Hair4Days

2 hours ago, 1978matt said:

Shave your head to see if you can live with the look.  If it's a yes, then do a conservative FUE to the front 3rd.  2000 grafts tops.

With your donor, short hairstyles are immediately gone if you go FUT.

Overall it's a tough call if you cant tollerate oral Fin.

I’ve heard of this approach before. What does it actually accomplish though? The ability to wear a shaved head with a stubble look in the front? I’d assume with 2k grafts spread out in the donor there would be no scarring 

Fibers look good Melvin. This shows that even with some hair (due to lack of growth from surgery, a lower density from a limited donor, or waiting for hair to grow out)  paired with concealer you can really pull off a look that’s superior to being bald. 

Great result, great density.

Does this gentleman have a projected lifetime graft count of 15k or something? I know he doesn’t have mid scalp or crown loss, but you cannot  predict someone’s final balding pattern so I’m curious as to why so many grafts?

It’s good to do the front half first like you said, then down the line schedule another for the remaining mid scalp & crown. Which doctor you going to? 3500-4K grafts is kind of a lot, I’m curious what they said about shock loss of your existing hair. Even though it’s miniaturizing, i know a guy like Dr. Konior wouldn’t graft at high densities for your case. Meaning you’d have to return once your native hairs fall out and do a second pass.. but then there’s other clinics willing to blow through that entire thinning area and dense pack. 

1 hour ago, Chances101 said:

I was speaking as in long hair. Fue the scalp to help the density blend better . Idk though sometimes I feel like camera angels and light is a gimmick with smp. They make it look better than what it is. Anyone ever seen long hair smp treatment in person? 

Yeah it’s a good idea. It darkens the scalp. Just like toppik does. You’d need at least like 20% density though. Other than that you’d likely see the dots pretty easily 

1 hour ago, SadMan2021 said:

this is actually fairly common. FUE in the front, SMP on the crown. 

But worn shaven down?

Did the clinic comment on this? It appears to show a more advanced pattern of loss since you shaved it down. I noticed the same thing with myself when i did that. I’m curious if they would of covered more of your frontal third if they knew you had more thinning going on. 

Trust me, there’s no desire to shave your head bald once you reach 30. Your 30s are your prime. No debate 

1 hour ago, Grouse said:

Hey! I’m on my way to a 6, and trying to book a virtual (maybe in person, I live close) with him. Not sure he’s even up for taking on NW6’s, happy to report back. 

Why wouldn’t he be up for that ?

I consistently see Dr. Koniors name as one of the best to ever do it. Mainly for his artistry and strategic abilities to get a solid result. I may be wrong, but i don’t usually see his name for megasessions like you do with h&w or other clinics. Would you include him on the list of surgeons you would consider if you needed 5-6K+ grafts? Personally i don’t see why not, but I’m curious as to everyone else’s opinions considering he’s usually mentioned for his strategic, conservative approach. He recommended less grafts than my other consultations for shock loss reasons, while others don’t have an issue working through existing hair. 

-J

Could probably only get an established hairline with scalp donor. Beard could be sprinkled throughout mid scalp I’d say.

For everyone else .. Are there signs of this pattern early on ? If so what should you look for and would there be signs of this at a particularly younger age ? 

2 minutes ago, Gatsby said:

Also you need to remember that zoomster's lower crown lifted (filled in) from taking Propecia! So being on finasteride, etc, is just as beneficial to being a Norwood 6 as it is for a Norwood 2.

Yes i remember him crediting fin for his lower crown which wasn’t transplanted. The topic in question is basically how many grafts does it take to restore a nw6 with no meds (on average)

13 minutes ago, digi23 said:

Yes Zoomster had 5400 scalp grafts, 1400 beard grafts, total 7000 the first procedure. Here he did not have full coverage and pretty low density. HT 2 he had 2400 scalp grafts and 2200 beard grafts. Total of 11600 grafts. 

Zoomster have almost perfect hair characteristics, salt and pepper hair, his donor is depleted but looks good when its grown out abit. 

I think its unfair to say that anyone can have a result like his, you see Melvin was also Norwood 6 and he have not yet covered his crown, now he decided to try to mix beard grafts with scalp grafts. He have awesome beard, for someone who does not have his beard, youd need to leave the crown or try to overharvest the donor and grow it out abit longer.

Ontop of all of this, you need to consider that your hair will thin out during your whole lifespan, so each year you are losing density, thats why it is so important and why all the best Drs in the world ask you to atleast try Finasteride to slow the process and in the end get a better overall result.

Melvin only had 5400 grafts done i believe. I think 1500-2000 grafts would do wonders in his crown. Which would put him at that 7k mark for total grafts. But when we discuss someone without the option of beard hair, the question is can the average  patient get 7k fue grafts  from their scalp donor. I’ve heard yes from konior & bisanga As well as others. 

