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Hello everyone,
Below are some pictures of my situation (pictures are taking at different times of day over a period of a few weeks -> different hair length):
I basically want to have more hair density on top of my head.
Background:
- 42 years old
- Blond, fine hair
- Hair loss started about 12-15 years ago
- I have slow but constant hair loss (over last 12-15 years)
- I used to take Finasterid, but stopped it about 3 years ago
- I still take Regain/Rogaine (Minoxidil)
- No previous hair transplantation
- My father has a full head of hair

So my questions are:
- How do I get more density (without using medication)?
- Is a hair transplant the right option for me?
- If yes, FUE or FUT? I like to have the hair short on the sides and on the back.
- Does the donor have enough grafts for a transplantation?

Thanks in advance.

01a-Front.jpg

02a-Top.jpg

02b-Top.jpg

02c-Top.jpg

03a-Back-longer.jpg

03b-Back_short.jpg

04a-Right.jpg

04b-Right.jpg

05-Left.jpg

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First of all, what are your expectations? Are you okay with having an empty crown or thin crown? Are you comfortable with having several hair transplant procedures to reach your goal? You can achieve good results with FUE, but you will need more surgeries, FUT allows to maximize your donor capacity, but you cannot wear your hair short. That said, depending on how well you scar, you may able to wear a #3 on the sides.

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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Thanks for your answer so far.

I was hoping to get more density on the whole top head (including crown), ideally with only one operation/procedure. So in your opinion this would only be possible with FUT?

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Also I have seen larger FUEs with good results, you see plenty in forums and on youtube, where men were almost bald and after that they had almost full coverage on their top head and the donor area still looked ok.

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Just now, agassi99 said:

Thanks for your answer so far.

I was hoping to get more density on the whole top head (including crown), ideally with only one operation/procedure. So in your opinion this would only be possible with FUT?

No, honestly you should reconsider surgery if those are your expectations. That's just not realistic. You will 100% require more than one surgery, in fact I would say at least 3-4 through out your lifetime, and in most cases the crown is left thin, and sometimes even bare. Sorry if i'm coming off blunt, but i'd rather give it you straight than BS you, that's not what we stand for here. 

Your first surgery you should expect to create a frame to your face with some some coverage in the midscalp, the second surgery would then either reinforce the front and mid with more density, or add some hair in the crown. However, the crown requires upwards of 3,000 grafts to have adequate density, the majority of men don't possess the donor supply.

Think of it this way, let's say you want to paint your entire house, but you only have a couple of gallons of paint. You have to choose what matters most, and what your guest will see when they enter your house. The living room, kitchen and bathrooms would probably the most important right? Since that is what your guest will see, the master bedroom, while important to you, isn't as important to the guest who enter your home.

Hope that makes sense.

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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3 minutes ago, agassi99 said:

Also I have seen larger FUEs with good results, you see plenty in forums and on youtube, where men were almost bald and after that they had almost full coverage on their top head and the donor area still looked ok.

Those are best case scenarios. Again, no two people are the same, just because one person can get 8,000+ grafts, doesn't mean you will. Your donor looks okay, not good or great. I don't see you getting more than 5K grafts via FUE without it starting to look motheaten. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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If it were me in your situation, I would not do FUE...Melvin is spot on and I agree that FUHT would provide the most harvestable grafts and then possibly utilizing FUE last.

You will need more than one session and I would also not do anything with the crown until at least the frontal zone is done.

Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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Sorry if i'm coming off blunt, but i'd rather give it you straight than BS you, that's not what we stand for here. 

No problem, I prefer a straight answer.

Quote

I was hoping to get more density on the whole top head (including crown), ideally with only one operation/procedure.

What I meant, is: surely there would be some kind of improvement to my current situation with only one FUE surgery? But you are probably right, what would be the point in having some half-baked situation..

I was told that with one FUT of 5000+ grafts I could get good coverage, but in that case I would need to have the hair longer on the side and on the back to cover the scar.

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Oh sure, yes of course there would be "some" improvement but it will take more than one session.

Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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1 hour ago, Melvin-Moderator said:
1 hour ago, agassi99 said:

Also I have seen larger FUEs with good results, you see plenty in forums and on youtube, where men were almost bald and after that they had almost full coverage on their top head and the donor area still looked ok.

Those are best case scenarios. Again, no two people are the same, just because one person can get 8,000+ grafts, doesn't mean you will. Your donor looks okay, not good or great. I don't see you getting more than 5K grafts via FUE without it starting to look motheaten. 

I didn´t mean 8000+ grafts, there are plenty of videos that show men who are almost bald, then get one FUE with 4000 - 5000 grafts and have a full head of hair one year later.

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1 hour ago, agassi99 said:

I didn´t mean 8000+ grafts, there are plenty of videos that show men who are almost bald, then get one FUE with 4000 - 5000 grafts and have a full head of hair one year later.

Don’t go into surgery thinking of best case scenarios on YouTube you will most likely be disappointed.

look at like 10-15 cases on here with similar hair characteristics and level of lose and if you would be happy with those outcomes any of them then have surgery if you wouldn’t be happy with more than half than don’t have surgery.

