2nd HT hairline repair decisions

[keysersoze]

HI guys,

 

I have posted about this previously but have a few questions hoping I might get assistance with and thought I would attach some recent photos taken today with shaved head to give better idea of what im working with. After thinking about it and discussing with wife, Ive decided not to remove the hairs (with electrolysis etc) and to get 2nd HT to fix it and much needed density. Still researching and contacting surgeons at the moment. Not sure who I am going to go with at this stage. I hate to say it cause i know, from obvious exp, cost shouldnt be a factor but unfortunately for it is so that will still be part of the decision. Reality is I wont be able to afford the more expensive options for some years and really would like to get on with life. 

So far all surgeons have quote similar - need between 1800 and 2500 in front to get good density. Im happy with that and been pretty consistent. I do have some questions though if possible:

 

1. What density should they aim for at front? My hair is pretty thick behind with really only the frontal recession (and high natural forehead which was the main reason for first HT).

2. Im 36 and on meds/minox. The last HT was about 4 years ago. Since that time the temples are receeded a little and im concerned about future loss esp with how aggressive hairline was. Should i redesign it like move it back and get some of the hairs removed you think? OR do the surgeons place grafts in the areas just behind first HT where there is still native hair but it is showing signs of thinning to sort of future proof? Does that make sense?

3. Does the thickness or calibre of the hair make the HT more difficult? Ive read a few posts which seem to suggest that. ANd i think my hair falls into that category. Also have thick skin as well (i think).

Anyway thanks for the help. Its been a long journey and ive really learnt a lot through it all. A dont care nearly as much about my apperance anymore which is liberating about really looking forward to just looking natural or normal if you know what i mean. Dont really care if that means receeding etc hence the initial thoughts to just remove the hair. 

 

Edited November 24, 2018 by keysersoze

[strategiccomboverartist]

I would look into Dr. Nader, you should aim for ~50 per cm for "full" density and go up as desired. Number of grafts depends on number of hairs per graft (1-4). I'm ~10 days post op on 5k+ grafts of my second procedure.  I recommend planning now for future hair loss.  Your young, what do you think you loss will look like at 40, 50 and 60...  Avoid the hype, go for the Dr. that runs a practice, not a business first.  When someone here says something positive or negative look into there perspective, do they stand to gain from advice/have bias or is it genuine help.  Best of luck.

[keysersoze]

@strategiccomboverartist Thank you. I have not heard of Nader or his work but will look into him!

[txtransplant]

I think it's cool how you have matured and realized hair isn't everything and one can look great without a 19 year old kid hairline. Some guys really loose there marbles here on this.  I think you are over complicating this personally. I see a few really good options for you.  The problem is not really the new hairline, but the stark contrast where the fake hairline meats your natural one. If you smoothe out that transition by adding hair to the new hairline it will be good.  So let's say your natural hairline that looks about an inch back is 60 FU's per cm2. The just add some grafts to the rearmost 1/4 inch to get it to 60cm2. Then the next 1/4" to 40. Next to 30 and leave the last and front edge of the hairline at 20cm2. It looks like 20cm2 is about the density you have there already. BUT I wold only do this towards the center and not fill the temples in so it would kind of create a bit of a widows peak or what we we call a "mature hairline".  Guys who loose their marbles over hair loose sight that a mature hairlines looks plain good on a guy after 30. In some people it looks better than a flawless youth hairline. Depends on the guy. But once you hit 30 a mature hairline is a good look on anyone and surgery is silly from an aesthetic standpoint as the world sees you. Basically, nice natural healthy hairline...bam. Nobody notices your hair. Just like if you nobody notices your eyebrows if they are normal. Bit really big or really think they will notice. But once you are in that "normal ideal" range, the human eye moves on. I think something like Chris Pratt's hairline would be a good fit for you now and attainable without much work.

  I am guessing you have about 20 sq cm of hairline that needs to be filled up. Since you already have some hair there, maybe you need an average 25-30 grafts per sq cm added to what is there if you have another procedure? I think if you just fill the front thickened up, then you will need maybe 1000 grafts depending on your hair characteristics. Don't forget, you want a nice 1/4" transition zone from your forehead to your hairline...so the front 1/4" that you have already needs nothing! Would look pretty natural if he hair is built up behind it.

