Eugenix (Drs. Das/Somesh/Vinita) | 11,102 grafts | NW 6/7 | 28 yrs old | 2022/2023/2024

[general-etwan]

Take my donor! Take it away! I want that beautiful dark brown hair on the top and around the crown. If we can achieve a full visual redistribution with this procedure, I expect I’ll be pretty satisfied for life.

Anyone think I need any more frontal work? I understand that my donor is limited. So I will want to take care of the crown and side ridges first. And I can always grow my hair longer in the front to help hide the hairline area. The problem is the receding temple areas. How many grafts would be needed for temple reconstruction? What do you think?

[aaalan]

10 minutes ago, general-etwan said:

Take my donor! Take it away! I want that beautiful dark brown hair on the top and around the crown. If we can achieve a full visual redistribution with this procedure, I expect I’ll be pretty satisfied for life.

Anyone think I need any more frontal work? I understand that my donor is limited. So I will want to take care of the crown and side ridges first. And I can always grow my hair longer in the front to help hide the hairline area. The problem is the receding temple areas. How many grafts would be needed for temple reconstruction? What do you think?

Yes for the temple reconstruction will serve you well in the future. 
 

i would say 200-225/ each side atleast. Mine were little over 250 on eachside from Dr Das.

[duckling]

if you keep this hairstyle (pic 1) always then i suggest temple not be done aggressively but a minor touch-up if you want as its trimmed at guard 1 i guess. But if you plan to keep sides little longer (pic 2) then you need temple work definitely and you have to do it. Btw read your thread now and great progress so far and good luck for second procedure.

1)

2)

[Xanadu]

The hairline shape looks good. Don't change that. How about the desity of the hairline - is that good? Hard to see in that pic

[EricEdwards]

On 5/27/2023 at 6:07 PM, general-etwan said:

Take my donor! Take it away! I want that beautiful dark brown hair on the top and around the crown. If we can achieve a full visual redistribution with this procedure, I expect I’ll be pretty satisfied for life.

Anyone think I need any more frontal work? I understand that my donor is limited. So I will want to take care of the crown and side ridges first. And I can always grow my hair longer in the front to help hide the hairline area. The problem is the receding temple areas. How many grafts would be needed for temple reconstruction? What do you think?

I think the photo shows an excellent distribution and transitioning on the front. Based on my opinion and from what I've researched, having a relatively higher hairline serves for future proofing. By that I mean you'll grow into it as time progresses. In contrast, lowering the hairline may not give a natural result as time goes by, in my opinion.  

[Gatsby]

@general-etwan your twenty six and I'm fifty six. I wouldn't go lower on the hairline at all. Those precious grafts are better served on more vital areas on top. Trust me as you get older areas of the donor just naturally thin out. You don't just want to look good at twenty seven. You want to look good at thirty seven, fifty seven, etc. At twenty six I still had my crown and vertex. Stay on the meds and stay conservative and you will have a great looking head of hair which you do now. All the best man!

 

[Fox243]

@general-etwan I think hairline is fine but probably some temple work would be nice as the frontal view is the most important. @Gatsby I think that given he's at NW7, there's not much room for the thick part of the donor to thin out which is DHT resistant. Even in the off chance that some of it might thin out, it looks better to have hair on top than on the back and sides.

[Gatsby]

42 minutes ago, Fox243 said:

@general-etwan I think hairline is fine but probably some temple work would be nice as the frontal view is the most important. @Gatsby I think that given he's at NW7, there's not much room for the thick part of the donor to thin out which is DHT resistant. Even in the off chance that some of it might thin out, it looks better to have hair on top than on the back and sides.

@Fox243 I’m a Norwood 7 and my donor at 45 was nothing compared to when I was 26. Always better to err on the side of caution. The donor area you are referring to is DHT resistant. It’s not DHT proof. 

[general-etwan]

Ok everyone, reading over some of your comments.

Here are some more pics to share at 8 months of the area to be addressed next week.

I am mostly satisfied with the hairline, though I wish I had a little more temple-area coverage to help with the presentation from the front. I of course would like the hairline to be 1 cm or so lower, but I understand that may not be realistic at this point and that it's not bad at all for a mature hairline height going forward.

As for the temples, if I were to get them done, I'd guess it would look something like this?

^Option 1: temple reconstruction straight up to meet hairline

^Option 2: Temple reconstruction curved to meet hairline (not sure about this...this is natural for a young male with no hair loss, but Eugenix doesn't really like to do curved like this. They believe straight to hairline is more appropriate for aging.)

^Option 3: Temple reconstruction + hairline lowered by 1 cm. Not sure if this is even an option. Might require too many grafts and be messy and risky at the front.

