Seeking advice for 2nd Hair Transplant - midscalp and crown area only

[dberliner]

So I had my first transplant 5 years ago With Dr. Paul Shapiro (you can find my review here on the forum under my username). I was very pleased with the result and the natural looking hairline the doc has designed for me (I'm in my mid-40's now) but I couldn't continue taking Finasteride as it was seriously adversely affecting me (heavy sweating, sexual dysfunction issues etc.) so the areas that could not have been covered by the original transplant have continued to progress in shedding, to the point where now my crown area is completely bald.

My original surgery was close to 4K grafts in the FUT strip method. I'm thinking of going with FUE this time, and also there is no need to really design a hairline here anymore, so the fine-tuning (I think, correct me if I'm wrong) is not needed as much.  

Was wondering if anybody else has found themselves in a similar situation and what you did:

1. Type of surgery you think should be done.

2. Doc recommendation - would like to not overspend here because I feel like this extra surgery should be simpler as design is not really an issue, but of course also not underspend to the point of risking safety and getting an underwhelming result (I'm located in West USA but willing to travel abroad if needed). 

I'm attaching some pictures of the affected area and the donor area.

Thank you!

DB

Edited June 7, 2023 by dberliner

[hairthere]

In my opinion the best way to maximize your donor zone is to do as many strips as possible and then switch to FUE. This was the approach I took and it allowed me to transplant almost 10k grafts. The problem with this approach is that consequent strip scars will likely be wider than the first. This could present an issue with the length you wear your donor hair. What is the quality of your current strip?

[Rahal Hair Transplant]

@dberliner,

I’m inclined to agree that since you started with strip, that you should potentially “strip out” before moving to FUE in order to maximize the number of grafts you can achieve, especially if you are attempting to tackle the crown area which is rather large in size.

I don’t know if you intend on doing any hairline refinement, but assuming you’re not, you will still likely need a substantial number of follicular units added into the midsection in order to connect and gradually taper from the hairline into the crown, etc.  

Now, if you would rather not go the strip route again and go right into FUE, of course is possible, but you will potentially limit the overall total number of grafts that can be achieved with your donor overtime.

I do need to bring up another and possibly the most important point.

In terms of medication, I can certainly understand why you wouldn’t want to continue taking it given the side effects you were experiencing.i

That said, it’s obvious that hair loss is progressing and continuing and there’s evidence that you are heading towards a full-blown Norwood 6 if not a full blown Norwood 7.  This is going to substantially limit your overall available donor hair, regardless of which procedure you choose..  

Assuming I am correct based on what I’m seeing in the photos, I don’t think it’s a good idea to touch your crown at all.  Instead, I would focus whatever available donor hair you have on doing any frontal area refinement, and then go back as far as you can into the mid scalp section.

Some of the grafts may be needed to fill in any of the areas on the sides that are “dipping” down due to the progression of hair loss into the higher Norwood classes.

Personally, I think that would be more important and relevant than attempting to fill in the crown because if the area on the sides below the transplanted frontal area dip down too far, there will be a space between your transplanted hair and your donor hair on both sides of the scalp 

So all that to say, I would be really careful with how you proceed here because as much as you likely want to target the crown, you may need some of those available grafts to keep your hair, looking natural in the vent you do continue to enter into the higher Norwood classes.

I hope this helps.

Rahal Hair Transplant 

Edited June 8, 2023 by Rahal Hair Transplant

[mr_peanutbutter]

if you consider fut id strongly consider hattingen in switzerland

[dberliner]

Hey Hairthere - Thanks for your reply. Seems like both you and Dr. Rahal think I should go again with the strip route. Not sure what you mean by the quality of it, but if you refer to it's esthetic look, I think it's pretty much as good as you would expect in this method. It's pretty narrow. 

 

Dr. Rahal - I understand that I have some temple area hair loss but I actually think it's covered pretty well when my hair is well washed and groomed (maybe not this picture). I've also sent you private images on your website. Not sure if you're answering this thread based on that but I think they're higher quality with better angles for you to assess. My main worry about another strip is the recovery part. Last time it took over a month before I was able to gain full neck mobility since lowering my head resulted in a very inconvenient "stretchy" feeling. I'm wondering if the recovery with subsequent strip harvesting is different in anyway. 

 

Thank you!

 

DB

[coolbreeze]

I see guys trying to cover their whole head when it might be better to cover the very middle and go two inches to each side. Would rather have hair there and some thinning sports visible than mediocre coverage all over.