mahhong

Yeah I agree. The fact this is the HTN means nothing. Men just want a good head of hair; being biased towards transplantation is ridiculous. Everybody is aware that in an ideal world it wouldn't be the standard measure against hairloss, but it's the only one that truly works consistently and permanently. If a drug or treatment comes out tomorrow that can do as good or better every man on here would be ecstatic about it. There's no bias. Hair Transplantation isn't a football team, it's the best options we have at the moment.

I'd be cautious over putting too much faith in any of the new treatments being tested. That's not because I don't believe in them, per se, but as Joe says, everything is hype until the results come out.

In addition, the idea that any drug is going to enter the market with the ability to straight up replenish your hair back to native density is a little bit far-fetched I think. There may be great treatments available in the next 5-10 years, certainly, but think about it. How long has hair transplantation been around? And how long has it truly been a refined procedure? There has been a long stretch of time when hair transplantation was a risky and very new endeavour with lots of unknowns and pitfalls. These days it's a much safer and more effective technique, but it's still progressing.

Drugs and other treatments are the same. Even if Replicel or Aderans came out with something in the next 5 years, it's very unlikely to be a magic bullet. It might help somewhat; might compliment existing drugs and surgical techniques, but it's unlikely to be in and of itself a cure for hairloss or anything like it. These treatments will still likely be refined over the following decades.

I could be wrong but I think Replicel's MD gave a talk the other day about their current study in which he described his idea of "brilliant" results as being able to rejuvenate something like 20-25% of the native hair, something on par or a little better than propecia (I cannot recall the exact numbers, but it was along these lines).

Granted this figure may improve as the trials continue, but it demonstrates something - the results currently being aimed for are modest at best. Still impressive, but nothing like the cure for hairloss we've been hoping for. And that's the way medicine works - small steps, continual refinement, implementation with existing treatments. In this day and age it's all but impossible for a new cure to come from nowhere if only because of the rigorous trialling everything must go through.

I do not mean to sound negative; I have great hope for the future and do see genuine progress being made - perhaps even in the next five years. But something that's going to replace hair transplantation? That's going to offer native density again? That kind of thing isn't going to spring up just like that.

I think the best we can hope for in the next 5-10 years is for a few new treatments like Replicel to start making their tentative steps into the marketplace. Perhaps then, if you have the time and inclination, you can maybe combine HTs, drugs and new therapies to get back more hair than you can currently. How much more hair I couldn't say, but it's still unlikely to be native density or anything like. But if you can get back 40-70% of your native hair instead of the usual 35-50%, or if you can offer a constructive hair restoration package for even extreme NW6 and 7 cases, then this would represent a great leap forward and something to look forward to.

So I think we have a right to be optimistic, but the idea we're about to hear of some breakthrough that revolutionises the industry is extremely unlikely. Hair transplants will still likely be around in 10, 20 and 30 years time and I reckon will form the cornerstone of a hair restoration plan for many years to come. If we can augment it with a few new, promising treatments, that's great.

Also, just as an aside, these drugs and therapies will come with their own prices, limitations and potential side effects. When people imagine the word "cure" it's usually synonymous with the fantasy of being safe, cheap and easy. But optimism should always be cautious about how viable any new treatments will be.

Evolution not revolution - and that's never truer than in medicine.

Brilliant work and a brilliant followup!

Also, slightly off topic, but has anybody else noticed that Ken bears a pretty strong resemblance to the actor Tim Roth? Even more so with his new hair!

It's sad when this sort of thing happens and I don't have a particular opinion on who is "right" or "wrong", but there is something that I would say in defence of Dr. Feller and hair restoration surgeons in general, even if I don't necessarily condone resorting to the legal system to get things done.

In the public domain a surgeon has much, much more to lose (and a lot more easily) than a patient. If I go get a procedure with a surgeon and it turns out below par, it is very easy for me to come on these boards (or any other public domain) and say that I'm unhappy and that the facts and options weren't made clear to me at the time.

We do see this sort of thing in many other walks of life; politicians/high profile businessmen who get embroiled in sexual assault cases is a common one. Often the evidence is scant and the claims murky but, the crucial point is, the damage is then done. These people lose their jobs and their livelihoods because the general public hear unsubstantiated rumours and comments and take them as fact.

