Patient vs. Doctor...who wins?

[xtatic5]

I'm a 28yo male with a 9cm hairline and I'm seeking to lower it 2.5cm via grafting. I've consulted several surgeons in preparation for my transplant and all of them tell me that my desired hairline is too low. I have lived with the embarrassment of a large forehead since high school and anything less than 2.5cm will leave me feeling less than confident.

 

I've actually come a long way since 4 months ago when I started considering HT; I originally wanted 3-4cm of lowering. After observing other guy's hairlines I came to realize that my concept of "average" was a bit off. The average non-receded hairline seems to be around 6.5-7cm.

 

I understand that HT surgeons have years of experience and that a hairline needs to be appropriate for both the present and the future. However, I see gray-haired guys with 6cm foreheads all the time. Plus, if I'm paying for a new hairline, why wouldn't I place myself among the lucky minority of guys who never experience recession?

 

So the big question is, who wins? Should I stick to my guns since I won't be happy any other way? Will a surgeon refuse to operate if he doesn't get his way? I don't think I'm being unrealistic here.

[Janna]

My personal opinion is that you should listen to the advice of all the physicians. You can stick to your guns but it won't get you a lower than recommended hairline. These doctors are looking out for your best interest.

[chrisdav]

xtatic5,

 

How many surgeons did you consult with?

 

Do you have any hair loss currently, and do you have any pictures?

 

If they are highly respected surgeons whom all told you the same thing, then I would tend lean to towards what they are saying.

 

You could quite easily go ahead with what you want as there are plenty of surgeons who will tell you what you want to hear, go ahead and do it, and then find you are in an even worse position.

 

I jumped into surgery too young, and was a victim of this personally as are a lot of guys.

 

This industry preys on the vulnerable, and there are significantly more bad clinics than good clinics.

[Cant decide]

It sounds to me like your expectations are way too high. If you have MPB and are shooting for a hairline that only the lucky few posess that have never seen any recession, then then you are asking for too much and need to re-evaluate your goals.

 

Trust me, at your age, you do not want a doc putting your hairline that low.

[orangehair]

Xtatic5.......be helpful to see a pic of your current hairline level and a depiction of the level your are wishing to obtain to comment on your situation but the bottomline is that you don't want to create a hairline that looks artificial in any way and it sounds like the doctors with whom you have consulted are looking our for your best interest in terms of a short term fix but with also with a bigger picture in mind.

[xtatic5]

I've consulted 4 doctors, 2 via email and 2 in person. 3 are recommended on this forum. None of them really gave an explanation except one said "I can't work miracles," which wasn't very convincing. We're talking 2000-2500 grafts which doesn't seem like a stretch.

 

Some background about my hair: I am not actively experiencing loss though it runs in the family. One of the surgeons examined my hair and said that I will likely not exceed a Norwood III based on the current state of my hair, so running out of donor grafts isn't too much of a concern. I intend to cut my hair rather short after the transplant, so I can't rely on bangs to conceal excess forehead.

 

I'm not one of these 19 year-olds who jumps into surgery impulsively. I have drawn several simulations of possible hairline designs and heights as well as observed other mens' hairlines online and in public. The hairlines the surgeons are suggesting are about 1.5-2cm, so we're not that far off from each other. I'm just not hearing any logical explanation as to why I can't have an average hairline.

 

Here is a pic of my actual hairline and the shaded area is my desired hairline. Is it too low?

 

[chrisdav]

The pic does not load up.

[Cant decide]

Thats just it. I dont think your idea of an "Average" hairline is "Average". The hairline you drew in that pic is a NW 0 hairline. Taking it up 2 cm is where it should be IMO.

 

If you do have loss and progress to past a NW IV with the hairline you drew, you would be screwed.

[chrisdav]

That is a norwood -3

[unclejesse777]

Hey man, despite what some others might say, I personally don't think your expectations are unrealistic, but there are a few things to consider. First, it looks to me like you're already a Norwood 3. I think you said one of the surgeons told you that you shouldn't progress beyond that, which is a good sign. If that's true, then you shouldn't really have to worry about conserving grafts for later procedures, which would allow you to focus entirely on the frontal region and hairline, like you want to.

