I'm Norwood 6 - is it foolish to go for HT if I may one day be Norwood 7?

[tedwuji]

I didn't mean permanent smp I meant trico pigmentation that fades, also I would never recommend treating Norwood 6/7 for FUT, the chances are you're going to need a huge strip, if your skin is not elastic your scar will stretch causing a bad scar, additionally, if the lateral humps drop and you become full blown Norwood 7 camouflaging the scar is going to be extremely difficult, it's much easier to camouflage FUE scars than a bad FUT scar, of course combining both procedures maximizes the donor capacity, I just don't like the fact that the scar might stretch and you may one day have to shave your head.

Traditionally higher norwoods have been suggested to go FUT by docs, because it maximizes precious donor hair in an unbalanced supply & demand scenario. I also maintain any SMP into scar tissue is a precarious scenario at best.

This is all without mentioning the fact norwood 6/7 will be investing considerable time, resources, and emotion into such an endeavor. Particularly if they require more than one or even two procedures spaced nearly a full year apart at a minimum. Norwoods of this magnitude typically do require two or more surgeries given the number of grafts (stacking price) needed to cover the lost ground. Then add in taking propecia for life and risking sides simply to maintain a few hairs as one poster above said.

It seems to me the situation is not without "costs" both literally and figuratively when it comes to higher norwoods specifically.

But who am I to tell what someone should or should not be willing to do? Its not my intention. As many have pointed out the potential patient needs to manage their own expectations and if they do, then there are some options available no matter how limited they may be compared to a norwood 4 or lower.

[HTsoon]

Traditionally higher norwoods have been suggested to go FUT by docs, because it maximizes precious donor hair in an unbalanced supply & demand scenario. I also maintain any SMP into scar tissue is a precarious scenario at best.

This is all without mentioning the fact norwood 6/7 will be investing considerable time, resources, and emotion into such an endeavor. Particularly if they require more than one or even two procedures spaced narly a full year apart at a minimum. Norwoods of this magnitude typically do require two or more surgeries given the number of grafts needed to cover the lost ground. Then add in taking propecia for life and risking sides.

It seems to me the situation is not without "costs" both literally and figuratively when it comes to higher norwoods specifically.

FUT first then FUE without a doubt maximizes the donor hair, i can only speak for myself being a Norwood 6 and already have done two FUE transplants, I knew going in that one day I may have to shave my head if they lateral humps drop, the scars are noticeable at a zero guard but only to the trained eye.

With that being said, it's going to be hard for anyone not a Norwood 6 to fully comprehend why one would want to have surgery starting with such disadvantages, for me personally, I'm under the belief that some hair is better than no hair and of course the framing of the face is without a doubt the single most important aspect, I disagree with needing finasteride for life, if you're Norwood 6 it's ill advised to take finasteride, it's like using fertilizer that can cause birth defects on a dirt crop high risk low payout my 0.2 cents.

[tedwuji]

FUT first then FUE without a doubt maximizes the donor hair, i can only speak for myself being a Norwood 6 and already have done two FUE transplants, I knew going in that one day I may have to shave my head if they lateral humps drop, the scars are noticeable at a zero guard but only to the trained eye.

With that being said, it's going to be hard for anyone not a Norwood 6 to fully comprehend why one would want to have surgery starting with such disadvantages, for me personally, I'm under the belief that some hair is better than no hair and of course the framing of the face is without a doubt the single most important aspect, I disagree with needing finasteride for life, if you're Norwood 6 it's ill advised to take finasteride, it's like using fertilizer that can cause birth defects on a dirt crop high risk low payout my 0.2 cents.

I dunno about birth defects, but maybe a temporary risk for lower libido.

[HTsoon]

I dunno about birth defects, but maybe a temporary risk for lower libido.

It was an analogy finasteride can only cause birth defects if cut or broken pills are handled by a pregnant woman, PFS does exist even if it's a 0.1% chance you may get it, think about how someone who's already completely bald would feel getting PFS for trying to save a few hairs like I said high risk low payout, at best you maintain what you have and keep from turning Norwood 7, at worst you get PFS impotent for life still bald and still may become Norwood 7.

[tedwuji]

It was an analogy finasteride can only cause birth defects if cut or broken pills are handled by a pregnant woman, PFS does exist even if it's a 0.1% chance you may get it, think about how someone who's already completely bald would feel getting PFS for trying to save a few hairs like I said high risk low payout, at best you maintain what you have and keep from turning Norwood 7, at worst you get PFS impotent for life still bald and still may become Norwood 7.

