HOW MANY GRAFTS DO A NW 6 NEEDS TO COVER UP?

[bllorayne]

HI.............everyone.i was wondering if someone goes for a mega session then how many sessions will a nw 6 require to cover up.how many grafts do a nw6 requires/.....i guess 8500 r more than enough...

[bllorayne]

HI.............everyone.i was wondering if someone goes for a mega session then how many sessions will a nw 6 require to cover up.how many grafts do a nw6 requires/.....i guess 8500 r more than enough...

[hdude46]

if you are a nw6, you most likely do not have that many graphs available. maybe the only clinic that could get that many graphs is h&w but even they might not be able to do it. it depends on your donor. you wont be able to cover your entire head regardless so u need to have realistic expectations of what a ht can do for u, especially on a nw6.

[dakota3]

if you are a nw6, you most likely do not have that many graphs available

 

hdude, Im not sure your NW level has anything to do with how many grafts you have available! For example Bill would be a NW6 I believe and has had over 10,000 grafts harvested if Im not mistaken.

[MikeTheDane]

Hard to say, it depends on hair characteristics such as hair/skin color contrast, hair diameter etc.

 

But most completely bald nw6 would probably need 8000-10000. Just a guess.

[hdude46]

yeah...and u can see Bill's scar clear as day and he is still pretty thin on top and in the crown. more over, that hair is not going to stay that thick forever, as he ages it most likely will thin out even more. by then he may be older and not care but it is just something to consider. while i agree that nw level and number of graphs available maybe dont have a direct correlation, they def are related.

[TC17]

I think what hdude46 is trying to say is that just because a man has X number of grafts at age 30 or so, does not mean that he will have that same amount at age 55. Look at bald men in their 60's and above and you will see that a sizable number do have a thin donor area.

 

I've had two in person consultations with doctors who are held in the highest regard on this site, and each told me the same thing. As of right now, at age 26, I have very good donor density. However, I was also told that what I must be aware of is that any surgery must be done with an eye towards what I will become, and not what I am now. Who the hell cares if at age 26 I have great donor in the "safe" zone, if by age 55 or so it is thinning?

 

I'm not trying to stir the pot here, but each time I see a NW 6 who is younger (like Bill, comb, drew35), it seems as though the doctors are managing to get A LOT of grafts, and provide good coverage. Yet, I very rarely see older patients who are equally as bald get anywhere near the number of grafts as the patients I mentioned above. (dr. rassman has an example posted on his site that is the exception to that point) Maybe the younger patients have better scalp elasticity, maybe the younger patients all have better density, or maybe the younger patients merely had grafts moved that will eventually fall out?

 

One final point. I have an uncle who was a NW 2 until age 30, and he was maybe a NW 4 at age 45. In the past 10 years though, he has progressed to a NW 6.5. He thought he was "in the clear" at age 30, he though certainly that by age 45 he wouldn't become "totally bald", and now he is just hoping that he doesn't lose his little tuft in the front. You can't predict the unpredictable.

[hdude46]

Good points....

 

Having an eye towards the future is perhaps the most important thing a ht transplant surgeon must consider when operating on younger patients. I'm willing to bet though that most nw 6-7's (and tc your uncle while definitely not alone is probably in the minority) get their quickly and in their early to mid twenties. I could be wrong on that, but I bet you see a higher degree of thinning in the safe zone on people who have been extensively bald for a long time.

 

My dad is 60 and his hair is still very thick. My gandpa is over 80 and I would say the hair he has left (nw4-5 diffuse) is pretty thick as well, especially considering his age, and could easily hide a scar if he had one. My point is that its hard to look at old people and say well this is how I will look in 40 years. For one, you dont know anything about their hair characteristics, when or how fast they were balding, age, ect. You cant predict the unpredictable but if you have a family full of 6's and 7's you are very likely headed down that path at some point in time. Likewise if your family history isnt as severe, while it isnt a sure thing, it is likely you won't advance to that severe stage of balding.

 

A lot of people have their hair loss slowed and stabilized in their forties or fifties anyway after years of balding while others may just be beginning their process. Regardless, its a pretty safe bet your hair will remain in pretty good shape (in regards to donor thinning) well into your 60's (just my own observations). By then, will it really matter if your transplant/donor starts to thin? By then (which is in 50 years) don't you think their will be a better hair loss product/treatment commercially available?

 

Dont live for now but also dont let what you may or may not look like at 70 or 80 stop you from enjoying a good head of hair between now and then.

[imissthebarber]

I agree that this is something that doesn't get talked about enough. Having the scar showing could be distressing for an old person. A constant reminder of a mistake they made in their youth, or just their youthful vanity.

