problems both time, stopped taking it and within a week or two felt OK again and I think most men who had problems with finasteride would echo my experience.

A HT won't give you all your hair back no matter how many you have or how much you spend, unfortunately. Some men have such severe balding a HT is not advisable for them, but most men are candidates for a HT these days as long as they understand what a HT can achieve for them. In other words, you have to be realistic and understand the limitations before a good doctor will perform surgery. That means, in the vast majority of cases, no juvenile/low hairlines, a realistic expectation of density and design and a plan that is achievable without being risky. The last thing you want is to get talked into doing some super-dense hair transplant and carry on balding and have no further donor left to deal with it!

But the results can be very good, even in some extreme cases of balding. Check the journals on here; a lot of guys have gone from bald to having really good heads of hair again. By really good I don't mean "completely dense" unfortunately, but in 90% of the circumstances the average Joe would never know.

If you can accept what a HT can do for you and you can get on the medication then you stand a good chance of being suitable candidate in the future. The best thing to do is see a hair restoration surgeon now to plan; they can help analyse your balding pattern, your donor, your concerns, your goals, and devise a realistic plan with you for now and the future. Any of the doctors recommended on this site are world class and represent about the best choices you can make.

One final thing; don't go to anybody who promises you full restoration, or super low hairlines, or secret techniques to make your hairloss disappear. They're cowboys and they will prey on your desire to have a full head of hair again. We've all been tempted by those guys but some have made the mistake of going with these butchers and they end up with clumps of hair and further balding and scars everywhere. I'm not saying this to frighten you but just to warn you; you want a full head of hair and anybody promising you that will sound very sweet indeed. But the frank truth is that it's not possible to do that, so go with the guys that tell you the facts and that come highly recommended.

Best of luck with your hair restoration journey! Browsing this site will be a source of inspiration! There are many amazing stories and amazing transformations and as long as you do the research and plan responsibly, there might be no reason why you couldn't be one of the success stories as well!

I don't think it makes a whole lot of difference in terms of suitability for a HT or the amount of hair lost.

Basically the major factor with a Norwood A variant balding pattern is that the hairline recedes backwards until the final pattern is established. Normal Norwood patterns will usually see crown loss at the same time as temple/hairline loss, leaving a sort of "island" of miniaturizing hair in the mid-scalp that you'll see commonly on a lot of men. Norwood A variant just means the hairline recedes and continues to recede until the final pattern emerges.

There are variants of the A pattern too, remember. NW3a generally just means recession of the hairline with most of the midscalp and crown remaining, NW4a will usually see the mid-scalp disappear but a lot of the vertex/crown stay, and NW5a will see most of the crown disappear, leaving a final pattern that is actually more like a milder NW6 in appearance, though there will probably be more miniaturized hairs still visible in the balding area than with an NW6.

So, in answer, you should be about the same level of candidate as a standard NW case and it doesn't necessarily mean you will end up with more or less hair than a standard NW case.

The only thing I don't know for sure is whether being a NWa case removes the risk of you becoming an NW6/7 as a final pattern. If that was the case, perhaps the only "advantage" of being a NWa case is that your suitability as a candidate for HT might be more likely, but I'm speculating here. Similarly, speculating on the negatives again, I don't know whether the successive, heavily patterned characteristic of a NWa case means you're more likely to need multiple HTs, because you'll need to fill in loss as time progresses. Medication would limit this risk, but chances are over your lifetime you'd still need mutliple procedures if you were heading towards a NW5a, because the medication is unlikely to halt your loss indefinitely.

Anyway sorry, I'm just speculating openly here!

Thanks for the photos Aaron! It's really great to see stuff like this because it helps people see the whole picture when it comes to getting a hair transplant!

To be honest I still think your hair looks pretty good even under the harsh lights! As you say, it's clear that the density is not as full under those lights, but in contrast you also have your hair styled well and spiked up at the hairline; two factors which in theory betray the density more easily. That's not a criticism because it's great to see people with HTs using their hair and making it part of their look, but what I meant by that is that these could be construed as factors that will make the lack of density more apparent; and yet your hair still looks great!

It would be very interesting to put non-balding men under the same lights, with the same hair style, just to compare. I'm sure some of them would show no thinning or diffuse loss whatsoever but I reckon you'd also find some whose hair began to look a bit see through who didn't expect it. That's the thing; when I was 20 I didn't ever think about how my hair looked wet, or in harsh lights or anything. If I'd shown a bit of scalp I would never have known it because I didn't check and it was never pointed out.

