Approach

29 minutes ago, wallie12345 said:

It's worth a shot but I don't have any donor area/hair left and I regret having those past HT's.  

Wallie, until you have a consultation with the top Norwood 7 doctors, you will never know.  Things have advanced since you scalp reduction 20 yrs ago.

On 5/10/2024 at 3:45 AM, Rasputin said:

Probably a class 6 max on the precise scale.

Looks like you have a more than decent donor area. With the beard grafts, I have no doubt the result 

I'm guessing his Density will end up great. Although I don't know how physically large his head is, 11,291 grafts for a NW "6" seems significant.  Looking forward to seeing his final results!

This may seem off topic, but if any of you guys are considering weight-loss (GLP-1) type meds like Wegovi / Mounjaro /  Zepbound, etc I'd be interested in hearing your feedback as it relates to side effects related to hair.  Specifically:  Do these meds truly cause some hair loss?  A lot, or a little?   If a guy has a HT, then 3 years later begins taking one of these weight loss drugs - Will he likely lose some of his newly transplanted hair?  If nothing else-  if anyone is considering these meds, pls research side effects first.  

17 hours ago, Gatsby said:

Hair greed is real!!!! . Trust me as a Norwood 7 with a diminished donor and scars before my first procedure. 

This is a really dumb question, but:  What does hair greed really mean?  I may be mixing up the term.  Is it simply:  The desire to continue HTs one after another until all bald spots are covered?  Or, does it refer more to "density" of everything.  Thank you.

16 hours ago, Al - Moderator said:

This is really something that I think needs to be discussed with Dr Pitella probably just before and during the surgery because being a NW 7 with only a small amount of scalp donor and using lots of beard donor, you really don't know how dense you're going to be able to get even if you used up as much grafts as possible. You may have to decide at the time you're going through the process because some of this is going to depend on whether he will be able to get either more or less grafts than he estimated and if you need either more or less than he estimated. I'd let him be aware that you'd rather be more full in the frontal half and are willing to leave the crown low density if he can't get enough to give full coverage everywhere or if he reaches a certain amount of grafts due to your budget or because you want to save some for later or don't want to be depleted.

With that said, at 52 and a NW 7 I'm guessing you'd be thrilled to have a rather full front half even if you're still very thin in the crown. Be aware though that hair greed hits a lot of us and you'll probably eventually be wanting to go back for another session to try to get enough grafts to fill in the crown anyway, so keep that in mind.

 

Al -- thank you for your feedback.  A few points that you said stand out to me.  That is:   "You may have to decide at the time you're going through the process because some of this is going to depend on whether he will be able to get either more or less grafts than he estimated..."  And, your other point about "hair greed" helps.  Thanks for the heads up.  Apparently hair greed is a bigger point than I realized.  I will keep this tid-bit of info in mind.  Thanks again.  

On 5/4/2024 at 11:36 AM, Fox243 said:

I personally think a strong hairline with enough crown to just look slightly balding on the crown is better than full bald. I would make sure you can get a good hairline though as frontal framing is what people look at.

Thank you for your feedback Fox.  Each tid-bit of feedback from guys on this forum is really helping.

I am a very high NW. (My question is not about cost.) Do any of you believe the following approach is a good idea with a reputable surgeon like Dr. Pittella: 

The primary goal would be to add density to the frontal portion of my head and frame it age appropriate.  And, another goal would be to add a modest amount of density to the crown-- similar to pic below.  Do most of you think this is a viable option, or would you aim to have a full head of hair -- esp since it might be Dr. Pittella. (I'm 52 y/o male).

On 6/30/2023 at 9:50 AM, Scarhelp said:

I'm not sure of how many grafts that they recommended for me. I saw the price tag of $6,500 and I deleted the email and never responded. 

I am currently talking to Dr Stoller. He seems to have good reviews and a good reputation, and he did have a link on his site for my exact problem. I'm going to have to research him a bit more. If you know anything about him, please let me know. 

I would not touch the scar until you have a solid plan.  "If" you need further HT surgeries, definitely wait until then since they can do another strip to harvest donor hairs (then suture it shut nicely).

