How should I approach this ?

[NewHare]

I'm somewhere between a norwood 5/6 and have had 4 previous FUT procedures.  With a little help from dermatch I can pull off a fairly full appearance.  However I've noticed lately my frontal third is looking thinner.  I don't believe I have enough donor left to fill in the whole frontal area but I noticed I can comb my hair more to one side which 'covers' that fairly well leaving the other side open.  I'm thinking if I do this and then transplant into the 'open side' I should probably get better overall coverage, as opposed to filling in the whole frontal third.  The area seems to be about 8-9 sq inches (58 sq cm).  Those are my thoughts,  how would you approach this ?   Should I just target a smaller area, or fill in the whole frontal third ? 

I used conditioner when I took these photos which gives my hair a thinner look. I normally use a volumizing shampoo which gives it a thicker appearance. But I wanted to make it easier for everyone to see the area in question.

 

[NARMAK]

6 minutes ago, NewHare said:

I'm somewhere between a norwood 5/6 and have had 4 previous FUT procedures.  With a little help from dermatch I can pull off a fairly full appearance.  However I've noticed lately my frontal third is looking thinner.  I don't believe I have enough donor left to fill in the whole frontal area but I noticed I can comb my hair more to one side which 'covers' that fairly well leaving the other side open.  I'm thinking if I do this and then transplant into the 'open side' I should probably get better overall coverage, as opposed to filling in the whole frontal third.  The area seems to be about 8-9 sq inches (58 sq cm).  Those are my thoughts,  how would you approach this ?   Should I just target a smaller area, or fill in the whole frontal third ? 

I used conditioner when I took these photos which gives my hair a thinner look. I normally use a volumizing shampoo which gives it a thicker appearance. But I wanted to make it easier for everyone to see the area in question.

 

That's not just your frontal third, but extending into the midscalp. I know you said you have had 4 FUT procedures, but you haven't mentioned anything about having been on medication at all. 

If you aren't already, Finasteride is your first step. It may help restore the area if there's native hair there to save and thicken as there seems to be. Also, you could try Minoxodil as well but i personally recommend trying one thing at a time unless you want to be really aggressive and willing to commit to the routine. 

Overall, i think if you could even get any extra hair, it may be best to evenly distribute then use fibres to give a fuller appearance rather than making it look lop sided. 

[NewHare]

Thanks for the reply Narmak.  At my last consult the doc had told me not to go with meds as I had lost all or most of my native. Risk, reward.  So I never went with Fin or Minox, though now I believe that was poor advice as I am in fact losing more. That said, I just started on 5% Minox foam.  How would one go about getting a script for Fin ?  Should I ask my PCP or would it better to go to an ht doctor ?   Or can this be done with an online consult ?

Judging by my photos, how many grafts would I need to fill the area in ?? 

I thought it best to focus more grafts on a smaller area, though you're saying to spread them out evenly.  Could you tell me why you would take that approach ?   I'm concerned with a limited amount it might not make much of a difference. Though I do understand having a lop sided ht would not look good either. 

That's why I'm basically here, as this is a hard choice to make.  Having the help and input of the community is a great asset.

Helpfully other ht vets will jump in as well.

 

[Rahal Hair Transplant]

There is no doubt that the frontal area is rather thin looking. How far goes back is hard to see by those photos. You said that you may not have that much donor left. Have you undergone strip or FUE? If you have undergone strip, you may still have enough graphs available via FUE to transplant the frontal zone providing more density.

Before proceeding however, I think it’s worth exploring why you may have lost some hair in the frontal zone.  Did you actually lose hair or is that area of the scalp just still thin despite your transplant? If you did lose hair do you think it was natural hair or transplanted hair that you lost?  You could have just lost some additional natural hair due to the progression of male pattern baldness but if it’s transplanted hair that you lost, the question is, why?   My concern is, if it was transplanted that you lost, what’s to stop it from happening again if you get another transplant?

I look forward to your response.

Rahal Hair Transplant

[NewHare]

On 10/3/2022 at 2:19 PM, Rahal Hair Transplant said:

There is no doubt that the frontal area is rather thin looking. How far goes back is hard to see by those photos. You said that you may not have that much donor left. Have you undergone strip or FUE? If you have undergone strip, you may still have enough graphs available via FUE to transplant the frontal zone providing more density.

Before proceeding however, I think it’s worth exploring why you may have lost some hair in the frontal zone.  Did you actually lose hair or is that area of the scalp just still thin despite your transplant? If you did lose hair do you think it was natural hair or transplanted hair that you lost?  You could have just lost some additional natural hair due to the progression of male pattern baldness but if it’s transplanted hair that you lost, the question is, why?   My concern is, if it was transplanted that you lost, what’s to stop it from happening again if you get another transplant?

