Scheduled An FUE Session: Need Some Advice!

[JoeTillman]

Hey Joe,

Just one question...

If you were a full blown Norwood 6, and had to do it all again...Would you?

..and if so, would you have done FUE?


I ask, only because it seems like you are making a strong effort in your videos and postings to discourage people from getting a HT, almost as if you regret it.


If I started this thread, and instead said that I was planning on having two FUE megasessions (one in front, and another in the back at a future date), would you have supported that plan?

You asked three questions, not "just one..."

1. If you were a full blown Norwood 6, and had to do it all again...Would you?

I get asked this question all the time. Knowing what I know now, no; I would not have a hair transplant again, much less would I have had eight more hair transplants, the third and fourth being with one goal which was to repair the first and second. To go further, would I change anything about my history and hair restoration? No, I enjoy where I'm at and what I've been through has made me the man I am today. Had a time traveling hair transplant patient advocate traveled back to 1992 and told me what lay in front of me I would have shaved my head and called it a day. I have a good head shape and my head looked good shaved before I had my first strip. I'd be a bald, tanned virgin scalp manning a dive boat in the South Pacific somewhere, completely oblivious to the life of a hair transplant patient.

2. ...and if so, would you have done FUE?
FUE was not available when I first started my journey so the question is moot.

3. If I started this thread, and instead said that I was planning on having two FUE megasessions (one in front, and another in the back at a future date), would you have supported that plan?

No, but I would not have been so against it, either. You are hoping to piece meal your multi-hair transplant surgical goals for the sole purpose of hiding your procedures from the world. By doing this you risk making it more obvious for the reasons I've stated. You don't have to have a megasession to do this right, just do enough so that the work itself does not stand out in contrast with your native hair.

And as HTSoon says, it is doubtful that Dr. Feller and Dr. Bloxham will agree with your plan. They will suggest one or two strip surgeries which I would not have a problem agreeing with. Just don't do a megasession strip, just like you shouldn't do a megasession FUE, either. The more you do in one session, the more you risk if it doesn't work out and the less you have to repair the damage, should any damage (poor yield, bad donor scarring, etc.) occur. I can tell you easily that, based on your photos, I would have suggested 4000 to 4500 grafts in one procedure via strip, when I worked for strip clinics. This would be pretty much a standard assessment given your area of loss and what appears to be a good donor zone. However, given that you are only seeking FUE work, it makes sense to find a clinic that specialized in your desired procedure and move forward with caution. Every clinic has screwups, which is why I always encourage a no surgery approach first. It is the only guaranteed avenue of safety. If you still decide to have surgery then hopefully you'll be better prepared if I made you think about the downsides more seriously and ultimately you'll be a better patient for it in the long run.

I ask, only because it seems like you are making a strong effort in your videos and postings to discourage people from getting a HT, almost as if you regret it.

I don't regret my surgeries. I just know that a lot of guys aren't equipped to deal with what I've been through. This is not to say I'm special, just that I've dealt with my troubles fairly well compared to a lot of guys I've met over the past fifteen years. Having bad hair transplant surgery changes you. It alters the way you look at the world when you realize that the steak isn't as good as the sizzle.

[HTsoon]

So...what I'm hearing is that you don't disagree with my approach, instead, you simply disagree with my choice of HT doctor?

The reason I chose Feller is because of his technique, his blunt honesty, and his use of manual punches (unlike other top docs out there like Rahal, who use the machines).

Yes, I assumed that he would be totally against a front-to-back FUE surgery, but I wanted to consult with his clinic anyway. I have a meeting with Dr. Bloxham, so we'll see what they say in person.

If they have a change of heart and say 'ok' to a plan that involves full coverage FUE for a NW6, do I get your blessing?

Joe makes a good point, buzz your head first, I buzzed my head for a year before deciding on an HT, if you have it in your mind that one day you might wanna shave, do it now it will save you a lot of time and money and potential heart ache, buzzing is inexpensive and no risk, once you embark on HTs there's no turning back. I could not accept being bald I wish I could but I just couldn't so I had three HT's do I regret them? No but I've been lucky to have had good results not everyone is so lucky, no one can guarantee a good result keep that in mind.

