had consultation w/surgeon, how come they cant do the crown on top of the head?

[chris_wellser]

hi,

 

i seen the doc in a consultation today. he says that he can do the front part of the head but not the crown. i dont understand why. having the part you cant see as bald is the worst. at least if you are balding on the front you can probably control it.

[chris_wellser]

hi,

 

i seen the doc in a consultation today. he says that he can do the front part of the head but not the crown. i dont understand why. having the part you cant see as bald is the worst. at least if you are balding on the front you can probably control it.

[pushing 40]

What rationale did he give for this? What Dr. is it? If he can't do it simply because he's not capable, then you had better not use this doctor. Is it because you don't have enough donor hair? What balding class are you; V, VI?

[MarylandGuy]

I'd be willing to be he didn't see a coalition doctor but instead went to MHR or Bosley. He could also be very young and perhaps they felt doing the front made more sense. I'm looking forward to see who said this and why.

[chris_wellser]

it was dr. cotterill

he said i should be older than 35 to get it done. im 29 yrs old now. he said he would do it if i was older than i am now. he said he would not want to have an island of hair at the back of the head when the rest thins out.

 

but couldnt you just fill in what i dont have? i could use my chest and back hair. would any docs do that?

[Dr. Michael Beehner]

Chris,

This is a common problem for young men, who want to have everything restored. I think your doctor was very wise in telling you what he did. You have no idea (nor does anyone else, including the doctor) how bald you may become some day. And if you start filling in the crown/vertex as part of the initial plan on a man in his 20's, and male pattern baldness progresses and logarithmically enlarges, as it almost always does, and the project in that area can't be completed, you will have a huge bald halo around a patch of transplanted hair and will look very abnormal, and there won't be any donor hair left to fill in the halo. By the time a man gets into his later 30's the surgeon gets a much better sense of where a patient is going to end up with regards to the eventual expansion of the crown and also the amount of "safe" donor hair that is remaining and then he can make a much more accurate determination as to whether he has a good safe margin of donor hair reserves to do everything that you want. The unfortunate truth, despite some of the wonderful medicines we have available now, is that male pattern baldness is a progressive condition. Propecia et al only stall the balding process; they don't arrest it.You only have to look around you at all the 60 and 70 year old men to see where things can end up. Each one of them was 29 once. Picture what there head would look like if a surgeon at that time tried to fill in all of the bald area. It takes courage for a hair surgeon to turn down a request like the one you made. You will thank him some day. The problem is that, if you keep looking around, you will probably find a hair surgeron who WILL fill it in and do your future a disservice. I have seen ten or so men over the years who had exactly that done at some time 10-15 years earlier and their head looked like a dead animal died in the middle of their head. They always asked me to remove all of the grafts, no easy task. I hope you accept his advice.

Mike Beehner, M.D.

[Bill - Seemiller]

Chris,

 

Dr. Beehner answered this question beautifully for you. Planning for the long term is vital to ensure the long term quality of your hair transplant. Because genetic hair loss is progressive, there is no telling where you will end up. So waiting to fill in the crown for younger patients is important.

 

Best wishes,

 

Bill

[notgoing2gobald]

Dr. Beehner,

 

so then why would the surgeon do the top of his head? Wont he run into the same problem as the crown years later (i.e. hair on top but bald everywhere else)?

[chris_wellser]

couldnt i cover up crown bald spot now with grafts and use the hairs from my back, chest and arms to fill in the area that thins in later years?

 

i would just have to keep dieing those hairs and keep the other hairs around the same length as the hairs taken from the arms, back and chest.

[notgoing2gobald]

I think body hair transplants are still in the experimental stage at this point.

[Dr. Michael Beehner]

That's a reasonable question to ask. I'll try my best to answer it. I'll start by saying that many of the men in their 40's that now have a Norwood VI level of baldness (that is, they are bald in a "horse-shoe" shaped area, with the side fringes still up high where the vertical/horizontal plane changes) - if you used both of your thumbs and middle fingers to make a large circle, and you put them around the entire top of the head, encircling both the frontal and the midscalp regions, and then go and do the same around the entire crown in back,- very often you will find that the two square areas are almost identical in size. So you have two "40 acre lots" to deal with. Which is the most important? The front and top, of course. So, in a young guy like yourself, we know that we can always at the very least perform a "forelock" type of transplant in dire cases that look like they might go on to a Norwood VII, and for most men can usually fill in from one side fringe to the other and create a full frontal hairline, feeling pretty confident that there will be enough donor hair over one's lifetime to keep that area filled in and natural . But it's a whole other story to begin that same large project in the back area on a man in his 20's. First, the vertex in back is admittedly not the most important area of hair loss, and it has a notorious reputation for dramatically enlarging to an extent that in some men you can never quite chase the borders with enough transplants to keep it filled in and dense appearing. The crown is also much more difficult to make look full compared to the top of the head, because "overlap" isn't used very much due to the "whorl" arrangement of hair.