Now, I am in no way accusing Jessie1 of lying or anything of the sort. Nor am I trying to defend Feller's methods. But I do see the frustration doctors like Feller must feel when their hard work can potentially be undermined by a few comments that snowball into a tidal wave of criticism and hearsay that can destroy their businesses. Are the comments regarding Dr. Feller true or false? I don't know. But I can see the difficulty doctors must face when dealing with unhappy patients keen on undermining that doctor's reputation.

I do agree Dr. Feller can be very "emotional" about his line of work; but this cuts both ways. I've heard stories of him helping people who are in dire straits, often giving them free or discounted procedures if circumstances truly warrant it. He's also been a very good contributor to these forums in terms of information and answers. Yes, I would ultimately agree sometimes his emotional approach can seemingly undermine his professionalism a tad, but it can also make him one of the most approachable and caring doctors on these forums.

I don't particularly support suing patients, but, if Feller believes he's in the right (which I assume he very much does), what options would people suggest he is entitled to? At what point is he overstepping the mark in his quest to defend and uphold his reputation?

I don't want to see anybody who is unhappy - doctor or patient. But there are shades of grey in this industry and if both Feller and Jessie1 truly believe they're the victim, and neither feels obligated to compromise their position, then the legal system is the unfortunate last step in a logical chain of progression.

Is it possible to lower high forehead by hair transplant method for a male? What's the success rate and is it okay to do it at the age of 24?

Hi beepz,

By "lower a high forehead" I assume you mean use donor hair to lower the hairline? Although in theory this is possible I think most doctors would be unwilling to perform such a procedure, especially aged 24. Hair transplants are really something that shouldn't be considered until at least your late twenties unless there are special circumstances.

The problem is nobody can say for certain if you'll bald or not in the future, so lowering a hairline is incredibly risky unless there is very, very good reason to believe MPB won't be a factor. Your family history may give you some idea about if you'll bald or not, but genes can skip generations and do all kinds of crazy things, meaning nobody can know for sure if they will go bald or not.

So unfortunately I don't think this is something that would be possible for you, though if it bothers you or you wish to get a professional opinion I'd recommend going to see a hair doctor or speaking to some of the doctors and assistants who are on these forums - they will know much more about what is possible and not possible.

Hair transplants are a big commitment, even when money isn't an issue. Think of the downtime from work, the constant exposure to the public, the potential need to take medication permanently and wear hairpieces for filming during the growth period.

In addition to that, as some people say, lots of people (even famous ones) just aren't very educated about the way these things work. Add to that the fact that not everybody is going to be a perfect candidate.

Finally, let's not forget that HTs are not 1:1 hair replacement opportunities. They can look really great, of course, but film stars need to look perfect. It's far easier (given the lack of concern for money) for them to get top of the range hair systems for their public and filming lives. They'll withstand all manner of harsh lighting, filming, water etc and can give the cosmetic appearance of total hair.

I'd opt for a HT any day, but then I'm not likely to be scrutinised a billionth as much as Travolta or Law.

And, of course, the final aspect to consider; confidence. These guys have money, fame, and probably feel very good about themselves generally. Nobody likes losing their hair but many people find the confidence to move forward in spite of it - it could just be these guys don't feel the need for them.

What mattj says is very true regarding complications of an HT.

As far as biotin is concerned, a lot of people have commented that it makes their hair feel stronger and healthier and seems to make it grow faster and somehow "better", so it might be worth a try given the ease you can pick it up. I do not imagine it will actually do a huge amount to cosmetically change your hair so I wouldn't expect drastic results from it, but if you want to give it a go I wouldn't see why not. I'm not sure what sort of doses are recommended but you can find more information by searching on these forums. Again, it's something of a long shot, but couldn't hurt!

Aside from that there's really not much you can do unfortunately. If you wanted you could always post some pictures of your hair up on here; there's no obligation of course but it might just help to see what you are talking about and see what you feel the problem is. Quite often people worry about things and, when they post them up on here, it's actually nowhere near as bad as it seems to them! There's definitely no point considering minoxidil or finasteride unless you were actually diagnosed with MPB and I think you're definitely right not to consider a transplant.

Hi Louis,

In short -probably not unfortunately. At very least not at so young an age. The problem is that nobody can foresee if you will bald or not in the future, and so a good doctor will be very unlikely to agree to transplant hair to a non-balding area at 20, as by the time you are 25 or 30 you may be experiencing MPB and the procedure may have been a major mistake.

