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Transplanting safely between existing hair


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Hi

I wanted to share my picture and wanted opinion on whether it’s safe to safely transplant hair between existing healthy hair in the frontal area that has lost density (but is not balding) compared to the rest of the hair on the scalp. The area that has lost density in encircled by the red line. Some clinics have said it’s safe while others have said it’s not. Wondering if lateral slit method or Stick and place technique would be better in this area if it’s safe to undergo transplantation. Thanks. 

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Interesting case...particularly since you seem to be thinning throughout the entire pattern.  Also notice well developed corners. So I venture to say there family history of hair loss. The next obvious "thing" is the stark color of your hair which is not helping you.  The contrast makes the loss even worse than what it is.  Fact wise, if you've lost, you will continue losing.  And, while it may be gradual, it will happen if you do nothing about it.  So the first thing to consider is medical therapy.  Hopefully you are doing something to protect the native stuff.  Can you transplant? Sure! Keep in mind doctors will typically work under magnification and can see/work easily through the native hair.  There are some very talented doctors out there that can actually achieve density in a single procedure.  Have you had any consultations yet?

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Whether its safe to transplant comes down to whether you want to take the risk of surgery and whether you are on medication or not -as its suggested to take fin so as to prevent shock loss to the surrounding vulnerable hairs. Most hairs lost by shock via the trauma of surgery return, but for some they do not. It really depends on how the patient responds to surgery

The lateral slit method is the type of incisions that are made. H&W invented it although ive seen some clinics perform sagittal slits as well.

Stick & place is the technique for how the grafts are placed ("stick"- making the incisions & "place" - place the graft) as opposed to making pre-made slits upfront then having the grafts placed at a later time. Another method is DHI. The reasoning behind why the stick & place technique is a better technique than pre-made openings is because the skin is elastic, so with pre-made slits the surgeons have to make the incisions larger to accomodate the grafts before the skin shrinks. These larger openings then have a greater impact on blood supply and thus a greater potential to adversely affect surrounding miniaturised hairs. With stick & place the incisions are specifically designed for the grafts about to be inserted, so are therefore smaller in nature (i.e. they accrue less scar tissue and minimise issues with blood supply). This is why it is the preferable technique for diffuse thinners whose hair is undergoing varying stages of miniaturisation throughout.

Without knowing your age, history, medications etc its VERY hard to give any advice, especially as youve only uploaded photos of your hair wet. Tbh it looks pretty lush to me, so If I were in your shoes Id try and enjoy what you have and maybe try medications first (if you aren't on any currently?).

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I would suggest not doing this. It's too risky and you risk shock loss with the existing hairs. You've provided photos with the worst conditions (wet and direct light). I would protect what you have now with finasteride/minoxidil and see how it progresses. 

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There is a case very similar to you by a forum member @duchaine now is it safe? That depends on the surgeon, their staff, how many grafts you're receiving, and whether you're on medication like finasteride.

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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.

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Thanks for the valuable insight guys.

im 45 and have never taken hair loss medication. The frontal zone (within the red lined boundary) hair thinning has been very gradual. It’s still ok I guess with no balding spots. It’s still a bit of bother for me. I’d get a transplant if there is no shock loss issue. The temporal points have been stable for decades now with no miniaturization happening on the sides. The center of the hairline hasn’t receded.

So for the temporal point bald spots lateral slit transplant would be best and for the thinning front zone stick and place would be used? Do doctors even use 2 methods in the same surgery?

There is no maj hair hoss history in my family. My hair loss pattern is very similar to my dad’s. He has the same temporal point recessions and no bald spots anywhere else. His hair isn’t even pure white but quite grey for his age as he’s approaches 80. 
 

Ill only go for a transplant if it’s safe and doesn’t damage existing hair. Filling in the temporal points shouldn’t be an issue. The thinning in this frontal region is homogenous throughout so either transplantation can be done in all this region or none at all. The consultations I done gave mixed reviews. Some say it can be done while others say it’s not recommended. Very confusing.
 

I’ll add more pictures to help understand the hair loss situation better. Thanks. 

 

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Would you consider trying medication for a year? If you go and check out Rassman's baldingblog he posts many cases of guys who have tried medications first and actually improved their hair loss situation. This thread by @Shifty shows how someone avoided a HT entirely by doing this (although he's clearly an outlier). Take some time to scroll through his thread which hes been updating for the last 2 years now 

Lateral slit and stick and place aren't mutually exclusive techniques, so yes they can both be used in the same surgery. Lateral slit has to do with the type of incision, whereas stick and place has to do with how the grafts are placed inside the incisions. 

