PLEASE HELP/need advice on what to do! - PICS

[baldboy123]

Thanks everyone for you advice and input. I greatly appreciate it. You all are really helping me get closer to finding a solution to my unlucky situation. I know the best thing to do would be to wait but its just extremely hard if your in my shoes. It sucks. I feel like I am the only one this bald in college. Its just destroying my confidence and I think Ronald has really hit the nail on the head with regards to my feelings and thoughts on what to do. Why not get a conservative hairline ht at a time when (and I think most of you can agree) physical appearance matters most? And if i were to choose strip, wouldn't i be able to fue in the scar if i decide to shave down?

[aaron1234]

If BB does a HT with the expectation of reaching a NW7, he might indeed have a natural hairline. But there will be nothing behind it to give an illusion of density. This could happen to him within a couple of years, even on the meds. I doubt BB would want to look like Joe Biden by the time he's 28. A shaved head look for the next few years would be the much safer way to go... by far.

[aaron1234]

BB, if you got a HT today it wouldn't be fully realized for another year. By that time, you'd be almost done with college (unless you are like me and choose 6 years of grad school). I really hope a sketchy doc doesn't take advantage of you right now. At least consult with a top notch, ethical clinic.

[thanatopsis_awry]

Ronald, agreed, and ty for taking the time to put this logic into words in this thread. And it's logic that doesn't dictate and demand someone *get* or *not get* a HT, but reveal someone a perspective that affords them greater flexibility and choice to make a decision upon.

 

I've always felt it to be an important concept, but quite difficult to simply sum up like you did. Whenever I've posted something about it, it kind of reminds me of having to work through an annoying IQ or LSAT problem.

 

But ya, there isn't necessarily some great shame in having a bald crown and nice hairline and top (this actually *is* a natural balding pattern that can and *does* occur!) -- not being able to get total coverage doesn't have to mean a crime against humanity has occurred, you will look like a FREAK, or even that such a look will be terribly inferior to natural baldness (if this end does arise). And, of course, having both the crown/top/hairline during your most formative years isn't simply a luxury of aesthetics and superfluous vanity.

 

The greatest fear I have for younger guys is that they will take the risk and forge ahead with a HT....but get an inadequate one whose fruits won't yield the juice to make the squeeze worthwhile. This most usually occurs because of low graft totals that don't meet the patient's goals *and* the patient's long-term benefit. As such, in younger guys with advanced baldness who might not be able to attain a full look in several (let alone one) session, I think the route of FUE to artistically achieve the constructs of a hairline, to subsequently shave down and forget about your hair and HTs is pretty attractive.

 

Bill makes an excellent point about the financial cost to all of this, as well. This is something that needs to be weighed carefully by any person, let alone a younger guy, and evaluated on a case by case basis. It could very well be that the financial toll negates any potential gains and simply getting on meds shaving, keeping on top of hair restoration and moving forward is best.

[the B spot]

I know I haven't spoken to you in a while Bill....we should get on the phone and yak, for sure.

 

All

I do want to point out that a HT at 20 is different at 25, 30, 40, etc...

 

At 20 with extensive thinning, you may be a NW7 at 25, should you perform ANY type of surgery at 20, you may be actually taking non-DHT resistant hairs that were destined to miniaturize regardless of extraction zone.

 

The BEST way to combat younger patient loss is through meds/topicals/education. It is not convenient. It hurts. But it is what is BEST.

 

As far as financial, yes, this stuff is expensive, but again, patients should know all of this up front.

 

At this point, there has been excellent discussion from all involved. There is no magic "age" to start treating your balding with a HT.

 

I know we prefer our patients to be at least 25. However, we do the occasional 23-24 year old.

 

Additionally, there is no "right" way to approach a younger patient. I gave my opinion as to why I feel the way I do. Others have disagreed to a certain extent and provided reasons why.

 

Let me end by saying that it has been my experience that most determined younger men WILL get a HT, despite any information to the contrary. They will also go from doctor to doctor until they find someone who tells them what they want to hear.

 

We end up repairing so many of these young men by 27-35 because they just look unnatural...hairline too low, hairline too dense, temple points overbuilt, donor over-harvest via FUE, recipient area scarring, ridging, cobblestoning, wide/raised scars, etc...

 

The common mantra is "I wish I would have waited" or "I wish I would have just buzzed my head and forgot about all of this"

 

Take Care,

Jason

[Ronald]

I agree that this is a very interesting discussion, to the point that it drove me to sign up and participate!

 

 

I know we prefer our patients to be at least 25. However, we do the occasional 23-24 year old.

