Pics for evaluation

[Gandolf]

I had called into the BTT show last night and spoke with Spencer and Dr. Kelly about the decision on having a HT on the air, just posting my pics here so they have a visual guide to judge, I welcome any other feedback as well, thanks. My stats are also below:

Age:29 (28 in the pics but no noticable changes since)

Medication:1 mg Propecia daily each am (no noticable side effects) and committed to take for life if need be, also use over the counter 1% Nizoral shampoo 2-3X per week

Family history:No males with extensive baldness, receding hairlines are common with thinning on top but I'm not aware of any close family members who reached anything beyond a NW4

Main concerns:My hairline corners have receded to a point where styling my hair is impossible. I already had very limited options due to very fine hair. I am confident that a HT would improve my situation in the short-intermediate timeframe, I just see other treatments and advances that MAY or MAY NOT be available/legit while I am still young and it makes me hesitant to use up my donor supply which as we all know is a scarce resource.

[Gandolf]

Eric,
You must have been referring to me, Dr John Frank (not Dr Kelly).
Spencer said there is nothing wrong with waiting and that's always good advice however, that doesn't take into the consideration that you are very anxious to do something...and DOING NOTHING doesn't solve that problem for you. You're committed to Propecia, you have a soft family history for balding, and you have good color match. So these are all good indicators for good results and these are very important years! So, if you decide to move ahead with the transplant, it's crucial that you keep the hairline high and resist trying to bring the hairline down low in the front. I don't think donor depletion will be an issue for you, as long as you keep it high.

Other than this, you can proceed. Again, keep the hairline high, and let me know if you want my advice on what would be an appropriate level. I'm in New York City, feel free to drop in.

Dr John Frank

Hey Dr. Frank,

Yes, you're correct I was trying to reach you I don't know how I mixed up the name there so I apologize. Thanks for your input. I think I could certainly live with my central hairline being right where it's at, it's just those damn receded corners and temple areas which make my hair so difficult to style. Thanks again for your professional input, and I enjoyed very much talking to you and Spencer last night on the program!

PS:GO BUCKEYES! Should be one hell of a season in 2013, despite being in MD I'm actually a huge OSU fan due to some family ties in OH so I find that really, really cool that you played college football at OSU!

[rev3]

it looks like you have above average donor density

and there is no doubt that using grafts to fill the temple angles to better frame your face will not be made in vein

i'd consult with rahal and konior as well

they specialize in face framing hairlines
many younger patients are realizing that framing the face with appropriate hairline design are worth the grafts needed to do so even though it might mean having lower mid or crown densities

in any case consult with these two docs, even if you are already set in your doc decision

[itsmyhairs]

That's a phrase that has been used for a long time when it comes to the hairline in relationship to one's face. And certainly an appropriately placed hairline tends to accentuate somebodies facial features. However, because hair loss is a progressive, dynamic problem in most people, it becomes especially challenging in young men as they have no idea what's going to happen in 10,20, 30 years. So for that reason (and because the donor area is finite) it's never a good idea to come too low when creating a hairline in somebody under 30 y.o. It is tempting to create a low hairline, but for a younger person it's very risky. Remember, you can always bring the hairline down more in the future, but you never want to be in a position of running out grafts to fill in the area behind the hairline (or even be forced to require more grafts in the future).

There probably won't be a cure in 5 years like people are hoping, but in 10 years they'll probably be doing stem cell replication for hair follicles.

It'll be, go into the clinic, they take 10 hair grafts, you come back in a week and get 10,000 implanted.


Gandolf is in a similar position to me, I still have good density and my hairline isn't too high, but it's those bloody temple peaks that shit all over my styling.
I say go for it if you have the money.

[gillenator]

Gandolf,

Based on the information that you provided, you appear to be a good candidate for surgical hair restoration.

You are doing the properly recommended medicinal regimen which appears to be working well for you and also the absence of advanced hairloss classes within your family history.

As you may already know, this is not an exact science but all of the indicators are good for you IMHO.

What I really wanted to add is to recommend that you look into and consider FUE for your first procedure. It sounds like you agree with a more mature and conservatively placed hairline so you should not need a very large initial session.