I look forward to your response.

Rahal Hair Transplant

Yes, my 4 previous procedures were all strip. 

It was somewhat thin after the procedures, though it has gotten worse over the last few months most noticeably.  I was able to conceal it fairly easily by styling up until let's say 6 months to a year. Now I need the help of Dermatch.

Much of the density in that area came from transplanted hairs, along with what ever native was left.  I'd have to say I probably lost both native and transplanted hair. 

What would cause transplanted hair to fall out if that is the case ? 

If I were to follow through with FUE, how many grafts I would need ?    

[GoliGoliGoli]

41 minutes ago, NewHare said:

I'd have to say I probably lost both native and transplanted hair. 

What would cause transplanted hair to fall out if that is the case ? 

 

How long ago was the surgery that transplanted hairs into this area? Was it pretty full illusion of density following the surgeries? How long did it stay dense? 

[NewHare]

21 hours ago, GoliGoliGoli said:

How long ago was the surgery that transplanted hairs into this area? Was it pretty full illusion of density following the surgeries? How long did it stay dense? 

 

My last surgery was back in 2007, which gave me a fairly good illusion of density.  And lasted up until about a year ago, more or less. But I really started to notice it thinning in the last few months.  Though yes, it certainly looked a lot better years ago.

 

 

 

[Doron Harati]

You need to upload good photos of your donor and use measure tape over the thin area for better estimation, you had 4 FUTs over the frontal area only?

How old are you?

[GoliGoliGoli]

 

3 minutes ago, Doron Harati said:

you had 4 FUTs over the frontal area only?

 

Ya I'm curious about the 4 previous as well, where were the recipient areas in these 4?

[GoliGoliGoli]

I have to say, this and a few other results where peoples transplanted hairs thin is pretty concerning. I get that donor hair is DHT resistant not DHT proof, but it seems like in some cases transplanted hairs end up falling out pretty rapidly (IE within 10 years or so). 

[NewHare]

On 10/5/2022 at 1:33 PM, Doron Harati said:

You need to upload good photos of your donor and use measure tape over the thin area for better estimation, you had 4 FUTs over the frontal area only?

How old are you?

No, the FUTs were spread out from the frontal to the crown. Though they were more concentrated in the front.

I'll just add the first two sessions were the old plugs (89'-90' +/-) That is what you see mostly in the hairline.  Back then they

pulled a few plugs out planted them in the hairline and crown and called it a hairtransplant.  We've come a long way.

I'm currently 65 y/o.  

 

 

 

 

 

[NewHare]

On 10/5/2022 at 1:37 PM, GoliGoliGoli said:

 

Ya I'm curious about the 4 previous as well, where were the recipient areas in these 4?

As I said, mostly in the front, though a few were planted in the crown as well.

 

On 10/5/2022 at 3:39 PM, GoliGoliGoli said:

I have to say, this and a few other results where peoples transplanted hairs thin is pretty concerning. I get that donor hair is DHT resistant not DHT proof, but it seems like in some cases transplanted hairs end up falling out pretty rapidly (IE within 10 years or so). 

 

Well my first HT (plugs) was +/- 1989-90, so yes it's been quite a while.  Though I was never on meds. I was told by a doc, that it wouldn't make much of a difference at that point.  Though I suppose that wasn't the best advice.  

Back when I first started (1990 ?) I was told to try Minox. It was very expensive then, and burned the hell out of my scalp so I just stopped it.  Probably a mistake on my part. 

 

 

[Dillpickle123]

I think you should consult with a HT surgeon, you may still have a bit of donor left and beard grafts even after the Fut procedures 

[NewHare]

On 10/7/2022 at 12:13 AM, Dillpickle123 said:

I think you should consult with a HT surgeon, you may still have a bit of donor left and beard grafts even after the Fut procedures 

Yes, I believe you're right Dill, however before I consult with an HT surgeon I was hoping to get some advice and insight from the group here.  How many grafts would I need ?  How does my donor look ? Would Minox, ect help ? What not to do ?  I think that would best help when I go to my consult(s). 

[Dillpickle123]

I think if you want the crown addressed 2500 graft for front and back your donor on the sides look good enough for fue and if you have a good beard that can be used for the crown don’t know if minox will work because the hair that fell out was transplanted? So wonder if it would couldn’t hurt but I personally don’t like it because you have to keep applying it to not lose gains rather have something more permanent 

[NewHare]

Thanks Dill. So you're saying 2500 would be enough for the front and crown ?  That's sounds good, I though it would be a lot more for both areas.  I was thinking maybe 2000plus just for the front third.