Generally speaking HTs for non-balding people are relatively rare anyway. Usually they are for special circumstances; burns victims that want to fill in bald patches, congenital deformities that can be cosmetically improved using HTs etc. Maybe when you get to your 30s a doctor would in principle more seriously consider your request (if there was still zero evidence of balding), but I think in honesty you'd still have a hard time finding a good doctor to do a procedure for this reason.

If you are worried about how fine your hair is (I assume you are concerned your scalp is showing) have you ever tried or considered concealers such as toppik/nanogen/dermmatch etc.? They can be applied to your existing hair and consist of tiny fibres that can cosmetically "bulk up" your hair a bit. They're relatively cheap and very safe/usable so these might be, overall, a better option for you?

Best of luck for the future!

I agree with what you suggest, that your hair loss will be closer to your father's. But I'm not a geneticist, and I don't think anyone else here is. I mean, one important part of genetics is variation...so who knows? If the hair loss is bothering you, though, it can't hurt to set up a consultation somewhere and see what they recommend.

I'll be getting a transplant (hopefully) one day in the not too distant future! I've been planning on that for a while, but I'm still away from making serious arrangements yet. I hope to discuss my hairloss with a doctor soon though!

I imagined the question was probably too complex to be answered on the forum (if it can be answered at all), I was just curious whether you could inherit genes from someone but express them differently at different times.

Stress-induced hairloss would likely grow back, but stress-accelerated MPB probably wouldn't. I had a stressful year last year and I'm fairly confident it accelerated my hairloss, but as it was MPB hairloss, I didn't see any growth back!

It's worth discussing with a doctor about going on propecia but it's primarily useful in vertex and crown loss and doesn't offer a lot of hope for men looking to maintain or strengthen their hairline (there are examples out there, but they are generally the exception and not the rule). If you're not seeing loss in the crown region though it's still debatable whether this is MPB or not and I guess you have to wait a bit to really see how it develops. Propecia is a safe drug but if you're not definitely experiencing MPB then it's best not to take it.

To me your photos don't necessarily indicate MPB but it's not easy to tell from photos alone. If you're worried and your doctor is happy to put you on propecia then I'd say go for it - but the downside is that might not necessarily slow or regrow any loss in the hairline.

My father's loss started probably a bit younger than me. Either that OR he had thinner hair than I do and it was more noticeable. I would say it was similar in the pattern of loss to mine, except his crown and hairline loss was a bit more pronounced but my hairloss is probably a little bit more diffusely spread across my vertex and mid-scalp than his was (though essentially my hunch is I'm going bald in very similar fashion to how he did).

My paternal grandfather I'm not entirely sure, though it was around mid-to-late twenties as well. An important point about his hairloss though is that I believe he is (or at least was) on oral minoxidil for a heart problem. Not sure if this made a major difference to the state of his hair, but he has more hair generally than my father (certainly more at the hairline and a bit less crown loss).

Regarding the drugs I've given propecia two trials (one 3 1/2 months, one around 6 weeks) and unfortunately experienced side effects on it both time. I'd say they were moderate side effects (watery semen, testicular pain, some ED and libido issues) but they didn't seem to diminish and they were persistent whilst taking the drug (cleared up both times relatively quickly after stopping the drug). I couldn't truly be sure whether these were psychosomatic or not, but they didn't feel like it and ultimately I just think I didn't tolerate the drug all that well. Minoxidil I have never tried but am going to look into.

Regarding what thehairupthere said about skipping generations, unfortunately I don't know much about my great grandparents. I know my maternal grandfather's father had hairloss very similar to my grandfather, but my paternal grandfather's father I never knew (think they had a bust-up years before I was born and as a result never met him or even saw him!). All my father knew was that he did have hairloss, but similar to my grandfather and father (impossible to say exactly but somewhere around NWIV/V or that sort of degree).

I'd love to have a miniaturization test done but I live in the UK and not sure if anybody over here even does it (I'll have to check up on Farjo, as he seems the most likely candidate in this country).