  I am not sure how the temples will look. Probably a bit unnatural as they are now. You have a few options there. One being have another 6-700 grafts done and just rebuild your current transplanted zone. I wouldn't do this. Will look too young on you going forward, waste a bunch of grafts you might want and wasted money. And worst, if the temples move back,,,island of hair that looks goofy. For the temples I would either have them zapped off to bring them close to your current natural hairline there, but leave about 1/4" as a transition zone. Plus temples are usually thinner than other areas. If you have them zapped artistically so it transitions from forehead to hairline then it should look good. just have to find that balance point. Another option might be having a good doc use a manual .7mm punch and harvest them out of your temples and replant them. BUT you would have to be sure it won't leave a scar and seems too risky to save well under 1000 hairs. 

 

So re-enforce the front into a bit of a peak, but keep the current hairline in the center and bring the temples up and you should have a terrific result, not spend a lot and have enough hair to get it tuned up over the years should you need it. You can always have the hairline selectively lasered in the future if you have a lot more hair loss and it becomes impractical. But for now, I can't see how you can go wrong with what I suggested. Think Dr. Nader is about $2 a graft.  But even with a limited budget, some really great doctors in the US can probably do 1000 grafts for an affordable price. I think there is a really good one in Washington that get's around $6 per graft. That should be affordable to most working adults in the US that have an easy enough life to even be concerned with their hairline. lol. I had Dr. Nader work on me. It is too early to give you my result. But it think it would be a pretty good option. You are really in a great place. Just add some hairs to smoothe things out and make a few adjustments and you will be golden.

[txtransplant]

Oh, also I have a suggestion. Cut some hair off the back at some point and use it in the front in the mirror one day to play with different hairline options to get an exact idea of what would work well for your face. And of course you can shave the temples areas to get an idea what you like there when you are figuring out what looks best for you. I mean it''s your head...don't be a dope and trust other people with deciding that. Try before you buy!

[keysersoze]

1 hour ago, txtransplant said:

I think it's cool how you have matured and realized hair isn't everything and one can look great without a 19 year old kid hairline. Some guys really loose there marbles here on this.  I think you are over complicating this personally. I see a few really good options for you.  The problem is not really the new hairline, but the stark contrast where the fake hairline meats your natural one. If you smoothe out that transition by adding hair to the new hairline it will be good.  So let's say your natural hairline that looks about an inch back is 60 FU's per cm2. The just add some grafts to the rearmost 1/4 inch to get it to 60cm2. Then the next 1/4" to 40. Next to 30 and leave the last and front edge of the hairline at 20cm2. It looks like 20cm2 is about the density you have there already. BUT I wold only do this towards the center and not fill the temples in so it would kind of create a bit of a widows peak or what we we call a "mature hairline".  Guys who loose their marbles over hair loose sight that a mature hairlines looks plain good on a guy after 30. In some people it looks better than a flawless youth hairline. Depends on the guy. But once you hit 30 a mature hairline is a good look on anyone and surgery is silly from an aesthetic standpoint as the world sees you. Basically, nice natural healthy hairline...bam. Nobody notices your hair. Just like if you nobody notices your eyebrows if they are normal. Bit really big or really think they will notice. But once you are in that "normal ideal" range, the human eye moves on. I think something like Chris Pratt's hairline would be a good fit for you now and attainable without much work.

  I am guessing you have about 20 sq cm of hairline that needs to be filled up. Since you already have some hair there, maybe you need an average 25-30 grafts per sq cm added to what is there if you have another procedure? I think if you just fill the front thickened up, then you will need maybe 1000 grafts depending on your hair characteristics. Don't forget, you want a nice 1/4" transition zone from your forehead to your hairline...so the front 1/4" that you have already needs nothing! Would look pretty natural if he hair is built up behind it.

  I am not sure how the temples will look. Probably a bit unnatural as they are now. You have a few options there. One being have another 6-700 grafts done and just rebuild your current transplanted zone. I wouldn't do this. Will look too young on you going forward, waste a bunch of grafts you might want and wasted money. And worst, if the temples move back,,,island of hair that looks goofy. For the temples I would either have them zapped off to bring them close to your current natural hairline there, but leave about 1/4" as a transition zone. Plus temples are usually thinner than other areas. If you have them zapped artistically so it transitions from forehead to hairline then it should look good. just have to find that balance point. Another option might be having a good doc use a manual .7mm punch and harvest them out of your temples and replant them. BUT you would have to be sure it won't leave a scar and seems too risky to save well under 1000 hairs. 

