Transplant AFTER sides have dropped?

[TommyLucchese]

Any examples of this? And is when the sides have dropped that someone becomes an NW7?

 

I'm becoming very curious about the sides dropping lately.

[1978matt]

Here's one:

 

http://www.dermhairclinic.com/fue-hair-transplant-repair-5000-grafts-bht/

Edited February 3, 2014 by 1978matt

[GoForIt]

If you look on Dr. Mike Beehner's website (can find his website on here or googling), he has quite a thoughtful discussion of the issue when he talks about transplanting in a "forelock" pattern.

[TommyLucchese]

If you wait until you're older for a HT and the sides drop, there's limited donor so not much can be done. But for young people, people say to wait because the sides may drop as they get older.

 

So, with my very limited knowledge, wouldn't it be better to have the HT and get as much coverage from the maximised donor. Then if the sides do drop, the lesser supply wont be so bad as the demand will be less.

 

If you grow your hair out a bit wouldn't that cover dropped sides anyway? People often look better with shaven sides and hair on top so would it make too much difference?

 

I've worded that very poorly but hopefully you'll understand what I mean.

[GoForIt]

If you wait until you're older for a HT and the sides drop, there's limited donor so not much can be done. But for young people, people say to wait because the sides may drop as they get older.

 

So, with my very limited knowledge, wouldn't it be better to have the HT and get as much coverage from the maximised donor. Then if the sides do drop, the lesser supply wont be so bad as the demand will be less.

 

If you grow your hair out a bit wouldn't that cover dropped sides anyway? People often look better with shaven sides and hair on top so would it make too much difference?

 

I've worded that very poorly but hopefully you'll understand what I mean.

 

Dr. Beehner talks about this on his website, and how he transplants hair if he's worried about this happening. Read about how he describes a forelock pattern for the transplant. It pretty much addresses what you're talk about - how to make a transplant look natural in this setting.

[gillenator]

It sounds like the discussion here is regarding the recessionary progression of the lateral humps (sides).

 

Probably the worst case that I saw in person was a man in his 50s. He had been experiencing successful results with finasteride however not in the side hump areas which continued to progress.

 

He told me that he went for 12 years or so with success from finasteride, then suddenly our of nowhere he started noticing the gap between his restored areas and the sides. By the time that we met, there was a clear visible gap of approximately 1.25 cm or so, and the gap was bare of any hair.

 

His gamily history on the paternal side had multiple men that hit class 7 by their fifties so he appeared to be experiencing the same thing.

 

He had four prior HT procedures so his donor was already pretty much depleted. That was about 6 years ago and his first 2 HT procedures were open donor (plugs). The last two were for filling in between his plugs which were pretty much confined to the frontal third zone.

 

So his donor zone looks very depleted and definitely IMHO does not have harvestable hair in his donor zones other than the side rims. It would take FUE methods to pull some of the hair just above his ears and behind them.

 

The gap was visibly seen on both sides. Six years ago I would have never recommended beard grafts to help fill in the gaps but today, it appears to have some success so that would be his last resort unless he is willing to try other BH sources which IMHO is risky.

 

One of the drawbacks in his case was that he went for high density in the frontal zone before the recession on the sides started to manifest.

 

So the lesson to be learned from this is to not get too aggressive with the density when younger so that there is always a donor reserve to draw from. When the scalp donor is gone, it's gone.

 

By the way, I did not notice the gap at first because he was using dermatch to hide the gap. His hair used to be very dark and had the salt and pepper look when I saw him. Still, there was definitely a gap once I got a closer look.

 

He said he could not wait until his hair was completely grey and for cloning or HM to arrive.

 

The secondary lesson to be learned is to think twice about HT surgery if the individual has class 7s in their family history. And then even if they still move forward, to do so with a plan that is conservative with a lifetime management of one's donor supply in the equation.

[TommyLucchese]

Dr. Beehner talks about this on his website, and how he transplants hair if he's worried about this happening. Read about how he describes a forelock pattern for the transplant. It pretty much addresses what you're talk about - how to make a transplant look natural in this setting.