I don't disagree with your choice of doctor, Dr. Feller is a good doctor that has a long track record, Dr. Bloxham likewise has been practicing a short period of time but what I've seen so far has been good. If you research a bit more closely you'll see Dr. Feller has made two things clear, you can not order which surgeon will perform your surgery, his clinic works as a team and you could have your procedure done by him or Dr. Bloxham you have no say in the matter. The other thing he has said is that you do not order procedures at his clinic off a menu like a restaurant, he will tell you what he believes to be the best thing (strip) and if you don't like it then that's it. I'm not saying that's a bad thing he doesn't try to hide this he's up front and honest.

One thing I noticed is that most of the doctors you mentioned are North American it is well known in the HT community that the FUE elite doctors practice out of Europe particularly Spain and Belgium. All of the doctors you mentioned are good doctors but none of them can be considered elite in the realm of FUE with the exception of Bisanga. Like I said research FUE a bit more closely, I would recommend looking at Lupunzula one of Joe's docs, look at Dr.Couto in Spain, take time to consult with several doctors don't limit yourself to the states or Canada.

With that being said, I don't like the plan, I agree with Joe, only addressing the recession can be highly problematic in the not so far future, it's not where you are today it's where you're headed and you are headed towards Norwood 6. I do not condone mega sessions, I think there are to many variables with mega sessions and if you get a less than optimal result then you have little to no options left. However, playing catch up with hair loss and HT's can also prove to be problematic as you never really achieve a good cosmetic result, because by the time your HT matured then you've lost more native hair and you're back to square one looking like you did before.

I think most docs would first address the hairline completely including the tuft and work in to the midscalp, then depending on donor density see about doing the crown. DO NOT assume you will be able to achieve full coverage and density, many men who are Norwood 6 do not achieve full coverage and density, some do not get any coverage in the crown because their donor does not permit it. There are other things to consider head size, hair characteristics (curly, wavy, straight) hair shaft thickness (fine, medium, thick) etc. All of these things will have an impact on your overall cosmetic result, no doubt FUT+FUE will maximize your lifetime grafts should you want to go that route, but you're limited choosing just one, any how good luck with your consultation

[jschwartz]

And you should also reconsider your plan of "just buzzing" your head if your plan falls apart. In fact, you should contact any and every doctor you're considering, or will consider, and ask them if they guarantee that you can do what you are planning. I doubt you'll get the same assurances you're expecting.

Hey Joe,

Just one question...

If you were a full blown Norwood 6, and had to do it all again...Would you?

..and if so, would you have done FUE?


I ask, only because it seems like you are making a strong effort in your videos and postings to discourage people from getting a HT, almost as if you regret it.


If I started this thread, and instead said that I was planning on having two FUE megasessions (one in front, and another in the back at a future date), would you have supported that plan?

[jschwartz]

There's no way Dr. Feller will ever agree to perform FUE on you, if you've decided to go with Dr. Feller than you should abandon the notion of FUE all together. He's made it quite clear that he will only offer FUE for those he feels are candidates which is generally no one with moderate to severe MPB.

IMO you should research FUE more closely, can FUE be done on Norwood 5+? The answer Absolutely, I was a diffused Norwood 6 with more hair loss than you and I've only had FUE, now is every surgeon confident and competent enough to perform the procedure on individuals with moderate to severe hair loss the answer NO.

I would suggest doing a little more research before proceeding, look at video documentation, MOST importantly look at patient reviews, if possible meet with patients. I think with some time and research under your belt you'll be educated enough to make a decision DO NOT rush in to anything.

Understand that every surgeon has a philosophy and agenda, you will hear some surgeons say FUE should be used for small cases because the growth is poor and it ruins the donor area making it impossible to have subsequent procedures. On the other end of the spectrum you have some surgeons claiming FUT is barbaric and surgeons who suggest this procedure are butchers, my point being don't place all of your trust on one surgeon or any surgeon, it's important that you do your own research and use some critical thinking. Think critically about your goals both long term and short term and you'll be able to devise a master plan with a surgeon that is able to achieve your specific goals good luck.

So...what I'm hearing is that you don't disagree with my approach, instead, you simply disagree with my choice of HT doctor?

The reason I chose Feller is because of his technique, his blunt honesty, and his use of manual punches (unlike other top docs out there like Rahal, who use the machines).

Yes, I assumed that he would be totally against a front-to-back FUE surgery, but I wanted to consult with his clinic anyway. I have a meeting with Dr. Bloxham, so we'll see what they say in person.

