2,500 grafts on a NOT so ordinary case

[Dr. Alan Feller]

This patient had EXCELLENT hair transplant work performed prior to visiting me. The only problem that gave him concern was the immense recession of his temple hair which left his top hair "floating". Now, this is ok to a certain extent, but the gap between his donor area and top hair transplants had gotten to a very obvious extent.

FORTUNATELY, he had a good enough donor area for a 2500 graft procedure. So we decided to connect the left side of his old HT to the left temple AND fill in the front part of the crown.

Here are his results at 1 year

 

[Dr. Alan Feller]

I need to make a clarification. I believe the actual number of grafts implanted is about 2500-2600, so one of the photo series in the gallery is incorrect where it says 3,000 grafts. I don't think we got that high due to his three prior surgeries.

 

Dr. F

[TC17]

Dr. Feller,

 

Do you know how many grafts this patient had transplanted prior to seeing you? Also, does he have any more grafts available from strip or FUE if he wants?

[aaron1234]

Dr. Feller,

Very interesting. I think most young men like myself who get HT's are worried about this kind of recession in the future. If this guy was on propecia do you think his temples would have receded this low? I'm really hoping that Fin will keep me from this kind of balding. Excellent job on a difficult case.

[TC17]

And one more thing, thank you for posting this result. I keep thinking to myself that many young patients who are experiencing balding will eventually end up with this man's pattern, and will not have enough grafts to keep up. What I don't understand though, is why this guys pattern isn't the template for every young, balding man who presents for a surgery. (of course, not all young bald men will become old men with this extreme baldness, but it seems likely) If this is the best that a NW 7 can get, why are the 25 year old NW 5's getting full scalp coverage? I am in no way knocking your work Dr. Feller, as I believe it is outstanding, I am just wondering what magic allows the scalp of a young patient to be filled in, but not the older patient? I guess what I'm getting at is that the younger patients always seem to have more grafts available than the older patients. If the number of grafts is both finite and fixed, the older patient should have as many grafts available at age 75 as he did at 25, and yet it doesn't appear that way. In your experiences, is that a fair and accurate statement, or am I off base?

[aaron1234]

Well put TC17. I see so many 70 year olds with virtually no donor hair and I must admit that that scares the hell out of me.

[hdude46]

tc, not every young guy balding is going to end up THIS bald, especially if they have no family history of guys advancing this far. i see your point about being concerned, but come on, this guy is very very very very bald, more bald than most. don't really see how u can say that this should be the template for all 20 something year olds, you say is likely but based on what? Most, not all, but most guys who end up this bald have been this way for a loooong time and were probably nw5-6 by the time they were 21, or somewhere close.

 

its obvious as one ages he looses a bit of density in the donor but how much no one knows. thats risk EVERYONE takes if they get a ht. look at jack nicholson, he had a lot of recession when he was young but his sides have held up great and he's definitely getting up there in age. my grandpa is the same way, donor hair has held up great. My dad is in his 60's and has a full head of hair with some diffuse thinning while his brother is almost the same age, probably a nw4 but great donor.

 

This guy could have had thin hair to begin with that just accentuated worse with age. no one knows. like i said its a risk. at some point you have to decide if that risk is worth it. if i had a bunch of family members w/ nw6-7 patterns i would be really hesitant, but i think with meds and decent family history and the hopes that in 30 something years propecia and rogaine arent the only things available to fight hairloss, that is all u have to go by and a chance a lot are willing to take.

[the B spot]

Excellent show Dr. Feller.

 

Guys, most men that bald do not end up, this bald....I think 11% of balding men end up a NW7. So in that vein it is ok to transplant guys...but this is why future planning is a must.

 

I was talking with Matt Zupan last night about this, and he said generally you like to take 2/3rds of the donor and leave a 3rd for future recession. Obviously we do not hold true on this for every patient for a variety of reasons, but it is a good rule of thumb we like to work from first.

 

My opinion on this gentleman is he can get a custom designed, low density crown piece to accompany his transplant work that will help with his over-all look....should he desire to do this. The work is standalone, but it is obvious he was bothered by it.

