Bit of a dilemma

[Melvin- Admin]

Hey Guys,

So I'm 8 weeks out from my third and hopefully last procedure for a while, and I'm having a bit of a dilemma. Previously I had thought to densen up my midscalp and maybe add a bit more coverage near the corners of my crown. But after consulting with a coalition physician I was told I have favorable donor characteristics and still have plenty of 2, and 3 hair FU's available. To add I don't have donor miniaturization which was a fear of mine.

 

So now with this information I'm considering doing my crown instead of thickening the midscalp, currently im able to layer my hair in a way that doesn't really show the midscalp weakness, however there's not much I can do for my crown, I have never been one to take concealers I just don't want to become psychologically dependent on them. What do some of you guys think? Someone with my advanced hair loss REALLY needs to plan and think critically about how every graft is used and placed so looking for some insightful opinions. Doctors have told me I have around 2,000-2,5000 scalp grafts left via FUE, after that i'd have to look in to either FUT or beard hair.

 

Here is a photo of my midscalp so you could see there is a lack of density

 

Here is a picture of my crown currently in HD

[chris39]

It's a tough call as you're well aware .What's the area of the scalp ?

 

Certainly something in your favour is that your scalp isn't slick bald . The number of grafts stated and being 2's and 3's should give you good coverage.

 

My scalp is pretty much slick bald , and reckon to have any decent coverage on my second pass will need a good 3000 grafts , which I'm not certain I have until a proper assessment . In that respect , I don't have the same dilemma , as it will all have to go into the crown .

 

I'm of the same opinion regarding concealers - don't want to become a slave to the habit.

[Melvin- Admin]

It's a tough call as you're well aware .What's the area of the scalp ?

 

Certainly something in your favour is that your scalp isn't slick bald . The number of grafts stated and being 2's and 3's should give you good coverage.

 

My scalp is pretty much slick bald , and reckon to have any decent coverage on my second pass will need a good 3000 grafts , which I'm not certain I have until a proper assessment . In that respect , I don't have the same dilemma , as it will all have to go into the crown .

 

I'm of the same opinion regarding concealers - don't want to become a slave to the habit.

 

Hey Chris,

Just saw your updated pictures congrats!! looking great you've come a long way, the area of the scalp I was previously thinking was essentially the middle where I'm parting my hair, I would be able to sport different hair styles and not be so dependent on layering.

 

But as I start to think, maybe layering is just something that I'll have to accept (which I don't mind beats being bald everyday and twice on sunday), I would rather have an even "full" looking head of hair then have a full dense 2/3rds of my scalp with a bald crown. My problem and dilemma which is one that you don't have is my age, I'm still only 31 years old with some miniaturized hair to lose in the future. I know i'm not done with transplants, i'm just hoping to be done for at least 10 years, hopefully the Lipogaine and Pumpkin seed oil will help maintain the hair I have for a while. But just trying to be smart in my planning.

[mahhong]

If you're willing to consider the body/beard hair route (if you ever did need it), then a procedure on the crown may be something you could do with some (but not all) of your remaining scalp donor.

 

Personally I think beard hair works best when it's used to add further density in and around previous transplants, rather than used purely in one area (for example solely on the crown). Because of the slightly different characteristics beard hair has, it looks better spread evenly throughout the scalp to provide more density.

 

To that extent, my personal option would be to use maybe 70-85% of your scalp donor to create general coverage over your head, with the focus in the hairline and frontal third/half and lighter coverage to your crown. You leave the remaining 15-30% to add further coverage if your continue to bald, as your sort of "rainy day" fund.

 

Then you can use beard and body to add maybe a bit more density to the crown and midscalp, probably not really using it for hairline or immediately behind the hairline, where you really want to try and focus your scalp donor. If you have favourable characteristics the beard hair should blend pretty well with the scalp and it's usually thicker than scalp hair, so it adds a bit more illusion of density (although they're usually only single grafts).

 

I think that would be the approach I'd be most interested in and it's the one I'm considering when I do get a transplant. We all recognise the need to prioritise the frontal third and accept that crown density is probably unrealistic, but I think coverage in the back half that could be beefed up by some beard hair in the mid-scalp and crown is realistic. I think if men have decent density in their frontal third even a dusting in the crown goes a long way to reducing the contrast from "not bald" to "bald" - some guys only need a few grafts per cm2 in the crown and it creates a much more impressive and aesthetic look than a sudden transition to baldness.

