Too early to transplant hairline or not? I'd like to bulk it up...

[rickyrixon]

Hi Guys

I am 29 year guy from the UK who is experiencing what I believe to be frontal hair loss. Both my father (70) and older brother (45) have advanced norwood 3 patterns (No balding on the top or the crown at all, just at the front with a persistent forelock) so I guess it isn't really a surprise that the same pattern looks to have started in me.

To give you some idea I found this picture on line which looks a bit like my fathers ... http://www.baldingblog.com/photos/070223_widows3.jpg (My father's is probably slightly worse than this).

Even as a teenager I had highish temple corners which I was very conscious of. I have always tried to style my hair in a way which covers the corners, but it is only the last year or so that I have noticed miniaturisation and further recession which I believe is beyond a mature hair line.

At this point it still isn't really noticeable to people if I style my hair forward but it still bothers me a lot in side (I am very vain) and I'd like to do something about it if possible.

So what would your advice be at this point? Should I wait until I recede further or could I have a small FUE transplant now of say 1000 grafts, and then get further transplants in the future if and when they were required? I am almost certain that I will never go bald anywhere else on my head as all males in my family tend to follow this deep norwood 3 pattern, so I assume donor hair would not be a problem?

Taking propecia is out of question for me so I guess it's a transplant or nothing.

What would you do in my shoes?

Please give me your honest opinion.

Thanks

Ricky

[1978matt]

Hello mate,

 

I think you may be underestimating the number of grafts needed. You would more likely require 2000+ to fill the temples even slightly. Basically, look at the area you would like to fill in, count the approximate sq cm and multiply by 40. That's the probably number of grafts.

 

Some surgeons will turn you away if you're not on propecia and in your 20s. Why won't you consider it?

 

Your hair still looks pretty good. Mine was like yours in the early 2000s and now, aged 34, I have nothing in the front third!

 

In your shoes I would try propecia and re-evaluate after a year. If you still don't want to try it then wait until you are at least 35.

Edited April 19, 2013 by 1978matt

[Blake Bloxham]

Ricky,

 

Keep in mind that your familial hair loss patterns are not a good indicator of your own eventual Norwood scale. The hair loss gene exhibits "variable penetrance," meaning that having the gene in your family indicates that you CAN suffer from androgenic alopecia, not how you WILL suffer from alopecia. What I'm trying to say is that just because your dad and brother's are NW IIIs, doesn't mean you will thin to the same pattern.

 

At 29 you could be a good candidate for an FUE procedure. However, like Matt said, it will probably be most effective if you investigate some sort of preventive method too.

 

Feel free to ask any additional questions.

[Spanker]

Personally, I would wait. While you do have recessed corners, by 29, you should be getting comfortable with it as many of your peers are actually starting to bald. I don't think you need any work because your hairline is solid. I had recessed corners that were diffused and it bothered me, but if I had a sold hairline like yours I never would have had surgery. I think you are looking at about 1500 grafts to drop the corners some.

 

I think it looks solid and would move on until there is a problem, but if it really really bothers you go for it.

[rickyrixon]

Thanks for being so kind and taking the time to reply I really appreciate it.

 

I am not taking propecia as simply I am just too afraid. I have experienced severe sexual side effects from anti-depressants in the past, some of which took months to recover from and the thought of having any side sexual effects (permanent or not) is not something which I am prepared to deal with.

 

I am surprised to hear that I may need as many as 2000 grafts just for what I believe to be a relatively small area of recession but of course I’ll take your word for it.

 

If it was simply a matter of getting an FUE done now I would definitely go for it… But if I’m not on propecia and lose more behind I can imagine it will look very odd… sigh

 

I guess as depressing as it is I maybe just need to wait to if and when my hairline any recedes more…

Which reminds me of my final question… Do you think there is any chance that this will be the extent of my recession and that it will stop dead in its tracks? Or is it a near certainty to continue?

 

RIcky

[1978matt]

Which reminds me of my final question… Do you think there is any chance that this will be the extent of my recession and that it will stop dead in its tracks? Or is it a near certainty to continue?

 

RIcky

 

It will probably continue but at what speed is difficult to determine.

 

In my own case I always used to see a lot of different thickness hairs in the shower - a sure sign that hair was miniaturising! It just a shame I didn't know that at the time.

[rickyrixon]

It will probably continue but at what speed is difficult to determine.

 

In my own case I always used to see a lot of different thickness hairs in the shower - a sure sign that hair was miniaturising! It just a shame I didn't know that at the time.

 

Thanks Matt!

 

How have things been for you on propecia? results and side effects?

 

You have an interesting dosing regime I see?

 

Ricky

[1978matt]

Thanks Matt!

 

How have things been for you on propecia? results and side effects?

 

You have an interesting dosing regime I see?

 

Ricky

 

I can't take 1mg a day - it gives me headaches. The current regime is fine after 15/16 weeks on it. My mid hair section appears to have improved a bit.

