noob seeking thoughts/future predictions

[calvinmd]

Hey. I've been lurking for months and finally started posting the other day. I'd love any input on my case, particularly if anyone has any thoughts/predictions on future loss possibilities. My case doesn't quite fit the common patterns.

 

-- 28-yo caucasian male. NW3, no HTs, just starting finasteride.

 

-- Currently a sharp-pointed NW3 in front. Visibly thinned front & top, but it's mostly still terminal hairs at this point.

 

-- NW4A-5A seems possible eventually. It's the only MPB pattern in any blood relatives. Center/ very top of my head is thinning and is gonna be gone eventually. But my crown still looks & feels very thick at this point.

 

-- No adult hair loss in my father or either of my grandfathers (all have lived to their 60s-80s). My father's brother is still a NW1 in his 50s. The only blood relative with MPB that I can find is one of my mother's cousins, who is a NW4A-5A in his 50's.

 

-- I didn't actually lose most of my temples to MPB. My natural (un-MPB) hairline has always been at least a NW2.5 ever since I was 15-16 years old. This temple-recessed hairline was stable and I had no thinning until my mid-20s. (My father also had the same severe temple recession as a teen, except that he is currently 61 years old with no further hair loss at all since his teens.)

 

 

Any thoughts on my hair loss case?

 

I'm eventually seeking transplants (but not this year. Probably wait until age 29-30). I'm trying to figure out what my long-term situation might be.

 

With future HTs, I'd love to do as much temple closing as possible. (My deep temple recessions are particularly ill-suited to my facial features. And as I said above, they've been that way since late puberty. So I've never gotten to be a NW1 or even a NW2 in my entire adult life.)

 

But I don't really have a good idea about what is in store for my hair loss. If I eventually end up having to live with visible crown loss (because of MPB progression vs the limits of my HT donor area), then I don't think a NW2 hairline in front would look normal at all. Do you guys think transplanting a hairline with NW2.5-ish temple points is a safe bet in my situation?

 

 

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[calvinmd]

Hey. I've been lurking for months and finally started posting the other day. I'd love any input on my case, particularly if anyone has any thoughts/predictions on future loss possibilities. My case doesn't quite fit the common patterns.

 

-- 28-yo caucasian male. NW3, no HTs, just starting finasteride.

 

-- Currently a sharp-pointed NW3 in front. Visibly thinned front & top, but it's mostly still terminal hairs at this point.

 

-- NW4A-5A seems possible eventually. It's the only MPB pattern in any blood relatives. Center/ very top of my head is thinning and is gonna be gone eventually. But my crown still looks & feels very thick at this point.

 

-- No adult hair loss in my father or either of my grandfathers (all have lived to their 60s-80s). My father's brother is still a NW1 in his 50s. The only blood relative with MPB that I can find is one of my mother's cousins, who is a NW4A-5A in his 50's.

 

-- I didn't actually lose most of my temples to MPB. My natural (un-MPB) hairline has always been at least a NW2.5 ever since I was 15-16 years old. This temple-recessed hairline was stable and I had no thinning until my mid-20s. (My father also had the same severe temple recession as a teen, except that he is currently 61 years old with no further hair loss at all since his teens.)

 

 

Any thoughts on my hair loss case?

 

I'm eventually seeking transplants (but not this year. Probably wait until age 29-30). I'm trying to figure out what my long-term situation might be.

 

With future HTs, I'd love to do as much temple closing as possible. (My deep temple recessions are particularly ill-suited to my facial features. And as I said above, they've been that way since late puberty. So I've never gotten to be a NW1 or even a NW2 in my entire adult life.)

 

But I don't really have a good idea about what is in store for my hair loss. If I eventually end up having to live with visible crown loss (because of MPB progression vs the limits of my HT donor area), then I don't think a NW2 hairline in front would look normal at all. Do you guys think transplanting a hairline with NW2.5-ish temple points is a safe bet in my situation?

 

 

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[Bill - Seemiller]

[calvinmd,

 

Welcome to the forums.

