Confused after consultation

[sila]

Hello everyone

I recently had an online consultation with a doctor to discuss my expectations for a hair transplant. This clinic is one that has been recommended by several members here, and is generally considered to be in the mid-to-high price range. The goal of my procedure is to restore my hairline and fill in the temples. Reference picture below. 

I'm aiming for full density in the front, so as to avoid a follow-up procedure, as any potential second hair transplant would focus solely on the crown. However, to my surprise, the doctor explained that achieving full density isn't possible, due to the need for a certain degree of spacing between grafts. Furthermore, it was  explained that my thin hair would contribute to the perceived lack of density, which left me quite taken aback.

Are my expectations unrealistic?

Any input or advice would be greatly appreciated. Thanks in advance!

Edited July 9, 2023 by sila

[Eli_Avdikian]

anywayDid the doctor ask you if you are on any medication ? Anyway, I think he's right about your fine hair calibre contributing to the impossibility of acheiving full density, keeping in mind that your receded temple area is quite big.

[sila]

1 hour ago, Eli_Avdikian said:

anywayDid the doctor ask you if you are on any medication ? Anyway, I think he's right about your fine hair calibre contributing to the impossibility of acheiving full density, keeping in mind that your receded temple area is quite big.

Yes, I'm starting with Finasteride as recommended by the doctor, which will be about six months prior to the hair transplant. 

I understand your point and it makes sense, but I was under the impression that achieving full density was simply a matter of the number of grafts used. I thought that with a sufficient amount, we could reach the desired density. At least that’s what I see here from other reviews of top clinics. 

[BackFromTheBrink]

You're right in that while it may require more than one surgery, it is a case of the number of grafts, the number of hairs per graft, any shape to your hairs, the diameter of the hairs and your hair colour to skin contrast ratio (and of course the surgeons ability in placement).

Your implanted follicles will also compete for blood supply so placing them close together can cause low yield.

In your case, it may be that you have high contrast and low diameter hairs. That combined with a finite donor area and relatively large area to cover may not give you the result you desire. 

Ultimately it's supply and demand since you're just moving hair from one place to another.

Edited July 9, 2023 by BackFromTheBrink

[Curious25]

If by full density you mean, native density (the same fu per cm2 as non balding areas of your scalp) - then yes, the Dr is correct by saying this is not feasible because 

1) the low end average of native density is around 70FU per cm2 and most Dr’s cite this as being impossible to implant in one sitting - I have only ever saw one particular Dr who claims to transplant at this density in one pass during the last 15 years. 

2) That level of density is not actually required to provide you with a full looking head of hair. 
 

3) You would probably utilise all, if not more, of your available grafts from your donor zone if you were to pursue with this plan. 
 

If the Dr is referring to not being able to get you to a point of looking like you have a full head of hair in the front after 1 pass, then he could be correct, however others might feel differently. You really need to go for in person consultations to get the most accurate assessments on your situation - uploaded photos are more times than not heavily deceiving of the reality of the situation.  

 

[sila]

Thank you both for your insights. While your explanations make sense, it's still somewhat disheartening to learn that after investing €10,000, a completely satisfactory result in the front might not be achievable in one go. 

It's a substantial investment, and naturally, I was hoping for a significant improvement. 

I will continue with my research on similar cases. 

Edited July 9, 2023 by sila

[A_4_Archan]

13 hours ago, sila said:

Thank you both for your insights. While your explanations make sense, it's still somewhat disheartening to learn that after investing €10,000, a completely satisfactory result in the front might not be achievable in one go. 

It's a substantial investment, and naturally, I was hoping for a significant improvement. 

I will continue with my research on similar cases. 

First of all you should understand that hair transplant creates an illusion of density in most of the successful cases and the full(very high) density is tough to achieve....for achieving full density(very high) all the involved factors should be favoring you and in your case they aren't....

 

- First of all your front portion seems to be wider than usual (though pictures can be deceptive) so too many grafts are needed just to create an illusion of density itself 

 

- more than usual grafts will be needed even if you do conservative hairline because of the wider size and thin hairs and you already have a forelock so the hairline can't be taken too high and somehow need to keep in sync with the forelock....

 

- you have got very thin hairs which will again add to the illusion of not so dense result 

 

- you have got many native hairs which can get damaged if your surgeon tries to implant new grafts very close to them

 

- sometimes too much dense packing leads to poor survival of grafts due to lack to blood supply to them

 

-the most important thing is that your surgeon has to preserve more grafts for your crown as it requires more grafts comparatively due to various factors plus have to save some grafts even for 3rd surgery as you may loose your forelock in future and have to recreate the hairline in future...

