NORWOOD 6 members who have had HT surgery

[35YrsAfter]

Then why not reference one of your own patients? I mean, you referenced Bobman as a great result (appreciated) but then go on to talk about how he refused to show his result in a specific angle in bright sunlight. Was that even necessary?

And there is no illusion of coverage. That is a misconception. Coverage is coverage, period. The illusion you get when an HT is done right is one of density.

Let's say a Norwood 6 patient has 7,000 follicular units with a 2.6 hair average per follicular unit. That's 18,200 individual hairs available for transplant to the bald Norwood 6 area. 65,000 hairs is an average and reasonable estimate a Norwood 6 could have had in his bald area before there was any hair loss. 18,200 is 28% of the original 65,000 hairs. The concept of illusion of coverage should become obvious when you consider the math.

The following is a photo of our patient who had 3007 grafts placed. The photo was taken in the sun and with styling, the illusion of coverage is created. Neither FUE or FUT is the perfect solution to MPB. People in the forums speak of FUE and FUT as if there were some product consistency like buying a car. For instance, you buy a Chevy Volt in Washington state and it's going to be the same car you buy off a lot in North Carolina. This principle is not a wise mindset for a prospective patient to have when it comes to FUT and FUE. Check out the doctor's work before diving in. BTW, I just recommended our patient go see Dr. Wong for a scar revision. Our patient asked me about ACell and wants the doctor who does the scar revision to use ACell. There were alternatives, but I recommended our patient see Dr. Wong even if he doesn't agree or see value in using ACell. I have a history of being complimentary of H&W results in the forum when I think it's appropriate, but I'm not willing to venture into used car salesman territory, jumping on the bandwagon perpetuating myths that a 2013 technology hair transplant will give a Norwood 6 his full head of hair back. Dive in the lake, the hair parts down the middle and the 9,000 graft Norwood 6 is going to look thin on top. Under windy conditions the 9,000 graft Norwood 6 might wish he had given his hair an extra shot of super hold hairspray.
Regarding jabs at ACell and PRP, if you feel strongly they are ineffective, you should contact the FDA and question their approval of ACell as a regenerative product. Also you might consider contacting Emory Hospital and University because they administer, teach, and promote the healing properties of PRP.

Again, here is our patient with a 3007-graft illusion of coverage as you requested. You may have heard the term "Steve Jobs reality distortion field". Bobman got a great result, on the other hand, reality distortion fields are not in the best interest of young men seeking a solution to their hair loss.

35YrsAfter also posts as CITNews and works at Dr. Cole's office

https://www.forhair.com

Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
Please feel free to call or email me with any questions. Ask for Chuck

[didi]

Let's say a Norwood 6 patient has 7,000 follicular units with a 2.6 hair average per follicular unit. That's 18,200 individual hairs available for transplant to the bald Norwood 6 area. 65,000 hairs is an average and reasonable estimate a Norwood 6 could have had in his bald area before there was any hair loss. 18,200 is 28% of the original 65,000 hairs. The concept of illusion of coverage should become obvious when you consider the math.

The following is a photo of our patient who had 3007 grafts placed. The photo was taken in the sun and with styling, the illusion of coverage is created. Neither FUE or FUT is the perfect solution to MPB. People in the forums speak of FUE and FUT as if there were some product consistency like buying a car. For instance, you buy a Chevy Volt in Washington state and it's going to be the same car you buy off a lot in North Carolina. This principle is not a wise mindset for a prospective patient to have when it comes to FUT and FUE. Check out the doctor's work before diving in. BTW, I just recommended our patient go see Dr. Wong for a scar revision. Our patient asked me about ACell and wants the doctor who does the scar revision to use ACell. There were alternatives, but I recommended our patient see Dr. Wong even if he doesn't agree or see value in using ACell. I have a history of being complimentary of H&W results in the forum when I think it's appropriate, but I'm not willing to venture into used car salesman territory, jumping on the bandwagon perpetuating myths that a 2013 technology hair transplant will give a Norwood 6 his full head of hair back. Dive in the lake, the hair parts down the middle and the 9,000 graft Norwood 6 is going to look thin on top. Under windy conditions the 9,000 graft Norwood 6 might wish he had given his hair an extra shot of super hold hairspray.
Regarding jabs at ACell and PRP, if you feel strongly they are ineffective, you should contact the FDA and question their approval of ACell as a regenerative product. Also you might consider contacting Emory Hospital and University because they administer, teach, and promote the healing properties of PRP.

Again, here is our patient with a 3007-graft illusion of coverage as you requested. You may have heard the term "Steve Jobs reality distortion field". Bobman got a great result, on the other hand, reality distortion fields are not in the best interest of young men seeking a solution to their hair loss.

