Hair Transplant Surgery Graft Strategy - Pics included

[didit07]

Hi All,

I was wondering if you guys would be willing to share your thoughts on my hair loss graft surgery. Attached I have drawn what I would like. Because I am diffusing it is a bit more complicated. I will be going to turkey and told them to cap it at 4,000 grafts maximum. Key areas for me are the crown,  the hairline(i dont care about dropping it just making it stronger) and the red circles in between. My mentality was that I would want the entire area i have drawn around but i dont believe I can do it all in one session.

 

Edit: please no comments about turkey. I am going and simply asking for opinions on graft allocation.

Edited July 19, 2020 by fabofly

[ITA]

@fabofly but have you already had another procedure before?  Your donor area doesn't seem so rich to me.

[didit07]

8 minutes ago, Egy said:

@fabofly but have you already had another procedure before?  Your donor area doesn't seem so rich to me.

I didnt brush my hair so it was kind of "nappy". Take a look now. Can you answer the question i posed as well.

[ITA]

6 minutes ago, fabofly said:

Can you answer the question i posed as well.

I would prefer some more experienced members of this forum to answer, I assure you there are, can I instead ask you where are you going to go to Turkey?

[Gasthoerer]

Before you "go" to turkey, my 50 cents:

- Your hair type is very challenging for FUE (which is the main method in turkey) due to the strong curve of the grafts. Unexperienced staff and tools lead to high rate of transection. 

- Most surgeons are not familiar with this hair type

- Your skin type is typically more prone to keloid scaring (making FUT challenging) and leaving white dots (in FUE)

Please go only to a clinic which is experienced with you hair type and when doing  FUE is using a trumpet style punch like the one from Devroye or Umar. 

I have seen great results from Umar, Konior, Feriduni and Lupanuzla for cases like yours (just the first out of my head). 

 

[didit07]

13 minutes ago, Gasthoerer said:

Before you "go" to turkey, my 50 cents:

- Your hair type is very challenging for FUE (which is the main method in turkey) due to the strong curve of the grafts. Unexperienced staff and tools lead to high rate of transection. 

- Most surgeons are not familiar with this hair type

- Your skin type is typically more prone to keloid scaring (making FUT challenging) and leaving white dots (in FUE)

Please go only to a clinic which is experienced with you hair type and when doing  FUE is using a trumpet style punch like the one from Devroye or Umar. 

I have seen great results from Umar, Konior, Feriduni and Lupanuzla for cases like yours (just the first out of my head). 

 

I'm going to the same clinic in turkey that about 20 black men who have vlogged their experience in youtube went to. I have no concern over their ability just thinking about graft allocation strategy 

[ITA]

8 minutes ago, fabofly said:

I'm going to the same clinic in turkey that about 20 black men who have vlogged their experience in youtube went to. I have no concern over their ability just thinking about graft allocation strategy 

Watch out for Turkey and don't trust YouTube videos, instead see if there are experiences of black guys operated in that clinic right on this forum.

[Melvin- Admin]

Before you agree to surgery, are you okay with having a thin/bald crown? I just don’t see you having enough donor supply to restore the crown. Maybe with some BHT, but not with scalp hair. 

[Britanium]

4000 grafts is enough for your frontal third and mid section. Say for example 2500/3000 up front and then 1000/1500 for the mid section you show.
You would need another Ht to address the crown area. We can see you have a strong beard so that could be used. 
I think if you try and spread up to 4000 grafts across all the areas you show then it wouldn’t be the overall improvement you would seek. 

[didit07]

10 hours ago, Melvin-Moderator said:

Before you agree to surgery, are you okay with having a thin/bald crown? I just don’t see you having enough donor supply to restore the crown. Maybe with some BHT, but not with scalp hair. 

Thanks Melvin. How are you assessing my donor area ? I am surprised at the doubt about my donor capacity. I went to two doctors in canada and they said my donor area is plentiful? I hope your reasoning is based on black donor area relativity

[didit07]

10 hours ago, JohnAC71 said:

4000 grafts is enough for your frontal third and mid section. Say for example 2500/3000 up front and then 1000/1500 for the mid section you show.
You would need another Ht to address the crown area. We can see you have a strong beard so that could be used. 
I think if you try and spread up to 4000 grafts across all the areas you show then it wouldn’t be the overall improvement you would seek. 

Thanks for your reply.  That forecssted breakdown is exactly what I was looking for. Ii came into this knowing I would need 2 transplants. Doing the front area and leaving the crown is an absolute non starter. I rather have everything look 70% ok vs 90% good in the front area and leave crown bald. They stated they could get about 600-1000 grafts from my beard which would bring me to a total of ~5000 grafts. One thing I am trying to decide if it makes sense only doing the areas that are extremely thin and leaving the areas that are semi thin for the next surgery. I just didn't want to play wackamole but I am realistic about my chances in one session.