 

Although each case is different, 25 seems to be the general rule of thumb. I have always wondered why that is. Does hair loss tend to stabilize after this age? Is it easier to predict one's hair loss after 25?

 

 

We end up repairing so many of these young men by 27-35 because they just look unnatural...hairline too low, hairline too dense, temple points overbuilt, donor over-harvest via FUE, recipient area scarring, ridging, cobblestoning, wide/raised scars, etc...

 

What you describe sounds like repair work done on account of poor technique (cobblestoning/recipient area scarring) and/or poor planning (hairline too low, over-harvest via FUE) as opposed to someone who got a ht done too young, since a 70 yr old with these issues would be driven to have repairs done.

 

I believe a conservative transplant with proper technique on a 20 yr old would not yield these issues.

 

I know Ive been arguing FOR but I want to provide another argument for AGAINST. I have seen some NW7s with so little hair that you can barely see that they have any, which would make their scar noticable if they got FUT.....Jason did touch on this point in his post and rightfully so. I once sat behind someone with this pattern.....

[Uk_lad]

I have a similar balding pattern at 24, I know how you feel buddy. However, I'd say after ten minutes in the morning in the bathroom, I can create an illusion of much fuller thicker hair using concealer. ATM i use courve, which is awesum for the crown, however definitely practice first before you go out. I have also used nanogen, which was good. My main problem has been finding a concealer that is the same colour has as mine (dirty blonde). But definitely give it a try, I recon you would have at least another years worth of the appearance of relatively thick hair.

[dakota3]

I would definatly say to shave your head and see if you can live with it. The earlier in life you start losing hair the greater the chances are that you will have extensive balding. Younger guys will often say they will not care as much when they are in thier 30's or 40's about thier appearance but I am living proof that this is just not true. I have been losing my hair since I was 20. I decided to have a HT at 28 thinking that this will be the cure to my problems. Now 3 years later I have lost more hair and have done enough research to realize that because I was so young when I started to lose my hair that chances are that I will never be able to keep up with the progression of hairloss to satisfy myself. You have people here saying that some is better than none but IMO this is also not true. A shaved/bald head is acceptable in society, but having hair just in the front 1/3rd and being completly bald in the back 2/3rds looks wierd IMO and looks 10X worse. Listen man from experience, shave the head and save yourself from years of heartache. gauranteed!

[Cam Simmons MD ABHRS]

Baldboy

 

I think you have had some great advice here.

 

I am concerned about some of the posts that may validate FUE as a viable option right now. I think you need to be just as cautious about starting FUE transplantation as you would be of starting FUT by strip.

 

FUE is still a relatively new technique and it is too early to know all of the long-term consequences. There are not a lot of photos of patients who have had thousands of FUE grafts transplanted. I have not seen one photo of a Norwood 7 patient treated by scalp FUE alone. I have been quite disappointed by the results I have seen on-line and in conferences of extensive body hair FUE.

 

More and more I hear the notion that it may be OK for someone to have FUE transplantation into their hairline then shave the head later if they lose their hair and don't want or can't do more hair transplantation. I believe that this is wishful thinking that has no basis in reality. Has anyone seen any good photos of anyone who has actually done this?

 

FUE scars are small but not invisible. If a patient comes in with medium or long hair I can always find the FUE or trichophytic scars with back-combing and careful examination. I can always see the scars from either method if someone has shaved their head. I have seen patients who had lots of FUE with grafts taken from well outside the safe donor area. I have also seen the start of a moth-eaten look in the donor area after extensive FUE. This is not to overlook the effects of strip surgery but just to state that FUE is not perfect either.

 

If you had a hair transplant then went quite bald and buzzed your head or shaved it slick, you would still have a five o'clock shadow in an unnatural pattern. The texture of the skin in the recipient area may be better than it would have been in the old days of the bigger graft but it won't be perfect.

 

To make a good decision it is important to have realistic expectations. FUE transplantation requires just as careful planning as strip transplantation ??“ especially for someone who could lose a lot of hair.

 

I believe that hair transplantation of any kind should be considered a permanent step with long-lasting benefits and long-lasting consequences. You cannot undo any hair transplant. The trade-off for having more hair on top is that the donor area will have some hair missing and some scarring. This can be minimized but not eliminated. Not everyone can get the coverage or density they would like but with careful planning they can have natural looking hair in a natural pattern that is better than they would have had without hair transplantation.

 

Generally speaking, men in their early 20s have a more unpredictable future and higher expectations to look like their peers. You seem to have a good understanding of how much hair you could lose. In my experience, intellectual understanding does not equate to emotional satisfaction. A conservative approach for someone who already has a Norwood 7 pattern makes a noticeable difference and can be quite satisfying. The same approach for someone who is headed toward a Norwood 7 pattern will have less visual impact and will be much less satisfying. Decisions must be made on an individual basis but I would encourage you to explore every other option instead of hair transplantation right now.

