41 yr Old Diffuse thinner looking for advice

[Cerlan]

Looking for some advice. I went to a consultation with an FUE surgeon at the weekend. I've put the results of his exam below. Apparently my hair is fine so a transplant will give me some coverage but it won't look very thick.

He recommended 1800 grafts on the crown area to begin with, with the front to be tackled at a later date.

My question is, has anyone with similarly fine hair gone ahead with a procedure and had a satisfactory result? My fear is that I will go for a number of procedures over the coming years and end up with results that I am not happy with, ending up with a similarly thin head of hair to what I have now. Just with transplanted hair, once all of my native hair falls out.

Assuming I will lose all of my remaining hair on top, which seems likely looking at the pattern in the photos, I don't think I'll have enough donor hair to give decent coverage. 

Would be great to hear from anyone who was in a similar situation.

I've attached some photos as well.

Norwood classification: NW 2V, Diffuse thinning
Hair Characteristics: Salt & Pepper, Slightly Wavy, Medium Fine Hair
Donor Density: Measured in 2 areas as 70/80 Follicular units per cm2, small follicular units
Miniaturisation: 15% of miniaturised hair in the donor area
Dermoscopy: Normal, no signs of scalp issues

 

[hairlossPA]

doesn’t seem like a typical evaluation with someone in your position. surgeons don’t usually start with the crown.. they start to rebuild the hairline and work the frontal third first, working their way to the crown for a later date. Is he a surgeon recommended by this website? i’d start with the front half of your head. probably somewhere around 3500 grafts 

[BuddyX]

As above, have no idea why any surgeon would say start with the crown.  Makes no sense at all.  Grafts are finite so you would always use them to fix the front to frame the face first. 

At 41 years old your hair loss isn't too bad, and 80 follicular units per cm2 is good.

Your donor looks decent enough too.  Did you get told how many grafts can be extracted from your donor zone ?  I'm guessing you could probably get around 6000 grafts out of there (maybe more) which is more than enough to tackle your current hair loss and give you full coverage that will look very good.

How long have you been balding for ?  

Are you using any medication to prevent further hair loss ?

Edited September 7, 2018 by BuddyX

[Melvin- Admin]

Believe me, you will not be satisfied if you do not do the front first. This is the fiest thing people see, the first thing you see. In fact, if youre worrying about coverage already, dont even touch the crown, because it will require double the amount of grafts as the hairline for visual density.

[Cerlan]

Thanks for the replies guys. I guess he recommended the crown first as that is the bit bothering me the most. My receding hairline hasn’t really bothered me too much over the years. But the idea of a bald spot bothers me much more for some reason.

I started thinning in my mid to late 20s. Started using minoxidil about 10 years ago. Looked into finasteride around the same time but read some horror stories online that stayed with me. The surgeon recommended topical finasteride which has less chance of side effects apparently so I will look into that.

Didn’t get a total graft number but apparently all the donor area is made up of one or two hair grafts so I’m guessing that won’t give great coverage. 

My main reason for not going straight for a ht is the fear that once all the rest of my hair is gone the transplanted hair will be too sparse to be of much use and I’ll have to go for a buzz cut anyway.

[Melvin- Admin]

Being brutally honest, if i were to meet yiu thhe first thing im gonna notice is your hairline is whispy and thinning. I probably wouldnt even pay attention to your crown cause my eyes are drawn to yours hairline. Without framing the face having a crown dense crown is useless.

[Cerlan]

4 minutes ago, Melvin-Moderator said:

Being brutally honest, if i were to meet yiu thhe first thing im gonna notice is your hairline is whispy and thinning. I probably wouldnt even pay attention to your crown cause my eyes are drawn to yours hairline. Without framing the face having a crown dense crown is useless.

That’s fair enough. Each to their own. I can honestly say that I don’t take much notice of hairlines but a big shiny hole at the back of the head is not something I’m a fan of. Maybe I’m in the minority though...

[JayLDD]

You're a NW4 without a doubt, not a NW2A. Pretty close to a NW5 also. 

I would find a surgeon who was willing to approach coverage across the majority of the scalp. Considering you're not on finasteride you will lose more hair than 1800 grafts will give you in a few years. For FUE I would only consider a megasession approach of someone like Erdogan, although definitely worth considering FUT with clinics skilled at large megassessions like Hattingen and Hasson + Wong.  FUE might not be a great idea considering the miniaturisation in the donor which is also quite visible. 

Imo 1800 grafts would be a waste of time and risk though. Your fear of going through multiple procedures and in the longer term not coming out much better than you are now is definitely justified unless you find surgeons skilled at high graft counts and broad coverage on high norwoods.

[journeyman]

Your crown doesn't look too bad from the backside.  I also think that tuft of hair in the front (the forelock) helps a lot for the front, some guys lose that entirely.  Maybe split the 1,800 grafts, 900 to pull the temples forward a tad and thicken the front of the hairline, and 900 for the crown.    I have fine hair and the same hairloss pattern as you and this is what I did (1,900 grafts).  A diffused head of hair looks better than bald spots IMO.

Edited September 8, 2018 by journeyman

[razzy]

Some really good advice in here. I suggest you listen.

Do the frontal area first. You can always use concealer if need in the meantime for the crown which will certainly give you a fuller look until you decide to address the crown later.

[Cerlan]

11 hours ago, JeanLDD said:

You're a NW4 without a doubt, not a NW2A. Pretty close to a NW5 also. 

I would find a surgeon who was willing to approach coverage across the majority of the scalp. Considering you're not on finasteride you will lose more hair than 1800 grafts will give you in a few years. For FUE I would only consider a megasession approach of someone like Erdogan, although definitely worth considering FUT with clinics skilled at large megassessions like Hattingen and Hasson + Wong.  FUE might not be a great idea considering the miniaturisation in the donor which is also quite visible. 

Imo 1800 grafts would be a waste of time and risk though. Your fear of going through multiple procedures and in the longer term not coming out much better than you are now is definitely justified unless you find surgeons skilled at high graft counts and broad coverage on high norwoods.

Thanks for the advice. I think you’re right on the Norwood scale. Asmed recommended 5000 grafts based on the photos I submitted placed all over as you suggested. My main fear with that approach is the shock loss to existing hair. Hadn’t really considered fut as I like the idea of being able to buzz cut it if everything goes pear shaped.

[Cerlan]

4 hours ago, journeyman said:

Your crown doesn't look too bad from the backside.  I also think that tuft of hair in the front (the forelock) helps a lot for the front, some guys lose that entirely.  Maybe split the 1,800 grafts, 900 to pull the temples forward a tad and thicken the front of the hairline, and 900 for the crown.    I have fine hair and the same hairloss pattern as you and this is what I did (1,900 grafts).  A diffused head of hair looks better than bald spots IMO.

Thanks for the advice. Took a look at your pics. Looks good! I think with darker hair though I probably need more grafts but great to hear from someone in a similar situation.