Yeah, and a lot of those guys that progress as far a full-blown nor 7 earlier in life also get some donor area thinning down the road. So the transplanted hair, in those cases may still benefit from the finasteride making the option of forgoing to take it still perilous. Its such a terrible struggle for high Norwoods, particularly early age ones. Then throw in choosing not to optimize the mathematical fact FUT provides more "sweet spot" safe zone hair and it's a potential recipe for disaster. Could be okay if planned right i guess, but seems risks are super high and effort required is too. FUE is also more expensive than FUT which in larger procedures moving maybe 6 or 7 thousand grafts could be detrimental to some depending on individual finances. And u get less hair in the end lol.

To me seems a Norwood 7 who is choosing no finasteride and choosing FUE over FUT could be asking for high risk.

[HTsoon]

Yeah, and a lot of those guys that progress as far a full-blown nor 7 earlier in life also get some donor area thinning down the road. So the transplanted hair, in those cases may still benefit from the finasteride making the option of forgoing to take it still perilous. Its such a terrible struggle for high Norwoods, particularly early age ones. Then throw in choosing not to optimize the mathematical fact FUT provides more "sweet spot" safe zone hair and it's a potential recipe for disaster. Could be okay if planned right i guess, but seems risks are super high and effort required is too. FUE is also more expensive than FUT which in larger procedures moving maybe 6 or 7 thousand grafts could be detrimental to some depending on individual finances. And u get less hair in the end lol.

To me seems a Norwood 7 who is choosing no finasteride and choosing FUE over FUT could be asking for high risk.

Why on earth would a Norwood 7 take finasteride? There is nothing worth saving. My question is what risk? Worst case scenario is you stay bald, there is far more risk with low Norwoods who have hair to lose, taking finasteride risks permanent sexual dysfunction on top of being bald.

FUT allows you to move more grafts yes, FUT is cheaper yes, however implying that FUT hair is somehow safer than FUE is wrong, in order to maximize the strip size you're going to have to have a strip taken to nearly to the temple this allows for a high number of grafts, this hair is not safe for Norwood 7's, I know for me my surgeon checked my donor for miniaturization, this is the best tool one has to use, everyone's safe donor zone is different, so there is nothing universal about the donor area. There are some surgeons that may extract out of the "universal" zone, this is only done on low norwoods, when you're Norwood 6 the pattern is established the crown has expanded all grafts that are available are within this "universal" zone which is hopeful at best just reality.

[tedwuji]

Why on earth would a Norwood 7 take finasteride? There is nothing worth saving. My question is what risk? Worst case scenario is you stay bald, there is far more risk with low Norwoods who have hair to lose, taking finasteride risks permanent sexual dysfunction on top of being bald.

FUT allows you to move more grafts yes, FUT is cheaper yes, however implying that FUT hair is somehow safer than FUE is wrong, in order to maximize the strip size you're going to have to have a strip taken to nearly to the temple this allows for a high number of grafts, this hair is not safe for Norwood 7's, I know for me my surgeon checked my donor for miniaturization, this is the best tool one has to use, everyone's safe donor zone is different, so there is nothing universal about the donor area. There are some surgeons that may extract out of the "universal" zone, this is only done on low norwoods, when you're Norwood 6 the pattern is established the crown has expanded all grafts that are available are within this "universal" zone which is hopeful at best just reality.

1. It is safer for high norwoods because hair comes from the sweet spot where hair is more genetically stable.... important for high norwoods.

2. And i said fin benefit IF thinning in donor (many 7s do).

3. And of course FUT graft maximization in an unbalanced supply & demand scenario.

[JoeTillman]

The issue of finasteride use on high Norwood patients is something I'm intimately familiar with. As a NW6"+" I believe finasteride is still necessary. When I add a "+" to my NW6 designation it is because my parietal humps are essentially gone and the sides are down, just not as far down as what would be found on a NW7. The crown too is not as large as that found on a typical NW7.

Why do I believe in finasteride? Because I don't want to become a NW7. It would require an actual combover to hide the very wide gap that used to be a part line and it would take far more grafts than I have available to restore this gap to an acceptable density.

The idea of transplanting on a NW7 is not as outrageous as some of you may believe. I've seen it done, with varying results, but sometimes it's just nice to have a hairline and enough hair to comb on top. And it's not true that the strip has to go into the temple, or close to the temple, to get enough hair. With enough laxity it is easy to get hair for the front. I've seen one NW7 that had nearly 14,000 grafts with strip alone. As a NW6+ I've personally had nearly 10,000 FU with on top of the 800 mini/micro's I had in 1993 and my strip scar does not go that far forward.

