What is the best strategy of those heading to NW7?

[mmhce]

Notwithstanding that one of the primary concerns would be the conservation of the limited donor supply:

 

1. What is the best strategy of those at NW3 heading to NW7?

 

2. Do we extract/excise the strip from the same occiptal bump region in the scalp? Or do we excise lower?

 

3. Assuming that surgical intervention is taken at NW3, how is the density of the transplanted grafts planned?

 

Thanks.

[Bill - Seemiller]

mmhce,

 

These are great questions that require more than a simple answer.

 

However, the first point to address is that hair loss is unpredictable. This means that it's possible that anyone will end up a Norwood level 7 however, I'm not sure it's predictable that a Norwood 3 will inevitably become a Norwood 7.

 

Hair transplant surgery is about risk management. Whether or not a patient is willing to try medication like Propecia and/or Rogaine and after some use how successful it is will help guide the long term hair restoration plan. Whereas I don't believe a surgeon should rely heavily upon the medication and use it as a reason to create aggressive hairlines and an abundant donor hair supply in small areas of baldness - I do believe medication has a place in minimizing the risks of future hair loss.

 

It's usually optimal to take hair on or above the occipital bump however, I've seen cases where a strip may be taken below. This has to be looked at on a case by case basis and risks discussed no matter what the strategy.

 

Ultimately, a Norwood 7 will have to have very realistic expectations and will not be able to cover the entire bald area with any real degree of density.

 

As a general answer to your last question, if hair loss is still aggressive at a norwood 3 level, if surgical intervention occured, the focus should be coverage with low density - but whether or not a patient will really be satisfied with this needs to be discussed before hands. This is part of managing realistic expectations.

 

There really is a lot more to say about this subject, but I think this is a start to addressing some of these concerns.

 

Best wishes,

 

Bill

[AMR1]

best strategy is to see Dr Humayun

[kaounis]

I think if you beleive you are headed for a Nw7, forget HT's. Just shve your head, save your money, and get on with your life.

 

 

Just a thought from the peanut gallery...

[Petchski]

Maybe it's best for NW7's to do that, depending on their goals, but if propecia can hold out and stop you progressing to NW7 then maybe not.

 

Problem is knowing if you will progress to a NW7.

[AMR1]

 

if u were a NW7 guess u might have a dfferent view

[Marvin]

If Dr. Humayun's results are real and not photoshopped, then it looks incredible. If I become an NW7, I would certainly seek a procedure like that. Sure, you're still bald, but having a little bit of hair on top creates the illusion, from at least some angles, that you're not really all that bald.

 

I had a Professor in college who had hair very much like one of those NW7 transplants (island in the top front that he combed back, crown almost entirely bald), and he looked very good from the front. Not sure if his was a transplant or not -- I didn't think so then but I suspect it now.

[Dr. Michael Beehner]

To mmhce,

First of all, it is very difficult to tell whether or not a NW3 is going to progress to a NW7, since by definition the hair all through the central area of the scalp would be thick. I am assuming you are referring to a male in whom you could see early thinning in a wide area throughout the top of the head and can project that the eventual area of baldness is going to be very large, and, in the case of a NW7, that the side fringes are going to reside down along the side of the head.

I agree with Bill's comments above. There is not magic presently that allows a hair surgeon to come anywhere close to filling in the entire bald area. So that leaves two choices as extremes: One, to place small grafts all over the balding scalp with rather sparse density, or two, to choose rather to place hair in a limited area that strategically does the most good and elect not to place hair in some of the scalp areas that are of less importance in styling.

The main thing that hair transplantion does for a man losing his hair is that it FRAMES THE FACE. A forelock type of pattern can do this for a man who has a severe degree of baldness (as the man in the link below with a before and after photo from my practice) and can also be used as a design template for a younger male who hasn't quite lost all this hair, but one is fairly certain this is what is going to happen. The forelock pattern seeks to place the relatively densest area in what we call the "frontal core" area at the front center, and then all the other hairs along the side hairline and behind the forelock are gradients of lesser density. This type of pattern is best styled backwards, either straight back or toward one of the rear corners.

Using this type of design, either the "shield" shaped one or the oval shape, almost every man who presents for hair transplantation can be helped. The only ones that can't be helped are those who can't lower their expectations enough to accept this type of design.

Mike Beehner, M.D.

[mmhce]

Thanks Dr. Beehner!

[AMR1]

Marvin I do agree with u 100%

 

Originally posted by Marvin:

If Dr. Humayun's results are real and not photoshopped, then it looks incredible. If I become an NW7, I would certainly seek a procedure like that. Sure, you're still bald, but having a little bit of hair on top creates the illusion, from at least some angles, that you're not really all that bald.

 

I had a Professor in college who had hair very much like one of those NW7 transplants (island in the top front that he combed back, crown almost entirely bald), and he looked very good from the front. Not sure if his was a transplant or not -- I didn't think so then but I suspect it now.

