Would you transplant the Crown with this head????

[jimmybald]

Background

 

29yrs, propecia 3yrs, rogaine 3 years, one surgery in the corners of hairline(temples??) 1800 grafts 1 year ago DR. Pong.

 

How many grafts do you think it might take? Who is the best crown doctor in your opinion?

 

Also my donor is dense, hair is wavy, and hair diameter in thick(spanish ancestors).. all positives.. negatives- young

 

No one in my family is slick bald. The only person with thinner hair is my moms dad but his crown is better than mine and he's 65. My dad and his dad have elvis hair. Life's not fair.

 

Anyway thanks for your input and advice.

Edited April 23, 2012 by jimmybald

[realquiet]

Assuming the propecia has stabilized your hair loss over the last 3 years, adding density to your crown at your age with your hair loss history seems completely reasonable if it's bothering you.

 

The good news is with your wavy hair there's a chance you might not need quite as many grafts as someone with straight hair. But my unprofessional opinion is it looks to be somewhere in the 1500-2000 range. If your donor area is as thick as you say, it should work out quite nice for you.

 

As far as the crown docs go, I would go as far to say that any of the recommended docs do great work. I've seen awesome results from all of the usual hairline suspects like H&W, Rahal, Alexander, Keene, etc... I don't want to downplay the crown, but it's just harder to judge artistic merit where most people have a blob of hair.

[tarepanda]

Hi Jimmybald

 

i can see that you are rather concerned about the slightly thinning crown because this the 2nd time that you are asking about it.

 

personally i think that your hair looks great and i will not fix the crown yet if i were you at this stage.

 

however, if all existing factors suggest that you might not be heading towards a NW 5 and above, then fixed it rather than letting it bothers your daily life.

 

but fingers crossed for your future, make sure you still have sufficient donor hair after your crown transplant in case your balding do get worse.

 

anyway, how is your hairline transplant progressing with Dr Pong? Is the results "wow" till date?

[jimmybald]

I wouldn't call my crown slightly thinning.

 

I didn't get barely any replies from my other thread because it was mixed up and I don't think many people bothered to open the message.

 

To be honest, it does bother me, a lot. I can get by with nanogen alright but it really sucks having a GF and freaking out when she touches my head. I'm still not sure what to do. I might hold out a few more years to see what happens with the rest of my hair. Although I have the money to do it now so that's why I'm considering just getting it over with.

 

I am happy with Dr. Pong for the most part. One side is less dense as I've said before, hard to see in the pictures which I took with my iphone. He has offered to fix anything I'm not satsifed with and has great communication with me. He has suggested 2000-2500 to the crown area.

 

Difficult choice

[orlhair1]

It really is a personal choice. If it bothers you, and you have plenty of donor for the future, you should do it. I had about 1000 grafts put into my crown area for the same reason and it made a big difference. If you click on my link you can see the before and after pics.

[RCWest]

Strange how the front half of your hair is so strong but the crown is disappearing. Anyways, I believe you would be a great candidate for a crown procedure. As far as who is the best, there are many very good doctors out there. I like Dr. Wong the best for crowns.

[NEWHAIRPLEASE]

I think transplanting the crown would be fine in your situation!

[Dr. Michael Beehner]

I hate to be a wet blanket, but I think, at the age of 29, it would be a mistake to transplant your entire crown area presently, especially using maximal density, which I am sure is what you probably would want.

In looking at your "top-down" photo, I can see obvious thinning in a 9-10cm diameter circular area in back. At 29, you likely have 50 years of life ahead of you in which male pattern baldness is going to progress. And unfortunately, the square area of the crown/vertex does not increase in a linear fashion, but rather in a logarithmic way.

The great majority of men at your age with your degree of hair loss do in fact eventually go on to the classical U-shaped pattern of a Norwood VI pattern. With such a future likely, the top of your head will always be the number one priority to save donor hair for. You mentioned that you have already had some work done in the front. I have seen at least a dozen men over the years who had the crowns filled in when they were younger, and who came to see me 10-20 years later with a 1-2 inch wide "halo" of bald skin around the dense hair in the center, giving it the appearance of a "bulls-eye". And, unfortunately, this "halo" area couldn't be filled in because the donor hair supply was exhausted and had shrunk dramatically with the advancing baldness.