Below are marked-up areas of what I believe absolutely needs to be covered:

 

I expect that the procedure may end up being more than the 2,000 grafts they've estimated at first glance. If we do the lower crown, plus the entire side ridges all the way to the front (basically what I need due to that area thinning), plus the temples, it's probably going to be more like 3,000, assuming we can get that many. What do you think? The middle of my donor area is still looking pretty solid, so I hope we can do at least 2,000 straight from that. Even some sideburn-area hair could be used (originally planned for my 1st procedure but then not used). And I guess some beard if needed again (500-1,000?).

Feel free to offer specific advice on the temple areas. I don't want to end up having unnatural looking temples.

Edited May 29, 2023 by general-etwan

[Shadman]

Hello, @general-etwan In my opinion,  I think you can go for option 1. Option 1 would be a better option for you. On the other hand, you can lower the hairline by 0.75-1 cm if you've enough grafts, which I think you'll have. In that case, it would be the decision of you and the doctors. I wish you all the best

[ready4Hair]

7 hours ago, general-etwan said:

Ok everyone, reading over some of your comments.

Here are some more pics to share at 8 months of the area to be addressed next week.

I am mostly satisfied with the hairline, though I wish I had a little more temple-area coverage to help with the presentation from the front. I of course would like the hairline to be 1 cm or so lower, but I understand that may not be realistic at this point and that it's not bad at all for a mature hairline height going forward.

As for the temples, if I were to get them done, I'd guess it would look something like this?

^Option 1: temple reconstruction straight up to meet hairline

^Option 2: Temple reconstruction curved to meet hairline (not sure about this...this is natural for a young male with no hair loss, but Eugenix doesn't really like to do curved like this. They believe straight to hairline is more appropriate for aging.)

^Option 3: Temple reconstruction + hairline lowered by 1 cm. Not sure if this is even an option. Might require too many grafts and be messy and risky at the front.

Below are marked-up areas of what I believe absolutely needs to be covered:

 

I expect that the procedure may end up being more than the 2,000 grafts they've estimated at first glance. If we do the lower crown, plus the entire side ridges all the way to the front (basically what I need due to that area thinning), plus the temples, it's probably going to be more like 3,000, assuming we can get that many. What do you think? The middle of my donor area is still looking pretty solid, so I hope we can do at least 2,000 straight from that. Even some sideburn-area hair could be used (originally planned for my 1st procedure but then not used). And I guess some beard if needed again (500-1,000?).

Feel free to offer specific advice on the temple areas. I don't want to end up having unnatural looking temples.

If I may, I'd consider the front triangle to be a preference but the large side one to be the 'must'.

 

[Xanadu]

I would go for option 1. But perhaps with a bit bigger temple points than you have drawn. That will take a bit more grafts, but have a pronounced effect on closing the forehead, and do so at less graft-cost than moving the entire hairline.

And yes, also add some grafts to the lateral humps (or how we might describe that long top line you marked in red).

 

Edited May 29, 2023 by Xanadu

[GoliGoliGoli]

I think your primary concern should be making sure you're not left with a disconnect anywhere between the transplanted hair and your natural hair, such as the ones you've highlighted in the lateral humps and back of crown. By adding temple points not only are you using precious grafts, but you're also adding in another potential area for a disconnect to arise down the road as you continue to lose more hair around the front of the ear area. 

I think some of the areas you highlighted earlier as potential places you can pull grafts from are not at all safe areas to be pulling grafts from so I'd really suggest only using very safe donor areas. You seem to be getting a good bit of hair greed which is totally understandable, but to be honest I think in your situation you're best served by being super conservative with the goal of maintaining a natural look. Adding temples does not serve that cause. 

The pic Gatsby posted is really important. I see it often on this forum where people go for what looks great right now, without thinking of the long term. Even people with the very best donor's need to consider the future and plan their HT's around that. But this is even more true in a challenging case such as yours. 

You've made a tremendous aesthetic improvement with your 1st HT that you can now build on. But the only thing worse than looking bald is looking unnaturally bald. By lowering your hairline or adding temple points you run the risk of leaving yourself unnaturally bald. Don't fall into that trap. 

Edited May 29, 2023 by GoliGoliGoli

[general-etwan]

37 minutes ago, GoliGoliGoli said:

I think your primary concern should be making sure you're not left with a disconnect anywhere between the transplanted hair and your natural hair, such as the ones you've highlighted in the lateral humps and back of crown. By adding temple points not only are you using precious grafts, but you're also adding in another potential area for a disconnect to arise down the road as you continue to lose more hair around the front of the ear area. 

