Please evaluate my donor supply

[Gandolf]

Here are the pics of the back of my hair, and one of the top. My hair is quite fine but I do have quite a bit of it on the back and sides. Any estimates on the number of grafts in my lifetime donor supply?

[1978matt]

From my (limited) knowlegde I think you could get 2500-3500 in a single strip session.

[Davis91]

Depends on your laxity as well and other issues. Is there not a coalition doctor near you to visit?

[Gandolf]

 

Depends on your laxity as well and other issues. Is there not a coalition doctor near you to visit?

I met in person with Dr. Feller and just recently filled out several online consultations with top doctors for which I'm waiting to hear back from. I asked Dr. Feller when I saw him in person and he said I had good donor supply and laxity but didn't give specific metrics as to the number of grafts I have available. I'm young (28) and his recommended number of grafts for a procedure as well as the hairline he proposed seemed a little too conservative for my desires so I wanted to get some other opinions obviously to see how they differ. I think the only other coalition doctor nearby is Dr. Lindsey, who I will probably go to see in person as well.

[1978matt]

I met in person with Dr. Feller and just recently filled out several online consultations with top doctors for which I'm waiting to hear back from. I asked Dr. Feller when I saw him in person and he said I had good donor supply and laxity but didn't give specific metrics as to the number of grafts I have available. I'm young (28) and his recommended number of grafts for a procedure as well as the hairline he proposed seemed a little too conservative for my desires so I wanted to get some other opinions obviously to see how they differ. I think the only other coalition doctor nearby is Dr. Lindsey, who I will probably go to see in person as well.

 

 

I think he's right to be conservative, I mean even if you have 8000 lifetime supply of grafts it's best not to use a big proportion of them in one go. You never know, you may need to go back in 10-15 years due to further loss behind the transplant.

[Davis91]

There are several other notable members in the NYC area if you saw Dr. Feller--Bernstein, Wessley, and others. Lindsey is in DC as you know. This website can help you determine where this doctors are to visit by location.

 

Don't get overagressive on the hairline too young (under 35). You will find a doctor eventually who will do what you want, but your approach should be to think conservative first and then question the doctor whether it is OK to go a little lower without compromising supply. I am a little surprised Dr. Feller would not give an estimate at all.

[Blake Bloxham]

Gandolf,

 

Can you share a picture of your hairline? It may be easier to evaluate the conservative nature of Dr. Feller's estimate if we could get a look at the recipient area.

 

Additionally, I personally think it's quite difficult to evaluate donor regions from images alone. Frankly, it looks like you have a good supply, and I think the number of available grafts will break down to hair characteristics and scalp laxity.

[Gandolf]

Gandolf,

 

Can you share a picture of your hairline? It may be easier to evaluate the conservative nature of Dr. Feller's estimate if we could get a look at the recipient area.

 

Additionally, I personally think it's quite difficult to evaluate donor regions from images alone. Frankly, it looks like you have a good supply, and I think the number of available grafts will break down to hair characteristics and scalp laxity.

Sure, here they are. Please also note, I only want to come down a VERY small amount in the center which Dr. Feller did in his proposed hairline, it was just the corners where I felt it was too conservative for my tastes. And no, this is not how I wear my hair in real life LOL I just wet it and combed it up in the front to demonstrate for the pics.

Edited May 13, 2012 by Gandolf

[Gandolf]

 

I am a little surprised Dr. Feller would not give an estimate at all.

To be fair, I asked the one time and the answer wasn't specific numerically, but I didn't follow up and try to pin him down. It wasn't like he refused to answer or dodged the question or anything like that. I meant to write up a list of specific questions to have ready prior to my consult and to bring it with me but like an idiot I didn't do that and lost my train of thought and got distracted at times during the consult. He did ask several times at the end if there were any other questions I had but unfortunately my mind wasn't working sharply as I had trouble getting to his office and nearly had a panic attack just before the consult as I was driving through New York.

[Al - Moderator]

There's no way to really know how many available grafts you have because what you have now may not be the same as what you have in 15 or 20 years. Let's say you have 9000 grafts available today and you have a session of 2500 to strengthen your front a bit. Maybe 5 or 10 years later you need another 3000 to fill in additional loss behind the hairline and a bit in the crown. You're thinking you have 3500 grafts left, but in another 5 or 10 years when you need more work, the donor may be starting to thin a little and you may only have another 2500 grafts instead of 3500 like you thought. Right now your donor may look great, but that can change over time, so anyone who gives you a number of how many grafts is just taking a guess. Don't rely too much on it.

[Gandolf]

 

There's no way to really know how many available grafts you have because what you have now may not be the same as what you have in 15 or 20 years. Let's say you have 9000 grafts available today and you have a session of 2500 to strengthen your front a bit. Maybe 5 or 10 years later you need another 3000 to fill in additional loss behind the hairline and a bit in the crown. You're thinking you have 3500 grafts left, but in another 5 or 10 years when you need more work, the donor may be starting to thin a little and you may only have another 2500 grafts instead of 3500 like you thought. Right now your donor may look great, but that can change over time, so anyone who gives you a number of how many grafts is just taking a guess. Don't rely too much on it.

