GratefulHead

Since I was interested in quantifying the improvement from my hair transplant (and I'm an engineer by trade), I attempted to calculate my post-op hair density increase. I'm sharing my methods here for those of you who are technically minded and would like to do the same. One disclaimer right up front is that these are very rough approximate calculations! More exact calculations would require additional scalp/hair measurements, a little gradient calculus, and more computation time on my part. The rough calculations presented here are good enough for my purposes and are vastly more meaningful than just qualitatively saying "my hair looks better after my transplant than before". It also will give those who recently underwent a transplant something quantitative to look forward to (and to keep busy with ) while they are in the long multi-month waiting period. Lastly, it should help people set realistic expectations for a given graft count transplant. Note: These calculations were actually performed with 12+ significant digits of precision carried all the way through, but all results (both intermediate and final) shown below are rounded off for simplicity/readability. This explains why you will obtain slightly different answers if you attempt to check my calculations using the intermediate rounded-off values. Without further ado, on to the calculations... AREA OF THINNING/BALD SCALP: ---------------------------- Since I'm approaching a Norwood 5A, I have an elliptical (that is, oval) thinning zone incorporating my front, midscalp, and vertex (a.k.a. crown). The length of my thin area "major" and "minor" ellipse diameters, d1 and d2, are 16cm and 10cm, respectively. Since a radius ® is defined as half a diameter, r1 = 8cm and r2 = 5cm. Finally, the area of my thinning ellipse (approximating to be planar) is r1 x r2 x Pi = (8cm)(5cm)(3.14159) = 125.7cm^2 (or centimeters squared). AREA OF DONOR STRIP: -------------------- My donor strip was an approximate 26cm x 1.2cm hemi-ellipse. A hemi-ellipse is like an oval with two sides somewhat flattened straight. Given the available measurement data and based on Dr. True's estimate, I will assume the middle 22cm of the hemi-elliptical donor strip is a rectangle and the last 2cm on each end are both "half-ellipses" (in actuality the strip is curved a little like a banana). Hence, the center rectangle of the donor strip is 22cm x 1.2cm = 26.4cm^2. Furthermore, putting both of the end 2cm half-ellipses together makes roughly a whole ellipse (or oval) with a major diameter of d1 = 4cm and a minor diameter d2 = 1.2cm. Thus, from before radius r1 = 2cm and r2 = 0.6cm. Then, the area at the ends of the donor strip is about (2cm)(0.6cm)(3.14159) = 3.77cm^2. Next, the total donor strip area is sum of the center rectangle and end half-ellipses or 26.4cm^2 + 3.77cm^2 = 30.17cm^2. To complicate matters even further, the donor region is stretched around 10% - 20% by injecting fluid to lift the skin away from the skull before excising it out. So finally we can conclude the original unstretched donor area is say 80% of the removed donor strip just computed or (30.17cm^2)(0.8) = 24.14cm^2. DONOR DENSITY: -------------- Of my 1503 follicular-unit grafts, 765 were single-hairs (51%), 541 were double-hairs (36%), and 197 were triples or rarely quadruples (13%). This adds up to 2458 total hairs (assuming 20 quadruples) and averages to 1.64 hairs/follicular unit graft. Since a typical young person has around 2.1 hairs/follicular unit, I am 22% below average density. The unstretched donor density is 1503 grafts / 24.14cm^2 = 62.27 grafts/cm^2 (verses a typical 80 - 120 grafts/cm^2 you are born with). However, people with fairly coarse hair like myself typically have lower density. The waviness of my hair is another offsetting factor. Lastly, 62.27 grafts/cm^2 x 1.64 hairs/graft = 101.84 hairs/cm^2 on average in the original unstretched donor area. Consistent with the above numbers, a typical young person has 168 - 252 hairs/cm^2. RECIPIENT DENSITY: ------------------ If I apply my average donor density over the entire recipient area, we have 101.84 hairs/cm^2 x 125.7cm^2 = 12,798 hairs originally before thinning. If I estimate my overall progressive thinning left 30% of my original hair on average, we obtain 12,798 hairs x 0.3 = 3839 hairs before my first transplant. If we assume a 98% graft survival rate (my personal estimate), we see 