[Al - Moderator]

if the best a NW 7 can expect to get is a very high hairline with some thin hair in front and none in the back, then what happens down the road to the 20 something year old NW 3 who has 2 megasessions to get hair as dense as he can? In 5 or 10 years when some of them progress to NW 7s they are going to be in bad shape. I know this from personal experience. I tried to continue filling in to keep up with the hairloss, but eventually the loss progresses to the scar. At that point you've already taken all the good hair on the sides and back out, so there's not much "safe" area left by then. I've been asked why I kept doing more HT sessions, but what choice does a person have? If you don't continue to fill in the sides as the area widens you just look freaky even sooner.

[Dr. Michael Beehner]

Be Happy,

You have summed up the dillemma of the young patient in a nutshell. The surgeon (nor the patient) really, really doesn't know how bald he is going to be 20 years down the road.

I do think, however, if you stay out of the rear vertex, don't put the hairline too low, and - most importantly - don't go too wide in front or try to close the fronto-temporal recession areas, that you will be safe in the long run, and even with borderline donor supplies, you can find some FU's to blur that space between the front-central forelock mass of hair and the side fringes. As I have said before, styling the hair backwards makes it look the best and the fullest. Some men have hair that "travels" well and can be taken back, while some men have wavy, stiff hair that doesn't lay over each other that well. A few of these maybe shouldn't be transplanted.

But you're right - once a hair surgeon gets you started with a low, aggressive hairline, you are stuck on the hair transplant merry-go-round, and unless you can remove all of them or at least the offending ones off to the side, you have no choices but to make the best of a bad situation. One solution that works great, but not many men actually do it, is to invest the transplants into the front half and get a small clip-op hairpiece for the back half and vertex.

Mike Beehner, M.D.

[Dr. Mohammad Humayun Mohma]

Dear Marvin

 

I have never shown any photoshopped picture except for hiding the face.

 

ealing with TYPE VII are bit different then others as you nee to play with the angle of exit and curl of hair shaft. Its how you strategically place the hairs.

All I need to see is do you have a donor area tha can donate 4000 grafts in total, if answer is YES, then I can assure you will have a great result (98%) 2% you migt not have a great result, every surgery have some unknown failure causes.

 

generally speaking if you know the family history and you see the donor area closely you can differentiate between the true donor area and the area that would go bald. SO to an extent one can tell roughly how bald you will go. Though not when you are really young but when you have reached type V stage no matter how old are you.

[imissthebarber]

Thanks to both Drs for your input.

 

Dr Beeher, in the case of a young NW3 you said that it is impossible to tell how bald they will become. However for a NW5, given a knowledge of the family tree, Dr Mohmand is confident he can get a reasonable assessment of how far the balding will progress. To what extent would you agree?

 

Also, for those hoping to avoid the bad situation BeHappy has unfortunately described, have you got any general guidelines about how wide the sides should be? How far should it be from a receded temple to the advancing crown? I think a lot of guys might find this helpful in getting a rough idea of how many grafts they should keep in reserve for this.

[Dr. Michael Beehner]

To "I miss the barber":

First of all, there's a huge difference between a Norwood III and a Norwood V. With a Norwood V, you are essentially looking at the outline of that patient's future Norwood VI pattern. All Norwood V patients go on to become at least Norwood VI's. So then you have good insight into how wide that man is likely to go, especially if he's in his mid-30's or his 40's. The family history is a nice piece of information to have tucked back in your brain, but it should never give a hair surgeon a confident feeling with a man in his early 20's that that patient cannot possibly go on to become a Norwood VII simply because his male relatives two generations removed didn't do so.

As to the "how wide the sides are," I had mentioned in previous notes that when a patient's certain width of baldness reaches 15cm, the surgeon should be thinking about a forelock type of pattern, with maximal density in the front-central area and a gradient of density between that and the sides, whatever distance that is. As far as the rear area of baldness goes, it is good in these situations of mismatch between available donor hair and massive areas of baldness to stay out of the rear vertex region - that is, the circular or oval area of the rear scalp that is behind that point at which the slope of the head starts heading downhill. I hope that helps answer your question.

Mike Beehner, M.D.

[imissthebarber]

Thanks again Dr Beehner yes that does help with both questions.

[mmhce]

Dr. Beehner,

 

Thank so much for your comments!

 

If you are still familiar with this thread, would you be kind enough to answer the questions posed on this thread found here:

 

http://hair-restoration-info.c...=651102481#651102481

 

 

which is an off-shoot based on the comments that you made previously here.

 

"As I have said before, styling the hair backwards makes it look the best and the fullest. Some men have hair that "travels" well and can be taken back, while some men have wavy, stiff hair that doesn't lay over each other that well. A few of these maybe shouldn't be transplanted."