[Al - Moderator]

You have hair that goes very high up on the sides, so I think you can get away with grafting only very lightly in the midscalp. That way you can concentrate more grafts to both the front and the crown where it's more noticeable. Perhaps something like the breakdown in the picture below for 4000 grafts you mentioned. You still have some hair at the hairline, so I think you can get away with not using up too many grafts in the front at this time, but you will probably have to go back at some point in the future to fill in some areas as the remaining hair falls out. The idea I think you are trying to do is to be strategic with placement to get the most visible thin/bald areas filled in with the first procedure, so you can hopefully hold off for a few years before needing an update.

 

 

 

 

[Melvin- Admin]

12 hours ago, fabofly said:

Thanks Melvin. How are you assessing my donor area ? I am surprised at the doubt about my donor capacity. I went to two doctors in canada and they said my donor area is plentiful? I hope your reasoning is based on black donor area relativity

It has nothing to do with you personally, but it’s just not realistic to expect to cover the crown which is a large area with FUE alone, especially in one shot. You may get some coverage, but it will still look thin, so before you agree to surgery. I’d like to make sure you’re okay with this, I don’t want you to get disappointed.

[didit07]

5 hours ago, BeHappy said:

You have hair that goes very high up on the sides, so I think you can get away with grafting only very lightly in the midscalp. That way you can concentrate more grafts to both the front and the crown where it's more noticeable. Perhaps something like the breakdown in the picture below for 4000 grafts you mentioned. You still have some hair at the hairline, so I think you can get away with not using up too many grafts in the front at this time, but you will probably have to go back at some point in the future to fill in some areas as the remaining hair falls out. The idea I think you are trying to do is to be strategic with placement to get the most visible thin/bald areas filled in with the first procedure, so you can hopefully hold off for a few years before needing an update.

 

 

 

 

Thanks for your response, this is exactly the perspective I was looking for. When you say "You have hair that goes very high up on the sides", what do you mean? You are aboslutely right that I will need another HT in the next 2-3 years which i am totally okay with. I dont plan to grow an afro or any elaborate hair style, if i can have a #1 and keep my hair at 4mm-6mm I would be pretty happy. Would you say that I should have grafts all through out the hair I have outlined but concentrate on the spots that are totally thinned out or are you thinking I should only focus on the near bald spots? They said I should be able to get 600-1000 grafts from my beard

[Portugal25]

@fabofly you should follow @Gasthoerer advice and go to a Doctor with experience with trumpet style punch like Lupanzula or Bisanga. 

[1978matt]

AA hair needs less density than caucasian hair.  4000 is way too much to do in one sitting.

2000 grafts by a proven doctor like Bisanga will look better than 4000 by some nameless technician.

I have a work colleague who went to turkish hairmill in late 2018.  5000 grafts for £2700.  The doctor sat in the corner of a room on a laptop while he and 5 others were worked on simultaneously.  His results look like 2000 grafts at best, placed too low and the angles are off so it sticks up at 60 degrees.

[AB2000]

OP, have you shared your long term objectives with your surgeon?  If so he probably has a game plan to achieve it.  If I were in your shoes I'd defer to his idea, or at least question why the clinic's version differs from yours.

What any good doc will do is have you leave your first HT such that you could live with the result if the unexpected happens and you never return for further surgeries.  ie. you don't want a result that looks like a work in progress.  This necessity will in part dictate how he lays out the grafts.

[didit07]

On 7/21/2020 at 1:52 PM, BeHappy said:

You have hair that goes very high up on the sides, so I think you can get away with grafting only very lightly in the midscalp. That way you can concentrate more grafts to both the front and the crown where it's more noticeable. Perhaps something like the breakdown in the picture below for 4000 grafts you mentioned. You still have some hair at the hairline, so I think you can get away with not using up too many grafts in the front at this time, but you will probably have to go back at some point in the future to fill in some areas as the remaining hair falls out. The idea I think you are trying to do is to be strategic with placement to get the most visible thin/bald areas filled in with the first procedure, so you can hopefully hold off for a few years before needing an update.

 

 

 

 

Following up

[Rolandas]

My suggestion is to stick with whatever your surgeon is proposing. If you have enough confidence in him to operate you, you should trust his opinion.
To me it sounds weird when guys are telling to a surgeon "implant here 1000 and there 2000". He is a surgeon, he (should) know better as he is doing it on a daily basis?

[DrTBarghouthi]

@fabofly Best of luck with your Ht. My advice would be :

1. Delay the crown area. I am not sure what your age is but crown will require a considerably large number of grafts. What is potentially ore dangerous is if the crown expands further and then you are trapped to filling it with another procedure and allocating the grafts to chasing that pattern up. Not the best value for money. I am not sure what age you are but even a slight enlargement in the crown will require a good number of grafts to repair. 

2. Use the 4000 for Front and Midscalp. Once you're happy with this and the pattern is maintained, you can think of any further surgery .

3. Make sure the team has experience with your type of hair ofcourse. I personally have patients with your type of hair consent for both FUE and FUT at the time of surgery, since if the curls are too tight regardless of the punch we use, an FUT is at times a safer option. Ofcourse, provided you have no documented history of keloids. 

 

Best of luck