For your specific amount of hair loss it can be a tough choice. The risks vs rewards might not be worth it, and you should be aware that you might end up in a worse state than when you started. The reason youre getting mixed responses from clinics is likely because of this, while also different clinics excel at different things and so might not be capable of pulling it off (and then some that are unethical and will tell you whatever you want to hear).

Consider medications (its a personal choice and might not be something you want to pursue), and try and take some time to find similar cases to your own on the forum. Message the guys privately and ask about their experiences/would they consider meeting you. I can see why your situation would bother you but nobody can promise you surgery is safe. The only thing we can help you do is make an informed choice about your own body and how to potentially mitigate any risks. 

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7 hours ago, Shah007 said:

Thanks for the valuable insight guys.

im 45 and have never taken hair loss medication. The frontal zone (within the red lined boundary) hair thinning has been very gradual. It’s still ok I guess with no balding spots. It’s still a bit of bother for me. I’d get a transplant if there is no shock loss issue. The temporal points have been stable for decades now with no miniaturization happening on the sides. The center of the hairline hasn’t receded.

So for the temporal point bald spots lateral slit transplant would be best and for the thinning front zone stick and place would be used? Do doctors even use 2 methods in the same surgery?

There is no maj hair hoss history in my family. My hair loss pattern is very similar to my dad’s. He has the same temporal point recessions and no bald spots anywhere else. His hair isn’t even pure white but quite grey for his age as he’s approaches 80. 
 

Ill only go for a transplant if it’s safe and doesn’t damage existing hair. Filling in the temporal points shouldn’t be an issue. The thinning in this frontal region is homogenous throughout so either transplantation can be done in all this region or none at all. The consultations I done gave mixed reviews. Some say it can be done while others say it’s not recommended. Very confusing.
 

I’ll add more pictures to help understand the hair loss situation better. Thanks. 

 

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You are literally a surgeons dream candidate for surgery. 
 

Your age, your hair loss pattern, your hair calibre - any surgeon worth his salt would be able to recreate your hairline and temple points for you, and leave you looking like an A lister! 
 

Medication won’t regrow your already bald temple areas, however may thicken your forelock, and stabilise the rest of your hair from any potential further loss. 
 

That being said, considering you have never taken medication, and looking at where you are at today factoring in your age and your family history that you briefly touched on, my non medical opinion would be that you are very unlikely to reach, let alone pass a NW5. 

The photo you have provided of the back of your head wet, presents some of the thickest hair characteristics amongst male patients. 

There is always a risk associated with any surgery, however after studying thousands upon thousands of cases over the years, I am confident that any top tier clinic would happily take you on and provide you with one of the best results this forum would see.  

Edited by Curious25
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3 hours ago, qui bono said:

Would you consider trying medication for a year? If you go and check out Rassman's baldingblog he posts many cases of guys who have tried medications first and actually improved their hair loss situation. This thread by @Shifty shows how someone avoided a HT entirely by doing this (although he's clearly an outlier). Take some time to scroll through his thread which hes been updating for the last 2 years now 

Lateral slit and stick and place aren't mutually exclusive techniques, so yes they can both be used in the same surgery. Lateral slit has to do with the type of incision, whereas stick and place has to do with how the grafts are placed inside the incisions. 

For your specific amount of hair loss it can be a tough choice. The risks vs rewards might not be worth it, and you should be aware that you might end up in a worse state than when you started. The reason youre getting mixed responses from clinics is likely because of this, while also different clinics excel at different things and so might not be capable of pulling it off (and then some that are unethical and will tell you whatever you want to hear).

Consider medications (its a personal choice and might not be something you want to pursue), and try and take some time to find similar cases to your own on the forum. Message the guys privately and ask about their experiences/would they consider meeting you. I can see why your situation would bother you but nobody can promise you surgery is safe. The only thing we can help you do is make an informed choice about your own body and how to potentially mitigate any risks. 

I don’t want to go on medication. Not comfortable with taking meds. It will not help my temporal points baldness anyways. 

So the insertion in the scalp can be done using the lateral slit method for a stick and place transplant as well? For my thinning area transplant would it be correct to assume that the best bet for avoiding damage to existing hair would be by going for a stick and place transplant?

Thanks!

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2 hours ago, Dr. Suhail Khokhar said:

Have you consulted with any surgeons? Where are you located?

Online consultations so far and like this discussion here, there have been mixed replies. I’m looking at a potential surgery a year or so from now as I build up my finances and the corona pandemic hopefully becomes manageable. I can travel anywhere for the right surgeon. Location is not a big issue. 

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3 hours ago, Curious25 said:

You are literally a surgeons dream candidate for surgery. 
 

Your age, your hair loss pattern, your hair calibre - any surgeon worth his salt would be able to recreate your hairline and temple points for you, and leave you looking like an A lister! 
 

