How many grafts/sessions for me? Pics attached.

[multiplier]

This fall, I have had consultations with with a reputable/HRN-endorsed NYC doctor who I will probably do a procedure with in the springtime. He suggested I had about 4000 grafts to work with and we could break it up into 2 sessions over a period of a year or two.

 

I just had a haircut and here's how I'm looking:

 

 

 

I think I am a realistic patient. Aged 35. Fairly straight hair, average quality. I don't expect to have a lower hairline or thick density. I don't mind people thinking I look "thinning". Mainly I just want to avoid the patchiness I have now.

 

Regarding the hairline, I don't need the temples filled in or the hairline lowered. I just want the procedure to blend everything together better.

 

Also I have been in Fin/Minox for 10 years and it has mostly halted my loss. Judging from my first procedure with MHR in 2000, though, I am susceptible to shock loss.

 

So - any feedback? Would two sessions of 2000 get me to a better place? Thanks!

[corvettester]

4,000 FUT is more like it.

[moses0324]

I'd say 3500 to 4000. 2-3 hair per would fill it nicely in the mid scalp area.

[multiplier]

4,000 FUT is more like it.

 

You mean in one session? 4000 FUT was the overall plan, just broken into 2 sessions. Are there reasons to do it all at once?

[moses0324]

Why not do it in one session. Save money, not risk infection twice. Why do it in two sessions? You will also save donor hair as you won't have to cut twice and ruin surrounding hairs.

[multiplier]

Why not do it in one session. Save money, not risk infection twice. Why do it in two sessions? You will also save donor hair as you won't have to cut twice and ruin surrounding hairs.

 

Good question. I guess a larger session like that seemed like it'd be more traumatic somehow. More shock loss, longer healing time, etc, though maybe I'm being paranoid. I also don't love the fact that 4000 might be all I have, donor-wise, and to see it all gone at age 35 when I'm not sure what other treatments might be available in the next 10 years...seems kind of scary. Again, maybe just being paranoid.

[moses0324]

You'll ruin more by cutting twice. You won't see nearly the coverage you want with 2000. If your donor is only good for 4000 you probably should reconsider a HT. With your diffused thinning. Its probably gonna take more than 4000 to get descent coverage. Just my 0.02.

[Jotronic]

Without knowing the specifics (size of donor scar, current laxity, etc.) I'd say that 4000 "should" be possible in one shot but I'd recommend scalp exercises to be sure. The advantages of one shot vs. two are:

 

1. Less down time.

2. Faster time to final result.

3. Less scarring.

4. Less donor damage.

5. Usually less cost.

 

Most better clinics have some sort of sliding scale fee structure so the more you get in one the less you pay per graft. You head back for a second then that fee structure resets and you wind up paying more.. The difference between two sessions of 2000 grafts each vs. one session of 4000 grafts can be several thousand dollars based on this fee structure.

 

Even with 4000 grafts your crown will still be thin but it won't be bald for sure. The difference will be huge but if you are looking for high density throughout then forget about another HT as your donor supply won't support this type of goal. If you are fine with a thinner look however then the final result should be quite good for you.

[amanindia]

JOTRONICS I COMPLETELY AGREE WITH YOU MATE ..... .dUDE 3000 WILL BE SUFFICIENT.

[multiplier]

Well, I guess that puts me at a bit of a crossroads. If the doc thinks I have "4000 to work with", I assume that means my donor is limited to that. Is that a reason not to get the surgery? What is the worst case scenario?

 

Even with 4000 grafts your crown will still be thin but it won't be bald for sure. The difference will be huge but if you are looking for high density throughout then forget about another HT as your donor supply won't support this type of goal.

 

No, I'm not looking for crazy density. Just enough to cover the scalp in the frontal 2/3 mostly.

[Spanker]

I am kinda wondering why you have so few total grafts.

[multiplier]

I am kinda wondering why you have so few total grafts.

 

What would you say is the average total estimate? Keep in mind I already had almost a 1000 done back in 2010. My hair is fairly straight/fine anyway, maybe that had something to do with it?

 

In any case, we didn't talk explicitly about what my "total" amount would be, other than him just saying, "you have about 4000 to work with". Could be more, but I assume he would have mentioned it.

[Tonycc]

have you gone to a dr yet to see what the recommendation is?

 

Also, you want to do as many as you can in one session. You should be able to get a complete procedure from one sitting. The benefits of this are tremendous. $$$$$

 

Good luck

[mattj]

You'll find different doctors give very different opinions on how many grafts a patient needs, and equally so for how much donor hair they believe to be available. That's not to say that the doctor you've spoken to is wrong.

