Ok- I think I am ready to do this!

[GreaseDJ]

Hello all!

 

My name is James. I have been lurking for a while here and thought I would introduce myself.

 

I appreciate all of the members of this forum. You have helped me more than you could imagine. I have been considering a HT since I was 18 (I am 32 now)

 

I recently consulted with Dr. Cooley in Charlotte, NC and he recommended a 2,000 graft FUT to restore my hairline. Surgery is scheduled for July 27, 2011. Since I am only a couple hours away (in Raleigh) I told Dr. Cooley's office I would be willing to come in on short notice if there is a cancelation. (I am kinda hoping there is so I can get it over with! )

 

I would love feedback if anyone has comments or advice!

 

I look forward to posting more.

 

Edited June 12, 2011 by GreaseDJ

[Cant decide]

Great choice in your doctor. My only advice is to get on Meds if you are not already to protect that mid and crown you have. You will be glad you did. I wish I had.

 

Good luck.

[GreaseDJ]

Thanks Cant decide!

 

I am on the meds. Using Minox 5% once daily and Propecia 0.5 mg Monday, Wednesday and Friday.

[TheEmperor]

I think you will need more lke 3000-3500 grafts to complete the front with a density that blends with the density you have behind.

 

If you are prepared for a second surgery, I think you can have an excellent result. I would consult with some clinics who can do larger sessions.

 

To give you an idea, to get the same density and coverage you have in the back 2/3rds would probably take 10,000 grafts. To cover the first third at same density would require 5K grafts or more. To get decent coverage in front will take 3K+.

 

Good luck

Edited June 12, 2011 by TheEmperor

[GreaseDJ]

Interesting - when I went in to the consultation I had the 3k number in my head. I decided to let Dr Cooley tell me what he thought before I said anything. He measured out the space to fill (pretending the peninsula in the center isnt even there) the hairline would arc just around the remaining peninsula and come down only about a cm. He came up with 10 cm x 5 cm. His recommendation is an average of 40 grafts per cm for a total of 2k grafts. Does that still sound too few? I was surprised the area to fill was so small- I guess I have a pointy head ;-)

[Spanker]

I think you will need more lke 3000-3500 grafts to complete the front with a density that blends with the density you have behind.

 

If you are prepared for a second surgery, I think you can have an excellent result. I would consult with some clinics who can do larger sessions.

 

To give you an idea, to get the same density and coverage you have in the back 2/3rds would probably take 10,000 grafts. To cover the first third at same density would require 5K grafts or more. To get decent coverage in front will take 3K+.

 

Good luck

 

You would never transplant, even with 2 passes close to that density and would not need to either, that said, I think that 2k is very low. I would have guessed 3500.

[GreaseDJ]

Ok, now I am starting to get worried! :-)

 

Both of you said 3500... given that it is an area of 50cm2, that would be a density of 70 grafts per cm2. Is that normal?

 

I was researching today and found:

 

"Coalition member Dr. Sharon Keene from Tucson, AZ showed that in “normal” men without male pattern baldness, the average follicular unit hair density at the front hairline was 51 FU/cm2 with a range of 38-78. The average density in the temple apex region (behind the recession) was around 44 FU/cm2 with a range of 25-64."

 

That makes me think that an average of 40cm2 isnt so bad?

 

Wow, this is confusing!!

[MusoInOz]

2000 is fairly low mate, I had 2800 and much less loss. Have a chat about your concerns with the Doc, we are not physicians obviously yet many can make a decent estimation on graft numbers.

I too would say 3500.

 

Cheers,

[MusoInOz]

2000 is fairly low mate, I had 2800 and much less loss. Have a chat about your concerns with the Doc, we are not physicians obviously yet many can make a decent estimation on graft numbers.

I too would say 3500.

 

Cheers,

[Spanker]

Are these the pics that you sent the doc? I have much much less loss and most have quoted me 1500 to 2k grafts. I would definately talk to the doc again.

[GreaseDJ]

No- I did not send them those pictures. I went for an in person consultation. Dr. Cooley designed a hairline and determined that there is only 50cm2 that he would work on. It is a very small area. I think the pictures make it look bigger than it is. So I guess the big question is: is 40 grafts per cm2 acceptable? Like I said, 3500 grafts as most of you are suggesting would be 70 grafts per cm2. I am now very concerned because in my months of research, Dr Cooley seems to get very high praise for his hairlines and now it seems everyone strongly disagrees with his assessment.

[Dutch]

The doctor might be seeing the clearer picture but based on those photos, you need 3k minimum to have a nice result. In photos, the forehead does appear larger than in real life.

Discuss it with him again. If you have the financial means, then 3k plus might be the better option for you. It's not often you'll have surgery so you want maximum impact.

[GreaseDJ]

I will definitely talk to him about it again. When I was there for the consultation, I said I was surprised (and relieved) that it would be only 2k grafts and his response was "We don't want to take you hairline any lower and I wouldn't recommend more than 40 grafts per cm, so that is 2k grafts"

 

What are all your thoughts on the 40 grafts per cm2? That is really the question since I am happy with the hairline he designed. It is not too young and not too old. (Like goldilocks says, Just Right :-) ) It is all about how dense it should be filled. Dr. Cooley said it would be denser near the back and density would fade down toward the front like a normal hairline. My hair is corse and thick shafted. Most of my naturally growing units are 3s and 4s.

