So here are the pics. What do you think?

[lookin]

I've truly decided to take the plunge. I've been contemplating for a long time, and after talking to a few of you, and a few docs, I'm ready.

 

The hard part is all the conflicting information...

 

I would love for any of you veterans here on the forum to take a look at my pics and let me know what you think.

 

I have heard as little as 2,400 grafts from Bosley (which was quickly dismissed by a rep from reputable Docs office on this forum...)

 

... all the way up to 3,500 from a very reputable doc.

 

Comparing pics all day, I feel like I should get a lot more???

 

What do you guys think?

 

thanks for your help

[Rootz]

This depends on several things including,

 

1. How much donor do you have available?

2. What kind of hairline are you looking for?

3. What kind of density in the hairline do you want?

4. The rate of progression of your hairloss. Have you been observing it closley for a while? How much is it changing?

5. Are you on meds? Which ones?

6. How old are you?

7. Do you want FUT or FUE?

[lookin]

Rootz, thanks for responding

 

1. I really don't know how that is calculated. I've never had an HT if that helps.

2. Not an aggressive hairline at all. Mayb brought down just a little in the front. Filled in a little in the peaks. Something age appropriate.

3. Again, this is fairly new to me. I'm not sure how to answer. Fairly dense? I've seen some posts talking about 40-60/cm giving good density. Some 60-80? I just don't know.

But I've been told the "forlock" is quite thick. No "miniaturization" at all, and I guess I would want it to match?

4. Started losing probably about 10-15 years ago. Haven't observed it closely at all... It's just slowly disappeared over the years.

I wish I had known about finesteride earlier. i may still have my crown if so.

5. No meds. Gonna get on fin. soon.

6. 44 years old

7. Would love FUE, but from all the research I've done, seems that FUT is the way to go for me. I have a lot of area to cover. The only thing I'm worried about is the scar, and I've seen some pretty amazing cases on this forum to put my mind at ease a bit.

 

Good doc, scar that can be camaflauged? (I know that's not in 100% of cases, but mitigates a lot of risk I assume)

 

Thanks!

 

All opinions welcome! Newbie here trying to learn!

[Rootz]

For someone with your type of hair loss (aggressive) I think it is imperative to stablize your hair first before getting any type of HT. I'm sure you're aware of the potential side effects of fin, but if you're serious about this you should definitely give it a go. It will greatly help preserve (and possibly regrow) some of your hair. Other treatments are icing on the cake and should also be considered.

 

You should consult with some doctors and get some estimates on how much donor you have. You might be able to do this online with quality pictures.

 

The reason I ask about hairline density is it's something you need to consider. I would say a density of 50/cm^2 is considered "high" and about as good as it gets. Keep that in mind, if you need to conserve grafts aiming for something lower than this might be a good idea. As for crown, you definitely want to do relatively lower density there as that area will consume copious amounts of grafts.

 

I would be extremely cautious about getting FUT. I'm not in your situation, so I can't fully relate, but I will tell you this... if I was in your situaiton, as best I can imagine, I don't think I would never get a FUT even if there was no other option. I also doubt you can't get the results you want with FUE. Ok there, I said it. Anyways.

 

I'll throw out a number for you but take it with a grain of salt. If you want a relatively non-aggressive hairline with moderate density that intersects your frontal hair and conservatively joins the sides of your temples, with your crown filled in with relatively low density to give a decent illusion of coverage, and nothing else you're probably looking at around 3,000 grafts. I think that could give you a pretty good looking, solid result. Again, take that with a grain of salt.

 

Keep in mind if you get on treatments for 6 months prior to surgery, you may regrow hair and need less grafts. Either way, definitely get on treatment.

 

I posted this in another thread but I think it may help you,

 

Basic steps to take,

 

1. Research your butt off and find out all the pros, cons, and risks involved with a hair transplant. Some people spend years doing this.

2. Research which treatments you need and determine what's best for you. It typically takes 6+ months to stabilize your hairloss once you begin treatment. The most common treatments are Finasteride, Minoxidil, and Nizoral and those are all taken together. If you're serious about stabilizing your hair, you need to take at least Finasteride (or an equivalent).

3. Take detailed pictures of your hair from many angles before you begin treatment.

4. Start treatment.

5. Determine very specifically what your goals are. This includes the design of the hairline.

6. Research doctors and get a list a few that you like the most. This can also take quite a while. Going by price is not recommended. Get consultations with said doctors (online might be good enough depending on your situation). Schedule a surgery date 6+ months out with the one you like the most.

7. After around 6 months, take new pictures and determine the state of your hair. If your hair is worse, you're not ready. Continue treatment and reasses in a month. If it looks the same or better, you're probably ready.