 

Dr Parsley posted some interesting low-dose examples which worked (1/4 tablet every other day I think)

[Blake Bloxham]

Ricky,

 

By nature, hair loss is a progressive condition. Because of this, I think there is a good chance the thinning could continue to progress. While hair transplant surgery can replace what you've lost, it does not treat the progressive nature of hair loss itself. Frankly, this is where preventive medications like minoxidil (Rogaine) and finasteride (Propecia) come into play. If you are concerned about the side effects of finasteride, it might be worthwhile to research minoxidil/Rogaine.

 

Good luck!

[Throwaway28925]

Hello! Like you, I refuse to take Propecia. I have a hairline very much like yours, and just like you, my dad has the same hairline. My dad is 48 now and he is still a norwood 2 so this led me to believe that mine will also not progress.

The only difference is that I'm 23 (24 by the time I have my HT) and I see no reason in you investing in a HT if you don't mind spending money later on in life to fix it up again.

Also, I was quote 2000 for the same style hairline as you.

 

I'm not saying go for it as there are many things to consider before a HT, but I've got to the stage where I just want to live my life and not constantly wear a hat, or be aware of the wind blowing my hair and exposing my hairline. I'm sure you have similar feelings.

[Nick153452]

You have a solid hairline like they're already said. There are many hairstyles that will be able to mask and "balding" that you have. I would wait if I were you, but if it's something that it really bothering you and you want fixed, go for it. I wouldn't think you would need any more than 1500 to get results that you wanted.

[mattj]

Your forelock looks very solid, but due to the unpredictable nature of MPB you can't count on this always remaining. Your family history works in your favour, as does the fact that your loss has been slow up until now. You don't seem to be destined for a higher stage on the Norwood scale.

 

You still have hair that is very styleable and which many MPB sufferers would give their proverbial left one for, but it's all relative and if you're bothered by how you look now then that's fair enough. I think most doctors would consider you to be a good candidate for a procedure as long as you're aware, and prepared, for another procedure in the future.

[rickyrixon]

Hello! Like you, I refuse to take Propecia. I have a hairline very much like yours, and just like you, my dad has the same hairline. My dad is 48 now and he is still a norwood 2 so this led me to believe that mine will also not progress.

The only difference is that I'm 23 (24 by the time I have my HT) and I see no reason in you investing in a HT if you don't mind spending money later on in life to fix it up again.

Also, I was quote 2000 for the same style hairline as you.

 

I'm not saying go for it as there are many things to consider before a HT, but I've got to the stage where I just want to live my life and not constantly wear a hat, or be aware of the wind blowing my hair and exposing my hairline. I'm sure you have similar feelings.

 

Don't you worry that you may start thinning behind the transplant? That's my biggest fear really... Having to live like that for however many months/years...

 

So you think I am still a norwood 2 or have I past that point now?

[Throwaway28925]

Don't you worry that you may start thinning behind the transplant? That's my biggest fear really... Having to live like that for however many months/years...

 

So you think I am still a norwood 2 or have I past that point now?

 

I am scared of that, but then I think about how much I hate my current hairline and how getting that area filled in now will buy me time to save up and pay for a smaller amount next. I think of it like this - I want to live my life right now, and I currently can't, so this will buy me say 5 more years.

 

Yea I'd say you are a Norwood 2.

[rickyrixon]

I sent an email with my pictures to Dr De Reys in Belgium and he told me that I would only need 1000 grafts to fill in the corners which is good to hear... Might look into it... Only 3000 euros which seems very reasonable and I've read numerous good reviews about him...

[rickyrixon]

Sorry to keep bumping this guys but I just have a couple more questions...

 

As I said I am strongly considering going to see Dr De Reys in Belgium to get 1000 grafts for my receded corners. Although there isn’t a great deal of his work online I am very impressed with what I have seen and I can’t seem to find a bad word written about him. I do find it interesting though about only needing 1000 grafts when many on here said i'd need 1500 - 2000.... So I might make a few more enquires with others such Dr Bisanga before taking the plunge.

 

I know many of you recommended that I should also consider some preventative measures (Propecia) but looking at my family history of hair loss i think I might be able to get away with it (slow and not too extensive). Is this fair to say or am I being naive?

 

I was also wondering if you could give me your opinion on my father’s hair loss. He is 71 and his hair has been like this ever since I can remember.

 

I'm asking as I believe that it is more than likely that this will be my final pattern too and I'd like to have some idea of how many grafts I could be looking at over my life. (My 49 year old brother is basically the same pattern as this as well which gives even more evidence).

 

Would you say he still a norwood 3? How many grafts do you think would be needed to restore his hairline?

 

Thanks again..

 

RIcky

[1978matt]

Once you've worked on the hairline it is essentially fixed and yes it is highly desirable to use meds to slow down progression.

