How many grafts?: please advice me

[octave]

Hello hair network community,

 

Here’s my issue; I'm 38 years old and I lose my hairs at a constant rate since I'm 16 year old. About 10 years ago, I did some research about HT but was cooled by some awkward results. Now, I’m reconsidering more seriously this option, encouraged by numerous of procedures that look by very natural and also the possibility to avoid huge scar with FUE.

 

I've already consulted a few surgeons, however, I'm a bit confused about the number of grafts that I would need, there is a huge discrepancy and it range 800 to 2500 grafts…

 

I understand that they have a financial incentive to do a maximum of grafts however my main objective is to get a procedure that is sustainable in the long run and to keep a maximum of hairs stock in case I would need further interventions.

 

Could you please advise me on the number of grafts that I would need? Here are my expectations:

 

1. To recover my hairline, starting from the first weak hairs

2. To get a bit more density behind the hairline

3. To slightly close the temples corners (I'm OK to keep the M shape)

 

Here are the quotes that I have from 3 surgeons:

 

1. Dr Wong , from H&W, advises me that 800 grafts would enough. He would start 2 millimeters bellow the first weak hairs and close lightly the temporal corners. I insisted on the number of grafts; do you think it will be enough? He told me that with more grafts and start a bit more upfront it wouldn't look natural since the transplanted hairs will look stronger than those at the back.

 

2. Dr Bisanga in Belgium; and he told me that I would need at least 1500 grafts otherwise I wouldn’t get enough density and it will look obvious that I had HT. (he will implant the hairline a bit more aggressively, than Dr Wong, by starting from the first front weak hairs).

 

 

3. DR Feriduni, after an online consultation, gave me a range between 2000-2500 grafts.

 

From the more conservative to the more aggressive surgeons the estimations very from double to triple, but as I said they have incentives to do a maximum of grafts but according to my goals and my age could you please give me a fair estimate to get a natural and sustainable result.

 

Thanks a lot for your contribution.

 

*Sorry for the quality of the pictures

[win200]

With all due respect to Dr. Wong, his number seems extremely low and would be unlikely to produce the cosmetic improvement that you're looking for. My loss was pretty similar to yours, and I had a 1,450 graft procedure that resulted in a very nice improvement, but not one of those dramatic transformations. Using half that number of grafts would make only a very marginal difference. I think 1,500 to 2,000 would do very nicely for you, but 2,500 is not a crazy number either.

 

Of course, the million dollar question is whether you're on finasteride/dutasteride. If not, I would go for 1,500 grafts because your loss will continue.

[octave]

With all due respect to Dr. Wong, his number seems extremely low and would be unlikely to produce the cosmetic improvement that you're looking for. My loss was pretty similar to yours, and I had a 1,450 graft procedure that resulted in a very nice improvement, but not one of those dramatic transformations. Using half that number of grafts would make only a very marginal difference. I think 1,500 to 2,000 would do very nicely for you, but 2,500 is not a crazy number either.

 

Of course, the million dollar question is whether you're on finasteride/dutasteride. If not, I would go for 1,500 grafts because your loss will continue.

 

I think 2000-2500 grafts would be really insane to cover such a small zone. I mean what about if I end up Norwood 6 when I will be 50-55... I will still have max 3000 grafts to cover a zone which is 5-6 time bigger.

[win200]

I don't think it's insane, and if you check out threads of other NWIIIs, you'll see that it's in line with the approach that plenty of other people have taken. 2,500 grafts would be relatively aggressive, but not "insane." Hence why I suggested 1,500 to 2,000; a very nice and obvious improvement, but not purging a ton of grafts. You still have a lot of hair for a 38 year old, so if you're on a DHT blocker and it's effective for you, there isn't anything wrong with using that many grafts.

[octave]

With all due respect to Dr. Wong, his number seems extremely low and would be unlikely to produce the cosmetic improvement that you're looking for.

 

Maybe he's too conservative but I guess his estimation is based on 1000's of experiences about hair loss pattern. I don't care to have an handsome hairline that last only 3-5 years.

I want a result that is possible to maintain in the long run let's say 25 to 35 years further.

 

I guess that some surgeons are more like carpet sellers, they only think to short term gains. While I'm looking more for an architect, that makes plans, and develop a strategies, that are realistic and sustainable.

