HT advice for unconventional balding pattern

[thebaldingkid]

Hi everyone! 

Another lurker here (been around for over 10 years technically, but let the Toppik do its work for far too long), but I finally feel it's time. 

I am 31 and have been balding since I was 17-18. I have a bit of an odd pattern in that my hairline has remained relatively strong (maybe a bit of lift, but not concerned at all right now). My crown has quite severely balded at this point though, and have pretty serious diffuse thinning on the temple as well. Photos below.

I live in London, and while I am willing to travel for a FUE procedure, my research has given me some confidence in Dr. Arshad in Leeds for now. I am aware that his results have been hit-and-miss in the past, and not everyone is 100% confident in his work.

All that said, I would love to get some educated advice from the community here, given the amount of compounded experience and kindness I've seen. Given this balding pattern and the need to seriously fill the crown area and alleviate the diffuse thinning: A) any sense of whether a single procedure could make a good dent in this? I'm open to 3000+ grafts; and B) any doctors to recommend who seem to have the best results for these particular areas?

PHOTOS (intentionally done under quite harsh lighting):

[Melvin- Admin]

I have seen some excellent results in the crown particularly from Dr. Arshad. I think you should plan for two-part procedure. First procedure should address the crown and upper midscalp, it’s the biggest area of concern. Second procedure should address the frontal third, to reinforce it with additional density. 

The crown/midscalp will require at least 3,500 grafts minimum. You have a large degree of hair loss. You will need a lot of grafts especially in the crown. Here’s the area I would have mapped out. 

[thebaldingkid]

Thanks so much for the quick reply @Melvin- Moderator! I was told about 2 years ago in a consultation that 2500 would be recommended, but it has certainly advanced and 3500+ seems reasonable (though I may not have fully realised it until now). Very much appreciate the advice.

Do you think it would be ill-advised to see if there is any room for some additional density in the front in the first procedure (provided it doesn't take away from the area of larger importance that you pointed out)?

Edited July 6, 2022 by thebaldingkid

[Melvin- Admin]

2 minutes ago, thebaldingkid said:

Thanks so much for the quick reply @Melvin- Moderator! I was told about 2 years ago in a consultation that 2500 would be recommended, but it has certainly advanced and 3500+ seems reasonable (though I may not have fully realised it until now). Very much appreciate the advice.

Do you think it would be ill-advised to see if there is any room for some additional density in the front in the first procedure (provided it doesn't take away from the area of larger importance that you pointed out)?

I wouldn’t touch the front. The back needs 100% full attention. The crown is particularly difficult because of how the hair is angled, and the sheer size. You also need a fair amount of grafts in the middle. It’s by no means a small or easy procedure. The surgeon should invest their attention to the crown the first round. 

[mr_peanutbutter]

are you on meds?

[asterix0]

51 minutes ago, mr_peanutbutter said:

are you on meds?

Yes, this is crucial, as your front is thinning as well and without meds is almost certain to be slick bald. 

[Rahal Hair Transplant]

The balding kid,

Out of curiosity, have you ever had an in-person evaluation with any hair transplant surgeon you are considering? I’m only asking because I’m concerned given your hair loss pattern that the donor area may be experiencing miniaturization.  

I’m not saying that is the case nor suggesting it based on photos but strictly because there are cases where men with diffuse thinning patterns possess DUPA (diffuse unpatterned alopecia). If this is the case and the hair on the sides back of your scalp is experiencing any signs of miniaturization, you may not be a good candidate for hair transplant surgery at all.

So just to be sure, I would definitely consult either with a dermatologist or do an in-person consult with any hair transplant surgeon you are considering to have your donor area evaluated as well. 

Assuming that you don’t possess DUPA and there is no signs of miniaturization  on the sides and back of your head, I would think approaching your case would be similar to any other.  This includes grafting from the front to back although in your case, you’re not going to need nearly as much hair in the front to re-create the hairline and / or temple areas.

Instead, most of the donor hair in the first procedure can be placed in the mid scalp and the upper part of your crown with just enough in the frontal region to give you a nice natural, conservative looking hairline.

