FUE surgery concept (hairline dense packing ca. 3000 FUs) - Need feedback please

[CEO_of_DHT]

Hello all,

I consulted with an experienced FUE surgeon for a second HT and he proposed the following surgery concept:

• dense pack only zone A with 1000 - 1500 grafts from scalp and 1500 from beard so that we close the temporal gaps and make a solid new hairline.
• We have to reconstruct your hairline using single hair follicles, that is the arrow of 1 cm where we will dense pack using 70 grafts/square cm.
• And then we shall use multi hair follicles at 55 grafts / cm2 to fully dense pack and fill zone A and some small part of zone B.
• We shall not remove old grafts, we shall place single follicle 1-2 mm below the current hairline and between to mask the ugly grafts and thus, the new hairline will be perfect.
• In simple words, we shall implant mostly between current hair so that improve density and make the hairline look realistic and natural.
• In the start of the hairline, we only use scalp follicles to have a natural look, beard is blend in below hairline in zone A.
• We need around 800 grafts single follicle to formulate the arrow of the new hairline, the rest will be double or triple follicles up to a total of 1500 as said and then we add beard.

 

I would like to hear your thoughts and feedback to this concept, particularly about the idea of dense-packing, the use of beard hair and the lowering of the hairline.

[Scalp Squad]

I can’t give you answers to your questions, but in my opinion, it’s way too early to talk about specific numbers when you’ve only just started taking the meds. By the time they take full effect, your situation might already look very different.

But it’s good that you’re taking different opinions btw.

[Berba11]

Lowering the hairline, gunning for 70 grafts per cm2 and 55 per cm2 behind it sounds nice if you were a virgin scalp with a good donor area, a conservative hairline to begin with, a bit older and stabilised hair loss but you're none of those things. 3,000 grafts is a lot, and you'd be depleting your reserves to the point where your frontal third might look impressive by itself, but if the lateral humps go and you've got an open crown and posterior midscalp, it's going to look weird. See @GeneralNorwood's initial surgery as an example of what an overly front-loaded design can leave you looking like in the context of higher NW hair loss.

Dr Sever's strategy made the most sense - improve the hairline by deduction rather than addition (at least initially), fill in the critical gaps with as few grafts as possible and leave a healthy reserve for the lateral humps when needed. His proposal also was not reliant on beard hair, so you'd still have that in additional reserve in the future.

It strikes me that for a surgeon to want to gun for 70 grafts per cm2 along your hairline, they may not have grasped the condition of your donor and the extent of your hair loss and its likely trajectory. I assume this evaluation was based on photos only, whereas Sever had the advantage of seeing you in person. This plan strikes me as overly ambitious in relation to your situation and might leave you in a muddle in the future.

Edited Friday at 11:55 AM by Berba11

[Chrisno]

Firstly, you might consider creating a thread under the "Hair Restoration Questions and Answers" part of the forum. And make one thread to discuss your planning. You don't need to create multiple threads that aren't reviews in the "review" section of the forum.

Secondly, I think the plan outlined is as very bad idea. You don't have enough grafts available. Beard hair in the mid scalp? Not my cup of tea. Never looks natural. What about your crown? You'll continue to thin, and won't have enough grafts available if you are going for 70 g/cm2 in the hairline.

In general: a very dense hairline of 70 g/cm2 will look out of place if the hair in the mid scalp is half that density.

Edited Friday at 04:42 PM by Chrisno
for clarity

[donpizmeov]

I would have to echo what has already been said - it feels like a (sales)plan has been made without proper and realistic due diligence based on your current situation. It would require a lot of follicles to lower the hairline, and where these hairs are located you are currently already very thin. When and if, hopefully, your donor bounces back, it might be a different story but i would still not lower the hairline but rather aim for a more homogeneous density.

 

Edited Friday at 08:17 PM by donpizmeov

[Berba11]

9 hours ago, CEO_of_DHT said:

an experienced FUE surgeon

And who was it?

[CEO_of_DHT]

8 minutes ago, Berba11 said:

And who was it?

Michalis

[Al - Moderator]

I think you are more in need of an overall density increase rather than mostly just bulking up the front.

 

[CEO_of_DHT]

10 minutes ago, Al - Moderator said:

I think you are more in need of an overall density increase rather than mostly just bulking up the front.

 

Yes I agree. I think 2000 in the crown and 2000 in the frontal third would be great... Maybe it becomes possible on Finasteride and using a bit of beard.