Great HT though, even in the worst of conditions! Do you know if you have any donor left and, if so, would you consider further procedures, or do you feel done with your hair now? I ask because I'm always intrigued to see what people's future goals are and if they have donor left to go for them!

Wow, El Nino is one lucky guy!

I think these days studious planning and monitoring makes it easier and more effective to plan your hair restoration goals, although it's still a case of supply and demand. But we can more accurately gauge miniaturization, balding area, donor supply and keep track of that prior to making decisions about our hair goals. In addition to that yield and the ability to maximise the donor supply is slowly improving, meaning that some doctors are getting pretty incredible amounts of hair out of the donor area. This is all still obviously limited by your physiology and even the best cases will never be able to replace close to every hair they lose, but it does seem that these days some NW5/6 patients with the right characteristics are able to look at restoring a good amount of hair on their heads, especially in the areas that matter like the hairline.

If a good doctor can give you a strong sense of the hair you're losing and the sorts of donor you might be able to harvest, you can make more informed guesses about how much hair you have and what you need to do with it. Things like finance will be obvious limitations, as it's not like most of us can just max out our donor at will (nor would it be wise to really do that), but I think you can really plan more diligently to get good results now, or at least know pretty well what you can hope to achieve and be realistic about whether that matches your goals.

aaron - Out of curiosity do you know the details of your case, like the balding area size, density you were planted at etc.? Your hair looks great by the way!

I think we have to remember that the "illusion" and "real density" are not explicit terms to describe two different things. There would come a point where the "illusion" turned into real density and the grey area in between would easily fool anybody.

And another factor to consider; most of us were probably living with the "illusion of density" long before we even knew we were bald.

A lot of men have to lose up to 40-60% of their hair density before it really becomes clear even to them that they're balding. If you think that these days modern transplants can put you back up to those sorts of figures if you're a suitable candidate, then many people might be returning to the sort of hair (at least in the frontal third) that they had before they even knew for definite they were losing it.

Also, that doesn't just go for NW3/4 cases. A lot of men with even NW5-6 are able, with modern techniques and the best surgeons, to get 6-8,000 grafts or more over a few procedures. For many of those men that could probably average around 35-50 g/cm2, which would be somewhere between a third and a half of their original density. If you artfully place those grafts so you pack them denser where it matters and slightly less dense where you can get away with it, you can really produce some impressive results. Add in to that the fact you can probably boost those numbers again with an FUE procedure and, provided you've been as thorough as possible in limiting the danger of future loss (meds and/or a thorough examination of miniaturization and studious planning) and it's possible, time and money willing of course, to restore a lot of your hair back. It all comes down to the fact that, again, even if you "only" have 50% of your hair back, chances are 90% of the time you'll just appear to be a man with hair.

Something else to consider with the "illusion of density" is that we shouldn't imagine every man who doesn't appear to be balding to have some uniform and consistent amount of hair per cm2.

The truth is balding men usually become insatiable about the idea of a full head of hair, to the point that it obsesses us. When I started thinning I started looking at hair a lot more and, what I started to notice is, a lot of men with full heads of hair actually do have some thinning and even some of those with great heads of hair sometimes betray a bit of thinning under harsh lights or certain lighting conditions. That's especially true of people with thin hair, very blonde hair, dark hair and pale scalps etc.

Ultimately we talk about the "Illusion" as if we're worried it's some cheap con we're trying to foist on others, but I would maintain a lot of men; even those with seemingly strong heads of hair, do have some sort of general thinning in the balding area. The vast majority of people will never notice the "illusion" because, even if they do see a bit of scalp or something, it doesn't really matter to them. We've become trained to look out for harsh lights, to study men's hair, to notice balding etc. I'm often surprised how many men are, to many of their friends and families, not bald, when in reality the trained eye can see that the reality is that there is some recession or diffuse thinning or something.

It does of course depend on your level of loss and size of procedure(s). But some men are getting 8-10k grafts or more over multiple procedures and, even at higher balding levels, are getting something akin to a good head of hair again. No doubt if you were to scrutinise you'd see the difference between a true non-balding man and someone with a transplant, especially in the crown, but you keep having to remind yourself; who is really looking that hard all the time? My best is the vast majority of people studying hair that hard are losing hair themselves!

In response to the OP, yes there have been a few critical cases on these forums, but they about the most consistent and admired surgeons that I know about. Crucial to this as well; their "showreel", so to speak, is massive. There are literally hundreds of presented cases between here and their website and some of them are incredible.

