TheHairLossCure

Barley,

Dr. Rose intermittently does consults in NYC. Currently, surgeries are done out of the Tampa office.

Bill,

"Guide" and "approximate" are the two key words, indeed!

IMO The system does work better with range you suggest (1000-1500) - for classes III, IV, V, and VI in particular.

It's usually not necessary to shave the recipient for less than 2,500 grafts, unless a) you require a high degree of dense packing or b) you have an enormous amount of existing hair.

I think you will find the shaving is not a requirement at most clinics for the session size you are talking about. You can add Dr. Rose to the list. I think the same still goes for the Shapiro bros as well.

You cannot multiply your Norwood class by 1,000 and get an appropriate number of grafts. This neglects issues like hair characteristics and patient expectations. I think 1,000 grafts for a Norwood I make no sense, nor does 2,000 grafts for a Norwood II. These patterns are not identified as hair loss patterns. 3,000 for a Norwood III? Maybe. But are we talking about a III, IIIa, or IIIv? It makes a big difference. See my point?

You referenced a Norwood VI getting a dramatic result with 2,000 grafts. It is totally possible if the grafts are used to build up a hairline/facial frame in bald area. This approach neglects the crown area, but the result from the front can be dramatic regardless.

Your case ??“ 2,500 grafts on a class IV ??“ sounds reasonable. More importantly you are pleased! Your density will impact the coverage IF your doc was refering to hairs/follicular unit.

Right on mtkneed.

Hair is not going to fall out in bundles if you stop taking medical therapy. To me that implies that you are worse off my taking medical therapy. If you take it, you will likely stabilize your pattern. If not, you will continue to lose hair. If you go on then get off, your pattern will progress to where it would have been had you not taken anything. I can't think of any situation where your hair is worse due to meds.

Wanthairs,

Without sounding too bleak, I know for a fact that there are a lot of patient that are not happy with their hair transplant results. Dr. Rose and many of the physicians that support this online community specialize in repair...and there is a reason for that.

On the upside, the readers and posters here generally know what to look for in a doc, clinic, procedure etc. That education clearly helps people make better decisions.

Don't get too disappointed. You don't necessarily have low density. Remember, even if your donor density is a bit below average, it is not the only hair/scalp characteristic that determines the quality of your results.

It has been my observation that Asians have lower follicular unit density on average, and therefore lower hair density. I am not sure about the averages in terms of hairs per follicular group, but it stands to reason that these averages may be lower as well.

Although it is rare, I have seen some results with medical therapy in the frontal area. If a patient is pretty much bald in the recessed areas, sometime they get some "Propecia fuzz." In other cases where the patient has weak and miniaturizing hair in the temples, the drugs can sometimes improve the hair shaft diameter, and thus improve the cosmetic coverage. Again, it is rare, but I thought I would mention it.

(A little off the topic of the posted link, but hopefully relevant...)

There are at least two types of unhappy patients. One type is unhappy because the surgical results are substandard. The second type is unhappy because the result, while good, did not meet their expectations. This raises the question ??“ why are some (good) results not meeting expectations? One reason is that the patient's expectation is too high based on information acquired outside of the clinic that did the surgery. Another reason is that clinic personnel may have lead the patient to believe that the result would be better in order to make a "sale." In either case, it is a big problem. Aside from doing great surgery, it is crucial that clinics honestly educate the patients, setting expectations in advance.

I think Calvinmd makes some good points about rationally weighting risk and reward. Ask a few transplant patients who are on Propecia how the side effects of medication compare to those of surgery. You need to recover from surgery - physically and cosmetically ??“ even with the best docs and techniques. This is usually not the case with medical therapy. Try to keep it all in perspective.

If Dr. Wolf does body hair transplants, I suspect they are very small part of his practice.

Unfortunately, I find that there is no hard line answer to how short your can clip you hair after a hair transplant. One thing I will say is that that curly donor hair helps to cover, conceal, and obscure donor scarring better than straight hair ??“ with STRIP and FUE. I think curly-haired patients are often able to get away with a shorter cut.

