Experience with two separate prodecures - one for frontal 2/3 + another for the crown?

[arniekander]

Hey everyone,

I've been recommended by pretty much all the doctors in the NYC area that the best course of action for me (Norwood Stage 4/5) is start with a procedure on the frontal 2/3 area with 3000 grafts, and then later down the road get another surgery to do my crown. Has anyone else gone this route? I've been searching for results on the forums where someone did this, but I'm having a hard time finding anything. 

My worry is that since the baldness is pretty bad on my crown that I'm going to look very weird with a full head of hair on the top and front while still having an ugly bald crown. I'd hate to have to go 1 to 2 years with a funky looking outcome before I can even consider getting my crown fixed.

I've also had other doctors outside of NYC (europe and turkey for the most part / for example, ASMED) say that I could do a full transplant of about 5/6k grafts and it won't be an issue, but the doctors in NYC are pretty much in agreement that it's not a good idea because I should try my best to preserve the donor area.

Anyone have experience with this problem? 

Photos for reference. 

 

 

Edited December 25, 2020 by arniekander
adding clarity

[DenverBuff1989]

36 minutes ago, arniekander said:

My worry is that since the baldness is pretty bad on my crown that I'm going to look very weird with a full head of hair on the top and front while still having an ugly bald crown.

to be honest I do think that would unfortunately not look great. Your crown loss is quite significant. There are plenty of guys who naturally have an amazing hairline but bad crown, so I think the result would still look natural. However, even tho it would still look natural, it would still not look good. Many, perhaps most, guys can get away with a little crown balding/thinness. However in cases such as yours I think no matter how great your hairline looks, your crown would overshadow it. 

I do understand the doctors saying they don't want to work with more than 3000 grafts in one go. But I'm unsure you'd really need to wait a long time before getting your crown done? How long do the NYC doctors say you need to wait in-between surgery?

You may want to look into concealer for your crown if you do decide to wait before getting work done on it. My crown loss is relatively mild, but concealer is amazing on it. Its worth a shot. 

[champybaby]

For someone with your level of hair loss, I'd be hesitant to go to Turkey and do 5-6K grafts. The reason being is doing so will more then likely cripple your future donor supply.

Judging by your post and pics, you are going to need to max out your donor supply. That said, you should take a hard look at FUT. I also don't think 3K upfront will give you the results you want. I suggest doing something like 3500 grafts via FUT, with about 500 going toward crown to hold you over. You would then have to schedule another procedure, which I also recommend as FUT, or a combo of FUT+FUE to reinforce the front a little more; the majority of grafts for your second session would go toward the crown. A mature hairline, which is not bad at all imo, should also be in order.

You will continue to lose more hair so if you go this route, assuming your donor is average, you should have about 2500 or so grafts left via FUE for a third procedure in the future. I would also encourage you to hop on fin + rogaine. That stuff really works.

Which doctors are you speaking with, btw?

[Al - Moderator]

The two procedure approach of doing the front first and then then crown on the 2nd procedure is somewhat standard with USA Drs when the patient is a higher NW. You won't look strange since it doesn't look like your crown goes far down the back of your head. You will actually look much better because the front will be much more full and you will have a hairline. There are people who lose the crown first and still keep thick hair in the front, so it will not look out of place. It only becomes an issue if your crown is more of the NW 7 type that has dipped far down the sides and back.

 

[UnbaldEagle]

OP, no offense, but I think you're very generous to yourself by saying you are a NW 4/5 only. 😳 That's a semi-combover and a small island of hair in the midscalp separating you from a full bloom NW7. 😕 You might want to forget about the crown and focus on the frontal regions for now, I agree with @BeHappy, it won't look out of place. You could use concealer for your crown area. 

[arniekander]

@UnbaldEagle What type of concealers do you all recommend? Is Toppik a concealer that can be used for the crown that people have experience with here? 

