Al - Moderator

Right now you have a good hairline for 31 years old. I wouldn't do anything as far as hair transplants right now. You have a good natural hairline and some thick hair. A hair transplant can make it worse as it probably won't look as natural. Enjoy your hair. You have more than most of us.

You don't look like you have enough hair loss for a transplant at this time. You should try taking finisteride if you aren't yet. You may benefit a lot from it as you still have a lot of hair.

The transplanted hair will last just as long as it would have lasted in the area that it was taken from. If it would have grown for the next 50 years if it wasn't transplanted then it will grow for 50 years after it's transplanted. 50+ years of hair transplants being done proves this.

What would make you think a NW 7 didn't go though the NW scale? All NW 7 men had a full head of hair at some point. They weren't NW 1 and then overnight become NW 7. Your thinking that they don't go from NW 5 to NW 6 and then NW 7 doesn't make sense. How else would they get there?? Look at the chart below. Work backwards. Doesn't it make sense that some NW 7s were NW6 prior to being NW 7? Doesn't it make sense that NW 6 was previously a NW 5? Of course! This NW chart below is basically how my pattern progressed. From everything I've seen over the years I think the men who get crown loss early on are much more likely to go through the scale towards a NW 7 than those who only get frontal loss early on. That makes sense to me because with frontal loss and no crown loss even if you are losing the entire front half you still don't have a crown that can open up and start creeping into the side to create that NW 7 steep side loss.

The first picture is 1989 in the chair ready for my first hair transplant. I don't have a picture from the side view, but you can clearly see my side hair goes very far up the sides of my head. The next picture is 1998. You can see the side hair line has moved downward considerable and is now moving past the top scars. Also note that the top scar was completely covered at one point with thick hair or else a strip would not have been taken from there. The next picture is around 2014

I'm in the same situation as the one posted. Why would you assume he had a rare underlying medical condition? I can tell you for myself I get a physical every year. At 53 years old I am not on any medication, I have normal blood pressure, normal cholesteral level, glucose under 100, everything else is in normal ranges except for biliruben which has always run a bit high, but was told last month at my physical that my kidneys are normal and my liver is functioning perfectly. You also say it's very clear whether or not someone is a NW5 or 6 final pattern even in the early to mid stages. I can tell you this is not true at all. My pattern just continued to expand over the years. When I was 17 I only had a thin balding area down the center of my head and a thinning crown. The sides and back were very thick. The center area continued to widen for the next 35 years. You are totally wrong on this.

Looks like it turned out really well.

Azza, Go to youtube and do a search for Dr Sanusi Umar Extreme Repair. You'll see what some people were able to have corrected. I didn't have work done by him, but I did have an online consultation and some follow up emails. I ended up going with Dr Dorin at True & Dorin in NY, but that was because it's not too far from me and they did not require me to shave my head which would have made it extremely hard to go back to work for a while.

I don't know about that. I never thought he wore a hairpiece. I combed my hair the exact same way when I was starting to lose my hair and I always had side recession too and never had an real temple points. I had thick forelock in the front, so I could comb my side part towards the front to cover the receding edges and then let the frontal forelock sweep sideways and back to cover the other side that was receding.

I don't see a problem with adding a few hundred grafts touch up at 11 months post op, but unless you're nearly at that point how do you know you need them? I guess it could be specific spots that weren't covered in the first hair transplant.

You are assuming the permanent zone is actually permanent, so with that you then assume that the reason for the hair loss must be because there is recipient dominance rather than donor dominance. The reason your conclusion is incorrect is because the "permanent" donor zone is not so permanent. This is one of the lies that all hair transplant Drs keep repeating. If they didn't say this then most of them would be out of business. Who would get a hair transplant knowing that the hair taken and placed on top may start falling out as soon as a year or two? Not many, I'd say. If the transplanted hair is falling out then the donor area hair is almost always falling out as well. You may not notice it because there is more hair in the donor than was transplanted. If you have 80 grafts per cm2 in the donor zone and take a strip of that and place grafts in the recipient at 40 grafts per cm2 you will then have basically 80 grafts per cm2 in the donor and 40 cm2 in the recipient. Now suppose you lose 30% of the hair in the recipient area over the next 10 years. You now have 28 grafts per cm2 in the recipient which looks obviously very thin. You will have also lost 30% in the donor zone too, but you will still have 56 grafts per cm2 there, so you may not even know yet that it's thinning. The result is it looks like you only thinned out in the recipient zone and not the donor zone.

I was thinking about this and here seemed like a good place to post this. I think a lot of men don't really understand the amount of grafts needed to fill in an expanding area or how one NW6 can differ from another NW6. I'm not even going to get into the hair shaft thickness or how much donor each one has. Let's assume two people both have the same hair type and donor quality and both are NW 6. Measuring my own head all around the side and back starting at one temple and going around the head to the other temple measures 35 centimeters. Let's assume these two men I mentioned are the same as that. However the first NW 6 has hair one centimeter higher up on the sides and back then the 2nd NW6. If they both go with 40 grafts per square centimeter the 2nd NW6 will need 1400 more grafts to get the same coverage that the first NW6 has because he has that additional 35 centimeters all around his head to cover. In addition to that, 40 grafts per cm2 is not very thick, so the 2nd NW6 will also probably look thinner even though he had 1400 more grafts placed because the first NW6 had maybe 80 grafts per cm2 in that same area, so he has more hair higher up on the sides and back to help with coverage even though the 2nd NW6 had grafts placed there. Now lets move on a few years later. The first NW6 was able to keep his balding area the same while the 2nd NW6 lost another centimeter all around. This means the first NW6 still looks great while the 2nd NW 6 needs another 1400 grafts just to get 40 grafts per cm2 in the area that the first NW6 still has 80 grafts per cm2. This also means the 2nd NW6 has a much more depleted donor area due to now using 2800 more grafts. Now remember both of these men were NW6 and had very similar hair loss patterns in pictures, but the number of grafts needed is much different EVEN WITH THE SAME DONOR HAIR QUALITY.