1 hour ago, bigmistake said:

Have you had a transplant previously ? 

Yes, 2 of them in the 1990's FUT

Melvin, I really appreciate your reply.  Indeed Dr. Pittella did explain all your points, and all points are truly valid! Thank you for reviewing the importance of setting realistic goals, and that ultimately it's up to "me".  It also helped that you reminded me: "Keep your expectations in check."  Thanks again!  I finally understand! 

PS) I now remember-- Dr. Pittella did speak to me about percentages of beard hair to scalp hair; and in my case the ratio would need to be closer to 50/50 due to my poor donor area.  

Thank you.  Fyi, Doctor P wants to use up all remaining donor hair.  (He said best case is 5,000 grafts.)  Then, he wants to take beard hair (on my face and under jaw line. (It's reasonable considering my poor donor area.) Estimated total grafts after surgery would be 10,0000 to 12,0000.  I sensed by our conversation that he isn't a big fan of body hair.  It's a last resort for him.  He explained that the growth cycle is different, etc.

On 4/8/2024 at 8:39 AM, Melvin- Admin said:

Personally, I wouldn’t do it. It depends, if you always shave and never wear your beard, then I guess you wouldn’t miss it. But I would not exchange my beard for hair on my head.

Also, the hair on your head will look like beard hair. There’s less blending with scalp hair. Beard hair works best when mixed with at least 70% scalp hair. Out of 10,000 grafts, only 3,000 from beard looks best. This will make it so the beard hair is almost undetectable.

Good point.  (My total grafts would be 10,000+)  (He said he would do his best to mix in the beard hair appropriately.)   Dr. P said to plan on removing a couple thousand grafts from back of my head.  However, he said he really wants to aim for closer to 5.000 grafts.  With that being said, this is nowhere close to the 70/30 rule you mentioned.  Sometimes it's confusing because:  Advice from knowledgeable guys like yourself makes sense.  So, why would a doctor push the envelope so far?  I think he's an awesome doctor, and I enjoyed talking to him.  But, I anticipated he would give me a yes/no answer.  Instead, he said:   If "you" (patient) wants a HT, then I'll perform it to the best of my abilities.  I asked him a few times:  But, do "you" (an expert surgeon) recommend I do it, based on your experiences, etc?  In the end, he said a 3rd procedure to fine-tune things and fill in any remaining areas would be the likely case.  So, in conclusion, I do believe that physically, Dr. P can get a full head of hair (especially because of a 3rd procedure - maybe even mixed with body hair). But, one good thing is:  he seemed confident I would be pleased.  He showed me pictures of other patients' he did like my case. *(PS - he said some guys are willing to do anything to get hair on top of heard - even if it's mostly beard hair/body hair as he has noticed improvements in self-esteem, etc.    Ughh, I wish I could pull this off with scalp hair only!

2 minutes ago, Berba11 said:

If I were in your situation - factoring in your age - I'd genuinely save myself the hassle and money. As I've said before, maybe what I'd do is look to have grafts placed into the FUT scars so that their visibility is reduced and you can wear a tighter buzz cut all over and move on with life. I'd also maybe look to have some of the old transplanted hairs punched out if they didn't quite look right buzzed down or they were bothersome in some way.

It really comes down to your propensity for risk; you'll be spending a lot of money on something that may end up disappointing you. This is a risk calculation that all HT patients make, but often their starting point is superior to yours, which mitigates some of that risk.

If anyone can get you at least somewhat close to where you want to be, it's Dr Pittella. You'd be in the best hands possible. Nevertheless, there's only so much that anyone can do in cases like yours so there is still more risk than usual. Would I want to take that risk on? I don't think so personally.

Thanks for your well-thought-out opinion.  It makes sense. I esp recognize your point about my "starting point" is not ideal / risk.  Thank again.

Did he use a lot of beard hair?

Via video consultation, Dr. Pittella said he can restore my NW 7 head.  He seemed confident.  There is a caveat though.  He said, although my donor area is poor, he estimates he can remove up to a few thousand grafts from the back of head.  As well, he will need to remove nearly every beard hair on my face & neck.  (He can leave enough hair to grow a goatee.)  Specifically, my question is:  If "you" were in a situation like mine, would "you" proceed or not? and *Why?   Thank you!  