I think some of the areas you highlighted earlier as potential places you can pull grafts from are not at all safe areas to be pulling grafts from so I'd really suggest only using very safe donor areas. You seem to be getting a good bit of hair greed which is totally understandable, but to be honest I think in your situation you're best served by being super conservative with the goal of maintaining a natural look. Adding temples does not serve that cause. 

The pic Gatsby posted is really important. I see it often on this forum where people go for what looks great right now, without thinking of the long term. Even people with the very best donor's need to consider the future and plan their HT's around that. But this is even more true in a challenging case such as yours. 

You've made a tremendous aesthetic improvement with your 1st HT that you can now build on. But the only thing worse than looking bald is looking unnaturally bald. By lowering your hairline or adding temple points you run the risk of leaving yourself unnaturally bald. Don't fall into that trap. 

For sure, I will make sure the plan is to first attack the lower crown and side ridge areas. Get that all uniform so I can grow hair out to some length and still have it look OK without any big thinning areas. And if that uses up all the available donor grafts I have left, then so be it. I can always keep the sides of my head buzzed super short or shaved; not a big deal at all. 

The temples would be so tricky like you said. I don't doubt that we could find the grafts to use from some donor, but the big risk would be creating too dark/thick hairs at the front of the temples with hairs that may thin over the years right behind, closer to the ear. I wouldn't want to deal with that visual issue.

I absolutely want to go all-in on getting rid of all the disconnect of natural hair on top/sides/crown. I'll make sure to plan with Dr. Das and Dr. Somesh that that thinning ring is 100% taken care of so that all the hair looks uniform.

Thanks for this input.

I expect the side ridge areas will be a bit tricky. But as Mr. Cross told me on Instagram, it's super important to get some hair as far forward as possible on the side ridges. Will help with visual appearance of thickness from the front if I want to be able to grow a medium-length fluffy hairstyle.

Something like this?

Edited May 29, 2023 by general-etwan

[GoliGoliGoli]

Yep that drawing looks good.
 

I guess my overall point is just to Make sure to leave something in reserve in your donor. Your plan to shave the sides/back in the future to avoid any disconnects is a good one I think, especially because you have pretty minimal scarring. But nevertheless i think you want at least 1000 in reserve  to deal with any eventual unforeseen thinning consequences 

[Benz]

On 5/29/2023 at 6:52 PM, general-etwan said:

For sure, I will make sure the plan is to first attack the lower crown and side ridge areas. Get that all uniform so I can grow hair out to some length and still have it look OK without any big thinning areas. And if that uses up all the available donor grafts I have left, then so be it. I can always keep the sides of my head buzzed super short or shaved; not a big deal at all. 

The temples would be so tricky like you said. I don't doubt that we could find the grafts to use from some donor, but the big risk would be creating too dark/thick hairs at the front of the temples with hairs that may thin over the years right behind, closer to the ear. I wouldn't want to deal with that visual issue.

I absolutely want to go all-in on getting rid of all the disconnect of natural hair on top/sides/crown. I'll make sure to plan with Dr. Das and Dr. Somesh that that thinning ring is 100% taken care of so that all the hair looks uniform.

Thanks for this input.

I expect the side ridge areas will be a bit tricky. But as Mr. Cross told me on Instagram, it's super important to get some hair as far forward as possible on the side ridges. Will help with visual appearance of thickness from the front if I want to be able to grow a medium-length fluffy hairstyle.

Something like this?

I agree with this last picture.
Two thousand grafts are like an area of 66 cm2 with 30 grafts per cm. I hope they can extract more if needed.
I think you should leave the temporal reconstruction and focus on both lateral sides + a decent connection with the frontal hairline. If some grafts are over left, they should use those for the frontal hairline to make it more symmetrical.

Your donor might take a hit but you can always do an additional smp at a premium clinic which will improve the overall; significantly. Your hair skin contrast ratio is relative low which gives you an advantage.


 

[GeneralNorwood]

On 5/26/2023 at 6:57 AM, general-etwan said:

June 8th. 2nd procedure with Dr. Das & Somesh. 2000 grafts estimated. 

 

I am surprised that your latteral hump area looks so bad. To be honest in previous pictures that you were posting i didn't see such lack of density. But now on this photo it's obvious and now when you grew sides longer, the contrast is easily visible. 

You should forget about lowering your hairline and doing the  temples, it's nuts 

Your front looks fine. You just grow hair little longer on the front and you get ilussion of lower hairline and forehead will be smaller. 

