Considering a 4th

[Guest]

Hello All, First of all, let me say thank you to everyone that contributes such helpful information on this website. It has been an invaluable resource for me. Ok, now for my question, but first just to give you a little background on me, I've actually had 3 HT's over the last 3 years done by two different surgeons. The first two procedures were definately sub-par(wish I'd found this site sooner!)The last procedure was excellent, performed by Dr. Keene. No need to mention the name of the first Doc, he went into retirement.(probably forced retirement) Anyhow, I had my first procedure at 23 and was a Norwood class 3 at the time. I've had a total of about 1850 grafts between the 3 procedures--about 300 grafts a piece for the first two ht's, and around 1250 grafts for the 3rd procedure with Dr. Keene. Now, my hairloss has very slowly progressed as both doctors told me it likley would. No surprise there. Basically, the hair behind the transplants, all of which were to the front third of my scalp, has slowly become finer and thinner and now some crown thinning is also becoming a factor. So, I'm considering a 4th, and definantly, last procedure to put some grafts behind the transplants I've already had. But the catch is, I also would like a little more density to the front of my head where the transplants are. The native hairs in the transplant area have slowly fallen out, leaving only the transplants which still look good, just a little on the sparse side. Now I know that I have a finite amount of hair to work with so I've come up with an interesting strategy to ask you guys about. What I've noticed is that thin hair is most obvious at the edges. In other words, when I part my hair, the thinness is most obvious at the edges of the part, but not nearly as much where the hairs are lying down together. So since I'm faced with having to make my remaining donor hair cover from midscalp to crown, plus a little more up front, would it make any sense to put some transplants just on the edge of my hairline and the area where I make my part but concentrate most of the transplants in back? For the front of my head, my thinking is to hide thinner areas of hair behind a facade of somewhat thicker hair along the edges. I'm not too concerned with having a great amount of density further back on my scalp and crown, since this area does'nt get as much viewership I would however like to have enough hair there in the future to be able to use something like Toppik. I will be 27 this August, so I am trying to plan for the long haul. I've done pretty good so far and am definently glad I had the HT's done. I'm just wandering if this strategy is viable or rubbish. Any answer is greatly appreciated. Thanks a ton.

[Guest]

Hello All, First of all, let me say thank you to everyone that contributes such helpful information on this website. It has been an invaluable resource for me. Ok, now for my question, but first just to give you a little background on me, I've actually had 3 HT's over the last 3 years done by two different surgeons. The first two procedures were definately sub-par(wish I'd found this site sooner!)The last procedure was excellent, performed by Dr. Keene. No need to mention the name of the first Doc, he went into retirement.(probably forced retirement) Anyhow, I had my first procedure at 23 and was a Norwood class 3 at the time. I've had a total of about 1850 grafts between the 3 procedures--about 300 grafts a piece for the first two ht's, and around 1250 grafts for the 3rd procedure with Dr. Keene. Now, my hairloss has very slowly progressed as both doctors told me it likley would. No surprise there. Basically, the hair behind the transplants, all of which were to the front third of my scalp, has slowly become finer and thinner and now some crown thinning is also becoming a factor. So, I'm considering a 4th, and definantly, last procedure to put some grafts behind the transplants I've already had. But the catch is, I also would like a little more density to the front of my head where the transplants are. The native hairs in the transplant area have slowly fallen out, leaving only the transplants which still look good, just a little on the sparse side. Now I know that I have a finite amount of hair to work with so I've come up with an interesting strategy to ask you guys about. What I've noticed is that thin hair is most obvious at the edges. In other words, when I part my hair, the thinness is most obvious at the edges of the part, but not nearly as much where the hairs are lying down together. So since I'm faced with having to make my remaining donor hair cover from midscalp to crown, plus a little more up front, would it make any sense to put some transplants just on the edge of my hairline and the area where I make my part but concentrate most of the transplants in back? For the front of my head, my thinking is to hide thinner areas of hair behind a facade of somewhat thicker hair along the edges. I'm not too concerned with having a great amount of density further back on my scalp and crown, since this area does'nt get as much viewership I would however like to have enough hair there in the future to be able to use something like Toppik. I will be 27 this August, so I am trying to plan for the long haul. I've done pretty good so far and am definently glad I had the HT's done. I'm just wandering if this strategy is viable or rubbish. Any answer is greatly appreciated. Thanks a ton.

[Smoothy]

I dont know if any of your surgeon's mentioned your age, but at 27 and having a 4th, I would have some reservations. More than likely your donor supply is depleting and mutliple scarring also takes it toll on donor hair. More than likely you will continue to loose/thin out over the next 20 years 45 yrs old or so. If you use all your donor buy 27, you could be left with some very unique head of hair when your in your 40's and since you've had 3 HT in 3 yrs, I would recommend not to have a 4th in 4 yrs at 27 yrs of age, but instead stay on your Propecia/Rogaine/MSM/multi-vit. regiement with a good DHT shampoo. Then in about 5 yrs look at a final HT if you want. I would be cautious of using your donor this young. (you could end up like James Cahn?)