 

Although you say you don't want to use concealers, if you have some coverage in the crown they work amazingly well just to thicken up the look of that area (and the mid-scalp too). It might be that you're not dependent on them, but could still use them just now and then when you really want to go for the thicker look.

 

The other option is SMP - it's only really suitable in certain candidates but, again, if you have some coverage it can work amazingly well to reduce scalp contrast and make average coverage look pretty full. It's not useful only for the "buzz" look, it can also be used with long hair in properly managed cases to really impressive effect.

 

So that would be my plan - use maybe 70-80% of your scalp donor to get good coverage front to back (with density focused in the front) and then maybe beef that up with some body/beard hair if you have the characteristics. SMP or concealer can do an excellent job of completing the illusion and you have a maybe 20-30% scalp donor left if you do see significant advancing of your balding in years to come, so you'll be able to address newly miniaturised areas with some scalp and maybe beard again if needs be.

[MrGio-WHTCClinic]

I suspect that beard hair could be a viable solution, especially since you may have several thousands of grafts available. The quality of the hair will offer coverage value even though the hair counts per graft will likely be lower.

[Spanker]

If it were me I would definitely place it in the midscalp. Maybe sprinkle in the upper crown. But you are at a low point right now at 8 weeks post op. You should see your results from the last op first.

[Melvin- Admin]

Mahnong, yes thats my goal, my plan is to get 1,500 grafts to the crown, leaving me with another 1,000 to 1,500 grafts left for that rainy day. So beard hair i would use simply as filler hair, luckily my beard to scalp characteristics are favorable so its most likely the route ill take in the future.

 

Spanker, I haven't actually had the procedure yet, im 8 weeks away from the procedure, initially my plan was to do the midscalp, but whats making me think twice is the fact that im able to style my hair in a way that layers the midscalp pretty good, ive had roughly 1,800 grafts in the mid. My main problem is the crown i just need some coverage to blend in too. But i have thought of doing the top crown and sort of combing it over but not sure howd that look.

[Spanker]

Yeah man, but with you not being on fin, you still have some coverage to lose in the midscalp. 1800 is not enough grafts to make your hair stand on its own. You are an informed guy and know your body better than anyone, but I still do not think its a good idea. You can expect to lose more of the midscalp and almost everyone looses hair mass from age related miniaturization eventually.

 

I just dont think its a good idea if you want to really pay attention to each graft you use.

 

That said, your donor looks pretty good.

[spyk777]

I think, do crown and later sprinkle everywhere with beard hair.

[Melvin- Admin]

Thanks for the suggestions guys, I definitely have some thinking to do, I know I still have some hair to lose albeit a small amount since I was nearly bald.

 

I'm thinking maybe a compromise, perhaps 500 behind the forelock and 1,000 in the crown, my thinking of placing the grafts behind the forelock is to allow for a complete layering effect as I comb my hair to the side. The only thing is 1,000 grafts to the crown won't be much at all, but maybe just enough for coverage and then down the line I could add beard hair to give it a boost.

 

It's really a game of chess, planning strategically how to move finite grafts to an ever expanding canvas.

[Al - Moderator]

I'm thinking maybe a compromise, perhaps 500 behind the forelock and 1,000 in the crown, my thinking of placing the grafts behind the forelock is to allow for a complete layering effect as I comb my hair to the side. The only thing is 1,000 grafts to the crown won't be much at all, but maybe just enough for coverage and then down the line I could add beard hair to give it a boost.

 

That is the route I would go.

[n00b]

Hi HTsoon,

 

I agree with the strategy to use 500 in midscalp and 1000 in the crown. You can use beard hair to add more overall density down the line instead of using it exclusively on one area. Since u already cut ur back and sides short, the scalp and beard hairs should be indistinguishable in the lower crown area if u choose to transplant beard hair in the crown in the future.

 

You mentioned you have favorable donor characteristics. Can you throw some light on it? Do you happen to know your hair thickness, graft density, percent of miniaturization, etc???

 

Also, I recall you were thinking a while back about transplanting scalp hair as much as possible and use beard hair to repair the donor area. Did you consult with your doctor whether this is a possibility?