You should be able to cover the donor incision and, hopefully, explain away the pinkness in the recipient area. The temporary scabbing in the recipient would be the bigger issue. Longer hair comes in handy when you are initially trying to conceal the work. Unless you lay low, you really do run the risk of your lady friend finding out. The question is: Is that such a bad thing?

NM-

I think you are doing yourself a disservice by trying to quantify a "dusting" in terms of follicular grouping per cm2. Density does not equate to the quality of hair coverage since hair characteristics are variable.

The reason a Norwood 7 is difficult to treat is that more than half the hair on the scalp is gone. Therefore, even if you surgically removed every DHT resistant follicle from the donor area - leaving it bare - you would still have not have enough hair to fully restore the front, top, and crown. I think of this when I see class 7's with shaved heads, since the donor follicles are the only hairs that remain. If you "spread out" the hair mass from the narrow zone in back to all over the head, would it be enough? For a TRUE class 7, the answer is most likely no - not for overall cosmetic density, not for overall scalp coverage.

What is possible is isolated areas of coverage -as Pat and Dr. B suggest. If you and your surgeon opt for this sort of realistic approach, I think you can definitely further enhance the look with concealers like you propose.

Doing surgery at a young age without the boost of medical therapy can be a difficult proposition. When you do your consults, make sure the physicians knows you are not planning on taking meds as this will surely impact the treatment proposition.

BTW, if your hair loss is negatively impacting you mentally as you say, you might look at minox and Nizoral shampoo. They are not homerun treatments, but they can help. Just a thought.

Good find, Emu. This is a very definitive thread by Dr Shapiro. It nicely covers the trichophtyic variations of Rose, Frechet, and Marzola. Thanks.

Bverotti,

I am not starting an issue about speed. I couldn't care less, and I am not particularly concerned how you market your FUE. PJ made a point about the average extractions per hour and I was merely adding that doctors do not extract for the entire procedure.

It is reasonable to do 200 FUE grafts per hour in terms of harvesting. A few things should be noted: 1) the surgeon is the not harvesting for the entire surgery 2) the doctor, staff, and patient will need to take breaks. My point is that an 8 hours surgery (for example) is NOT likely to yield 1,600 FUE grafts, even if the surgeon is getting 200 grafts per hour.

Grafts tend to grow in a random and staggered fashion. This does not appear to be related to size. Single hair grafts are more fragile than multiples so, if anything, the singles might take longer to come in. But as far as I know, the size of the graft does not have a clear-cut relationship to the growth timetable.

Gorpy,

I second Bill - very natural looking work you got there.

mm,

"Bumps" and elevated scars are not attributed to the closures discussed in this thread. These problems are more associated with bad techniques and individual healing tendencies.

Consider taking some more photos of the front, top, back, and sides of your scalp. Send the photos to 5 or 10 clinics ??“ clinics you consistently hear good feedback about on this and of the sites. Multiple opinions are great because, while every doc will have a different recommendation, you will begin to see a trend. Hopefully you start to get an idea of what can be done for you and what to expect. Then it is just a questions which doc to go to.

Educate yourself first. Take advantage of the free resources you have at your disposal ??“ this research forum and free photo consults with reputable docs.

Dr. Rose's Ledge closure is a technique where he uses a scalpel to score the lower edge of the strip incision. He uses a scalpel to cut the epidermis at a 1 mm depth. This method is very accurate as a scalpel can be used to pick the follicles to be included or exclude. Also, a true right angle is created. Some physicians use scissors to create a slope rather than a ledge. In Dr. Rose's opinion, this slope results in a less secure closure verses the more secure ledge.

Dopey,

In my mind, creating a stand-alone hair transplant has a lot to do with building a "zone" such that, if surrounding hair falls out, the work will still look complete and natural. I have a couple concerns here. 1) 1,300 grafts is usually only enough to build a hairline. In order to build up the frontal third (zone), you would likely require 2,200-3,500 fu grafts. 2) You are a little young for a transplant. It is a commitment, particularly when you are in the process of losing hair versus when you are at a more mature stabilized level.

I think if I were in your shoes I would wait, save my money, and try to get the front done in one pass at a later time. But I am admittedly not an advocate of people getting surgery at your age.