Dr. David Josephitis (SMG) | 2,309 grafts | 35 years old | Dec. 20 / 21, 2022

[Balding Bad]

DRY HAIR

[Balding Bad]

DRY HAIR - DIMMER LIGHTING

[Balding Bad]

I'm curious to hear the community's opinion on this question:

Should I undergo a potential 2nd procedure, how many grafts do you believe would be needed to achieve a satisfactory illusion of density / fuller looking frontal third?

🤔

[mister_25]

7 hours ago, Balding Bad said:

I'm curious to hear the community's opinion on this question:

Should I undergo a potential 2nd procedure, how many grafts do you believe would be needed to achieve a satisfactory illusion of density / fuller looking frontal third?

🤔

We are in similar situations

First and foremost, I feel like you had less grafts than what is generally prescribed for your area of loss. So its not only just "lower yield" but it was also a lower density transplant to begin with. Which is good for your long term donor preservations

Most people on this forum stress enough that hair transplants are all about restoring a "illusion of density" which isn't being done here. There is no possible method, or illusion that you can create without using further concealing products like hair fibers to have a "dense" look even if it isnt real. 

To answer your questions. In my opinion your looking at something in the 1000-2500 range;

I believe 1000 will give you a weak illusion to work with to help you confuse the people that aren't in the know, this will only apply to milder conditions

somewhere in the 2000-2500 range will give you something solid to work with in my opinion

[Balding Bad]

49 minutes ago, mister_25 said:

We are in similar situations

First and foremost, I feel like you had less grafts than what is generally prescribed for your area of loss. So its not only just "lower yield" but it was also a lower density transplant to begin with. Which is good for your long term donor preservations

Most people on this forum stress enough that hair transplants are all about restoring a "illusion of density" which isn't being done here. There is no possible method, or illusion that you can create without using further concealing products like hair fibers to have a "dense" look even if it isnt real. 

To answer your questions. In my opinion your looking at something in the 1000-2500 range;

I believe 1000 will give you a weak illusion to work with to help you confuse the people that aren't in the know, this will only apply to milder conditions

somewhere in the 2000-2500 range will give you something solid to work with in my opinion

Appreciate you chiming in and opining on the matter.

I just want to make sure I'm understanding your response correctly, but you think my overall yield of the grafts I received was low (poor)? I'm curious what percentage you would say my overall yield was?

When I had my one-on-one with Dr. Joe he stated that my growth/yield was looking to be on track, but when he said that I personally didn't believe that to be the case. I'm of the opinion that the yield wasn't great also. Not sure if my quantification is accurate, but I'd say the overall yield is give or take about 60-70%?

According to my assessment, I feel like an additional 1,000 grafts would help achieve a more fuller/dense looking hairline, but you think upwards of 2,500 would be optimal? I dunno, I feel like that may be overkill because that would mean in total my frontal third (including my 1st procedure) would be at nearly 5,000 grafts, which seems quite excessive!

I'm open to hearing what other folks think though.

Edited September 29, 2023 by Balding Bad

[mister_25]

2 hours ago, Balding Bad said:

Appreciate you chiming in and opining on the matter.

I just want to make sure I'm understanding your response correctly, but you think my overall yield of the grafts I received was low (poor)? I'm curious what percentage you would say my overall yield was?

When I had my one-on-one with Dr. Joe he stated that my growth/yield was looking to be on track, but when he said that I personally didn't believe that to be the case. I'm of the opinion that the yield wasn't great also. Not sure if my quantification is accurate, but I'd say the overall yield is give or take about 60-70%?

According to my assessment, I feel like an additional 1,000 grafts would help achieve a more fuller/dense looking hairline, but you think upwards of 2,500 would be optimal? I dunno, I feel like that may be overkill because that would mean in total my frontal third (including my 1st procedure) would be at nearly 5,000 grafts, which seems quite excessive!

I'm open to hearing what other folks think though.

I would say you have three factors that are affecting your results for your first procedure. I'll try to give you my insights on why I think this way as well.

The first is low graft count, generally speaking to cover the frontal third in its entirety I would say the average amount of grafts it takes is somewhere between 2700-3600. You had 2300 which in my opinion and observations is below the "minimum" required to restore the frontal third. This is a good thing for donor preservation/your final result after the 

The second factor is in my opinion there is rather lower yield. On the positive note since there was a smaller size of grafts used (Low 2000) your not losing much on your "future" results and that the "potential" of all your transplants put together is still rather in tact. On the negative note, I don't think your aesthetically much different than where you started, I feel like you could start using fibers and see some big change though. I would say your yield is probably about something like 62-65% when I eyeball it into a small range.