The biggest problem is that now sides are disconnected from the front. It's similar case like mine. You have to do laterals, this is top1 priority. Crown work is like blackhole, many grafts needed there.

Sides anyway look best when you cut them short, you have already depleted donor above the ear. 

Sorry that im so harsh, but thinking about doing front right now is delusional. And it's pointless, because your frontal look is on the spot. 

 

I don't know how your left lateral hump looks, but based on this photo you should focus on improving this area that i marked on black "top1". Do this and after 2nd HT you will know where you are standing. No temples, no lowering hairline,  you don't have donor supply for that. 

 

 

And cherry on top. You will be cutting your sides very short, so why do the temples? Transplanted temples look good when you grew them longer and do you plan to grew your sides long? I don't think so. 

Edited May 30, 2023 by GeneralNorwood

[Xanadu]

10 minutes ago, GeneralNorwood said:

 

I am surprised that your latteral hump area looks so bad. To be honest in previous pictures that you were posting i didn't see such lack of density. But now on this photo it's obvious and now when you grew sides longer, the contrast is easily visible. 

You should forget about lowering your hairline and doing the  temples, it's nuts 

Your front looks fine. You just grow hair little longer on the front and you get ilussion of lower hairline and forehead will be smaller. 

The biggest problem is that now sides are disconnected from the front. It's similar case like mine. You have to do laterals, this is top1 priority. Crown work is like blackhole, many grafts needed there.

Sides anyway look best when you cut them short, you have already depleted donor above the ear. 

Sorry that im so harsh, but thinking about doing front right now is delusional. And it's pointless, because your frontal look is on the spot. 

 

I don't know how your left lateral hump looks, but based on this photo you should focus on improving this area that i marked on black "top1". Do this and after 2nd HT you will know where you are standing. No temples, no lowering hairline,  you don't have donor supply for that. 

 

[Xanadu]

If I remember correctly Etwan is not on Fin and that might explain why this humps disconnects seem bigger now than before. Or am I misremembering and Fin is used?

[GeneralNorwood]

1 minute ago, Xanadu said:

If I remember correctly Etwan is not on Fin and that might explain why this humps disconnects seem bigger now than before. Or am I misremembering and Fin is used?

I don't remember if he is taking fin, but it's not the issue.  He was posting pictures from flattering angles. Now he posted pictures from unflattering angles. 

[GoliGoliGoli]

5 minutes ago, GeneralNorwood said:

I don't remember if he is taking fin, but it's not the issue.  He was posting pictures from flattering angles. Now he posted pictures from unflattering angles. 

I actually do think that's the issue, at least partially. Compare to the pics from February 22nd. 

10 minutes ago, Xanadu said:

If I remember correctly Etwan is not on Fin and that might explain why this humps disconnects seem bigger now than before. Or am I misremembering and Fin is used?

Etwan says in his initial post that he is using fin. The problem is fin isn't very effective in guys with very aggressive baldness. Fin doesn't put your DHT to zero, so if your follicle has a high affinity for DHT the DHT is going to find a way to latch to it. 

[GeneralNorwood]

27 minutes ago, GoliGoliGoli said:

I actually do think that's the issue, at least partially. Compare to the pics from February 22nd. 

DIfferent lighting, different angles. 

 

From February 22nd. This is more flattering angle and lighting and sides were cutted short, so contrast is less visible. I believe it was the same as now, just picture were made in different conditions : 

 

 

[general-etwan]

3 hours ago, Benz said:

I agree with this last picture.
Two thousand grafts are like an area of 66 cm2 with 30 grafts per cm. I hope they can extract more if needed.
I think you should leave the temporal reconstruction and focus on both lateral sides + a decent connection with the frontal hairline. If some grafts are over left, they should use those for the frontal hairline to make it more symmetrical.

Your donor might take a hit but you can always do an additional smp at a premium clinic which will improve the overall; significantly. Your hair skin contrast ratio is relative low which gives you an advantage.

I agree, SMP always available for back and sides if it gets too thinned out. 

2 hours ago, GeneralNorwood said:

I am surprised that your latteral hump area looks so bad. To be honest in previous pictures that you were posting i didn't see such lack of density. But now on this photo it's obvious and now when you grew sides longer, the contrast is easily visible. 

You should forget about lowering your hairline and doing the  temples, it's nuts 

Your front looks fine. You just grow hair little longer on the front and you get ilussion of lower hairline and forehead will be smaller. 

The biggest problem is that now sides are disconnected from the front. It's similar case like mine. You have to do laterals, this is top1 priority. Crown work is like blackhole, many grafts needed there.

Sides anyway look best when you cut them short, you have already depleted donor above the ear. 