This doesn't mean that every high NW should jump in to have surgery, quite the contrary. High NW patients should really consider their options carefully.

Here's my take on it. I get asked all the time if I would "do it" all over again.

1. Since I have already been through I don't regret it one bit? I enjoy my hair. I enjoy the fact that when I get dressed to go somewhere I can style my hair and just hit it with a bit of spray in the front to make it stand up and I've got a style I like. It's modern, it's clean and I can do this as a 46 year old man that was once bald as f*ck with a pluggy hairline that was horribly embarrassing and was impossible to hide.

2. Knowing what I know now would I do it all over again? No, I would not. I have a good head shape and I'd be a head shaver. Easy, done. I've often thought of shaving my head just for the Hell of it but the strip scar prevents this. I've thought about it despite the scar since I'm comfortable with myself enough that I could shave it to show people what it looks like. I still may but my wife would really not like that idea

So the message here is, don't count NW7 guys out of the surgical game. There might be an option but if one is a NW7 and they are considering any specific doctor INSIST on seeing cases comparable to your own. Not just in pattern but hair type and characteristics. Be realistic and don't expect full coverage not dense coverage in any given area. I was lucky, most are not.

[tedwuji]

The issue of finasteride use on high Norwood patients is something I'm intimately familiar with. As a NW6"+" I believe finasteride is still necessary. When I add a "+" to my NW6 designation it is because my parietal humps are essentially gone and the sides are down, just not as far down as what would be found on a NW7. The crown too is not as large as that found on a typical NW7.

Why do I believe in finasteride? Because I don't want to become a NW7. It would require an actual combover to hide the very wide gap that used to be a part line and it would take far more grafts than I have available to restore this gap to an acceptable density.

The idea of transplanting on a NW7 is not as outrageous as some of you may believe. I've seen it done, with varying results, but sometimes it's just nice to have a hairline and enough hair to comb on top. And it's not true that the strip has to go into the temple, or close to the temple, to get enough hair. With enough laxity it is easy to get hair for the front. I've seen one NW7 that had nearly 14,000 grafts with strip alone. As a NW6+ I've personally had nearly 10,000 FU with on top of the 800 mini/micro's I had in 1993 and my strip scar does not go that far forward.

This doesn't mean that every high NW should jump in to have surgery, quite the contrary. High NW patients should really consider their options carefully.

Here's my take on it. I get asked all the time if I would "do it" all over again.

1. Since I have already been through I don't regret it one bit? I enjoy my hair. I enjoy the fact that when I get dressed to go somewhere I can style my hair and just hit it with a bit of spray in the front to make it stand up and I've got a style I like. It's modern, it's clean and I can do this as a 46 year old man that was once bald as f*ck with a pluggy hairline that was horribly embarrassing and was impossible to hide.

2. Knowing what I know now would I do it all over again? No, I would not. I have a good head shape and I'd be a head shaver. Easy, done. I've often thought of shaving my head just for the Hell of it but the strip scar prevents this. I've thought about it despite the scar since I'm comfortable with myself enough that I could shave it to show people what it looks like. I still may but my wife would really not like that idea

So the message here is, don't count NW7 guys out of the surgical game. There might be an option but if one is a NW7 and they are considering any specific doctor INSIST on seeing cases comparable to your own. Not just in pattern but hair type and characteristics. Be realistic and don't expect full coverage not dense coverage in any given area. I was lucky, most are not.

This is pretty much exactly what I wanted to tell people, originally. Joe has articulated it here better than I could.

[tedwuji]

Joe, I am considering my options for hair transplantation. Is it possible for me to get personalized advice from you?

[JoeTillman]

Sure, hit me up at my website below. Send me photos, your family hair loss history, and any information you've received from various clinics.

[tedwuji]

Sure, hit me up at my website below. Send me photos, your family hair loss history, and any information you've received from various clinics.

Cool, ill gather what I have and do that. Thanks!

[HTsoon]

1. It is safer for high norwoods because hair comes from the sweet spot where hair is more genetically stable.... important for high norwoods.

