My donor capacity - Any guesses?

[SD1984]

Looking to get thoughts from some experienced members. What do we think based on the photographs? I've had my donor assessed by a top HT doc in Manhattan who said 4-4500 max for my donor, but another surgeon beleives that was a conservative number and we can definitely get more.

Based on all I know and have seen with many years of experience and knowledge, I really think things would max out around 5k before overharvest. The problem with the donor isn't the lack of density. It has that. The problem is its a VERY narrow area in person. The retrograde is obviously a huge factor which hurts a lot as I'm sure you can understand as you can only harvest so much from there until you run into serious problems with an overharvest appearance.

As far as my hair in general goes, my fear is the unknown. I'm now 36 yrs old (37 next month) and am not on Finasteride as it gave me a bad experience and it appears I am heading up sh-ts creek without a paddle considering my family's hair loss history of NW6's on my Father's side. Though I will say I'm in the process of getting a prescription for Oral minoxidil and even considering PRP. Now there IS a NW7 in my family (paternal grandfather), but can we all agree that if I was headed to Norwood 7 my hair would be much worse by now? But I just don't know sometimes, as even though the lateral humps are still kinda hanging on (I guess?), you can clearly see a horseshoe pattern forming. My mothers side of the family has immaculate hair, for what that's worth.

What are the odds in your guys' minds that the neck hair recedes up and I'm left with a legit Dr. Phil horseshoe by the age of 55? I have been in touch with a great HT surgeon and I told him I'm fully aware that there will be challenges after a potential hair transplant surgery, whether that means another surgery or two down the road or even having to wear a hairpiece behind what will be (hopefully) a beautifully reconstructed hairline.

Thanks in advance .

 

 

Edited July 8, 2021 by SD1984

[pre-screened]

1st - just given your issue with oral propecia - you should really look at trying topical solutions.....propecia or dut......if your in NYC think Dr.Weselly sells it........preserving what you have is vital as you move forward..... with your retrograde being quite extreme...........I'm not sure I'd do anything re:HT till you get things stablized for sure.......get baseline density measured by HT doc....implement medicine plan.......then revert a year later to see if its improved or halted the sitation.....think topical was made for someone in your shoes. ONLY then would I pull the trigger on a HT otherwise....without stablization your chasing your situation.

On the doner estimation you got is this for FUE/FUT? Again my first instinct on looking at your situation is that you are more than likely the model case for as much as possible FUT++, followed then by FUE to fix emergent loss in the future

[SD1984]

33 minutes ago, pre-screened said:

1st - just given your issue with oral propecia - you should really look at trying topical solutions.....propecia or dut......if your in NYC think Dr.Weselly sells it........preserving what you have is vital as you move forward..... with your retrograde being quite extreme...........I'm not sure I'd do anything re:HT till you get things stablized for sure.......get baseline density measured by HT doc....implement medicine plan.......then revert a year later to see if its improved or halted the sitation.....think topical was made for someone in your shoes. ONLY then would I pull the trigger on a HT otherwise....without stablization your chasing your situation.

On the doner estimation you got is this for FUE/FUT? Again my first instinct on looking at your situation is that you are more than likely the model case for as much as possible FUT++, followed then by FUE to fix emergent loss in the future

The estimation I got was for FUE. I know FUT would give me a bit more room but I really don't have much interest in FUT as it really only gets done in the US which I could not afford. I am looking at clinics overseas. When you say get "baseline density" measured what do you mean exactly?

As far as meds go I'm first going the route of looking into oral minox and PRP. Topical Fin would be a last resort.

I know trying to preserve what I have is huge, but also as noted I am open to the possibility of a hair system behind a trasplanted hairline.

Edited July 5, 2021 by SD1984

[Hair4Days]

The only reason to worry about stabilizing what you currently have is to prolong a second surgery so soon. The better advice would be to see what’s possible with surgery alone if you go completely bald up top. Then you don’t need to stress about committing to medication for life and dealing with any side effects. Expect to be fully bald, even if you won’t. Ask the doctors if your donor would allow for coverage from hairline to crown it you progressed to a Norwood 6. If they’re optimistic then you’re good. Medication or not 

[SD1984]

14 minutes ago, James C said:

The only reason to worry about stabilizing what you currently have is to prolong a second surgery so soon. The better advice would be to see what’s possible with surgery alone if you go completely bald up top. Then you don’t need to stress about committing to medication for life and dealing with any side effects. Expect to be fully bald, even if you won’t. Ask the doctors if your donor would allow for coverage from hairline to crown it you progressed to a Norwood 6. If they’re optimistic then you’re good. Medication or not 

Well fortunately I don't care about my crown. I'm VERY low maintenance in all of this which is a positive. Simply ending up with a framed face again a presentable frontal third when all this is said and done would leave me on cloud 9. I cringe when I see all these guys freak out about wanting more coverage on their crown area or being upset about light density in the front when meanwhile I'd kill for a decent hairline again, haha

With regards to no stabilization, I get it all, and have been talking at length with a HT surgeon about it all. As noted in my original post, I understand that I'm looking at 2 surgeries minimum, or some sort of hairpiece/transplanted hairline combo, with hair fibers and everything else forever. No problems with that here. Everything is on the table for me at this point as I've reached this critical point in my hair loss journey. I know I'll never ever have a full head of hair again or anything close to it. I guess I just get nervous about the very narrow and limited donor. It's one thing to have a result that will never give me what I really want (which I understand), but it's another thing to not have a donor that doesn't look right after 2000 grafts are extracted from it. As far as going bald and having enough donor, the doctor has assessed my photos several times and beleives my goals are realistic, though again, he knows that I know my result from surgery #1 will end up not being the best case scenario.

