How many grafts? FUT or FUE?

[dooooder]

I'm 35 years old, and I'd like to fill in my hairline in the areas that are clearly diminished to have a full and thick hairline. I've had a few online consultations now, and estimates have ranged from 1000-2500 grafts. I'm lost on how much I'll really need, which is also affecting my decision for FUT vs FUE.

If I only need fewer grafts (~1000), then I'd prefer to opt for FUE. At ~2000+ grafts, FUE seems like it's no longer a good option due to the increased cost and the damage to the donor area.

You can see in the first picture, it doesn't look very bad when my hair is coming forward a bit. In the other pictures, with the hair pulled back, the effect is maybe a bit exaggerated. I also included a picture of the donor area, which is very thick.

Edited August 14, 2020 by dooooder

[hairlosscpa]

FUE about 1,500 grafts by a reputable surgeon should probably give you the coverage you desire. I would even do FUE for 2,000 grafts if it came down to it, but I dont think you need that many for your case. Anything greater than 2,500 I would go with FUT. The scar and recovery process is not worth it for anything less. Obviously all my opinion.

You have great head of hair though but I do understand your concerns. 

[Sam818]

     Are you on any meds? You have a great head of hair. I see your concerns but you need to also understand the risk of permanently shocking out those miniaturized hairs along your hairline with surgery.
    Before considering surgery take a look at this thread and what thus guy was able to accomplish with meds and microneedling. There is a strong chance you may be able to get some impressive results with a similar routine which would look much more natural than a hair transplant because it is. Trust me I was in a similar position as you with minimal hair loss and approaching my mid 30’s and thought I was a great candidate and now and regret my decision to have surgery.   
     Having a great head of hair with minimal hair loss at your age doesn’t make surgery low risk it makes it MUCH HIGHER risk because you have more to lose if it goes wrong.

 

[dooooder]

Thanks for the replies. I've been using minoxidil for about 3 years, and finasteride for the last year. Neither showed any noticeable improvement. I think minoxidil may have given me some regrowth at first, but I think I've probably already lost whatever gains I may have had from it.

I've also tried microneedling, but was never able to consistently commit to it. Never saw results from that either.

I've had those minaturized hairs in the corners since I was 30 or 31 (when I first noticed I had any kind of hairloss). Those areas used to be just as dense as the rest of my head, but I noticed the hairs were shorter and thinner there. Over the past few years, the hairs there have lost a ton of density, as you can see in the pics above.

[dooooder]

Hope it's ok to bump this once more if anyone else can weigh in

[dooooder]

I understand why you'd say that based on the first picture which was taken head on (and also with my hair worn in a way that helps conceal it), but I feel like the thinning is pretty obvious in the other pictures. I can't wear my hair back, or have a side part without those thinned corners being extremly noticable.

10 minutes ago, transplantedphil said:

id be highly curious which clinics are willing to accept you as a patient.

I've done online consults with some of the most reputable clinics in North America, which are very prominent on this forum (not sure if it's appropriate for me to name names). All have said I would be a good candidate for surgery, and have given me recommendations typically between 1000-2500 grafts. Perhaps the most popular of all clinics recommended 3,000+ grafts if I wanted a "slightly more aggressive approach".

[Melvin- Admin]

I would try dermarolling before getting a hair transplant. Honestly it’s not worth the risk or the money.

[ADuckwithNoHair]

I've said something similar to this before, this forum leans conservative on recommending hair transplants which I generally support. However past the requisite amount of caution, those considering a procedure also need to know the potential benefit to their personal situation. Yes @dooooder has good hair already, but there are trouble spots that he wants to improve on and which CAN be improved on. This forum would have told this Dr. Cooley patient not to implant between grafts, or to stop completely after his first procedure, but he did round 2 and now he has movie star hair. Same for this Dr. Bloxham patient who was experiencing corner thinning (not even recession), but after a small procedure has a breathtaking head of hair. Transplanting into areas of minor loss does come with risks but there are also upsides that often get glossed over.

Anyway, back to the topic. IMO 1,500 grafts seems like a "safe" estimate. As for FUT vs. FUE there is a strong case for both in your situation. You wear your hair longer which negates much of the downside of having a linear scar in the back of your head. Although you don't look destined for advanced hair loss, FUT will also yield more lifetime grafts. FUT also may have higher graft survival than FUE... Finally, FUT will be less costly. The benefit of FUE for you is that lifetime grafts may not even matter since your loss is so minimal, so why bother with a linear scar at all when for a small FUE, the effect to the donor will be practically invisible.

 

Edited August 20, 2020 by ADuckwithNoHair

[dooooder]

11 minutes ago, Melvin-Moderator said:

I would try dermarolling before getting a hair transplant. Honestly it’s not worth the risk or the money.

I've tried dermarolling, as well as min for 3+ years, and finasteride for the past 1+ years, but never saw any visible regrowth from anything unfortunately. It bothers me enough that I've tried all these things, spent countless hours staring at it in the mirror, worried about how much I'm shedding and if the areas are getting worse, and spent more time than I'd like to admit styling my hair to conceal the areas. At this point, I think it's worth it for me.

 

11 minutes ago, ADuckwithNoHair said:

You wear your hair longer which negates much of the downside of having a linear scar in the back of your head

Thanks for your feedback! I do like to wear it shorter a lot, which makes me definitely favor FUE. I think at this point the main deciding factor between FUE vs FUT for me would be the price and the graft count. If I truly only need ~1500 grafts to have a nice dense hairline, I would go for FUE. If I need closer to 2500, FUE cost becomes so great that I don't think I could justify it, and would probably opt for FUT.

[ShadowMoon]

One thing I'd like to point out is you have very dark hair and what looks to be lighter skin. Your hair shaft diameter looks to be pretty large as well. Those two things could lead to some pretty noticeable scarring were you to go FUE. Even with a small procedure of 1500. Whichever route you go, you may have to keep your hair longer regardless. 

As a side note, I know you are 35 which is a relatively later age to be getting a transplant. However, you have a high likelihood of losing more hair in the future. You won't be happy with an aggressive hairline and balding behind it at 55 or maybe even 65. If you put any hair at all in that front bit, that is a very aggressive NW0. Be prepared to need a lot of grafts to maintain that hairline for the rest of your life. It never goes away. If your plan is to shave it later in life, don't bank on dodging scarring by getting FUE either, as you will likely need larger punches to accommodate your thicker hair. Going gray will help but won't completely eliminate the problem.

Getting a hair transplant sucks. It is a last resort and creates a host of problems. You should only get one if you are willing to trade your current problems with all the problems that come along with a hair transplant. You might even get hosed and get the worst of both worlds, due to low graft survivability, permanent shockloss, or keloid scarring. Very, very rarely will you not notice a difference in transplanted hairs vs. native hairs when you look in the mirror every morning. It's not a perfect solution.

That being said, the two cases that @ADuckwithNoHair mentioned earlier were both FUT. I am a firm believer that FUT gives you the best chance at graft survivability, which is important if you want a one and done procedure. It's also much easier to fix a bad FUT donor area as opposed to a bad FUE donor area. Diffuse thinning in that region is a bitch.