Hair4Days

How does this happen exactly?

As we all know, realistic expectations is the name of the game. When it comes to graft availability, it’s usually always a given that a more advanced patient will need to compromise density in the crown. With that being said, does anyone have examples or input on how, say 20 or 30 grafts per sq cm looks visually?  Dr. Konior once mentioned even a 10% restoration in the crown would make an impact compared to a shiny bald area. My question is, how thin does a 10-30% restoration appear to the naked eye.  

On 11/30/2022 at 10:44 AM, Calihome1 said:

Only 500 for that entire middle portion? That doesn’t sound right

It depends on how many grafts are needed for a frontal half restoration for this patient. If the number is 3500 then that middle portion would need 700. 

maybe @Raphael84could give further detail on graft count for that middle portion in the event it thins out.

What is this patients projected graft availability in his donor?

On 11/24/2022 at 10:25 AM, Calihome1 said:

Nice result, but, seems like a ton of grafts for a small area

I think people viewing cases like this compare it to other cases where less grafts were used for the same surface area treated. It’s understandable to get confused. I’ve seen many cases where patients had around 3000 grafts covering the entire zone underneath that red line @Raphael84 posted, including that middle portion that wasn’t worked on. As he explained, the corners do go pretty deep, so that’s where extra grafts were placed.  But i can see why people question why  2858 grafts were used in an example like this and not to include the center portion.@Raphael84can correct me if I’m wrong, if  that center portion that is untouched right now is grafted in the future it would take maybe 500 or so grafts to match its surroundings? So essentially 2800+ 500 would put this patient at 3300 grafts for coverage in his entire frontal third into his mid scalp which is a standard graft count for this surface zone. I hope I explained this correctly. 

What did dr Bicer say about it?

What pre op and what’s post op out of these pics 

What about the scars showing ?

Could you put grafts there ? 

Where is everyone getting their topical fin?
 

Has anyone tried For Hairs topical finasteride? I used to use Dr Wesley’s but stopped. Wasn’t seeing any difference. Figured I’d try a different company. Thoughts on switching?

5 hours ago, mr_peanutbutter said:

 

 

maybe its a question of definition but for me "coverage“ doesn’t necessarily meant "fullhead of hair“, not even necessarily "the illusion of fullhead of hair"

with 20 grafts per cm^2 you get coverage but without the use of hairfibers it will definitely look like that area is thinning/balding from certain angles

 

 

Absolutely. And for a Norwood 6 that’s fine in the crown. 

best to use the 40-30-20 rule. 
 

40 grafts per sq cm in the front, 30 mid scalp, 20 crown. 

Most realistic and logical scenario for a Norwood 6 with a 250 sq cm balding pattern using that strategy would require 7500 grafts.
 

If you have 6-7k scalp grafts, great. You could use beard for the remainder.

How we looking ?

2 minutes ago, Hair4Days said:

Or bloxham- he’s pro fut

You wouldn’t measure it from temple to temple to calculate surface area of your recipient zone. Chances are your hairline design would have some sort of conservative curvature lessening the surface area within your frontal third versus going straight across like that. 
 

also, if you’re saying you have 80-85 fu/sq cm AND you have a big head, these seem like two golden reasons to do Fue lol.. but yeah, i guess if you’re going for a reliable fut scar, h&w. Not many options nowadays due to it becoming less desirable. 

19 hours ago, Everyday_Platypus said:

Yeah I tend to wear my hair short and can definitely pull grafts from my beard.  I figured I'd get a second HT for added density/touch up and to fill in the scar down the line.  

If you could get 6/7k fue grafts from your scalp plus 1500-2000 beard then i wouldn’t even bother with fut at this point. I used to feel fut was the better option for advanced hair loss but that scar could be devastating. Especially if your wear your hair short 

Bloxham gives the best hairlines. Don’t go anywhere else for strip. But in all honesty, that scar is not worth it bro. You’ll get very close to the total amount of Grafts in your donor via FUE if your donor is relatively average. Do you have a decent beard? If so, that makes it an even easier decision to go fue 

25 minutes ago, WhereIsMyMind said:

How much is the current waitlist for Bisanga? Both first consultation + transplant? I have emailed but they don't reply . How much did you personally wait?

Good luck !!

A few months for the consult & im not sure about the surgery. I’ll find out this weekend.

Hey guys. 

After about 4-5 years of research and many consults, i wrap things up with my final ever consult with Dr. Bisanga next week. A majority of my previous consultations were mainly just a visual assessment and a typical game plan like we hear everyday. The good old 2500- 3000 frontal restoration, and then address the crown at a later date. While this seems like the right way to go to start my journey, I’ve noticed I’ve never had my donor examined in depth like Dr. Bisanga supposedly does. I hear he digs deep into the raw data and prioritizes the analytics. Hair groupings, grafts per sq cm, hair diameter, percentage of miniaturization. With this information, hopefully I’ll be able to determine my total donor graft count. I’ve heard as low as 5k all the way up to 9k, so I’m hoping with actual measurements, i could receive a more accurate number.. For anyone Here, especially those who have been to Dr. Bisanga, how much value do you believe you get from a consultation like this versus a basic visual consultation like many others provide. Either way, I’m excited to finally meet Dr. Bisanga and feel pretty confident if i were to chose him as my doctor. The research i have done over the years has been extremely intense. I know so much about this industry now. I believe ive done my due diligence to the point where i can make a highly educated choice.

