31 yo, first HT - to front only or front and crown?

[tremblant]

[Sorry for the duplicate post - posted it under the wrong forum the first time!]

I need some advice on how to do my first HT.

I'm 31, balding since 21, destined for complete baldness (dad/both granddads totally bald). Currently on Rog 2x/day, Fin 1.25mg/day (R for 10 yrs, Fin for 1 mo.).

Current level of baldness hard to rank, maybe closest to NW5? Complete bald spot for me at crown about 3-4" wide, and significantly thin across the front/top, however I have close to my natural hairline level except it is thin like the rest of the top. I have black hair and white skin.

I spoke with a few surgeons, each advocate an initial surgery (I know I will def need more given my future loss) of 2000-2500 grafts -- HOWEVER, some say to put it all on the front/top now, while others say to put most on front/top and some (maybe 20-30%) on crown at the bald spot. I actually favor the latter, but worry that continued gradual hair loss will make the transplanted crown hairs more conspicuous? [as discussed in point #2 on page 3 of this article: http://www.dricohen.com/news/A...etworkwithHeader.pdf

Those who advocate leaving the crown alone for a year and doing the front/top first -- then I'm left with at least a year of being self-conscious about the bald spot before going for another surgery to address the crown ... although front density is important given that it's thinning to where scalp is visible... which way is best for first surgery, given that I'm destined to lose all my natural hair?



Thanks in advance for your comments!

[CIT_Girl]

If you anticipate becoming a Norwood Class 6 or 7, I'm not sure it makes sense to have a hair transplant at all. Regardless of the quality of your donor hair, no scalp donor area has enough to treat a class 6 or 7 because, at this point, you have lost 60% of your hair. Even if the surgeon took the entire 40% remaining, leaving the donor area bald, this would not be enough to cover the top and front. The general rule is that you need to maintain at least 50% of original density to reach an acceptable level of coverage.

However, if you do decide to proceed with a hair transplant, I think option #2 makes more sense. If you focus on reinforcing the hair line now, you risk further recession and ending up with a line of hair at the front with no hair behind it. Also, if the bald spot on the crown is what makes you the most self-conscious, I would make sure to have a decent number of grafts placed there.

Make sure that whatever doctor you select and procedure you choose, you and your doctor come up with a long-term plan for your progressive hair loss. It's also important, particularly due to your degree of hair loss, that you maintain realistic expectations and remember that whatever you have done is permanent so proceed carefully.

Best wishes with whatever you decide to do!

[tremblant]

Thank you for your reply.

The counterargument would be, if you can have decent coverage up front and maybe thin coverage in the back, why not go for that, since that would be much better than being totally bald. After all, when people look at you from the front they see the front 2/3 of your hair, and if that has decent coverage it makes a big difference. I don't need a low hairline, one that is conservative (but not too much so) is fine with me.

As long as after transplant, and then after successive years of continued hair loss, everything still looks natural, it would still be better to have some thin looking hair up front than nothing. Also, there are a couple examples of people who are NW6 or 7 on these forums who have good aesthetic results after transplant.

Most people seem to favor going with the first option (front only), but I do appreciate your opinion.

Anyone else have thoughts on this?

[CIT_Girl]

Your point definitely makes sense and I agree that, with a fairly limited supply of scalp donor hair, valuable grafts might be better used up front. It's also easier to camouflage thin hair in the crown area (with Toppik, for example) than it is to create the illusion of a thicker hairline. As long as you have realistic expectations (which it sounds like you do) and a long-term plan, you can have nice HT results even as your hair loss progresses.

[Dr. Lindsey]

I am a proponent of fixing the front first. First you see it everyday once its grown in. Second, most folks get a crown bald spot if they live long enough... Third, framing the face makes a bigger change in the "bald appearance" than addressing a crown. Fourth, if you are losing in both, be conservative with your frontal hairline and there may be sufficient hair to deal with your entire head...you can always bring the hairline down a little, but once placed too low, you are stuck with it. And fifth, don't sprinkle too few grafts over too much bald head.

Shown below is a recent fellow we repaired, preop. He's paid a large chain for 2000 grafts which they "sprinkeled" all over, hence he looks like he had nothing. We packed the front 2 weeks ago, but he has VERY thin hair and we'll make an improvement, but if he'd have saved those previous 2000 grafts used previously, we could have given him a better result in either one or 2 surgeries.

Dr. Lindsey McLean VA