What really is the safe area??

[NervousNelly]

I just wanted to start this thread to get some insight from many of the educated on this forum to get their opinions. I don't intend to pannick people it is just my mind thinking.

 

 

What really is the safe area of the donor region? I'm sure many of you have noticed that older people start to really thin diffusely once they reach a certain age. I have seen many men/women over the age of 60 that have quite a bit of thinning in the donor region. That leads me to 2 questions:

 

1. If we have transplants, will after a certain age some of the recipient hairs start to leave us? You have to figure that if naturally donor regions thin in many of us I would have to think that likely some of the transplanted hairs will fall out after a certain age. (maybe 60+)

 

2. I would think that those getting Fue would have to be even more careful because if fue naturally thins the donor region, then it would only get worse after a certain age. (again 60+)

 

I think that a lot of our research and forethought only gets us so far because lets face it, how many 70+ men do you see with dense scalp and donor hair? Now ofcourse I have to readily admit that as it thins it might just look natural--or will it?

 

Once again just me thinking out loud and curious about this topic??

 

NN

[NervousNelly]

I just wanted to start this thread to get some insight from many of the educated on this forum to get their opinions. I don't intend to pannick people it is just my mind thinking.

 

 

What really is the safe area of the donor region? I'm sure many of you have noticed that older people start to really thin diffusely once they reach a certain age. I have seen many men/women over the age of 60 that have quite a bit of thinning in the donor region. That leads me to 2 questions:

 

1. If we have transplants, will after a certain age some of the recipient hairs start to leave us? You have to figure that if naturally donor regions thin in many of us I would have to think that likely some of the transplanted hairs will fall out after a certain age. (maybe 60+)

 

2. I would think that those getting Fue would have to be even more careful because if fue naturally thins the donor region, then it would only get worse after a certain age. (again 60+)

 

I think that a lot of our research and forethought only gets us so far because lets face it, how many 70+ men do you see with dense scalp and donor hair? Now ofcourse I have to readily admit that as it thins it might just look natural--or will it?

 

Once again just me thinking out loud and curious about this topic??

 

NN

[Guest]

NN, those are valid concerns you have brought up.

 

There are some procedures where I have seen the donor strip being taken into the zone past the ear & into the temple region.

 

In severe balding cases & with age ( think Tim Conway, Don Rickles ) I would be concerned that these areaa will thin leaving the strip scar exposed.

 

I don't believe there is much of a chance of this happening with the back of the scalp since even the baldest seem to retain that hair.

[Guest]

Originally posted by NervousNelly:

 

What really is the safe area of the donor region? I'm sure many of you have noticed that older people start to really thin diffusely once they reach a certain age. I have seen many men/women over the age of 60 that have quite a bit of thinning in the donor region.

NN

 

Nice topic. I have seen such men too. They seem to diffuse out in their so called safe donor area.

[NervousNelly]

Folica,

 

Ya I know what you mean. I wasn't even thinking about this type of scar but ofcourse it could become fully exposed under certain conditions. I was referring to even the normal scars in the back that might become more difficult to hide as you thin in your old age. Moreover, what about the transplanted hairs in the recipient region? There does seem to be a point when most of us thin a lot in the donor region.

 

I guess though a visible scar at the back of my head when in my 80's might be the least of my concerns.

 

NN

[Guest]

NN, I deleted my last pst since it wasn't relevant to what you were thinking & I don't want to stir up any controversy if you know what I mean.

 

But yes we do tend to thin even in the so called safe zone as we age. I think if you have a good scar in time it should just fade into your white hair...

[MrJobi]

Valid concern

 

I thing about this as well due to many doctors taking a donor strip rather high across the sides of the head.. If the patients hairloss continues, they would indeed have a visible scar. This is why "stabilizing hairloss" is very important to attempt to predict the future balding pattern.There are no guarantees. This is a key point why I like my doctors conservative approach ..

 

Think long term !!!

[the B spot]

Good Topic NN---- good replies all.

 

I think the issue of donor thinning may eventually be more relevant to fue, as opposed to strip.

 

With strip, we are actually reducing the surface area of our donor area and subsequently our coverage area in the donor region.

 

As we get older, the Testosterone we manufacture lessens to a great degree, and because DHT is a byproduct of this, it stands to reason that DHT will lessen as well.

 

Obviously some of us, most of us, will continue to thin a bit or have some donor thinning, but it should slow to a very manageable degree, we hope.

 

With FUE, you do NOT reduce the surface area of the donor region, so in essence, you still require a great deal of hair in order to cover the donor region.

 

Most sane and logical estimates state that 33% of the donor region can be extracted through fue before donor thinning is noticeable.

 

Obviously, there are those who exceed this number, and there are patients that cannot afford 25% extraction.