[Guest]

Thank you smoothy for your response. I will definently take your advice into consideration. Donor area scarring has been an issue for me. I owe it to the first two procedures I had--which I reffered to as sub-par. The surgeon insisted that only small procedures (around 300 grafts) were practical. Therefor, he had me back fairly quickly for a second procedure.

 

He used the strip excision method to the right side of my head twice, taking out a strip about 3 inces long or so and about the width of a finger. On the second procedure, he took a strip from the exact same area. When he stitched the wound closed, my scalp was so tight it was unreal. I mean, I knew going into it that the scalp may feel a little tight because it did after the first procedure. No big deal. But the second time around, it was incredibly tight! Now, the donor scar there is pretty gaping, close to a half-inch!

 

The third procedure I had with Dr. Keene was 1250 grafts and the strip was about ear to ear in length. She and her staff were excellent and I had very minimal discomfort during the procedure, unlike the first two which were pretty agonizing. She told me that she would try to remove the scar tissue since she would be re-opening the original scar on this last procedure, but she warned me that it could redevelop--which it did. But it's not that bad as long as I avoid very short hair cuts like a buzz. The scar on the side where only Dr. Keene worked is pretty much invisible. How I wish the other side was the same. Oh well.

 

But thanks again for your recommendations. They are very helpful.

[Smoothy]

When you do your next procedure in 5 yrs or so, they can extract the scar (cuting below and above it) which will result in just 1 total scar. Prior to the procedure (4 months prior) do scalp excercises as it will loosen your scap before surgery allowing for a better extraction of the scar.

Until then try using Mederma for 8 weeks 2x a day which really helps.

[arfy]

Mederma just makes a scar blend in better, it doesn't shrink a scar.

 

To Harve, you should be trying to retain your existing hair. Ive you had 300, 300 and 1250 grafts, and you los all your hair, those grafts aren't going to do all that much good. I think you may be underestimating how much hair you have left.

 

As far as your plan, most doctors do add density in key areas so you can get a combover effect. A typical pattern is the "hockey stick" which runs along the part and into and along the hairline (soft "L" shape). So when you comb your hair, you get a little eextra combover. Your idea is not far fetched.

 

However you may be underestimating how many grafts it takes to do your crown (it takes a LOT. You could use your entire donor supply just in the crown).

 

The best idea is to run your ideas past Dr Keene, who already worked on you and can examine you in person.

[damo]

Harve the first two procedures seem so minimal for the little amount of grafts you got out.?

 

 

Damo

[Guest]

Thanks guys for your follow up advice. I'm for sure trying to hang on to my existing hair. I've been taking olive oil and fish oil in daily doses and that seems to have helped a little as far as the thinning in the back of my head. The hair shafts have enlarged a bit and don't seem to be as fine. I use Nizoral shampoo 2-3 times a week as well.

 

I know Arfy that you are right about crown coverage. There's no way that I could hope to completely cover this area should all the existing hairs fall out. I'm hoping that I can prevent or greatly slow down more loss there and just focus on the front, hairline etc. I've cooled my jets a little as far as not having another transplant in the short term, as smoothy has suggested. But I still would like to discuss with doctor keene my ideas about the graft placement in a possible future HT, as you've told me that you don't think it's far fetched.

 

My scalp does seem to be getting more flexible on the side where the first two procedures were done. But I would think that to make it even, in terms of symetrical extractions from both sides of my head, then a future procedure would have to focus on taking donor hair from the left side of my head. I could be way off on that, but just reasoning it out.

 

Damo, do you mean that the physical sizes of the first two procedures I had seem small for the amount of grafts they yeilded? I'm not quite clear as to what you mean.

 

Thanks again to all of you guys for your responses.

[kg007]

Wow!!! this raises question for myself. I am 24 rightnow. I had my first procedure with Dr. Keene when I was 23 and half - 1500 grafts to cover crown. I am planning on going back to her this November for 2nd procedure of 1000 grafts to add density on the top and front which should give me pretty decent coverage everywhere. By the time I am 25, I would have 2 HT procedures and used 2500 grafts. Now this question me if I should go for 2nd procedure so soon. Give me your feedback. I will have to post my pictures so you guys can see my situation.

 

Thanks,

 

KG

[damo]

Harve i mean the physical sizes of the first two procedures mate seemed small for the amount they took out!

Kg007 Im 30 and have had two procedures now.I went for my 2nd procedure 12 months after my 1st with no problems.Please post a pic so i can see ,it will make it easier to judge.