13 minutes ago, digi23 said:

Well you can see someone with thinner hair like @Rolandas is a good example, they used a little bit over 6500 grafts on him with a conservative hairline. He was Norwood 5A. He had 55 microns hair with 85 grafts per cm2 in the donor. If Rolandas were to be Norwood 6 instead with that hair calibre, you would probably need about 3000 more grafts because of the low crown dip. So someone with thin hair you are looking at about 9500 grafts for the whole Norwood 6 area, I would say less than 50% of patients have that available without overharvesting. 

For me I have 45 microns thickness, I doubt I can even reverse Norwood 5 without overharvesting.

I don’t know about another 3000 grafts for a dipping crown. I’d say another 1000 for the lower hemisphere of the crown. Depending on how wide it is.  Look at @Zoomsterhe achieved it all. With the use of beard hair as well 

4 minutes ago, digi23 said:

Well I agree that Norwood 5, even with thin hair calibre can do it without medication. Norwood 6 it becomes more difficult, specially if you have thin hair like under 60 microns, it would still be possible if you have a high amount of grafts per cm2, but you might need to overharvest on purpose. 

If you have thick hair calibre like 80 microns+ thats where you see all those amazing Norwood 6 to Norwood 1 cases. 

Not even back to Norwood 1 though. A nw6 back to a nw2/3 with a conservative age appropriate hairline is usually doable in the average patient with no meds using roughly 5k grafts give or take. Ideally 6k. That crown is going to be light though. But that’s better than shiny bald.  But yeah, ultimately comes down to donor characteristics 

12 hours ago, digi23 said:

The most crucial step for you would be to try Finasteride and see if you feel fine on it with no side effects so you can be on it long term. When you know that you can start to think about a hair transplant or in your case probably more than one. You look to be heading towards Norwood 6, but you have alot of hair to try to keep with medication. 

A problem also if you do a hair transplant now without medication, is that you might lose alot of minatuarized hairs due to shock loss if you are not stabilised. Preferably you should be on Fin for 6-12 months before the transplant.

Your donor looks pretty good.

Without medication you are in for a tough battle, might be possible but personally I would not risk it. 

Take a look at his second photo again. What hair is worth worrying about in regards to shock loss? There’s very few remaining hairs which are clearly on their out. A 2500-3000 session to rebuild his hairline/frontal third is clearly an option for this patient. It would make a massive difference in the hands of the right surgeon. As for the whole medication topic…It’s better to find out what’s possible with surgery alone for your particular case in case you go completely bald. Take a look at some nw5/6 restoration threads. You’ll be surprised what they’ve accomplished with just surgery & 4-5k grafts. 
 

1 minute ago, James C said:

 

Don’t see why anyone is saying you can’t or shouldn’t get surgery. For starters, your donor is shaved down to a number 1 or 2 in these photos, everyone’s hair looks thinner when it’s shaved that low. Guarantee grown out your donor looks healthier and people have different opinions. And second, instead of being rejected completely what’s wrong with saying you may just be sacrificing any crown coverage. That’s usually the typical response to those battling advance NW levels. 3500-4000 grafts gets you a hairline and midscalp coverage, you look like you’d be able to Atleast do that . Being optimistic here 

Do you have any photos of the crown area?

5 hours ago, deeznuts said:

That's never bothered me that much with them. A lot of people appreciate the higher density and they seem pretty confident that they can predict future loss fairly accurately while still leaving enough donor should  balding progress further. Plus, a lot of people would rather just get one hair transplant instead of having to get 2 or 3 to do the same thing.

Plus, those kinds of operations are on guys with limited future loss, lower NWs and for the most part just guys who aren't strapped for donor and benefit from less operations/higher density

It’s rare you get a doctor who will personally predict or guarantee someone’s final balding pattern especially at a young age. You just can’t do it. I’ve seen people have the thickest hair with no sign of balding at 25, and lose it all at 40.  Every consult I’ve had with these top tier surgeons never want to directly say what can or cannot be done and the reason is always because it’s borderline impossible to predict someone’s final Norwood level. So i don’t necessarily agree with packing a frontal third with 4000 grafts regardless of the situation. That’s more than half of your donor supply.  I also thought 40 grafts per sq cm gives the illusion of your native density on average? Why would you need to pack that many grafts in a 80 sq cm zone

3 minutes ago, Adam7463 said:

Thanks for the input. I've spoken to most except for Rassman.

I'd say either FUT/FUE , although some of these mainly just do FUT like Feller & Bloxham  (I think Bloxham does most of the surgeries). 