35YrsAfter also posts as CITNews and works at Dr. Cole's office

https://www.forhair.com

Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
Please feel free to call or email me with any questions. Ask for Chuck

Looking at the above numbers its pointless for most NW6s to have traditional HT...28% of original density is too thin and that's if guy is lucky to have 7000 grafts available..I always wonder what would this person look like under sunlight without hair sprays and makeup.

We desperately need donor regeneration in order to solve high NWs


35YrsAfter

"Dr. Cole has been exchanging emails with Dr. Nigam and recently requested more information about his research related to his claim of 100% regeneration.
Dr. Nigam may be on to something. Dr. Cole has an open mind and will check this out."



Any update on this?

[35YrsAfter]

Looking at the above numbers its pointless for most NW6s to have traditional HT...28% of original density is too thin and that's if guy is lucky to have 7000 grafts available..I always wonder what would this person look like under sunlight without hair sprays and makeup.

We desperately need donor regeneration in order to solve high NWs


35YrsAfter

"Dr. Cole has been exchanging emails with Dr. Nigam and recently requested more information about his research related to his claim of 100% regeneration.
Dr. Nigam may be on to something. Dr. Cole has an open mind and will check this out."



Any update on this?

Here is an example of our Norwood 6 patient who received a little over 6,000 grafts. In my opinion his appearance from the front and sides is dramatically improved. Many younger people have standards that are not reachable for advanced Norwood patients. When I was 18 for instance a thinning spot on a man's head the size of a silver dollar was completely unacceptable. My expectations changed when I got older.

35YrsAfter also posts as CITNews and works at Dr. Cole's office

https://www.forhair.com

Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
Please feel free to call or email me with any questions. Ask for Chuck

[Dan26]

That is not true. Both FUE and FUT each have their place. For some people FUT is the better option. There are more factors involved than you realize.

Fair enough. I'm bein a bit of a ball breaker tbh. I would never want to keep my sides long personally (or my entire head of hair), unless I had great density. Not a fan of oldman hair, even if it is nw1-2, I see a lot of middle aged guys walkin around that I believe would be better served with shorter cleaner hair styles.

[topcat]

The illusion of density for those with extensive hairloss in my opinion outside of hair characteristics really comes down to placement. That small band about 3-4 cm behind the hairline really needs to be where most of the hair should be placed with it being much thinner in the hairline and crown at least this is my opinion and it seems many good clinics plan the same way. I think these young guys that go for the super density in the hairline are making a very big mistake but they are also very hard to convince. Even in my own situation the hairline probably has more than enough hair it’s that band behind the hairline that gives the illusion.

Note Oliver Stone’s photo here with different lighting. That second photo, the illusion is lost due to poor lighting but if that band behind the hairline had more density it is quite possible the illusion would still hold up even in that lighting and you would not have the tell tale see though look of the hair transplant.

[DesperateOne]

Artists I am sick of you hiding the cure from us, stop it already!!

[3rd time]

I began as a nw6 at 28 years old. In the past 6 years i have had three HT's. All up about 7500 grafts. The above picture of Oliver stone was roughly what I was able to achieve. Unfortunately I was only able to cover the crown with very little hair.

The main problem for me is that I have no idea what the future will hold. Im in my early 30s I have a depleted donor and I cannot tolerate propecia even at very small doses. I'm so upset about this because it does wonders for keeping your native hair.

Through the whole process I can't say that so far I have been overjoyed with my results. I went to a very trusted doc who has a lot of respect from his peers and clients. My hair is dark and skin fairly pale so that doesn't help with the illusion of density. This doc gave me a terrible hairline and truly believe he could have utlilized the grafts in a better way.

My hair loss has continued to progress. This third procedure was done by a new Doc less than a month ago. The plan was to rejoin the side hair with the transplanted hair on the top. My native hair on the sides continued to recede and left the HT looking like an island of hair. This needed to be addressed. Also to add some density to the front hair line. Turned out to be a very long procedure due to popping and hoping I have no problems with yield. Finger crossed.

Currently under any type of harsh light I have no hair line. It just looks like a see through mess. I'm really hoping this third HT grows and gives me a hairline.
I can only style my hair one way. That is, slicking it all back and using that method to cover some crown. I use concealers and will probably continue to do so. Just not enough density in the crown.

I'm a very bad example of a hair transplant candidate. However, once you start this journey you really can't go back... In the future if I do need more work I will look at FUE BHT and PRP.

I remember reading jotronics posts and seeing both his and bobmans results and thinking wow!!!!! Unfortunately my baldness was a lot more aggressive and got no where near the results they got. No propecia = more balding for me.