Edited July 5, 2021 by SD1984

[Hair4Days]

I think you’ll have enough donor for a thick front half, then less density as it flares back toward the crown. In a worst scenario a lightly covered crown. Which is fine and better then being bald. You also have a good beard which can be a good source. Your sides don’t look like they’re gonna drop that low. The crown may 

Edited July 5, 2021 by James C

[SD1984]

7 minutes ago, James C said:

I think you’ll have enough donor for a thick front half, then less density as it flares back toward the crown. In a worst scenario a lightly covered crown. Which is fine and better then being bald. You also have a good beard which can be a good source. Your sides don’t look like they’re gonna drop that low. The crown may 

I was told by another HT doc that my beard is 10/10 and they could harvest a LOT from it if need be. Now if only I could get that kind of growth on my head!! 🤣

I still don't really understand how beard grafts work though. So guys end up showing off 1,000 FUE scars under their chin whenever they shave forever? No thanks.

 

Edited July 5, 2021 by SD1984

[MachoVato]

9 minutes ago, SD1984 said:

I was told by another HT doc that my beard is 10/10 and they could harvest a LOT from it if need be. I still don't really understand how beard grafts work though. So guys end up showing off 1,000 FUE scars under their chin whenever they shave forever? No thanks.

You should do more research on beard transplants.

[SD1984]

1 minute ago, MachoVato said:

You should do more research on beard transplants.

It's one of the few areas left that I'm not really knowlegeable on. Can you explain? Do the scars heel differently?

[Berba11]

6 hours ago, SD1984 said:

It's one of the few areas left that I'm not really knowlegeable on. Can you explain? Do the scars heel differently?

I'm no expert on beard hairs/scars but from what I've seen, any scarring often looks very subtle. I suspect it's because a smaller punch is typically used to extract the grafts, it's under the chin where nobody is likely to see and they get consumed by the surrounding stubble.

I'd certainly be looking at a combo of scalp and beard grafts if I were you. To me that sounds infinitely better than going through PRP sessions & such like. It looks like you've still got plenty of hair to work with at the front, so wouldn't be needing that many grafts for the front? Were you given a quote for what you'd need to achieve what you wanted hairline-wise?

[SD1984]

1 hour ago, Berba11 said:

It looks like you've still got plenty of hair to work with at the front, so wouldn't be needing that many grafts for the front? Were you given a quote for what you'd need to achieve what you wanted hairline-wise?

The front is completely shot. Severely recessed temples and a forelock that is so thin you can see through it unless it's combed over which it is in the pics. The pictures and the dark hair make things look a lot better than they are. There has been no official quote yet as I have to be seen in person the morning of the potential surgery (overseas) but there is a ballpark number of I'd say 1500-1800 grafts needed to restore something decent at the hairline. It would be a very conservative hairline of course given the circumstances. Aand given the limited donor in general, I'm hoping it all can be pulled off with 1500, but I'm leaning towards a higher number as you really want to get some sort of density up front more than anywhere else.

[DrTBarghouthi]

@SD1984by the looks like of it, your donor would probably yield around 5000 grafts if not more with FUE. Ofcourse not all should be done in one go. Depending on actual examination, it might yield more based on head size and hair density. But I dont think it will yield anything less than that to be honest. 

[Melvin- Admin]

You have fairly aggressive retrograde alopecia. I would say you're probably around 5000 grafts max via FUE, and you will definitely see signs of surgery. If you were to combine FUE and FUT perhaps you could be at 6500. 

[SD1984]

1 hour ago, Melvin- Moderator said:

You have fairly aggressive retrograde alopecia. I would say you're probably around 5000 grafts max via FUE, and you will definitely see signs of surgery. If you were to combine FUE and FUT perhaps you could be at 6500. 

When you say signs of surgery you mean just a thinner back and sides, right? It's interesting because with my retrograde alopecia, perhaps thinning out my back and sides might not be such a terrible thing. Might blend better with the retrograde.. ?

[ML488]

A very narrow area indeed. I know your hair is grown out a bit so it's more pronounced, but it's as if the alopecia is literally attacking your donor in some of those pics. That being said I do think your "pattern" is pretty much set at this stage. Looks like a future NW5/6 as you alluded to. As far as a transplant goes it could work, but the donor makes me nervous. At the end of the day even though you still have a decent amount of (albeit thin) hair at almost 37 you still have a lot of life left to live. By 57 and without meds things certainly aren't going to get BETTER for your back and sides and what could eventually be a transplanted hairline. I'm sorry Fin didn't work out for you. Same here. If only scientists cared enough about hair loss research/drugs maybe we would have had something better in the last 25 years.

