Senior Member TC17 Posted April 20, 2009 Senior Member Share Posted April 20, 2009 At what stage in the balding process can a doctor definitively state which Norwood pattern the patient will end up? I see on Dr. Rassman's baldingblog that almost all Norwood 7's have extensive balding in their early 20's, yet my uncle didn't begin balding until about 30 and he is now a Norwood 6.5 heading towards a full blown 7 at age 57. Even if he had been conservative at 25, 30, 35, etc., he might still look absurd right now with an exposed scar and/or islands of hair. And if anyone responds, please do not use the tired cliche of "well you need to go to a responsible doctor". I don't care how responsible a clinic is, no doctor is Nostradamus. Unless there are statistics that are accurate almost 100% of the time that correlate age and present balding with future balding pattern aren't we all running a huge risk of looking silly down the road? (one final thing, I understand propecia, but with that there are no guarantees it will work forever, and I for one would prefer to NOT stay on a drug the rest of my life) Any thoughts, preferably from a physician? Link to comment Share on other sites More sharing options...
Senior Member TC17 Posted April 20, 2009 Author Senior Member Share Posted April 20, 2009 At what stage in the balding process can a doctor definitively state which Norwood pattern the patient will end up? I see on Dr. Rassman's baldingblog that almost all Norwood 7's have extensive balding in their early 20's, yet my uncle didn't begin balding until about 30 and he is now a Norwood 6.5 heading towards a full blown 7 at age 57. Even if he had been conservative at 25, 30, 35, etc., he might still look absurd right now with an exposed scar and/or islands of hair. And if anyone responds, please do not use the tired cliche of "well you need to go to a responsible doctor". I don't care how responsible a clinic is, no doctor is Nostradamus. Unless there are statistics that are accurate almost 100% of the time that correlate age and present balding with future balding pattern aren't we all running a huge risk of looking silly down the road? (one final thing, I understand propecia, but with that there are no guarantees it will work forever, and I for one would prefer to NOT stay on a drug the rest of my life) Any thoughts, preferably from a physician? Link to comment Share on other sites More sharing options...
Regular Member Mane Attraction Posted April 21, 2009 Regular Member Share Posted April 21, 2009 I'm not a physician, but doesn't Dr. Rassman advocate getting your hair mapped for miniaturization so that you can work out a long term plan for your specific hair loss pattern? I believe that the purpose of this mapping is to determine which follicles are affected by the early onset of MBP, even when it's not yet visible to the naked eye. Apparently, this allows the doctor to make an educated prediction (based on the status and location of affected hairs) what NW level a person will eventually recede to. Dunno how many doctors actually offer this miniaturization mapping service though. My Hair Loss Website - Hair Transplant with Dr. Rahal Link to comment Share on other sites More sharing options...
Senior Member Marvin Posted April 21, 2009 Senior Member Share Posted April 21, 2009 I'm also extremely interested in the question of predicting one's final NW number, for selfish reasons of wanting to know my eventual fate. Do we have even anecdotal evidence that some doctor can share? Link to comment Share on other sites More sharing options...
Senior Member phxind Posted April 21, 2009 Senior Member Share Posted April 21, 2009 I know coalition doctors who don't map hair for miniaturization. Maybe some doctors can comment on what their thoughts on mapping for miniaturization are. ------------------------------------------------------------ My Hair Loss Website - Hair Transplant with Dr. Alexander Link to comment Share on other sites More sharing options...
Senior Member TC17 Posted April 21, 2009 Author Senior Member Share Posted April 21, 2009 I think Dr. Rassman is very bright, and the concept of miniaturization mapping seems to make sense to me. However, absent already existing miniaturization what good is it? I understand that the miniaturized hair is visible under a microscope well before it becomes so to the naked eye, but what good is that if the only area that is miniaturized is for a NW 5 pattern because the guy is young and he ends up a NW 7? Now, if a NW 5 pattern at age 30 leads to a NW 7 pattern later in life in only 5% of the population, the risk may be worth taking. But, if the percentage is higher and the risks of a visible scar and/or transplanted hair eventually falling out are relatively high, maybe surgery should not be done. It seems that doctors use the age of 25 as the threshold for when they will feel comfortable in transplanting, and I just want to know why. If future balding is not predictable, why transplant someone so young when the risk of severe future loss (because anyone getting a HT at age 25 must have started losing hair early, and that would appear as though he is destined for a high NW pattern) is so plainly evident? What am I missing? Link to comment Share on other sites More sharing options...