 

Great example Dr. F and thanks for having the guts to show this. GREAT PERSPECTIVE.

 

Jason

[hdude46]

I think if you are this bald you should just shave it. you arent fooling anyone with a comb over and imo it just looks bad. I just think that there needs to be a line drawn as to who is and isnt a ht candidate and its clear this guy should never have been one. If he was that concerned about being this bald, he should have gotten a hair piece.

 

another thing that isnt talked about enough is also your rate of balding and what meds can do for you. matt at smg told me that propecia makes the hair that you would otherwise lose in 5-10 yrs lose it instead in a 30-35 yr time frame. i also heard from another doc that he has never seen anyone go "bald" while on proecia.

 

you cant just pluck random people out of the population and say this is the template for everyone. its a case by case basis, which includes family history, meds, hair characteristics, ect...

[The Bench]

Good save dr. Feller!

 

(what you read below may sound negative, but it is the reality)

ive done my research! and im not a angry guy, on the contrary quite positive!

this is what much of the transplanted fear of being bald, sure hair characteristics play a big part in the transplant but once and if the temples do drop you end up with something a bit less manageable. i think that everyone should go into a transplant with the mind-state that his results will end up like the gentleman here, and if your ok with that then follow through, you can do all the family balding research you want and take all the pills and potions, but still the harsh reality is you are balding and who knows how far it will go. but if your gonna be this bald and proud (in my opinion of course) your best bet is to shave it ugly or handsome, on occasion ill see a guy shaved up with a long but clean horse shoe scar on the back of his head, kudos to him for outing his bad decision... dr. feller keep working on the single hair techniques i think you always show the truth in your photos and are very talented as well, but you YOUNG guys out there considering, consider, but consider shaving it! give it a try for a year, its nice not analyzing your hair loss pattern and trying to cover it up- or buy a nice hat- perhaps dress a bit more sharp, get buff loose the gut, its something to embrace! your missing all they joys in life by worrying about something so small in the big picture of living... have we all forgotten that vanity is a terrible thing to chase. your life is writing your book, do you think someone really wants to read a chapter about how hairloss has effected your life so you got a transplant- doubt it- remember your not alone in this, millions of others are going through what you are and if your a BIG enough man you will be able shrug this off in no time and be out of your house living, you know- river rafting, working on a 1972 chevy pickup in the driveway, hiking a mountain, learning guitar, (insert your hobby here) -i guess what im saying is BEING A MAN, trust me there is nothing masculine about a hair transplant...nothing!!! a uber man would just say fuck it and keep on living ,doing, and creating!

and for those of you in your 20's and early 30's who have had a transplant or 2, i wish you the best of luck in the coming years, and i hope it brings you true happiness, honestly!

[TC17]

hdude46,

 

I realize that not every patient will wind up as bald as this man, and in fact I said that in my post. The point though, is that neither you nor your doctor know if you will become that guy who is the NW 7. Sure, family history can be used as a guide and meds may delay or even stop the inevitable, but none of those are fool proof. We don't have a picture of this man at 20, 25, 30 to see how bald he was to make a comparison. Dr. Beehner posted a photo of a 55 year old NW 7 that he worked on when the patient was 28, and I was shocked at how much hair the man had at 28. Yes, he was receded and we could not see his crown, but he had way more hair than I would have anticipated. My dad is BY FAR the baldest man in his family. If he were 25 or 30 years old and went to a doctor with his family history, I am sure that the doctor would have told him that the likelihood of his progressing past a NW 4 or 5 would have been minimal, and yet here he is at age 57 with a NW 6 to 6.5 pattern. I found a photo of him when he was 44 and he was only a NW 5. My mom's brother (no relation to my dad) was a NW 2 at age 30, and at age 55 is now a NW 6. Isolated instances like that prove nothing, I realize that. I'm not trying to prove anything, merely giving personal examples to illustrate why I'm concerned, and why I ask so many questions. The fact of the matter is that like aaron1234, I see an alarming number of old men with very thin donors and advanced balding patterns, and I wonder what they would have looked like if they had undergone a procedure using today's methods 40 years ago.