 

I'd say your dad is probably at least a NW5. He probably wouldn't need too many grafts for a conservative hairline because his hairline has already receeded back a fair bit.

 

The grey hair helps also as there is less colour contrast. He could probably get away with 2000-2500 grafts.

[rickyrixon]

Once you've worked on the hairline it is essentially fixed and yes it is highly desirable to use meds to slow down progression.

 

I'd say your dad is probably at least a NW5. He probably wouldn't need too many grafts for a conservative hairline because his hairline has already receeded back a fair bit.

 

The grey hair helps also as there is less colour contrast. He could probably get away with 2000-2500 grafts.

 

Thanks for your reply but can you please explain how my father would be norwood 5 at least? I don't understand how you come to that... Yes he has receded badly at the corners but the forelock is still in place (albeit looking a little thin) and he has no hair loss at the crown what so ever. How is that a norwood 5 which apparently looks like this?

[Cant decide]

Your dad looks like a NW 3.5 to me. I would say a NW 3 if his forelock were a bit more intact. The fact that his bridge and crown are strong tells me he is not above a NW 4 for sure.

 

I was a NW 5 once upon a time and I would have killed for your dad's hair even though he is 30 years older

[1978matt]

Thanks for your reply but can you please explain how my father would be norwood 5 at least? I don't understand how you come to that... Yes he has receded badly at the corners but the forelock is still in place (albeit looking a little thin) and he has no hair loss at the crown what so ever. How is that a norwood 5 which apparently looks like this?

 

Well he has limited denisty in the front half which looks similar to the NW5 image you posted, regardless of what the crown looks like. If he were a 3 I'd expect that forelock to be quite dense, or if there was reasonable density with evidence of thining I'd say a NW4.

 

Very hard to tell with just the one photo!

[Spanker]

I would agree with a 4A. I think that if you had your dad's hairline, and you wanted to have the hairline that you want, he would be looking at 4000 grafts.

 

You have to consider that your dad's hairline is quite a bit further back than yours. For a nice density hairline to be dropped 2 cm, you are looking at 2000 grafts.

 

Be careful not to go to a doctor just because he gives you the number that you want. Just because he says that you need 1000 grafts doesn't mean 1000 grafts will make you happy.

[RyanVodka]

anything greater than 1500 would be good for you If you are set on having work done. Focus on improving your existing hairline and not lowering it to a more youthful level. My suggestions would be to go fue, choose a top doc, and be conservative with the hairline.

[BlackAmish111]

I would recommend erring on the side of more if money isn't issue. Although I only had 900 to even out the hairline and somewhat fill the temples -Im still a little worried about the area directly front/center behind the perimeter and asked for more though the Doc said the hairs in that area were too strong and adding there could cause shock loss. She also said that once the new hair grows long -it will feather nicely with the hair behind it -but im still a little nervous. Also my hair is more wavy/curly so apparently less grafts can still have a bigger impact as the hair "bushed out" a bit

 

Point being that I'd rather have it all done at once with just one scar and one scheduled break from work/travel etc than multiple so you may want to consider this.

[rickyrixon]

Thanks for the replies guys... Again I'm surprised to hear that people are saying I would need 2000 grafts for what I believe to be quite minor recession..

Anyway I have been doing a lot of thinking and have decided that I am going to put any HT work on hold until at least my early 30's. Looking at my family history it looks inevitable that I will slowly recede more, and without Propecia I feel it may not be such a good idea to get anything done right now... If styled properly I can still get a way with people not noticing my loss loss at the moment.. Until that day ends I think I will just hold out.. and yes I certainly wouldn't want my hairline restored to anything lower than a mature hair line.... I hope your transplant turns out how you hope BlackAmish111

[Dr. Timothy Carman]

I have always found it a bit interesting when anyone makes estimates based on photos. There are varying sizes available in human heads, and they all have about the same proportions- So making any specific numbers statement really is premature (for me at least) until the actual area can be measured. I think those should be qualified with statements like "assuming an average head size, donor, etc.

The issue of predicting your loss, as pointed out earlier, may mimc your dads, gfs, etc, but it may not. However, just because you MAY lose crown hair in the future does not IMHO prevent you form addressing your concerns via a small transplant. I have always been of the opinion in plastic surgery that less is more- even in hair. It is not (again, IMHO) the amount of transplanted hair you have, it's the design and planning that goes into creating a long term natural effect that utilizes your donor to it's greatest advantage. I am of the opinion, in your case, that no more than 800-1000 grafts could create a healthier, natural looking hair line in your receded areas (again- assuming you have an average size human head and average donor- your donor if low would adjust the design and hence the number, that's why it is important) and leave you in fine shape for whatever comes down the pike in the coming years. As for meds- I feel that is a very personal decision, one that every patient should think about but not feel pressured to take. I personally do not alter the design of any of our transplant approaches whether the patient is on meds or not. One must be conservative with donor usage regardless. My two cents.