My only concern with H&W is that they seem to do high megasessions and that just makes me a little anxious personally. I'm looking for someone to do ~2000 (maybe little less) mainly hairline and midscalp.  I also heard about dr. robin unger the daughter of walter but her before & afters don't seem so impressive. 

@Runitback thanks for providing waitlist times, does anyone happen to know the others? I've spoke to most prepandemic so figure waitlists are now longer

 

 

I said the same thing about h&w. I’ve seen cases of theirs where they’ll say a frontal third received at outlandish graft count like 4,000. When You usually see 2500 for the same sized recipient zone.

We hear a lot about some people only getting 4k grafts, while some get 7,8k. What specifically defines a great donor area? When calculating how many grafts someone can get from their donor or how much coverage they can expect what are the key variables. Is it more so how thick the hair itself is? Or is it mainly a Donor that doesn’t look transparent or sparse?

7 hours ago, Curious25 said:

Thats a prehistoric trail of thought these days. Top tier clinics experience near identical levels of transection between FUT and FUE procedures now.  
 

I occasionally wear a skin fade after 2500 FUE , and no one notices the scarring. That’s not to say that it’s not there, and it’s also not to say that some people experience worse scarring than others. @Rolandas has experienced this, despite an excellent overall procedure. 

That’s incredible. To be able to do a skin fade. Explain to me why someone would go fut nowadays? Lol.. and that’s becoming a serious question.

4 hours ago, Curious25 said:

Given your desire to limit the amount of times you go under the knife, Dr Hasson's approach seems to be the more suitable of the two for you, however both approaches have their merits, and both are very skilled and informed surgeons. 

FWIW - I'm in a similar boat to you, I imagine I will eventually reach NW5 at least, and I have opted for FUE all the way through, however will be following a path which is more closely aligned with Dr Konior's proposed strategy. I also have a pretty good beard, and that was one of my justifications for 'sacrificing' more grafts via a combination of FUT and FUE, that I will be able to get over 2000 BHT to place around my mid scalp areas as a filler. 

I'm watching the donor restocking threads with huge interest, to see whether it eventually turns out to be a more optimal strategy to deplete the donor and maximise scalp grafts into the recipient area, and then later restock the donor with BHT. I like the theory, yet the jury is still seemingly out as to whether or not this practice is beneficial, so I will keep my eye on this movement as I say, and make up my own mind in years to come. Thankfully I'm still a long way off having to worry about this just now, so I have the luxury of sitting back on industry development for the next 10 plus years. 

 

Seems like very similar boats. I’m in no rush personally since I’m not 30 yet, however I’m prepared to address my hairline fairly soon. As far as the opting for fue topic, it just makes me feel more comfortable. I know people say you lose the opportunity to shave your head regardless of which method you use, but if im god forbid in that situation, i rather have fue scarring. dr konior also explained beard hair is an excellent source, so at this point it seems like a no brainer for fue if you can make up those grafts you leave on the table by not doing strip.. Unless you get that transaction and growth rate argument from people who say the growth survival isn’t as good with fue

For a while now, i was set on getting a strip procedure, setting myself up to utilize my donor to it’s highest potential (according to many Ht surgeons). I’m a diffused nw 5/6 which is not noticeable with hair grown beyond 1 inch. With hair grown longer + toppik in the frontal zone, i look like i have a full head of hair. However, Having shaved my head down to a number 3 during COVID, i saw the diffused pattern throughout my top + my crown dipping downward similarly to  @Zoomster .. This confirms i will be a Norwood 6 as my final pattern once developed over time. This is why i was pretty set on starting with FUT. But as of late, I’ve been seeing more and more advanced Nw patients go the FUE route and the results look good. Between having an above average donor + good beard supply, I’m beginning to lean towards fue even as a future nw6.  I currently use minoxidil and topical fin As a preventative. I’m considering Dr Konior & Hasson for FUE, but both have way different approaches. dr. koniors strategy consists of a “density boost” in the frontal hairline of 1500-2000 grafts. He explained he doesn’t feel comfortable grafting at a high density  To avoid shock loss. He told me I’d need to come back to readdress the same area in the future once the native hairs fall out, or i could wait til I’m much balder and do a larger procedure grafting at higher densities. 
Dr Hasson on the other hand recommended 3000 grafts in the frontal third and working into the mid scalp. This would provide a new hairline and dense pack the entire front working through the existing thinning zone. This would future-proof the area so i would not need to return for the same area. I’d only need to return for non transplanted zones in the future like the mid scalp and crown. Does anyone have any opinions on each of these approaches? One sounds conservative and one sounds more aggressive. Ideally I’d like to limit how many times i go in for surgery. And for the record, i am willing to compromise a couple thousand grafts that could be used in the crown by going fue, but with a solid beard this could hopefully makeup for those scalp grafts I’d be giving up