[Melvin- Admin]

Hi HTsoon,

 

I agree with the strategy to use 500 in midscalp and 1000 in the crown. You can use beard hair to add more overall density down the line instead of using it exclusively on one area. Since u already cut ur back and sides short, the scalp and beard hairs should be indistinguishable in the lower crown area if u choose to transplant beard hair in the crown in the future.

 

You mentioned you have favorable donor characteristics. Can you throw some light on it? Do you happen to know your hair thickness, graft density, percent of miniaturization, etc???

 

Also, I recall you were thinking a while back about transplanting scalp hair as much as possible and use beard hair to repair the donor area. Did you consult with your doctor whether this is a possibility?

 

Hi n00b,

Thanks for your input that's exactly my thinking, in regards to my donor characteristics, this is what I received in a letter from a coalition physician which includes my donor density, laxity,hair shaft thickness, and miniaturization. I do not know the exact micron of the follicle unfortunately but I was told it was above average. Also, keep in mind my donor density is slightly below average because of the 4,000 grafts that were extracted, I wish I would have known my density prior to my surgeries. I hope this info helps

 

[mahhong]

Having had a closer look at your photos as well I really wonder if adding SMP might be a really good option for you. You look like you have the right characteristics - uniform black hair and a good complexion to your scalp too.

 

I've seen some great results with people using SMP and long hair to really create the illusion of greater density. You have good quality hair so I think SMP would blend really well with it.

 

It's a tough one - I do think a little coverage in your crown would make a big difference for you. If that was combined possibly with SMP I think you could look great. I do agree with Spanker's point about your mid-scalp - unfortunately us men with higher Norwoods do have to prioritise the hairline and mid-scalp, especially if finasteride is not in the mix (although even then you have to exercise caution). You do want to focus more of your hair there to create a natural look and put the donor where it's going to make the most impact.

 

With that having been said, you have good hair characteristics, you're willing to consider beard hair and you also have options like SMP and concealers enhance the illusion of density (I think both would work great in your case). To that extent, I think some light crown work is achievable and I do think it would make a difference to have some hair back there. It wouldn't look full but sometimes all you need is less contrast between fuller mid-scalp and bald crown to really improve the look, and even a little bit of hair back there gives you options with concealers/SMP.

[Spanker]

Did it tell you the fu per cm2?

[Melvin- Admin]

No unfortunately it did not tell me the amount of FU per CM2 only the average of hairs per FU.

[matt1164]

Wow. This is a dilemma. You're obviously intent of going all the way w this. Have you looked into higher dose rogaine w azealic acid. There's a 15% rogaine out there that works well. I've used it.

 

As for how to split up your hairs into crown or midscalp I think your right to split them to get some coverage everywhere on your scalp w no big 'bald spots'. As long as the hair line is strong and the face is framed well is the big thing

[n00b]

Hi n00b,

Thanks for your input that's exactly my thinking, in regards to my donor characteristics, this is what I received in a letter from a coalition physician which includes my donor density, laxity,hair shaft thickness, and miniaturization. I do not know the exact micron of the follicle unfortunately but I was told it was above average. Also, keep in mind my donor density is slightly below average because of the 4,000 grafts that were extracted, I wish I would have known my density prior to my surgeries. I hope this info helps

 

 

Thanks for the info HTsoon!

 

I am surprised that you have zero donor miniaturization as I thought everyone has around 10% miniaturization due to the telogen phase.

 

If you are curious about your hair caliber, you can can buy a micrometer to measure hair thickness. I bought one on amazon for $40.

[Melvin- Admin]

Wow. This is a dilemma. You're obviously intent of going all the way w this. Have you looked into higher dose rogaine w azealic acid. There's a 15% rogaine out there that works well. I've used it.

 

As for how to split up your hairs into crown or midscalp I think your right to split them to get some coverage everywhere on your scalp w no big 'bald spots'. As long as the hair line is strong and the face is framed well is the big thing

 

I used to take the Lipogaine back when it had Azealic Acid in it, it was fantastic, I haven't been able to find minoxidil that caries AA anymore though, they sell the powder on Amazon I've thought of just mixing it in to Lipogaine myself. To be honest since I started using Lipogaine about 1.5 year ago, my crown actually looks better then it did. I know that medicinal treatment at this point will only help me maintain but if I want to get some coverage it'll have to be the surgical route.

