31yo, 1st HT, destined for more -- front only, or front and crown?

[tremblant]

Hi,

Really sorry for the duplicate post, but I need some advice on how to do my first HT.

 

I'm 31, balding since 21, destined for complete baldness (dad/both granddads totally bald). Currently on Rog 2x/day, Fin 1.25mg/day (R for 10 yrs, Fin for 1 mo.).

 

Current level of baldness hard to rank, maybe closest to NW5? Looking at Bill pics before his first HT, I have about that level of baldness (complete bald spot for me at crown about 3-4" wide, and significantly thin across the front/top, however I have close to my natural hairline level except it is thin like the rest of the top). My crown loss may be a bit more than what Bill was, BUT I have black hair and white skin.

 

I spoke with a few surgeons, each advocate an initial surgery (I know I will def need more given my future loss) of 2000-2500 grafts -- HOWEVER, some say to put it all on the front/top now, while others say to put most on front/top and some (maybe 20-30%) on crown at the bald spot. I actually favor the latter, but worry that continued gradual hair loss will make the transplanted crown hairs more conspicuous? [as discussed in point #2 on page 3 of this article: http://www.dricohen.com/news/A...etworkwithHeader.pdf

 

Those who advocate leaving the crown alone for a year and doing the front/top first -- then I'm left with at least a year of being self-conscious about the bald spot before going for another surgery to address the crown ... although front density is important given that it's thinning to where scalp is visible... which way is best for first surgery, given that I'm destined to lose all my natural hair?

 

 

Also, any difference in using a coalition surgeon vs. non-c, provided that the non-c surgeon uses ultra-refined FUG and has good patient testimonials and extensive experience?

 

Thanks in advance for your comments and sorry Bill if you didn't want your pre-op pics brought to attention! But you have had a great result though.

[Dr. Glenn Charles]

The most conservative approach is to have the front 1/2 including the hairline done first. It is probably smart to prioritize. Most patients agree that the front is more important than the back. When you spread the grafts out over a larger area in younger patients like yourself, tend to be dissatisfied with the results because the density is not what they were hoping for.

[tremblant]

Dr. Charles,

Thank you for the reply.

I imagine you would still hold the same opinion if I were to tell you that I am willing to have a follow-up surgery one year after the first?

[hairthere]

tremblant, your other option is to go for more grafts. I would consult some other docs such as h&w, feller, shapiro, etc.

[tremblant]

Originally posted by hairthere:

tremblant, your other option is to go for more grafts. I would consult some other docs such as h&w, feller, shapiro, etc.

 

That wouldn't be considered "blowing my donor" site too soon (if I put 3000+ grafts in the first procedure to spread some into the crown too)?

[hairthere]

tremblant, Firstly, it would be a good idea for you to post some pics, along with your family history of hairloss and any other relevant info so we can give you a more accurate opinion.

 

Secondly, the term "blowing my donor" usually refers to when a patient uses all of his donor prematurely to build an aggressive hairline without leaving much for the vertex and crown. Megasessions of 4k plus are becoming more commonplace. I had 2k put into my hairline/frontal area and 1200 in the crown in my first surgery and I still have plenty left in the donor reserves. But everyone's different which is why you should provide your info/pics if you want proper advice.

[Tao]

Tremblant,

 

I was in the same boat as you. I was losing my hairline, but it really bothered me also having that large shiny white crown blaring for all the world to see. I needed two procedures for sure and I had doctors willing to go either way (doing only the front first, or doing a little of both). Dr. Konior convinced me to start with the front first, reasoning (correctly, as it turns out) that that would have the most immediate impact. I went with his professional opinion and lo and behold, he was dead spot on. The framing of my face has had a dramatically positive result and most people actually cannot see my still sparse crown unless they're over me. Now, when I look in the mirror, I always smile as the result was pretty miraculous.

 

I'm headed back for HT #2 in June and am looking forward to covering my crown. However, Dr. Konior may add 100 or so grafts to the front to fine tune it. The good new is that I won't need to be shaved down for the second HT (I wasn't for the first either as I had about 2700 grafts and Dr. Konior is extremely patient and skilled). That should make the re-entry back into society much quicker.

 

I think if i had had some grafts placed in my crown during my first HT, I would have been disappointed with the results as the density would have been disappointing and the cosmetic difference much reduced. The way I went, the cosmetic difference was dramatic (though not complete), I'm extremely pleased, and now I get to finish it off with the crown work. If you go the other route, you may end up in the same place, but you may have to wait years (2 HTS and two waiting and growing periods) to finally get the dramatic cosmetic difference that we all want.

 

That said, if you go to H&W or some other place that does mongo megasessions and you have the right donor characteristics (and that's not a sure bet), you could get more done during the first HT, giving you the option to hit the crown in that session as well as the frontal portion. For me financially, two sessions worked better as I saved and then payed off the first one and am now saving for the second one. If I had the dough up front though, that likely would have influenced me. But maybe not.

 

Just my .02 cents based on my own experience. Good luck with whatever you decide.

[tremblant]

Hi Guys,

Thanks for your replies. Hairthere, I appreciate your reply; I'm not ready to post pics yet however.

 

Tao, thank you very much for your comment -- I'm glad that your decision worked out best for you. I think we may have different levels of balding at the crown though, since I have a complete white spot several inches across, and you mentioned that "most people actually cannot see my still sparse crown unless they're over me". I would have thought that standing behind you they could see a bald spot pretty easily.

 

I hear your argument for tackling the front only though for the first HT and it's pretty compelling. Maybe I could see if some grafts could be extended a bit further back on the top towards the crown to decrease the white spot radius by a bit (I guess provided it didn't sacrifice much front density).

 

Thanks again.

[Tao]

Tremblant,

 

I'm exaggerating some when I say no one can see my bald crown unless they are above me. From the back, yeah, I'm sure they can see it. However, if I'm talking to someone face to face, they can't see it now because of all the hair I have up front. Let me be clear, I have a pretty baldy crown still and I had your exact concerns. I was almost willing to do the crown first and work my way forward. But I listened to the doc and he was right. The most impact with the first transplant was accomplished by doing the front first. For my second one, the doc will take a hunderd grafts here or there and shore up the front a little and then fill in the crown with the rest. Believe me, I'm quite excited about finally losing the glaring bald crown. But I wouldn't do anything different.

 

Cheers (and good luck).

[tremblant]

Tao,

Thanks for the clarification. Out of curiosity, are you genetically destined to become a NW6/7? Also, what is your hair and skin color if I can ask?

 

Thanks so much again for your input.

[Tao]

Tremblant,

 

I'm 42 and my hair loss has pretty much stabilized. I think I would have been categorized as a NW5 as I lost most of my hair from the front all the up to and past my crown. Fortunately, I have a lot of donor hair with good characteristics (mainly quite thick and coarse). I received about 2750 graphs to my front and will get about that much to my crown. My hair is dark brown and my skin is white so it's not the greatest combination. However, my coarse hair is working well in my favor.