Lowering Hairline vs Filling in Corners (Pics Included)

[GoliGoliGoli]

Hey all, I'm going in for HT number 1 in November. Curious to get some thoughts on what I should do in my hairline. Overall I'm not too displeased with my current hairlines "depth" in regards to how far down my forehead the forelock extends, and have no plans to lower it by very much (if at all). I'm thinking I'll just fill in the corners. However one concern is that my forelock will continue receding and leave me with a "W" as opposed to an "M". So I guess I'm asking if it's best to plan for lowering the forelock a little to give the center of the hairline more of an "illusion of density", or if this is faulty thinking? Basically, do you guys think it's better to go with "option 1" (first pic, less aggressive) or "option 2" (second pic, more aggressive)?

I have pretty significant loss on my crown (Pic included)  so I'd like to put a lot of focus there which is another reason I'm leaning towards option 1 more than option 2 as it will save grafts. Also as mentioned above I'm cool with the "Depth" of the hairline at the forelock as it is, so I don't see any need to lower it aesthetically as long as the corners are filled in .I guess I just want to know if their are any reasons I'm missing that should make me consider going with option 2. I'm not on Fin/Dut but seem to respond quite well to Minoxidil. I know I will need another HT or two down the line. 

[GoliGoliGoli]

Also curious to know peoples estimates for how many grafts it would be for both option 1 and 2. 

Forgot to mention, I will be 1 month shy of 34 when I go in for my procedure. Donor is above average. Hair loss is relatively non-aggressive - I started balding around 24/25 so what you see is 9-10 years worth of gradual loss. Not diffuse as you can probably tell from the pics. 

Also, below is the unedited picture of my hairline for reference. Taken maybe 3 months ago before I started Minoxidil. 

Edited September 15, 2022 by GoliGoliGoli

[Hairy Henderson]

I would suggest uploading more pics with multiple angles.  You will receive more educated responses

[Curious25]

20 minutes ago, GoliGoliGoli said:

Hair loss is relatively non-aggressive

I’m afraid to be the bearer of bad news, but your loss would be classed as more towards the aggressive end, than non aggressive given the pictures you have presented us with. 
 

With regards to your hairline design, transplanting into the forelock will be necessary, not only to help ease the aesthetics for when future loss creeps up on you, but it already shows to be mildly diffusely thinning as it stands today.
 

A simple flat line across from the lowest part of your forelock won’t cut it in terms of naturalness, due to your temples showing recession also, therefore I would recommend some mild work in this area also, mainly focusing on the corner point connection from the hairline and upper temple region, which shouldn’t use up too many grafts. 
 

Without knowing your hair calibre or average groupings, I would hazard a guess of at least 3000 grafts for your frontal restoration, and between 2500 - 3000 for your crown.  

In an ideal world, you would look to restore the front over a 2 day period, (1500 grafts each day) . . . Wait 9-12 months, and go back to address the crown. 
 

The Spanish docs such as De Freitas and Lorenzo have historically lead the way and championed this form of step by step intervention, and it works very well; mitigating a lot of surgical risks, which potentially saves the patient thousands of grafts. 
 

All the best, 

[shiba1985]

40 minutes ago, GoliGoliGoli said:

Hey all, I'm going in for HT number 1 in November. Curious to get some thoughts on what I should do in my hairline. Overall I'm not too displeased with my current hairlines "depth" in regards to how far down my forehead the forelock extends, and have no plans to lower it by very much (if at all). I'm thinking I'll just fill in the corners. However one concern is that my forelock will continue receding and leave me with a "W" as opposed to an "M". So I guess I'm asking if it's best to plan for lowering the forelock a little to give the center of the hairline more of an "illusion of density", or if this is faulty thinking? Basically, do you guys think it's better to go with "option 1" (first pic, less aggressive) or "option 2" (second pic, more aggressive)?

I have pretty significant loss on my crown (Pic included)  so I'd like to put a lot of focus there which is another reason I'm leaning towards option 1 more than option 2 as it will save grafts. Also as mentioned above I'm cool with the "Depth" of the hairline at the forelock as it is, so I don't see any need to lower it aesthetically as long as the corners are filled in .I guess I just want to know if their are any reasons I'm missing that should make me consider going with option 2. I'm not on Fin/Dut but seem to respond quite well to Minoxidil. I know I will need another HT or two down the line. 

Option 1. No doubt. 

[GoliGoliGoli]

10 minutes ago, Calihome1 said:

I would suggest uploading more pics with multiple angles.  You will receive more educated responses

Sure, see attached 

[GoliGoliGoli]

11 minutes ago, Curious25 said:

I’m afraid to be the bearer of bad news, but your loss would be classed as more towards the aggressive end, than non aggressive given the pictures you have presented us with. 
 

With regards to your hairline design, transplanting into the forelock will be necessary, not only to help ease the aesthetics for when future loss creeps up on you, but it already shows to be mildly diffusely thinning as it stands today.
 

A simple flat line across from the lowest part of your forelock won’t cut it in terms of naturalness, due to your temples showing recession also, therefore I would recommend some mild work in this area also, mainly focusing on the corner point connection from the hairline and upper temple region, which shouldn’t use up too many grafts. 

