Opinion sought on suitability of donor area

[Tobias Funke]

Hi

Firstly I'd like to say thank you to those who contribute to this forum and providing such valuable information. I have been reading quite a lot of the topics in recent weeks.

I am scheduled to undergo an FUE transplant early in the New Year. Based on photos I have submitted to various surgeries I have been advised my donor area can provide anything from 2,800 to up to 4,500 grafts.

The clinic who I am due to have my procedure with in January has advised my donor area is good and will enable them to extract 4,000 grafts, perhaps even up to 4,500.

With a mature/conservative hairline they say this should cover everything with the exception of the crown.

However I have just heard back from another clinic who say they would only be able to extract between 2,000 - 3,000 from my donor area and say they would not recommend I undergo FUE surgery as this would only create the hairline and nothing more.

I have provided some photos based on growing my hair for approx 3 weeks after a 1mm shave.

Does anyone have any opinions on the suitability of my donor area?

Thank you for your time.

 

[Ccd99]

It is difficult to say as the photo quality and lighting could be better but honestly speaking I can see some diffused thinning on your donor area which could be a sign of DUPA (needs to be confirmed using a microscope).

Your crown has also dipped quite a lot, so I personally think you may struggle to get 4000 without causing visual impact to your donor area (but then again there are some wizards out there like Dr. Zarev).

Can you visit a local HT clinic for an accurate consultation/assessment? Alternatively, speak to other clinics and send photos for a second opinion.

[LaserCaps]

A couple of concerns,

Looking at the last photo, it sure seems you're still expanding the pattern. Just look at what's happening in the perimeter and how far you're dipping.  My first question, what are you doing to mitigate the progressive nature of this condition?  It's important to recognize, if you've shown the propensity to lose, you'll continue losing. 

I once worked with a doctor who used to say, "It makes no difference where the hairline is as long as there is one."  The farther back you go, the farther back the doctor can work so as to minimize the size of the crown.  You can always add a tweak at a later time.  The second thing that goes hand and hand with this being pattern appropriate.

Review the Norwood chart and notice the progression.  The key here is to understand how each pattern is identified.  An advanced pattern, for example, would never have a juvenile hairline.  (Research the Rule of Thirds.  This should give you a decent idea where your hairline ought to be.  Be conservative).  

Everyone'an expert.  I often chuckle when I read recommendations in the 4K - 6K per procedure.  There's only so much you can harvest per time.  Why is that?

As long as the punch is smaller than a .9mm, it'll leave a micro-scar which will not be visible to the naked eye.  The punch is so small, however, so will the graft.  Not a lot of substance nor hair.  And while this has improved greatly, the fact is, you can get more with "O" than you can with "o." Larger punches will leave circular type scars - which defeats the whole purpose of FUE.

You typically want to spread the harvest to avoid over harvesting.  Taking every 7th, for example, would perhaps allow a second procedure down the road.

You can typically harvest 2000-2500 grafts at any one time.  So, how do you get from this to 4K+? You could do both FUT and FUE procedures, (2 day procedure).  You can split grafts, or you can over harvest.  (Follicular units can come with 1-5 hairs.  You could take a 5-hair graft and convert into 5) 1 hair grafts.  While you get the numbers, you lose the density.  Placing one hair grafts throughout would yield a diffused and an unnatural look).  Given the way you style your hair, it's likely you would consider FUE.  

Over harvesting...hmmm.  This is something to consider.  If the doctor removes all your donor and places it on top - would that be a consideration?  If you plan on always keeping your hair in a high and tight on the sides and back, why not?  I would, at least, have that conversation with the surgeon.  

 Lastly, donor limitation often guides the approach.  There's typically not enough available to allow for density in the front, top and back. It's for this reason most doctors will suggest working the front first.  It's the area you see when you look at yourself.  It's also the area others see when they interact with you.  (Having hair in the front will alway serve you well.  It'll help frame your face and give you styling options).  

[Tobias Funke]

12 minutes ago, Ccd99 said:

It is difficult to say as the photo quality and lighting could be better but honestly speaking I can see some diffused thinning on your donor area which could be a sign of DUPA (needs to be confirmed using a microscope).

Your crown has also dipped quite a lot, so I personally think you may struggle to get 4000 without causing visual impact to your donor area (but then again there are some wizards out there like Dr. Zarev).

Can you visit a local HT clinic for an accurate consultation/assessment? Alternatively, speak to other clinics and send photos for a second opinion.

Thank you. Of the six clinics I have 'consulted' i.e. submitted photos to, the average figure would be 3,200 grafts. The latest feedback that they do not recommend I undertake FUE at all has concerned me. 

[Tobias Funke]

8 minutes ago, LaserCaps said:

A couple of concerns,

Looking at the last photo, it sure seems you're still expanding the pattern. Just look at what's happening in the perimeter and how far you're dipping.  My first question, what are you doing to mitigate the progressive nature of this condition?  It's important to recognize, if you've shown the propensity to lose, you'll continue losing. 

I once worked with a doctor who used to say, "It makes no difference where the hairline is as long as there is one."  The farther back you go, the farther back the doctor can work so as to minimize the size of the crown.  You can always add a tweak at a later time.  The second thing that goes hand and hand with this being pattern appropriate.

Review the Norwood chart and notice the progression.  The key here is to understand how each pattern is identified.  An advanced pattern, for example, would never have a juvenile hairline.  (Research the Rule of Thirds.  This should give you a decent idea where your hairline ought to be.  Be conservative).  

Everyone'an expert.  I often chuckle when I read recommendations in the 4K - 6K per procedure.  There's only so much you can harvest per time.  Why is that?