2458 transplanted hairs x 0.98 = 2409 net hairs are added to the recipient area. 2409 transplanted hairs / 3839 "before" hairs = 62.7% increase. (2409 net hairs added + 3839 "before" hairs) / 12,798 "original" hairs = 48.8% of original hair is now present after first transplant. Since a typical rule of thumb is hair loss isn't very noticeable until the density drops by 50%, I shouldn't be too far from appearing follicularly full after the transplant completely grows in. This may be deceiving, however, when one considers that my original thinning was asymmetrical (uneven) and my transplant was heavily weighted towards the front (around 25 grafts/cm^2) and thinner areas as opposed to the midscalp/vertex and higher density areas. From a high level, approximately 800 grafts were placed in the front and around 700 in the midscalp/vertex area. Hence, I will surely have a thinner midscalp/vertex area and a thicker front region and will likely require another transplant to improve density in some places. Dr. True told me "further treatment (would be) needed to add density..." at my consultation. At 6.5 months out from my transplant, I do indeed have full-coverage, but with the expected thin look on my midscalp and vertex. Aesthetically, I would say my hair appearance agrees with these calculations and looks 2/3'rds better (without camouflage) than it did pre-transplant. With the aid of Toppik, I have the appearance of pretty much full normal density. This is SOOO AWESOME to me because I haven't had that look for a good 7 years!! I invite you to extend and improve the calculation techniques presented here by employing densitometry measurements, accounting for density gradients, approximating 3-dimensional recipient/donor surface areas, and any other accuracy enhancement you feel so inclined to pursue. Some doctors would probably do well by improving and automating these calculations in a spreadsheet (i.e., Excel) and offering these "rough estimates" to their clients with appropriate unpredictability disclaimer statements. I hope this append is understandable and will be useful to some of you for planning purposes. GratefulHead [This message was edited by GratefulHead on December 19, 2003 at 08:10 PM.]

Since I was interested in quantifying the improvement from my hair transplant (and I'm an engineer by trade), I attempted to calculate my post-op hair density increase. I'm sharing my methods here for those of you who are technically minded and would like to do the same. One disclaimer right up front is that these are very rough approximate calculations! More exact calculations would require additional scalp/hair measurements, a little gradient calculus, and more computation time on my part. The rough calculations presented here are good enough for my purposes and are vastly more meaningful than just qualitatively saying "my hair looks better after my transplant than before". It also will give those who recently underwent a transplant something quantitative to look forward to (and to keep busy with ) while they are in the long multi-month waiting period. Lastly, it should help people set realistic expectations for a given graft count transplant. Note: These calculations were actually performed with 12+ significant digits of precision carried all the way through, but all results (both intermediate and final) shown below are rounded off for simplicity/readability. This explains why you will obtain slightly different answers if you attempt to check my calculations using the intermediate rounded-off values. Without further ado, on to the calculations... AREA OF THINNING/BALD SCALP: ---------------------------- Since I'm approaching a Norwood 5A, I have an elliptical (that is, oval) thinning zone incorporating my front, midscalp, and vertex (a.k.a. crown). The length of my thin area "major" and "minor" ellipse diameters, d1 and d2, are 16cm and 10cm, respectively. Since a radius ® is defined as half a diameter, r1 = 8cm and r2 = 5cm. Finally, the area of my thinning ellipse (approximating to be planar) is r1 x r2 x Pi = (8cm)(5cm)(3.14159) = 125.7cm^2 (or centimeters squared). AREA OF DONOR STRIP: -------------------- My donor strip was an approximate 26cm x 1.2cm hemi-ellipse. A hemi-ellipse is like an oval with two sides somewhat flattened straight. Given the available measurement data and based on Dr. True's estimate, I will assume the middle 22cm of the hemi-elliptical donor