One other word of caution is that you have been on medication, which is a good thing and I'm sure you look better now because you have been on them. My hunch is that, if you had not taken medication, you would see quite a bit more hair loss presently and actually have better insight into what is going to happen in the future. So these treatments, which are great for helping delay the eventual balding pattern, do in fact "mask" what would really be going on now otherwise, and thus can make you a little more over-confident now that everything can be filled in densely and cover your bald area for your lifetime. I'm simply saying that, for the great majority of men who are going to eventually be Norwood VI patterns, the center of the crown/vertex is not where you want a bunch of dense hair.

Two final points: For many men with a thinning crown your age I will fill in whatever is on the horizontal plane, which often is almost 80% of the circular crown area, as seen from that top view, but I preserve a concave curve at the rear of this transplanting (as seen from the back), so that if the "bottom drops out" with a large area of balding beneath it, I am not committed to chasing after it.

The final point is that I think, at 29, some light coverage with low density 1-hair and 2-hair FU's is ok to do at this time in your entire crown, because that will never look freakish later, should you bald to a Norwood VII or advanced VI, and it doesn't take that much donor hair to likewise transplant in a similar fashion to the area in which baldness advances.

My cutoff for transplanting the rear vertex is 35. After that, I feel it is possible to make a pretty good assessment of where a given male is heading and being able to see if there is a comfortable "cushion" of donor hair available, so that the top and the vertex can both be filled in.

As always, the goal is to be as helpful as possible for the patient, but not to create short-term happiness now for misery and deformity later in life.

Mike Beehner, M.D.

[jimmybald]

Thanks so much Dr. Beehner for taking the time to reply in such detail, it is really helpful for me in my decision. Sometimes the cold hard truth, as much as it stinks, is what needs to be said.

 

I have been told that I need 2500 grafts but the doctor never mentioned other possibilities or future complications if hair loss continues.

[scar5]

Dr. Beehner's comments are interesting in respect to your case Jimmy, especially the portrayal of crown balding being tricky to predict, or at least more dicey than frontal recession. I think you are bordrline OK, but if you cut really short to disguise it, you might open a can of worms. But having nice hair elsewhere and a dying crown sucks! But what I am really curious about is how many doctors have steered you away from proceeding with the crown, 'at this stage' on account of doing harm to the existing hair in that region. This kind of shockloss is rarely spoken about - or should I say written about - because it is bad advertising, but I have found over the years, despite docs and reps assurances on message boards, come consultation time, an ugly prospect rears it's head (sorry about pun) . That is the doc, saying, 'sorry, pal, I wouldn't go in there, you might lose what you have now, forever'. It's almost as if you have to live with feeble minatirizing hair on your crown, until they have almost gone, and then the docs proceed to plant there. I wonder, how often, if often, have the docs told you this?

[Shampoo]

wow....Dr. Beehner that was very informative. Thanks.

[jimmybald]

Quick Update on my situation.

 

I have decided to have surgery with Dr. Panine out of Chicago. Dr. Panine and his staff will add density to the thinning crown and refine the hairline from my previous surgery. I will be having this surgery on Friday, April 27th . I think I will get between 2000-2500 grafts.

 

I very excited about having a surgery with someone that is recommended on this site. That's not to say I am unhappy with Dr. Pong, my previous surgeons, work. Although. I'm curious to hear a professional opinion about my prior surgery from Dr. Panine.

 

Wish me luck!

[tarepanda]

looking forward to hear from you regarding ur previous HT and ur upcoming HT

all the best!!!!

[mahhong]

Best of luck with your surgery jimmybald!

 

One question I did have though; has Dr. Panine seen you in person and/or performed any kind of miniaturization/bulk analysis of your hair or had a look at your donor area and made any estimations of available donor? I think Dr. Beehner raised some great points and, whilst you've found a good, reputable doctor to do your surgery and hopefully achieve your goals, I think you need to try and plan as best as possible for future loss. I'm sure Dr. Panine will be able to go through all of this with you but I'd recommend discussing thoroughly what the plan might be for your future if your balding progresses.

 

My personal instinct is that surgery like this can only be effectively performed if part of a 'Master Plan' that tries as best as possible to take into consideration all aspects of your hairloss and ambitions and tries to create contingencies for any future loss. If you've had 1800 on the temples and now let's say 2500 in the crown, that's 4300 FUs of your donor used up. That's a good chunk of your donor change and potentially over 50% of your donor hair gone.