Sorry that im so harsh, but thinking about doing front right now is delusional. And it's pointless, because your frontal look is on the spot. 

I don't know how your left lateral hump looks, but based on this photo you should focus on improving this area that i marked on black "top1". Do this and after 2nd HT you will know where you are standing. No temples, no lowering hairline,  you don't have donor supply for that. 

And cherry on top. You will be cutting your sides very short, so why do the temples? Transplanted temples look good when you grew them longer and do you plan to grew your sides long? I don't think so. 

Yeah, so we knew going back from the first procedure those lateral humps and lower crown were significantly thinned out areas; they wouldn't address those all in the same 1st procedure. It's an illusion indeed that when the sides and back are buzzed and faded super short, lateral humps and lower crown look passable from a distance but they never actually have been in reality, with hair grown out longer.

Also to clarify for everyone else too: Yes I am on finasteride and have been since Jan 2022. But like it has been said, it probably doesn't even really do a whole lot for me. And once hairs lose over 50% of their original natural density, it's game over. I have also stopped using Minoxidil and Pyrilutamide; they told me to stop use 1 month prior to surgery and honestly I got lazy and stopped using both about 2 months before next week. I suspect minoxidil + pyril was keeping some illusion of thickness in the lateral humps that is lost as soon as I stop use.

For sure, I agree completely with your analysis: lateral humps are the #1 priority, and lower crown 2nd. I don't have plans to grow out the sides super long, no. But I definitely would like a medium length hairstyle on the top and upper sides, which means those lateral humps are super important for creating that framing. The lower sides and back can always be buzzed down.

[general-etwan]

2 hours ago, Xanadu said:

If I remember correctly Etwan is not on Fin and that might explain why this humps disconnects seem bigger now than before. Or am I misremembering and Fin is used?

2 hours ago, GeneralNorwood said:

I don't remember if he is taking fin, but it's not the issue.  He was posting pictures from flattering angles. Now he posted pictures from unflattering angles. 

2 hours ago, GoliGoliGoli said:

I actually do think that's the issue, at least partially. Compare to the pics from February 22nd. 

Etwan says in his initial post that he is using fin. The problem is fin isn't very effective in guys with very aggressive baldness. Fin doesn't put your DHT to zero, so if your follicle has a high affinity for DHT the DHT is going to find a way to latch to it. 

On finasteride since Jan 2022 so nothing has changed there. What has changed is I stopped using minoxidil and pyrilutamide several weeks ago in leadup to this 2nd surgery. And that picture I posted the other day is literally like 2 feet directly underneath three bright bathroom lightbulbs. Yes. So super harsh lighting and angle.

[general-etwan]

Thanks for the input here everyone. One more thing I wanted to state which is pretty much common sense though: those thinning lateral ridge areas, which have been that way for many years...they look okayish when everything under them is buzzed super short. But when grown out, that's where the obvious disconnect appears because the hairs on the lateral ridges literally stop growing at a certain length. I've gone 2+ months without a haircut now and the hair there just won't grow any longer. It won't keep up with the top or lower sides.

So this is what I'm thinking now:

• 1st priority: lateral ridges (humps as you guys call them) all the way to the front of the hairline
• 2nd priority: lower crown area to match upper crown density (which is already done) as closely as possible.
• No temple reconstruction; no grafts will be available for that most likely

Some more pictures (I hate the look on my face in these so I'm not sharing it with y'all lol). Also this was straight out of the shower with no styling or anything, so hair looks pretty meh. But you can see where the lateral ridge work is absolutely needed.

I want to compare to someone who has a similar hair pattern to mine: Dustin Johnson. Age: 38, hair loss def started in 20s.

If you look closely, you can see he's lost a significant amount of temple-area hair too. But despite suffering from hair loss at a young age, his look is still quite okay, mainly because he's been able to hold onto the middle portion of the front, and the lateral ridge areas aren't too bad. I'm looking at his situation for inspiration for my case. 

So, I'm going to go in with this plan:

I will tell them to use some sideburn hair (circled blue #2) because if you go back and look at my pics from 1st procedure, they marked that area as usable for donor if needed but then didn't end up using it. Plus, since the temples have already thinned, it will look better if the hair underneath them in the sideburns thin more similarly anyway. I don't ever plan to wear my sideburns all wild like I have them in this picture. I'm just not touching anything until next week so Eugenix can see everything as it is.

Here, the black dotted line is just an imaginary line of where the temples would go to, if I were to have work done there. But since it's so minor, and it's more important to focus the hair on the lateral ridges/top/lower crown, really not worried about that at this time.

Edited May 31, 2023 by general-etwan