Senior Member Reverse the Curse Posted April 21, 2009 Senior Member Share Posted April 21, 2009 tc no one can truly predict future hairloss. they can guesstimate but will never know. i often see men with 2" strip around their head & i pray i never become that. if so i'd be screwed because of my scar. if i had fue then most of that hair would have refallen out. if you feel you may become nw7 i would advise against ht. buzz down & accept the enivitable. i advise everyone the try this before ht to see how it looks. many are surprised the 1st time they do it. the 1st time i did it was after ht & i liked the look over a lot of hair with a bald top. i looked less bald with buzzed look. i love my ht now that it is in & have accepted my crown will always lack hair. rtc Link to comment Share on other sites More sharing options...
Regular Member Mane Attraction Posted April 21, 2009 Regular Member Share Posted April 21, 2009 These are good questions, TC17. Perhaps all decent HT doctors routinely consider that every patient could potentially recede to a NW7, and always plan for this eventuality by keeping enough donor hair available for future surgeries. The age of 25 might be a baseline figure, just to buy a little bit of extra time. True, a HT surgeon could act unethically by using too many grafts in the frontal area, while failing to account for future hair loss in the crown. But we also need to consider that good HT's require a mutual, long term plan between doctor and patient. Just as the doctor needs to keep enough of the patient's donor hair available for future surgeries, the patient also must ensure he's considered the possibility of becoming a NW7 and that this is factored into his overall strategy. It's really the same thing as the patient needing to manage his funds for a future transplant, should he require one. If he runs out of hair OR money, then either way he won't be able to have additional surgeries and will end up looking the same in both situations! It's really just a matter of planning for the long run in every possible aspect. Miniaturization mapping, from what I gather (and even though it's probably not 100% perfect) seemingly gives the doc the ability to make a more accurate *guess* about the patient's future hair loss pattern based on the evidence of hair shrinkage they're seeing on the scalp. If a mapped patient seems like a good transplant candidate who *probably* won't become a NW7, then the doc might feel more confident being less conservative when planting grafts into his frontal area. Whereas a doctor who doesn't map might be seen as leaving more to chance and the patient's fate. Making this call would also likely depend upon whether hairs in the NW7 zone start becoming affected by DHT (even in the most minutely detectable way) as soon as the first signs of MPB set in. Does DHT "infect" new hair progressively, starting at the front and working its way back? Or does DHT "infect" all vulnerable hairs on the head simultaneously from the very outset, with some hairs just succumbing faster than others? If it's the latter, then I imagine this would define the patient's final balding pattern well in advance. But again, I'm not a physician so take all I say with a grain of salt! Have you considered posing these questions to Dr. Rassman himself on his blog? My Hair Loss Website - Hair Transplant with Dr. Rahal Link to comment Share on other sites More sharing options...
Dr. Bernardino Arocha Posted April 21, 2009 Share Posted April 21, 2009 TC17 thanks for the interesting questions. It is correct that the evolution of Norwood patterns fallows a bell shaped distribution curve. Indeed, miniaturization may be less prominent at an earlier age, it usually is. Only about 20% of men become bald in their twenties, it is for these younger patients that the crystal ball is cloudiest. So to answer your question, I assume that all my patients will develop the advance stage male pattern baldness. It is important, to fallow sound surgical planning for both the recipient area as well as the donor. Of course, I examine the scalp carefully looking for miniaturization, but the absence of it does not guarantee that it will not develop in the future. Remember that Androgenetic alopecia is a two prone process, in which we inherit a pattern of hair that is sensitive to the DHT. When the sensitivity develops varies amongst the afflicted, and is contained in their genes. Sensible treatment should employ surgery to restore the hair, which has been loss, and pharmacologic treatment to prevent the progression. The fallowing article discusses the treatment of the most advanced MPB in a patient with limited donor, here it is: http://www.regrowhair.com/hair...patterned-hair-loss/ Please copy and paste unto your browser if it is not active. Dr. Bernardino Arocha is a member of the Coalition of Independent Hair Restoration Physicians Link to comment Share on other sites More sharing options...
Senior Member TC17 Posted April 22, 2009 Author Senior Member Share Posted April 22, 2009 Dr. Arocha, Do you have any updated pictures of that NW 7 patient? Link to comment Share on other sites More sharing options...