Of the more negative cases I've read on here, none have stood out as "suspicious" in the sense that the doctor's were genuinely at fault and trying to hide or cover it. The problem H+W often face is that many of their results are so good not even acceptable is acceptable. Some people are going there expecting miracles and not everybody gets them, which is to be expected.

Yes, if you dig around, you will find some less than happy customers from H+W, but they are few and far between amongst a sea of pretty stellar results. In addition, I don't think I have ever read any negative comments about their professionalism or treatment of patients. Some people have been unhappy with the results but I can think of only one negative case I've read where someone felt they had been badly misled.

If you are considering a HT H+W is literally about the most highly recommended and consistently exceptional surgery. If their ratio of happy/unhappy customers puts you off then I don't think anybody on this planet could offer you better odds of a successful procedure. I'm sure your procedure will go great and you'll love the results, but as always be upfront and clear about your goals, listen to their recommendations and advice on limitations and make decisions based on fact and not hope. It's easy to get a bit too comfortable with a surgery and stop being communicative about concerns or ambitions. H+W will understand you being thorough and exact about what you want and they'll treat you exactly the same way. It's the best chance you have of everybody being happy with the final outcome.

I was one of the people that initially defended his This Morning appearance (on the basis that we didn't know everything about the results or have any comparable pictures, even if it was pretty obvious he wasn't being entirely straight). Having seen this now, though, it is pretty bad.

Incidentally there are photos of him on Ziering's website here:

(Link removed by moderator - See Terms of Service)

It's probably the most honest representation of his HT that I've seen, even if the pictures are pretty small.

The irony is, for 3,500 grafts, the work actually looks not too bad. The area covered was large so anybody half familiar with a HT will know the density looks about what you'd expect and the work actually looks pretty clean. I'd be pretty confident he'd have another 3,500 in his donor to get a 2nd procedure and that would probably make his results solid. Quite why he had to try and sell the procedure the way he did I don't know; he actually had a golden opportunity to educate the public and be upfront about the fact he needed and was going to get a 2nd procedure.

Ziering and Gardiner have done themselves and the industry as a whole a disservice and the annoying thing is they've done it for no good reason really. Gardiner was pretty noble in his courage to be so open about his procedure, but he ruined all that by lying about the end results when he really didn't need to. Ziering also shot himself in the foot; he's just going to have a legion of prospective patients now disappointed when they see what 3,500 grafts will really achieve.

Everybody who does serious research knows that, if you're an NW5+, you're looking at at least 5,000 grafts to seriously attempt to cover the whole balding area. But thanks to those two there will be lots of people thinking it's a no-brainer how to get a full head of hair again.

Oh well, they're both going to ultimately regret being so underhanded I reckon. And Gardiner definitely needs at least one more procedure. He must be caking nanogen on by the bottle at the moment!

Just a question on this. Is it well documented that you get the max out by combining FUT and FUE?

For example, most people would perfom two FUT to get the 6-10k grafts. From that point you imply that a natural third HT might be best done by FUE to get more grafts. At the same time we have for example Joe from H&W here who has had four HTs, all of which FUT.

Is that more an unusual solution you think?

Of course you can get grafts from a bigger area with FUE, but on the other hand FUT would have a bettter covering effect in the donor area as the remaining grafts are stretched over a bigger area.

As you already have a scar and a thinning donor area, why not just keep going with smaller FUTs at least until the last <500-1000 grafts?

I think it used to be the case that patients went in for several smaller sessions but, with advances in understanding and skill in so called megasessions, the tendency now is to try for fewer, larger procedures.

Chances are if you're going to max out your FUT and then do FUE you're pretty advanced on the balding scale (NW5+). Now, it used to be that getting 2-3,000 grafts was considered a large procedure, but these days relatively common to be getting 4-6,000 per procedure with the best doctors. That means, in principle, 2 procedures today can net you between 8-12,000 grafts, which is very likely to be the limit of your donor via FUT. That's why most people assume after two procedures your third would be FUE.

The jury is out on whether to max out FUT and then do FUE or use any alternative systems, but ultimately it seems to make more sense to go FUT as far as you can and use FUE for smaller, less ambitious procedures after the main bulk has been done, to do things like close temples, add a bit of density to certain places etc. FUT still has overall the best yield rates so, if you're looking to put 6,000+ grafts up there, you might as well commit and go FUT first and stand the best chance of getting good coverage and density, then use FUE (if you can and want to) to complete your transformation.

Most of the patients who have multiple procedures are usually either older patients who started their journey when the techniques and procedures were slightly less refined and ambitious, or men who are witnessing slow, steady thinning over the years and need repeated procedures to maintain their density and fill in areas of increased thinning. If you've lost significant amounts of hair though, and/or are not on medication and need a serious procedure to give you good coverage and as much density as possible, the larger, fewer procedures makes more sense.