8. Determine whether taking the treatments from step 1 for the rest of your life is worth it, that you're willing to accept the risks involved with the hair transplant and the strong possibility for needing work done again in the future.

9. Get a hair transplant.

[Nick153452]

I think that you've already gone past the point where finasteride and minoxidil would have been the most helpful, but it can't really get on it to see what happens. As far as graft count, you may need more than your donor has. 3,500? That seems like a really low number and I'm curious as to what they planned to achieve with that. I've seen reputable doctors throw 3,500 grafts in the crown and it still looks questionable. If I were in your particular case, I would throw about 5,500-6,000 to reshape face and add some density to back to where you can use concealer without it looking weird. That's just my opinion. I think that any less, and your density would be fulfilling. I had much less hair loss than you (although I didn't have a strong forelock), and I put in 3,222 and am still looking for more density.

[Rootz]

Without treatment I think there's a good chance the rest of his hair on top will fade or disappear, and he still has quite a bit of hair on top. He may be one of the lucky ones who experiences noticeable regrowth too. At the very least OP I think you should try Minoxidil / Nizoral, and if you're really serious about this consider giving Fin a try.

[lookin]

Thanks for the replies.

 

I'm definitely going to give Fin a try. Going to go see my doc today.

 

The reason I'm really concerned is that from all the pics I've researched, there seem to be LOTS of guys who get a good result with a NW5... But that doesn't seem to be the opinion here.

 

I definitely don't want a less than desirable result, and am thinking about foregoing coverage on the crown (at least with the first procedure).

 

What do you think of that idea? Whispy, see-through, or obvious, is definitely not what I'm after. If I can't get a good result, then I probably won't proceed.

 

I'm talking to a couple docs right now, and am going to get their opinions on these concerns too so I have the right expectation.

[Rootz]

here seem to be LOTS of guys who get a good result with a NW5... But that doesn't seem to be the opinion here.

 

I think you can get a fantastic, long lasting result so long as you choose the right doctor and stabilize your hairloss. Lorenzo and Bisanga come to mind as producing wonderful large scale FUE results.

 

As for skipping the crown and only doing the hairline, I don't think that is necessary if you have enough donor grafts available and you are able to get on treatment (preferably Fin) for a period beforehand and stabilize your hair. No matter what you do you need to stabilize your hair though otherwise you'll be losing a one sided battle over the next 10-20+ years.

[Shampoo]

3,500? That seems like a really low number and I'm curious as to what they planned to achieve with that. I've seen reputable doctors throw 3,500 grafts in the crown and it still looks questionable. If I were in your particular case, I would throw about 5,500-6,000 to reshape face and add some density to back to where you can use concealer without it looking weird.

 

I agree....but I guess it depends on his goals.

It seems to me like 3500 for him is really only a starting point.

I would think over the long term he is looking at 2-3 surgeries

and will need 6000-8000 grafts.

But with the right doctor he can certainly achieve a nice result/improvement.

[Nick153452]

I agree....but I guess it depends on his goals.

It seems to me like 3500 for him is really only a starting point.

I would think over the long term he is looking at 2-3 surgeries

and will need 6000-8000 grafts.

But with the right doctor he can certainly achieve a nice result/improvement.

 

If I remember correctly, which may not be the case as I read his initial posts at like 4 AM, he stated that he was looking for a higher density coverage, meaning that he may not be able to address much on the crown. However, if his donor allows, I believe that he canget his crown covered with enough density to where a concealer could pick up for the lacking density and make it unnoticeable. Truth be told, the front is what people notice the most and I believe that's what this patient should focus on. He has a lot of reshaping to do because his sides have receded, but I believe for his goals he will be needed at least 6,000 grafts, obviously more being more desirable for anyone provided that money and donor are not an option.

[hairthere]

Firstly, I think you are more likely a NW6 than a 5. You can see where your crown has thinned more and is going to drop even further. If you were going the FUE route I don't see you getting more than 3-3500 grafts in one procedure. Depending on your laxity, though, you might not be able to get that much from strip either. Have you had an in-person consult yet?

 

That forelock is a blessing and a curse. Since it's still appearing to hold so strong I would definitely get on meds for at least 1 year prior to having surgery.

[lookin]

When you guys say 5-6,000, even 6-8,000, are you estimating to that's what it would take for a full head of hair, with good density all over?

 

 

 

Also, how long should I be on the finasteride prior to surgery?

 

Of course Nick, you mention being "past the point" of it helping, so is it even really necessary? I don't know that I have a whole lot left to stabilize!