 

I'm certainly grateful for my frontal third it's really natural and dense enough so my face is certainly framed well, its just that pesky crown, I find myself still being insecure to turn around and expose my bald spot, I'm no longer self conscious about meeting people face to face as I no longer see wandering eyes which is such a great feeling, I just can't help but feel that maybe doing the crown would really top things off for a while. I'm trying to stay grounded and not let Hair Greed get the better of me that's why I made this thread sometimes outside opinions certainly help. Thanks for the suggestions.

 

Thanks for the info HTsoon!

 

I am surprised that you have zero donor miniaturization as I thought everyone has around 10% miniaturization due to the telogen phase.

 

If you are curious about your hair caliber, you can can buy a micrometer to measure hair thickness. I bought one on amazon for $40.

 

I think one of the reasons why I don't have much miniaturization is because I apply minoxidil in my donor area also, Minoxidil keeps hairs in the Anagen phase longer which could be a reason. I was kinda curious but at the same time I always knew I had thick coarse hair from before I was bald.

[chris39]

Hey Chris,

Just saw your updated pictures congrats!! looking great you've come a long way, the area of the scalp I was previously thinking was essentially the middle where I'm parting my hair, I would be able to sport different hair styles and not be so dependent on layering.

 

But as I start to think, maybe layering is just something that I'll have to accept (which I don't mind beats being bald everyday and twice on sunday), I would rather have an even "full" looking head of hair then have a full dense 2/3rds of my scalp with a bald crown. My problem and dilemma which is one that you don't have is my age, I'm still only 31 years old with some miniaturized hair to lose in the future. I know i'm not done with transplants, i'm just hoping to be done for at least 10 years, hopefully the Lipogaine and Pumpkin seed oil will help maintain the hair I have for a while. But just trying to be smart in my planning.

 

Hey HT ,

 

Thanks for the comments .

 

Bang on about the age consideration . Hopefully I'm at a stage where any major further is loss is negligible , but I suppose I still need to excercise some caution just in case . Actually , this thread hs made me think a lot more about a strategy for my next procedure . As it will likely be my last , I need to make sure I think things through thoroughly .

 

I'm sure I'll be posting a lot of questions around that time. This forum and the honest and educated second opinions you can get really helps with the planning process .

 

Will be interested to see what you go with .

[Rashid36]

I saw someone with alot of hair at the front and mid scalp and nothing at the back.

 

I Don't know if this person had surgery or if the hair loss was like this but it did not look good at all. I know its best to start with front but for me i think overall coverage is the best or nothing just buzz it down to one same level depending on the loss amount in the crown.

 

People say only the front is looked at but so is the back and if there is alot at the front the back will look more worse and stand out more

[gillenator]

HTSoon, got your PM my good friend. Lots of very insightful comments already provided.

 

Listen my friend, I have always thought you had awesome results from your previous work and your frontal core looks amazing. Obviously from your before and after pics, most of the frontal zone are grafts.

 

We both share the same profile in that we have a wide color contrast between our complexion and hair color. Like you, my crown was going as well yet I never had a lot of grafts placed there.

 

And I agree that some level of SMP would potentially help to reduce the reflection of ultra-violet light off your scalp especially the crown.

 

The challenge you face is the fact that you will experience further loss in both the mid-scalp and crown. I know that you are pretty much decided against using low dose finasteride in your regimen yet that in itself would definitely help to stabilize further loss in that region because it is the most efficient in the crown. The crown shows advanced diffusion and is impeding into the coronet area of the crown.

 

Now, could it be possible that you have more FUE grafts available especially if some were extracted above the ears? Yes you could use some beard or even chest hair but would it be practical to have most of your crown filled in with BH? If you do decide to go that way, I would do a more conservative approach to see how you respond to it and how visually compatible it would look.

 

You also will want to have some level of reserve (scalp donor) for touch-ups in the frontal zone or temporal areas in case you recede further there. But it should not be substantial since again, most of what's there are grafts.

 

What I chose to do was to dedicate roughly 1,000 of my 7,000 grafts to the crown. Yes it looks somewhat thin but not bald. I grow my hair much longer in the frontal zone and do a front-to-back brush style which helps to cover my mid-scalp where I did not have any grafts. I am 6'1" so really no one sees my mid-scalp unless I am sitting down.