 

I understand the concern with using up what could be all of your grafts, but as you would be covering most of the entire balding area with them, (if I understood your goals correctly) they wouldn't be being misused. Basically, they'd be exactly where you want them in the future.

[Jotronic]

Multiplier,

 

It is difficult to say what you actually have "to work with" because you will get a wide variety of recommendations from various clinics, regardless of their reputation. For the record, if you've had 1000 grafts already I would find it highly unlikely, given your photos, that you only have 4000 left in your donor bank. In our clinic the average virgin scalp has 6500 to 8500 grafts in "x" number of sessions. Now, having had 1000 grafts your donor area becomes more of an unknown variable because we cannot assume that you have average laxity but we can use our experience to make an educated guess however we'd need to see better shots of your donor area including your donor scar.

 

My gut feeling though is that you have more than that if it becomes necessary to actually get more.

[multiplier]

I understand the concern with using up what could be all of your grafts, but as you would be covering most of the entire balding area with them, they wouldn't be being misused. Basically, they'd be exactly where you want them in the future.

 

Right, that was my feeling, too.

 

Best case scenario: I get hair evenly transplanted all over the front 2/3 of my scalp and I continue using Fin/Minox religiously to keep the back/crown steady.

 

Worst case scenario: at some point Fin/Minox stop working and I've got an "island" of hair toward the front, and much balder toward back. Meanwhile donor hair is gone. Then what? This scenario could be 10 years away. I can only hope better options will be available by then.

 

we cannot assume that you have average laxity

 

FWIW, Doc felt around and said my laxity was good.

[multiplier]

Well, now I'm a bit more confused.

 

This is what I read in a previous post by Dr True:

 

You raised a question about the treatment size I recommended (800 vs 2000). As you have indicated in your previous posts on this forum you are a diffuse thinner, exactly the sort of case in which shock loss could be a very significant factor. In such cases I often suggest proceeding in smaller steps focusing on the areas of greatest thinning and proceeding from there to minimize the shock loss factor. The way you described our interaction suggests that I simply acquiesced to your request for 2000 graft option. I know that in including such an option I would have explained that while the size of your balding pattern could certainly demand a 2000 graft treatment, doing so would carry more risk of shock loss.

 

 

When I met with Dr True and mentioned a fear of shock loss, he said it was not a term he liked to use since it was often temporary and never scary as it sounded. But I am a diffuse thinner and a 4000 session would no doubt cause significant shock loss, no?

 

I do want to add Dr True and his staff have been 100% above-board and informative. But seeing this comment made me stop short and think maybe that's why two separate procedures was recommended instead of one big one.

[lorenzo]

Multiplier you have found the right site to research. Every doctor has their opinion based on their experiences. I am sure doctors like Feller, Rahal and Hasson and Wong would probaly disagree with Dr. True comments. Not to say he is wrong but their experiences are different. I have witnesses and seen many patients after they have recieved 4000, 5000, even over 6000 so in my opinion I also disagree with those comments.

I feel the myth that is better to do 2 session of 2000 rather than 1 session has been proved incorrect in many aspect of this forum. Just look at the patients blogs that recieved sessions over 3500 they will give you the correct answer.

 

Maybe I dont understand fully diffuse thinning but my understanding its thinning over your head. There is no pattern of hairloss just all over it is thinning. Therefore if I am correct you would not be a good canditate for a transplant. It is because you would be thinning as well in the donor and no guarantees your hair will grow since the diffusing is unpredictable with no pattern.

Maybe I am wrong but that was my understanding.

 

Regardless good luck on your research.

Edited December 31, 2010 by lorenzo

[corvettester]

You mean in one session? 4000 FUT was the overall plan, just broken into 2 sessions. Are there reasons to do it all at once?

 

I didn't specify. Whether it's one session or two depends on you and your doctor and all the variables mentioned by previous posters. I've seen great results from both. I just meant that it looks like you would need 4,000 FUT in total. I opted for potentially two sessions for two reasons in particular.

 

First, 1,700 was the median number of grafts suggested by all the doctors I consulted with. Therefore, I reasoned that 1,700 should be enough. Dr. Dorin actually wanted 1,500 but due to a good donor supply and laxity, he ended up harvesting 1,696 grafts... I wasn't complaining!

 

I don't need dense packing. Bear in mind that I naturally have thin hair so I didn't want to overdo it. I think my natural density is 60 FU/cmsq.