 

I'm just curious, have you consulted with Dr. Feller? I've had work done with him, and really can't say enough good things about him. I also wanted to lower my hairline, and have been thrilled with the results. Now let me just say, I was only a Norwood 2, and the area I wanted filled in was a little smaller, but after Dr. Feller determined that I most likely wasn't going to lose any more hair, he had no problem giving me the hairline I wanted. You can read about my experience and see some pictures here:

 

http://www.hairrestorationnetwork.com/eve/160946-my-hair-restoration-journey-dr-feller.html

 

Currently my hairline begins 5.5 cm above my eyebrows. Some may think that's too low, but I love it. I've never bought into the whole "Low hairlines don't look appropriate on older men" thing. Guys like Brad Pitt, Richard Gere & Bill Clinton all look fine to me. So, if you really want to lower your hairline I think you should definitely at least consult with Dr. Feller. If he determines that you shouldn't experience more hair loss in the future, I'm sure he can help you. There's one other thing you should know though. To cover an area the size of the one you showed in your picture, you're going to need more than 2500 grafts. I'd say you'll probably need closer to 5000 to get really good density. Good luck man.

[chrisdav]

You have got great hair Jessie by the way and fantastic result, but you were in a better position with your native hair before surgery than xtatic5 is.

 

Realistically, that is going to take a hell of a lot of grafts.

 

http://www.hairrestorationnetwork.com/eve/162969-dr-rahal-patient-3249-grafts-7-months.html

 

The guy who Rahal done had an exceptional result and it has taken 3250 grafts to lower it by a smaller distance.

 

There are only a couple of Dr I know of go above 3500 approximately in one operation. That is providing it was acceptable to do the surgery of course.

 

I believe Jotronic mentions somewhere in another thread how many grafts it takes to lower a hairline per mm I think it was.

Edited December 6, 2012 by chrisdav

[xtatic5]

Thanks for your support Jesse, I'm glad someone else shares my view. It's tough to get reliable opinions on here because every situation is unique. It sounds like we've got similar hair situations.

 

As far as the current condition of my hair, perhaps that's a bad angle? I am not a NW III, I'm a NW I at most, as confirmed by a surgeon. My hairline is naturally high and always has been. The hairline illustrated in the pic is only lowered by 3cm at the peak, similar in distance to the guy in Chris' post.

 

About the # of grafts required, the highest quote I have received from 4 surgeons is 2500. My hair is black, curly, thick, and I have darker skin. These qualities mean that I require less grafts for the same visual density as someone with brown, straight, fine hair and light skin.

 

I don't intend to reach NW III because I'll take meds at the first sign of thinning.

[unclejesse777]

Chris, thanks for the compliment. You're right, I had less area to fill in. I did mention that in my previous post, because I wanted to give xatic5 an honest and realistic opinion, particularly about the number of grafts he might need.

 

Xatic5, I don't know, maybe the picture is a bad angle, but it does look like you have a high hairline. Not saying that to insult you or anything. Again, I just want to give you some honest insight as someone who's been through this already. While the hairline you want may only be lowered by 3cm, keep in mind that it has to go across your entire far-head, which makes the total area to be covered quite large. Honestly, for an area that size, I don't think 2500 grafts will cut it. The surgeon might be able to spread them out over the entire area, but I think it will probably look kinda thin and you'll most likely need a second procedure.

 

I'm only telling you this, because I don't want you to be misinformed about anything. That is what I feel happened to me when I consulted for my first procedure. I was originally quoted for 1100 grafts, and actually told that anything more might be too much. So, I was believing that after 1 procedure of 1100 grafts I'd be set. Then, on the day of my surgery I was told I was going too probably need a second procedure. Trust me the 1100 grafts I was given hardly even made a dent. That's when I decided to go see Dr. Feller, who gave me another 2200 on top of the 1100 I already had. And I've actually gone back to him since to add more even more density.

 

Now I should probably mention that I'm not your typical hair transplant patient. First off, I had a lot more hair to begin with than most patients, and only wanted to focus on my hairline. Second, I've heard many patients say that the goal is to achieve 50% of native density. That wasn't my goal though. I'm extremely vain, and a perfectionist, so I wanted to get my density as close to 100% as possible. But my point is that I've had over 4500 grafts put into my hairline region, and I had a smaller area to fill in than you do.

