FUE crown advice needed - 2 yrs after 2000 grafts in Australia

[jay87]

Hi everyone,

Have been around the forum for some time now, and have seen the pre-screened physician area, but am hoping for some advice and referrals of surgeons who have been getting good results for FUE crown procedures.  

I’ve already had a 2000 grafts FUE crown hair transplant in Australia but am unhappy with the results due to low density. The doctor didn’t even focus on my crown and blended way too far into my existing hairline! 2 years later and my crown is still thin. 

After speaking to all the main hair transplant surgeons in Australia, I have concluded they are all low quality and shady. Therefore, I’m prepared to go overseas for my next procedure. North America is convenient, and I’m impressed with gallery pictures from Dr. Parsa Mohebi as well as Hasson and Wong.  

I’m thinking 500-600 FUE grafts (up to 1200 hairs) at 30 grafts per cm2 with an effective crown design should give me a significantly better cosmetic outcome than what I have now? Currently my crown looks ok when viewed from front and sides but looking from top and back it still looks quite thin/bald and that’s what I’d like to fix.

Being in my early 30s and not on any medication (except PRP) I’m hesitant to use too much donor area since I haven’t touched my front hairline yet. Even though my hair loss seems stable and I have good density/coverage at the front, who knows what further procedures might be needed in the future. 

I’ve attached photos of:
The day before my first transplant
The day after the first transplant (showing in yellow where in my opinion grafts are still needed at a minimum)
3 x pics of my crown now 2 years post-surgery

Appreciate any comments and feedback. Thank you.
 

Edited April 10, 2019 by jay87

[LaserCap]

Thanks for posting the photos. This helps.  500-600 grafts? That's a spit in a bucket and it will do absolutely NOTHING for you.  Looking at the last photo you submitted, it seems as if your pattern is expanding from back to front.  Medical therapy, (all options), should be your first goal.  Unless you retain what you have. you may not have enough donor to address the loss that's coming.  No one with an advanced pattern has enough donor hair to achieve a full-looking set of hair. Good thing your hair not not stark black otherwise the contrast would make it even worse.

On the second photo, when you did the transplants, you drew lines.  Of those, concentrate on the one that is long, in the back of the head.  I am guessing you think this is the crown area?  Forget all that.  When you look in the front just look horizontally  as far back as you can see, (without tilting your head forward).  That's the front and top.  Typically the crown will be the intersecting point between these two lines in the back.  

The problem of filling that line is the fact that if you continue dipping the pattern in the back, now you look as if you have a happy face in the back of the head.  One way to do this, and to help you minimize the crown without looking like a target, (think of filling a circle.  You fill the circle with hair.  But, because you've lost, you will continue losing and you lose all the hair around the circle of grafts - now you look like you have a target area), is to work the area behind the front, (mid back). and go back as far as you can horizontally so as to minimize the size of the crown.  The trick here is to finish with an inverted U.  This way, if your pattern keeps expanding, you will still round and natural in the back. As you let the hair grow it will help you cover.

 

 

[Curious]

At your age you should leave the crown alone and save precious donor hair for the front if it's needed.  Based on your photos, it looks like your surgeon made the right call in placing the grafts.

[Kiwi Guy]

I think what Laser stated is very accurate, remember the crown always needs more grafts to cover the area adequately, have you found that the PRP has worked in any way?

[jay87]

Thanks for the replies. The last picture was just to show the worst it can look nowdays. 

I've attached a couple of pics from today: hair grown out slightly and being a fairly good hair day.

I still can't help but think 500ish grafts, placed on a diagonal, filling in the yellow drawn areas will finish things off and at least take the focus off the scalp? 2500 total grafts for top of head and crown seems like a fair amount to take from donor area I would have thought?

Plus, since that entire area of my head would then be covered in grafts there should be no future target look, because the only potential further loss at back could be dipping on the very back of my head (just above donor area) like LaserCap pointed out ...? Hmmm this is why filling the yellow areas might be best kept at 20 grafts per cm2 to blend at the same density of the first transplant? I guess this would provide coverage but still look a little thin if light is blasted on it.... At least it wouldn't look so bald. 

As for PRP, I definitely think it works for me. Not so much for growing new hair follicles, but thickening existing hair.  I started off getting injections, but there is a practice nearby that uses a roller needle and is much cheaper. Getting 1-2 a year to keep hair as thick as naturally possible seems to be a plausible alternative instead of using medication. 

Edited April 11, 2019 by jay87

[Raphael84]

@jay87

How are you?

Judging by your photos I would agree that 500-700 grafts would not be a sufficient graft count to fill your crown area. You mention lower density, which would of course bring the graft count down somewhat, but the safest approach for crown work is to start from the outer part, and working in to ensure a more natural result in the event of further loss.

Another poster makes reference of your age which I can not see. I apologise if it is mentioned. How old are you?

Out of interest where/why are you referencing 500-600 grafts to be appropriate?

Anything I can do to help!

[jay87]

On 4/12/2019 at 1:58 AM, Raphael84 said:

@jay87

How are you?

Judging by your photos I would agree that 500-700 grafts would not be a sufficient graft count to fill your crown area. You mention lower density, which would of course bring the graft count down somewhat, but the safest approach for crown work is to start from the outer part, and working in to ensure a more natural result in the event of further loss.

Another poster makes reference of your age which I can not see. I apologise if it is mentioned. How old are you?

Out of interest where/why are you referencing 500-600 grafts to be appropriate?

Anything I can do to help!

Hi @Raphael84, thanks for your reply.

