How to move forward from here ???

[Torn]

Hi all,

 

I am a male in my late 50's, live in NY and have had three early 90's 'plug' procedures, and one recent strip procedure a few years back by a so called 'top doc'. Of which I was very disappointed with the results, as it did very little to add density or soften the pluggy hairline. All my procedures so far have been strip.

 

Here's the problem.... the plugs were concentrated mostly in the frontal area/hairline and as I continued to loss hair I am now left with a pluggy and heavy hairline with little volume behind it which looks very unnatural. The hairline itself is now more pluggy looking because the hairs that were once there and blended with the plugs are mostly gone leaving only the plugs to fend for themselves.

 

I was told by the 'top doc' after the procedure I had approx 1600 via strip left.

 

The question is what if anything can I do to finally correct this ? I feel my options are...

 

a) Fill in the area behind the hairline, as I wear my hair down (combed forward Caesar style) and deal with the hairline, which is for the most part covered by the styling.

 

b) Fill in both the area behind the hairline and soften up the hairline. Which would leave less hair to fill in behind.

 

c) Breakup the hairline/plugs via fue along with the 1600 or so available and fill in the needed areas accordingly. Possibly losing more hairs in the process.

 

d) Call it a day....

 

 

The area I’d like to fill in behind the hairline is approx 7sq inches (or 45 sq cm ) going back 2 inches, or 9 sq inches (58 sq cm) going back 3 inches from the hairline. Not sure if I should be going back 2 or 3 inches from the hairline (the frontal third) ? And as I said I have approx 1600 or so left though that depends on the doctor doing the procedure.

 

Is there enough available donor to make a difference ?

 

Is this even worth doing.... and if so how should I proceed ?

 

What is the necessary amount per sq cm I’d need to add to the existing hairs to make a difference ? And exactly where should I add it to make the most difference ?

 

 

I'll just add comparatively the plugs are not that bad, as plug jobs go. I've seen much worse, but it’s certainly not natural looking at all.

I suppose like most Im just tired of living under a hat, but yet don't want to go through the expense, hassle and embarrassment of yet another procedure which ultimately just yields poor results.

 

I uploaded a few photos... how I usually wear it to cover, and messed up to show the area that needs work.

 

All opinions, suggestions and experiences are welcome, I want to see this from as many points of view as possible.

 

Thanks, Torn

[Torn]

Anyone ???

[Garageland]

Sorry to hear about your situation and that no one has reached out to help but the photos are not great to be able to offer advice on what might be best for you.

 

Only photo 3 shows me anything. It looks like the you have quite a dilemma.

 

I agree with the options that you have to either add density into the immediate hairline by placing single hairs around the old grafts to make this area more natural. The down side of this will be that the mid scalp which is already looking thin will look even thinner in contrast and it will still be as it is now a unnatural pattern of loss.

 

Ideally you would have enough grafts to do the above and add density into the area behind and the mid scalp. You may be limited on what you can get again with strip as you most likely have several scars and limited laxity?

 

The other option would be FUE if your laxity is limited again the number won't be great as you will need to keep more donor hair to cover existing scarring in the donor.

 

I would need to see clearer photos of the hairline with the hair pulled back to expose it and some of your donor area. Cases like yours really need in person assessments and whilst it might not be the most convenient thing to do it is essential in your case.

 

If the old grafts are too pluggy and you don't have enough donor to fill in the front and mid scalp the other option might be to punch out some of these of grafts so you don't have this rim of hair in the hairline. Again this should be done in small sessions and you need to get advice from in person consults.

 

If the hair is viable it can be trimmed and redistributed behind the hairline.

 

I think you should get your donor evaluated by other docs as you might have more than 1600 grafts. I had a similar case to you with mini and micro grafts into the hairline.

[KO]

Your hair characteristics are excellent. I think repair should be pretty straight.

[MusoInOz]

Agree with KO, have seen far worse come out as a knock out result!

 

Smartest move would be do build on those established areas not punch and relocate. I guess once you

I also wouldn't say the current situation is "pluggy" there is pluggy and there is pluggy!

 

GARAGELAND has offered some great advice there mate. You need to research some great repair results and determine the right surgeon.