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2 hours ago, agassi99 said:

I didn´t mean 8000+ grafts, there are plenty of videos that show men who are almost bald, then get one FUE with 4000 - 5000 grafts and have a full head of hair one year later.

Again, those are best case scenarios. The majority of men do not get those results in one surgery. That’s a fact. If you’re not willing to invest the time and money, don’t get a hair transplant. This is a life long investment. One and done is not realistic and does not happen. If you wouldn’t be satisfied having a thin/bald crown, forget about hair transplants. 
 

Take a look at @gbhscot he has great results, but he’s disappointed because he believed the hype on YouTube and instagram, and his expectations weren’t realistic. I would rather you hold off than be disappointed. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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What do you guys think?

I´d go for only one FUT and try and get as many grafts out of the area, I was told up to 5000 - 5200+ would be possible. That would leave a small amount for FUE touch up, e.g. on the scar in later years.

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Your donor looks quite lacking in density on the sides.

On top you would need around 8000 grafts to get full coverage to around 50% original density.

Try to get your donor evaluated by a top doctor in person.

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4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013

1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018

763 FUE grafts (2,094 hairs) with Ray Konior, MD - January 2020

Proscar 1.25mg Mon/Wed/Fri.

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2 hours ago, 1978matt said:

Your donor looks quite lacking in density on the sides.

On top you would need around 8000 grafts to get full coverage to around 50% original density.

Try to get your donor evaluated by a top doctor in person.

I already did, just want to get some second opinions

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21 minutes ago, agassi99 said:

I already did, just want to get some second opinions

Which doctor and what did they say your donor was? 5000+ in one go will be pushing it and you will need to have very good laxity for this to happen. I had 4400. I disagree with needing 4 operations. You can do two FUT megasessions and you will be fine. You could look at H&W in North America and Hattingen in Europe, depending where you are based, as these are probably the best two clinics in the world for FUT megasessions. If you look at my thread, I had one mega session, at Hattingen, and the result is good. However, your hair is quite fine, especially in comparison to mine, and you may not get the same result. I echo what others say about not looking at other people online and expecting your result to be the same when you may not share characteristics with that person. This is what happens with the Spanish clinic results - Spanish hair is perfect for transplants.

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Before HT go back on Fin for 18 months. Your hair loss progression “looks” like it would be a great responder to this type of therapy. If used at correct dosage everyday, you may not need the HT

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I know I’m saying what you don’t want to hear, but I say no. People throw around huge graft numbers around like it’s the norm. I can count on one hand the number of guys who’ve been able to get 5,000 grafts in one sitting.

With each strip excision you have less laxity, the chance of getting another mega-session is unlikely, again only a handful can. The chances of a stretched scar also increase. These are real possibilities that no one talks about. 

Your donor doesn’t look great, and your hair is fine. Add to that your expectations, and it’s a recipe for disappointment. This is a life commitment, and shouldn’t be taken lightly.

It’s easy for guys to say “get two mega-seesion FUE’s or FUT’s one for the front and one for the crown and bam done.” But for one what type of density are we talking, and two can your donor even withstand it. Graft estimates are just estimates, and there’s no guarantee you’ll get that many grafts.

That’s why I preach expectations above everything, because you can get a cosmetically good result, but become disappointed in the end due to failed expectations. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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58 minutes ago, Melvin-Moderator said:

That’s why I preach expectations above everything, because you can get a cosmetically good result, but become disappointed in the end due to failed expectations. 

I do understand this. I might have high expectations, but I am also realistic about it, I know that I won´t have a dense head of hair post surgery. In my case I will have to decide, am I happy with the thin looking, short head of hair I have now, or can I somehow get an improvement, that might require me to have my hair longer and still have some thin patches in between, but which I might be able to cover up with longer hair. 

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1 hour ago, Melvin-Moderator said:

It’s easy for guys to say “get two mega-seesion FUE’s or FUT’s one for the front and one for the crown and bam done.” But for one what type of density are we talking, and two can your donor even withstand it. Graft estimates are just estimates, and there’s no guarantee you’ll get that many grafts.

Btw, what sort of density are we actually talking about? And what density is required to create the illusion of sufficient coverage?

My expectations are not 70/80 follicular units per square centimetre, I am expecting around 40-50 maybe. 

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1 hour ago, Melvin-Moderator said:

I know I’m saying what you don’t want to hear, but I say no. People throw around huge graft numbers around like it’s the norm. I can count on one hand the number of guys who’ve been able to get 5,000 grafts in one sitting.

With each strip excision you have less laxity, the chance of getting another mega-session is unlikely, again only a handful can. The chances of a stretched scar also increase. These are real possibilities that no one talks about. 

Your donor doesn’t look great, and your hair is fine. Add to that your expectations, and it’s a recipe for disappointment. This is a life commitment, and shouldn’t be taken lightly.

It’s easy for guys to say “get two mega-seesion FUE’s or FUT’s one for the front and one for the crown and bam done.” But for one what type of density are we talking, and two can your donor even withstand it. Graft estimates are just estimates, and there’s no guarantee you’ll get that many grafts.