If they have a change of heart and say 'ok' to a plan that involves full coverage FUE for a NW6, do I get your blessing?

[JoeTillman]

I agree with HTSoon. I didn't want to really say as much until I knew if you had a consultation with him or not. It is well known that he does not think about FUE the same way that most other well known doctors do. If he gives you an assessment that includes FUE as the only surgical method for the short and long term, I'll be shocked.

Well part of the plan is to have multiple surgeries (as most people who plan to have a HT should do). I wouldn’t put myself in a situation to only have ONE surgery.

I don't believe in one big surgery, either. My point was that by placing 600 grafts for the temples you are running the risk of the result standing out from the hair around it. Your hair is miniaturizing behind the temples and all over the top save for the central forelock region. The texture and diameter difference may stick out. That is my point.

The "two horns" comment was referring to what it would look like if you were in a position that prevented you from getting more work done. That is an unknown. What is not unknown is your future loss potential. I hope that makes more sense.

But with FUE, we can control and cherry pick the grafts (both the caliber and the count).

I have yet to see a single case where a doctor has shown a game plan up front that includes this "cherry picking" we all hear so much about and then show off a result that benefits from this approach. The cherry picking that is possible is choosing to get mostly multi-hair grafts instead of singles when trying to add bulk and density. The idea that one can cherry pick singles that are finer than others is, to me, a myth. When you look at a follicular unit, say a single in this case, and it appears to be finer than the neighboring hairs, it usually means it is either DHT sensitive or it is coming out of a telogen phase and only recently re-entered anagen. No one can tell one way or another which is true for each follicle they are examining. Finer hairs can be taken from the nape, and they can be taken from above the ears, but sometimes they too are DHT sensitive. It is overall just an unreliable approach and was used in the old days to differentiate FUE from FUSS.

I think at a minimum you should consider more in the range of 1200 grafts to address the temple recession (mature closure) and the entire frontal hairline. Use the additional grafts to strengthen the entire frontal line so that you don't have to worry so much about the hair shaft diameter/terminal hair vs. miniaturized hair cosmetic disparity issue that I'm referring to. You won't have to worry so much about shock loss because the forelock won't be filled, just the periphery of it. I think your approach may sound safe but I think it is more of a piece meal strategy that could bite you in the ass.

This is true, but I don’t understand your point.

The point is that the work, no matter how natural, will stand out as a contrast to your native hair in the immediate vicinity of the work performed.

By your logic, my CURRENT situation is unusual. The hair that is currently behind my forelock is finer and more miniaturized then my forelock. All I would be doing with this first HT is fill the temporal angles so that I can effectively connect my forelock and sides of my head, with matching hair caliber and density (to eliminate the mohawk hairline).

So, yes, the mid-scalp area behind my forelock and temples (going toward the crown area) would continue to be fine and miniaturized, but so what?

I would simply look like a person who has crown loss only. There are many people who have this sort of hairloss pattern where the front of their head is not receded at all, yet they have crown and mid-scalp thinning (or baldness).

No, my logic does not dictate this. Your current situation is very normal. I see it all the time. My original point is that the temple work you plan on, by itself, might not blend the way you hope it does. This is a different look than what you're saying looks normal in nature. Yes, men lose crowns but keep their native hairlines. I've seen it many times but the finer points of those cases is beyond the scope of this particular discussion.

The SMP issue is another variable you can't rely on. SMP does not always work in scar tissue. Hell, it doesn't always work in healthy skin tissue, either. This goes for temporary or permanent. With scar tissue the result is less predictable. I've seen it disappear. I've seen it spread. No one can guarantee what it will do so you can't rely on this option as a reliable fall back.

And you should also reconsider your plan of "just buzzing" your head if your plan falls apart. In fact, you should contact any and every doctor you're considering, or will consider, and ask them if they guarantee that you can do what you are planning. I doubt you'll get the same assurances you're expecting.

[Stevedawg18]

Few things to think about having to surgery:

1. You're going to look weird for a while (ugly duckling phase)
2. It's painful
3. You have to limit physical activity afterwards
4. You have the agonizing time of waiting for it to grow

I'd want to go through this as few times as possible. I'm 6.5 months out from a HT, it's good now, but don't want to go through this period again anytime soon.

