BackFromTheBrink

For me, your hair is looking good. There's clearly a lot of grafts/hairs in your hairline giving a natural look. If you're being really picky there is a less dense area (left centre in your pictures). In my opinion, that's likely to stay less dense than the rest, but may thicken enough to make it less visible. We rarely look at people without hair loss, but if you were to, you'd see that there's some inconsistencies naturally.

Another thing to consider is that density and caliber of hair is different across colours. As a result you're conditioned to expecting different characteristics for each colour. Since people with blonde hair have fewer follicles on their head naturally, it'll be easier for a surgeon to get closer to natural density.

I'm not sure why laxity has anything to do with it then. Usually doctors will give a FUE estimate, and a margin of a few percent that they'll include in the quoted price.

It sounds like they are talking about an FUT procedure. They'll extract a strip, the size of which they will determine based on the amount of grafts they believe you'll need. They'll only know the final number when they've cut up the strip and counted them. So, they're answering your questions very literally. What they'll do is examine your scalp and assess your loss. Look at your donor area, the density, number of hairs per follecular unit etc. With strips they'll be able to get a larger strip if you have good scalp laxity. Armed with that, and an estimate on the number of grafts they think they can get, they'll then be able to plan the hairline and work with you to find an agreeable plan. On the day they may get more grafts than they forecast, and we able to change the design slightly.

Not sure I buy that, though it depends on what you consider 'corrected'. How many more grafts would you say I need to meet that definition?

Unfortunately so. It'll be 6 months before you can make a relatively accurate judgement. I'd echo what others have said - finesteride will help your hair generally, if you can tolerate it. If it is shock loss it may indicate extensive miniaturisation. Fin will help reverse that.

I'm going to go against the grain here and say the grafts were taken with sufficient gaps and so with 3k grafts I think it's shock loss and will grow back. Are you on any medication?

Take a look at my thread (which has pictures). You are right, grafts go further in the hands of top tier doctors. With a picture of your current hair and an idea of the proposed hairline, it'd be easier to give a view. That said, even with elite doctors, I've never seen a Norwood 5a get full coverage with 2000 grafts - it's just too large an area regardless of how optimal the placement is. Given an average patient, I'd say 5-6k is average, 4k is 'good', 3k 'absolute minimum but probably not full coverage' and 2k for hairline and mid scalp.

Agreed. My 3100 was low for a 5a. Did he address hairline and crown or are you expecting a second procedure?

For weeks not years, surely?

I'm confused. Surely transplanted grafts are just as robust as native hairs? Why would vitamins damage hairs (and if they do, why recommend Biotin)?

Some very lucky people don't shed their grafts at all and so do get growth from day 1. I had quite a few survive. At 6 weeks a previously bald area looked like this: You can see some have tiger stripes (they just continued to grow) and others have already started to grow, albeit without pigment and/or thin. Hopefully you'll be one of the lucky few too!

Definitely some of the reason the graft count was relatively low. The mix of density and selection of follicular unit counts was carefully considered too. We'd originally planned to use a little more on the crown but towards the end of the day the anaesthetic was becoming less effective so we had to call it a day.

Here's the day afterwards showing placement. As you can see, the grafts were placed at different density in 3 areas from front to back.

It's voodoo as far as I can tell. With a large head and the extent of the loss, I've no idea how he did it. Will post a photo after the surgery later. Even after a year I have an itchy head where hairs are breaking the scalp (I assume just thickening up), and it's looking denser. This is me today under a harsh overhead electric light...

Thanks Adam! The clinic have been great, starting with you calming me down on the day of the procedure just about a year ago. I'm due to come back at some point soon for my annual check up so I can say thank you in person when I do 🙂

The good news is that donor area looks untouched - plenty of scope there for your second surgery. Are you taking may medication to strengthen your existing hair? I'd say you didn't have a fantastic survival ratio, but it your hairline looks solid and frames you face. Perhaps your fine hair is also a larger contributor to that. I personally had 3100 grafts around the same time and also covered a large area with good resultant density. The clinics you've listed are much better than your first list. Eugenix are a forum favourite for high Norwoods. Would you consider using beard/body hair in combination with scalp?

The results I've seen from Dr Arshad in 2022 have all been very good. Given I was a Norwood 5a, Im amazed at the density he managed to achieve from 3100 grafts so absolutely no concerns from me.

I'm doing ok - if you look at my profile you'll be able to see pictures of my hair from yesterday. I would say that the non surgery options are good to consider first. However, hair vitamins and the like are (in my opinion) not likely to lead to any significant improvement. The only FDA approved treatments are minoxidyl and finesteride. Worth researching them both. Best of luck with your journey and research.

Should also say, your donor area does look relatively thin, especially on the sides. It may be they considered taking from the back of the head mainly to avoid over harvesting, and thus reducing the available follicular units.

Your loss looks headed towards where I was before surgery (NW5). My advice would be to consider getting on finesteride immediately and seeing how you respond over 6-12 months. Id say the graft count they quoted is conservative, but probably sensible; using 2k for frontal third is likely to give good density and the best use of those grafts for an aesthetic improvement. In terms of overall doner capacity, they'll know better than us, having examined your hair, but you would hope more would be available for a second surgery later. How you respond to finesteride will also contribute to the health of your existing hair, ans number of grafts usable.

Thanks Melvin. I had quite a large amount of shockloss in the recipient area due to the weakness of the hairs. I had miraculously early growth though - fine hairs after just 5 weeks. It grew steadily over the year and fortunately I'm still seeing growth in the crown.

Hi, I'll post my journey in more detail later (since the surgeon and team need a lot of credit) but since Im approaching a year post surgery I was reflecting on the difference the procedure had made to my appearance, and thought I'd post to get some feedback from others. I was a Norwood 5a so as a first surgery we focussed on the hairline and midscalp with a smaller number in the crown. Given my age and extent of my loss, we also decided on a fairly conservative hairline. Im unsure whether I'll opt for a second surgery (and if I did it would be for density in the crown and maybe a tidy up at the front to pack the grafts a little). Here's me looking pretty sad about the situation just before surgery: And a couple from the past few weeks: Hairline in bright light:

I had growth at about 6 weeks. They didn't have the diameter or colouring of mature hairs though... Everyone is different and there isn't a correlation between when growth starts and the yield, afaik.

OP: have you tried topical medication or just oral? For those sensitive, it's sensible to try a reduced dose of fin, or apply it topically. As others have said, medication in some form is usually needed unless you're prepared to continue chasing your loss with multiple surgeries