Even if you progress more, and no doubt you will with time, the fact that the hairloss history within your family is not advanced, you may not need that much follow-up work or touch-ups in the future.

And should you decide that you want to wear a much shorter hair style or even buzz your hair in the future, there will be no donor scar to contend with.

If your hairloss was much more advanced or you had it in the cards so-to-speak, then IMHO, strip would be a better approach because of the better documented yields and the fact that our donor is limited as you previously stated.

Just be sure that the FUE surgeon you choose has proven documented prior results with the FUE technique.

BTW, feel free to stop by my office as I am close to you if you live in Maryland. There is no charge for the appointment. Just pop me an email.

One last comment: Although I am a Redskins, Nationals, and Capitals fan, I still have a heart for the Ravens and used to go and watch the "Birds" play at Camden Yards before the Wash Nationals arrived. I used to have an office in downtown Baltimore years ago.

GO RAVENS!

[gillenator]

Thank you Dr. Frank as you make a good point. FUE in itself does not guarantee "no visible scarring" and I have seen enough pics of shaven donor areas post-op where the healed extraction sites were in fact noticable, and some extremely noticable.

When FUE was first introduced in North America and even up to the present day, there are at times clinics who come on strong with a marketing campagin driven by a so-called "scarless technique" which is anything but the truth. And this is why the patient must consider their potential for hairloss over the long term. Many men suffering from MPB will need/want more coverage and more procedures. I had four strip procedures myself for just under 7,000 grafts and still only one donor scar. I can hardly imagine what my donor region would look like with that many extractions! I also hear from guys every now and then who chose FUE when it was a hot in the forums and then chose FUHT for their subsequent procedures.

IMHO, this is why FUHT may indeed be a better option for those who are headed for the higher Norwood classes. Better yields considering our limited donor supplies.

This is why I believe that FUE is better suited for those who have limited hairloss in their family histories and do not wish to have a long donor strip scar. Keeping a higher more age suited placement of the hairline also helps preserves that limited donor supply as you pointed out earlier.

[Gandolf]

Thanks for the replies everyone. The donor scar doesn't really scare me too badly because I don't wear my hair short and certainly wouldn't want to if I spring for the HT (what would be the point in dropping 10k just to shave it all off?).

So, I'd be doing FUT if I did have a procedure shortly. I am still on the fence, the stuff I'm seeing from Dr. Gho who claims to be able to get 80-90% donor regrowth intrigues me, but I think the results are FAR from being proven and I don't want to be a guinea pig.

For the poster that mentioned Rahal, he is one of the doctors I've consulted with. He recommended 2400 grafts based on the pictures I posted in this thread. I also met in person with Dr. Feller who recommended 1800 (the hairline he drew on me was practically right overtop of what I have, even in the corners so I crossed him off my list), and finally H&W recommended 3500 grafts. Interesting how 3 of the top clinics in the world have such a variance in what they recommend.

[Gandolf]

it looks like you have above average donor density

I've been told I do by both HT doctors and barbers alike over the years, but my hairs are VERY fine. I've heard that blondes have, in general, the highest hair counts but the thinnest individual hairs and I definitely fit the profile.

[drybone]

Hey Gandolf.

If its any comfort, I just did my first hair transplant 2 1/2 months ago and it went fairly well.

I just jumped onto finasteride with no sides yet.

Its not bad. Make sure the doc gives you the good stuff. Vicodin.

How many grafts do you want? From your photo it looks like you could get away with dense packing about 3000 and that should take care of it. But I am no expert.

Let us know how it goes

[rev3]

go to Rahal and stay at the Brookline House, residence for all Rahal patients which is down the block from the clinic. it is inexpensive has a spa-like feel

[LMS]

I also have blonde hair and its always been super fine it kind of sucks lol.

OP whats you ancestry? You look east baltic ie. Lithuania, Estonia, Latvia

[35YrsAfter]

IMHO, this is why FUHT may indeed be a better option for those who are headed for the higher Norwood classes. Better yields considering our limited donor supplies.

This is why I believe that FUE is better suited for those who have limited hairloss in their family histories and do not wish to have a long donor strip scar. Keeping a higher more age suited placement of the hairline also helps preserves that limited donor supply as you pointed out earlier.