I agree genetics is a tricky one! I didn't imagine there'd be much in the way of conclusive understanding, but I did wonder whether the relative slowness and lateness of my balding pattern compared to my maternal grandfather meant there was at least a higher chance I'd take more after my father and his side of the family. I guess ultimately nobody can truly call it one way or another, but I can live in a bit of hope because that side of the family, whilst they still have hairloss, at least do look to have the sort of hair and quantity of hair that would make considering the HT route sometime in the future!

Hey Everyone,

I have a question that I wanted to ask more knowledgeable people on these forums about. I'm 28 and my hair is now pretty noticeably thinning (it has been slowly going since around 25/26 but it only really became noticeable the last 12 months, though there is still a fair bit left). It's thinning pretty much all over the top, most noticeably at the sides of the hairline and the crown, but in other places too. I still look and feel like I have very strong back and side hair and I would estimate my hair to be about a NWIII vertex overall at the moment - though obviously I know it's too early to make any definite assumptions. There is still a fair bit of hair on top of my head but it's now clearly thinner at the crown and hairline and a bit more see through across the vertex and mid-scalp sort of areas.

My question is about genetic hairloss and patterns. My father is an NWV and his father an NWIII vertex I would say. On my mother's side her father was somewhere in appearance between an NWVI and VII and had been ever since I'd been born.

I know there's no medically accurate way to determine exactly how your hair will end up but I was trying to find patterns in the way the men in my family lost their hair and the way I am losing it. I was, of course, worried about ending up like my maternal grandfather and losing a huge amount of hair. Recently, however, I saw a photo of him when he was about 23/24 and noticed he already had major loss at the sides of the hairline and temples (the photos were old and only from front on, so I couldn't make any guesses about the crown or vertex, though the density of his scalp hair did appear thinner than the sides of his head from that angle).

I found this photo interesting (and initially encouraging) since at 23/24 I had no noticeable hairloss and, even now at 28, I would hazard an educated guess I have much less hairloss than he did at 24, judging from the few photos I have. My question was; does that possibly mean an indicator that I am more likely to be heading in my father or paternal grandfather's footsteps with hairloss than my maternal grandfather? I have very different hair than my dad in terms of texture and characteristics, but the pattern of my hairloss is much more in line with his I would guess.

I don't know enough about genetics/MPB to know whether the balding pattern is intrinsically linked to the way in which that pattern develops? For example, is it possible to bald differently to my maternal grandfather but still end up in the same place as him in terms of eventual hairloss? Or does the very different and later onset of my hairloss suggest I'm less likely to end up like he did?

Any light anybody can shed on this would be very interesting! Thanks in advance for your time.

Hi Katie,

Sorry about your negative experience here thus far; I don't think people mean to be that way but after being on these forums a while you discover the good and bad sides of hair transplantation and people are just concerned for your boyfriend and his long-term well being and appearance.

We're all glad your boyfriend is happy with his HT and hope he regains the confidence he desired regarding his appearance, but the concerns many people raised were legitimate. A really reputable doctor should not really have let your boyfriend have a HT as he is very young and already clearly noticeably balding. These are indicators that by the time he is older - maybe 30, 40 or 50, he could have severe loss. That could mean a Norwood 6 or 7, which is a lot of hair to have lost and not really enough donor hair left to fill in all the blanks.

Another thing that concerned me was that you said the doctor put your boyfriend's hairline "back where it was". I don't know where your boyfriends hairline was, but I assume you mean near enough how it was when he was juvenile. This is a very risky path to take - the vast majority of doctors will transplant a more "mature" hairline as it reduces the amount of donor hair needed for the procedure and the amount of space left to fill in if there is further balding.

Since your boyfriend has had his procedure done now we can only go forward from that point, so there is little reason for us to continue listing reasons why it was inadvisable. There is, of course, a chance that this may all turn out exactly as you have hoped and 20 years down the line he and you will still be very happy with the decision - but we have all been on these forums too long to believe happy endings are commonplace in cases similar to this. That having been said, everybody here is on "your side", so to speak. But the number one rule of a HT is to research, research, research and bide your time. People on these forums are just disappointed to see another risky case being undertaken by a doctor whose credentials are not the highest.

If you can get your boyfriend to post on here that would be a really big help for him, I feel. I know these forums have not seemed the kindest place to you, but advice is always impartial and if people think you have made a mistake, they will feel duty bound to be honest about that. They will also always be duty bound to help you as much as possible and always on hand to let you know about what can be done in the future if you decide to consider further procedures or have any concerns and questions about hairloss and your options.