[win200]

I totally understand what you're saying, but I do not think that 800 grafts will satisfy the goals you have clearly states. And 1,500 grafts leaves plenty of room for long-term thinking.

 

It's great that you're being, if anything, TOO conservative... many people have the opposite problem.

[Melvin- Admin]

I'd recommend 1,200-1,500, you're almost 40 with minimal hairloss, the chances of you balding to a Norwood 6 is low, most men with aggressive hairloss would be significantly bald at your age, with all due respect you're not that young, being that conservative is for guys in their early 20's not for guys nearly 40 that's my opinion.

[mav23100gunther]

Yeah, 800 grafts seems inconsequential. I would suggest going to Rahal for a densly packed Rahal hairline 2,000 - 2,500 should do the trick.

[destorius]

I think 1500 is about spot on. 800 graphs will not do a great deal and IMO 2500 is far excessive. I really respect how you are taking such a long term viewpoint on your hair! Having met Bisanga, I think you would be in good hands!

[LondonHT]

Hi Octave. I went to Bisanga from Italy. One of the best choices i have ever made.

[Shadow of the EMpire State]

I think 2000-2500 grafts would be really insane to cover such a small zone.

 

It's not that small. Sure, you have a pretty good head of hair for 38, but to get a non-balding "mature" hairline, 2,000-2,500 seems about right. Of course, it would've helped had you taken a picture of the front of your face so that we could gain a better understanding of how high your hairline actually is.

 

I mean what about if I end up Norwood 6 when I will be 50-55..

 

That's highly unlikely to happen given your age and Norwood pattern. There have been studies on this, and Dr. Raissman has referred to some of them at his web site. Basically, the overwhelming majority of people who are destined for the Norwood 6-7 category will reach that stage by 30. Meanwhile, you're nowhere close. Moreover, you've been losing hair since 16, so yours has been a very slow process. Frankly, in my lay opinion, I think you're probably a good candidate for an aggressive procedure.

[JohnCasper]

I think you would be more than satisfied with 1,500-2,000 grafts. I would also base this on whether your hair loss has stabilized at 38 years old. I'm 53 but noticed hair loss stabilization the last 10 years prior to my surgery in 2012.

[octave]

Thanks for your replies. Now I have taken some pictures of my hears wet.. and I'm effectively loosing some density from the hairline to the crown.

 

So dense package is definitively not suitable for me...

 

I'm still wondering about the best strategy to manage the hair stock... with a long term perspective in the long run.:confused:

Edited October 7, 2015 by octave

[octave]

I've found that chart 1 bellow with a grafts estimate for different Norwood scales.

 

3000/4000case Photo by paulshapiromd | Photobucket

 

I think it can help to avoid the mistake of being too agressive.

 

From the table 2 bellow we can see that the central core region require 4 times more grafts that the transition zone and 33% more than the defined zone.

 

Zones Photo by paulshapiromd | Photobucket

 

If those charts are still accurate doing a dense pack on the transition and defined zones for a NW2/3 case is foolish, since eventually the process will continue with less grafts available and a large zone that require a greater number of hair per cm2...

 

Thanks for you thought

[Sethticles]

wow i'll against the grain here and say, mate you dont need a hair transplant, or at most 800 but really why bother - unless im looking at the wrong images

[Melvin- Admin]

I wonder what would happen if this guy actually had bad hairloss, he's got a natural part in his hair which he says is a definite thinning, he's been losing his hair since he was 16 but thinks he'll go full blown Norwood 6 in 10 years, even though his hairloss has been slow for over 20 years.

[LondonHTseeker]

I wonder what would happen if this guy actually had bad hairloss, he's got a natural part in his hair which he says is a definite thinning, he's been losing his hair since he was 16 but thinks he'll go full blown Norwood 6 in 10 years, even though his hairloss has been slow for over 20 years.

 

To cast aspersions over his potential ability to cope with more extensive hair loss just because he's keen to fix moderate hair loss is truly pathetic and further reveals you, HTsoon, to be a bitter and desperate individual unable to come to terms with your own extensive balding. Nobody knows how his hair loss will progress in future. It could start to accelerate exponentially as he hits his 40s.