Let's hope!

Also, to some extent the skill of the surgeon dictates how many grafts you can get, at least on a session by session basis. Guys going to the top, top doctors are consistently getting more grafts than guys who aren't. Obviously doctors can't reduce or expand on the number of grafts you physically have available, but they can make the most of your donor if they have the skills!

I hadn't seen this until now, but I'd be VERY cautious. There's no information on research or trials on the site (that I can find) and frankly the before/after gallery is very dubious. It seems that the only people desperate to spend lots of money on such revolutionary treatment have very, very minor hairloss!

The old adage "if it sounds too good to be true it probably is" springs to mind. I reckon these guys are basically doing something medically legal but, in terms of effectiveness, completely bogus. The website is one of those classic, sterile looking sorts of marketing company jobs.

I'd bet good money this was bogus. Effective stem-cell treatments like this aren't just going to appear out of nowhere and there'd be a huge amount of medical literature to back up the ideas and treatment plans if they were sound. If they had "case studies" of men with no hair being turned into men with full heads of hair I'd be curious, but those called case studies offer nothing really.

I'd say leave alone!

Yeah I think NEWHAIRPLEASE has it about right, it's more like 6-8k average from strip and perhaps another 1.5-2k average FUE.

As you say though, the numbers can range hugely. Without wanting to sound drab, the more important thing is a solid plan and top notch surgeons to perform the procedures. Some surgeons will be able to make grafts go further by way of their experience in planning and placing your transplanted hair, so it's not always just about getting as many grafts as possible.

Also, of course, depends on balding pattern. That doesn't affect the donor yield, per se, but it does have an impact on the plan. If you're heading towards NWV/VI then you might have to start thinking about getting as much donor as possible, but if you're balding more conservatively you won't need that 8-10k hopefully!

I'd say with both combined you should be able to get at least 6-7k and probably at most 10-12k. There will be rare exceptions both sides of that of course, but you always have to assume you're the rule and not the exception!

Fantastic result! It's a great style for him as well! It's nice to see patients who are both regaining their lost hair but also do something stylish and modern with it.

Brilliant stuff. Lots of real estate to cover but it looks nice and dense, even with the styling. Even more amazing if you consider the relatively modest number of grafts used.

I agree, this is a great result (especially considering he's not halfway through growing!) and it's nice to see some successful examples of patients not using propecia. At only 4,569 grafts this patient must have at least another 2,000 in reserve, and maybe considerably more, if he does see further loss, which I would imagine means he should at least be able to maintain his current look if he does see continued thinning.

Many people are either unsuitable, unable or unwilling to take propecia, so it's good to see that there is, in the right circumstances, still effective surgical options available for them. Even if this guy could have had improved results on propecia, it's quite clear that he's had very good results without it!

This is one of the major reasons doctors a reluctant to perform transplants on patients under 30.

Generally speaking (and it is only generally) NW7 hairloss is characterised by earlier and more aggressive loss. Therefore, by the time you're into your late 20s/early 30s, there will probably be good evidence you could be heading that way. Things like bulk/miniaturization analysis can help test that theory by looking at your hair right across your scalp for evidence of thinning in areas where it is not obvious visually. These are by no means 100% foolproof tests, but they can help make reasonable guesses.

Norwood 7 is relatively rare compared to the other NW classes and the older you are before you consider transplantation, combined with a thorough analysis of your hair prior to making any decisions, are factors that can help limit the risk as much as possible that you will do something you'll later regret! If by your late 20s there are no visual or analytical clues that you're heading towards NW7, there is a fair chance you've managed to steer clear of that problem!

Family history can also be a factor. If there are lots of NW7s in your family on both sides, there is a higher risk of you becoming one, and vice versa. Again, not foolproof as the balding gene can come from both sides of the family and skip generations, meaning you could be unfortunate to inherit the balding gene from great great great grandpa Joe whose photo or history you know nothing about! Generally speaking though, immediate family history of a few generations is a helpful clue as to where you might be heading.

Medication of course can also slow the progression of any hairloss, meaning NW7 patients will hopefully keep hold of existing hair much longer.

If you do get an HT and progress to NW7, then I suppose you can try and shave your head and go for the horseshoe look. That's really not ideal though! The best thing to do is wait as long as you can before having a HT, see a good doctor and get a thorough examination. Those are the factors that will best diagnose where you are or might be headed (though nothing is certain) and if a doctor thinks based on your examination and family history you have a reasonable chance of heading towards NW7, they will likely not recommend a HT at all.