 

I have pretty much learned to live with having a thinner crown and since I have already had 4 separate FUHT procedures, I would need to do FUE if I were to have any more work done.

 

You are still young so again, I would not use up what scalp donor is left for the crown entirely.

 

Here's another thought. There is always the option of going with a high quality partial system for solely the crown. I know a number of guys who do this and honestly, you cannot tell it's there and yet they are sporting a full head of hair! Just something to think about.

 

As always, wish you the best in your decisions HTSoon...

[Melvin- Admin]

 

You also will want to have some level of reserve (scalp donor) for touch-ups in the frontal zone or temporal areas in case you recede further there. But it should not be substantial since again, most of what's there are grafts.

 

What I chose to do was to dedicate roughly 1,000 of my 7,000 grafts to the crown. Yes it looks somewhat thin but not bald. I grow my hair much longer in the frontal zone and do a front-to-back brush style which helps to cover my mid-scalp where I did not have any grafts. I am 6'1" so really no one sees my mid-scalp unless I am sitting down.

 

I have pretty much learned to live with having a thinner crown and since I have already had 4 separate FUHT procedures, I would need to do FUE if I were to have any more work done.

 

You are still young so again, I would not use up what scalp donor is left for the crown entirely.

 

Here's another thought. There is always the option of going with a high quality partial system for solely the crown. I know a number of guys who do this and honestly, you cannot tell it's there and yet they are sporting a full head of hair! Just something to think about.

 

As always, wish you the best in your decisions HTSoon...

 

Thanks for your in depth reply Gillenator, I definitely want to keep some grafts in the bank just in case I ever want to thicken the front, although as you said most of it is transplanted hair.

 

I definitely don't mind living with a thin crown, I just need coverage so that there isn't a wall of hair with bald scalp, I have thought about body hair and I really only see it viable as filler hair, and because of the different growth cycles I'm not sure how well it would work, I think beard hair may be viable but that's something I wont venture in to until after my scalp is done.

 

I definitely agree using the rest of my donor for just my crown would be a bad move, do you think 1,000 grafts would be enough to get coverage?

[mav23100gunther]

Thanks for your in depth reply Gillenator, I definitely want to keep some grafts in the bank just in case I ever want to thicken the front, although as you said most of it is transplanted hair.

 

I definitely don't mind living with a thin crown, I just need coverage so that there isn't a wall of hair with bald scalp, I have thought about body hair and I really only see it viable as filler hair, and because of the different growth cycles I'm not sure how well it would work, I think beard hair may be viable but that's something I wont venture in to until after my scalp is done.

 

I definitely agree using the rest of my donor for just my crown would be a bad move, do you think 1,000 grafts would be enough to get coverage?

 

HTsoon I think you know better than anyone that 1,000 grafts to the crown isn't going to make much of a difference. Seems like a waste to be putting such a few in there if it's not going to really change much aesthetically. All or nothing when it comes to the crown, but you should know that. Rather focus on the mid-section. Did you consider getting PRP a cell treatment to the midsection by a Dr Cooley?

 

Question, do you have any regrets at not having started with FUT to maximize the grafts?

[Melvin- Admin]

HTsoon I think you know better than anyone that 1,000 grafts to the crown isn't going to make much of a difference. Seems like a waste to be putting such a few in there if it's not going to really change much aesthetically. All or nothing when it comes to the crown, but you should know that. Rather focus on the mid-section. Did you consider getting PRP a cell treatment to the midsection by a Dr Cooley?

 

Question, do you have any regrets at not having started with FUT to maximize the grafts?

 

Well I'm not sure if 1,000 grafts would be a waste, I guess everyone's goals are different, i'm not looking to achieve visible density just coverage, with my advanced hair loss there is simply no way I will ever have a fully restored crown, that is something I came to terms with prior to having any hair transplant. I think if I can get coverage I can certainly fade my hair in to the crown and make it match the donor so you don't see much of a visible difference between the crown and the donor (helping the illusion).

 

I've thought about PRP but it's to expensive, I saw a video of Schmoe Schillman and to be honest I saw no difference. I don't regret not getting FUT, never wanted the linear scar and I never wanted the combination of FUE and FUT, a couple of doctors I've consulted with in person have told me I could still do it, I just don't want to thin my donor and possibly expose a linear scar, with that being said that is definitely the best way to maximize grafts.