The third factor which is a bit of nitpicking is the "inconsistent, assymetrical growth". It looks like one side is doing significantly better than the other and that stands out a bit in certain angles. This is what I am struggling with the most in my case as of now. In my case, my left side hairline is significantly weaker than the right side, but the area behind the hairline my left is doing much better than the right. It has this wonky shape to it that makes me look like I'm balding more on one side of my head. In your case I don't think its that bad, but it makes your weak points stand out alot more specially that bald spot at your peak.

Overall, my opinion is that whilst it is disappointing, in the long term (multiple surgeries) this result isn't enough to make me think that you've done damaged to your potential, just delaying.

2500 comes to mind if you were trying to restore to some form of density rather than illusion. Albeit that's at a high length and I think that is seen as the "at most" end. I would think you can be perfectly happy with something along the lines of 1800-2000 depending on how you yield

 

 

Edited September 29, 2023 by mister_25

[Balding Bad]

8 hours ago, mister_25 said:

I would say you have three factors that are affecting your results for your first procedure. I'll try to give you my insights on why I think this way as well.

The first is low graft count, generally speaking to cover the frontal third in its entirety I would say the average amount of grafts it takes is somewhere between 2700-3600. You had 2300 which in my opinion and observations is below the "minimum" required to restore the frontal third. This is a good thing for donor preservation/your final result after the 

The second factor is in my opinion there is rather lower yield. On the positive note since there was a smaller size of grafts used (Low 2000) your not losing much on your "future" results and that the "potential" of all your transplants put together is still rather in tact. On the negative note, I don't think your aesthetically much different than where you started, I feel like you could start using fibers and see some big change though. I would say your yield is probably about something like 62-65% when I eyeball it into a small range.

The third factor which is a bit of nitpicking is the "inconsistent, assymetrical growth". It looks like one side is doing significantly better than the other and that stands out a bit in certain angles. This is what I am struggling with the most in my case as of now. In my case, my left side hairline is significantly weaker than the right side, but the area behind the hairline my left is doing much better than the right. It has this wonky shape to it that makes me look like I'm balding more on one side of my head. In your case I don't think its that bad, but it makes your weak points stand out alot more specially that bald spot at your peak.

Overall, my opinion is that whilst it is disappointing, in the long term (multiple surgeries) this result isn't enough to make me think that you've done damaged to your potential, just delaying.

2500 comes to mind if you were trying to restore to some form of density rather than illusion. Albeit that's at a high length and I think that is seen as the "at most" end. I would think you can be perfectly happy with something along the lines of 1800-2000 depending on how you yield

 

 

Appreciate your detailed analysis!

Yeah, when I learned the final graft count was 2,300, I was very surprised, but I interpreted that as a positive since I thought that meant the existing hairs in my frontal third were ample enough to carry some of the heavy lifting and, thus, meant my hair loss in the frontal third wasn't as bad. In hindsight, Dr. Joe was just too conservative (which he admitted as such as well). I think had I received 2,500-2,700 grafts instead, I'd be a much happy camper...maybe not fully satisfied, but at least more content with the overall outcome.

Okay, so your yield estimation is more or less on par with mine, just on the lower end of the spectrum. Ultimately, I'm unsure if the poor yield has anything to do with SMG or something physiological on my end or maybe a combo of both. But because of that, I'm in the same boat as you where even if I do undergo a 2nd procedure, I'll be concerned about the yield since that's a bit of an unknown.

In terms of the asymmetrical growth, yes, that's an issue I don't see improving. The right side of my hair line (which was artificially lowered, even though I didn't want to) has much better growth, whereas the center and left side of my hair line is lagging/lacking, which is clearly evident in the photos. I guess in any hypothetical 2nd procedure, there would be more emphasis placed in those regions.

I think overall the outlook for a 2nd procedure is theoretically positive. I think if I settled in the middle at around 1,500 additional grafts, that would land me somewhere I'd ultimately be content with. Once again, I'm not expecting my 14-year-old hair line or a thick impenetrable wall of hair, but something much stronger than what I currently received. I think that's totally attainable and not too much to ask for.

Edited September 29, 2023 by Balding Bad

[Melvin- Admin]

A second procedure makes sense. 

[baldfighter]

it doesn't look too bad to me with this lighting. Could you take some photos with brighter light or outdoor?

[davidjosepha]

On 9/28/2023 at 3:26 PM, Balding Bad said:

I will say that overall, it's a marginal improvement from where I started pre-op

I agree that it's not a perfect result—as has been discussed it seems like number of grafts was too low—but this seems overly pessimistic.

This is where you were at before:

And this is where you're at now:

That is a night and day difference. Your hairline is a bit thin now, I agree, but you didn't even have a hairline before—you had a handful of miniaturized hairs where your hairline used to be. That is a massive improvement and it doesn't look half bad even in direct light when you're pulling your hair back. In dim light, it frankly looks quite good:

I understand wanting a second procedure, and that's probably a good decision given you were hoping for more density, but I think you're being overly critical of your results or not entirely honest with yourself about how bad the front third of your hair was before the procedure. I seriously doubt you only had 60-70% yield—you just didn't have enough grafts to cover an essentially completely bald area. And you don't need to wear a hat; your hair looks better than half of 35 year old guys who don't shave their head.

