N-6

Its hard to say if you are starting to experience male pattern baldness or if your hairline is simply maturing. I would set up a consult with a reputable HT doc to assess the state of your hair, including any miniaturization. They will be able to best guide you on whether you need any medical treatment, including whether propecia is needed and could be taken at such a young age.

If I understood your message correctly that you consulted with someone at hairclub who does FUE, I would personally stay away. FUE hasnt been around for very long and there are not many people in the world who have mastered the procedure. Hairclub has traditionally been a hairpiece company so that they are now doing surgeries is surprising. Go with a doctor who has experience and a solid reputation in the hair transplantation industry or things could be worse off for you long term. I understand you want to make a decision soon but you really need to research this topic thoroughly. This is surgery after all and not a decision you should rush. As for strip versus FUE, I've never heard the claim that FUE can grasp on to thicker hairs. I don't even know what that really means. Strip has better yield and is more efficient at harvesting grafts than FUE. I think FUE is good for a select group of patients but I don't see how a 28-year old like yourself who seems like he already has extensive hair loss and will likely lose more in the future is even a candidate for FUE in the first place. Where would an FUE doc get the necessary grafts to give you a cosmetically satisfactory result long term? Check the link below to a thread re: varying thoughts on FUE and its permanency in certain patients. http://www.hairrestorationnetwork.com/eve/164188-fue-permanent.html Research, I really can't stress that enough.

Its hard to tell but from your profile photo, it looks like you have virtually no hair in the frontal 1/3 and little hair in the crown. I don;t know what your goals are but 1500 grafts will not do much for the front at all much less for front and crown. I think FUE is fine for some patients but for someone like you who seems to have extensive loss at age 28, I would be curious to know who said you were an FUE candidate. If your hair loss is as seems to be depicted in your profile photo, you would need way more than 1500 grafts to obtain a decent result. FUE is more expensive and less efficient at harvesting grafts than strip. Importantly, the more grafts you need with FUE, the higher the danger that those grafts are taken from potentially non-permanent areas. Its hard to tell but you might fall into that risky category.

StaggerLee, based on the fact that you've only had about 1600 or so grafts, then I'm assuming most of your hair is native. You should look into a combination of rogaine and propecia to try and strengthen your native hair. I would also consult with several reputable docs. You will find some on this site. If you come across the name of a doc that's not on here, they may still be great but just not have a big online presence. After your research, run the names of your docs across this forum to try and get some feedback. I personally would recommend Dr. Ron/Paul Shapiro in Minneapolis and below is a link of one of their recent repair jobs. http://www.hairrestorationnetwork.com/eve/134995-bullitnuts-hair-loss-repair-program-shapiro-medical-2.html I think you need to add some density and try and revise the scars but I don't think your hair looks bad. Best of luck and keep us posted.

I definitely like the use of nape hair for the hairline, it makes lots of sense instead of having to split up other grafts. That said, how strong is nape hair in the long term?

You may be able to speed up the re-growth of your pre-existing hair with a supplement called MSM. For me, I think it has sped up the re-growth of areas trimmed in the donor scar area and the area that was trimmed in the recipient site. To speed up growth of the newly transplanted grafts, I'm not sure of anything that can for sure.

