Norwood VII Patient, now and at 28y/o; Dr. Beehner

[Dr. Michael Beehner]

This male in his mid-50's was presented in this section several weeks ago, and one of the commentators asked if it was possible to find out what he looked like when he was a young man, andif there would have been clues at that time that he was destined to have this much hair loss in the future.

I contacted the patient, who gave permission to use the photos, and this black and white photo is this man when he was 28y/o. As you can see, he had what for all intents and purposes looks like a pretty decent head of hair. So you would be left with taking a good familyl history, looking for miniaturization, and, most importantly, also just being conservative in the planning if he started his transplants in his 20's. This is why it is so perilous and risky to bring the fronto-temporal angles way up and flatten them out or totally fill in the crown/vertex in young men. You run the real risk of turning them into freaks some day, who will be recluses and never present themselves in any social situations. We hold these people's future in our hands and can ruin it if we are short-sighted.

This patient recently had two procedures done to produce the look that you see, and did undergo a third procedure which hasn't grown out yet.

Mike Beehner, M.D.

 

[TC17]

Thank you very much for posting this picture Dr. Beehner. It's clear that the patient had a receding hairline at age 28, but judging from his current hair loss pattern, I would have guessed that he would have had far greater loss by age 28. I must say, every young patient should carefully look at this guy prior to undergoing a transplant, because this very well may be any of us someday.

- this is the link to the original post that has far more photos of the patient. http://hair-restoration-info.c...=392102603#392102603

 

also, on a related note, fmr. sec of state mcnamara died today, google his pictures from when he was in his 40's, and 50's (where he appeared to be at most a NW 2.5, and compare them to the more modern ones, where he is a NW 7, very scary)

[Cam Simmons MD ABHRS]

Thanks for posting these photos Dr. Beehner. They better demonstrate the need for long-term planning than a thousand words.

 

Your patient must also be pleased that his follow-up photo looks more like his 28-year-old photo than his pre-op photo.

[hdude46]

good post...however just b/c this guy looked like that at 28 and now at 50 doesnt mean we all will. but i think what u are saying is plan safely and conservatively. what do u mean by an indistinct fringe though. can you post a picture showing what u mean? thanks!

[Dr. Michael Beehner]

hdude46,

I have added to the photo gallery a couple of examples of what I would call "indistinct fringes" in young men in their 20's, both of whom I feel are at risk for later becoming a Norwood VII. For this reason they both had a "forelock" type of pattern used in their tranpslant procedures. When using magnification in the upper fringe, you typically will see 5-15% of the hairs are miniaturized, which usually helps "tell the future" - and it isn't good.

Mike Beehner, M.D.

[sylus]

Sorry for the hassle,

 

I was looking for some clarification on where the 23 year old is showing miniaturization on the sides. Do you mean directly near the upper ear region? Or where there is some scalp showing in the vertex a little bit? I do see a difference between the lower sides and upper sides but that just look like longer hair.

[youngsuccess]

Great result.

 

I agree with the post; however, I wouldn't classify the patient at 28 as someone with some normal, mild recession. Based on the black and white photo, it looks to me like he's got a non-existent hairline, fading temple points, and was already beginning to resort to a combover type of style.

[Telepinu]

Personally I am not surprised by the level of baldness. At 28 he looks like he was headed for this direction, you can clearly see it in his hairline. it almost looks like he was sporting a comb over.

[Dr. Michael Beehner]

Thanks for the recent comments and interest in this series of Norwood VII (or potentially) patients and the forelock design used in their cases.

Regarding the 23 year old fellow, who is viewed mostly from the side somewhat obliquely, if you drew a line straight up from his left ear to the top of his head, that upper 1 1/2 inch of hair has around 30% miniaturization within it at the time of the photo, which is distinctly abnormal (more than 5% is abnormally high and protends probably later complete hair loss in the area). What is more important, is that when you look at the hair on the side of their heads, it is hard to pin down a point at which the bald/thin hair on top becomes dense and full. It is very indistinct. My point is that these are the young men that a hair surgeon should suspect are going to some day be Norwood VII's, and whom will look like freaks some day if you just transplant them with the business-as-usual approach. The forelock type of design works very nicely for them and protects their future appearance.

Mike Beehner, M.D.

[TC17]

Dr. Beehner,

 

Once again, thank you for this post, it is quite informative. In your opinion, if a patient DOES have a distinct separation between miniaturized hair and dense/full hair, is he not likely to proceed to a NW 7 level?

