Dr. Paul Rose

I believe that the appearance can be enhanced and made to look far more natural. As was pointed out your donor area may be lack adequate density. It is difficult to assess from the pictures. Similarly it is important to know what your expectations are and what could be accomplished I would suggest consultations with several physicians before deciding on a course of action.

After having a session of follicular unit grafts it may be four or five months before the hairs BEGIN to grow. The full result may not be seen for nine to twelve months. I know it is difficult but try to be patient

Just a few things to add: Avoid aspirin or aspirin like products such as advil,motrin,naprosyn,(non steroidal anti inflammatory drugs)Your dr should give you a least of drugs to avoid for several weeks prior to the HT. Avoid alcohol for a week before surgery Avoid vitamin E, garlic,St John's Wort I advise removing sutures in7-12 days. Longer than that and the sutures/staples are likely to become embedded in the skin

A good HT can be undetectable. This is especially true for individuals with light color hair and a fair complexion.Follicular unit transplantation allow us to achieve remarkably natural results. Individuals with dark hair and light complexions are more diffcult. You are correct that the coarseness of the hair plays a role but we can pick out the finest hairs to place at the temples and frontal hairline. We can if necessary slightly injure a part of the hair follicle to create a finer hair. It is also important to create gradations in density,undulate the hairline, place appropriate caliber hairs in certain areas and place some hairs outside the hairline to create a natural appearance.

I'm a bit confused about what you mean by a Norwood 5 without crown balding. A norwood 5 or 5a has a fair amount of crown balding. I will try to approach the problem a little differently and hopefully answer youe question. First let me point out that at birth most people have about 80-100 follicular units per sq cm. To see thinning/baldness the density has probably diminished to 40-50 fu per sq cm. In most men the frontal region measures about 90-110 sq cm. Assuming that the area is 100 sq cm we would probably suggest transplanting 2000+ grafts in an initial session.This would give a density of 20fu per sq cm which would be fairly thin. In some men with light colored hair that is coarse,curly or wavy such a density might make them happy.Most men will choose to have a second session to reach a density of at least 40 fu per sq cm.This density often offers adequate density as their is a high degree of camouflage from the shingling of hairs as well as gradients of density that can be constructed. In some instances, especially patients with darkhair and light complexions, a third session of perhaps 1000+ grafts may be desired. As noted in previous posts a great deal depends on hair characteristics such as caliber,color,texture etc.Of course patient expectations must be taken into account as well.

To a large extent I think that you are correct. Nevertheless any surgical procedure should not be taken lightly.Their are risks to any surgery. Seemingly wasting,several thousand dollars would not feel too good either. Fortunately the techniques we utilize today are very reliable.Assuming that a person is in good health, follows pre and post op directions etc one can expect a very succesful result.

Judging from your pictures I think that you may be closer to a Norwood III.I recommend that young patients like yourself consider using Propecia/Rogaine in an effot to stop the hairloss process. You may notice some regrowth and be able to forego a HT if you are happy with the results. If after at least 6-9 months of use you are still concerned about the frontal area, I would consider HTs. I would caution you to be very conservative. As I have written to others with a similar concern you need to concentrate on the frontal area, keep the surface area as small as possible and keep the hairline relatively high. You need to be thinking about where you might be in twenty or thirty years.You want to be in a position to use the avilable donor hair for the highest priorities.It is best to be prepared for a worst case scenario. I suggest a consultation where your family history and medical history can be reviewed and a physical exam can be performed.

To my knowledge there is no study that has been undertaken to answer this question. My personal feeling is that you should be fine

I know that it can be very discouraging for a patient to experience shock loss and apparently lack of growth. 5 months is too soon to judge. Sometimes we don't see the full results for a year or more. The fact that you smoke and take various medications may play a role in delayed growth and possibly diminished growth but again it is too soon to tell. I would suggest considering using Rogaine and Propecia. Things will probably be fine. Try to be patient and discuss the situation with your physcician.