Icecreamman, I've had sutures and most recently staples for my procedures. Sutures-felt a little pain for first 2-3 days (maybe a 2-3 out of 10) and then just some itching, tightness and discomfort through suture removal at about day 10. Staples-pain was about same level for first couple of days with staples as with sutures but for me that level of pain and discomfort lasted longer with staples. This mostly happened at night when I was trying to find a comfortable position to sleep and tried to avoid staples pressing against the pillow. This can be alleviated somewhat with a travel pillow or a towel under the neck. I had staples in longer than 10 days so pain/discomfort lasted through staple removal but decreased throughout that time. Once they were removed, the pain/discomfort went away pretty fast and I began sleeping fairly normally. I'm about a month post-op and feel no pain and virtually no discomfort in my donor area anymore. I'm also sleeping normally now. You will get pain meds, I took them the first few days but didnt want to continue taking them after that. Not a big fan of that stuff in my body. I don't think there will be a recognizable difference between the pain/discomfort of 1200-1500 strip and one that is 2000. If its like 4000 grafts, then maybe there will be some difference. Exercise- Pre-HT, I was at gym, lifting and doing cardio 3-4 times per week and basketball about once per week. Postop, I did none of this for first 2 weeks. From 2 weeks until now (1 month post-op), I've been doing recumbent bike and eliptical (w/o using arm rails) 2-3 times per week. I plan to start light weights, high reps at about 6 weeks post-op and will be very cautious about avoiding exercises that may pull on donor. Then I will play by ear as to when and whether to increase weight. I'm not doing basketball for awhile, at least until I feel comfortable with a fairly normal routine at gym. I just think there are too many sudden head movements, ie, trying to play D, crossover, make a move to the hole, not to mention getting hack a shacked, that could pull on the donor area. This is my plan, everyone heals differently though. Talk to your doc and listen to your body. Below is a recent thread on post-op exercise. Happy Holidays. http://www.hairrestorationnetwork.com/eve/160044-post-op-exercise.html

You questioned why I posted this topic, I gave you a response and asked you a question. I appreciate your input on the topic but I completely disagree with your position as I think its based on conjecture rather than actual medicine. My position is based on research, observations, and significantly, the strength of literature published by medical doctors, including a pioneer in the field of hair transplantation.

Thehairupthere, I posted a question to gather info on a topic I was actively researching and share my preliminary opinions on the matter. Surely, you're not saying that I'm not allowed to do that in a public forum? You also misunderstand my point-I'm not saying that the FUT and FUE donor area are always different, just that sometimes they are. I've cited several blogs which contain photos clearly depicting this very point. Are you really disputing what is clearly visible to the naked eye? If you are, what do you think about this case-a 24 year old with self-described "strong family history" of baldness who undergoes nearly 3K grafts via FUE during a 2-day period. Is his donor area in the safe zone? Or are you going to explain that this is the safe zone because the doc says its the safe zone? http://www.hairrestorationnetwork.com/eve/163495-2-968-fue-dr-feriduni.html You also say: "But one quote "the latter two session would nearly always exceed the established "safe donor area" boundaries" I do not agree with because a reputable doctor would always know to not exceed these boundaries no matter the circumstance". This quote shows the fallacy of your argument. No doc, no matter how reputable, can reliably predict hair loss progression in a younger patient so how can he ever know what the safe boundaries are in the first place for FUE? You're basically saying a doc knows what the safe zone is because that zone has hair that will be fairly resistant to DHT and the doc knows it is fairly resistant to DHT because it is the safe zone. Classic circular reasoning. The article I cited does not say that only large FUE sessions are inefficient. In fact, it says that FUE of any sort when compared to FUT is inefficient "because all of the FU in a strip are utilized, whereas only every third to fifth FU can be extracted from a FUE donor area; * * * to get the same number of FU as you would from a strip requires a donor area that is 3 to 5 times as large". You further state: "None of this however has anything to do with the FUE grafts being non permanent, because they are permanent just like FUT". Really? Guess you missed this from medscape: "Furthermore, as each individual follicle extracted must be separated by three or more intact neighboring follicles so as not to create a uniformly alopecic donor area, the risk of needing to harvest follicles from a larger surface area that extends beyond the limits of the safe donor area is heightened (see the image below). Over time, as the fringe hair beyond the safe donor area is lost, the punctate scars may be exposed and transplanted follicles harvested from this fringe area may disappear". And you did allude to this and large FUE sessions are certainly being done: The latter two sessions would nearly always exceed the established "Safe Donor Area" boundaries. This would result in non-permanent FU transplantation and potential small round scars becoming visible as that area loses the original hair. As implied from the preceding, the younger the individual is, and therefore the less certain one can be about the ultimate width of the fringe, the more likely that this will occur. The older the patient, the less likely this will happen. Disphair, you get what I'm saying. This isnt a black and white issue by any means. In FUT, the safe zone is well-established as a zone that is fairly resistant over a certain period of time to DHT. By definition, this excludes the area where some FUE donor hair is being extracted, particularly for those younger patients who want and receive mega-session FUEs. Now a patient's donor area can vary from patient to patient but when I see a case of a young patient like the one above undergoing FUE donor harvesting that far above the well-established FUT safe zone area, it concerns me.