[jschwartz]

Ooh, this is exciting!
I get my questions answered by the veteran Joey Tills
Please continue to be blunt, and let me know if I’m still way off base in my responses. Thx.

It is my opinion that starting out with 600 grafts to fill your temples, especially with a high forehead, is a bad idea especially with your already established position regarding minoxidil and finasteride. What happens if you are in a position where you can't have a second surgery? Your loss will continue and you'll have two horns sticking out of your forehead. I've seen it happen.

Well part of the plan is to have multiple surgeries (as most people who plan to have a HT should do). I wouldn’t put myself in a situation to only have ONE surgery.

RE: your comment about the two “horns sticking out of your forehead” situation…

Yes, this is something I had already thought of. However, I don’t think it would be a ‘forehead’ situation as my plan is to maintain a mature hairline and not to bring it down to 20 year-old levels (which would definitely create a potential “hair out of the forehead” look).

In your words, getting a “tangible sized procedure of 2000 to 2500 grafts that will address the front and mid-scalp” is a decent strategy.

I have thought of this in the past, but I question whether or not it’s a good strategy to subject my native forelock hairs with ‘shockloss’ for no real reason other than to simply “get it out of the way” with one big surgery.

Obviously, if I was getting STRIP surgery, then this would make sense. But with FUE, we can control and cherry pick the grafts (both the caliber and the count).

Don’t get me wrong…addressing the forelock and mid-scalp is still part of the plan. But instead of one massive 2500 graft surgery, I would be splitting it into two surgeries.

Because of the potential of shockloss to native hairs, I would think it’s better to address the loss when it begins to occur. Also, as an added bonus…I believe doing the temporal angles first (without shaving my head) gives me a ‘stealth’ recovery period where I can cover the transplanted area with existing forelock hairs as it begins to grow.

In the short term, temple work that is mature in six months to one year will be noticeably different than the hair behind the forelock. If you look at the forelock the hair is terminal which means it is healthy with a normal shaft diameter. There are some miniaturized hairs but overall this area will last a while. The hair behind your forelock is a different story. It is all miniaturized and fine. The hair transplanted to close your temples will be much stronger, terminal hair, with a thicker diameter. I feel that this may stand out and look unusual. This is based on the overhead photo in your collage.

This is true, but I don’t understand your point.

By your logic, my CURRENT situation is unusual. The hair that is currently behind my forelock is finer and more miniaturized then my forelock. All I would be doing with this first HT is fill the temporal angles so that I can effectively connect my forelock and sides of my head, with matching hair caliber and density (to eliminate the mohawk hairline).

So, yes, the mid-scalp area behind my forelock and temples (going toward the crown area) would continue to be fine and miniaturized, but so what?

I would simply look like a person who has crown loss only. There are many people who have this sort of hairloss pattern where the front of their head is not receded at all, yet they have crown and mid-scalp thinning (or baldness).

The great thing about this is that I could finally cut my hair very short, and the area that people most notice (the temples & hairline) would look nicely framed (which is totally not the case today). Of course, the area behind the forelock (and also the crown) would be less dense than the front of my head, but this is very common in regular people that you see every day..and it looks a lot better with shorter haircuts than it does with longer ones.

The idea that you can use body hair to fill the donor area after FUE has been discussed off and on for nearly fifteen years. To date I have yet to see a single case where donor recharging (as it has been called) has ever worked. Body hair is already a low yield donor source so when you add that to the potential low yield recipient that scar tissue is classified, the lack of results makes sense. Don't count on this. Dr. Feller is a very good hair transplant doctor but I would not believe he'd acknowledge your plans as being sound.

He didn’t, and I haven’t had my in-person consultation just yet. I’m not really considering BHT (I was reading up on it last night and it was stuck in my head as I typed this all).

I am only really considering SMP to fill any gaps in the donor area. I “think” that my donor is pretty good so I wouldn’t have to resort to this. But this is going to be determined at my consultation.

I could go on but you asked if your plan is too ambitious. I think it is because there are too many variables that you're hoping will be positive in your favor. Those are huge odds to bet on.

Well, it’s just the approach that is different.

My plan is no different than the standard plan that many people do, which is to do two BIG hair transplant megasessions (one for the front and one for the back).

I am simply just breaking it into three sessions (temporal angle HT, crown HT, and midscalp/forelock HT).