I hope your boyfriend's procedure grows out successfully and gives him the results he wants - but having read through this thread I do urge him and you to read and understand more about what might be in your future. It gives nobody pleasure to be pessimistic about life changing decisions for other people, but there are potential problems and pitfalls that he faces in the future and this is amongst the best places on the web to discuss them and weigh up options. You might not always like what you read, but you can nearly always rely on it.

Best of luck and thanks for sharing your story - your boyfriend is lucky to have such a supportive and enthusiastic girlfriend in yourself!

Definitely well advised to stay away from a hair transplant! I think the shaving down idea is a good one - it could potentially really suit you and is a proactive way of dealing with hairloss and accepting it!

And, as Jotronic said, don't be tempted by anybody that tells you they could get good results for you from body hair transplants or other similar procedures - there is nothing currently out there that would give you the head of hair you want. Unfortunate, I know, but the bright side is you haven't had a HT, which would have been a nightmare for you!

This may seem a little random but have you noticed that most of the alcoholicsa and drinkers we see have a full head of hair! I'm starting to think that alcohol must have an effect on DHT or play a role in effecting the hair and that it must lower it somehow! What do you guys think?

If I recall there is some evidence that alcohol has a beneficial effect on hairloss and I too have noticed that trend across quite a few alcoholics! I don't think the precise causative link has been established or proven though and, besides, I don't think I'd trade alcoholism for hairloss!

I have heard of bizarre side effects that seem to have a fairly large presence on the internet. According to some, people have experienced pore enlargement, bags under the eyes, and over all facial aging. This scares me, as I have been using minoxidil for two months now. I did not know about these claims before i started.

 

Does anybody have any insight into these claims?

I wouldn't worry too much. I too have heard some of these claims anecdotally across the net but there is no real evidence to support them and the drug has been fully tested and deemed very safe. It's usually one of those situations when people start stressing and worrying and then begin chalking up every little problem and pain and change to the drug(s) they are taking.

Stress and anxiety about minoxidil is much more likely to age your face than the drug is I would imagine! Of course, if you do see any changes or problems you feel you should get checked out, see a doctor. But the drug is very safe and the overwhelming majority of people seem to take it just fine with no observable side effects.

There's no evidence that taking propecia whilst trying to conceive will affect a child, but if a pregnant woman handles the pill or comes into contact with it it can cause birth defects.

I have always felt this is one of the drawbacks of propecia. Although there is no evidence that a man who is taking propecia will have a higher chance of producing a baby with birth defects, I think most sensible men would be hard pushed to use the drug whilst trying to conceive. It's one of those situations where, as logically as you look at it, if anything was to be wrong with the child (no matter how small or unimportant), you'd find it very hard not to at least feel guilty if you were still on the drug, even if the evidence suggests otherwise.

The other drawback I find with propecia is in fact related to the other factor David mentions! Propecia is a lifelong drug that you have to take no matter how you as an individual change; irrespective of illness, physical condition, lifestyle or environmental changes etc. Whilst I do believe propecia is essentially safe, you are taking a drug that causes a consistent change to an inconsistent body. For most people I doubt this ever matters, but I can understand the anxiety some people have about this. You are not going to be hormonally the same at 50 as you were at 20, but propecia will continue to do what it does regardless of this. There is no specific scientific data that this causes a problem, but it is an idea I am somewhat uncomfortable with!

Thanks for letting us know David! I really hope the loss isn't too severe and I'm sure another HT can compensate, even if it is a hassle. But more importantly, congratulations on the bride and the forthcoming baby! These are most definitely priorities above and beyond hairloss, so everybody will understand where you're coming from!

It will be interesting to see how your withdrawal from propecia unfolds if you are planning to document it. I wish you all the best with what was no doubt a difficult decision, but equally no doubt for the right reasons!

Thanks for the replies everyone. It's like everyone I ask tells me that I have no hair loss, and that I have nothing to worry about, but I dunno, I'm overly conscious of my temples. It used to be of my crown, but now am more concerned about any temple recession. I've even started looking at other peoples hair, to try and gauge my hairline against theirs.

