Low Norwood (2-3) hair transplant strategy?

[deeznuts]

I'm a NW2 at age 30. I've got temple recession which is messing with my ability to execute certain hairstyles how I want and maybe I've got a bit of a five head as well. Classic M-shaped hairline. 

I went to a local doctor and he drew a NW1 hairline on me and quoted me 1200 grafts. He literally just drew a horizontal line on my forehead so no norwood 3 or lifting up at the corners like the hairline some guys get. Like you could have created that hairline by tracing the edges of a hershey bar. He did say it wouldn't be super high density (i.e. 40 grafts/cm) to give an idea of what kind of procedure we were discussing. 

My doctor was a bit on the conservative side so all he wanted to do was create that NW1 look.  The thing is, I was hoping to lower my hairline by like 0.5-1cm as well because I feel like my forehead is a bit too big which doesn't suit my face all that well. My local doctor didn't want to lower my hairline (said something about how since he was the doctor, he also had input and he didn't really want to do that kind of hairline) while the H&W rep recommended against it but also said that it would be X amount of grafts per 0.1 cm. 

I was just wondering though if lower NWs can go for stuff like this and how reasonable would it be? I know a lot of doctors like to talk about donor management and talking down the guys who want a Sean hannity hairline while they're a future NW7... But for a lower NW patient who's hairline may just end up matching his fathers Nw2/nw3 at 60, would it be unreasonable to try and lower the hairline while at the same time filling in the temples? My donor capacity I think is about average though my hair shaft thickness is probably a bit above average 

Also, what kind of limitations do lower NWs generally have when transplanting? At what point does it become a point where the patient is being unreasonable in their goals?

Edited February 28, 2021 by deeznuts

[Ajamilo]

Do you have picture of your hairline and how low you want to lower it?

Edited February 28, 2021 by Ajamilo

[Curious25]

If you are able to post pictures of your front, top of head, and donor, that will greatly help in terms of the feedback people are able to give. 

What is your family’s history like in terms of hair loss, and are you currently taking medication? When did you first start receding? 

The case that you have presented us with leaves open far too many variables that need to be considered before providing you with solid advice. 

Here’s an example - 40 graft pcm2 density may give you a really dense appearance if you have thick native hair, and low native density pcm2. However if you have native density of say 90cm2 , and fine calibre hair, the chances are 40cm2 in your temple recession is going to look unnatural, and leave you unhappy with your overall result. 

 

[deeznuts]

1 hour ago, Curious25 said:

If you are able to post pictures of your front, top of head, and donor, that will greatly help in terms of the feedback people are able to give. 

What is your family’s history like in terms of hair loss, and are you currently taking medication? When did you first start receding? 

The case that you have presented us with leaves open far too many variables that need to be considered before providing you with solid advice. 

Here’s an example - 40 graft pcm2 density may give you a really dense appearance if you have thick native hair, and low native density pcm2. However if you have native density of say 90cm2 , and fine calibre hair, the chances are 40cm2 in your temple recession is going to look unnatural, and leave you unhappy with your overall result. 

 

Well you can't really say for sure even knowing the family history or the first noticeable recession I'd imagine. But let's assume it's just a fairly linear and slow recession (as evidenced by NW2 at age 30). And let's say it's fairly consistent so a bald spot won

't randomly appear 10 years down the line. Also, fwiw, the doctor said that 40 grafts/cm2 would give the appearance of thinning. Given these parameters, do you think it's reasonable for lower NWs to ask this kind of thing?

Based on your response, it seems like a case-by-case basis which gives me the feeling that it is fairly reasonable to get your hairline lowered as a lower NW provided that there are a decent number of grafts and the progressive loss is fairly predictable and stable.

 

4 hours ago, Ajamilo said:

Do you have picture of your hairline and how low you want to lower it?

Well, it'd only be 0.5-1cm. Which iirc, it's 100 grafts per 0.1 cm from H&W. I could be wrong as I don't remember off the top of my head

 

[BLE123]

Same situation for me. 30 and NW2 with a high-ish hairline but I have pretty thick hair like one of those coconut mats, it's only the past 2-3 years that I've noticed the corners going slightly up and in. I'd also like to slightly lower the central part of the hairline by 0.5-1cm but I don't actually want a flat NW1 so the amount of grafts needed would probably be offset anyway.

Anyway, I don't think you're being unreasonable to want to lower the hairline, it doesn't sound like your local doctor is your best bet though. Do your research and find a surgeon who has a track record for similar cases.

Edited February 28, 2021 by BLE123

[nicoandgello]

19 minutes ago, deeznuts said:

Well you can't really say for sure even knowing the family history or the first noticeable recession I'd imagine. But let's assume it's just a fairly linear and slow recession (as evidenced by NW2 at age 30). And let's say it's fairly consistent so a bald spot won

't randomly appear 10 years down the line. Also, fwiw, the doctor said that 40 grafts/cm2 would give the appearance of thinning. Given these parameters, do you think it's reasonable for lower NWs to ask this kind of thing?

Based on your response, it seems like a case-by-case basis which gives me the feeling that it is fairly reasonable to get your hairline lowered as a lower NW provided that there are a decent number of grafts and the progressive loss is fairly predictable and stable.

 

Well, it'd only be 0.5-1cm. Which iirc, it's 100 grafts per 0.1 cm from H&W. I could be wrong as I don't remember off the top of my head

 

If you want to lower it by 1 cm it will be 1000 grafts because:

Temple to temple is usually 20cm, so 20 cm × 1 cm of height × average of 50 FUs per sq cm = 1000. 

Take a tape, measure your head and multiply by grafts you want in that area.

[Curious25]

51 minutes ago, deeznuts said:

Well you can't really say for sure even knowing the family history or the first noticeable recession I'd imagine. But let's assume it's just a fairly linear and slow recession (as evidenced by NW2 at age 30). And let's say it's fairly consistent so a bald spot won

't randomly appear 10 years down the line. Also, fwiw, the doctor said that 40 grafts/cm2 would give the appearance of thinning. Given these parameters, do you think it's reasonable for lower NWs to ask this kind of thing?

Based on your response, it seems like a case-by-case basis which gives me the feeling that it is fairly reasonable to get your hairline lowered as a lower NW provided that there are a decent number of grafts and the progressive loss is fairly predictable and stable.

You’ve hit the nail on the head, it’s absolutely a case by case basis. And although family history isn’t always a good indication as to where you will end up . .  More times than not, it is.
 

Because predicting an individuals future hair loss pattern as it stands in 2021 being an impossible projection to manifest, you almost have to clutch at straws with the small pieces of information that you are privy to, such as family history, age at onset of balding, balding rate, medication protocol, reaction to medication. protocol etc. to help ascertain as accurately as one can where the patient is likely to progress to. 
 

For what it’s worth, NW2 at 30 isn’t indicative of aggressive balding . . However it doesn’t mean you are completely off the hook, as some males maintain NW1 hair until they are in their late 30’s and early 40’s, only to then suddenly start to bald at a fast rate. It happens. It’s a totally unpredictable condition - but I would be confident in suggesting that more often than not, balding rates tend to slow as we age.
 

Most doctors would be comfortable in performing a hairline correction to a NW2 patient aged 30.  

Edited February 28, 2021 by Curious25