 

Now it all depends on what your goals are. As I said, many patients are happy achieving 50% of their native density. But I honestly believe that even with thick, curly, black hair, 2500 grafts isn't going to be enough for that size area, particularly if you want good density. You could always get the 2500 grafts and then decide if you want a second procedure done, but again, I don't think that amount of grafts will get you what you want. I'm not trying to be negative here, I just want to make sure you have a realistic idea of what you can expect. I really would recommend that you consult with Dr. Feller before making any final decisions. The man is fantastic at what he does, and my experiences with him have been nothing but positive. Plus, it couldn't hurt to get 1 more opinion, especially from a doctor who is recommended by the forum. Whatever you decide to do, I wish you the best of luck, and I hope my insight helped a little. Keep us posted.

[s2thoudriver]

In my opinion...

 

A bad surgeon will just agree to what you say, do the procedure and take your money, not caring about you, or how your hair/face will look in the future.

 

A good surgeon will consider how you should look now in relation to your age, how will look and feel in the future, how your hair and face will mature (your forehead will drop over time due to gravity, remember that!) and will be clear about the limits they will go to. If they are not happy, they will not do the procedure.

 

Think Michael Jackson....bad surgeons, no ethics, didn't care that he looked like a freak.

 

A good example... When i had my HT, i wanted a slightly lower hairline, they refused as they informed me that the transplanted hairs will not shed over time, therefore as my face ages (and goes south due to gravity and stretching/ageing), my hairline will effectively drop, so if it's too low, it would look wrong and i would be back wanting them to remove some grafts! I also wanted my temple points filling in more but they said no as it would look un natural in 5 years time due to my hair type, how it will mature and colourings. I agreed with their comments and am so glad i did!

 

Another example, not hair related...i also asked about having Blepharoplasty (eye bags and eye lids trimmed) with one of their surgeons, to freshen my face up. They refused, due to the fact that although i would look better, the requirement wasn't high enough to get the 'wow' result i would be expecting and ultimately i would be back there in 5 years wanting it doing again. They said wait until i'm 38/40yrs old and come back then!

 

A bad surgical team would have just taken the money for the extra hair grafts and another chunk of money for the blepharoplasty and not cared.

 

Rob

[xtatic5]

Jesse, I'm not offended at all. I just think you've misdiagnosed the extent of the work I need done. I understand that you needed 4500 grafts to achieve your fantastic result and, like you, I also want full density. However, my hair is less dense than yours; 100% density for me is less than 100% density for you. I agree that I will likely need more than 2500 grafts to achieve my ideal result but I'm expecting 3500 max. Who knows, neither of us are doctors, but thanks to your shared experience I have asked my prospective surgeon to clarify the density that I can expect with 2500 grafts. I may also shoot an email to Dr. Feller.

 

S2thou, most importantly, what year and color? I'm '00 NFR. Garage queen, detail whore, you know the drill.

 

I'm not looking for a surgeon who will say yes to anything, but when he says no there should be a logical reason behind it. For reasons I've explained, donor depletion is not a concern for me. For reasons Jesse has explained, future "appropriateness" is largely exaggerated. Besides, I don't think a 6cm hairline is unnatural at any age.

 

This is the first I'm hearing of the forehead "dropping" with age. Sure, skin sags because the muscles have atrophied, but I don't see what effect that would have on the scalp. I'll ask about it. In any case, amid all this discussion I raised the hairline in the picture (by .5cm) and it's starting to grow on me now. Maybe there's room for negotiation.

Edited December 6, 2012 by xtatic5

[unclejesse777]

Yeah, I have to say I've never heard of or seen anyone's far-head drop with age either. I've only ever seen it get higher, when certain people lose more hair. And that isn't the case for everyone either. Not everyone is going to lose hair throughout their whole life. Some people may experience a little hair loss in their 20s, and then have it stabilize. That's the way it was with me.

 

s2thoudriver, I know that there are plenty of bad surgeons out there who will just take a patient's money, and do what ever to them, without considering the future. However, that doesn't describe Dr. Feller or my experience at all, simply because he gave me what I wanted. I experienced my hair loss between the ages of 19 and 22, and then it stopped, and I didn't experience any more for nearly 10 years. So I finally decided to have a procedure done. When my scalp was analyzed, I was told there was no reason to believe I would experience any further hair loss, plus there is no history of baldness in my family. In addition, donor supply wasn't an issue, so there was no reason for me to be conservative.

 

Now I realize that many patients don't fit into my category and can't achieve the same results as I did. In those cases, or in any case a doctor should always be up front and honest about what type of results can be achieved. Of course if someone shows signs that they may experience further hair loss, then they should be more conservative with their grafts and graft placement, and their surgeon should definitely address those issues before any procedure is performed. But in cases like mine I don't see any reason why a doctor can't or shouldn't give the patient what they want.