Aaron, thanks for the article. Running through this thread there is an underlying assumption that the donor area for FUT is necessarily the same as the donor area for FUE. It is not. The donor area for FUT as a safe zone has been well-established for a number of years based on research and practice. FUE is a relatively new procedure which many times extends beyond the traditional FUT safe zone. Look at the FUE donor areas immediately post-op on this site, many of them extend beyond the traditional FUT safe zone. Given that it sometimes extends past that zone and that docs cannot reliably predict hair loss, FUE, in my opinion, can be very risky for a younger patient because the transplanted grafts may eventually fall out with the progression of hair loss. This topic is touched upon at the following link, which has images of the actual safe zone for FUT versus the area where FUE may harvest grafts. Medscape: Medscape Access Below is also a quote from the website of Dr. Walter Unger, a well-published physician in hair transplantation. One of the often unmentioned, but major, potential drawbacks of FUE versus SSSH, is that if very large numbers of grafts are likely to be required in a single or multiple sessions over the patient's lifetime, a larger percentage of the transplanted hair is more likely to be lost in the future than would be the case with SSSH. This is because all of the FU in a strip are utilized, whereas only every third to fifth FU can be extracted from a FUE donor area; taking more than that with FUE would result in that area being left with hair that would be too sparse and/or the small round scars being noticeable (Figure 17). Thus, to get the same number of FU as you would from a strip requires a donor area that is 3 to 5 times as large. A consequence of that is a FUE session of 1000 to 1500 FU spaced every 3rd to 5th FU apart, generally can be accomplished within "The Safe Donor Area", a 3000 FU session would require harvesting from twice that scalp area and a 4500 FU session would necessitate FU extraction from over three times that scalp area, etc. The latter two sessions would nearly always exceed the established "Safe Donor Area" boundaries. This would result in non-permanent FU transplantation and potential small round scars becoming visible as that area loses the original hair. As implied from the preceding, the younger the individual is, and therefore the less certain one can be about the ultimate width of the fringe, the more likely that this will occur. The older the patient, the less likely this will happen. A less important, but not unimportant, additional potential drawback of FUE is that the grafts produced via FUE have less protective tissue surrounding the hair bulbs within them and may or may not result in a lower hair survival than that seen with grafts that are microscopically produced from a strip (Figure 3). Welcome to Dr. Walter Unger | The Procedure

I respectfully disagree about the safe zone. Calling it a safe zone over and over doesnt magically transform the area into the safe zone. If a doc cant predict a young patient's ultimate hairloss pattern, then I just don't see how they can say a zone of scalp is safe in the long run. The distinction I'm making is between short term and long term yield. At the end of the day, if a younger FUE patient is well-informed by his doc about the procedure and the patient agrees to do the procedure, then that's between the doc and the patient. FUT has a track record but I guess we will see what FUE procedures will look like 10-15 years down the line. I definitely agree that propecia and rogaine are essential especially for young patients but we all know that their effects could have a shelf life.