Senior Member Shadow of the EMpire State Posted April 22, 2009 Senior Member Share Posted April 22, 2009 You answered your own question: no doctor is Nostradamus. The answer, then, is that there are no answers. And is this really any surprise? All we do in life is play percentages. And the percentages tell us that the younger you start balding, the worse it'll be. Are there some cases where a guy gets to 35 or 40 with Brad Pitt's hair and then winds up with a pattern more advanced than a guy who was NW 3 at 18? Sure. Is it common? Not at all. Is it worth worrying about? Not in my opinion. Look at RTC. He had a full head of hair at 35, but he went bald. You can never tell. But the truth is that guys like RTC are a rarity here. In the vast majority of cases, the guys who go very bald are very bald in their 20s. Link to comment Share on other sites More sharing options...
Senior Member mmhce Posted April 23, 2009 Senior Member Share Posted April 23, 2009 Thank you for your valued contribution Dr. Arocha! It is correct that the evolution of Norwood patterns fallows a bell shaped distribution curve. ALL biologically natural processes follow the normal distribution. Only about 20% of men become bald in their twenties 20% of all men suffer some sort of minituarization of the hair follicles and not necessarily "complete" baldness. take care... Link to comment Share on other sites More sharing options...
Dr. Bernardino Arocha Posted April 23, 2009 Share Posted April 23, 2009 TC17, We have talked and he stated that his hair has grown much thicker. He has been rather busy with work and his personal life, and it has been impossible to get him to come in for a fallow up visit. Dr. Bernardino Arocha is a member of the Coalition of Independent Hair Restoration Physicians Link to comment Share on other sites More sharing options...
Dr. Bernardino Arocha Posted April 24, 2009 Share Posted April 24, 2009 Shadow of the Empire State, it is not necessarily so that the younger the start of pattern hair loss the more severe or advance the Norwood stage that will develop. The final pattern is programmed in the genes. In general, the incidence of AGA Norwood III, IV, V, VI, and VII increases steadily with aging. The Norwood VI and VII patterns occur in 10% of men age 50-59, 23% of age 60-69, 22% of age 70-79 and 30% of age 80-89. In this study of 1000 patients there were no patients 20 something with Norwood VII. The important point is that even with the severe presentation of Norwood VII with thin donor it is possible to obtain a very pleasing hair restoration outcome, as long as, sound hair restoration principles are fallowed along with reasonable expectations. mmhce, thank you for your appreciation. Hair loss is usually never easy or welcomed, but it is more acute in the younger patients. In your twenties with only 20 % affected by hair loss or miniaturization you seem to stand out more against the 80% of your peers without the affliction. Dr. Bernardino Arocha is a member of the Coalition of Independent Hair Restoration Physicians Link to comment Share on other sites More sharing options...
Senior Member Shadow of the EMpire State Posted April 27, 2009 Senior Member Share Posted April 27, 2009 Doctor, I'm more than willing to yield to your comments about the progress of hairloss. After all, you're the doctor, not me. But I couldn't help but shudder when I read this: The important point is that even with the severe presentation of Norwood VII with thin donor it is possible to obtain a very pleasing hair restoration outcome, as long as, sound hair restoration principles are fallowed along with reasonable expectations. With all respect, unless you have some revolutionary technique that remains unknown to the rest of the world, I would tend to regard that statement as absurd. I'm not a doctor, but I have seen hundreds (thousands?) of transplants over the last seven years, and that time has taught me a thing or two about the limitations of hair-transplant surgery. Simply put, in my experience, Nowrood 7s with thin donors do not have "pleasing outcomes" unless the expectations are nil. In fact, I have never seen a NW 5 (let alone a NW 7!) have a cosmetically acceptable transplant with "a thin donor." Even with a thick donor, the incidence of quality NW6 restorations is few and far between. Who's out there? Bobman and Futz. After that, there really isn't anyone. Link to comment Share on other sites More sharing options...