As long as the punch is smaller than a .9mm, it'll leave a micro-scar which will not be visible to the naked eye.  The punch is so small, however, so will the graft.  Not a lot of substance nor hair.  And while this has improved greatly, the fact is, you can get more with "O" than you can with "o." Larger punches will leave circular type scars - which defeats the whole purpose of FUE.

You typically want to spread the harvest to avoid over harvesting.  Taking every 7th, for example, would perhaps allow a second procedure down the road.

You can typically harvest 2000-2500 grafts at any one time.  So, how do you get from this to 4K+? You could do both FUT and FUE procedures, (2 day procedure).  You can split grafts, or you can over harvest.  (Follicular units can come with 1-5 hairs.  You could take a 5-hair graft and convert into 5) 1 hair grafts.  While you get the numbers, you lose the density.  Placing one hair grafts throughout would yield a diffused and an unnatural look).  Given the way you style your hair, it's likely you would consider FUE.  

Over harvesting...hmmm.  This is something to consider.  If the doctor removes all your donor and places it on top - would that be a consideration?  If you plan on always keeping your hair in a high and tight on the sides and back, why not?  I would, at least, have that conversation with the surgeon.  

 Lastly, donor limitation often guides the approach.  There's typically not enough available to allow for density in the front, top and back. It's for this reason most doctors will suggest working the front first.  It's the area you see when you look at yourself.  It's also the area others see when they interact with you.  (Having hair in the front will alway serve you well.  It'll help frame your face and give you styling options).  

Thank you.

I have never done anything previously to mitigate my hair loss e.g. drugs.

I am quite settled on the idea of a conservative/mature hairline - probably the kind that would lead many to undertake a hair transplant procedure! But I'm more at the happy with whatever I can get stage! 

Are you suggesting that if I had a shaved back and sides in the future I should not be over-concerned about the donor area? This is a new concept to me as I was under the impression I would need to grow this out to compensate for any loss in that area.

[LaserCaps]

9 minutes ago, Tobias Funke said:

Thank you.

I have never done anything previously to mitigate my hair loss e.g. drugs.

I am quite settled on the idea of a conservative/mature hairline - probably the kind that would lead many to undertake a hair transplant procedure! But I'm more at the happy with whatever I can get stage! 

Are you suggesting that if I had a shaved back and sides in the future I should not be over-concerned about the donor area? This is a new concept to me as I was under the impression I would need to grow this out to compensate for any loss in that area.

Wait, what?  Let me see if I understand.

If you've never tried anything, I would encourage you to do all modalities and give them a year.  You can then decide if the time, effort and expense are worth continuing.  (It does take a year to confirm what exactly the meds will do.  It also takes a whole other year to mature the results of a procedure - so you're now two years into this.  Why not do both transplants and meds at the same time?  A year from now you'll have more density in the front because of the procedure, but perhaps more in the mid-scalp and crown because of the meds).  It also seems you have realistic expectations - which is a good thing.

Now, let me see if I can decipher what you mean by what you wrote in the second sentence.  

Is having hair in the sides and back important to you?  If your ultimate goal is to keep those areas tightly shaven, you could contemplate the idea of moving all the hair you have in those areas and move them to the top.  

Growing the hair in the donor.....how does that compensate loss?  Pls clarify.

 

[Doron Harati]

How old are you?

In your case there are bigger concerns than the grafts amount you can have.

You need to grow your hair for more 1-2 weeks with videos, it won't be enough to review photos only. We need good quality video of you use a comb over your sides and back donor to exam the quality of grafts roots, with these blurry photos it's hard to understand if you have diffused patches over your donor.

Base on these photos I think you have narrow scalp which is good.

With high quality videos and photos we can understand what resembles the reality of your properties.

[Tobias Funke]

44 minutes ago, LaserCaps said:

Is having hair in the sides and back important to you?  If your ultimate goal is to keep those areas tightly shaven, you could contemplate the idea of moving all the hair you have in those areas and move them to the top.  

Growing the hair in the donor.....how does that compensate loss?  Pls clarify.

I have no set ideas for the style I want in the future - just having more/some to play with will be nice! To clarify, I was under the impression that a close shave in the donor area would highlight where grafts had been removed and that longer hair would better cover this. Are you saying a close shave in the donor areas is actually a good/feasible option? 

[Tobias Funke]

29 minutes ago, Doron Harati said:

How old are you?

In your case there are bigger concerns than the grafts amount you can have.

You need to grow your hair for more 1-2 weeks with videos, it won't be enough to review photos only. We need good quality video of you use a comb over your sides and back donor to exam the quality of grafts roots, with these blurry photos it's hard to understand if you have diffused patches over your donor.

Base on these photos I think you have narrow scalp which is good.

With high quality videos and photos we can understand what resembles the reality of your properties.

Hi, I am 39. What are the bigger concerns? I will look to share a video in a couple of weeks to provide a clearer picture.

Many thanks.

[Doron Harati]

1 hour ago, Tobias Funke said:

Hi, I am 39. What are the bigger concerns? I will look to share a video in a couple of weeks to provide a clearer picture.

Many thanks.

Your donor quality

[Berba11]

You need an in person consultation with a good doctor before committing to surgery. You donor does look to have a patch of thinning underneath where the crown is dipping.

In which country are you based?

[Tobias Funke]

3 hours ago, Berba11 said:

You need an in person consultation with a good doctor before committing to surgery. You donor does look to have a patch of thinning underneath where the crown is dipping.

In which country are you based?

Thank you. I am in the UK.

[Berba11]

5 minutes ago, Tobias Funke said:

Thank you. I am in the UK.

Super - in which case I’d urgently seek an in person consult with Dr Ball at the Maitland Clinic in Portsmouth. Will cost you £100 but with the conflicting estimates etc you’ve had you need a proper scalp examination.