 

Thanks I did read the site, he seems very conservative - I wonder what other more aggressive doctors would do for the NW7 man he showed pictures of.

 

It sounds like the discussion here is regarding the recessionary progression of the lateral humps (sides).

 

Probably the worst case that I saw in person was a man in his 50s. He had been experiencing successful results with finasteride however not in the side hump areas which continued to progress.

 

He told me that he went for 12 years or so with success from finasteride, then suddenly our of nowhere he started noticing the gap between his restored areas and the sides. By the time that we met, there was a clear visible gap of approximately 1.25 cm or so, and the gap was bare of any hair.

 

His gamily history on the paternal side had multiple men that hit class 7 by their fifties so he appeared to be experiencing the same thing.

 

He had four prior HT procedures so his donor was already pretty much depleted. That was about 6 years ago and his first 2 HT procedures were open donor (plugs). The last two were for filling in between his plugs which were pretty much confined to the frontal third zone.

 

So his donor zone looks very depleted and definitely IMHO does not have harvestable hair in his donor zones other than the side rims. It would take FUE methods to pull some of the hair just above his ears and behind them.

 

The gap was visibly seen on both sides. Six years ago I would have never recommended beard grafts to help fill in the gaps but today, it appears to have some success so that would be his last resort unless he is willing to try other BH sources which IMHO is risky.

 

One of the drawbacks in his case was that he went for high density in the frontal zone before the recession on the sides started to manifest.

 

So the lesson to be learned from this is to not get too aggressive with the density when younger so that there is always a donor reserve to draw from. When the scalp donor is gone, it's gone.

 

By the way, I did not notice the gap at first because he was using dermatch to hide the gap. His hair used to be very dark and had the salt and pepper look when I saw him. Still, there was definitely a gap once I got a closer look.

 

He said he could not wait until his hair was completely grey and for cloning or HM to arrive.

 

The secondary lesson to be learned is to think twice about HT surgery if the individual has class 7s in their family history. And then even if they still move forward, to do so with a plan that is conservative with a lifetime management of one's donor supply in the equation.

 

Thanks for the reply. If your hair is a bit longer could that cover the sides? Do you think if he hadn't had the previous poor surgeries he would have had the donor to sort everything?

[gillenator]

Tommy,

 

Yes, there is potential to wear the hair length longer but every case is different.

 

The fundamental problem that the patient that I posted about simply had his initial procedures when he had significantly more coverage and probably was a Norwood class 4-5 when he started. No one, and I repeat no one had informed him about the reality of losing more hair as the years went by and the fact he would need multiple future procedures to chase his hair loss.

 

One would think that any individual would seem to know that hair loss progression was in their cards when their father, uncles, grandfathers all lost their hair and ended up in the advanced classes of hair loss.

 

His destiny was Norwood 7 and he eventually arrived there in his 50s when I saw him. His donor zone was also thinning so IMHO did not feel that any more grafts taken from the back of his scalp (occipital zone) would prove to last. Plus it was already thinned out from his past surgeries.

 

His hairline was situated too low to begin with from the first procedure so he had an independent island of hair in the frontal zone and nothing behind it. Then the gaps on the sides just made everything look worse. He was in his late 20s when he had the first procedure and Propecia was not around back then.

 

In the end, the only real viable alternative was to either shave everything off or make a complete switch to a hair system. I encouraged him to think everything over before making any more decisions.

 

The gap that he was experiencing is probably even worse by now and I never did hear back from him so he is one of multiple examples of someone who has class 7 in their family history.

 

Possibly not having the initial "archaic" procedures would have left him more harvestable donor but the equation almost always turn out the same for class 7s. Never enough donor to cover one's hair loss over their lifetimes.

 

Many class 7s eventually end up with donor zone thinning so even if there is more visible hair in the donor zone, it's not terminal hair, meaning, it can be lost even if it is transplanted.