Noted. I said "Relatively non-aggressive" just because I see stories of a lot of others who go from NW1 to NW5 or NW6 over the same period of time. But nevertheless I agree I am probably more on the aggressive side than non-aggressive side depending on how you define it. 

When you say "transplanting into the forelock" do you mean directly within the forelock or more "in front" of the forelock? If directly into the forelock, wouldn't I be trading native hairs for transplanted hairs due to shock loss? 

For reference, my Dr quoted me 2500-3000 grafts for the front, and 1000-1500 for the crown. However this was from pictures alone, not an in-person consult. When we had a video consult he said it may end up being less than 4000 needed but I think I'll end up closer to 4000 for the first HT. 

[GoliGoliGoli]

12 minutes ago, shiba1985 said:

Option 1. No doubt. 

Interesting, this seems in opposition to what @Curious25says!

[HairEnthusiast101]

In my opinion I’d say 1500 in the back and maybe 2500 in front. I’d do just the sides and then fill in the front of the forelock to make it look stronger but don’t make a completely new hairline. To be honest I think using rogaine in the forelock is plenty good for now and you don’t need to fill it in yet because it could just need some rogaine.

[Curious25]

4 minutes ago, GoliGoliGoli said:

When you say "transplanting into the forelock" do you mean directly within the forelock or more "in front" of the forelock? If directly into the forelock, wouldn't I be trading native hairs for transplanted hairs due to shock loss? 

Yes, and yes you will risk that. Different surgeons have different styles - Bisanga and H&W for instance both tend to transplant into thinning areas to account for future loss. Other doctors leave these sorts of transition zones alone, and just stick to completely slick bald areas. 

[GoliGoliGoli]

Just for reference, the HT James Van Der Beek got is kind of my inspiration. As @Melvin- Moderatormentions, he didn't lower his forelock at all, just filled in the corners. Perhaps he had some implanted into the forelock too but it doesn't look it it.

Similar to his case, I'm also happy to show some minor recession - I don't want a low/flat/straight hairline at all as I think it ends up looking childish for lack of a better term. Of course the difference between me and Van Der Beek is that I have significant loss on the crown and want to address both the crown and hairline in a single procedure, so need to be even more careful with how I plan to use the grafts. 

 

Edited September 15, 2022 by GoliGoliGoli

[FixMyHair213]

definitely option 1. the pic of james looks really good and natural. you will also save a lot of grafts if further hairloss occurs. 

[MKE 1968]

i agree with option #1

[NARMAK]

You need to be conservative as possible in the hairline design with an aim to preserve as much grafts as possible. 

You actually imo have got quite aggressive loss in terms of your crown and its when you pull the hair back and show the actual hairline quite high and probably Norwood 4 Vertex. Your beard looks like it could be a solid source of grafts for the future but you definitely will need to go with a conservative hairline and high. Which is also as a result of you not using if i'm correct, medication like Finasteride etc. 

Long term, you could with a proper plan account for future hair loss and multiple procedures necessary to keep it looking solid. 

[GoliGoliGoli]

1 hour ago, NARMAK said:

You need to be conservative as possible in the hairline design with an aim to preserve as much grafts as possible. 

You actually imo have got quite aggressive loss in terms of your crown and its when you pull the hair back and show the actual hairline quite high and probably Norwood 4 Vertex. Your beard looks like it could be a solid source of grafts for the future but you definitely will need to go with a conservative hairline and high. Which is also as a result of you not using if i'm correct, medication like Finasteride etc. 

Long term, you could with a proper plan account for future hair loss and multiple procedures necessary to keep it looking solid. 

I think I still qualify as NW3 V since I still have a pretty strong area between my crown and hairline!

But it's a immaterial distinction, the progression is towards NW4 and likely further so I think the advice of not being "aggressive" is the right approach. I was more wondering if their was any long term benefit to putting some in front of the forelock (Or within it, as Curious suggested) that I hadn't considered or heard discussed. 

And correct no Fin, I do seem to be a good responder to Minox though so I think that should at least allow me to delay. 

Edited September 16, 2022 by GoliGoliGoli

[Gatsby]

MPB is progressive so I would try and stabilize your hair loss with medication. The problem I see here is that your crown area will continue to grow leaving what you having transplanted grafts appearing like an island. So I would be planning surgery for the lifespan of MPB. If you are now only three months on minoxidil then I would not be having surgery until giving minoxidil a good 6-12 months at least to see how you benefit from the drug. All the best.

[GoliGoliGoli]

49 minutes ago, Gatsby said:

MPB is progressive so I would try and stabilize your hair loss with medication. The problem I see here is that your crown area will continue to grow leaving what you having transplanted grafts appearing like an island. So I would be planning surgery for the lifespan of MPB. If you are now only three months on minoxidil then I would not be having surgery until giving minoxidil a good 6-12 months at least to see how you benefit from the drug. All the best.

Thanks and well said. Definitely understand I'm going to need multiple HT's. Fortunately I should knock a good bit out of the way by getting 3500-4000 grafts with the first pass. If I'm able to get by with another 2 in my lifetime I would consider that a success. 