 

On the other hand, there may well be better treatments in forty to fifty years. I also agree that there is not much point in worrying about something 40 years down the line.

[Dr. Paul Shapiro]

This is a very good thread and has brought up a lot of good issues. It is important to remember that balding is a complex multi-genetic trait, and the balding genes are expressed very differently in each individual. What age these 'balding genes' turn on, the rate of balding, and how sever the balding will be is difficult to predict early on. Your family history and how much hair loss you have in your 20's is a guide to future hair loss, but not a predictor. The only thing I can say for sure is that if someone has significant balding in their early 20's they are likely on their way to be a Norwood type 6 or 7. But the opposite is not true. I have seen many patients in which their hair loss did not start until they were in their 30's, some do become a Norwood type 6 or 7 and some do not. I come from a family of 4 boys (my poor mom). Two of us have a full head of hair and two have significant balding.

 

Secondly, I do think that it is very rare to find someone who will have 10,000 FU donor grafts over a lifetime. If my memory servers me correctly I have seen only a few patients posted on the HTN who have had 9,000 to 10,000 grafts total. I am concerned that to get so many grafts we may push the limits of taking hair from the safe donor area. I have seen some transplants in which to get such a large amount of donor hair, the donor is taken from outside the 'safe' donor area. Not only is there a potential to see the scar, but there is the potential that this is not permanent hair. So the hair that is transplanted may fall out like all the other hair with male pattern balding. I have spoken privately to some on the HTN about this. These hair transplant patients say they are aware of the risk they are taking, and would rather look good today and take a chance on tomorrow. This is a personal choice for each patient to make, but I do think the risk/benefit ratio should be made clear prior to the surgery so each patient can make an educated decision. I do like to point out that we are living longer, and the US divorce rate is over 50% so there is a good chance a lot of us will be single in our 50 or 60's and back on the dating seen. I also like to point out that we can get a very good cosmetic look with less grafts then a lot of the HTN patients seem to think they need.

Please look at my post 'How Many Grafts are Needed in a Hair Transplant'.

http://hair-restoration-info.c...66060861&m=615103223

Third is an issue that is hardly mentioned on the Hair Transplant Network. As we age our safe donor area does lose hair and becomes less dense. I have not seen any good studies on this phenomenon but there is a general consensus in the hair transplant medical community that this does happen. I have notice that most of my older patients have less donor density then my younger patients. I believe this is a process of aging just like we get wrinkles in our skin due to less collagen in our skin. This thinning does not seem to be hormone related like the hair loss in male pattern baldness because the donor area never becomes completely bald like in male pattern baldness, but just thins out. If there is a hormonal component to this thinning of the donor area it is different then the male pattern balding process. The amount of thinning varies with each individual. So if you your donor density is 90 FU/sq.cm when you are 20 it may thin out to 80FU/sq.cm when you are 50. So I don't think one can count on having the same donor density thought out ones lifetime.

I hope this information is helpful.

Dr. Paul Shapiro

[TC17]

Dr. Shapiro,

 

When you say "significant balding in their early 20's", what exactly does that mean? I'm 26, and would describe myself as closest to a NW 3v. However, upon magnification I was told that I have miniaturized hair hair in a class 5 pattern. Would that fit with your definition of "significant balding"?

[Al - Moderator]

Regardless, its a pretty safe bet your hair will remain in pretty good shape (in regards to donor thinning) well into your 60's (just my own observations). By then, will it really matter if your transplant/donor starts to thin?

 

 

What makes you think that it's a safe bet that someone you don't know won't be thinning in their donor area until their 60's or later? Your own observations? What would those be? Looking at men who are stage 7 with thin donor areas and ASSUMING they are 60, 70, or older because they look older to you?

 

When I was young I thought my uncle was at least 10 years older than my father because my uncle had no hair on top and didn't even have enough hair on the sides of his head to cover the sides. I found out years later that he is actually a few years younger than my father. He was only in his late 30's, early 40's then and had see-through donor hair already.

 

I've been battling a thinning donor area since my early 20's. I had a HT at age 22 and one of the things I hoped to fix was the thinning on the sides and back of my head, the so-called safe area.

 

Another thing to remember is once you get a HT you removed the best hair from the sides and back. If you max out or near max out, what you are left with is hair in the lower neck and just above the ears that generally thins out sooner than the areas taken for the HT. You also have the hair above where the HT donor was taken which also is out of the safe area and as your thin/bald area gets larger, that is the hair that will go. Add to that because of several HTs you may have had, what's left of the donor area is already thinned out because the area had to stretch back each time leaving more space between each hair there, so you're already starting off with a thinner area after the HT than you would have if you didn't have any HTs.