There shouldn't be a problem with taking the Propecia and utilizing a hair piece. A problem can occur when a person uses adhesives or clips in an area and the hair is continually pulled out.

The hairs obtained by Follicular Unit Isolation should grow just as well as hairs obtained by strip harvesting. A concern occurs with the rate of transection.The rates of transection can be higher than with strip harvesting. If one is implanting transected hairs the survival rate and caliber of hair may be diminished

Dr Beehner did a nice job discussing the differences between types 5 and 6. Before considering transplanting the front and crown it is important to assess the donor area. Although most type 5 and 6 patients are good candidates for HT not all of them can achieve complete coverage of the balding areas. In general I recommend concentrating on the frontal one third to one half of the scalp.Once the patient is satisfied with the frontal area it may be reasonable to do work in the crown. It is important that you consult with a hair replacement surgeon who will evaluate your situation, assess your hair characteristics and general health.The surgeon should be able to tell you if your goals for hair replacement can be reached and how to proceed

I don't think that 26 is too young to consider a HT. That said it is important to be conservative. By this I mean keeping the hairline relatively, focusing on the frontal area and limiting the surface area to be covered.You want to avoid transplanting the crown, at least for the time being. It is crucial to plan for the future and do everything possible to conserve donor hair.You don't want to be in a situation 20 years from now where you need to restore the front but lack donor hair.Similarly you don't want to have transplanted the central crown only to find that the hair has receded from the sides, leaving a "bull's eye" appearance. Propecia can certainly help decrease the rate of hairloss and it is a useful adjunct to HTs. Rogaine 5% is also helpful and can be used in conjunction with Propecia.

In rare instance there can be a raised area around single hair follicles. When it occurs it is only evident when light is reflected from certain angles and occurs with hairs that are very coarse and dark. I beieve that this may result from a couple of causes. There may be an inflammatory process followed by microscopic fibrosis (scarring). The situation may occur when the follicle is implanted perhaps high in the skin. I believe that the indentation mentioned by Dr McClellan is essentially pitting and occurs when the hair is placed too deep or the recipient site is too large allowing the skin edges to collapse inward.The grafts must be placed at the appropriate height to avoid this problem.Again if it occurs it is more pronunced in those with dark hair.This also relates to reflected light.

I have had some patients who have experienced a temporary increase in hair loss when starting propecia.This may be due to the change in cycles of the hairs;more hairs may be changing over to the growing cycle and so the hairs in the resting or end part of the cycle are extruded in greater number initially. That said I find that that propecia is very effective in limiting hair loss in most men.

If destroying the hairs is not a concern then I would consider raising the hairline by removing the grafts with a laser.This can be very successful and if done correctly will not leave scars.Some of the hairs may miniaturize providing a very natural transition. Patients with dark skin may have some pigmentation problems depending on the laser utilized. It is also important to avoid tanning before and after treatments. The laser systems work best with dark colored hair as the laser wavelength is selected to be absorbed by melanin (pigment).The most effective lasers seem to be diode lasers or alexandrite lasers Blond, grey or white hair is difficult to treat We recently did this for a patient who had a very "pluggy" hairline. He was also scheduled to have additional grafting to make the hairline more natural. He was extremely pleased with the results; so much so that he felt the we had achieved the natural appearance he wanted without having to do any more grafts Alternatively one could remove the follicular units surgically (probably with a small punch)and reimplant them in another area. There may be a potential problem with scarring. .It may also be possible to perform a forehead lift and remove the grafts in an excision. A scar would be created but I believe that it could be minimal. A sufficient number of grafts could be placed in the scar and in front of it for camouflage .

I believe that it is ethical to perform a HT in a patient who is 25 years old as long as one takes into account several things and follows a conservative course. It is important to get a sense of the "worst case scenario"; how extensive will the balding be? Is there enough donor for the future? Is the patient on Propecia/Rogaine and can you expect him to continue? What are the patient's expectations? Be very conservative. Keep the hairline high and don't overcommit too many grafts. Educate , educate, educated the patient so that he know the risks. Explain the logic of transplanting the frontal area and not the crown.