 

For example, if an average white male has 90 fu's cm/2 of donor density, removing 30 fu's a cm/2 from his donor leaves a donor density of 60 fu's cm/2, which is barely above the accepted limit of 45-55 fu's generally held as the acceptable limit for the "illusion of density."

 

In this case, a gentleman who has a donor density of 60 as he ages will become very thin, quite possibly markedly "ragged" looking as he hits his 60's/70's etc...

(remember, you still have the FULL donor region to cover)

 

I just want to point some things out as well.

 

Anyone who believes that a cure will be available in 10-15 years is grossly inaccurate.

 

Anyone who believes they will not care what they look like at 50,60, 70+ is lying to the pretentious prick looking back at them in the mirror every morning.

 

Anyone who believes that meds will stave off hairloss indefinately is incorrect.

 

Anyone who has already lost enough hair to warrant a HT in their 20's is headed toward a NW5-6 possibly a 7.

 

Last, anyone who cannot face the reality that SUPPLY will NEVER meet demand for advanced balding (regardless of what snake-oil salesman posing as doctors tell you) should not enter this type of treatment.

 

Take Care,

J

[NervousNelly]

Thanks for the great post Bspot. Very imformative and certainly will have people think that Fue isn't the quick answer if avoiding a scar.

 

NN

[TheHairLossCure]

If we have transplants, will after a certain age some of the recipient hairs start to leave us? You have to figure that if naturally donor regions thin in many of us I would have to think that likely some of the transplanted hairs will fall out after a certain age. (maybe 60+)

 

Senile alopecia is a real phenomenon and many patients will experience some thinning in the donor area, as they get older. This thinning will impact transplanted hair also. Interestingly, gray and whites hairs give more coverage (for caucasians) than brown and black hairs. So going gray with age might temper (to some extent) the visual consequences of donor thinning.

[Dr. William Reed]

Dear Forum Members,

 

The responses to NN's concerns are very good. Perhaps it is worth adding that of course this thinning of any part of the donor can be ruled out with greater confidence as the patient ages. The other side of this is that we should be less confident in donor stability the younger a person is. I agree with the FUE remarks and with the remarks of being wary using the scalp above and in front of the ear in younger people as donor for fear of its thinning with time much more frequently than the rest of the donor.

 

Other considerations spin off of the central concept of "hair mass". Hair mass is reduced disproportionately by FUE vs strip harvesting as was well articulated. . FUE is only a marginally superior solution as it may leave no scar yet it leaves an equal amount of scar for each follicle it removes. This is in contrast to the ellipse which takes out the bald skin between follicles as well as the scar at the follicles' sites but leaves a linear scar. FUE's benefit also assumes the "scar" at the site of the extraction is not visible which is not always the case. The trichophytic closure seems very effective in minimizing the visibility of the ellipse's scar.

 

Hair mass is also limited by our fiber diameter, curl, donor density and by how incompletely we have gone bald in the recipient area. Some folks just have more and thicker hair in the donor to start with and/or don't go as bald as others. The most "follicularly-challenged" are the fine-haired people who have a double curse if they also have low donor density. Such people with low hair mass may never be candidates for hair transplantation and certainly shouldn't be at young age due to the uncertainty that comes with the young age. Seeing through the donor to the skin and scar is especially the problem when the hair is wet. Grafting this young man is particularly a bad idea if under magnification the donor shows interspersed miniaturized hair. Such miniaturization has ominous implications for future thinning of the donor as I doubt that it was present at age 15.

 

I am attaching two photos. One is my brother at age 22. I don't have adequate photos as a 59 yo but take my word that he is Stage 7 and has very, very sparse, "see-through" donor. I think you can see this coming in hindsight when you see his 22 yo photo but he nevertheless still looks better off than many young men considering transplantation today. The other photo is a young man in whom I would transplant a conservative hairline at age 25 due to his hair characteristics. (I know we appreciate his giving permission to use the photo to help our community's understanding.) He would be the exception, as, in my opinion, he has the hair characteristics and, importantly, expectations that allow surgery should he choose.

 

I hope this helps young men out there understand the risks of transplantation. I get a very large number of consult requests from HTN from young men in this distressing situation. Unfortunately, in many such young men they will be not better candidates at 30. At that age however, we may have a better idea about donor stability and they may be receptive to a more conservative hairline than is usually the case for a man in his early 20s. (Doesn't it seem as if what we want in a hairline is something like a lagging indicator?: We usually want what was an "average" hairline for about ten years earlier.)

 

With best regards,

 

Bill Reed, MD

[calvinmd]

Very good post.

 

Your brother's thinning donor from age 22-59 really makes the point.

 

It all just makes me more and more convinced that getting HTs below the mid-20s is a bad risk regardless of the indicators. We just need to realize that we're not making a safe move at that age. We're really betting our future appearances on the idea that better MPB treatments will bail us out within 20 years.

 

 

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