That’s why I preach expectations above everything, because you can get a cosmetically good result, but become disappointed in the end due to failed expectations. 

Hasson and Wong have 3 pages of results on their website alone of patients with 5000 or more grafts done with them with good results. Hattingen regularly go above this number too but their website is limited in showing cases because of Swiss law. Both clinics get great results. It does depend on laxity, obviously, but I had average laxity overall (quite tight in the corners he said) and still got 4500 with no complications and a great scar. Just because most clinics can't do it does not mean it cannot be done and isn't done relatively regularly. I have seen more than a couple of very large FUEs from Eugenix too. If I go back for 2500-3000 grafts now, that will mean I have had 7000-7500 grafts as a NW5 which is pretty much what most people will have across their lifetime (if it needs that many grafts - lower NWs may not). I agree with your point about expectations but going to a world class clinic that specialises in doing work this size means you can are negating some of this risk and taking advantage of the virgin scalp with a huge amount of grafts and then touch up for increased density on a second pass.

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21 minutes ago, agassi99 said:

Btw, what sort of density are we actually talking about? And what density is required to create the illusion of sufficient coverage?

My expectations are not 70/80 follicular units per square centimetre, I am expecting around 40-50 maybe. 

There's a good video on coverage value by Dr. Lorenzo, but the density depends on the size of your scalp, the thickness of your hair follicle, and the density of your donor. To have the 'illusion of density' some require 40 grafts per cm2, but these are usually those with thick coarse hair. It's just not realistic to expect density, coverage, and all in one surgery for you. Your donor looks fine and on the sparse side. Guys like @TrixGlendevon are always impressive, but his hair his thick and curly, his coverage value is a lot different than yours. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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12 minutes ago, TrixGlendevon said:

Hasson and Wong have 3 pages of results on their website alone of patients with 5000 or more grafts done with them with good results. Hattingen regularly go above this number too but their website is limited in showing cases because of Swiss law. Both clinics get great results. It does depend on laxity, obviously, but I had average laxity overall (quite tight in the corners he said) and still got 4500 with no complications and a great scar. Just because most clinics can't do it does not mean it cannot be done and isn't done relatively regularly. I have seen more than a couple of very large FUEs from Eugenix too. If I go back for 2500-3000 grafts now, that will mean I have had 7000-7500 grafts as a NW5 which is pretty much what most people will have across their lifetime (if it needs that many grafts - lower NWs may not). I agree with your point about expectations but going to a world class clinic that specialises in doing work this size means you can are negating some of this risk and taking advantage of the virgin scalp with a huge amount of grafts and then touch up for increased density on a second pass.

Of course they have several pages, they have been performing surgery for decades. Nevertheless, those are cherry picked and exceptional cases. I have yet to see more than a handful of regular guys come on this forum and reach that number of grafts in one sitting, and getting close to the same number of grafts twice is exceptionally rare. I would rather people look at the results posted on this forum as a gauge for what is realistic, because again those are best case scenarios, and may not reflect real world reality.

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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1 minute ago, Melvin-Moderator said:

There's a good video on coverage value by Dr. Lorenzo, but the density depends on the size of your scalp, the thickness of your hair follicle, and the density of your donor. To have the 'illusion of density' some require 40 grafts per cm2, but these are usually those with thick coarse hair. It's just not realistic to expect density, coverage, and all in one surgery for you. Your donor looks fine and on the sparse side. Guys like @TrixGlendevon are always impressive, but his hair his thick and curly, his coverage value is a lot different than yours. 

Completely agree! I have said this to people via PMs - don't look at my hair and expect the same result even going to the same surgeon with the same pattern. My hair calibre is about average, I was told, but it is wavy/curly. Which helps with coverage.

I was also told, as we are discussing density, by a couple of clinics (including mine) that the number isn't necessarily important as you can use some small tricks like putting hairs in at certain angles etc. to give even more illusion of density. I think having in-person consultations with top clinics that are ethical and get consistently good results over an extended period of time will 1) inform you about how good your donor is and what your expectations can be and 2) what kind of density you will need

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10 minutes ago, Melvin-Moderator said:

Of course they have several pages, they have been performing surgery for decades. Nevertheless, those are cherry picked and exceptional cases. I have yet to see more than a handful of regular guys come on this forum and reach that number of grafts in one sitting, and getting close to the same number of grafts twice is exceptionally rare. I would rather people look at the results posted on this forum as a gauge for what is realistic, because again those are best case scenarios, and may not reflect real world reality.

Also a fair point and I agree with using normal people as an indicator and not cherry picked amazing cases on the websites. 2 counter points: 1) I was just replying to your comment that implied this size of surgery is extraordinarily rare and I don't think it is at certain clinics. There are other fora too with cases. H&W also now do FUE which I think is more popular, rightly or wrongly, which also reduces the amount of these megasessions they do as it eats into the amount of FUTs they do. It does not mean they can't and don't still do them though. 2) this is why I suggest in-person appointments with top clinics to determine where they are on the scale of good candidates and that way can adapt their expectations accordingly. Without going back through the thread, I can't remember off the top of my head if the OP has had any consultations yet or not.

Edited by TrixGlendevon
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