It seems to be Dr. Sethi based on the cases 

My question is, 

What makes a “Norwood 7” doctor? All surgeons are dealing with the same donor area in a single patient, how is it that one doctor is able to restore more then the next guy? Trying to make sense of it

4 hours ago, Danzig323 said:

Yes, but how can you know your donor characteristics after 10 years? If you don't have DUPA now, who can guarantees you will not have it for 5-10y?

That’s a good point but i would say if you have a low percentage of miniaturization right now in your donor then in a worst scenario your transplant would just thin out as you age. You never see peoples donor completely bald out like the top of their scalp so maybe when your in your 60s your hair just looks like it’s thinning out naturally. But it’s not likely to happen rapidly so you should get a good amount of time with a nice result. 
 

you can check for miniaturization using a usb microscope. 

4 hours ago, HappyMan2021 said:

. Hair transplants are not meant for NW7s. 

 

How do you explain what eugenix is doing for Norwood 7s?

Basically..

If you have a lot of native hair left, find out that in the event you lose it all, if your donor allow for full restoration with surgery. If the answer is no due to poor donor characteristics, then it’s a bad idea to do the frontal third, and then take finasteride to hold onto the back half of your scalp. You confirmed your donor is poor so now you depend on a drug to save you from looking bad with just a frontal third. What happens when you decide to stop taking it? Alternatively, if a doctor says your donor likely has enough to give you full coverage if you go fully bald in the future, then taking finasteride is then just up to you and the only real benefit is delaying when you go for a second procedure 

It only delays the inevitable. Your genetics win in the end. You may take meds now & decide to stop them down the road, or they may lose potency (and yea Medications can do that over time for all the pharmacists here) , or you may develop side effects you don’t want to tolerate. Many reasons why you shouldn’t rely heavily on a tablet when pairing it with a transplant. I never felt comfortable being told finasteride is an absolute necessity if you go for a HT. You need to know what can be achieved with surgery alone and i stand by this. Once you can confirm  what your situation would allow via surgery then you can make the choice to take finasteride or not. At that point your playing with house money and it’s lower risk. But to depend on it?  Asking for trouble 

4 hours ago, Rahal Hair Transplant said:

Hair4days

I think a case can be made for most scenarios. I’m a firm believer that there are exceptions to every rule and that there are certainly times where it may be appropriate to at least use some of the available during her hair to fill in the lower crown in particular in cases where it’s fully bald.  In my case, I only experienced moderate thinning in the lower crown so it really wasn’t noticeable. I think by filling in the upper crown and the entire top of the scalp without at least using some of the donor hair for the lower crown might look a little awkward. 

Now this is just my personal opinion and not necessarily that of Dr. Rahal’s (I’d have to ask him his opinion on this) but in a case such as the photo you presented above, I would personally suggest grafting from front to back like we discussed but stop around the midsection of the scalp with a gradual fade of course.

Then, having left enough donor hair for what’s next, I’d suggest possibly use some donor hair to shrink down the size of the bald crown by adding some hair in or around the upper crown region and then cover the lower crown with lower density so that the lower crown is no longer bald but just thin.

Ideally however, there would be enough donor hair to cover both the upper and the lower crown even if it’s low density. This will illuminate the bald spots  And the entire crown region would just appear thin.

Now, if the patient is a Norwood class seven or an advanced class six, they’re probably would not be enough don’t know how to do it I’m suggesting unless they have exceptional amounts of donor hair   In cases like this, I would say one or two things. First, these individuals may not be good candidates for her transplant surgery at all or, they would have to have exceptionally realistic expectations and deal with the reality that there’s going to be some areas of the scalp that can’t be covered.  

So in extreme advanced cases, these hair loss suffering men likely wouldn’t be good candidates for surgery. Thus, the scenario as to whether or not to start grafting front to back or to use that donor hair for the lower crown wouldn’t even exist   Only if what I suggested above is possible (which means they either have enough donor hair or not as advanced balding) would they possibly even be candidates for surgery in the first place.

like I said originally though, there are exceptions to every rule. There are always cases to be made for and against surgery even for extreme cases.  But the above is my opinion as a general rule for those types of cases.  

Best wishes,

Rahal Hair Transplant 

I agree cutting the density down significantly in the mid scalp and grafting at a lower density to obtain coverage in the upper AND lower crown. I was actually behind someone in line at the store today and he appeared to be a Norwood 6, however, he had a bald upper crown with some hair in his lower crown. Not much, but enough where it wasn’t completely bare. I was able to see the overall shape of the horseshoe but the hair he had in the lower crown made a massive difference. The way the hair lays in the lower crown is like a curtain. It falls straight down. I’m guessing this is a good thing as far as coverage and the illusion of density. i would assume a small number of Grafts in this lower crown zone would go a long way. 

8 hours ago, BeHappy said:

Yes. Not so much for NW 6 because they don't have a bald crown that goes far down the back of the head, but for a NW 7 I feel it's better to transplant the lower and sides of the bald crown and leave the upper portion of the crown with less grafts. I am a NW 7 and am in this situation. It would look totally ridiculous if I leave the lower crown completely bald.

 

Exactly my point