2. And i said fin benefit IF thinning in donor (many 7s do).

3. And of course FUT graft maximization in an unbalanced supply & demand scenario.

1. No its not
2. If your donor has miniaturization you should not be getting any form of hair transplant as the donor hair is not DHT resistant, regardless finasteride only blocks 60-70% of DHT meaning the other 40-30% will still attack follicles, hair loss is slowed down not stopped completely or cured.
3. FUT+FUE maximizes the donor capicity

Joe you bring up a valid point about shaving, I actually shaved my head for a year prior to hair restoration, the strip scar is what kept me from getting a hair transplant back in 07, I had been researching from hair restoration from back in the Armani days, back then FUE was in it's infancy and it wasn't until the recent years that surgeons have actually past that learning curve, it was only then that I decided to undertake this journey, I do believe finasteride may be helpful for us norwood 6's from keeping the lateral humps or parietal humps from dropping, personally though I don't think the risk is worth it, I tried finasteride when I was 21 and I got sexual side effects from every dosage 1.25 to 1mg to 0.5mg, back then though I had a full head of hair so the risk was worth it, someone in my shoes now I would not want to put their sexual health at risk especially young guys with wives, another great point you bring is managing expectations, before I had any surgery I knew going in that I would never have my teenage hairline or density, currently my results have changed my life although my crown is untouched I can live with a bald crown so long as my face is framed and midscalp has good density, these trade offs are something high norwoods need to come to terms with.

[tedwuji]

1. No its not
2. If your donor has miniaturization you should not be getting any form of hair transplant as the donor hair is not DHT resistant, regardless finasteride only blocks 60-70% of DHT meaning the other 40-30% will still attack follicles, hair loss is slowed down not stopped completely or cured.
3. FUT+FUE maximizes the donor capicity

Joe you bring up a valid point about shaving, I actually shaved my head for a year prior to hair restoration, the strip scar is what kept me from getting a hair transplant back in 07, I had been researching from hair restoration from back in the Armani days, back then FUE was in it's infancy and it wasn't until the recent years that surgeons have actually past that learning curve, it was only then that I decided to undertake this journey, I do believe finasteride may be helpful for us norwood 6's from keeping the lateral humps or parietal humps from dropping, personally though I don't think the risk is worth it, I tried finasteride when I was 21 and I got sexual side effects from every dosage 1.25 to 1mg to 0.5mg, back then though I had a full head of hair so the risk was worth it, someone in my shoes now I would not want to put their sexual health at risk especially young guys with wives, another great point you bring is managing expectations, before I had any surgery I knew going in that I would never have my teenage hairline or density, currently my results have changed my life although my crown is untouched I can live with a bald crown so long as my face is framed and midscalp has good density, these trade offs are something high norwoods need to come to terms with.

1.sweet spot hair is more stable.
2. See explanation below.
3. Of course it does, i meant starting w/ FUT.

if donor area has minaturization at the time a transplant is desired then of course 110% DO NOT transplant. What i meant was that for men who progress to norwood 6/7 at an early age (20s) and may appear stable in the "permanent" zone at the time of transplantation could LATER experience thinning in what was not thinning even under microscopic inspection (minaturization mapping of scalp).

Example man begins losing hair rapidly after age 18 and has strong family history of premature MPB. Is diagnosed by a dermatologist with MPB upon clinical inspection. Then, progresses to a norwood 7 before age 25. Gets a transplant not on finasteride at age 25 because there is no detectable donor thinning and already a 7.

In this case at age 35, 45, 55 etc. That currently 25 year old man might develope some thinning that wasnt readily apparent in his younger days. This does happen.

And i wanna be clear, because i should have specified this originally: if there is confirmed donor thinning during initial assesment or anytime before transplantation u should absolutely NOT transplant.

Also, HTsoon if those are your pics, your hair looks good bro.

[JoeTillman]

1.

Joe you bring up a valid point about shaving, I actually shaved my head for a year prior to hair restoration, the strip scar is what kept me from getting a hair transplant back in 07, I had been researching from hair restoration from back in the Armani days, back then FUE was in it's infancy and it wasn't until the recent years that surgeons have actually past that learning curve, it was only then that I decided to undertake this journey, I do believe finasteride may be helpful for us norwood 6's from keeping the lateral humps or parietal humps from dropping, personally though I don't think the risk is worth it, I tried finasteride when I was 21 and I got sexual side effects from every dosage 1.25 to 1mg to 0.5mg, back then though I had a full head of hair so the risk was worth it, someone in my shoes now I would not want to put their sexual health at risk especially young guys with wives, another great point you bring is managing expectations, before I had any surgery I knew going in that I would never have my teenage hairline or density, currently my results have changed my life although my crown is untouched I can live with a bald crown so long as my face is framed and midscalp has good density, these trade offs are something high norwoods need to come to terms with.

Imagine if you had that hair transplant back in 07. Not only did you save yourself future potential heartache, you can appreciate what you've gained back through hair restoration more now that you've crossed over and back again.