Dr. Bernardino Arocha Posted April 27, 2009 Share Posted April 27, 2009 Shadow of the Empire State thank you for your comments and questions. The key is reasonable expectations. I don't think that you have read my article entitled, 'Approach to Surgical Hair Restoraiton of Advanced Stage Male Patterned Hair Loss.' The fallowing is a condensed version of a presentation I gave at a cosmetic surgical meeting. Mon 9 Jun 2008 Approach to Surgical Hair Restoration of Advanced Stage Male Patterned Hair Loss Category: Complications , Donor Issues , FUT (Follicular Unit Transplant) , Hair Transplant Surgery , Post Operative Concerns , Session Sizes This insightful hair transplant article was written by Dr. Bernardino Arocha of Houston, TX who is one of our recommended hair restoration physicians. A survey of this hair transplant patient's bald head, shows that the lateral fringes and crown have completely been eroded. The lateral humps have been obliterated, and the hair on the temporal areas (sides) is quite low. This isa level 7 on the norwood scale of hair loss country, it is a follicular unit barren real estate , where there is more hair loss, then there is remaining hair! As if, that is not enough, study of the permanent donor area reveals that the hair density is decreased and the total occipital hair remaining is very diminished by baldness on two advancing fronts. From above, Androgenic Alopecia is eroding the crown, while from below a Retrograde Alopecia is raising the neck hair line. After careful study, it is determined that a minimum of 2000 follicular unit grafts will be needed to commence the hair restoration process. That is, 500 follicular units to raise the lateral humps. Into which, we can anchored the hair line , which is estimated to need at least 1500 follicular units. We do not know at this juncture, whether, we can achieve the full 2000 hair grafts, much less, any extra to transplant into the area beyond the hair line. As always, key is to conserve this limited donor hair resource. That means, binocular microscopy, for slivering and follicular unit trimming. This should increase our donor yield by 25-30%, by minimizing hair transection in this process. Also pivotal, is the use of single blade free hand harvesting of the donor strip. We also planned for a maximal donor harvest. The hair growth yield for this patient came in at 3500 follicular units, meeting our definition for a small hair transplant megasession . It was possible to accomplish the framing of the face, the single most important objective. Then we transplanted the frontal and mid scalp areas, addressing everything minus the bald crown. The crown was left to medical hair loss treatment, Propecia and 5 % Rogaine (minoxidil). While the medical therapy did not cause hair regrowth in the crown, it did improve the donor hair density and hair characteristics overall. Hence, the balding patient has the donor for another large procedure to address the crown or further enhance other areas. The patient had a very good early result at only 3 months post transplant, however, it was much better at 7 months, even though there is much more to come. The donor hair is coarse, making it more difficult to achieve a soft hair line. These results are very natural and the patient of course is thrilled. It may be only hair, but hair is only at the surface, what is even more gratifying is the boost in self-confidence that has been restored, alone with a much more optimistic outlook! Bernardino A. Arocha M.D. ??” Bill - aka Bill'Associate Publisher of the Hair Transplant Network and the Hair Loss Learning Center'View my Hair Loss Weblog Technorati Tags: hair transplant, norwood scale, hair loss, hair density, baldness, Androgenic Alopecia, Alopecia, follicular unit grafts, hair restoration, follicular units, hair grafts, donor hair, hair growth, hair transplant megasession, bald, hair loss treatment, Propecia, Rogaine, minoxidil, hair regrowth, hair characteristics, balding Thank you for sharing: | Ask a Question Related Posts: The Hamilton/Norwood Scale Is it Normal to Experience Hair Shedding With Propecia? How Can I Be Sure a Hair Transplant is Permanent and My Donor, DHT Resistant? What is the Cost of Hair Transplantation and How Many Treatments are Required? Can I Shave My head After a Hair Transplant? ADD A COMMENT You must be logged in to post a comment.'If you have a question, please use our "Ask a Question" page. Dr. Bernardino Arocha is a member of the Coalition of Independent Hair Restoration Physicians Link to comment Share on other sites More sharing options...
Dr. Bernardino Arocha Posted April 27, 2009 Share Posted April 27, 2009 Please use this link to the article as the pictures did not copy. Hope this helps. The results were at only 7 months, he has reported that his hair has improved considerably, but he has not come in for fallow up. Here is the link again:http://www.regrowhair.com/hair-transplant-surgery/approach-to-surgical-hair-restoration-of-advanced-stage-male-patterned-hair-loss/ Dr. Bernardino Arocha is a member of the Coalition of Independent Hair Restoration Physicians Link to comment Share on other sites More sharing options...
Senior Member hairthere Posted April 27, 2009 Senior Member Share Posted April 27, 2009 shadow, you should keep in mind too that the people who post results on these forums are just a fraction of those having ht surgery. I am the owner/operator of AHEAD INK a Scalp Micropigmentation Company in Fort Lee, New Jersey. www.aheadink.com Link to comment Share on other sites More sharing options...
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