The variables (donor density, matching hair caliber, planning for future loss) are all the same.

The only other difference is that I am attempting to pull off some ‘stealth’ recovery process, which may or may not work, but it should not impact the long term results either way.

I think you should rethink your priorities and maybe not have a hair transplant. With so many small steps you're planning on and with the alternative treatments you're considering in case of bad outcomes, you're asking for trouble.
I made this video two months ago to help drive home the reality of hair transplant planning. Watch it, think about it, and move forward based on how you feel afterward.

Thanks for the advice. I’m glad you’re giving me the bad news instead of the good, but I still think that in a worst case scenario, I can still just buzz my head with FUE and use SMP to fill in any scarring or bald areas.

I still don’t see any bad FUE scarring photos from top docs like Feller, Shapiro, Rahal, Bisanga, etc which gives me confidence that any scarring would be minor. SMP is my only real question mark, as we do not have the forums and patient history of SMP results like we do with HTs, so it’s iffy when trying to find a top SMP tech.

Also, part of the reason I booked with Feller is that he’s very cynical in his online videos. He doesn’t seem like the salesman type who is trying to sell you a HT. This is good, as I think I would get an honest in-person assessment from him re: my donor and plan.


Joe, thanks for the responses. I’m looking forward to your responses to my above comments.

[HTsoon]

There's no way Dr. Feller will ever agree to perform FUE on you, if you've decided to go with Dr. Feller than you should abandon the notion of FUE all together. He's made it quite clear that he will only offer FUE for those he feels are candidates which is generally no one with moderate to severe MPB.

IMO you should research FUE more closely, can FUE be done on Norwood 5+? The answer Absolutely, I was a diffused Norwood 6 with more hair loss than you and I've only had FUE, now is every surgeon confident and competent enough to perform the procedure on individuals with moderate to severe hair loss the answer NO.

I would suggest doing a little more research before proceeding, look at video documentation, MOST importantly look at patient reviews, if possible meet with patients. I think with some time and research under your belt you'll be educated enough to make a decision DO NOT rush in to anything.

Understand that every surgeon has a philosophy and agenda, you will hear some surgeons say FUE should be used for small cases because the growth is poor and it ruins the donor area making it impossible to have subsequent procedures. On the other end of the spectrum you have some surgeons claiming FUT is barbaric and surgeons who suggest this procedure are butchers, my point being don't place all of your trust on one surgeon or any surgeon, it's important that you do your own research and use some critical thinking. Think critically about your goals both long term and short term and you'll be able to devise a master plan with a surgeon that is able to achieve your specific goals good luck.

[Sean]

Not sure what this means. Did you mean to say "60 follicles per cm2"?
for this first HT, I am doing my temporal angles, which have no existing native hairs. We may go a bit into the hairline, but not too deep into the native hair area.

Meant grafts per cm2, for more info on this and some recommendations, see the following discussion

https://www.baldtruthtalk.com/threads/9272-Grafts-per-cm2-for-good-coverage

Yea, I always noticed this in those before and after HT photos. Not sure why such a thick marker is used for such precise surgery and hairline design.

I am going with Dr. Feller. His hairline designs are generally very good. I already know what I am going for re: the hairline, so I will be very anal when it comes to this.

Dr. Feller is a good surgeon. He has mentioned pros/cons FUE approach and his protocol online. You have every right to be anal about the hairline design and goals. Based on your physiology, If a surgeon can successfully accommodate your request and deliver, then that is great news.


Yea, my first procedure is expected to be only 600 grafts for the temporal angles, and I fully expect to harvest from a wide area across the back and sides of the head. It's the subsequent HTs that I have to be careful with when the graft count increases.


I just saw your photos and it is important to think your goals through. If you are destined to be a norwood 6 without treatment, you may have to be conservative or consider this, even though FUE seems like great option, you may or may not have adequate grafts in donor to pull this off in the long term. If you do, that is great. Some folks may suggest FUT in this case. You have to be really cautious of donor thinning or permanent shockloss conscerns with a procedure of this magnitude (5000+ grafts). I know you are trying to be discreet but cutting the hair before a procedure may assist in better placement. You do not want to create added obstacles that may hinder maximum recipient graft placement/quality.

I am not much of a fan of temp SMP as it is temporary. Id be cautious with who does it, how its done, the ingredient makeup of the pigments.