Medication won’t regrow your already bald temple areas, however may thicken your forelock, and stabilise the rest of your hair from any potential further loss. 
 

That being said, considering you have never taken medication, and looking at where you are at today factoring in your age and your family history that you briefly touched on, my non medical opinion would be that you are very unlikely to reach, let alone pass a NW5. 

The photo you have provided of the back of your head wet, presents some of the thickest hair characteristics amongst male patients. 

There is always a risk associated with any surgery, however after studying thousands upon thousands of cases over the years, I am confident that any top tier clinic would happily take you on and provide you with one of the best results this forum would see.  

Thank you for the complements 😀

This is my dilemma. A successful transplant would be an amazing home run but if there’s damage to existing hair then I’ll be left worse off. 
One things for sure, I’ll have to go for the top surgeons to maximize the chance of a successful transplant for my tricky situation. So far in my limited research Dr Hasson and Dr konior’s results have really stood out. 

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6 minutes ago, Shah007 said:

So the insertion in the scalp can be done using the lateral slit method for a stick and place transplant as well?

yes.

6 minutes ago, Shah007 said:

For my thinning area transplant would it be correct to assume that the best bet for avoiding damage to existing hair would be by going for a stick and place transplant?

yes. But an in person consult should be able to tell you what degree of miniaturisation you have in that area - so your concerns about shock loss might not even be warranted. Even if you did lose more as you fear, you do seem to have excellent donor hair characteristics so as long as you were willing to consider further surgery down the line the risks might be worth it. Further surgery is always a possibility for anyone that starts down this HT route.

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1 hour ago, Shah007 said:

Thank you for the complements 😀

This is my dilemma. A successful transplant would be an amazing home run but if there’s damage to existing hair then I’ll be left worse off. 
One things for sure, I’ll have to go for the top surgeons to maximize the chance of a successful transplant for my tricky situation. So far in my limited research Dr Hasson and Dr konior’s results have really stood out. 

2 of the best names in the industry, so you are on the right lines. 

You can't guarantee a successful surgery, however you can mitigate the risks associated by choosing an elite surgeon or clinic - and I am very confident the two names you have already mentioned would happily take you on as a patient, and give you an amazing result.

I am going to link you a nice case that was posted on this forum that is partially similar to your own situation, and want you to consider;

-He was 15 years younger
-He had more advanced hair loss
-He didn't take meds
-He didn't go to what most on here would consider 'a world class clinic'
-He had a strong donor, however doesn't seem to be as strong as your own going off the pics
-The native hair mid scalp shock loss he may or may not have had, regrew, 

Enjoy 
 




 

Edited by Curious25
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4 minutes ago, Curious25 said:

2 of the best names in the industry, so you are on the right lines. 

You can't guarantee a successful surgery, however you can mitigate the risks associated by choosing an elite surgeon or clinic - and I am very confident the two names you have already mentioned would happily take you on as a patient, and give you an amazing result.

I am going to link you a nice case that was posted on this forum that is partially similar to your own situation, and want you to consider;

-He was 15 years younger
-He had more advanced hair loss
-He didn't take meds
-He didn't go to what most on here would consider 'a world class clinic'
-He had a strong donor, however doesn't seem to be as strong as your own going off the pics
-The native hair mid scalp shock loss he may or may not have had, regrew, 

Enjoy 
 




 

Yes 👏 and he even came back and provided us with a 3 year update ! And was still good. 

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Ok so I have done some online consultation for finding out the no of grafts I’ll need. The doc wanted me to draw the desired hair line which I’m showing in the pictures I’m attaching. I’ve been given a no of 1600-1800 grafts required. I also drew the boundary between the mid and front scalp. The encircled area between this boundary and hair line has been thinning and the doc is confident that it’s safe to transplant hair between existing hair. It’s a relief to hear that! 
Regarding density, I’ve been told    40-50 sq cm would be the target density. I’m not sure how much this density looks like. Hope thats dense enough. 

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Good hairline design. Graft count sounds about right as well.

50 FU per cm2 is pretty much a standard number given regarding the density of the hairline, with the areas behind it blending down to 40 (i.e. enough to give you the illusion of having a full head of hair). They will be always be a lot of variables in play like your donor hair thickness, skin to scalp contrast, how much remaining native hair is in the region etc that will effect the appearance of your final result, but ultimately if you like the docs work and they can provide similar examples of what's achievable thats all that matters. 

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On 4/5/2021 at 11:42 PM, Shah007 said:

Thanks for the valuable insight guys.

im 45 and have never taken hair loss medication. The frontal zone (within the red lined boundary) hair thinning has been very gradual. It’s still ok I guess with no balding spots. It’s still a bit of bother for me. I’d get a transplant if there is no shock loss issue. The temporal points have been stable for decades now with no miniaturization happening on the sides. The center of the hairline hasn’t receded.

