Few Weeks away from HT (Advice Needed)

[deitel130]

I am scheduled for a FUT HT in a few weeks. The Dr has given me two options, either spread out 3500 grafts to the front and mid scalp of just cover 3500 in front. Either option i will still be going back a year later for another 3500 grafts to cover the crown at the least.

 

Should i spreadout the 3500 grafts to cover a larger area?

 

Should I just cover the front with 3500 and then add 2500 to mid and 1000 to crown a year later?

 

Perhaps I can ask the Dr to cover the front with 2500, mid with 1000, that way next year i can add 1500 to mid and 2000 to crown?

 

The drawn out plan and pics are attached. Which would give me better results and also would it look strange with so much in the front and very little in mid and crown while i wait for my second HT? Would the option with covering the front give me good coverage and also be able to conceal some of the back as I wait a year?

 

Appreciate advise from ppl who have had a HT.

[deitel130]

The picture with 1 refers to the 3500 graft coverage which will occur during first and the 2 refers to the coverage that will occur during 2nd HT.

[Cant decide]

I would do the thrid option that you suggested. You dont want to just do the front even though you are going back a year later. That would be 6+ months of a fairly dense front and would not very look good in the short term. By doing your option three, you will achieve your long term goals and also look decent in the short term.

[Michael5577]

Go for the front first. If you spread it out, you might suffer shock loss after a subsequent procedure. Although the transplanted hair is supposed to come back, I wouldn't want to see my already transplanted hair disappear even for a few months. It's a bit too traumatic.

[Dutch]

Maybe go for the front half first.

 

Who's the doctor? That's important

[Tao]

I had the exact same concern as I had a glaring bald spot on my crown that bugged me. But my doctor highly recommended we do the front third first and in hindsight, he was absolutely correct. Why? First off, concentrating on that zone makes the biggest positive cosmetic difference by far. Frames the face and covers the area that is visible to most people (outside of giants). Secondly, when I went in for my second HT to address my crown area, we could shore up the few places in the front zone that needed it and then throw use all the rest to address the crown area. Bear in the mind, the crown area isn't called the black hole of grafts for nothing. You can waste a lot of grafts in that area with much less impact than if you used those grafts where you really need them first. Fix up the front first and then throw the rest of what you got at the crown. You can take a look at my link below to see how it turned out for me. Good luck!

[deitel130]

Dutch - It's Dr. Simmons in Toronto. Does that help or change the decision? I had a really good consultation with him and he was very helpful even with my on going questions afterwards.

[Cam Simmons MD ABHRS]

Deitel130

 

Just to clarify. These plans were drawn for 3000 grafts in the first session but you chose to safely transplant 3500 grafts. With either option we would cover a larger area with 3500 grafts, than drawn in either photo. The area drawn for the second session in the first photo was for 2500 grafts. We usually aim for fewer grafts in a second session than the first because we remove the old scar and take a slightly narrower donor strip.

 

You have a Norwood 6 thinning pattern with miniaturizing hair over a big area. Medical treatment can help preserve that hair but we can't count on you using medical treatment forever or medical treatment working forever.

 

Our goals were to cover the front and midscalp, while keeping a narrow scar in the safe donor area, and donor hair in reserve for the future. You are young enough that we still have to be cautious about transplanting your crown until we see how your future hair loss unfolds. Your donor density and scalp flexibility allow you to transplant a lot of grafts but not enough to cover your whole front and midscalp to a finished density in one session. We would need 2 sessions to achieve these goals.

 

Those 2 sessions can be done in 2 basic approaches. In the "front-to-back" approach you would see a finished look in front after one session and could return as soon as 9 months later to transplant your midscalp. You still have hair in your midscalp and we would fade out the transplant so it wouldn't look (between sessions) like your hair suddenly stopped at the back of the transplant. There is a higher chance of postoperative shedding when we "dense-pack" the area but each area would be finished after each session. In the "spread out" approach, we would give you a more gradual restoration and would cover a larger area less densely. We can spread the hair out a little but if we try to cover too big an area with too few grafts, I can guarantee that you will be disappointed. Spreading the grafts out would not give as dramatic a change after one session but would give a more balanced look if you postponed the second session. You would have to wait at least a year after the first session to see the full growth before adding more hair. We could fine-tune the plan for the second session based on the results of the first session. There are advantages and disadvantages to either approach but either is acceptable. You can think of the "front-to-back" approach as the more direct route and the "spread out" approach as the scenic route. Either path can take you to the same destination after 2 sessions.

 

Youger men who still have some hair on top usually prefer a front-to-back approach and older men who are bald on top tend to prefer a spread out approach .... but not always.

 

I hope that this helps with your decision. You can certainly solicit other opinions here but feel free to contact me directly with other questions.

 

I will follow this thread with interest.

Edited March 31, 2011 by Dr. Cam Simmons
did not address the 2nd session of "3500 grafts" at first

[deitel130]

Thanks again Dr. Simmons for the on going advice. I'm still unsure of which approach to go with but like you advised earlier I think I will wait until the surgery date and some examples from you the morning of. I might a tad bit be leaning towards the dense pack front approach I guess it will all come down to how much of the front will be covered since the original plan was for 3000 grafts and it will now be 3500 grafts.

 

Another point you have brought to my attention which I never really thought of was that you will fade out the grafts to the back and that will help in my decision making once we finalize the exact front area to be covered if dense packed.

 

You know better then I and so I guess the crown cannot be covered since I am still young and so I guess I will wait. However, I would still like to be able to lightly cover some of the crown in a years time but not sure if that's a good yet either.

 

I am in the process of growing my hair longer and that will eventually give you a better idea of how much hair I do have since it was too short during the consultation. In the end I will look to you for your advice on the surgery day to see what you feel is a better approach and exactly how much shock loss you think I might get based on the current hair I have (pre-HT).

 

Again I really appreciate you replying to my on going questions, it shows that you care and want to provide your patients with the right advice.

 

If anyone had a similar experience please free to share pics and comments as the more pics and references the easier the decision making.