 

My second concern was cost. To go for double would have cost double and I had already spent over a year saving for the first procedure and I'll spend another year paying off the remaining balance, so I really didn't want to wait any longer.

 

Clearly, I'm hoping that the 1,700 FUT in my hairline and temples will be enough and that I won't have to go back for a second session. But if I do, I'm fine with that. And as far as price goes, it will be the exact same price per graft as before ($4.00), which is the lowest T&D goes, so I'm not sweating it.

 

I took a more conservative approach but then again, I'm a NW3 at age 29 with a good donor supply and laxity (I was quoted as having at least 8,000 available grafts in my donor area). So now I have at least 6,300 more left over.

 

I'm going to wait well over a year before I even consider another HT because I want to see how the density turns out with my current HT, and also because I want to monitor whether or not I end up having more hair loss.

 

Corvettester

Edited January 1, 2011 by corvettester

[corvettester]

p.s. did you edit your post? I don't remember it reading the way it currently reads...

 

I could be mistaken, but when I first read it on 12.29.10, I could have sworn you asked something different. I thought you were asking if you thought that 2,000 FUT was enough to cover your head or something like that which is why I said "4,000 FUT seems more like it..." but now it reads completely different... please clarify.

[multiplier]

Thanks for the feedback man. 8000 sounds like a good donor supply, wish that applied to me.

 

p.s. did you edit your post? I don't remember it reading the way it currently reads...

 

 

Nope, not edited. In fact, when you responded about 4000, I thought maybe you had misread me. I wonder if you saw "2000" but not the part about two separate sessions.

 

In any case, I don't want to break it up into sessions if it's worse for the donor area. I want to get everything I can out of it. But admittedly it is scary to think 4000 is the max and after that....what next?

 

I emailed folks from True/Dorin this week asking them to address some of these things, but because it's a holiday week I don't think they checking email.

[corvettester]

Thanks for clearing that up for me Multiplier. I must have just misread it.

 

Yeah, I always just call T&D when I have a question. I usually get someone immediately or they just call me back shortly thereafter- afternoons are usually best.

 

It seems like if you ask 10 different HT docs for a graft estimate, you'll get 11 different answers... don't pay much mind to it. I had the same initial concerns. I got about 5 or 6 consultations and in which the estimates ranged from 1,000 - 2,700 grafts.

 

Even at T&D, Dr. True suggested 1,300 for my case while Dr. Dorin wanted to go up to 1,500. Even though there was only a 200 graft difference, I respected the fact that the two partners worked independently of each other. This actually made me trust them more. I went with Dr. Dorin simply because he had an opening before Dr. True and I was anxious to get my HT over with and start growing.

 

Although it's totally understandable, don't let paranoia get the best of you. We're here for you bro:)

 

Corvettester

[multiplier]

Thanks Corvettester. Hopefully after the holidays, I'll get the answers I'm looking for.

 

I'm trying to not to let paranoia get the best of me, I'm just ultra cautious due to past surgeries. 10 years ago LASIK really screwed my eyes up and I really never should have been a candidate. And my previous HT surgeon never mentioned diffuse thinning + shockloss, so I had to wear a hat for 6 months after the surgery. Some of the hair never grew back.

 

I guess that leads me to another question: since the front third of my hair is mostly transplants, I'm guessing that's not as susceptible to permanent loss as native hair would be?

 

I also keep reading threads about diffuse thinners not being good candidates, which scares me. Some of the threads are old and I realize the technology/methods of HTs improve all the time, but still, I don't want to make a precarious situation worse if I'm not actually a great candidate. FWIW, 2 top referred docs said that they would work on me, so I trust their judgment. I'm just a little haunted by Dr Bernstein's "don't take 1 step forward while taking 2 steps back" quote in regards to diffuse thinning, shockloss and HTs.

[tarepanda]

hi multipier

 

i too am suffering from shock loss ard my recipent area. its has been 6mths since my transplant and the shocked hair does not seems to be growing back.

 

i am considering another HT but my main concern is any permanent shock loss at the recipent area.This is holding me back...

 

i have scheduled a consultation with Dr Path on Feb... after that, i will probably wait till 1 yr post ops then decides whether to go for the HT.

[aseda1979]

Hey multiplier

I saw your pics and you still have a bunch of hair up there. With 3K grafts I think you will get very decent coverage but I don't know what your goals are and Im not a doctor so its just my opinion.

It's a tough choice between a megasession and possibly losing half of the donor grafts you already have and undergoing HT to get a desired hair coverage....