 

Something to think about before ever getting in the chair to begin with...:rolleyes:

[TommyLucchese]

That's a great post, thank you

 

I have some 7s in my family and started receding very slightly at 15/16.....I wonder what the future holds. Let's hope propecia works for a lifetime!

[Spanker]

That's a great post, thank you

 

I have some 7s in my family and started receding very slightly at 15/16.....I wonder what the future holds. Let's hope propecia works for a lifetime!

 

 

I think one of the good things about propecia is that even if it doesn't work a lifetime, it may get to you to being a much older person before you thin worse. Som keeping reasonable density up front will age well. A guy in his 50's and 60's that is thin but still has coverage pulls it off much much better than a guy in his twenties that is thin and still has coverage.

 

It would be pretty cool if they did come out with a truly scarless FUE. Then (if you were rich), you could pretty much transplant any hairline you wanted, and as you aged an thinned you could reharvest the hair and put it back further to match your age/grey/etc. That would be cool but it is likely just a fantasy. They have come close to that, but its not truly scarless and I would venture to guess that you would have a decent amount of transection to get scarless. Maybe Dr. Wesley's deal will turn out well and they will be able to pop the hair out from the bottom like Bugs Bunny stealing carrots.

[gillenator]

On Saturday a good friend of mine stopped by as he just returned from India where he had just under 3700 FUE with Dr. Bhatti mid January.

 

Both his donor zones and his recipient site looked very good and clean regarding visible scarring. He also healed extremely well and he is 26 years of age.

 

He lives in my area so he is going to keep me updated on his progress and time will tell regarding his overall yield.

 

A very good example of a "clean" FUE procedure...

[TommyLucchese]

Now my hairline is sorted I find myself noticing how high other people's crowns/sides are now, rather than any recession or loss at the front (which used to be what my eye was drawn to immediately). I see a very bald on top fella and instead of thinking of the bad hairline, if the sides are good I think that they could be transformed with a good megasession.

[Dr. Michael Beehner]

As I have said many times in the past, for Norwood VII patients with their side fringes down the side of the head, I use what I term a "forelock pattern" approach. This basically has two principal features: One, the main area of relative hair density is created in the front-central aspect of the man's scalp. And second, the vertex/crown area way in back is pretty much left alone. In other words, you try to make a difference in the most important area of the head which frames the face, and, due to the very limited donor resources and the vast area that needs filling in, you prioritize and hopefully the patient in the consultation sees the wisdom of that approach and you end up with a very happy patient who otherwise would face being very, very bald the rest of his life.

It is also possible to look for warning signs in young men in their 20's who you can predict have a strong chance of going on to a Norwood VII pattern later in life. In such young men, I use a forelock template when getting them started with hair transplantation.

I have attached two examples of mature aged men with Norwood VII balding patterns. The one gentleman, whom is viewed from the right oblique angle, he had only one session of 1500 grafts, and was actually having his final, second session the day the "after" photo was taken. The other fellow, who is viewed from the left side, had two sessions of around 1600 FU's each time. His drawn pattern is shown also, which shows the pear-shaped area in the front-central region which was transplanted with more density and using more 2-hair and 3-hair FU's in this region. The drawn pattern from the side view shows the use of "filling in the humps" on the side, so that there is a meeting of low density FU's near the crease on top, thus creating a "mirror image" effect.

Mike Beehner, M.D.

[gillenator]

IMHO, that's a big visual improvement, looks natural, and age appropriate. Some might say that it was of no value but really, it comes down to what makes the patient happy and each individual goal. It also confirms that no matter hold old we get, we still would like to have a fame to our face.

 

Tommy, a peak at the Norwood scale shows that the fundamental difference between a class 6 and 7 is the regression of the lateral humps and also how far the crown recedes downward into the coronet area (bottom) of the crown.

 

In many class 7's, the progression of loss recedes and impedes into what many docs might classify as the so-called "safe zone". And when a young man in his 20's has not yet receded that deep, it can and will happen as he ages.

 

This is why consideration of family history IMHO is a critical element to be considered when planning restoration over a lifetime.