Some of the warning signs that might make a hair surgeon go to a "forelock" type of transplant pattern rather than a side-to-side fill in would be the following: family history of Class VII males, "whisker hair" (curly, oily looking hairs around the ears, an indistinct fringe without a strong border of dense hair, and a history of his hair loss occurring rapidly over a short number of months/years. The most important thing that hair transplantation does for most males is FRAME THE FACE, and it doesn't take that much hair to begin to do that for almost anybody. The only thing required on the patient's part is that he have realistic expectations for what can be done, given his age and apparent "safe" donor supply.

Mike Beehner, M.D.

[notgoing2gobald]

Dr. Beehner,

 

thank you for that great response. What exactly do you mean by the "whisker hair" comment and how does the nature of that hair factor into the equation if its by the ears?

 

My hair is kind of like that on the sides and by the ears in the back.

[Dr. Michael Beehner]

"Whisker hair" is a very non-specific sign, one first described by O'Tar Norwood, the creator of the Norwood Baldness classification system, which he felt was an omen for later significant balding. It's just one more little clue that would make a hair surgeon a little more cautious in a very young man. I will try to attach a couple of photos of examples of "whisker hair."

Mike Beehner, M.D.

[Guest]

DR.Beehner, i just want to get your advise, i have HT done almost 2months ago(08-0807) i was not bald at all in any spot of my head , i just wanted thicker ..i did not do any searching i just read and watched the pic's pf DR. Richard Ochs on line then i went over there and have 4000 graft as he said it will make my head full thick. i thought all doctors do the same Ht the same way, so i asked him all questions was on my mind, like do i will lose my existing hair? he said noooooooo, also i asked him how long it will take to see gowth of new hair ? he said 3 to 4 months! after the HT i lost most of my original hair and there is no any pumples or redness on the top plus the scalpe with no holes!! like puffy skin? no any signs can tell i have HT , plus i lost few grafts i saw after the ht like a week later.. i'm dying every time i look in the mirror .. i feel like he have cheated on my transplants hair count ..and called him many times even i went to see him and asked him what's going on,,he said wait wait be P. PLEASE adivse me what you think was happened to me. thanks

[NervousNelly]

Bibarz,

 

The doctor is correct. You need to wait. Most of your native hair was likely shocked and will probably come back. The new hair will take another month or more before it starts to grow. I would wait for another 3-4 months and I bet you will start to feel a little more confident about things. Also, you are going to have to wait 12-18 months for things to be fully resolved. Good luck with things.

 

 

NN

[Guest]

Originally posted by chris_wellser:

it was dr. cotterill

he said i should be older than 35 to get it done. im 29 yrs old now. he said he would do it if i was older than i am now. he said he would not want to have an island of hair at the back of the head when the rest thins out.

 

but couldnt you just fill in what i dont have? i could use my chest and back hair. would any docs do that?

 

Seems like good advise to me. The crown can keep getting bigger bald spot that you may not be able to fill in with any amount of donor hair. That was my understanding.

[Bill - Seemiller]

bibarz,

 

I'm not sure exactly how your conversation went with Dr. Ochs, but a simple "yes" or "no" is often a poor answer in the realm of hair transplantation. To answer "no", that you won't lose existing native hair is sadly not necessarily true. The answer is "maybe" because shock loss is possible and not fully predictable. Learn more about shock loss. You will most likely see signs of visible new hair growth between 3-5 months, but hair growth is a gradual process. Don't expect to see your full result until approximately month 12.

 

At 2 months you have to be patient and wait it out. Between 1 and 4 months post op is the most difficult time because we often look worse than we did before surgery. The good news is, anything that was temporarily shocked will grow back - however weaker hairs on their way out may not return.

 

I encourage you to post your experience and before, immediately post op, and monthy photos on our site so we can walk with you in your journey.

 

Best wishes,

 

Bill