I'm 31 and some surgeons tell me I should only use 350 grafts to fill that area (which seems way too low). I've also had others tell me 1500 more grafts.

If I measure the bald area, the yellow drawn banana shape (in picture 2) is approx. 8cm x 3cm = 24cm2 | 24cm2 x 20 grafts = 480 grafts. Then adding more density to the right side 'triangle' shaped yellow area above the banana shape is 3cm base & 5cm height = 7.5cm2 | 7.5cm2 x 10 grafts = 75 grafts. Next to that is a small rectangle area, which may or may not need an extra 10cm2 grafts added for density but let's not include that for now. 

480 + 75 = 555 grafts in total for hair transplant #2 to bring my total crown and vertex area to 20 grafts cm2 with full area coverage.

20 grafts per cm2 is technically classified as 'low density', but as long as my hair is no shorter than a 3 blade the hairs should group together when I brush (since there would be full coverage) to cover the area to a fair cosmetic extent. 

I understand that 40 grafts per cm2 would give me the same visual density coverage as the front, but keeping in mind my age and the fact that I've already used 2000 grafts, I think the 20cm2 density (with artistic angling and placement by the surgeon) will at least get rid of the major bald patch people see when I'm sitting down and they look at the back of my head. 

I have come across these photos from Dr. Wong's patient results page on this forum. 846 FUE grafts he used to get an exceptionally good cosmetic result in my opinion. And considering I don't need to fill to the same length as this patient (who goes further up towards the top of his head) as well as the fact I already have grafts in that area from hair transplant #1, it seems fair to me that 555 grafts should work?

Edited April 15, 2019 by jay87

[JohnMelb1234]

On 4/10/2019 at 8:43 PM, jay87 said:

Hi everyone,

Have been around the forum for some time now, and have seen the pre-screened physician area, but am hoping for some advice and referrals of surgeons who have been getting good results for FUE crown procedures.  

I’ve already had a 2000 grafts FUE crown hair transplant in Australia but am unhappy with the results due to low density. The doctor didn’t even focus on my crown and blended way too far into my existing hairline! 2 years later and my crown is still thin. 

After speaking to all the main hair transplant surgeons in Australia, I have concluded they are all low quality and shady. Therefore, I’m prepared to go overseas for my next procedure. North America is convenient, and I’m impressed with gallery pictures from Dr. Parsa Mohebi as well as Hasson and Wong.  

I’m thinking 500-600 FUE grafts (up to 1200 hairs) at 30 grafts per cm2 with an effective crown design should give me a significantly better cosmetic outcome than what I have now? Currently my crown looks ok when viewed from front and sides but looking from top and back it still looks quite thin/bald and that’s what I’d like to fix.

Being in my early 30s and not on any medication (except PRP) I’m hesitant to use too much donor area since I haven’t touched my front hairline yet. Even though my hair loss seems stable and I have good density/coverage at the front, who knows what further procedures might be needed in the future. 

I’ve attached photos of:
The day before my first transplant
The day after the first transplant (showing in yellow where in my opinion grafts are still needed at a minimum)
3 x pics of my crown now 2 years post-surgery

Appreciate any comments and feedback. Thank you.
 

Hi, I've just read your post and wondering which doctor you went to to get this done? Thanks

[Gatsby]

I would never consider having a hair transplant here. For the same money you could go anywhere and have surgery with someone who has the skills and ethics. It was only two years ago that Dr Rhett Bosniach who was a prominent hair transplant surgeon in Melbourne was found dead one morning from a recreational drug overdose with his wife. Can you imagine being operated on by someone high as a kite or coming down!!! Obviously this can happen anywhere but the consultation I had with him and so many others over the past 35 years have been very poor. The hair transplant surgeons here just do not have the skill set and in many other cases the ethics to warrant you handing over your hard earned money. The risk of your results are not up for debate. For the hassle of a return plane flight (apart from Turkey) will be forgotten in the years ahead when you look in the mirror everyday.

[JohnMelb1234]

On 4/10/2019 at 8:43 PM, jay87 said:

Hi everyone,

Have been around the forum for some time now, and have seen the pre-screened physician area, but am hoping for some advice and referrals of surgeons who have been getting good results for FUE crown procedures.  

I’ve already had a 2000 grafts FUE crown hair transplant in Australia but am unhappy with the results due to low density. The doctor didn’t even focus on my crown and blended way too far into my existing hairline! 2 years later and my crown is still thin. 

After speaking to all the main hair transplant surgeons in Australia, I have concluded they are all low quality and shady. Therefore, I’m prepared to go overseas for my next procedure. North America is convenient, and I’m impressed with gallery pictures from Dr. Parsa Mohebi as well as Hasson and Wong.  

I’m thinking 500-600 FUE grafts (up to 1200 hairs) at 30 grafts per cm2 with an effective crown design should give me a significantly better cosmetic outcome than what I have now? Currently my crown looks ok when viewed from front and sides but looking from top and back it still looks quite thin/bald and that’s what I’d like to fix.

Being in my early 30s and not on any medication (except PRP) I’m hesitant to use too much donor area since I haven’t touched my front hairline yet. Even though my hair loss seems stable and I have good density/coverage at the front, who knows what further procedures might be needed in the future. 

I’ve attached photos of:
The day before my first transplant
The day after the first transplant (showing in yellow where in my opinion grafts are still needed at a minimum)
3 x pics of my crown now 2 years post-surgery

Appreciate any comments and feedback. Thank you.
 

Hi, which doctor in Australia did you go to? I'm thinking of getting it done in Australia but not sure where. Thanks