 

Use the feature on this site to search by NW type and look at the 6's and 7's, VERY few 6's have anything approaching full restoration and low hairlines, and NO 7's have it. If you are OK with risking that you won't be the baldest member of your family, rock on brother, but just know that it MIGHT be you.

 

If we assume that Jason's statistic that only 11% of men end up a NW 7 as fact, ask yourself what percentage of your friends, acquaintances, coworkers, etc. your age are balding worse than you? If you're on this site seriously contemplating a hair transplant, I'd venture a guess and say that for most people, you are that 11%. I know that if I stand in a room with 100 guys 26 years old, I'm probably in the bottom 15% for hair loss, and that scares the hell out of me.

[TC17]

One more thing, I'm not knocking Matt from SMG or the doctor you spoke with, but absent a DeLorean, I don't see how anyone can affirmatively state that propecia will stop hair loss or delay it by 30 to 35 years. It hasn't been on the market nearly long enough to justify those type of statements outside of maybe on a theoretical basis. And hdude46, I appreciate your statements as I feel that it is good for all members to be exposed to both sides of an issue.

[hdude46]

what you fail to understand is that age is only one component of the equation. as much as you should be concerned about balding at a young age, family history and genetics is just as if not more important. you assume that just b/c you start to bald in your twenties that you are automatically in that 11 percent, which I dont honestly know how you can say. and yeah, you did in fact state that most twenty somethings will reach that pattern

 

"I keep thinking to myself that many young patients who are experiencing balding will eventually end up with this man's pattern, and will not have enough grafts to keep up. What I don't understand though, is why this guys pattern isn't the template for every young, balding man who presents for a surgery. (of course, not all young bald men will become old men with this extreme baldness, but it seems likely)"

 

The fact is, if you have a history of family members with severe balding, whether it starts at 35 or 25 or 45, you will most likely reach that pattern at some point, whereas if you dont you are more likely to level out at some point. Rate of balding also matters. someone may start to bald in their 20's at a slow but steady pace whereas someone might not loose thier hair til they are almost 40 but have it fall out at a rapid clip.

 

you seem to think that everyone will reach this level of balding at some point when that is simply not the case. you bring up examples of other patients who are now bald who might have had a decent head of hair in their 20's but fail to mention they probably had a family history full of baldies and did not take any meds whatsoever.

 

Sure propecia has only been around x number of years but from talking to the ht docs most of their patients do very well on it with no side effects and they really believe in it.

 

I get what you are saying about how know one knows for sure how far you will advance and how it is a risk and that family history cant tell us everything and that meds only do so much but tell us something we don't know....I'm not really trying to engage in a debate or argument so this is all i have to say on this but I suggest if you are so concerned to not go thru with having ht and wait til hair multipication comes out or something. its no guarantee but im willing to bet techniques, medicines, and treatment of baldness improve by the time im 50, which will be in over 20 years.

[Ron J]

Originally posted by the B spot:

 

Guys, most men that bald do not end up, this bald....I think 11% of balding men end up a NW7.

ht's involve risks, we all know that; but so do most of our daily activities - i.e. driving on the freeway, plane flights, etc. - the point is, you weigh the risks & a cost/benefit analysis and make your decision. Given these odds, 11% of men who are balding reach a NW7, I like my chances and the benefit far outweighs the (potential) costs of something that will more than likely never happen.

 

If your not willing to take that risk, then you simply probably shouldn't get a ht; because if you want to use a NW7 template for all men, than just as Hdude46 said you should probably just shave your head, because the 'density/coverage' or lack thereof, will be completely undesirable to most. Simply look at any NW7 guys who have had a ht and ask yourself if you'd be happy w/that "look". If everyone used a NW7 as a template, than I bet 80%+ of the hts on this forum couldn't be achieved w/respect to the total #'s of grafts used and the location in which they were distributed. You'd end up w/such a thin, gimp, hairline that you couldn't style it and would probably rather shave.