Thehairupthere, isn't it true that no currently available exam of the scalp, including one which analyzes miniaturized hairs, will allow a doctor to reliably predict future hair loss in a younger patient? It will allow the doc to see where not to harvest from currently but certainly cannot predict eventual miniaturized hairs years later. This is where I think the problem lies. As far as the safe zone, I know the safe zone isnt the scar. The scar is just the end result of a slice of donor being removed. The width of the donor is dependent on the number of grafts. I really don't understand saying that the safe zone is 2-3 inches above the occipital bone. This is a first for me. That's the equivalent of 5 cm - 7.5 cm. Do multiple strips ever amount to that much donor taken out? I thought the average donor was 1 cm wide? Also, if the safe zone was really that far up the back of the scalp, then Norwood 5s and above shouldnt undergo FUTs because their hair loss can dip into the 2-3 inch safe zone. Look at the results of hadenuf and FUE3545, does that look like the safe zone we generally see? If the back drops to the point where they become a NW5 or 6, they're partially screwed as the grafts transplanted from that part of the scalp will fall out. Of course, it may be that this never happens but I think this is a very real risk with younger patients. I definitely think that for these patients, propecia/rogaine/nizoral are essential to ensure they keep as much hair as possible. Another interesting article, thanks Sean, keep up the great growth! Thanks all for your responses to this topic. Pretty interesting stuff, well maybe for a nerd like me.

Microscopes can determine current miniaturization but I don't think there's really anything which can reliably predict future (10 years plus) hair loss patterns and this is what makes some FUE procedures in younger patients concerning. It would be great if we could hear from some surgeons about this topic, including what kind of conversations they have with these patients about risks pre-op.

Newhair/Aaron, here is my point, if its difficult for a doctor to reliably predict the eventual hair loss pattern of a younger FUE patient, then how in the world can they determine what the "permanent" safe zone is for that patient? Also FUE has not been widely performed long enough (maybe 8 years at best) to assess its long term yield especially for mega-session FUEs which extract grafts from areas way outside the FUT permanent safe zone in order to yield the required number for a mega-session.

Sean, I really appreciate you taking the time to post some interesting articles. This is the type of stuff which really helps this discussion. I don't think an ethical doctor would extract grafts via FUE from an area he knows is unsafe. That said, however, even ethical doctors make mistakes and make judgments that are incorrect. What concerns me about FUE is not the 50-year old plus patient whose hair loss pattern may be fairly well-established and more predictable at that stage of life. What I'm concerned about is the lack of predictability regarding future hair loss for a patient who's in their 20s, 30s and 40s where its harder to predict even though the doc meticulously elicited a wealth of family and medical history from the patient and conducted an in-depth analysis of the scalp. Hair loss patterns become more uncertain for these patients. The wiki article you cited states as follows: "Of course, the safe donor area represents a generality that cannot be reliably depended upon for any particular individual. For example, the likelihood of the long-term survival of hair outside of the "safe donor area" will be greater in an older patient than in a younger one - in whom ultimate fringe width and fringe hair density is less predictable than in an older man. What can be depended on, however, is that the closer the donor sites approach the advancing edges of MPB (the upper and lower borders of the fringe) the more likely the previously noted risks will become a reality". In the below link, Bill states Unfortunately, hair loss is mostly unpredictable and though a dermatologist can perform hair miniaturization tests (which can be helpful), he/she can only draw conclusions from your present state of baldness. The future remains unknown. A new genetic test that may help predict early onset of female and male pattern baldness, called HairDX is also available. It does not however, predict how far it will progress. Hair Loss News - Can Future Hair Loss be Predicted and What Treatments Work to Prevent it? - Hair Loss Open Topic Wiki (I know wiki isnt gospel so check cites) on FUE However, with FUE, the follicles are harvested from a much greater area of the donor zone compared to FUT, estimated to be eight times greater than that of traditional strip excision so requires patients to have hairs trimmed in a much larger donor area.[12][13] As a result, the hair in the lower and upper parts of the donor area, where the grafts were taken from, may thin and this can make the donor scars visible.[5] Follicles harvested from borderline areas of the donor region may not be truly “permanent,” so that over time, the transplanted hair may be lost.[12] http://en.wikipedia.org/wiki/Follicular_unit_extraction This is what concerns me. The higher you go above the occipital bone in the back of scalp of certain younger patients, maybe the higher the risk of those grafts not surviving long term. Im talking about 10-20 years down the line. I just hope that FUE doctors are very clear with younger patients about those potential risks. Btw, your hair looks great Sean, excellent result.