strip is a rectangle and the last 2cm on each end are both "half-ellipses" (in actuality the strip is curved a little like a banana). Hence, the center rectangle of the donor strip is 22cm x 1.2cm = 26.4cm^2. Furthermore, putting both of the end 2cm half-ellipses together makes roughly a whole ellipse (or oval) with a major diameter of d1 = 4cm and a minor diameter d2 = 1.2cm. Thus, from before radius r1 = 2cm and r2 = 0.6cm. Then, the area at the ends of the donor strip is about (2cm)(0.6cm)(3.14159) = 3.77cm^2. Next, the total donor strip area is sum of the center rectangle and end half-ellipses or 26.4cm^2 + 3.77cm^2 = 30.17cm^2. To complicate matters even further, the donor region is stretched around 10% - 20% by injecting fluid to lift the skin away from the skull before excising it out. So finally we can conclude the original unstretched donor area is say 80% of the removed donor strip just computed or (30.17cm^2)(0.8) = 24.14cm^2. DONOR DENSITY: -------------- Of my 1503 follicular-unit grafts, 765 were single-hairs (51%), 541 were double-hairs (36%), and 197 were triples or rarely quadruples (13%). This adds up to 2458 total hairs (assuming 20 quadruples) and averages to 1.64 hairs/follicular unit graft. Since a typical young person has around 2.1 hairs/follicular unit, I am 22% below average density. The unstretched donor density is 1503 grafts / 24.14cm^2 = 62.27 grafts/cm^2 (verses a typical 80 - 120 grafts/cm^2 you are born with). However, people with fairly coarse hair like myself typically have lower density. The waviness of my hair is another offsetting factor. Lastly, 62.27 grafts/cm^2 x 1.64 hairs/graft = 101.84 hairs/cm^2 on average in the original unstretched donor area. Consistent with the above numbers, a typical young person has 168 - 252 hairs/cm^2. RECIPIENT DENSITY: ------------------ If I apply my average donor density over the entire recipient area, we have 101.84 hairs/cm^2 x 125.7cm^2 = 12,798 hairs originally before thinning. If I estimate my overall progressive thinning left 30% of my original hair on average, we obtain 12,798 hairs x 0.3 = 3839 hairs before my first transplant. If we assume a 98% graft survival rate (my personal estimate), we see 2458 transplanted hairs x 0.98 = 2409 net hairs are added to the recipient area. 2409 transplanted hairs / 3839 "before" hairs = 62.7% increase. (2409 net hairs added + 3839 "before" hairs) / 12,798 "original" hairs = 48.8% of original hair is now present after first transplant. Since a typical rule of thumb is hair loss isn't very noticeable until the density drops by 50%, I shouldn't be too far from appearing follicularly full after the transplant completely grows in. This may be deceiving, however, when one considers that my original thinning was asymmetrical (uneven) and my transplant was heavily weighted towards the front (around 25 grafts/cm^2) and thinner areas as opposed to the midscalp/vertex and higher density areas. From a high level, approximately 800 grafts were placed in the front and around 700 in the midscalp/vertex area. Hence, I will surely have a thinner midscalp/vertex area and a thicker front region and will likely require another transplant to improve density in some places. Dr. True told me "further treatment (would be) needed to add density..." at my consultation. At 6.5 months out from my transplant, I do indeed have full-coverage, but with the expected thin look on my midscalp and vertex. Aesthetically, I would say my hair appearance agrees with these calculations and looks 2/3'rds better (without camouflage) than it did pre-transplant. With the aid of Toppik, I have the appearance of pretty much full normal density. This is SOOO AWESOME to me because I haven't had that look for a good 7 years!! I invite you to extend and improve the calculation techniques presented here by employing densitometry measurements, accounting for density gradients, approximating 3-dimensional recipient/donor surface areas, and any other accuracy enhancement you feel so inclined to pursue. Some doctors would probably do well by improving and automating these calculations in a spreadsheet (i.e., Excel) and offering these "rough estimates" to their clients with appropriate unpredictability disclaimer statements. I hope this append is understandable and will be useful to some of you for planning purposes. GratefulHead [This message was edited by GratefulHead on December 19, 2003 at 08:10 PM.]