 

I can see why you'd want an HT, octave. The thinning doesn't look bad at all but the hairline can definitely be reconfigured. I agree 2500 sounds like a decent graft count to rebuild the front. Also, you should go on meds if not already on them. That was my mistake. I now need another 1000 FUE grafts to fix the thinning areas on my vertex. I'm your age.

[octave]

To cast aspersions over his potential ability to cope with more extensive hair loss just because he's keen to fix moderate hair loss is truly pathetic and further reveals you, HTsoon, to be a bitter and desperate individual unable to come to terms with your own extensive balding. Nobody knows how his hair loss will progress in future. It could start to accelerate exponentially as he hits his 40s.

.

 

Thanks for your answer LondonHTseeker. I understand that my questions may appear mundane to those whose have more advanced cases.

 

As I said from my modest knowledge, the main issue is to be too aggressive too early...

When I read posts from 25-30 years old that do dense packs with so many grafts... I cross my fingers for them.

 

If I can do the maths for the worst case scenario... the area that I want to cover 1/10 of that patient bellow. 8400 grafts / 10= 840 grafts. Or at worst 2/10 it will be 1640 grafts

(I'm OK to keep the M shape)

 

https://hassonandwong.com/hair-transplant-results/patient-1908/?_sfm_norwood_scale=type_6&_sfm_number_of_grafts=0+11000

 

Now I don't know if it's really achievable but at least what I know is that I'm not so interested to end up like this

http://farm3.static.flickr.com/2634/3827297494_861d80bfb7.jpg

 

But I guess it's only a question of personal tastes

[Melvin- Admin]

To cast aspersions over his potential ability to cope with more extensive hair loss just because he's keen to fix moderate hair loss is truly pathetic and further reveals you, HTsoon, to be a bitter and desperate individual unable to come to terms with your own extensive balding. Nobody knows how his hair loss will progress in future. It could start to accelerate exponentially as he hits his 40s.

 

I can see why you'd want an HT, octave. The thinning doesn't look bad at all but the hairline can definitely be reconfigured. I agree 2500 sounds like a decent graft count to rebuild the front. Also, you should go on meds if not already on them. That was my mistake. I now need another 1000 FUE grafts to fix the thinning areas on my vertex. I'm your age.

 

If you're going to call me out, do me a favor and read the thread, if you were to go to the previous page you'll see where I advised him to get 1,500 grafts, my post was not in reference to him not getting an HT, my post was in reference to him wanting to be conservative when he's nearly 40 with minimal hairloss, the chances of him progressing to Norwood 6 in 10-15 years is highly unlikely if he's been balding for over 20 years at a slow rate. I'm bitter lol that's the pot calling the kettle black, you're the pathetic one bad mouthing Dr. Feller and bloxham in every other post, yet you were quite quiet when they were gonna give you a procedure free that's pathetic.

[Stig]

To cast aspersions over his potential ability to cope with more extensive hair loss just because he's keen to fix moderate hair loss is truly pathetic and further reveals you, HTsoon, to be a bitter and desperate individual unable to come to terms with your own extensive balding. Nobody knows how his hair loss will progress in future. It could start to accelerate exponentially as he hits his 40s.

 

I can see why you'd want an HT, octave. The thinning doesn't look bad at all but the hairline can definitely be reconfigured. I agree 2500 sounds like a decent graft count to rebuild the front. Also, you should go on meds if not already on them. That was my mistake. I now need another 1000 FUE grafts to fix the thinning areas on my vertex. I'm your age.

 

Wow, once that free offer was taken off the table your knives really came out. Really amazes me to see a grown adult behave like you do, especially the fake way you were so nice to everyone whilst waiting for the Dr to see you. Least you didn't bite all your tounge off during the 3 months that offer was on the table. Feller must me breathing a huge sigh of relief he never performed that procedure on you - you can bet that the minute after you would have walked out the surgery you would have reached for your device to bitch about it. How is that crusade against Feller about waiting 6 months vs 8 months going?

[ModernHair]

@octave - My personal thought (and you may not want to hear this) is that you wait for a little bit, maybe until at least your early 40's. You seem really conscientious and concerned about the future, as you should be. But I think that going for 800 or even 1,000 now won't make enough of a difference (2,500 seems really aggressive to me!).