 

And in my opinion the whole "future appropriate" thing is a crock. It's one thing for a surgeon to be honest with a patient about what can be achieved. Obviously people with extensive hair loss can't and shouldn't expect to get their high school hairline back. But for people who haven't experienced that much, and don't show any signs of experiencing future loss, there's no reason why they can't expect to get what they want. For anyone to say, "Oh, a hairline like that won't look appropriate when you're 50," is just ridiculous. Look at John Stamos and Brad Pitt. They're both 49, and they look amazing. Is anyone really going to say that their hairlines don't look appropriate for their ages? Also, is anybody going to tell me that they'd rather have a hairline like Jude Law or Nicolas Cage rather than one of these guys if given a choice?

 

I'm not trying to start an argument or anything, just making a point, and that is that no matter what age you are, a fuller head of hair always looks better than a thinner or lesser one. Just Google "Ralph Macchio Hair Transplant" and tell me where he looks better, before or after? And he's 51 for the record. Richard Gere is an even better example. He's 63 and still has a fantastic head of hair. I really don't see how anyone looks inappropriate with a full head of hair later in life. I honestly think that's something people with more extensive hair loss came up with to feel better about the limitations of their own procedures. Don't get me wrong, I know most people don't expect to get a hairline like mine and many are completely happy with their results, and rightfully so. I'm not saying everyone should want or expect to get a high school type hairline, but for people to say that a hairline like the one I have won't look age appropriate in the future is just ignorant in my opinion.

 

As for the Michael Jackson reference, I get what you're saying, but that's something completely different. He went way overboard with the amount of things he did to his face to the point where he didn't even look human any more. I only had my hairline lowered some. I still look like me, just a younger and a little better looking version of me. That's all xtatic5 is looking to do as well.

 

Xtatic5, glad to see you're taking your time about making a decision. Like I said earlier, I don't think it would hurt for you to speak with Dr. Feller, even if you decide to go with someone else. I know he'll give you an honest assessment of everything. Again good luck to you, and keep us posted.

Edited December 7, 2012 by unclejesse777

[Cant decide]

I know MANY people that did not have any loss at 40 and ended up a NW VI. This is why age appropriate hairline planning is not a "Crock". You may think you wont lose more hair but its a big gamble. We all would love a Brad Pitt hairline but you dont need that hairline to still get a great look without taking such a risk IMO.

 

Good luck in whatever you decide.

[unclejesse777]

You're completely right, not everyone needs that type of hairline to get a great result. That's not what I'm saying. But there are those of us, like me, and from what I can tell so far, xtatic5 too, who desire that type of hairline to make us happy. So, what I am saying is that in those types of situations, if that's what a patient wants, and the doctor feels that this particular type of procedure is right for them, then they should be able to have it done.

 

However, it seems like almost every time someone comes on the forum and says they want to have their hairline lowered and their temples closed, right away people start posting comments saying how they shouldn't do it, because it won't look appropriate when they're 50, and they need to be conservative for future procedures. It's like they just assume everyone is automatically going to lose more hair later in their lives, and that simply isn't the case. I'm aware that some people may lose their hair later in life, but that doesn't mean everyone is going to. As we all know, hair loss is mostly genetic.

 

Also, I didn't mean that planning for the future by going with a more conservative hairline is a crock. In fact, I clearly said in my last post that I think someone who is at greater risk for future hair loss should absolutely be more conservative with their grafts. Of course that's not a crock, and I think that is the right thing to do in those cases. But again, that doesn't include everyone. There are plenty of people who might experience a little hair loss, and then have it stabilize and never lose any more. And if those people decide they want to restore a more youthful hairline, then that is their right. What is a crock is saying that someone won't look appropriate when they're older if they don't have a more conservative hairline. And that is what a lot of people imply on these forums, whenever a case like xtatic5's comes up.

 

Again, not trying to start a fight, just making a point. How can someone who is older look inappropriate, simply because they have a lower hairline? I stand by my statement that that is a crock, and it is. Some people lose hair, other's don't, so what exactly is appropriate anyway? To say one person looks appropriate because he has a higher hairline and some recession, while another person doesn't because he has a lower hairline with no recession is just crazy. Again, can anyone honestly say that people like Brad Pitt, John Stamos, Bill Clinton, or Richard Gere don't look appropriate for their ages, simply because they have great hairlines? That's ridiculous.