I am interested too.

Here I go talking about temple points again (sorry)!  Any thoughts?

2 hours ago, KartikV said:

 

 

I have seen many bad reviews and results of Eugenix. 

Additionally, I have grade 7 baldness and I did not see any great result in NW 7 given by Eugenix. I already consulted Eugenix, they have given me different packages with different doctors, I don't know whether they are qualified and experienced enough to give me a good result. So Eugenix is not my choice.

Kartik -- it's great that you are thinking through things and doing research!  No offense whatsoever that you feel differently about my suggestion.  Your question asked about doctors in India, specifically.  Truly, there are great HT surgeons in all parts of the world though.  Gatsby and Melvin are great resources.  You may hear different opinions from members on the forum and that's ok!  Nothing personal.  Listen to each members opinions.  This will give you constructive way to compare and contrast.  

16 hours ago, KartikV said:

Hi Guys,

I am newbie here, want to know some best clinic in India for my hair transplant. I have a NW 7.

please suggest me best doctor with best price.

Thanks in advance

Welcome to HRN.  As with anything, I definitely wouldn't shop on price alone - especially for something as important as HT.  Take your time, talk to the guys on this site and meet doctors (in person when possible) for consultations.  There are great doctors all over the world, but to answer your question:   I've heard Dr. Sethi in India is a great doctor for NW 7 if you're a candidate.

2 minutes ago, LeonBlack said:

That is a concern with pushing the limits…. as stated above time will tell. 

I realize time will tell.  I just wanted to be sure I understood clearly, ie, potential to fall out someday.  Thank you for clarifying.  

On 3/3/2024 at 12:33 PM, LeonBlack said:

incredibly impressive indeed…. but are you concerned about the longevity of the hairs from the outskirts of the dht-resistant safe zone? Is it fair to say we don’t yet know how this approach will go long-term?

Can you say more?  Is your point ---  Some of the newly transplanted hairs could eventually miniaturize and fall out?

5 hours ago, Melvin- Admin said:

These cases are super risky for the surgeon. I feel like maybe he should’ve been turned away. I’ve seen cases like this with Dr. Sethi and despite the best efforts, it’s impossible to achieve a super meaningful result. 

The key is realistic expectations. I would imagine most, if not all of the grafts are BHT. So even if he gets 10k grafts, thats more or less 10,000 hairs on an area that had 50,000.

It will be an improvement and a base to use fibers. But it won’t be a usual Pittella case, at least that’s my speculation. Given the quality of his donor. 

Interesting, Dr. Pittella and Dr. Zarev are the only docs I’ve ever heard talk about contraction. But perhaps this is the key to achieving these high numbers.

You are the voice of reason.  Well said!

4 hours ago, Berba11 said:

Fair enough. 
 

It’s borderline impossible to find hairs from anywhere else on the scalp that are as fine and soft as native temple point hairs. This means there will always be some kind of contrast between transplanted hairs and native hair in that area, especially at buzzcut length. When things are grown out everything blends very naturally however, which is true for HT’s in general - a bit of length helps everything!

Obviously the hairs selected need to be soft singles, and the angle and direction has to be nice and flush to the scalp to help the blending process. 
 

Lots of surgeons do temple points, though many only do subtle enhancements rather than full reconstruction of the temple points. 

Thank you for the thorough explanation.  I found it especially helpful you mentioned:  Subtle Enhancements (than full reconstruction).  I get it now.  Thanks again.

9 hours ago, Silent123 said:

Hey man. Where are you based? Temple point reconstruction is tough to get right. Do you have any photos? 

Hey Silent....I'm in Baltimore.  I'm not necessarily looking to have my temple points reconstructed.  I was just curious about the topic.  That's all.  It's interesting.

6 hours ago, laverita said:

It is not only the skill of cutting the site angles correctly and density and direction, they are usually under 15% and very flush. But, also choosing the right hairs, if you fill them with coarse occipital hair then don't expect a natural outcome. 

Thank you.  Good point about the angles.