 

I just took another picture with my own drawing of Dr. Cooley's hairline plan just for perspective. (Now how do I get Sharpie off my forehead? :-) )

[biscuit]

There are a few guys in Dr cooley's gallery section with similar hairloss.

 

Jerry E. Cooley, MD Hair Transplant Surgeon in Charlotte, North Carolina

 

FWIW, a lot of those results aren't documented very well and they will look thinner in real life. Since you're local, ask if you can contact & meet a few of the most similar patients. Big red flag if they won't do that.

 

2,000 grafts is on the low side. 3-4k is more realistic, with the assumption that your hairline will continue to receed and thin.

 

example:

Hair Restoration Site for 502hairplease

 

I'd recommend a more rounded closure where the temples meet the hairline.

 

G'luck with it.

[aaron1234]

Cooley is great but I would consult with at least 3-5 other coalition surgeons. I agree that 2,000 grafts just ain't going to cut it.

[GreaseDJ]

Ok guys... I hear ya. But i still have the same question for you all....

 

I agree with Dr Cooley on the hairline design. It is exactly what I want. It is 50 square cm of space (including if we cover the forelock as though it isnt even there.)

 

So if we keep that hairline, we are talking about density now. I have to keep asking the question: what is an appropriate density? 2000 grafts would be an average of 40 grafts per square centimeter for that hairline. Are you all really suggesting 70 grafts per square centimeter? My hair is thick shafted and corse.

 

What I have been reading is that anything over 40-45 grafts per sq cm has yield issues and doesnt really help the "illusion" of density.

 

Please dont get me wrong, I am very very appreciative for all the comments. I am just a little frustrated that all the responses say "2k it way too low" without answering the density question.

 

My question is - ok if 2000 is not enough, where do we put the additional grafts? I like the hairline proposed and everything I have read says going over 40-50 grafts per sq cm is either not necessary or risky yield-wise. Does that make sense? I am overthinking this?

[mattj]

What did the doctor say about your donor density? This could've factored into his recommendation.

[GreaseDJ]

He said there was "fantastic donor density, good laxity" Also said that most of my units were 3s and 4s and very thick hair shafts.

[MusoInOz]

I'm slightly confused when you say anything over 40-45 has yield issues?

I still believe you require more than 2000 grafts, have a look on my posts and check the photos I was in better shape and had 2800 performed by Dr Rahal at around 65fu per cm/2

40-45 is very low density, you claim to have coarse/thick hair then 40 may give an obvious change from Transplant to native hair.

I don't think anyone is questioning Dr Cooley's recommendations he is a fantastic Doctor, but it is always good to consult with 3 or more physicians regardless just for an overall feel.

 

Great hairline Doc's include: Shapiros, Rahal, Feller etc.

 

Cheers,

[GreaseDJ]

Thanks guys, I will get in touch with the Dr first thing Monday to discuss why they recommend what you guys are saying is such low density. This is my first time doing this and thought I had researched pretty excessively, but I guess when it comes to looking at myself, my vision might get cloudy.

[Spanker]

I have heard that over 45 cm2 in one pass could reduce yield. After looking at Dr C's patients on the attached link, I would say that he has some hits and some misses. Take a look for yourself. Also, your area looks a lot lot more that 15 cm2, you can check it yourself, a cm is pretty stinking small. I would also do your own geometry on your head.

[biscuit]

Just keep in mind that very few clinics or patients document the density. It's more of a ballpark figure that isn't super accurate because it's difficult to count. The exact same planting density on two different patients can produce wildly different results depending on the yield and hair charactertics.

 

For me I look at the area that needs to be covered. In your case you have some hair remaining up front, but I would write that off to future recession and the very real possibility that it's already weakened and won't make it through the surgery/healing phase.

 

The most accurate way to see what you really need is to shave your head or go with a really short cut. Doing that will avoid overestimating your current condition and being overly optimistic about your results. For those of us who've been on the forums for over 5 years, it's all too common to see high hopes dashed by a clinic that underestimates what you really need for a satisfactory result. IMO, if you get 2k grafts I guarantee you'll be back in the chair at least one more time, soon.

[GreaseDJ]

I have heard that over 45 cm2 in one pass could reduce yield. After looking at Dr C's patients on the attached link, I would say that he has some hits and some misses. Take a look for yourself. Also, your area looks a lot lot more that 15 cm2, you can check it yourself, a cm is pretty stinking small. I would also do your own geometry on your head.

 

It is 50sq cm. I have measured myself

[Trichologist]

That does seem pretty low density alright, whats the news from the Doctor?

[Cant decide]

I dont think the alarm bells should be raised here. 2000 may be very appropriate in this case. 40 Grafts/Sq cm may give a perfectly acceptable density for him. In his case, he has a very thick hair shaft diameter and allot of 3-4 hairs per graft so in his case, planting 40 may be like planting 50-55 inguy who may have a thinner hair caliber and less 3-4s to add density.

 

Its about the number of hairs and not the number of grafts.