 

Mike

[Torn]

Thank you for your insight and encouragement guys...

 

 

Garageland, I agree adding density to the hairline would only make it thicker and draw attention to the thin area behind it creating a very unnatural appearance. That and by doing so would leave less hair to thicken up the mid scalp region. This is my biggest concern. Not sure how to approach this ??

 

That is why I thought it best (?) to thicken up the area going 2 - 3 inches or so back from the hairline which would create a more natural normal appearance. And leave the hairline alone. I'm just not sure if this is the correct approach ? Unless of course I have enough to actually do both properly.

 

It took a few tries (not easy to get clear focused shots) but I added the hairline photos you mentioned. I hope these are more helpful than the first batch.

 

Yes, FUE is a consideration. Though it seems my laxity is still pretty good. I thought strip first, then FUE to maximize harvesting. Is this a realistic approach ?

 

 

 

KO, thanks for the encouragement I hope you are right.

What did you mean by hair characteristics ? Are you referring to the texture ?

 

 

 

MusoInOz, actually I'm hoping I won't have to punch out the plugs. I felt it would just add more complications and I'm concerned I will lose more hairs in the process.

It seems your sentence was cut off ? "I guess once you..." if you remember could you finish that ?? Yes I agree as you said Ive seen much worse !

 

 

Guys,

 

How many grafts would it take to fill in that area behind the hairline along with the existing hairs ??? And, how far back from the hairline should one go to achieve a natural look ?? I thought either 2 or 3 inches back from the hairline would be appropriate. That would give me either 45 or 58 sq cm to cover (with existing hairs) .

 

What repair approach would best address this situation ?

 

Also to get the terms right, what is the area from the hairline back three inches or so actually called ?

 

 

Thanks, Torn

[Garageland]

Torn,

 

Thanks for posting the updated photos, in my view you should wear your hair back as it immediately gives better coverage and the area behind the hairline which is just called the frontal area btw looks fuller as a result.

 

If you have the laxity and you need the most grafts then another strip followed by tapping out the donor with FUE that will get you the most amount of grafts. But that will depend on the location of your existing scar(s)

 

Looking at the hairline you will probably get away with not taking any old grafts out although the temples have been closed off a bit aggressively imo but the trauma to the skin would most likely be too great to take them all out. I would beef up the hairline and work back through the frontal area to the mid scalp if donor allows.

 

You should loosen up your scalp with exercises for a couple of months and see if you can get 2500 plus. Some donor shots will determine better the numbers possible.

[1978matt]

Not as bad I thought it might be. My doc posted a result for someone quite similar:

 

http://www.hairrestorationnetwork.com/eve/178626-raymond-konior-md-%96-chicago-hair-institute-%96-refinement-plug-hairline.html

[Gram]

Speaking of Konior he has a couple results with hairline restoration and hair pieces in the crown. That could be another option

[Blake Bloxham]

+1 for extracting the plugs and dissecting and redistributing the grafts. In fact, you could probably combine this with an FUE procedure focused on the hairline/density in the frontal scalp.

 

Let me know if you have any questions. Best of luck!

[Torn]

I re-read and realized I never posted donor photos.

 

I believe the back has little left to harvest though I'm wondering if you can combine a scar revision with a strip proceedure. Meaning by removing the larger stretched scaring take advantage of the hairs that will also be removed along with the scars.

 

As to harvesting, I will most likely have to focus on the sides and FUE.

 

 

 

 

Garageland,

 

Speaking of laxity I'm wondering if since I've had multiple strip procedures and therefore have multiple scars would the scalp exercises have a negative affect in stretching already stretched present scars ?

 

As to combing the hair back, I wish I could that would make life easier. However I suffer from Dolphin Head Syndrome, which has been exacerbated by my hairline being placed too high up. Presumably to save on hairs. I fall well out of the Rule of Thirds and therefore have to go with the Caesar/bangs styling to bring things back into proportion. So I will have to focus on adding density to the Frontal Area as opposed to the hairline itself.

 

 

Blake

 

Could you elaborate further on why you prefer dissecting and redistributing the plugs/grafts from the hairline ? My main concern with this besides the added complication, would be the loss of more hair in the process.

What would the benefits of this be ?

 

 

Torn