 

I personally would rather wait a bit until you know more about your hair loss and feel more confident ,and when you will likely need a larger transplant that can make a real difference and give you confidence that you'll have plenty of donor hair leftover for future needs.

 

To give you perspective, I had a HT this past April and needed roughly 1,800 FUE grafts which filled a good bit of 3 zones - the front (transition) zone, the defined zone right behind it and a bit into my central core. I am VERY happy about my coverage at only 6 months and am excited about the growing I still have left to do.

 

I also preserved a good bit of my donor hair for any future needs, although since I am in my mid 40's, my doctor thought I may not need anything further since I had minimal miniaturization in my remaining hair and am now using Minoxidil daily. But if I do end up needing more, I have plenty.

 

Anyway, hope that gives you something to consider and maybe takes the urgency away from doing something immediately.

Edited October 11, 2015 by ModernHair

[LondonHTseeker]

you're the pathetic one bad mouthing Dr. Feller and bloxham in every other post, yet you were quite quiet when they were gonna give you a procedure free that's pathetic.

 

Not really, it's just politics. It's not like I hate them or anything. As a matter of fact I'm glad they won't operate. Now I can get 1000 FUE grafts for around 2k dollars in Turkey and not have to shave down the recipient. That's way better than paying for a return flight to the US plus New York hotels, plus shaving down completely. Doesn't even compare. Only reason I was going along with the free offer was on the off chance they'd offer to do like a 3000 graft procedure. Lol. It turned out there was no chance of that.

[LondonHTseeker]

Wow, once that free offer was taken off the table your knives really came out. Really amazes me to see a grown adult behave like you do, especially the fake way you were so nice to everyone whilst waiting for the Dr to see you. Least you didn't bite all your tounge off during the 3 months that offer was on the table. Feller must me breathing a huge sigh of relief he never performed that procedure on you - you can bet that the minute after you would have walked out the surgery you would have reached for your device to bitch about it. How is that crusade against Feller about waiting 6 months vs 8 months going?

 

No doubt Feller is relieved he didn't operate. However, I'm pretty sure the free offer wasn't a serious one. As it happens, I'm also relieved he didn't offer to operate. I have a much better option in Turkey. What crusade? Heh, your weak-minded vitriol is about as savage as being mauled by a guinea pig. And you sure do a lot of mind reading. Do you know me? Nope. But carry on with your foolish and feeble assumptions if it makes you feel perspicacious.

[LondonHTseeker]

Thanks for your answer LondonHTseeker. I understand that my questions may appear mundane to those whose have more advanced cases.

 

As I said from my modest knowledge, the main issue is to be too aggressive too early...

When I read posts from 25-30 years old that do dense packs with so many grafts... I cross my fingers for them.

 

If I can do the maths for the worst case scenario... the area that I want to cover 1/10 of that patient bellow. 8400 grafts / 10= 840 grafts. Or at worst 2/10 it will be 1640 grafts

(I'm OK to keep the M shape)

 

https://hassonandwong.com/hair-transplant-results/patient-1908/?_sfm_norwood_scale=type_6&_sfm_number_of_grafts=0+11000

 

Now I don't know if it's really achievable but at least what I know is that I'm not so interested to end up like this

http://farm3.static.flickr.com/2634/3827297494_861d80bfb7.jpg

 

But I guess it's only a question of personal tastes

 

No problem, octave. I think if you go on meds you can afford to use a couple of thousand grafts on the hairline. Your crown doesn't need any grafts does it?

[Melvin- Admin]

Not really, it's just politics. It's not like I hate them or anything. As a matter of fact I'm glad they won't operate. Now I can get 1000 FUE grafts for around 2k dollars in Turkey and not have to shave down the recipient. That's way better than paying for a return flight to the US plus New York hotels, plus shaving down completely. Doesn't even compare. Only reason I was going along with the free offer was on the off chance they'd offer to do like a 3000 graft procedure. Lol. It turned out there was no chance of that.

 

Politics eh, well politicians are fake and phony, the fact that you attacked me for something that you completely misunderstood shows your character (vindictive), I guess I've made it to your little vengeance list along with feller and bloxham. So along with feller and bloxham I guess I should come to expect these little unwarranted attacks from you, but in the future please read the thread, if you're going to be malicious get your facts straight, it makes you look sad and foolish in the end.