[davidjosepha]

As for number of grafts, I imagine 1000 more would be plenty to fill that out, but if you're worried about still not being happy with it even after a second procedure, and you're going to do the procedure anyway, I would consider doing a bit more on the front and getting some of the crown and maybe mid done as well. I don't know how pricing works with other clinics, but if it's similar to Shapiro (or if you go with them again, sounds like they may give a discounted rate), the price drops off a lot after a certain number of grafts (2000 with SMG). So you may want to consider filling out some of the rest while you're at it to save cost and to save yourself another procedure in the future. You do run the risk of using your finite donor supply in places that might never need it, but if you notice your crown thinning, there's a pretty standard pattern to how that happens that you can use to predict where it'll be needed.

[Balding Bad]

On 9/29/2023 at 9:59 PM, baldfighter said:

it doesn't look too bad to me with this lighting. Could you take some photos with brighter light or outdoor?

I think the usual lighting conditions in my bathroom are plenty bright, but I'll try an outdoor one too.

[Balding Bad]

On 10/6/2023 at 7:19 PM, davidjosepha said:

I agree that it's not a perfect result—as has been discussed it seems like number of grafts was too low—but this seems overly pessimistic.

This is where you were at before:

And this is where you're at now:

That is a night and day difference. Your hairline is a bit thin now, I agree, but you didn't even have a hairline before—you had a handful of miniaturized hairs where your hairline used to be. That is a massive improvement and it doesn't look half bad even in direct light when you're pulling your hair back. In dim light, it frankly looks quite good:

I understand wanting a second procedure, and that's probably a good decision given you were hoping for more density, but I think you're being overly critical of your results or not entirely honest with yourself about how bad the front third of your hair was before the procedure. I seriously doubt you only had 60-70% yield—you just didn't have enough grafts to cover an essentially completely bald area. And you don't need to wear a hat; your hair looks better than half of 35 year old guys who don't shave their head.

Appreciate your two cents. As the saying goes, we are our own worst critic. While I wasn't chasing a thick teenage hair line, what I did want though was a relatively strong, restored hairline...not one where it still looks like I'm visibly thinning to a lesser degree.

The aesthetics of not looking like I'm struggling with hair loss was key here. Elon Musk and Machine Gun Kelly both don't look like they're struggling with hair loss/thinning anymore...just two dudes with decent hair lines now. And that was what I was seeking too and I don't think that's too much to ask for.

Ultimately, I do believe a 2nd procedure will correct/satisfy the lack of density, but I did feel given SMG's reputation and Dr. Joe's expertise, a 2nd procedure would have been avoided altogether. I initially thought the 2,300 grafts received was a bit low but decided to trust Dr. Joe's experience and the process, but now we know it was indeed not enough.

[baldfighter]

sounds like there is not much improvement this month?

[HairFunk]

Balding Bad - I personally wouldn't touch it as it looks very natural, almost as though it has naturally crept back a little bit. In other-words no one will ever know you've had a hair transplant and as you get much older this will look really good vs a highly dense wall of hair on your hairline in old age. 

Your question reminds me of another user on here 'Greg' who was on the fence about topping up his hairline repair. The general consensus from the forum was to leave it alone as it looked very natural. Not sure what he did in the end, you could reach out to him.

https://www.hairrestorationnetwork.com/topic/53283-softened-hairline-result-opinions-please/

I personally like recreated soft and loose hairlines with a good use of single hairs. Always a natural look vs super dense and looking like work has been done. Certainly have a good think. 

 

[Balding Bad]

19 hours ago, baldfighter said:

sounds like there is not much improvement this month?

It's more or less the same in my opinion. I've taken photos and will likely upload either tomorrow or the following day, so stay tuned.

[Balding Bad]

2 hours ago, HairFunk said:

Balding Bad - I personally wouldn't touch it as it looks very natural, almost as though it has naturally crept back a little bit. In other-words no one will ever know you've had a hair transplant and as you get much older this will look really good vs a highly dense wall of hair on your hairline in old age. 

Your question reminds me of another user on here 'Greg' who was on the fence about topping up his hairline repair. The general consensus from the forum was to leave it alone as it looked very natural. Not sure what he did in the end, you could reach out to him.

https://www.hairrestorationnetwork.com/topic/53283-softened-hairline-result-opinions-please/

I personally like recreated soft and loose hairlines with a good use of single hairs. Always a natural look vs super dense and looking like work has been done. Certainly have a good think. 