 

I think it's great that you are taking your time, researching, and not jumping into the chair to get surgery as the first fix...as you know, hair transplantation is NOT a cure for hairloss. Being that you still have thinner hairs on top, these hairs will most likely die without medication.

 

I'm glad to hear you just started finasteride...for I believe that is the first line of defense. You might want to consider minoxodil too (if you don't mind the messy regime) to see how it all works out for you.

 

I think it would be difficult to really give you any advice at this point other than that for a couple reasons:

 

1. You are waiting to get an HT, and your hairloss case might be different in a year or two (either for the better or worse)

 

2. You only just started finasteride which needs to be taken at least 6 months (more like a year) in order to see its effectiveness.

 

The rule of thumb is to multiply your NW level by 1000-1500 in order to determine approximately how many grafts you will need to give you decent coverage and density. YOU will have to weigh when the time comes (if you have extensive loss) which is more important to you...more density or more coverage. It is difficult if not impossible to have a LOT of both on a NW5+. But certainly, many people can achieve a good look even on a complete NW5 with the right number of grafts/hairs and the right clinic.

 

If you'd like more advice at this point regarding a strategy based on your current hairloss condition, feel free to post pictures.

 

I think it is always wise (even if you wait a couple years), to start conservatively on the hairline, leaving you with a mature and natural looking hairline rather than a low high school hairline. Just remember, the lower you make your hairline, the harder it will be to achieve a dense look behind the hairline.

 

I hope this helps get you started.

 

Bill

[calvinmd]

Thanks for the quick response, Bill.

 

The "high school hairline" idea has never even been on the table for discussion with me. I think a NW#2 with a mild widow's peak would be the best-looking hairline on my face, period. (Even if donor hair wasn't any limitation.)

 

 

 

However, I do have some real demands about density in transplanted areas. I see photos of way too many HT patients that barely look better than if they had just stayed un-transplanted. Bad hair sometimes looks worse than baldness. Maybe I can't get near original density, but at the same time I'm not gonna live in concealers and fear every rainstorm or gust of wind for the rest of my life.

 

Does 50% of original density provide a "normal looking" density in the average case, realistically? Or do most of these HT patients still live in concealers 24/7 and build their whole hairstyle around hiding the lack of density?

 

 

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[Bill - Seemiller]

calvinmd,

 

Everything I read states that hairloss isn't even noticable until about 50% of your native hair is gone...however, certainly, in certain lighting, etc. our hair will appear thinner. Depending on how many donor grafts you have available and how much coverage you will need will depend on how dense of a transplant you can get. But even at high densities, a semi "see-through" look in some angles/lights will most likely happen.

 

Bill

[TheHairLossCure]

You made an interesting observation when you said that a (permanent) Norwood 2 frontal hairline may not look normal if you experience extensive crown loss. There certainly is a normal pattern in nature where a relatively low hairline is coupled with crown thinning or loss. The pattern is a Norwood 2V. However, the surface area of crown loss in a 2V pattern is typically not that big. If you are destined to lose significant hair over a large surface area of the crown, you might not want to be married to a low HT hairline.

 

Post pics if possible. You might also want to send along photos to some well regarded physicians. I think you will find that most reputable docs will try to make you happy in both the short term and the long term. Therefore, if you are a reasonably good candidate for a lower hairline, there is no sense in being unnecessarily conservative. On the flipside, if you are a bad candidate for aggressive work, an ethical doctor will tell you so and give you other options.

[TheHairLossCure]

I believe there is some soft data that suggests that 50% of original density will give the appearance of full density. It is sort of a broad statement and I do not know that I totally agree with it. Hair characteristics can work greatly for or against any given patient. Some guys with good donor hair characteristics are going to do great will less that 50%. Others with less than good donor resources are going to need to move a lot more hair to get a full look.

 

All that being said, I believe a good cosmetic HT density in the frontal third is possible with most patients. The appearance of density is very subjective and it is good to check out live patients if possible.

 

"But even at high densities, a semi "see-through" look in some angles/lights will most likely happen."

 

I tend to agree here and candidates with very high expectation will do well to keep this in mind.

[calvinmd]

Good to know. Good to know.

