Confused!

[Danny1671]

Hi all, 

I’m new to the site so apologies if I’m posting in the wrong place.  I’m nearly 37 and I’ve been losing hair slowly since 2008 so about 11 years.  I won’t bore you with too many details about lack of confidence etc, we all know hairloss is crap!  I think I’m currently a norwood 4-5 but not totally sure.  I feel I’m very close to pulling the trigger and getting an fue procedure. I’ve narrowed my search down to 2 surgeons who are Dr Edward Ball and Dr Christian Bisanga as I have been really impressed with their results.  

My question is, from my pictures, what are your opinions regarding realistic expectations in terms of hairline, density and numbers of grafts required for good coverage. 

Should I get all balding areas covered?

I have had an online consultation with a representative of Dr Bisanga who has been extremely helpful and have a consultation booked in with Dr Ball next month.  18 months ago I had a consultation with Dr Shamalak of the Crown Clinic and he recommended 1200 grafts into the hairline, and said he wouldn’t touch the crown.  Dr Bisanga has recommended 4000 grafts....

Im confused!

Any opinions welcome, and thanks in advance!

[Fozzie]

Are you on hairloss medication? Your crown isn't totally bald but looks  like it will get there at some point without medication (finasteride). When Dr Bisanga quoted you 4000 grafts, did he mention how many in the front and how many in the back? Guessing, I'd say something like 3000 in the frontal area and 1000 in the crown. Just be aware that if you are not on medication, the crown (as well the the front/mid area's)will continue to lose any remaining hair and you may be back to square one if you have hair transplanted there now.

Personally I think 3000-3500 in the frontal/midscalp area with a conservative, mature age appropriate hairline will give you a good result. In the 2nd picture looks like your temple areas have recessed quite a bit and the midscalp is also thinning.

I might be tempted to hold fire on the crown unless you are taking finasteride as I wouldn't be surprised to see that develop into a slick bald spot further down the line. If not on medication, maybe look to address the crown when the hairloss there has stabilised.

With regards to the various surgeons mentioned, I hold Dr Bisanga and Dr Ball in higher regard than the Crown Clinic. In the UK, I'd only really consider Dr Reddy and Dr Ball personally.

[MarshallUK]

Hi Danny,

I personally dont think 1200 grafts will touch the sides if you want a full hairline. I went with dr b from his recent results and was a bit taken back by the 3000+ he quoted me but so glad I listened as I think I would be quite sparse otherwise.  I have also seen good results from dr ball so both good choices. I would agree with the chaps above 3-3500 if the front to mid to reinforce the front and then possibly a 2nd OP for the crown in the future. 

Regards 

[hairlossPA]

1200 wont do anything in terms of changing your appearance. 3-3.5k sounds right to solidify the frontal third and hairline. Dr B is great and I’ve been jealous of a ton of his results. Haven’t heard of the other doctor.

[gillenator]

I would recommend starting with 3,000 to 3,500 grafts in the frontal third and nothing more.

I think you would get a nice result with that...just let everything grow out and re-evaluate after 12 months have passed.

[Danny1671]

Thankyou for the replies all. I forgot to mention that I use Rogaine foam once or twice daily, and every week I use Nizoral shampoo.  I’m scared to use Finasteride due to the potential side effects although sometimes I just think sod it I’ll give it a try!  Dr Bisanga’s rep advised I try a topical finasteride as there are some cases where results have been positive. 

Dr Bisangas rep suggested 3000 grafts into the hairline and frontal 3rd and 1000 into the crown area. I guess I like the idea of hitting all the areas that are thinning, but my concern is whether or not my donor area has enough supply to keep up with my hairloss should I decide to not take finasteride or don’t take well to it. I guess without an in person consultation with the doctor I’m not going to know the official donor density.  I am fully expecting to undergo more surgery as time goes on but would rather not be left with a ‘bullseye’ in the crown.  Man I wish I was more decisive!!

[hairlossPA]

are you dead set on FUE? FUT would give you a lot of graphs for 1 sitting, and you could knock a lot more of it out (more than you could do with 1 FUE sitting)

[DrTBarghouthi]

Your frontal zone is probably around 70 cm2. Considering you have some hair in the mid-frontal zone, then an average density of 40-50 grafts per cm2 will be great imo. Maintain what you have aggressively, ignore the crown for now and aim for around 3000-3500 grafts for now. This is only my opinion. 1200 is a bit far off what you need. 

[Danny1671]

16 minutes ago, DrTBarghouthi said:

Your frontal zone is probably around 70 cm2. Considering you have some hair in the mid-frontal zone, then an average density of 40-50 grafts per cm2 will be great imo. Maintain what you have aggressively, ignore the crown for now and aim for around 3000-3500 grafts for now. This is only my opinion. 1200 is a bit far off what you need. 

Thanks Dr T,

Can I ask what you mean when you say  maintain what I have aggressively? Are you referring to medication or transplanting into the area of scalp that currently has more hair on it?

I’m certainly getting a general vibe that it’s maybe a little early to start filling the crown. I’d like to be able to shave my head if it eventually does not work out by running out of donor hairs etc and for it to look natural. I actually don’t mind the look of a strong hairline and frontal third with a thinning crown.  That’s a common balding pattern that I’m sure I’d be fine with especially as I get older.

[Danny1671]

43 minutes ago, hairlossPA said:

are you dead set on FUE? FUT would give you a lot of graphs for 1 sitting, and you could knock a lot more of it out (more than you could do with 1 FUE sitting)

Hi there,

Im dead set on fue as I like to wear my hair very short sometimes especially as my wife likes that look. An fut scar is something I’d like to avoid if possible.  I can see what you mean about yield etc.

 

thanks for your help 👍🏼

[DrTBarghouthi]

6 hours ago, Danny1671 said:

Thanks Dr T,

Can I ask what you mean when you say  maintain what I have aggressively? Are you referring to medication or transplanting into the area of scalp that currently has more hair on it?

I’m certainly getting a general vibe that it’s maybe a little early to start filling the crown. I’d like to be able to shave my head if it eventually does not work out by running out of donor hairs etc and for it to look natural. I actually don’t mind the look of a strong hairline and frontal third with a thinning crown.  That’s a common balding pattern that I’m sure I’d be fine with especially as I get older.

Yes I meant taking medications to maintain as much as possible. Based on your expectations and styling preferences, I see that it is best to focus on the front with good density. I do believe that if you maintain what you have you might eventually be able to transplant the crown. 

 Remember that if the crown is not transplanted and you end up shaving your head, then SMP will also be a good option for the crown down the road. 

[Danny1671]

Ok so now I’m a bit worried! I have just returned from the barbers and had a grade 1.5 back and sides and noticed that it looks like a may be thinning lower than I thought. To me it doesn’t look like a typical  balding pattern in the average man but I’d love to hear your thoughts.  Should my strategy change in terms of future planning if this will go too? Do you think I’d have a dense enough ‘safe donor zone’ to have a good hairline and mid scalp or is it game over?

what would you do??

cheers all

[gillenator]

Unless that is grey hair, it does appear that you have some thinning in your donor zone...definitely should have it evaluated with an in-person examination...get several opinions.