Do you have other resources, beard etc hairs as backup if you run into issues later on and deplete donor out in the future? Not saying it will hapoen but just make sure your bases are covered.

Why only 50/50?

It all depends in protocol and care. It has to be done properly by a highly experienced doc with a very meticulous surgical protocol. If something goes wrong, you will be in a puzzle and will have to figure out what to do next for repairs. Hopefully, the docs you choose deliver and work with you no matter what happens. Those photos you see online posted by some clinics showcasing wow results, let me tell you that some of those cases are dependent on a variety of different factors. This can include hair caliber, density, physiology of the patient. Actually, Id think it is quite misleading in some cases.

My advice to you is to research real FUE patients that post on forums that have or had similar hair loss concerns as you. Those that had similar surgical procedures as you and number of grafts placed as you. See if you can meet such folks in person and if they are willing to meet and show you how it looks like in real life. See some patients from a variety of surgeons. It may help you gauge if this is right for you.

Honestly, proceed carefully for your safety. It can make or break you. Small session of 600 grafts may be good to see if you grow any grafts, but even then, approach carefully. Best of luck and wish you well

[JoeTillman]

J,

Thank you for your photos and additional information. I'm going to be blunt. Hold tight...

I'm reading a lot of "...maybe I can..." and "I was thinking..." in your posts. This is the wrong way to start a plan.

You are not a NW3v. Unfortunately you are far from it and are closer to a diffused NW6 with a frontal forelock. I think in five years you will much worse. It is my opinion that starting out with 600 grafts to fill your temples, especially with a high forehead, is a bad idea especially with your already established position regarding minoxidil and finasteride. What happens if you are in a position where you can't have a second surgery? Your loss will continue and you'll have two horns sticking out of your forehead. I've seen it happen.

In the short term, temple work that is mature in six months to one year will be noticeably different than the hair behind the forelock. If you look at the forelock the hair is terminal which means it is healthy with a normal shaft diameter. There are some miniaturized hairs but overall this area will last a while. The hair behind your forelock is a different story. It is all miniaturized and fine. The hair transplanted to close your temples will be much stronger, terminal hair, with a thicker diameter. I feel that this may stand out and look unusual. This is based on the overhead photo in your collage.

The idea that you can use body hair to fill the donor area after FUE has been discussed off and on for nearly fifteen years. To date I have yet to see a single case where donor recharging (as it has been called) has ever worked. Body hair is already a low yield donor source so when you add that to the potential low yield recipient that scar tissue is classified, the lack of results makes sense. Don't count on this. Dr. Feller is a very good hair transplant doctor but I would not believe he'd acknowledge your plans as being sound.

I could go on but you asked if your plan is too ambitious. I think it is because there are too many variables that you're hoping will be positive in your favor. Those are huge odds to bet on.

I think you should rethink your priorities and maybe not have a hair transplant. With so many small steps you're planning on and with the alternative treatments you're considering in case of bad outcomes, you're asking for trouble. You should ask yourself if hair transplant surgery is really that important to you. Do you have to have these small temple corners filled? Do you have to have more hair in general? I think that if the answer is yes, you do have to have surgery or do something for more hair, you should not tempt fate with multiple small and medium stop gap procedures. Get a tangible sized procedure of 2000 to 2500 grafts that will address the front and mid-scalp and then monitor it as it thins because of your native hair continuing to fall out. Then maybe consider a fill in procedure if necessary. If you aren't in a position to have more surgery you'll not look so unusual as you would if only the temple corners were addressed. The crown is absolutely going to get bigger with time as well but unfortunately you need more hair in this area than you do the front to get a similar appearance of coverage.

You have other options but I think your current strategy is just asking for trouble.

I made this video two months ago to help drive home the reality of hair transplant planning. Watch it, think about it, and move forward based on how you feel afterward.

I'm happy to help you figure this out so ask any more questions if you have them.

[jschwartz]

I would like to give you my opinion on your goals but it would be useless without photos to go by. Would you mind uploading some to show us your case?

Thanks for offering to take a look. Photos of my temple and crown are attached.

My temporal angles are receded by a half inch inward (similar to Jude Law's hairloss pattern), and the crown area that I would hope to fill (in a future HT) is roughly 3 inches by 1.5 inches. Not looking to bring down that hairline at all, really just looking to create a nice frame by closing off the receded temples and flattening that mohawk-hairline.