My two cents anyways.

[the B spot]

Well, the odds are in our favor, but you try to PLAN like a person might be a NW6-7...the younger the patient, the more you plan. As a person hits 30's, 40's, 50's you can obviously get progressively aggressive with regards to density and use of the donor.

 

My father and my grandfather have the exact same balding pattern that I have...my GF is 78 my dad is 51....my GF's donor is a solid 6, non-see through, my dad is a solid 6, non-see through. Both were this bald from 30.

 

Again, the patient Dr. Feller posted was likely a marginal candidate from the beginning and had very realistic goals....lets remember not to place our 25-35 year old perspective on a guy who just wants some hair to comb and frames his face.

 

We could debate the initial approach and which method of surgery should have been employed, but on another thread of course.

 

Jason

[aaron1234]

Good points made all the way around. I'd have to say that even though this guy is so bald, HT's work for him. His look is certainly passable for a 50/60 year old man. So even if we all end up that bald, it could still be remedied with the correct approach.... much like the one Dr. Feller presented here.

[TC17]

If I were 50 or 60 years old, I would prefer this look to the shaved head. I know some of you said that you would shave down, and I respect that, but I personally feel that men of his age look bad with the shaved head. On the same token, I believe that men under the age of 40ish look better with the shaved head than with this hair. Just my opinion, but I would be content with what this guy has if I were his age and that bald.

 

My concern (which maybe I wasn't clear in outlining) was that even if statistically speaking few of us will ever reach this particular man's baldness pattern, what happens to those unfortunate individuals who have undergone a procedure and do reach that level? If you're the one being attacked by the shark, I doubt a person yelling from the boat that statistically speaking that is an unlikely occurrence would be of any consolation.

 

The balance between what looks nice now on a young man versus what will look nice on an older man who balds extensively is delicate, and I just would like some doctors to offer their philosophies on such matters. How does one plan for for such an uncertain future? Are the doctor's relying on meds staying effective? If I presented to Dr. X with my current NW 3v balding pattern but a family history that included men with this guy's pattern, how would I be worked on? Would any doctor go more aggressive on me than this guys pattern? If the doctor would go more aggressive, how can that be reconciled with the knowledge that I may end up at this guys level? (for the record, I don't think anyone in my family is this bald, I was merely speaking hypothetically. I would really appreciate some insight though.)

[Dr. Alan Feller]

Thank you all for the comments and replys.

 

What makes this case "not so ordinary" is the extent to which he lost his temple and even superior donor area. This is VERY uncommon.

 

I don't remember how many grafts he said he had in his prior surgeries, my guess is b/w 2500 and 3000 over 3 or procedures. I suspect he already had alot of temple recession by the time he had those procedures.

 

We recently perfomed a second surgery on him to reconnect the right side and do some touch up in other areas. We'll post them when he follows up next spring.

[JimJohnson]

Dr. Feller, I'd love you to check out this topic.

http://hair-restoration-info.c...66060861/m/447108824

[Lastchance]

Originally posted by JimJohnson:

Dr. Feller, I'd love you to check out this topic.

http://hair-restoration-info.c...66060861/m/447108824

 

which part? your appeal for all those on the thread to stay on topic?

[thanatopsis_awry]

LOL! Well played, LastC.

 

This is a very interesting thread, and case -- pleasure to view and read.

[JimJohnson]

Originally posted by Lastchance:

Originally posted by JimJohnson:

Dr. Feller, I'd love you to check out this topic.

http://hair-restoration-info.c...66060861/m/447108824

 

which part? your appeal for all those on the thread to stay on topic?

 

Sorry, you're right about that. I just didn't know how to draw his attention on another way. Is this what the "Invite UserXY to a Private Topic" function is for?

[Bill - Seemiller]

JimJohnson,

 

If you genuinely want a response from Dr. Feller on another topic, try sending him a private message rather than posting a link to it on an unrelated thread.

 

Bill