By the time of my surgery I will be a week shy of 6 months on Minoxidil. We'll see if Minox and Nizoral can carry the load and at least buy me some time

Edited September 16, 2022 by GoliGoliGoli

[mister_25]

2 hours ago, GoliGoliGoli said:

I think I still qualify as NW3 V since I still have a pretty strong area between my crown and hairline!

I wouldn't consider yourself a Norwood 3V. I would probably say you've just begun your transition into a Norwood 4. The crown is too large in my opinion to be called "beginning phases" of crown loss which is what Norwood 3 Vertex is. Its a slick bald patch that you commonly see in Norwood 4/5 patients.

Judging by my observations from all the transplants I've seen. You have a large amount of native hair left over and I think something around 2000 in the front and 2000 in your crown throughout your lifetime could be sufficient if you don't lose a significant amount of your native hair.. Maybe a tiny bit sprinkled in the midscalp if it looks thinner in certain conditions (wet/harsh lighting).

 

[Mike10]

You are NW3V at 34 which is more on the aggressive side. Further, you are considering HT without Propecia.  You need to be cautious here. You should  book a few physical consulations with well regarded Drs (like Dr Bisanga). Take your time and do not rush into anything.

 

 

[NARMAK]

11 hours ago, GoliGoliGoli said:

I think I still qualify as NW3 V since I still have a pretty strong area between my crown and hairline!

But it's a immaterial distinction, the progression is towards NW4 and likely further so I think the advice of not being "aggressive" is the right approach. I was more wondering if their was any long term benefit to putting some in front of the forelock (Or within it, as Curious suggested) that I hadn't considered or heard discussed. 

And correct no Fin, I do seem to be a good responder to Minox though so I think that should at least allow me to delay. 

The way i personally think about a hair transplant hairline is that i'm going to be looking in the mirror and seeing the front almost 99% of the time and people usually will see that 80% of the time, so it makes the most sense to visually make that look as nice as possible within a reasonable graft range. 

The crown is a black hole. You could probably put 4k grafts into it and it might still look sub par depending on certain factors. That's why personally i would seek to rebuild it using a middle amount of scalp and maybe strategic use of beard grafts and let it still look a little more thin and bolster the area with fibres. Similar principle with the midscalp where you can get away with using fibres a bit more. 

Ultimately and i've said this before, the only way we really solve the problem of a finite donor area is with those clone grafts eventually being figured out and we get an unlimited well of grafts, until then extremely careful use of donor area with medications/treatments to preserve hair is the best we got. 

[GoliGoliGoli]

Thanks for everyone's responses. I'm pretty much resigned to the fact that I will need multiple HT's as time goes on and I think my donor should be able to handle that. I'm just hoping Minoxidil will allow me to get at least 5 years or so between each one but maybe that's optimistic.

I'm also open to using SMP to create more of an illusion of density, although oddly I haven't seen a ton of examples around here of people combining HT's with SMP. 

[Delta Bravo]

Just now, GoliGoliGoli said:

Thanks for everyone's responses. I'm pretty much resigned to the fact that I will need multiple HT's as time goes on and I think my donor should be able to handle that. I'm just hoping Minoxidil will allow me to get at least 5 years or so between each one but maybe that's optimistic.

I'm also open to using SMP to create more of an illusion of density, although oddly I haven't seen a ton of examples around here of people combining HT's with SMP. 

Consult good clinics and take your time to go through each and everything in detail. It took me 6 years to decide a clinic. 

Wish you luck pal, keep us updated 

[Mike10]

13 minutes ago, GoliGoliGoli said:

Thanks for everyone's responses. I'm pretty much resigned to the fact that I will need multiple HT's as time goes on and I think my donor should be able to handle that. I'm just hoping Minoxidil will allow me to get at least 5 years or so between each one but maybe that's optimistic.

I'm also open to using SMP to create more of an illusion of density, although oddly I haven't seen a ton of examples around here of people combining HT's with SMP. 

But why do not you book some physical consultations?  They can assess your donor and do a miniturization mapping on the remaining hair. They will tell you about the risks of your strategy. At the very least, you will be a better informed afterwards. 

Edited September 16, 2022 by Mike10

[GoliGoliGoli]

11 minutes ago, Mike10 said:

But why do not you book some physical consultations?  They can assess your donor and do a miniturization mapping on the remaining hair. They will tell you about the risks of your strategy. At the very least, you will be a better informed afterwards. 

This is probably really good advice. TBH there aren't many reputable HT Dr's in my area (Dallas TX) so it makes doing an in-person consultation challenging. Arocha is in Houston but that's a solid 4 hour drive. Either way you're right, it's probably worth the time to drive down there. 

That said, I'm pretty confident that my donor is really strong and in good shape. I've spent a lot of time around here and have become able to see a strong from a weak donor, and my donor is pretty much as thick now as it was when I was 16. But I do agree with your point. 

[GoliGoliGoli]

I suppose I could also go for a consult with a "less reputable" Dr in Dallas. Maybe even if they aren't so reputable they are still a safe bet for examining the donor?