So for the temporal point bald spots lateral slit transplant would be best and for the thinning front zone stick and place would be used? Do doctors even use 2 methods in the same surgery?

There is no maj hair hoss history in my family. My hair loss pattern is very similar to my dad’s. He has the same temporal point recessions and no bald spots anywhere else. His hair isn’t even pure white but quite grey for his age as he’s approaches 80. 
 

Ill only go for a transplant if it’s safe and doesn’t damage existing hair. Filling in the temporal points shouldn’t be an issue. The thinning in this frontal region is homogenous throughout so either transplantation can be done in all this region or none at all. The consultations I done gave mixed reviews. Some say it can be done while others say it’s not recommended. Very confusing.
 

I’ll add more pictures to help understand the hair loss situation better. Thanks. 

 

2E246981-6172-4C20-9DDF-807F858AC0FA.jpeg

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Your donor quality and density is exceptional. If you go to one of the names you mentioned, I don’t see how you wouldn’t get a stunning result. 

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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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15 minutes ago, Melvin-Moderator said:

Your donor quality and density is exceptional. If you go to one of the names you mentioned, I don’t see how you wouldn’t get a stunning result. 

That’s the plan if I go ahead with a transplant. Idk if H&W use the stick and play method like Dr K does. Tending more towards Dr K for this reason. His immediate post op pics are unreal. You can tell just by looking at them that his methods are the best bet against possible shock loss (which is basically my primary concern). Time to save up :)

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1 minute ago, Shah007 said:

That’s the plan if I go ahead with a transplant. Idk if H&W use the stick and play method like Dr K does. Tending more towards Dr K for this reason. His immediate post op pics are unreal. You can tell just by looking at them that his methods are the best bet against possible shock loss (which is basically my primary concern). Time to save up :)

H&W created the lateral slit technique which is equally good. They both have amazing post-op photos.

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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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7 minutes ago, Shah007 said:

That’s the plan if I go ahead with a transplant. Idk if H&W use the stick and play method like Dr K does. Tending more towards Dr K for this reason. His immediate post op pics are unreal. You can tell just by looking at them that his methods are the best bet against possible shock loss (which is basically my primary concern). Time to save up :)

I’d be tempted to hedge a bet this could be one of the greatest HT results of all time in Dr K’s hands. What was his waiting time ? 

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20 minutes ago, Curious25 said:

I’d be tempted to hedge a bet this could be one of the greatest HT results of all time in Dr K’s hands. What was his waiting time ? 

Just doing online consultation with them atm plus due to this corona pandemic I cannot travel anytime soon. Looking forward to HT in approx 12 months time. Saving up in the meanwhile. Quality never comes cheap after all but is well worth it in the end. 

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40 minutes ago, Curious25 said:

I’d be tempted to hedge a bet this could be one of the greatest HT results of all time in Dr K’s hands. What was his waiting time ? 

I understand youre tying to be supportive, but I dont think its helpful to raise expectations too much. The best we can do as patients is help educate one another through our own experiences and try to minimise any unnecessary risks. 

I went to highly regarded doctor and didnt get the best results. 

50 minutes ago, Shah007 said:

That’s the plan if I go ahead with a transplant. Idk if H&W use the stick and play method like Dr K does. Tending more towards Dr K for this reason. His immediate post op pics are unreal. You can tell just by looking at them that his methods are the best bet against possible shock loss (which is basically my primary concern). Time to save up :)

Might be worth asking how H&W will approach the thinning areas/will handle potential shock loss. Some clinics will transplant into native hair regions knowing you will one day lose them - thereby making issues such as shock loss and the need for further surgery redundant. 

Edited by qui bono
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35 minutes ago, Shah007 said:

Just doing online consultation with them atm plus due to this corona pandemic I cannot travel anytime soon. Looking forward to HT in approx 12 months time. Saving up in the meanwhile. Quality never comes cheap after all but is well worth it in the end. 

Absolutely spot on.

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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 hour ago, qui bono said:

I understand youre tying to be supportive, but I dont think its helpful to raise expectations too much. The best we can do as patients is help educate one another through our own experiences and try to minimise any unnecessary risks. 

I went to highly regarded doctor and didnt get the best results. 

Yea that’s fair enough - perhaps I am coming across a bit OTT in this instance, however I think it’s likely to stem from my initial confusion whilst first reading through this thread and seeing the uncertainty of responses regarding OP as a candidate, with even a doctor suggesting he was a bad candidate. For me, candidates don’t get better than this, for reasons I have outlined in my previous posts on this thread. 

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