[Al - Moderator]

18 hours ago, SD1984 said:

Well fortunately I don't care about my crown. I'm VERY low maintenance in all of this which is a positive. Simply ending up with a framed face again a presentable frontal third when all this is said and done would leave me on cloud 9. I cringe when I see all these guys freak out about wanting more coverage on their crown area or being upset about light density in the front when meanwhile I'd kill for a decent hairline again

 

Be careful about areas you think you don't care about. Is it really because you don't care about crown loss or are you fooling yourself into thinking you don't care about it because you don't have much loss there to worry about NOW. What happens if you fill in the front, but in a few years you have a large bald crown? Think back to when you were maybe 17 years old. You probably didn't worry about your frontal hair loss then either, but that's because you didn't have any loss there to worry about. Now that you have hair loss in the front, you are concerned about it and you get more anxious and worried about it as it gets worse. Don't just assume you won't feel the same about crown loss if it starts falling out rapidly.

Just something to think about as you plan you hair transplants.

 

 

[Legend007]

The current going rate for a new hair  a left nut.. so if u don’t think saving your crown is important .. ask yourself would you be willing to give up your left nut for good crown coverage .. then u know how important it can be.. 🤨😃

 

[SD1984]

2 hours ago, BeHappy said:

 

Be careful about areas you think you don't care about. Is it really because you don't care about crown loss or are you fooling yourself into thinking you don't care about it because you don't have much loss there to worry about NOW.

2 hours ago, Legend007 said:

The current going rate for a new hair  a left nut.. so if u don’t think saving your crown is important .. ask yourself would you be willing to give up your left nut for good crown coverage .. then u know how important it can be.. 🤨😃

 

 

 

It's not that I don't care about my crown at all. It's just really not very important to me in the grand scheme of what's going on and it's also me being very realistic about my hair and what's capable. I don't have enough donor to give me solid coverage everywhere and even if I did I'm not one of these guys who would be up for returning to the chair 3-4 times. For me it's a 2 surgery mindset. It's taken years to get to this point mentally and to understand my hair, transplants, and the reality of my goals.

To understand that I have a limited donor and that each graft is crucial. Obviously I'd love my crown to be filled but that's just probably not in the cards for me. What's really in the cards is 2 surgeries, probably 2000 grafts a piece, giving me coverage everywhere except for the crown. I've also been a master with fibers and dermatch for years, so using those for my crown for many years to come would be no problem at all. Worse case scenario I also have no problem using a hairpiece back there one day down the road if it gets that bad, Ted Danson Cheers style.

[SD1984]

Nice fresh cut today. Hair cut a tad shorter than usual.

@Melvin- Moderator and others, do you think I could pull off this length after a 2000 graft procedure?

 

Edited July 6, 2021 by SD1984

[aaron1234]

On 7/4/2021 at 6:16 PM, SD1984 said:

What are the odds in your guys' minds that the neck hair recedes up and I'm left with a legit Dr. Phil horseshoe by the age of 55?

The good news is that you are 36 and you haven't lost your crown or lateral humps yet.  The bad news is that you are only 36 and you could still lose them.  You may not reach Dr. Phil's level of loss, but you don't need to to be in a bad situation.  Not being on fin is more or less daring mother nature to see how far down the NW scale she will take you.  Have you tried lower dosages or alternate days?  You still got a lot of native hair to preserve, so at your age it will only get worse unless you get serious about fighting it (topical fin?).

Edited July 6, 2021 by aaron1234

[Legend007]

I don’t think ur hair look  that bald .. just thinning hair,, Kinda natural progression of age .. I don’t know, but I would guess dr Phil, was losing his hair in his early 20 twenties to get to where he is now . 

[SD1984]

13 hours ago, Legend007 said:

I don’t know, but I would guess dr Phil, was losing his hair in his early 20 twenties to get to where he is now . 

Dr. Phil in 1986 (36 years old)

[Melvin- Admin]

On 7/5/2021 at 11:53 AM, SD1984 said:

When you say signs of surgery you mean just a thinner back and sides, right? It's interesting because with my retrograde alopecia, perhaps thinning out my back and sides might not be such a terrible thing. Might blend better with the retrograde.. ?

Yes overall thinning, perhaps it would look more homogeneous with the retrograde alopecia. You’re definitely more limited with your donor.

[Doron Harati]

For 1st procedure around 3500-4000+ grafts, if you'll need 2nd procedure it will be 70% minimum amount of the 1st procedure. 

[1978matt]

I think you could probably get up to 6000 in total before it starts to look rather thin at the back.

You really must go to a doc who doesn't waste a single graft.  depending on how the front looks, I'd only go 1500-1800 tops.  Surgeries 2 and 3 later down the line would be about 2000 a piece.  You will probably only have enough for the frontal 2/3rds at best.

A doctor utilzing a small punch and well spread out extractions should hopefully leave you with a reasonable 'get out' to cut things short in the future, but no real guarantees.