 

I hope that this helps and that you excuse me for my little rant.

[youngsuccess]

Originally posted by Dr. Cam Simmons:

More and more I hear the notion that it may be OK for someone to have FUE transplantation into their hairline then shave the head later if they lose their hair and don't want or can't do more hair transplantation. I believe that this is wishful thinking that has no basis in reality. Has anyone seen any good photos of anyone who has actually done this?

 

 

Originally posted by thanatopsis_awry:

I've never seen it practiced, but I often recco it and think it's wise for a lot of people. Poster "youngsuccess" was the first to ever mention it as far as I know (couple years back).

 

Yeah, I've mentioned this guy before a few times, but I think Zidane could be a good example:

 

This obviously isn't ideal; however, I think it could be a viable alternative for guys who get hairline work too early and go on to lose a significant amount of hair. Zidane's hair even looks GOOD from the front, IMO. I have also seen plenty of guys in public who seemed to have retained a somewhat juvenile hairline and bald behind it sporting shaved heads who look fine.

 

Dissatisfied with my my own hairline, which isn't disastrous but contains too many doubles and some slightly awkward angulation, I buzzed my head down with a #2 a few months ago. The recipient zone was virtually indistinguishable from my native hair. This suggests to me that a Grade-A, carefully planned transplant on a patient with the intention of keeping a closely-cropped scalp can look even better.

 

This wouldn't be a "wall" of hair; you'd have to allocate most of the remaining donor behind the hairline fading into the mid scalp, neglecting the crown. But some guys will be left with two options: a sub-par hairline with an irregular balding pattern, or a natural hairline fading into an irregular balding pattern. I'd take the latter in a second.

 

I recognize that this in theory vs practical application is another story entirely, but if the best HT doctors in the world can't accomplish this, I'd be pretty surprised.

[TC17]

I am not disagreeing with Dr. Simmons as I believe his post is mostly spot on. However, I have seen a patient who has had FUE performed completely shave his head. My ex girlfriend's dad was the principal of a high school in Cincinnati, and he underwent a procedure with Dr. Wolf. As part of a fundraiser for the school, he agreed to allow the students to shave his head bald if they raised X amount of money. Sure enough, they accomplished their goal and he kept his word. There was no evidence of any scarring.

 

Again, I agree with Dr. Simmons that no patient should rush into any type of surgery and that there are risks associated even with FUE, but in my opinion, those risks are less than with strip.

 

*kudos to Dr. Simmons for his second to last statement of his post. to anyone who thinks that all ht doctors are in a rush to push people into the chair, read that statement again.

[TC17]

One other point. I think that even if a patient progresses to a NW 7 level he should be able to accomplish a pattern better than that of Zidane. If you are willing to keep your hair that short, you get away with less density, and 4,500 grafts from FUE should easily be able to cover the frontal 2/3rds. Assume the patient has 225cm2 of area to cover, the frontal 2/3rds would be 150cm2. At 30 follicular units per cm2, that's a total of 4,500 grafts.

[Ronald]

Assume the patient has 225cm2 of area to cover, the frontal 2/3rds would be 150cm2. At 30 follicular units per cm2, that's a total of 4,500 grafts.

 

Based on the threads I have read, there seems to be a big misconception regarding the size of the NW7 area, as most say around 200 cm2.

 

It is actually the crown of a NW7 that is 200cm2, the TOTAL area in a NW7 is closer to 400 cm2.

 

See this article by Dr. Bernstein:

 

http://www.bernsteinmedical.co...voiding-pitfalls.php

[Bill - Seemiller]

Dr. Simmons,

 

I couldn't agree more with your post.

 

Well said.

 

Bill

[baldboy123]

Thank you everyone for all your input I really appreciate your knowledge and opinions on my situation...So after weighing the benefits and possible consequences of getting a ht, I decided to have a consultation with a very highly respected doc (Dr.Cooley). I told him Ive been on propecia for nine months and i just started rogaine a month ago. It seems like hair loss is minimal right now (maybe it has almost stabalized). His opinion (rather the consultant relaying what Dr.Cooley thought) was that I could either hold off or receive a ht of 3000-3500 grafts to fill in the frontal region fading into the front outer edges of the crown but not actually touching the crown of course. He would make a hairline from where it is now (fill in the receding area)and not drop it any lower. I think I am going to go through with a procedure in the coming months. by the way... i had a phone consultation and the pics he had of me were the ones i posted on this forum as well as a couple more photos of the sides and back of my head.