 

Damo

[Guest]

Yeah Damo, I guess it must be that the density in my donor area was high enough to yield that many grafts for a small area. I wish I had asked the surgeon about that at the time. When I had my first consultation with him, he estimated that I had upwards of 7,000 grafts available. His attitude seemed to be that my donor supply would be well adequate for any type of future hairloss. I now know that even though I had that many grafts available, it does'nt necessarily mean I can use them all due to issues like scarring and scalp flexibility.

 

When I had my last procedure with Dr. Keene, she focused on the importance of trying to prevent or slow down the progression of hairloss and she recommended Propecia--which until now, I've been reluctant to do. We did'nt really discuss all of the future hairloss scenarios I could have and how the donor supply would come into play. I have emailed her with questions about a future procedure and she has asked me for some pictures and also about the flexibility of my scalp.

 

I think the biggest issue I face now is one of priorities. In other words, if I have to choose between more density in the front and the hairline or putting some grafts toward the back and crown, I'd have to go with the front. That leaves me with only prevention to fight hairloss in the crown. So I guess I'll have to get busy with propecia.

 

kg007, your definently sitting better than me because your first procedure was with Dr. Keene. I'm positive that I would'nt be worrying about scarring and scalp flexibility if I had had my first procedure done by her. I think both of us at our ages need to look at prevention of future loss very strongly.

[gillenator]

Harve,

 

I truly believe Dr. Keene genuinely has the best interest of her patients in mind. Anyone can view her interview at hairsurgeons.com and learn more about her philosophy.

 

I wanted to add that based on your comments you may be very well seeing the evidence of further miniturization in the front and mid sections of your scalp even though the hair is still there.

 

Because MPB is progressive added to your young age, try to consider the total zone of demarkation (total areas where natural hair can be lost to MPB) in your lifetime. You definitely want to save donor for those future high impact areas. And now you are committed since you already had several prior procedures. I think you are definitely correct in taking a more conservative approach in the crown. Best wishes to you.

[Guest]

Yeah gillenator, I've tried to stay on top of the progression of hairloss for the last five years, taking into account the worst case scenario.

 

Fortunately, the hairloss has been very slow. I do think I made the right decision as far as beginning the procedures when I did. I can look back at pictures prior to my HT's and definitely see that I was well on my way to a bald look. Thanks to the HT's, the worst I've had to endure has been looking a little thin sometimes.

 

I know the advantage to waiting longer than I did would have been that I could see the full extent of the hairloss and then be able to judge which areas I would most like covered, having all the donor hair available. Having said that though, I definitely think the front and hairline is more important. As far as further progression, I'm seeing a somewhat narrow band of thinning right downt the center of my scalp from behind my transplants.

 

If I get my wish, in a next procedure, I would like to fill in my hairline just a little bit more, and then spread some grafts behind the transplants I already have, which would be from about midscalp back. Even if I could get very thin coverage here, I would be happy with that.

 

I've believe I've seen some positive results in slowing down more hairloss by using Nizoral shampoo and some herbal remedies. I'm considering Propecia as well.

 

Thanks gillenator for your comments and advice.

[PCC]

Harve,

 

Your experience parallels mine in many ways. I am a veteran of 5 HT proceedures spanning my late teens to early 30's. See my post "Sharing my story" for details and my resume. The last was 10 years ago, the surgery and recovery took a lot out of me physically and emotionally, and I swore "never again". The results however ended up being an improvement upon the earlier work and here I am now at 41 considering further refinement/correction to the hairline, improved density in front, and reduction of old donor scarring. I have concerns about how much usable donor I have left. I dread the thought of it but realize "one more" may be inevitable. Now though I have the benefit of a great support like this site and owe it to myself to consult with one of the top independent docs.

[damo]

PCC i have just had my 2nd procedure with Dr Martnick 1 month ago and are very happy so far until it all grows through.How many in total (grafts) have you had done?

 

Rgds

Damo

 

http://www.inperth.com.au/users/damo/

[kg007]

Hello Harve -

 

I see that you are also very young like me and had a procedure done by Dr. Keene. May I ask how old you are and what was major hair loss concern (front/back?). How many grafts have you used so far in 2 HTs?

 

KG

[Guest]

Hey kg007, I'm going to be 27 this August. The main area of concern for me has been the front/hairline from the get-go. That is where I first noticed the hairloss back when I was 22. To this date, I've had around 1850 grafts in 3 procedures, from midscalp forward to the hairline.

 

I've been mostly happy with my results, but would still like a little more density. Right now, unless I comb my hair forward and down in the "ceasar" style, it does give the appearance of being a little thin. Further back toward my crown has shown some thinning as well.

 

Basically, just a little more density in front and I think I would feel great. As far as the back/crown is concerned, I'm hopeful that I can see positive results from the hairloss products I'm using in terms of re-growth maybe, but at the least, slowing down/stopping more loss back there.

 

PCC, thanks for sharing your experience. It always helps to know there are others going down (or already been down) the same road as me.