 

If Dr. Panine has agreed to perform the surgery I'm sure you'll be looked after and a careful idea of your future planned out. I'm just saying these things to make sure you have all the information you can have.

 

Happy growing after the procedure!

[Shampoo]

This kind of shockloss is rarely spoken about because it is bad advertising, but I have found over the years, despite docs and reps assurances on message boards, come consultation time, an ugly prospect rears it's head. That is the doc, saying, 'sorry, pal, I wouldn't go in there, you might lose what you have now, forever'.

 

Scar5 is it widely accepted as fact that "shockloss" is much more severe in the crown area? I was not really aware of that until your post and just want to make sure I am correctly reading your input about crown shock loss vs shock loss else-where.

[bonkerstonker]

Don't blame you i would put that many grafts in the crown too so you can enjoy your youth what's point in messing around you may as well make it worth while it's a shame to have so much hair in the front and top then virtually bald crown.

[Shampoo]

it's a shame to have so much hair in the front and top then virtually bald crown.

The problem is....with his already "balding at 29 or even younger genetics" will he still have "so much hair in the front" 15 years from now when he is a relatively young 44 years old? I would be careful in preserving as much donor supply as possible. Already at 4300 of a limited donor supply at 29 years old with a very uncertain future is something to think about. I am sure he will be thrilled for awhile and I sincerely hope it works out long term. One thing working in his favor is even if he gets low on donor hair in his forties I predict by then this field could be revolutionized with new technologies, discoveries, and procedures that are unheard of today.

[bonkerstonker]

The problem is....with his already "balding at 29 or even younger genetics" will he still have "so much hair in the front" 15 years from now when he is a relatively young 44 years old? I would be careful in preserving as much donor supply as possible. Already at 4300 of a limited donor supply at 29 years old with a very uncertain future is something to think about. I am sure he will be thrilled for awhile and I sincerely hope it works out long term. One thing working in his favor is even if he gets low on donor hair in his forties I predict by then this field could be revolutionized with new technologies, discoveries, and procedures that are unheard of today.

 

Will he be at 4300 grafts after this operation? If so he is pushing it a bit he needs to know what he will have available in his donor using strip and fue. I've seen Rahal patients have about that many grafts in the front third of their head before i know the front is the best place to load up but still the doc must know the patient has quite a bit more donor stock so if this patient has enough i don't see why not to go for it if he's on meds.

 

Personally i'd still go for it and live my youth as long as he's on meds he's cool. I had my first ht at 25 it was the best thing i ever did.

[jimmybald]

I have already considered the unpredictable future of my hair loss. I understand the potential issues that can arise if I continue to bald. I'm not going to hit the crown with density, just 1500-2000. I am going to stay on the horizontal plane of my head as Dr. Beehner mentioned in a previous post. I am also committed to Propecia until a better drug comes along or until I die.. or I'm so old that idgaf about hair loss.

 

Thanks Bonker for your encouragement. I agree with you about doing it while I'm young. When I see 50-70 year olds getting transplants, I wonder why they care after being bald for so many years. Obviously it has affected them for a long time and if they had the technology in the past, when they were young, they would have jumped at the chance. Therefore I'm going to trust in the knowledge of a hair network coalition member and pray that it all works out.

[bonkerstonker]

So if you use 2000 grafts how many will you have used in total mate? Or is this op your first ht?

 

I think you'll be fine you've got to remember crowns aren't solid thick anyway so 2000 should be fine. Some people refer to the crown as a black hole but you can style a crown in a few ways to get better coverage.

[Shampoo]

So if you use 2000 grafts how many will you have used in total mate? Or is this op your first ht?

 

Background : 29yrs, propecia 3yrs, rogaine 3 years, one surgery in the corners of hairline(temples??) 1800 grafts 1 year ago DR. Pong.

 

Quick Update on my situation. I have decided to have surgery with Dr. Panine out of Chicago. Dr. Panine and his staff will add density to the thinning crown and refine the hairline from my previous surgery. I will be having this surgery on Friday, April 27th . I think I will get between 2000-2500 grafts.

 

 

1800 + 2500 = 4300 grafts before he is 30 years old

 

1800 + 2000 = 3800 grafts before he is 30 years old

[RCWest]

Jimmy-I am one of Dr. Panine's biggest fans. He will take good care of you! I am certain that he will have your best interests in heart on surgery day!