 

Look, everyone is entitled to their own opinion, and that's just mine. I don't think people should just make comments that suggest lower hairlines don't look good when people get older, because that simply isn't true. There are many people who have great hairlines well into their old age, and they look fine. Some people may agree with me, others may disagree. To each his own.

[LondonHTseeker]

Hi, your request is very similar to what I had done. Check out my photos. I had 700 more grafts put into it from a further strip procedure with Dr Feller (in October) since the photos were taken. I'm hoping the 700 will make a good difference.

[Dr. Ricardo Mejia]

Dr Keene and myself years ago did a study looking at men's hairline and found that men who were not receding did have hairlines approximately 5 to 6.5 cm from the glabella. We typically used to use the rule of thirds to define the Hairline or 8 cm above the eyebrows / glabella. This did justify support for lower hairlines in men without a big history of androgenetic alopecia. However, ultimately the decision rests on the physician patient consultation and examination. This is something that cannot be duplicated on the Internet with photographs and or paragraph summaries or two dimensional drawings. There is a reason why several physicans opted out. Were your expectations to unreasonable? Was the hairline drawn too unnatural? Was there any compromise? Did you discuss a two step approach? That is lower according to physician recommendation and if still not happy

you can always lower more later? Irrespective of the answers, I have to live with the surgical decisions I make and if I personally do not feel it is medically reasonable or in your best interest, then I would not put my reputation and skill at risk. So in the end the decision is the doctors. You can keep searching and might find someone to do it only to later realize it really wasn't what you wanted. Good luck

[Cant decide]

UncleJess- I think you may be missing the point as to why many say that a low hairline will not look good at 50. There is no doubt that a NW 0 hairline looks good at any age and the celebs you mentioned certainly look great. I believe most of us on here would love that hairline even at 90. Having said that, I think when docs say "age appropriate", they are taking into account wrost case if you did lose hair, that the hairline you end up with will look good at any age.

 

You do have a point that if you have no loss and no family history of loss, but just a naturally high hairline at 30-40 for example, one can certainly make a case for getting pretty agressive with a hairline.

[Spanker]

Based on that picture, I would say that you are looking at 3000 grafts and that would be at transplant densities, not original density. I just really don't see you being happy with that. Take a look at my pics, I had 2000 grafts and had a lot of hair where I was transplanted already in an area your size or smaller. Do you have any actual male pattern hair loss, ? You say you have always been like that. Perhaps you would be a candidate to surgically lower your hairline. This is mostly performed on women, but I have seen it on men.

 

Bottom line is that you may not have realistic expectations.

[unclejesse777]

Can't decide, I totally get that, and I think that doctors should approach theses cases with caution. Thank you for seeing my point as well.

[xtatic5]

Thanks for replying Dr. Mejia. It appears that your research says it all, a 6cm hairline is not unusual at any age. Only one surgeon really examined me closely (looking at pictures of me 10 years ago vs. today, using the micrometer to find vellous hairs, etc.) and he doesn't foresee much future hair loss, if any. Yet, even he wanted to give me an 8cm hairline for no apparent reason. I think these doctors are just playing it safe.

 

I think cosmetic surgeons walk a fine line. On the one hand, they are competing in an industry where reviews are everything, so I can understand that keeping the patient satisfied both now and in the future is better for the bank account. On the other hand, nobody knows what the patient wants like the patient himself. For a surgeon to say "I refuse to give you what you want today because in 10 years you won't like it anymore" seems a bit presumptuous. I'll make that call, thank you.

 

Remember, we're not talking about heart surgery here. This is cosmetic surgery. The entire purpose is to make the patient happy (not the surgeon).

[xtatic5]

Thanks LondonHT and spanker for sharing. Your pictures are really giving me an idea of what to expect.

 

LondonHT, I see that 2000 grafts over that area is not acceptable for me.I wonder if even 3500 would be sufficient.

 

spanker, your result looks great and if I end up needing a 2 stage procedure then I may start with what you've got or just settle for that entirely.

 

I'm also impressed by the guy in chris' post here:

http://www.hairrestorationnetwork.com/eve/162969-dr-rahal-patient-3249-grafts-7-months.html

 

He got great density in an area roughly the same as mine. Is it just me or did the hair grow in lower than the pre-op drawings?