So for those guys that are young and have aggressive baldness my advice is;
1. Get on propecia if you can. If you get side effects then try experimenting with a smaller dosage (speak to your HT doc) and hope your body can tolerate it. You need to halt future loss.
2. Go for a conservative approach. Make sure your doc uses your grafts wisely. Meaning, add density behind the hairline where it's needed so you get less of that see through effect. I think you will still get that ugly see through look under certain lighting. However, if you can minimize that you've done well.
3. Research your doc and be very specific as to what you want. You will have to make choices because your grafts will be limited so if a thin crown doesn't bother you then you can achieve something decent.
4. Concealers may be needed if you want to cover most of the crown.
5. Fancy hair styles are not an option. A simple slick back style will get you the most coverage.
6. If the crown bothers you, speak to your doctor about a partial crown restoration and use that hair to cover the bald area.
7. Take photos to see your results. As spex says, hair greed will occur and you will want more and more hair.
8.Fix your hairline before you do anything else. After all that's the most important part.

When I look back at how I was as a nw6 to where I am now its a big difference. Am I 100% happy with my results? No. BUT I do look better, people that knew me before have said the same thing, im more confident and happier.

Anyway I hope this helps. Good luck and be prepared for a long journey. Take care.

[3rd time]

Topcat

Great post. And excellent advice.

[35YrsAfter]

Fair enough. I'm bein a bit of a ball breaker tbh. I would never want to keep my sides long personally (or my entire head of hair), unless I had great density. Not a fan of oldman hair, even if it is nw1-2, I see a lot of middle aged guys walkin around that I believe would be better served with shorter cleaner hair styles.

It's interesting how styles have transformed over the years. When I was a teenager and in my 20s, the popular short haircuts today would have been considered "oldman hair". I prefer today's styles BTW.

35YrsAfter also posts as CITNews and works at Dr. Cole's office

https://www.forhair.com

Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
Please feel free to call or email me with any questions. Ask for Chuck

[35YrsAfter]

I began as a nw6 at 28 years old. In the past 6 years i have had three HT's. All up about 7500 grafts. The above picture of Oliver stone was roughly what I was able to achieve. Unfortunately I was only able to cover the crown with very little hair.

The main problem for me is that I have no idea what the future will hold. Im in my early 30s I have a depleted donor and I cannot tolerate propecia even at very small doses. I'm so upset about this because it does wonders for keeping your native hair.

Through the whole process I can't say that so far I have been overjoyed with my results. I went to a very trusted doc who has a lot of respect from his peers and clients. My hair is dark and skin fairly pale so that doesn't help with the illusion of density. This doc gave me a terrible hairline and truly believe he could have utlilized the grafts in a better way.

My hair loss has continued to progress. This third procedure was done by a new Doc less than a month ago. The plan was to rejoin the side hair with the transplanted hair on the top. My native hair on the sides continued to recede and left the HT looking like an island of hair. This needed to be addressed. Also to add some density to the front hair line. Turned out to be a very long procedure due to popping and hoping I have no problems with yield. Finger crossed.

Currently under any type of harsh light I have no hair line. It just looks like a see through mess. I'm really hoping this third HT grows and gives me a hairline.
I can only style my hair one way. That is, slicking it all back and using that method to cover some crown. I use concealers and will probably continue to do so. Just not enough density in the crown.

I'm a very bad example of a hair transplant candidate. However, once you start this journey you really can't go back... In the future if I do need more work I will look at FUE BHT and PRP.

I remember reading jotronics posts and seeing both his and bobmans results and thinking wow!!!!! Unfortunately my baldness was a lot more aggressive and got no where near the results they got. No propecia = more balding for me.

So for those guys that are young and have aggressive baldness my advice is;
1. Get on propecia if you can. If you get side effects then try experimenting with a smaller dosage (speak to your HT doc) and hope your body can tolerate it. You need to halt future loss.
2. Go for a conservative approach. Make sure your doc uses your grafts wisely. Meaning, add density behind the hairline where it's needed so you get less of that see through effect. I think you will still get that ugly see through look under certain lighting. However, if you can minimize that you've done well.
3. Research your doc and be very specific as to what you want. You will have to make choices because your grafts will be limited so if a thin crown doesn't bother you then you can achieve something decent.
4. Concealers may be needed if you want to cover most of the crown.
5. Fancy hair styles are not an option. A simple slick back style will get you the most coverage.
6. If the crown bothers you, speak to your doctor about a partial crown restoration and use that hair to cover the bald area.
7. Take photos to see your results. As spex says, hair greed will occur and you will want more and more hair.
8.Fix your hairline before you do anything else. After all that's the most important part.

