Long term Strategy to maximize available grafts and density

[Djd0020]

Hi, 

 

I am a long time lurker and first time poster. 

Details

AGE: 32

NW: about a 3 with thickish midscalp and crown

history: dad NW 5 and Brother NW4 wispy

Medication history:

finasteride (20-26)

minoxidil foam (21-31)

Dutasteride (26-present)

Oral minoxidil (31-present)

 

My question is really about what kind of hairstyle can I rock to have the fewest surgeries over time, but maximize the density of the hair? 

- I basically want to build a master plan already. My thinking is that if make sure not to broaden my hairline much at all, but maybe lower the very center point, this will enable me to defend a smaller area in the future while continuing to give my face a frame of reference.

This is all about math IMO.

This is because I have a strong feeling that my hair in the midscalp, frontal third and forelock area will continue to slowly thin over time. 

My consultations with Dr's suggest 1500-1800 grafts to restore hairline. 

My donor area is very thick and feels like an entire head of hair on the back of my head. 

 

Pre-selecting an area is basically determining future hair styles.  

 

These styles below are what I am talking about. They all require a somewhat lower center point but less broad in the hairline and temples. This amounts to less area to defend with grafts. Final picture is my hairline. 

 

I am open to general help/direction and criticism.

 

Thanks for any input and happy to be a part of HRN. Also big thanks go out to @Melvin- Moderator for all you have done for the community ! 

 

 

 

Edited June 30, 2022 by Djd0020

[NARMAK]

Honestly, with that sort of medication stack, Dutasteride and Oral Minoxodil, your hair loss would have to be extremely aggressive and you'd be unlucky if you're taking a full 0.5mg everyday of Dutasteride and somewhat high dosage of oral Minoxodil. 

I'm of the opinion that you can be conservative in the hairline design BUT imo, a higher temporal area and lower middle actually makes it look like you're receding more. Mainly because a Norwood 3 pattern of hairloss is deeper temporal recession. Lowering them down actually would give better framing. 

I'm genuinely not sure we can do a proper gauge of your hair with that final picture. Post a few more including donor, midscalp and crown as well as another frontal with maybe the hair more pulled back to expose the frontal hairline fully. 

Personally i think hair loss becomes less aggressive as we age but it's not 100% guaranteed as we don't really know whether it's the fact that our most vulnerable hair is being protected and the loss staved off by medication or something else that abates with age. 

So, we could preventative have Finasteride etc. at our late teens, early 20s and then stop in our 30s and if that block is gone, it may seem really aggressive. 

[Djd0020]

18 minutes ago, NARMAK said:

 

I'm of the opinion that you can be conservative in the hairline design BUT imo, a higher temporal area and lower middle actually makes it look like you're receding more. Mainly because a Norwood 3 pattern of hairloss is deeper temporal recession. Lowering them down actually would give better framing. yeah this is what im trying to decide is what the points should be? whats the right ratio? 

I'm genuinely not sure we can do a proper gauge of your hair with that final picture. Post a few more including donor, midscalp and crown as well as another frontal with maybe the hair more pulled back to expose the frontal hairline fully. agree and will do

Personally i think hair loss becomes less aggressive as we age but it's not 100% guaranteed as we don't really know whether it's the fact that our most vulnerable hair is being protected and the loss staved off by medication or something else that abates with age. I dont know if I agree or disagree. For my own case its not true but I caught my loss very very early. 

For my case I can feel and tell a large difference between the NW4 area and the sides/back of my head in terms of hair quality/caliber/density/thickness. 

I think for my scalp, medication has simply changed how many hair cycles all of my DHT susceptible follices will have. They are like Frankenstein hairs in that I KNOW they would be dead without Medication but as long as I am on it, I have X amount of years left. 

 

 

 

[GaryStruthers]

I think the 2nd pic (Ryan Reynolds) a good one. How did you feel about switching to oral Min? Extra hair growing in places that you don’t want, or is it manageable?

[Boomerang]

1500 - 2000 grafts seem reasonable depending on what density and how low you want to target, it’s a personal choice. Personally I would stick with hairline design close to where it is with added density, considering your age. So probably 1200 to 1500 grafts.

you’ve done done well preserving lot of hair to 32. Looking at you pic, looks like it’s working for you. Your hair look dense on top.

I would also add micro needling once a week. From personal experience, it worked for me. Made hair thicker and improved scalp quality like no dandruff etc. I just had HT 4 months ago so not needling at this stage but with resume after 1 complete year.

don’t discount the impact of your medication. I was on fin for 7-8 years from 22 to 29/30. Then stopped for 8-9 years coz we were planning to have kids. Got 3 beautiful healthy kids. But I lost a lot of ground in hair. Back on fin now for 2 years and hair shed has stopped. 

Good luck! This is a wonderful forum full of wonderful people and you are here at the right time.

[Djd0020]

Gary:

I never saw results from topical min but the topical foam made my hair feel thicker so i continue to use it.

 

i took oral min and have had to really up the dosage. My first 6 months was insane. Like I went wolfy but then it slowed a lot and was totally managable. 

 

I lost a lot of ground between 2021-2022 due to a post covid shed. I had a really bad case of covid and lost hair all over my head and hairline didnt come back.

 

Boomerang,thanks for the comments!

do you notice how thick your native is compared to areas that are probably more dht susceptible?

 

i also got off dut for making a kid in 2021 and lost a bit there as well.

[Boomerang]

2 hours ago, Djd0020 said:

Gary:

I never saw results from topical min but the topical foam made my hair feel thicker so i continue to use it.

 

i took oral min and have had to really up the dosage. My first 6 months was insane. Like I went wolfy but then it slowed a lot and was totally managable. 

 

I lost a lot of ground between 2021-2022 due to a post covid shed. I had a really bad case of covid and lost hair all over my head and hairline didnt come back.

 

Boomerang,thanks for the comments!

do you notice how thick your native is compared to areas that are probably more dht susceptible?

 

i also got off dut for making a kid in 2021 and lost a bit there as well.

Yes I could definitely tell what hairs are DHT susceptible. They felt thinner and didn’t grow as fast. Native hair on top grew as fast as hair at the back of head.  But in my case dermaroller definitely made a difference. After 6 months of needling I could tell DHT susceptible hairs were thickening.

Also mistake I made when I hopped off fin for having kids is that I stopped minox as well and wasn’t micro needling either. I believe if I had continued minoxidil and started needling I could have saved some roots. As YouTube got more popular I learnt a lot from guys like Derek, Melvin, Rolandas and Matt Dominace . In my case they helped a lot. Huge thanks to them for sharing their experiences.

[Djd0020]

Update:

Here is an example of sort of the long term thinking that I am concerned with. This fellow had aggressive early loss while I have slow loss but a defined pattern or slow miniaturization of the entire NW4 area. 

 

If I book the FUE I am considering, it will be with this type of result in mind for the long term. The FUE to my hairline will be enough to frame my face while I have the option of growing it out for a while or straight to 0 guard buzz or clipper to nothing. 

my path:

NW3 thick CURRENT --> hairline back to solid NW2.5 ish--> continued thinning even while on Dut---> buzz to 0-----> maybe 2nd HT for thinning areas. ---> buzz cut to 0 or grow out. 

 

All the while, I will have something of a frame for my face. 

 

Any thoughts or problems that you see with this?