 

Thank you for your feedback and I will definitely take it into consideration. To clarify, I'm not looking to rush into anything at the moment. I'm just thinking out loud and voicing my opinion in real-time. I'll obviously contemplate a 2nd procedure very thoroughly before pulling any triggers. What's important is that I see the one-year journey through first.

Thanks for providing "Greg's" thread. I'll look into it and use it to reflect on my progress thus far.

In terms of my hair line, I'm perfectly okay with a soft hair line. What bothers me is that it's immediately sparse and thin right behind the already fine hair line, thus giving off the impression that I'm thinning out (still). I think this hair line would be suitable if I was in my late 40s or early 50s, but in my mid-30s, I am actually still passable for my late-20s, so the visibly thinning hair line just doesn't fit...there's a clear disconnect with my still youthful looking face.

[ALittelTeal]

Would love an update on how everything is going!

[consequence]

I agree, though it is an improvement, it's not a thick or robust hairline for 10 months.

Have you thought about PRP or laser helmets? I know you can't take oral finasteride, topical? Oral minoxidil? Ketoconazole shampoo?

Please keep us updated.

[Balding Bad]

OCTOBER 21/22, 2023 UPDATE (304/305 DAYS POST-OP [10 MONTHS])

First of all, major apologies in my supreme lack of consistency. I acknowledge that it's been an entire quarter since my prior update, however I always intended on following through and made sure to continue taking monthly photos but obligations with life and a general lack of impressive results (in my opinion at least) contributed to dropping this in terms of priorities. However now that we're in the new year and I've got some downtime, I wanted to provide the community with an update on October/November/December 2023 and account for the full year's documentation.

For October I can't really say there was much drastic improvement over September or August. And in my honest opinion/assessment, it seems my results really topped out/peaked in those 2 months. I feel like everything after that has more or less been the same with MAYBE minor aesthetic improvements since none of the original concerns regarding weak frontal hairline/weak density was ever allayed.

I do want to flag that around 10/15/23 - 10/20/23 or so I did notice I began to exhibit sexual side effects (the return of watery seamen) with only taking Fin 4x a week at .25mg dosage. So on 10/27/23 I decided to scale back my intake to just TWICE a week, every Tuesday and Thursday, to see if that would help mitigate sides.

Overall, my review for October would be the same as September. Good from head on angle (especially when hair is wet), but if you observe hair from above or if hair is dry then the aesthetics become worse. The see-thru effect is still blatant depending on the lighting. If you look at photos in the "Wet Hair - Dimmer Lighting" section, you'll see prime examples of how the illusion falls apart when there's a light source behind my hair. It has, what I would call the scaffolding effect, where the transplanted hairs do give off a framework/lattice structure for the basis of hair, however the sheer lack of density makes it look incomplete and just odd...or just makes my hair look "thinning."

October's score would remain the same at 4 out of 10.

Please note photos below were taken during the course of 2 days.

WET HAIR

 

Edited January 10 by Balding Bad

[Balding Bad]

WET HAIR - DIMMER LIGHTING

[Balding Bad]

DRY HAIR

[Balding Bad]

DRY HAIR - DIMMER LIGHTING

[Balding Bad]

NOVEMBER 20, 2023 UPDATE (335 DAYS POST-OP [11 MONTHS])

As we begin to round out the year there wasn't much more meaningful improvements in my opinion. It more or less was the same as the prior month. Same issues continued to persist, which are low density in the frontal third and my hair looking very poor/thin when the hair is dry.

I continued to utilize the concealing styling technique, although I must admit that around this timeframe I started thinking about embracing my hair as is. I realized it wasn't going to get any better and getting it to a place where I would ultimately be truly happy wouldn't be until 2-5 years from now since I don't want to rush into another procedure. I spent a lot of time, money, and effort to get my hair to where it currently is and I shouldn't/can't hide behind the concealment and hat forever...

Thus, the seeds were planted for potentially wearing my wet hair out in public since, admittedly, it does look quite good to me and passable as long as it's viewed head on...but for the month of November I dared not venture out with my hair "exposed."

During the course of October into November through, my Fin usage was once again altered since the sides still remained/got worse (become even more watery), so I decided the best thing to do was to scale back my intake even more. So on 11/18/23 I decided to only take Fin once a month, every Thursday, still at the .25mg dosage.

Why didn't I just go cold turkey completely? Well, I recognize that if I want to stave off future hair loss, Fin is (for better or worse) my only real weapon in the arsenal. So dropping it completely would only do me harm in the long run, but if I could somehow manage the most minimal dosage/intake and build a tolerance then that would be preferable.

Hair rating for the month of November I would still keep the same at 4 out of 10.

WET HAIR

Edited January 10 by Balding Bad

[Balding Bad]

WET HAIR - DIMMER LIGHTING