When I look back at how I was as a nw6 to where I am now its a big difference. Am I 100% happy with my results? No. BUT I do look better, people that knew me before have said the same thing, im more confident and happier.

Anyway I hope this helps. Good luck and be prepared for a long journey. Take care.

Excellent post. Have you tried Avodart (Dutasteride)?

35YrsAfter also posts as CITNews and works at Dr. Cole's office

https://www.forhair.com

Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
email 35YrsAfter at chuck@forhair.com
Please feel free to call or email me with any questions. Ask for Chuck

[fred970]

If he already has sides with finasteride, how will switching to a more powerful inhibitor make a difference?

Anyway, great story 3rd time. I'm a NW5 with very aggressive hair loss for my age (23) and donor density slightly below average. I can't take finasteride either because I've already undergone gynecomastia surgery a year ago.

I don't know what the outcome of my FUE's will be but my main goal is just to restore as much frontal part as possible. Maybe I'll add some dermmatch in the mix afterwards.

[Dan26]

It's interesting how styles have transformed over the years. When I was a teenager and in my 20s, the popular short haircuts today would have been considered "oldman hair". I prefer today's styles BTW.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
Please feel free to call or email me with any questions.

I just find that when hair has thinned a bit, it has a flat, brittle/dry +weak appearance when it is long and sitting atop a head like a mop. Even when my hair gets long it just looks brutal on the top but when i get it cut it appears thicker.

[3rd time]

35yrsafter
I haven't tried avodart I was under the impression that it was stronger than finasteride? I figured if I could not tolerate fin not to try avodart.
I am willing to try it if it would help.. I'm going to do some research on it. Thank you for the suggestion.

[John P. Cole, MD]

it's really interesting. some individuals who had side effects to Propecia did not have them to Avodart. You'd expect more with Avodart. I prescribed it for years. I never noted an increase in side effects with Avodart.

A short hairstyle can make a person with fine hair appear to have more hair.

I did a study over the past two years with cross sectional trichometry. I studied donor areas in patients with no previous surgery, patients after FUE, and patients after strip surgery. What I found was that the average virgin donor area was a 74. After my version of FUE, the number dropped to 66. After a similar number of grafts done by strip the number was 52.

This number reflects the cross sectional surface area of a bundle of hair from 4 square cm. What it means is that the surface area drops significantly more following a strip procedure than from a proportional number of FUE grafts, at least harvested my way.

Why does this occur? In a strip, we remove a section of tissue containing hair. We then must close this void with the surrounding skin. We now have to use the remaining hair to cover a larger portion of the scalp or the portion that was removed. In that you have the remaining number of hair must now cover more surface area, the density is reduced. The traditional safe donor area is about 203 sq cm. Thus, if you remove 40 square cm, the remaining hair in the remaining 163 sq cm must now cover 203 sq cm of scalp. The number of remaining hair is the same, but the surface area they must cover is larger. The density goes down and so does the cross sectional trichometry.

In FUE, the surface area remains the same or decreases. Density is reduced by the removal of follicles. The remaining follicles are not stretched out to cover a void, however so the cross sectional trichometry is reduced, but not as significantly was with a strip procedure.

In a strip procedure, the remaining hair must also cover a scar. This is why you cannot remove as many grafts via strip as with FUE. With FUE, you can take more because you don't have to worry about covering a scar.

Now guess where the cross sectional trichometry is reduced the most following a strip. Is it above the strip scar or below the strip scar? It is reduced more above the strip scar. Which hair is more important to cover a strip scar? Is it the hair above the strip or below the strip? It's the hair above the strip unless you want to walk around on your hands. Thus, where you need the hair the most is where the hair density is reduced the most following a strip procedure.

As an example, I had a patient in today who had two strips done by a well known and well respected physician. I think he does good work. The patient had a CST of 42 above the scar and 56 below the scar. What does this mean? We can't harvest as much hair above the scar as we can below the scar even if we correct his 5 mm wide scar, which was his primary concern. The area below the scar is the area prone to retrograde alopecia so even though we can harvest more hair here, the hair is more prone to loss over the next 10 to 20 years. This is why I'm no fan of combining strips and FUE. It's just better to do FUE from the beginning.

[3rd time]

Dr Cole, thank you for this information its very interesting to read. I have had three strip HT and have noticed thinning around the nape of the neck making this hair unusable for future treatments. Both docs told me this hair was thinning.
I always had thick hair around the donor area but not anymore. I can defintely say my hair has declined in quality after these three procedures and no meds to halt further losses.

I may have to try avodart as a last alternative.

Dr Cole
For someone like me who has basically depleted their donor do you think FUE would be an option? I was told by another Doctor it's not a good idea for me as it may do more damage than good.