 

Due to all such factors its tough in your case to give you so much density and even its a wise thing not to attempt it..good that your surgeon already asked you to keep your goals in check...i know it feels bad when our expectations is not met but imo a long term plan will be more wiser than a short term WOW result...i hope this helps you ..best of luck...

 

 

[Al - Moderator]

When you go back to do the crown, you can also add some density to the front, so you would still only go through two procedures. Just because the front doesn't get as dense as you would like, it may still be enough improvement so that you won't need to go back right away and you can wait a couple of years when you decide to fill in the crown.

 

[Bucky O Hair]

What is your definition of "full density"?

Also, did your HT doctor examine your donor, measure your hair caliber, measure the recipient area, and give you an estimated number of grafts and density (in cm2)?

All conversations with a HT doctor are pointless without the numbers.  

If your definition of "full density" is to achieve your original native density (which is usually measured between 80-100 grafts per cm2) then no HT can achieve this definition of full density.
The safest density that a HT can provide is usually 50 grafts per cm2, which is (in my opinion) good enough for the appearance of "full density".

Not sure if you've ever met anyone with 50 cm2 density, but it could be what you are looking for.  50cm2 is pretty much at full density, but again, we all have differing opinions.  
I would try and possibly meet people who were NW3 patients like you, who received 40-50 grafts per cm2 in their frontal area to see if it's something that meets your expectation of full density.  
 

[sila]

4 hours ago, BeHappy said:

When you go back to do the crown, you can also add some density to the front, so you would still only go through two procedures. Just because the front doesn't get as dense as you would like, it may still be enough improvement so that you won't need to go back right away and you can wait a couple of years when you decide to fill in the crown.

 

Good point, thank you!

4 hours ago, Bucky O Hair said:

What is your definition of "full density"?

Also, did your HT doctor examine your donor, measure your hair caliber, measure the recipient area, and give you an estimated number of grafts and density (in cm2)?

All conversations with a HT doctor are pointless without the numbers.  

If your definition of "full density" is to achieve your original native density (which is usually measured between 80-100 grafts per cm2) then no HT can achieve this definition of full density.
The safest density that a HT can provide is usually 50 grafts per cm2, which is (in my opinion) good enough for the appearance of "full density".

Not sure if you've ever met anyone with 50 cm2 density, but it could be what you are looking for.  50cm2 is pretty much at full density, but again, we all have differing opinions.  
I would try and possibly meet people who were NW3 patients like you, who received 40-50 grafts per cm2 in their frontal area to see if it's something that meets your expectation of full density.  
 

Thank you for your constructive feedback. As there hasn't been an in-person consultation, no measurements of my hair or recipient area have been made yet.

The figure of 50 grafts per cm² was indeed mentioned during the consultation, but without a visual reference, it's challenging to envision the end result. When I referred to 'full density,' I meant a result that wouldn't necessitate a follow-up repair procedure.

I appreciate all the information and advice shared here. It's clear I need to adjust my expectations and potentially seek an in-person consultation for a more accurate assessment. Thanks again for your help!

10 hours ago, A_4_Archan said:

First of all you should understand that hair transplant creates an illusion of density in most of the successful cases and the full(very high) density is tough to achieve....for achieving full density(very high) all the involved factors should be favoring you and in your case they aren't....

 

- First of all your front portion seems to be wider than usual (though pictures can be deceptive) so too many grafts are needed just to create an illusion of density itself 

 

- more than usual grafts will be needed even if you do conservative hairline because of the wider size and thin hairs and you already have a forelock so the hairline can't be taken too high and somehow need to keep in sync with the forelock....

 

- you have got very thin hairs which will again add to the illusion of not so dense result 

 

- you have got many native hairs which can get damaged if your surgeon tries to implant new grafts very close to them

 

- sometimes too much dense packing leads to poor survival of grafts due to lack to blood supply to them

 

-the most important thing is that your surgeon has to preserve more grafts for your crown as it requires more grafts comparatively due to various factors plus have to save some grafts even for 3rd surgery as you may loose your forelock in future and have to recreate the hairline in future...

 

Due to all such factors its tough in your case to give you so much density and even its a wise thing not to attempt it..good that your surgeon already asked you to keep your goals in check...i know it feels bad when our expectations is not met but imo a long term plan will be more wiser than a short term WOW result...i hope this helps you ..best of luck...

 

 

Thanks! I will indeed document my results and progress. Hopefully, this will provide insights to the next person with similar characteristics as me -wider front portion as usual -  , making their journey a bit easier. This forum is a fantastic resource! Thanks again to all of you for your support and guidance.