Mahair, My doctor (True) gave instructions to use "Head & Shoulders for Oily Hair" as part of my post-op care. Even though I tend to side more on dry hair, I followed his instructions and didn't have an issue. I continued to use up the whole bottle for months afterwards since it is mild enough to use everyday. It worked fine and I plan to do the same thing for my second transplant. I don't know if you have let your scalp get over exposed to the sun/UV or not, but that would definitely be something to avoid! You need to be patient during your healing and regrowth phase until you see your final result. Getting all worked up and fretting before then will acomplish nothing positive. Once a good 9 months has gone by, evaluate what needs to be done to improve your appearance, form a plan, and carry it out. I wouldn't get a second repair-type transplant before 15 months personally. I hope things get progressively better and better for you. Peace. GratefulHead

Hi Rooster75, I experienced a very similar scab period back in June 2003 as you are now. It's good you quickly realized all is well. The only thing I want to add (if you don't already know) is soaking your head for 20 minutes in a warm bath once a day and/or applying baby oil before going to bed can both aid in shedding the scabs. Also, avoid any prolonged scalp exposure to the sun for a good month or so to prevent recipient skin damage/discoloration. You probably know all this already. Happy healing and future growing! GratefulHead

Nike, Does Rogaine make your scalp real itchy? If it does or if you don't see yourself dealing with the hassle of applying it twice a day over the long-term, I would stop using Rogaine and put the money you save toward other hair appearance improvements. Even when it does work, Rogaine only grows peach-fuzz type hair for the vast majority of people. Second, I would go see your general doctor and talk to him about prescribing Proscar (1/4 tablet per day = 1.25mg Finesteride). This is the FDA approved DHT blocker of choice. It can and does thicken up peach-fuzz type hairs into normal thickness hairs and helps maintain whatever hair you still have. This is key for a young guy like yourself who is experiencing early hair loss. Stay on this every day for at least 12 months and then evaluate the effectiveness. Taking before and after pics under the same conditions might help you make a more unbiased judgement of the results. Third, consider trying Toppik as a camoflauge. This is one of the best ways to immediately improve your hair's appearance. Lastly, if after 12 - 18 months of using Finesteride and researching about Hair Transplants you are still bent on getting one, go to a top all-follicular unit Doctor and get a consult. If you decide to go forward, the time you were on Finesteride will have thickened up your hair... which is one of the best things you can do to limit shock loss. I'm 6 months out from 1500 FU transplants by Dr. True and am quite pleased thus far. Click on the little index card / person icon above and then select "View Recent Posts" to hear a little more about my story. I would not get a hair-piece ever! Again, take the money you save by not buying/maintaining a hair piece and spend it on other hair remedies. I provide the above advice based on my own personal experience and learning. Oh yeah -- and it doesn't hurt to pray about every decision along the way. Serious. May your hair prospects and future be bright. GratefulHead

I had 1500 FU grafts (800 in front and 700 in crown/vertex) transplanted with Dr. True in June 2003 and five months out I am happy with the results to date. I was progressing toward a Norwood 5A with thin coverage over the whole top of my head (non-uniform 20%-40% my teenage density) and the right-side of my front hair line was super-thin. Since I have dark brown hair and a somewhat fair complexion, I had A LOT of see-thru under good lighting. My donor density was below average, but I have the positive qualities of coarse and wavy hair. Dr. True is a skilled doctor who took the time to answer my MANY technical questions -- all to my satisfaction. My procedure took a little under 9.5 hours and resulted in hardly any pain. I do like their computerized-wand anesthesia injection system. I took one day off from work and worked from home / remotely for another week. I went to a wedding 8 days after my surgery and with a little help from DermMatch and Toppix to cover the lingering scabs and redness, NO ONE NOTICED A THING. Even more so, I went to a party after the wedding reception with a whole different circle of friends and they didn't notice either. I WAS STOKED! I had my typically short hair-cut at the time (about 3/4 inch) and even the shaved donor area and sutures were unnoticable (dark brown sutures to match my hair). I did get