 

So... even if you would be someone who normally wouldn't thin out in the donor area until age 60+, you're going to be thinning out years earlier than that because the best hair in that area has been removed.

[TC17]

BeHappy,

 

What doctor performed your surgery? Based upon your statements, it would seem to me as though you would not have been a candidate for a surgery. I'm astounded that a scrupulous doctor would take on the case of a 22 year old who already has donor thinning.

[hdude46]

like i said, it was my own observations, not a fact i was stating...people will thin later, people will thin sooner. dont chastise me though when i clearly said this is just my observations. did i say im looking at men and assuming they are older? no, i gave 2 examples of males in family and said that is where they were at. sheesh.

 

you are assuming everyone will progress to a nw 7, everyone's donor will thin out completely. like you said you dont know them so dont make assumptions about which hair will go and which hair will stay. i have seen almost no 22 yr olds with donor thinning so i assume u are a rare case.

[Dr. Paul Shapiro]

Originally posted by TC17:

Dr. Shapiro,

 

When you say "significant balding in their early 20's", what exactly does that mean? I'm 26, and would describe myself as closest to a NW 3v. However, upon magnification I was told that I have miniaturized hair hair in a class 5 pattern. Would that fit with your definition of "significant balding"?

From what you describe I would consider you to have significant balding. If I was to plan a hair transplant surgery on you I would plan it as if you may become a Norwood 6. That would mean keeping the hairline at least 8 cm above the glabella and not bringing out the temporal angles too much. Of course this is all without seeing you and in any surgery the plan would have to frame the patients face nicely and end up with a good cosmetic effect. Also, when I see a patient like you I discuss with them how we can not exactly predict the future. And sometimes I am more or less aggressive depending on each patients goals, family history, how their donor looks today, their response to medications.

Dr.Paul

[TC17]

Dr. Shapiro,

 

Out of curiosity, why wouldn't you plan for a person in my shoes to become a Norwood 7?

[hdude46]

i dont want to speak for dr. shapiro but I'm pretty sure he would if he knew you have a family history of nw6's and 7's and arent responding to medication. the other thing to consider is rate of thinning and the extent of hair loss. you say you are a nw 3v but is your crown completely bald or just starting to thin? is the thinning slow or fast? both could be considered nw 3v's but with with different properties for sure. dr shapiro made a few great posts in the how many graphs do i need section in which he showed an average but completely bald nw5 patient get full coverage by being conservative with the hairline and distributing the graphs properly...

 

i think the key is getting on meds...ive read to many dr's say these drugs really work and really stop/greatly slow hair loss. between propecia, rogaine, and now hopefully prp, along with a ht and if you really want, concealers, even if no new technology comes out for the next 50 years u should be in pretty decent shape between all those things.

 

I really dont think hair cloning or anything similar will be available anytime soon. Ive read and heard its coming at a rapid clip and we are closer now than ever before but everyone said the same thing about hiv/aids in the 80's/90's...yet here were are over 20 years later and while medication has improved, syill no vaccine or cure. I think that is what you will see with hair loss. I hope I'm wrong of course but time will tell. Maybe Dr. Shapiro can chime in as he is more in touch in the hair restoration community.

[Dr. Paul Shapiro]

Originally posted by TC17:

Dr. Shapiro,

 

Out of curiosity, why wouldn't you plan for a person in my shoes to become a Norwood 7?

TC17:

 

Usually when I consult with a young patient who has significant hair loss I like to wait a few years before doing a surgery. I always wet their hair to see how much thinning is in the temporal hump area and the lower crown area. The worse the temporal hump area and the crown area are, the more likely they will become a type 7. I like to follow how they respond to medications, and how their hair loss progresses over time, including the miniaturization that is seen. Using all this information and the patient's family history I then make my estimate if I think they are going to become a type 6 or type 7. But of course this prediction is not an exact science. I do not have all your information and there is a possibility you may progress to a Norwood type 7. I just did not mention that in my post.

 

Then, if I go ahead with surgery I do plan the first surgery as if they may become a type 6 or type 7 using all the information I have. If I fell strongly that a patient may become a Norwood type 7 I may be a bit more conservative in their first surgery. My goal in the first surgery would be to devise a pattern that would look natural even if the patient progresses to a type 6 or 7, leaving enough donor hair to build up the temporal humps if necessary and still be able to hide any donor scar. I take into consideration that a second surgery down the road is a likely possibility. Many young patients when seeing this type of plan think it is too conservative. For some patients they may just opt out of having any surgery and decide to keep their hair short. Or after discussing the risk and benefits of a surgery I may be a bit more aggressive as long as the patient if fully educated in the risk they are taking.

I hope this is helpful

Dr. Paul ShapiroI