Funny article! There is a lot of truth to it though, these things just take so long. And the word "cure" is so tricky - a cure is really only going to be the right word when we can take a pill or have treatment that is cheap, sustainable, and able to turn everybody, right up to an NW7, into someone with a thick head of hair again. That magic bullet isn't going to be with us in 5 years, probably not in 10 years either.

Hair transplants are still the best way to go, combined with medication and hopefully some other treatments that may rear their head in the next 5 years or so. But it will be combination therapy to restore a solid head of hair, not a single therapy to restore a complete head of hair. But I think if most guys can put 35-60% of the hair they've lost back on top of their head, that will look good and realise their goals. But that's the realistic aim for most men who suffer from maybe NW3-6 (in some cases not even 6). And that requires dedication, money and a realistic expectation of what can be achieved.

Hello All,

 

I would like to wish you all a very happy new year and propersous 2012 and with loads of hair

 

I have finally consulated with Dr. Umar in person and he was quite shocked to see me in person that I have so much hair left. I always thought I was norwood 6 even most top notch doctors who I had sent my pictures said the same but he belives i am norwood 3 to 4 after seeing me in real life. I giuess the pictures were not clear enough since I am using hairpiece so you cannot see a reall growth there. WE have agreed to do the surgery sometimes in June

 

1. I have been on proscar since October 11 and so far I have not seen any effect on my beard of body hair. I will however continue taking proscar and keep the remaining hair and hopefully grow some more since the hairpeice might have casue some to fall

 

2. He has told me that I will only need one surgery (opposed to original plan which was communicated through emails) and I have allowed him to go up to 10000 grafts using hair and beard starting from front line all the way to crown. He said there is a chance that we might do 8000 as he does not want to put hair on top of exisiting hair but I told him you are free to put as many numbers as you wish.

 

3. After this surgery, he reckon I will have zero recession so back to norwood zero. However since I am young I will have to see him probably in 4 or 5 years.

 

I would appareciate your expert opnions as I would like to make sure I am making the right decision.

 

Best regards,

Ryan

I think if you've seen the results Dr. Umar can achieve with BHT and you like them, and this is his opinion having seen you in person, then it sounds like the right step forward for you. 8-10,000 grafts should give you good coverage and density and if you're happy using BHT I think Umar is probably about the best and most consistent performer I have seen using this technique.

The only thing I would say personally is - are you sure you want to try and go for NW0/1? I know it sounds like every man's dream and it would be if density and donor wasn't an issue, but it just seems to me too aggressive whatever NW you are and whatever surgical technique is being employed. It's obviously a personal thing so if you really feel you want it and can get it, then that's your decision. I would just think about having a slightly more conservative hairline with good density and saving a bit of donor, rather than trying to go full blown NW1 and finding out in 10-20 years time you don't have enough donor if you need another procedure.

I don't know how young you are, but if you are young (20's/early 30's) being really aggressive will probably be to your detriment. I know BHT offers more donor if combined with traditional FUT, but if you're heading towards NW6 or NW7 (very good chance you might be heading that way too) all the donor on your body won't give you totally natural density right back to NW1.

Dr. Umar is a good doctor and his results are consistent, so if you and he have developed and agree on a treatment plan, I am sure he will have every faith he can achieve your goals and leave enough contingency to address potential future problems. I would just be cautious dreaming about NW1, zero hairloss paradise, because ultimately it still can't really be done even by the best doctors (just a simple case of mathematics). But only you and Dr. Umar know your case properly and his advice and opinions are the most important.

Whatever you do though, best of luck! This is an ambitious procedure and I really hope it gives you the results you want!

As Joe says, controversial. Nape hair is definitely not categorically "safe" as some men do lose their nape hair, but not all. But as Joe points out, if you take it out via FUT and then it does disappear, you've got a transplanted hairline that erodes away AND a balding nape revealing a clear strip scar.

I have seen doctors use nape hair and sometimes it can look good. To that extent, if you're not genetically disposed to losing it, it can be great. But nobody can tell for sure how your nape hair will turn out and so even in the hands of experienced doctors nape hair transplantation is a risk and an unnecessary one! Dr. Umar does good work but he's absolutely bound to have some disappointed patients coming back in years to come telling him that their hair transplant isn't permanent. I guess if that's a risk he and the patient are willing to take then I guess that's fair enough, but it does seem to me an unnecessarily large risk to take in your hair transplant planning.