 

So re-enforce the front into a bit of a peak, but keep the current hairline in the center and bring the temples up and you should have a terrific result, not spend a lot and have enough hair to get it tuned up over the years should you need it. You can always have the hairline selectively lasered in the future if you have a lot more hair loss and it becomes impractical. But for now, I can't see how you can go wrong with what I suggested. Think Dr. Nader is about $2 a graft.  But even with a limited budget, some really great doctors in the US can probably do 1000 grafts for an affordable price. I think there is a really good one in Washington that get's around $6 per graft. That should be affordable to most working adults in the US that have an easy enough life to even be concerned with their hairline. lol. I had Dr. Nader work on me. It is too early to give you my result. But it think it would be a pretty good option. You are really in a great place. Just add some hairs to smoothe things out and make a few adjustments and you will be golden.

Thank you for your comments and detailed suggestions.

Oh trust me i lost my marbles initially after the HT. In a big way. My biggest fear more than anything was looking like i had a HT and well....yeah it got realised. But then after a while I just wanted to look natural, didnt even care if I looked like or was balding etc. So after this experience its a little bit, i dont know freeing? Dont get me wrong, I wish this had never have happened but at least I care far less about my appearance now. Far less. 

I'm in Australia just have to factor in the travel etc but looking into a few surgeons and will add Nader to my list. Definitely affordable.

[Spanker]

That looks pretty bad. Sorry.  Do you wear your hair forward? 

The rest of your hair looks to be pretty good, I would not suggest redesigning the hairline. 

I think a well placed 1700 grafts should sort you out. I would get a reputable doc for sure. You dont want to go through this twice. 

 

Do you wear your hair forward? 

[Triple7]

I agree with Spanker. The first 1” of your hairline is very weak but you have great hair everywhere else. I would just add density to the weak hairline area. I personally think your best hairstyle option would be to brush your hair forward to hide the hairline area until you get that area fixed. If you go to a top not doctor, you will be an easy fix. Don’t bargain shop. If you have to take out a loan or get on a payment plan then that is what you do. 

[keysersoze]

6 hours ago, Phil36fromaus said:

i thought I was the only one. I'm also in Australia, also had problems with my hairline not being addressed properly by an overseas doctor, and have also lost my marbles on numerous occasions [see pic below]

What was the reason it happened if i can ask? The transplant did not work or the doctor did not place enough hairs there?

Your hairline seems to be less dense than mine which would really suck trying to conceal (guessing you tried toppik and dermatch?) but from what I can tell from your side pictures your donor area hair seems really strong so it should be an really easy fix. Post a pic of the back of your head if you can.

There are loads of posts here about best hairline doctor so it has come down to personal choice. I can suggest a few if you want, but as finances seems to be an issue Keser would be a great choice. My only concern with him is it hard to find his results (he only does 600 grafts a day average so doesn't turn out masses of patients).

If you have any questions etc feel free to PM me;, I've basically been obsessively researching this and would only be too happy to help or discuss things with you.

And to answer your questions from first post:

1. Most people want a high density hairline so anything around 55FU per cm2 would give a great result. If you can measure the area that you want to fix that would give a good indication of how many grafts you'd need. I think the area you need to address is about 32cm2 (16cm length x 2cm width).

So my estimate would be 32cm2 x 55 FU per cm2 = 1760 grafts 

2. That's a question your hairline doc can answer and help design with you (depends on your donor area, if your balding is stabilised, and what your preferences are etc). This site has loads of examples of what is possible but if you want to go conservative to compensate future balding that's an option. Then again if the rest of your hair pictured is native hair (,and not transplanted), it looks phenomenal. Im jealous really. So it's really up to you. 

3. Curly and wavy hair make extraction by FUE harder for unskilled doctors (I had an inexperienced HT doctor use a motorised drill and basically messed up my donor area), so if you choose FUE make sure they are skilled and use a manual (not motorised!) means of extraction. FUT doesn't make a difference from what I understand.