 

I have an uncle who is not blood related that recently turned 87 and is a NW 6 with a very, very thin donor area. What's interesting is that if you were to look at photos of him from 15 and 20 years ago, his sides were still extremely thick, and he was at most a NW 5. I'm curious as to whether a microscopic examination of his hair would have shown that he was destined to continue losing hair, as well as having his donor thin, and if so, at what age that evidence would have presented itself.

[hdude46]

cameras 15-20 yrs ago are going to make anything look thick. if i were u, i would get on proscar and not worry too much about what you are going to look like as an 87 yr old man. if u are so concerned as to what u might look like and how u might progress, getting a ht is probably not the best option for you. Its a risk for everyone who does it.

[TC17]

As I said hdude46, he is not related to me by blood, so I am not using him as a possible reference point for my future hair loss. Instead, I am merely using his hair loss as an indicator of what can happen to any of us.

 

It's possible that the lighting in all of the pictures of him was off and subsequently his hair appeared thicker than it actually was at the time. Similarly, it's possible that he is atypical in continuing to bald without stabilization. But, I don't feel that either of those are likely. Photos can be deceptive, but they can't turn a NW 6 pattern into that of a NW 4/5. Simply put, 20 years ago he had hair in places that he has since lost, and his sides were significantly higher. As for the fact that his donor area has thinned, that belief does not stem solely from photos, but also from the fact that he, and everyone else in the family, recognize that the hair on the sides of his head has become noticeably thinner. For a while there we all believed that he was receiving a bad haircut every two weeks, but we now recognize that his hair has thinned.

 

Hell, I may never make it to 87, and even if I do, odds are good that I won't be that concerned with my physical appearance. However, to bog yourself down with the details of my uncle and him being 87, is to do a disservice to this community. Your statement that hair transplants are a risk is far too cavalier considering that some patients will lose hair like my uncle did, only not at age 87, but at 47, or 57. As Dr. Beehner noted, some patients can look like freaks if proper planning isn't utilized.

 

As for me personally, I am on proscar, but finasteride is not a cure for hair loss. It is very possible that even if I were to take proscar for the rest of my life, (which, let's be honest, that seems like a pain to do) it might lose effectiveness over time. And for the naysayers out there who disagree, ask yourself this question, if finasteride were to work indefinitely, why does a certain doctor with the initials A.A. have a poor reputation regarding ethics? If someone is really that sure that finasteride will continue to work forever, then lowering the hairline of a young patient, filling in the crown at an early age, or closing in the temples would not be an issue. And yet every scrupulous doctor refrains from doing those things.

 

Dr. Beehner has tried stressing the significance in future planning, and yet it seems to have fallen on deaf ears. Paying lip service to the concept of risk, while flippantly dismissing my position is exactly the type of dangerous post that can contribute to someone making a bad decision.

 

A hair transplant has to be about minimizing risk, not ignoring their existence. If Dr. Beehner, or any other physician can offer his expert opinion as to common indicators that a patient will become a NW 6 or 7, I would welcome that. Does that mean that those indicators will ring true in all cases? Of course not, but that doesn't mean we shouldn't arm ourselves with as much knowledge as possible.

 

These doctors have performed thousands of procedures, and I'm sure that they've talked to the patients about when the hair loss started, the family history, etc. I'm sure that there are common factors shared with most patients that presented with advanced level balding. It would be nice to know what those were.

[hdude46]

Im not disagreeing with you or 'flippantly dismissing your position'. But any ethical dr. on here, which most are considering their recommendation on this site, is going to plan for the future for their patients. They always include a plan for 'just in case' scenario. But lets face it, not everyone is at risk for going to a nw6-7. Thats why some have lower hairlines than others and not everyone has the hairline that dr. beehner did for this patient, same goes with crown work.

 

In a 10 yr follow up study to the propecia 5 yr study by the fda almost all the patients had similar hair counts as the did at the 5 yr mark. Yes, some patients will lose hair, but at a considerably slower rate. Yes, people with family history's of nw6-7's are more prone to having donor thinning. But just b/c THIS man looked like this at this age doesn't mean we all will at 50. Who knows about his family history, use meds (doubtful), rate of loss, ect.

 

Thats also to ignore that in 50 some yrs, I would be willing to bet their are more useful hairloss treatments that propecia and rogaine. heck probably within the next 10-20 years.

 

No use in getting in a back and forth discussion. I think the best is for patients to consult their physician and lay out a plan for THEM.