Since I wanted to be discreet during my recovery, the plan is to not shave my head (only the donor area of course) and transplant follicles into my temporal angles. I would take a couple weeks off work, and use the existing hair on the top of my head (central forelock area) to comb over my temporal angles (as I usually do anyway) to cover up the pinkness until hair starts to grow.

A year after this hair transplant I should have a decent, framed hairline. At this point, I would go for a second FUE HT to address the crown. I originally figured I would have to shave the head for this, but since I still want to be discreet, it may be possible to do one in the crown without resorting to shaving the head...but this would mean transplanting into the near bald areas only, and not the overall 3" by 1.5" area (where there is thinning native hair too). Still undecided on this strategy.

In order to maintain the discreetness during recovery, I was thinking of shaving my head and getting some temporary SMP in the crown prior to my crown FUE hair transplant. That way, during recovery it would just look like I shaved my head (as there would be some faux-stubble in the crown area during recovery). I know very little about SMP, so I'm not really sure if this would be a good strategy. But it's all about discreet recovery during those first few months, and anything I can do to hide that I had a HT...I will do.

On another note, you can see on the top view of my head that I am destined to be a Norwood 6 as the hair between my hairline and crown is pretty thin (however it's not that noticeable when it is washed and styled). Hoping that a third HT will address this down the road when I need to. If at that point I don't have enough donor to get decent density, then I would just space out whatever follicles I can get into that balding area so I can pull off a "shaved head with somewhat decent stubble everywhere" look. FUE scarring is one of my biggest concerns though as it would kill any potential to pull a nice shaved head look, but I've never seen any photos of bad FUE scarring from the top HT docs.

If my donor starts to get some sort of moth-eaten look from all the extractions, maybe I can fill it in with BHT (as I have a lot of thick beard hair, and a decent amt of body hair) but again, SMP and BHT are really just last resorts that I don't want to ever have to do.

Kind of an ambitious project, but let me know what you think.

Your advice is much appreciated!

[JoeTillman]

I would like to give you my opinion on your goals but it would be useless without photos to go by. Would you mind uploading some to show us your case?

[jschwartz]

Depends on your donor density, expected recipient density, hair caliber, depth of your wallet, choosing the right surgeon.

Yea, I am going in for an in-person consultation before my surgery largely because I want to confirm with them that I have good donor density and talk about recipient density (the follicle quote seemed a bit low at 600).

I booked with Feller, and he is one of the best. So, I think I will be fine with choosing the right surgeon. Depth of wallet is not an issue for now, so I don't mind spending a bit more to get an HT doc that is proven.

I didn't think about the 'hair caliber' thing. I hear that FUE growth is worse than FUT. I always assumed it was yield, but I wonder if this is caliber as well. It's a good question to ask.

[jschwartz]

Working around native hairs probably is risky especially if the doc dense packs it more than 60cm2 in those native hair filled recipient zones imo.

Not sure what this means. Did you mean to say "60 follicles per cm2"?
for this first HT, I am doing my temporal angles, which have no existing native hairs. We may go a bit into the hairline, but not too deep into the native hair area.

Make sure the hairline design is well designed and properly framed inclusive of temple work and is even. Some docs may have a habit of keeping the left side lower and the right side higher in elevation. You do not want to deal with hairline issues later on. Make sure the doc marks your hairline with a skinnier pen or marker, if they use a thick line marker, it can throw you off of the real hairline which could be starting behind the thick marking.

Yea, I always noticed this in those before and after HT photos. Not sure why such a thick marker is used for such precise surgery and hairline design.

I am going with Dr. Feller. His hairline designs are generally very good. I already know what I am going for re: the hairline, so I will be very anal when it comes to this.

Make sure donor extractions are well placed and spread out so you do not have any shockloss issues or uneven donor depleted areas that may look like distinct halos later on.

Yea, my first procedure is expected to be only 600 grafts for the temporal angles, and I fully expect to harvest from a wide area across the back and sides of the head. It's the subsequent HTs that I have to be careful with when the graft count increases.

imo it's 50/50 odds

Why only 50/50?

[Louish]

Depends on your donor density, expected recipient density, hair caliber, depth of your wallet, choosing the right surgeon.