Almost all the doctors I've sent photos to have said I'm stage 5, but I've sent them all about 8+ photos, so perhaps they are seeing more with additional views? I've had a few say stage 4, and one say stage 6.

It's crazy how different everyone's opinions are about what I should do, and what stage I am! All of these conflicting opinions is really maddening! 

In NYC, i've been talking to Bloxham and Wesley as well as a few others, and in Turkey I've been communicating with ASMED, Dr. Yaman, and Civas, although Civas did say that I should have two separate procedures like the NYC docs did.

I also spoke with Eugenix out in India who recommended about 5k total for everything, but taking 1,500 from my beard area, but I'm unsure if I want to go through the hassle of getting a medical visa to travel to India right now.... 

I'm also considering talking to True/Dorin and Bernstien, but the $180 consultation fees seem excessive when the other doctor's haven't asked for that. 

Edited December 25, 2020 by arniekander

[arniekander]

As a follow up to my last reply - here is another photo after a haircut and my hair parted in the middle. 

FYI - I’ve been on Fin since I was 19, but unfortunately was not taking enough (my doctor only prescribed me .5 mg every other day) and then last year another doctor advised that I tamper off the medication because he said there could be links to cancer. I tampered off the medication in March of this year, and started heavy losses in the summer. Of course, my doctor then comes back and tells me that actually i shouldn’t be worried about the medication. SMH. Now I’m taking it again.

 

Edited December 25, 2020 by arniekander

[giegnosiganoe]

4 hours ago, arniekander said:

As a follow up to my last reply - here is another photo after a haircut and my hair parted in the middle. 

FYI - I’ve been on Fin since I was 19, but unfortunately was not taking enough (my doctor only prescribed me .5 mg every other day) and then last year another doctor advised that I tamper off the medication because he said there could be links to cancer. I tampered off the medication in March of this year, and started heavy losses in the summer. Of course, my doctor then comes back and tells me that actually i shouldn’t be worried about the medication. SMH. Now I’m taking it again.

This is interesting.. Even if you were only taking 0.5mg EOD, I wouldn't have thought you'd go this bald considering you started at 19.

Some questions:

1) How old are you now?

2) Do you have any photos of your hair from when you were 19?

3) Do you have any photos of your hair from before you tapered off the medication in March of this year?

[aaron1234]

@arniekanderSomeone with your level of loss should anticipate multiple procedures regardless whether you transplant the crown in round one.  Why not look into Hasson & Wong who specialize in larger sessions?

[Guanyu76]

7 hours ago, champybaby said:

For someone with your level of hair loss, I'd be hesitant to go to Turkey and do 5-6K grafts. The reason being is doing so will more then likely cripple your future donor supply.

Judging by your post and pics, you are going to need to max out your donor supply. That said, you should take a hard look at FUT. I also don't think 3K upfront will give you the results you want. I suggest doing something like 3500 grafts via FUT, with about 500 going toward crown to hold you over. You would then have to schedule another procedure, which I also recommend as FUT, or a combo of FUT+FUE to reinforce the front a little more; the majority of grafts for your second session would go toward the crown. A mature hairline, which is not bad at all imo, should also be in order.

You will continue to lose more hair so if you go this route, assuming your donor is average, you should have about 2500 or so grafts left via FUE for a third procedure in the future. I would also encourage you to hop on fin + rogaine. That stuff really works.

Which doctors are you speaking with, btw?

this would be the way to go

[Tao]

I had three procedures.  First was just to address frontal third.  Second was to shore up frontal third and address the crown.  Last was to shore up my part and pour more grafts into the black hole of the crown.  I haven't updated my profile to show results of third procedure yet (I'll get to it eventually) but you can check out my first two results following the link in my signature line.  I had FUT first two times and then FUE the last go around and I don't regret it as I think it maximized my donor grafts.  The strategy to address the front first is sound as that's what people see when they look at you.  It frames the face again, which is huge.  The rest is mostly hair greed and frosting on the cake.  Good luck!