 

I've never been convinced that 50% is truly fine for a "full coverage" appearance, but I can live with that density as long as it looks decent and not unnatural. Sunny, wet, dry, bright light, etc. It doesn't have to look ideal but it has to look natural all the time.

 

I'm a lot more concerned about getting extensive HTs, and then discovering that I'm trapped into a very specific hairstyle and constantly using concealers just to keep it looking half as good as I thought it would look in the first place.

 

Is this why there are so many spiked-up hairstyles among HT patients? Do even the "dense" transplanted regions still look unnaturally thin otherwise?

 

 

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[TheHairLossCure]

Naturalness is conquerable in hair restoration. I think it is fair to say, certainly for Dr. Rose and many of the excellent physicians you may hear about in this discussion group, that naturalness takes precedence. It is very reasonable for patients to expect an undetectable result from their hair restoration. In fact, patients SHOULD expect naturalness.

 

With the technology and instrumentation available today it is possible to design and place a recipient zone without HT "tell signs" (i.e. ??“ pitting, visible scarring etc). Graft selection is very import too. Building the leading edge of the frontal hairline with exclusively single hair grafts is key. Then, you have the physician's innate aesthetic sensibility and eye for what looks right presently and what will look right in the event of additional hair loss.

 

If you get top-notch hair work, you really should not be a slave to any particular hair style. With state-of-the-art Follicular Unit Grafting, the grafts are small enough and placed close enough together that you will be able to finish an area with natural results in a single pass. That's not to say that you are not going to want to treat another area of the scalp later or perhaps up the density slightly from the first session. It depends, but you should NOT *need* to do more work to look natural or acceptably dense.

[TheHairLossCure]

By the way, I do not want to sound foolish optimistic about the field of hair restoration. There are a lot of sub-par docs doing sub-par work that is not going to deliver what I think of as acceptable density or naturalness. I trust you will check out a good handful of solid clinics and get a sense of work that is being done.

[Bill - Seemiller]

Something to keep in mind, as it's been touched on already is that "naturalness" is not the same as "fullness". I believe too, that naturalness is conquerable in hair restoration WITH the right clinic...however, fullness can be defined differently depending on who you talk to. I believe a "full" look in hair restoration is both decent coverage and decent density. But how would one define "decent"? Well, a lot this will depend on how many grafts you place on a given area. Those with extensive hairloss will NEVER be able to achieve the fullness (remember, coverage and density) that someone with minimal loss can achieve. Do the math...

 

limited donor supply (constant) + smaller area to cover = more fullness.

 

limited donor supply (constant) + larger area to cover = less fullness.

 

This doesn't mean that those with extensive loss can't get decent fullness...but as explained above...don't expect a completely thick high-school like head of hair...it's not a realistic expectation.

 

Great conversation all!

 

Bill

[hairbank]

Great thread and great advice!

 

TheHairLossCure- Thanks for sharing your insight to these questions as well. Dr. Rose is a gem.........you're working with one of the best!

 

I think what you said in your last post is very true............I also believe with a quality surgeon that acceptable density and naturalness can be achieved. At the same time, there are MANY surgeons out there still performing HT's delivering unacceptable results on a daily basis. All the more reason a person really should do their homework before getting in the HT chair. I can't tell you how many disappointed posters we've had here that would have done it differently the first time if they'd have frequented the site (or any site) and spent valuable time separating the "wheat from the chaff".

[calvinmd]

Thanks for all the responses everyone.

 

I've already done enough research not to let 95% of the HT industry anywhere near my head (and I'm not done researching yet!). I guess it's just more of a concern about what's achievable even in the best docs' hands.

 

I mean, almost every patient I see who was over a NW3 to begin with . . . seems like they ALL end up wanting to deplete their donor area as much as their money & long-term hair loss plans will possibly allow. That tells me that almost NOBODY is getting as much hair density/coverage as they'd really like, not even the HT patients who look great in their grown-out "after" pics.

 

 

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[Bill - Seemiller]

calvinmd,

 

Good luck in your research. Your expectations may very well be too high...that's something you will have to determine as you go. I believe one can achieve excellent results, but ithe word "excellent" becomes relative when you compare it with one's expectations.

 

Bill