EDIT: went through your prior posts, so the hairline area was too densely packed? Is that what happened? I would want to get the recipient area (hairline) assessed first to see what type of scarring has occurred and why the first HT did not work in the first place before I'd get another transplant. 

Hey mate I'll PM you. Good to see another Australia here and can relate. 

No, it wasnt densely packed. No scarring or anything. It was just never dense enough right from the start. Not enough grafts I think and just not densely packed. 

[keysersoze]

4 hours ago, Spanker said:

That looks pretty bad. Sorry.  Do you wear your hair forward? 

The rest of your hair looks to be pretty good, I would not suggest redesigning the hairline. 

I think a well placed 1700 grafts should sort you out. I would get a reputable doc for sure. You dont want to go through this twice. 

 

Do you wear your hair forward? 

No need for apologies, if we cant be honest with each other here what chance do we have. Also it helps i have long ago accepted it. 

I used to wear my hair foward, really long and just combed over front like bangs to hide it. Which was devasting to worry about your hair finally do something just to have to worry about it even worse and hide what you did. The shame of caring I guess. But out the other side and I dont care so much now, so thats a plus. Know it looks ridiculous bad weirdly few people say anything lol. Too polite i guess. 

Its hard to hide it because of how low it is and how thin it is and the temple recession. So its a weird combover thing that looks horrible. Makes my hair look even worse if possible. Probably not. But generally yes I try to. Ive been shaving my head last few months though because I was going to go get it lasered off, or get a 2nd HT and i wouldnt be able to hide that. The first time i was read for months. 

I definitely dont want to go through this twice, that is for sure mate

[keysersoze]

5 minutes ago, Phil36fromaus said:

 

How many grafts did the original surgeon place in your hairline? Do you know?

It's a strange set up. As I'm in a similar situation I've literally had to try and explain to it doctors how it happened and as to why a surgeon would even let it happen. So we are talking about elite HT doctors with 20+ years experience and thousand of operations underneath their belts all looking at me utterly confused. I used to think I was unique so Im a little upset you even exist tbh, but here's a high five anyway for making me feel less lonely in the HT world.

Sent you a PM. Feel free to contact me whenever. I'm basically spending all my free time researching this stuff

Done.

Yeah i dont know either mate. My surgeon also seems to have fair amount of decent results so im at a loss. Think bad results must have to happen to some people. 

It could also be thick wavy hair. My hair gets pretty wavy when a bit long and it is quite thick. ALso i think i have thick skin. Like i remember even a crunching sound when they were doing it and a comment about how thick it was so maybe that. 

Your photo certainly looks like mine, only Im in a worse spot so just think mate, always good be worse!!

Oh and sorry it was about 1500 grafts they said. I wanted more but he said no that was enough.

 

Edited November 26, 2018 by keysersoze

[keysersoze]

10 minutes ago, Phil36fromaus said:

1500 grafts hmm. That should be enough. I'd book a (free) consult with an Aussie Dr or even a dermatologist and get inspected before committing to surgery elsewhere. Just don't commit to any aussie HT surgeons please ... most are truly terrible. I saw one in Sydney whose after pics on his website look like most doctors before pics.  

No hair thickness wouldnt be an issue. Was it FUE or a FUT strip surgery? Do you remember them placing all the hairs in your hairline or did they just do a few and not bother? 

Id rather be in your place tbh. My donor area was messed up by an inexperienced Dr so i only have one surgery left to get things right. Otherwise I'm stuck like this permanently (I used to work in the film industry ... lets just say I've had to have a career change)

Oh damn man Im sorry to hear. I definitely wouldnt see an Aussie surgeon. Ever. Good idea to see a derm though. TBH im not that sure. I just knew when it was all over and bandages came off it didnt look like the photos id seen here and look really sparse and bad. Obviously you have to wait 18 months etc but you could tell it wasnt a good result and its ended up like it seemed it would. 

My big concern is what youve said. Why it was bad. The doc is recommended and i have seen a decent amount of good results so was it my hair? Skin? I dont know.  Its also not like they tried to scam me because i intially asked for more grafts because i was so concerned about density (oh fate you cruel little minx) and he said no, so think it was on the up and up. They said it was fine and none of that was a problem but said the result was ok too so who knows. 

Also FUE didnt want scar just in case

Edited November 26, 2018 by keysersoze