 

I've just had my haircut, and I pulled my hair back to check my hairline again, and to see if I can see any miniaturisation... and I don't really know what am looking for. Because my hair is blonde, am unable to see if any of the hairs are thinner. The majority of them appear to be of the same length as the rest of the hairs on my fringe, bar a couple which are shorter... but then I dunno whether that's just because I've had my hair cut.

Something you have to bear in mind is that mild temple recession could just be the development of a "mature" hairline. A mature hairline is NOT hairloss - the overwhelming majority of men who don't bald still see some very mild recession in their temples (NW2 on the Norwood scale). You will find very, very few men that don't experience at least a bit of temple recession at some point in their lives.

As it stands I can't even see any temple recession from the photos, but even if you could see some this is not indicative of MPB. I wouldn't worry about it at all, you clearly have masses of hair and no evidence of real balding.

Cool! Good to see the trials are at least progressing smoothly, let's just hope there is positive clinical news at the end of things!

You show absolutely zero signs of hairloss as far as I can see!

Hopefully you'll find a way to deal effectively with the fears of hairloss combined with the OCD. The good news is that your fears are totally unfounded - there really isn't any suggestion you have any loss. I know it's not as easy as simply saying "don't worry" but you have to make sure as best as possible you don't fall victim to fears over hairloss because you don't want to get consumed by the worry, especially when it has no foundation!

I never have taken any meds (ie: Rogaine, Min., Fin.) & don't plan on to after my HT. I am 37, Norwood 5A . Is anyone out there doing the same or is it like a foregone conclusion that you have to.

 

Thanks

thehairupthere sums everything up perfectly. There are quite a lot of men that choose not to take drugs alongside their HT. It's certainly doable but there are some things you need to bear in mind:

* You have a stronger chance of losing more hair in the short and mid-term without taking finasteride and/or minoxidil. That doesn't mean you definitely will, but it does mean you may need one or more transplants in addition to this one further down the line to maintain the look you want.

* You might see shock loss after your procedure. If you have a lot of miniaturized hair in the recipient area you may find some of this hair falls out when you receive your transplant. Men on finasteride have a lower chance of this happening because their native hair is usually improved by the drug and able to withstand the trauma of surgery. Again it isn't certain this will happen, just a possibility.

With that having been said, there are men who have HTs without medication and get great results and 5 or 10 years later are still looking good. You just have to be prepared to deal with further loss much earlier than someone who is on drugs.

No. Don't believe anyone who tells you that you can get FUE once the donor is maxed out. If the donor is maxed out then you're already looking at not having enough hair above and below the scar to cover the scar. Taking out more grafts by FUE will only make the scar show even more.

I don't think that's entirely true since the donor area is a bit larger in FUE. You don't have to take immediately around the strip; you can spread it over the whole donor area and use sections that will not compromise hiding the FUT scar.

That having been said I don't think the FUE donor levels after maxing FUT are all that stellar; maybe another 10-20% of your FUT donor yield if lucky. It's not like you're going to get 8,000 from FUT and then another 6,000 from FUE - maybe another 1,000 if you're fortunate. But there's a lot of tweaking and finalising you could do with a final FUE procedure so for some men it's probably still worth considering.

I hear a lot about expectations and what a hair transplant can and can not do.

 

I think the problem with this is that it varies so, so much for each individual.

 

In my opinion, there are some patients, base on their NW level and type of hair that look great and acually look like that never lost hair.

 

Then there are some, again, depending on the type of hair and the NW level that get transplants that just look like transplants. Even on this site.

 

 

So I guess my question is, when you hear a doctor saying things like "There are limitations to transplants." What does that mean?

 

Is the limitation that it is going to look like a transplant? That one may only be able to sprinkly the crown? I hear things like limitations and illusions, and other words like that just don't mean much since I have not seen many in person. (No good ones in person.)

 

 

There is my rant. Fire away.

Well, the problem is donor supply vs. demand ultimately. I would estimate across the area affected by MPB (top, back and sides) there is probably, in a non-balding person, somewhere between around 18-25,000 follicular units. In the average man the donor supply available is probably around 6-8,000 follicular units.

As you can see, even if you're lucky enough to have 10 or even 15,000 follicular units in your donor area, you still can't get all your hair back. So, in men with more severe balding (let's say NW5+), you probably only have on average maybe 1/3 of the original density to play with if you're lucky. In really severe cases maybe even much less.

