DrTBarghouthi

Looks impressive! Keep it up. 👍🏼

Thank you for having a look. The gentleman had few failed procedures done and thus his donor area was depleted. We only managed to transplant the first 1.5-2 cm of the frontal zone (hairline and frontal zone). So in general just a 2 cm frontal border. The system was of medium density matching his hair calibre and curl and starts just behind that transplanted area.

I strongly believe that this is the best approach when it comes to hair systems. I personally never use a full system on male patients for the obvious reason that system hairlines are never perfect. A hairline from a system is what will make patients remove it as soon as it is attached. To solve this, I actually experimented with a good hair system manufacturer to design the system in a way that starts behind the natural hairline or even the areas that we can transplant. I believe we were among the first to actually demonstrate that and I coined it the “hybrid approach in restoration”. It really solves a lot of issues especially with depleted donor, large areas of loss and patients with high density expectations.

In the areas you specified, I find that around 800-1000 hairs per side should be enough. Generally this is achieved using around 1000-1200 grafts as we like to use only singles or doubles for the beard.

Thank you. Judging by his donor currently. I believe he could go for another 2500 grafts at least. Which should be good for the crown and any future losses. I have stressed the importance of good maintenance in his case too.

Please feel free to contact me anytime and hopefully we can come up with a suitable plan. In al cases you will need to wait a bit longer anyway.

Well said. I agree that it is an interesting topic indeed. It’s quite annoying how far people go nowadays to ruin reputations or to even book a case. It is a more transparent and easier path to just learn and be good at what you offer.

Those car photos are killing me 🤣 can’t agree more.

Seems like a very favourable condition. Good donor and an early stage of hairloss. In your case anything between 2200-2800 should be sufficient in my opinion depending on your hair characteristics.

Very nice outcome!

Can help yes. I definitely recommend it if there is any evidence of donor shock loss.

I wouldn’t worry about that. It could be simply a delayed graft shedding or a hair follicle that did not survive or even one that is growing but went into a resting stage quite late. Hard to tell but I wouldn’t worry about it if the odd ones are like that.

@JohnAC71thanks my friend. I Have changed that now. It seems 2020 was a year that the mind doesn’t want to register 😂😂

Dear community, This is a 27 year old gentleman who had his FUE HT done in December 2020 . He is a NW 6 with a family history of the same. He has been placed on finasteride for 6 months prior to surgery almost. We decided to attempt a two staged coverage. We started with the Frontal and midscalp areas initially with around 3141 grafts. Photos were taken recently around 6 months from surgery. Surgical details: FUE 0.9 mm punch Hairline 577 refined single hairs 1: 577 2: 1233 3: 1148 4 and over: 183 Total: 3141 with an average of 2.39 hairs/graft. Sites made using 0.8 mm and 1.4 mm Sapphire blades. Planning and before photos: Immediately after surgery 10 days post: 1 month post: 6 months after: Will keep you posted with updates.

It is indeed a stage 6 with possible progression. Maintenance is extremely important, as well as reasonable expectations and knowledge that you will most likely require a staged approach. I agree that the beard can be utilized if it has good density.

Hello @harryhouston I agree with others in saying your donor is quite low in density. The numbers that can be safely removed from it will not be enough to give decent coverage on top. I tend to put patients in a similar situation on finasteride for 6-12 months. I then reassess the donor and the improvement in hair which can in some cases change the initial plan. Nonetheless you have to be realistic in your approach.

Thanks for the mention @JohnAC71 @M.Malik Medications in the form of finasteride is my current advice. It is too early to embark on any HT at this age and with your current pattern. Get it stabilised first and then you can plan the course of action. It is quite dangerous to do anything at this point.

You do have what seems like early male pattern hair loss. It is genetically predisposed and hormonally mediated. I suggest getting on some good maintenance meds such as finasteride (oral or topical) or whatever suits you best. Still too young for a hair transplant given your early pattern.

What is your age if i may ask ?

Ofcourse from an area and density/numbers point of view men would need more grafts. Nonetheless, a diffuse thinning female in a ludwig 2 and above pattern might not be suitable for surgery anyway. The challenge with females is in no way numerical (in most cases) that’s what I meant to stay. It is purely more technical/ aesthetic. Furthermore, remember that fewer females are actually suitable candidates. The bulk of the Androgenetic Alopecia females are not and if they were to have a transplant their results won’t be impressive at all. Your opinion is rightly driven by good female results that you are seeing based on good work and good patient selection. However, you should see the amount of failed female hair transplants that I see for example from other clinics and this is simply based on poor selection and a big female loss pattern that can not be made dense in anyway.

Female hair restoration is a double edged sword. The areas usually desired are the hairline and hairline lowering which makes the area quite limited and hence we have a smaller area to fill, potentially yielding denser results. Nonetheless, the female hairline is by far more challenging than males due to different directions, angles, shape and temple design. A botched female hairline is unforgiving in many ways and can really be difficult to repair or salvage. Women can not simply shave or do SMP to hide a bad job in their hairline. Moreover, female donor areas tend to have finer hairs and I find the FUE extraction in females far more challenging due to finer hairs generally and a more acute exit angle.

@SavemyhairlineI think you got yourself a well informative thread here. Certainly a lot of valid options and strategies and excellent clinic choices. If I’m to be totally honest with you, I believe that finasteride in your case is a must. I am an advocate of 3 times a week and build it up according to how you tolerate it. It is certainly effective. I do feel that a NW2 is your utmost goal. If that’s the case, I think it is important to set your goals and know your limitations early. With your dipping crown and ongoing loss on the midscalp, along with your young age, I do believe that it is only doable if lets say one area such as your crown is probably somehow compromised. I think 3000-3500 grafts will give you the frontal third that you desire, but I will certainly be open to having less density further back or even a good quality hair system for the areas that could be less fortunate to fill. Just be careful that once you get that NW2 hairline, “hair greed” might kick in and then you might not be too flexible or happy with a thinning mid scalp or crown. You can do a lot if you accept the limitations that might occur and plan for them from the beginning.

I dont use headbands. My swelling prevention instructions are: 1. Ice 2. Elevation (includes sleeping in a somehow reclined position for 5 days. 3. Avoidance of forward head tilting (phone, laptop use unless reclined) 4. Reducing dose of steroids orally for the first 5 days. 5. Injected steroids mixed in the tumescent fluid. Swelling usually peaks day 3/4. So it is important to stick to the above for the first 5 days really.

Yes most likely a maximum of 1000 depending on actual real life examination.

I just came across this. It seems that in harsh conditions, you would likely need around 2000-2200 grafts. You hair color and characteristics would help a lot too imo.