considerable swelling from about day 2 to day 4 post-op. Although I slept with my head elevated and tried to ice twice an hour, I may have slid down too far one night and waited too long between some ice applications. Since then, I've let my hair grow longer than in recent years and I'm still using Toppix, but my (5 months post-op) hair looks like a good thick head of locks. Dr. True does not dense pack hair and hence I don't expect to have "teen" thick hair after one procedure without any camo. He told me up front a second procedure would be needed to improve density. From everything I've read, this is the standard for hair transplants. Although I've seen some impressive high-density pics, I personally would prefer a non-high density transplant to ease the trauma on all my existing hair. For the first 3-4 months, all you got is your existing hair and you don't want to over-traumatize it into excessive shock. Getting a hair transplant is a serious decision and one of the best things you can do to become informed is to read all the forums here on applicable topics, read published hair restoration papers, and look at before/after results for a given number of FU grafts. You will have to weed out some of the hype, but doing this research will help you develop a balanced, realistic set of expectations. Overall, it has been a positive experience for me with Dr. True so far. I do not have any regrets at this point. I've gotten considerable positive remarks and inquiries about my hair over the last 6 weeks, but no one knows the real deal except one close friend who I decided to tell. I wish you the best in your hair improvement efforts. GratefulHead [This message was edited by GratefulHead on November 10, 2003 at 06:20 PM.]

I had 1500 FU grafts (800 in front and 700 in crown/vertex) transplanted with Dr. True in June 2003 and five months out I am happy with the results to date. I was progressing toward a Norwood 5A with thin coverage over the whole top of my head (non-uniform 20%-40% my teenage density) and the right-side of my front hair line was super-thin. Since I have dark brown hair and a somewhat fair complexion, I had A LOT of see-thru under good lighting. My donor density was below average, but I have the positive qualities of coarse and wavy hair. Dr. True is a skilled doctor who took the time to answer my MANY technical questions -- all to my satisfaction. My procedure took a little under 9.5 hours and resulted in hardly any pain. I do like their computerized-wand anesthesia injection system. I took one day off from work and worked from home / remotely for another week. I went to a wedding 8 days after my surgery and with a little help from DermMatch and Toppix to cover the lingering scabs and redness, NO ONE NOTICED A THING. Even more so, I went to a party after the wedding reception with a whole different circle of friends and they didn't notice either. I WAS STOKED! I had my typically short hair-cut at the time (about 3/4 inch) and even the shaved donor area and sutures were unnoticable (dark brown sutures to match my hair). I did get considerable swelling from about day 2 to day 4 post-op. Although I slept with my head elevated and tried to ice twice an hour, I may have slid down too far one night and waited too long between some ice applications. Since then, I've let my hair grow longer than in recent years and I'm still using Toppix, but my (5 months post-op) hair looks like a good thick head of locks. Dr. True does not dense pack hair and hence I don't expect to have "teen" thick hair after one procedure without any camo. He told me up front a second procedure would be needed to improve density. From everything I've read, this is the standard for hair transplants. Although I've seen some impressive high-density pics, I personally would prefer a non-high density transplant to ease the trauma on all my existing hair. For the first 3-4 months, all you got is your existing hair and you don't want to over-traumatize it into excessive shock. Getting a hair transplant is a serious decision and one of the best things you can do to become informed is to read all the forums here on applicable topics, read published hair restoration papers, and look at before/after results for a given number of FU grafts. You will have to weed out some of the hype, but doing this research will help you develop a balanced, realistic set of expectations. Overall, it has been a positive experience for me with Dr. True so far. I do not have any regrets at this point. I've gotten considerable positive remarks and inquiries about my hair over the last 6 weeks, but no one knows the real deal except one close friend who I decided to tell. I wish you the best in your hair improvement efforts. GratefulHead [This message was edited by GratefulHead on November 10, 2003 at 06:24 PM.]