Then, assuming you have the donor hair for it, you can undergo a second procedure to add density to the areas previously transplanted and work on thickening the lower crown region.  But again, this will all depend on available donor hair not just in a single procedure but over lifetime. Dr. Rahal possesses and uses a scientific formula to calculate this.

equally as importantly, if you’re not on hair loss medication finasteride, I strongly suggest considering it in order to slow down, stop or even reverse the progression of male pattern baldness. If your hair is continuing to thin at this stage, transplanting hair in his areas may expedite the progression of genetic hair loss and the end result will likely be a net loss or an equal amount of hair rather than a net gain.  

if I can be of any additional assistance, please let me know.  

Best wishes,

Rahal Hair Transplant 

Edited July 6, 2022 by Rahal Hair Transplant

[Rahal Hair Transplant]

In going back and looking through the photos that show your donor area, I am honestly beginning to think it’s possible that you possess signs of miniaturization on the sides and back of your scalp. Again, I don’t want to draw any conclusions especially because they’re just photos, but I can definitely see some thinner looking areas in the donor area.

In my opinion, before really thinking and preparing for surgery, I would get an in person evaluation to see if there’s anything going on in those regions.  If you possess DUPA, hair transplant surgery is not going to be a good idea.

Because of the principle of “donor dominance”, hair always maintains its original properties.  That’s why hair removed from the sides and back of the head don’t thin out when moved to the balding areas. They start out DHT resistant in the donor area and retain their DHT resistant properties when moved.

But if these hairs are miniaturizing and not DHT resistant, they will also maintain those properties when moved.  So it’s very important that hair in the donor area is DHT resistant or any hair that’s moved would likely thin out and disappear just as the natural hair in that area did.

Rake a look at the circled areas in the photos you presented. Now in the one photo with the smaller circles, it’s possible that’s brown hair and not scalp but it just happens mass exact color of your scalp so it looks thin to me. That’s why I’m concerned that there might be miniaturization which really needs to be checked before undergoing surgery.

Best wishes,

Rahal Hair Transplant 

Edited July 6, 2022 by Rahal Hair Transplant

[thebaldingkid]

1 hour ago, mr_peanutbutter said:

are you on meds?

I got on finasteride a couple of years ago, but was experiencing some uncomfortable brain fog. I've just reordered and am going to restart and see how I go. I realise that it's advanced quite a bit.

[thebaldingkid]

Thank you for the look. I am having an in-person consultation in the next few weeks and will definitely ask about this. Fingers crossed.

2 minutes ago, Rahal Hair Transplant said:

In going back and looking through the photos that show your donor area, I am honestly beginning to think it’s possible that you possess signs of miniaturization on the sides and back of your scalp. Again, I don’t want to draw any conclusions especially because they’re just photos, but I can definitely see some thinner looking areas in the donor area.

In my opinion, before really thinking and preparing for surgery, I would get an in person evaluation to see if there’s anything going on in those regions.  If you possess DUPA, hair transplant surgery is not going to be a good idea.

Because of the principle of “donor dominance”, hair always maintains its original properties.  That’s why hair removed from the sides and back of the head don’t thin out when moved to the balding areas. They start out DHT resistant in the donor area and retain their DHT resistant properties when moved.

But if these hairs are miniaturizing and not DHT resistant, they will also maintain those properties when moved.  So it’s very important that hair in the donor area is DHT resistant or any hair that’s moved would likely thin out and disappear just as the natural hair in that area did.

Best wishes,

Rahal Hair Transplant 

 

[thebaldingkid]

2 hours ago, Melvin- Moderator said:

I wouldn’t touch the front. The back needs 100% full attention. The crown is particularly difficult because of how the hair is angled, and the sheer size. You also need a fair amount of grafts in the middle. It’s by no means a small or easy procedure. The surgeon should invest their attention to the crown the first round. 