OK. There is a difference between full coverage and full density. Can you get full coverage? Sure if you are willing to go with a low density because anyone can get a lower density in order to cover a larger area. Is this the right way to go? That depends. Most people will go with higher grafts density in the front half and low density in the crown. That's usually possible, but again, depending on how much area you have to cover you still may be getting a rather low graft density in the frontal half. This can usually be satisfactory on older men who just want to get some coverage and look good for 60 something years old, but that amount of coverage would rarely be acceptable to someone at 30 years old. It all depends on where you are in life, how much hair you have, and what your goals are.

Azza, I remember your case from back in 2007 when you had your first hair transplant. I was just becoming a member then, but I was a lurker here since the forum started. I had a very similar experience as you and it has affected my entire life for over 35 years now. I started losing my hair at around 14 or 15. I had my first hair transplant in 1989 when I was 22. I was probably between a NW 5 and NW 6 at the time, similar to where you were. I wore a hair piece for a year before I started with hair transplants as I didn't want to have surgery, but the hair piece was a horrible experience and I would never do that again no matter how bad I look. When I had my first hair transplant I still had hair high up on the sides and thick sides and back. After each hair transplant, by the time the hair would start growing more hair than was transplanted had already fallen out and so I never got any actual improvement and kept chasing the loss. Eventually the hair loss started going past the FUT scars and all of the remaining sides and back began thinning, so all of the transplanted hair began falling out as well. I was looking really freaky with lots of visible scars and almost no hair left on top. They made a new FUT scar each session in those days, so I had about 7 or 8 rows of scars around the entire sides and back of my head. It just kept getting worse over the years. It's extremely hard to deal with. There was nothing I could really do. Some people told me I should just shave my head, but with all the scars that wasn't really an option as shaving wasn't going to make it look any better. It would look different, but not better. Over the years body hair grafts started being used and that finally gave me some hope of getting this mess fixed and being able to have a normal life without people constantly staring at my head and giving me strange looks. I've had over 4600 chest and beard grafts done so far and while it doesn't look like a full head of hair (yet) it does look much more normal as it just looks more like I have some thinning hair all over. I still want a lot more to get where I want to be because even now I'm not quite at the point where I started. I think one more session will finally get me back to where I was at around 20 years old when I first started this. Anything I get after that will finally be improvement.

I've had over 4600 grafts taken from my beard and chest. The scars are minimal and nobody can tell. For the beard they take grafts from the area under the chin, so it's not easily noticed anyway because the area is downward facing, so nobody really sees it. It also won't leave any more scars on your head because you won't be taking any grafts from there, so that makes it worth a try or at least worth considering and looking into.

If you have a good beard then you should really look into using beard grafts before trying to get more from the scalp donor area. Most people with decant beard hair can get several thousand grafts from the beard.

I took finisteride for about 11 years from 1998 to 2009. It may have helped a bit for the first few years, but I was definitely losing more hair after about the 5 or 6 year mark. By the time I got to 11 years of using it and seeing how much hair I had lost over that time there was no reason to continue with it. Besides I knew at that point that I had to eventually try using body hair grafts as they were just beginning to be used in some extreme repairs and the finisteride was thinning my body hair.

I like the new look with a bit of length on the sides better than the shaved sides look. I never liked the look of having a lot of hair on top and shaving the sides.

I slept in a recliner chair with a pillow under my neck for the first few days. I didn't get a whole lot of sleep, but it works.

On some men donor absolutely thins everywhere and it can make the hair transplant useless over time, although it may be very beneficial for some years until then. My donor area is much thinner now than it was 10 years ago. When I started having hair transplants I had at least two older relatives who had almost no hair at all on the sides of their heads. I was told that once the hair is transplanted it will grow forever and never fall out, so I tried to move as much hair as possible from my donor to my bald area because I knew it would fall out if I didn't move it when I was young. There was no way my uncle who was older than I was could get a hair transplant since he had no hair to work with. I didn't want to wait to be like that and then not be able to do it. I didn't know I was being lied to about how the donor grows after transplanting it.

Good news on myself though...Yesterday I had a family member ask if my hair was growing back in. I hadn't told any of them I was going for more hair transplants, so it was nice to hear someone was noticing an improvement without them ever knowing I was doing something.

If you think you are saving enough grafts for the future I can tell you that if you had a lot of transplanted hair placed on top then it will take a LOT of grafts to cover the lateral humps because if you only add a small amount it will still be thinner than the mid scalp and will still make you look like you have a balding ring around your head. You have to add enough to at least get somewhat close to matching the front and mid scalp to make it look natural. You also won't be able to comb it to the side unless you add a large number of grafts because you won't be able to make a part with thin hair and whatever amount you do comb over the top won't be much to cover anyway if your top/mid scalp is thin. This is coming from personal experience from someone who is going through this.

I know there are a number of men who go with the every other day routine to cut down on side effects, so I don't think it will significantly change your results.

Yep. Me too. I've trimmed my chest hair for years because it grows too long.

I don't agree with this because mine does grow long. This is why I think this approach doesn't make sense. You are transplanting twice for no reason.