Newhair, this is not clear cut in my eyes at all. There are two issues here: 1. Is FUE taken from the same area as FUT? I completely disagree with Thehairupthere that it is. In the back of the head, FUT donor is taken from an area of scalp just below the occipital bone. Any quick search on here of FUE patients' results show that in the back of the scalp, FUE is clearly taken in many cases from above the occipital bone. Obviously, this is very different. Take a look at the hair blogs of FUE3545 and Hadenuf as examples. 2. Also, you assume that a doc will take FUE from the safe zone but in an younger FUE patient, how can a doc even know what the safe zone will ultimately be if its not easy to predict eventual hairloss?

To say that FUE is taken from the same permanent zone as FUT is really inaccurate in my opinion. Look at the number of photos posted, many FUE grafts are taken way above the area of FUT. I do agree that a patients safe zone will vary from patient to patient but how does a doctor know what the permanent safe zone of a patient in his 20s, 30s or 40s will ultimately be? Are you saying that a doc can reasonably predict the norwood scale for a patient at these ages?

Im asking about patients who want to undergo FUE in their 20s, 30s or 40s whose hair loss pattern may not be completely established. I know docs look at family history, medical history and study the patient's scalp. However, isn't it true that even with this, a doc cant predict a patients ultimate hair loss? And since FUE is many times taken above what is considered the permanent safe zone, isn't that FUE patient at risk of possibly losing those grafts years later? Are these issues discussed by a doc with a patient before FUE?

I would be careful with concealers in recipient area post HT due to possible clogging of grafts although ive heard this is more a problem with dermamatch and couvre than toppix. Still im not taking a chance, best check with your doc.

Oh I hadn't seen on his website and haven't come across on this forum but good to know that he does more extensive hairloss as well.

7000 plus hairs in the front only plus patient's hair characteristics and doctor's skill makes this a nice result. Does Rahal only do hairlines? Does he perform HT on patient's from a NW 5 and above?

Yeah I don't see diffuse thinning at all and he certainly had a lot of hair already and didn't need additional work done as his hair looked great already. The additional 3k did create a nice widows peak and filled in his hairline even more.

Thehairupthere makes a crucial point. We all want juvenile hairlines but this is not always realistic. Research and consult with multiple reputable doctors. As a patient you need to have realistic expectations or else you could be very disappointed by the outcome of your surgery.

I don't know the extent of your hair loss, how much work you're thinking of getting done and where you need it placed and importantly whether you're going to do strip or FUE (although if you're talking about sutures then youre doing strip), so its hard to be specific with your situation. That said, 11 days will generally be fine. I went back at day 15 and no one noticed anything even though I had staples in. Recipient area-scabs should be gone by day 11, you might have some lingering redness and may experience some shock loss. So this may or may not call attention to your scalp but i dont think enough for people to assume you underwent a procedure. It is also important to know if you plan to have surgery with a surgeon who shaves the recipient area because this could dramatically change your appearance post-op. Donor-As i said, I went back with staples and this was my biggest concern, but with some concealer, no one said a thing to me. It is important that you have enough hair to cover the scar and how much you need will vary with the patient. If you have good donor density then this a plus. Other factors are obviously your hair length in the donor area, how much hair the surgeon trims in the donor area and possible donor shock loss. People on here say 1-1 1/2 inches but I would play it safe with at least 2 inches back there since every patient is different. Eventually you should be able to cut your hair closer in the donor area, in my experience, this happens around month 5-6.

I think combo of SMP and HT could be a winning one. HT hair for the front and SMP for some density in and around existing hair and/or scar. It would be great if we could see more photos of this here.