So the limitation is simple supply and demand ultimately (though hair/skin characteristics are also important). If you have let's say 250cm2 of baldness to deal with and 6,000 grafts in your donor area you can achieve a maximum average of 24 grafts per cm2. That's not going to give brilliant coverage, so a doctor will prioritise the most important areas cosmetically; the hairline and mid-scalp. The crown is the least important area because, generally speaking, it doesn't frame your face or have any bearing on your general appearance from the front or sides (this is of course not entirely true, but generally). So a doctor might want to put say 40g/cm2 in your hairline and just a light covering of 10 or 15/gcm2 in the crown to not make too much of a contrast.

Another reason why a transplant might not look entirely natural that I've noticed is that sometimes people transplant a relatively even number of grafts right across the balding area. In men with more severe balding, this can give a kind of "fake" look, because nature did not intend for you to have light coverage right across the top of your head and normal density along the back and sides. It's ultimately more natural to have a denser hairline and mid-scalp and lighter crown than a sparse but even layer right across the top of your head.

All HTs are therefore something of an illusion. People see lots of hair on your head and essentially their eye assumes you have a full head of hair. If they were to look very closely they'd notice you don't actually have as much hair as you appear you do - but the average person not concerned with balding will rarely if ever tell the difference. I can vouch for this; when I started thinning I analysed every guy's head I came across and I was surprised how many men were technically balding that I'd once assumed just had a good head of hair. I realised that a lot of men who look to have a "full" head of hair really just carry of a strong illusion of having so, but closer up it's clear they've lost density in MPB susceptible areas.

So a HT still remains the art of replacing hair in such a way that creates the visual look of a full head of hair without requiring a full head of hair! In most men these days, even up to some NW6s, the results can be truly dramatic. You really can gain a very decent head of hair again that 99% of people would just look at and say "yeah. he's not bald".

So the limitations are how much you want to cover and how much hair you have to do it with. If you have a lot of real estate and not a gigantic amount of donor hair, the results will be something along the lines of moderate to decent with a good doctor. You'll get a head of hair back and in most circumstances it will look good, but under strong light or when wet it'll be clear you still have some thinness. If you have less dramatic hairloss and/or more donor or better characteristics, the results will improve proportionately.

Thanks for all the great thoughts on this gents.

 

I did not realize that DHT blockers such as Finasteride and Dutasteride were not really that helpful to the hair line. Learning this kind of makes me want to avoid Dut, especially if "the jury is out," as it were, with regard to how much difference it might make. Or maybe it's worth a try in the short term?

 

Has anyone experimented with taking Fin and Dut at the same time - or is that ill-advised?

Yeah I think most doctors will tell you there's really little you can medically for the hairline. Some men do see growth or stabilisation using DHT blockers and/or minoxidil, but that's very much the exception.

I'm not particularly educated on DHT blockers but I believe Dut is essentially just a stronger Fin, so I don't imagine taking both will be of much help and probably not recommended purely for use against hairloss. That having been said I have seen a few men switch from Fin to Dut and receive prescriptions from their hair doctors for that, so it's worth discussing it with a doctor if you're interested.

The main thing with Dut is just that it's more potent than Fin, so whilst it's possibly more effective on hair there is the chance of increased likelihood of side effects etc. That increase in risk is still statistically very small though; it's very much thought of as a safe drug.

This is to some extent unfortunately the limitation with DHT blocking though. It does not work forever because you cannot safely remove DHT from your body, and so you have to find the dosage that offers the best compromise between lack of side effects and improvement in hairloss. You will always end up losing the battle but, if you can hold on to that hair for 10 or 20 years and then lose it at a much slower rate, that's very likely a battle worth having! But transplantation will probably have to come into the equation somewhere and now could be the time perhaps.

Well that's what I always thought. Genetically your balding is fixed the day you're conceived and so, to that extent, you can't really be "moving" through the NW system. If you're an NW6 genetically, then that's what you are. You might appear to be moving through from NW1 to 2 etc, but ultimately there is only one destination and only artificial means (medication, transplantation etc.) can slow that down.

To that extent, in my head the logic would be that your NW classification has to be the extent of your miniaturization. so if you have only moderate thinning in the crown, for example, surely from a NW classification that has to be taken into account as a higher NW category?