Does hair in the donor area thin? Isn't all that hair DHT resistant?

[aaron1234]

Gandolf,

 

I think you have a decent head of hair right now. I would be very careful with a HT at this point simply because you have a lot of native hair to lose with shock loss. I see that you are on finasteride - good! You seem to be holding onto your crown fairly well, but you never can know for sure if you will keep it forever. I'm not saying you shouldn't get a HT, it's just not urgent right now. Just do your research for awhile and take your time. You've come to the right place.

[aaron1234]

Does hair in the donor area thin? Isn't all that hair DHT resistant?

 

Donor hair will change in characteristics as you age. It could thin, start to grey - but in most cases it won't fall out. A small percentage of elderly men experience senile alopecia where the donor hair begins to miniaturize and fall out. There are no guarantee's. Hopefully Finasteride is a weapon against senile alopecia but we don't know that for sure.

[Gandolf]

Gandolf,

 

I think you have a decent head of hair right now. I would be very careful with a HT at this point simply because you have a lot of native hair to lose with shock loss. I see that you are on finasteride - good! You seem to be holding onto your crown fairly well, but you never can know for sure if you will keep it forever. I'm not saying you shouldn't get a HT, it's just not urgent right now. Just do your research for awhile and take your time. You've come to the right place.

Doesn't shock loss of the native hair almost always grow back? It doesn't bother me much to have the hair fall out and look bad for 6-12 months while I wait on the final results because I'll be doing that anyway with the transplanted part in the front.

[1978matt]

Donor hair will change in characteristics as you age. It could thin, start to grey - but in most cases it won't fall out. A small percentage of elderly men experience senile alopecia where the donor hair begins to miniaturize and fall out. There are no guarantee's. Hopefully Finasteride is a weapon against senile alopecia but we don't know that for sure.

 

Quite right. I saw an interview with one doc (can't remember who) who said that not everyone retains donor, but for the vast majority (high 90 percents) it is there for life.

[Gandolf]

 

Quite right. I saw an interview with one doc (can't remember who) who said that not everyone retains donor, but for the vast majority (high 90 percents) it is there for life.

I'm hoping I have my dad's genetics. I look just like him and have nearly identical hair characteristics and thinning patterns. He had recession like mine and some light thinning on top in his late 20's and early 30's that barely progressed much at all from that time until now in his early 60's. And he has all of his donor hair as thick as it's ever been. In fact, his hair actually got thicker and coarser with age once it turned grey. And it's not just my dad, no one in my family has anything even close to a horse shoe pattern on top so while anything is possible I don't think I'm likely at all to lose my crown, especially since I'm also committed to taking Propecia for the rest of my life. I'm willing to take a small but calculated risk and be a little aggressive now just given these circumstances but yes I agree and understand that anything can happen with my hair as I age. Edited May 13, 2012 by Gandolf
Spelling/Grammar

[aaron1234]

Doesn't shock loss of the native hair almost always grow back? It doesn't bother me much to have the hair fall out and look bad for 6-12 months while I wait on the final results because I'll be doing that anyway with the transplanted part in the front.

 

Shocked hairs will most likely come back if they were healthy, terminal hairs in the first place. However, there are most certainly some miniaturized hairs in your frontal third and you could very well lose them for good. Some say one shouldn't undergo surgery unless they are a NW3 or worse. If you get surgery with a lot of remaining native hair there is a possibility of a net zero trade off. Again, just a scenario to consider before taking the plunge. With propecia you may be less of a risk for this outcome.

[Gandolf]

 

Shocked hairs will most likely come back if they were healthy, terminal hairs in the first place. However, there are most certainly some miniaturized hairs in your frontal third and you could very well lose them for good. Some say one shouldn't undergo surgery unless they are a NW3 or worse. If you get surgery with a lot of remaining native hair there is a possibility of a net zero trade off. Again, just a scenario to consider before taking the plunge. With propecia you may be less of a risk for this outcome.

Do we have any pictures here on the forum of patients who went to coalition doctors and had this type of permanent shock loss you describe to their native hairs?

[aaron1234]

That's a good question and unfortunately none come to mind at the moment. I think I've heard of this concept more from consultations with doctors and discussions with forum members than seeing photographic evidence on this site.

[Brad3451]

Gandolf,

 

I think you have a decent head of hair right now. I would be very careful with a HT at this point simply because you have a lot of native hair to lose with shock loss. I see that you are on finasteride - good! You seem to be holding onto your crown fairly well, but you never can know for sure if you will keep it forever. I'm not saying you shouldn't get a HT, it's just not urgent right now. Just do your research for awhile and take your time. You've come to the right place.

I'm on board with these thoughts.....

[Gandolf]

 

I'm on board with these thoughts.....

At this point I'm about 99% sure I'm going to do it. I appreciate the concern and I know it's genuine, but I'm just not happy being a 28 year old with a receding hairline. My facial features and hair characteristics don't lend well to a bald or receding look, so I figure if I'm going to get it done at some point, why not now and I can enjoy my 30s and look good

[Gandolf]

Well, the email consultation results are flowing in and I'm honestly amazed at just how much the opinions vary from doctor to doctor. I should note that I only solicited opinions from the very top echelon of clinics in the world.