 

 

 

I did talk to a doc's rep who told me maternal family history is a factor, and the men on that side aren't too much further along than I am (yet 20+ years older)... so I don't know if that means that this is about "stable" for me? They all have MPB, but have a wider "horseshoe" like me, and some whispy hair on top... Same with Dad, so does that mean that without HT a NW7 is not really in my future? And if not, I'm guessing that helps with an HT?

 

 

 

Also, hairthere you said the strong forelock is a "blessing and a curse," can you explain? I want to make sure I'm discussing everything I should at my consults.

 

(yes and no on the consults, I'm just setting up a few Skype consults now with reputable docs from the forum... I made the mistake of visiting Bosley, and after getting a bad vibe, decided to do a lot more research)

 

 

Thanks for all your help guys

[Shampoo]

When you guys say 5-6,000, even 6-8,000, are you estimating to that's what it would take for a full head of hair, with good density all over?

 

Yes exactly... in my opinion it's going to take over 5000-6000 grafts to make a big dent in your overall balding look.

 

Of course you can do it in steps. The first step can be to get 4000 grafts to the front and then that part is basically "solved".

 

Then a year or two later go for another 3000+ into your "greater crown" area.

Then the crown will be basically "solved".

 

It may seem kind of daunting now, but if you go with a clinic that specializes

in mega-sessions (like Hasson/Wong, Rahal, ect..) you could get a really

good look after two mega-sessions.

I advise against Bosley.

 

Of course budget, time, desire/motivation, and donor hair will play

a factor in your gameplan.

 

If I were you I would stay on or get on finasteride.

Sure you've already lost a lot that is not coming back,

but you don't want to lose what remains on top and

you want to slow down any further loss in the crown.

[Rootz]

Also, how long should I be on the finasteride prior to surgery?

 

Ideally about a year, but around 6 months would probably be good enough. Some people experience shedding that can last a long time, if that's the case with you then obviously you wouldn't want to proceed with a HT until the shedding has stopped and your hair has stabilized.

 

I don't know that I have a whole lot left to stabilize!

 

See all that hair between your frontal hairline and crown? That's the main thing left you want to hold on to. That's probably 10,000+ hairs. More than likely if you do not get on treatment this will happen: the hair between the frontal forelock and crown will disappear, the crown will become bigger, your frontal forelock will form an island, and that island will shrink to a much smaller size. This is just speculation, but it is a very strong possibility IMO.

 

I did talk to a doc's rep who told me maternal family history is a factor

 

That factor is just an indicator of liklihood. I like the philosophy prepare for the worst, hope for the best. Don't prepare for the best.

[hairthere]

Well, it's a blessing because it will give you some hair to work off of, which means less grafts and better coverage. It's a curse because given your pattern, family history, etc. it will disappear one day, and it can happen suddenly, leaving you needing more surgery.

[Nick153452]

See, I take the whole genetics thing and throw it out the window. My mother and fathers side of the family have all great sets of hair. All of my cousins (And I think I have 40+ cousins) have great hair. My uncles have good hair, and my grandpa died with a full set of hair, yet, ever so oddly, I started losing hair before I turned 18.....

 

If I were you, I would still get on finasteride. It may not do the most for you, but you never know, it could get you some back and significantly thicken up what hair you do have on the top and in the back.. Never know. It could save you thousands of grafts that would be on their way out. Better safe than sorry.

 

I would disagree with addressing your crown too heavily. It's known as the black hole of hair transplantation for a reason -- you can put a lot of grafts there and it still looks questionable. I would worry about reshaping your face, adding a good amount of density on top and just adding a few grafts in back so you can conceal. You will save yourself thousands of dollars, you will have an overall better aesthetic look from in front, and your hair will be much denser.

[Shampoo]

I would disagree with addressing your crown too heavily. It's known as the black hole of hair transplantation for a reason -- you can put a lot of grafts there and it still looks questionable. I would worry about reshaping your face, adding a good amount of density on top and just adding a few grafts in back so you can conceal.

 

You would add only "a few" grafts in the back?...to this crown?

 

How many is "a few"?

 

My concern is if he has enough donor to address both areas,

but if it is determined he does, then personally I'd go for both.

Of course "gobbling" proscar the whole way!

 

[Stoploss587]

I hope this isn't extremely taboo to mention...how about a hair piece/system? At least for the crown? That would also leave more donor to transplant upfront and make denser.

Another idea, after using as many graphs as possible all over, donor allowing, and then to shave shorter and add SMP.

What is everyone's opinion on these two above options? Best of luck to you OP!

[Noodles123]

I've thought about this too. Since a hair transplant is essentially creating an illusion of hair, why can't you take it one step further and do a transplant and hair piece combo. Couldn't one conceivably implant densely at the hairline and wear a VERY well made piece behind it?