This makes sense. I'll see what I hear from an in-person consultation, but I think that strategy makes sense given the amount of area that needs to be covered. That's providing the donor area is found to be strong...

 

Thanks again.

[Mike10]

I also have doubts whether you're a candidate for HT

[Eugenix Hair Sciences]

12 hours ago, thebaldingkid said:

Hi everyone! 

Another lurker here (been around for over 10 years technically, but let the Toppik do its work for far too long), but I finally feel it's time. 

I am 31 and have been balding since I was 17-18. I have a bit of an odd pattern in that my hairline has remained relatively strong (maybe a bit of lift, but not concerned at all right now). My crown has quite severely balded at this point though, and have pretty serious diffuse thinning on the temple as well. Photos below.

I live in London, and while I am willing to travel for a FUE procedure, my research has given me some confidence in Dr. Arshad in Leeds for now. I am aware that his results have been hit-and-miss in the past, and not everyone is 100% confident in his work.

All that said, I would love to get some educated advice from the community here, given the amount of compounded experience and kindness I've seen. Given this balding pattern and the need to seriously fill the crown area and alleviate the diffuse thinning: A) any sense of whether a single procedure could make a good dent in this? I'm open to 3000+ grafts; and B) any doctors to recommend who seem to have the best results for these particular areas?

PHOTOS (intentionally done under quite harsh lighting):

You would require around 2500 grafts approximately for the crown transplant.

 

9 hours ago, thebaldingkid said:

I got on finasteride a couple of years ago, but was experiencing some uncomfortable brain fog. I've just reordered and am going to restart and see how I go. I realise that it's advanced quite a bit.

Finasteride should help you with prolonging baldness and also in maintaining the transplanted hair.

[Z--]

Dude, we have nearly the exact same hair loss pattern and hair type (thick black). You are very likely going to thin in the front -- you can see in Photo 3 that the midscalp and hairline look thinning.  

Obviously defer to actual doctors, but I would focus on front first. It'll look super weird if you have a full crown but no hairline...

Perhaps @DrTBarghouthican weigh in on whether this looks like DUPA and the best approach? 

[thebaldingkid]

2 hours ago, Z-- said:

Dude, we have nearly the exact same hair loss pattern and hair type (thick black). You are very likely going to thin in the front -- you can see in Photo 3 that the midscalp and hairline look thinning.  

Obviously defer to actual doctors, but I would focus on front first. It'll look super weird if you have a full crown but no hairline...

Perhaps @DrTBarghouthican weigh in on whether this looks like DUPA and the best approach? 

Interesting! Yeah I haven't seen any cases of this really, so thanks for the advice. I do find that my daily troubles do come more from being unable to style/control the thinning hair at the front and it quickly becoming a mop (no matter how many fibers I have in). This has gotten much worse in the past few years. 

That said, a fuller crown is also a total lifelong dream at this point. I will see what doctors say about my candidacy and what they think will happen. It's good to hear from someone with this pattern though. Thanks!

[thebaldingkid]

10 hours ago, Eugenix Hair Sciences said:

You would require around 2500 grafts approximately for the crown transplant.

 

Finasteride should help you with prolonging baldness and also in maintaining the transplanted hair.

I am in touch with your clinic, so we'll see what they say. Thanks.

[mcr7777]

Do you have itching with hair loss?  Your pattern looks similar to some cases of LPP (lichen planopilaris)

 

I'd suggest seeing a hair specialist derm (not a HT surgeon) before going forward with any surgery  to be certain.

Edited July 9, 2022 by mcr7777

[thebaldingkid]

On 7/9/2022 at 10:19 AM, mcr7777 said:

Do you have itching with hair loss?  Your pattern looks similar to some cases of LPP (lichen planopilaris)

 

I'd suggest seeing a hair specialist derm (not a HT surgeon) before going forward with any surgery  to be certain.

Interesting. I used to get a lot more itching, but not much anymore. The scar you see on the centre right of the crown is from surgery done 12 years ago to remove a lump of aplasia cutis that I had since birth. It did feel like the thinning had accelerated for a time after that surgery.