The art of hair restoration is such a mixed bag. We all, including me of course, have opinions that are heavily influenced by our personal experiences. I have seen a few mature strip scars that are barely visible while running a comb up the back of the patient's head. I have seen the white FUE dots that aren't noticeable unless the patient's head is shaved to the bone. I've personally had thousands of FUE extractions and the only area where they are even barely visible to the naked eye when light hits the shaved skin at a certain angle, is where a larger punch was used. The best strip scar I have ever seen on a shaved head oddly enough, was done by the very clinic that butchered my head years ago with shotgun scars. I'm still in the process of fixing those scars with beard hair. The doctor who plugged up my head years ago still practices hair transplant surgery and was dishonest with me while I sat in the chair back in the early 80's. Of course with the larger clinics, it's often a crap shoot related to the quality of doctor you get unless you specifically request a particular physician with a decent reputation.

Every week here at Dr. Cole's office, we seem to have between one and four patients in for strip scar repair. I commonly see scars wider that an inch from ear to ear. I have even seen multiple wide strip scars crisscrossing the back of a patient's head.

Personally, here at work, I'm seeing great results and promise with the use of ACell and PRP in patient's donor and recipient areas, when used in conjunction with minimal depth FUE. In light of the donor follicle regeneration we are seeing with minimal depth FUE, I'm personally leaning more toward FUE in the right hands as being the preferred method for larger sessions.

Today I had 500+ beard hairs extracted and placed in my shotgun scars and crown. My donor and recipient areas are being treated with ACell over the next few days.

The most discomfort during surgery I experienced today was from holding my head in a particular position for an extended period of time. Only local anesthetic is necessary. I personally hate needles and get a little anxious before surgery, but every time the pain has been insignificant. I began typing this post approximately an hour after my surgery. I feel fine and the only pain is a slight burning sensation on my neck where the grafts were removed. Kind of like when you scrub your skin too much to the point it feels slightly raw. On the pain scale of 1-10, it's less than a 1 without any pain medication like Aspirin or Tylenol.

How many people have a job where you work with people day in and day out and all of a sudden, you're sitting in a surgical chair with your friends and coworkers huddled around you assisting your doctor/boss in restoring your hair?

35YrsAfter works at Dr. Cole's office.

[Gandolf]

It looks like you are certainly doing your homework. I'm curious about why you were so quick to discard Dr Feller. I imagine he would have adjusted the hairline to match your opinion, wouldn't he?

Because the way you are describing it, you seem to really be just looking for reasons to "NOT" do this.
It seems pretty clear you'll get a good transplant, but is there some other reason that's holding you back? Happy to learn more about you, this is informative for me as well.
All my best,

Dr John Frank, MD

Hey Dr. Frank,

Regarding Dr. Feller, as soon as he showed me the hairline he drew in the mirror, I told him I was looking for something a little more aggressive, especially in the corners of the hairline and asked if he'd advise that. His response was that he wouldn't recommend it but I could always make it lower in the future. He was pretty dismissive about my concerns I felt. To me, that simply made no sense, to take the plunge on do a HT now that wasn't going to meet my satisfaction, only to plan to come back later and lower it.

And there was more to it than the actual diagnosis from Feller that caused me to discard him as an option. While I was in the waiting room before my consultation, the patient he had just operated on earlier in the day came out with head bandaged and I could see the recipient area. After a quick look at my head in my consult Dr. Feller said, and I quote "did you see the guy in the waiting room before you came in? Your him. I'd do the same exact procedure." I asked some questions and it turns out this guy was considerably younger than me and had very different hair characteristics, which I was able to see in the waiting room. I also felt that his hairloss especially in the crown area was significantly different than mine (his was worse and at a younger age). Given several important differences between me and this patient, I don't understand how he would advise to do the exact same procedure. I just felt that, in addition to his diagnosis being too conservative, I had just used PTO from work and spent hundreds of dollars between gas, hotel, toll fees, etc to get a 2 second diagnosis like that. And there were many important aspects of HT that I know as someone doing my research he should have asked. For example he never even asked me about family history of baldness and what the other men in my family ended up looking like.

Because the way you are describing it, you seem to really be just looking for reasons to "NOT" do this.
It seems pretty clear you'll get a good transplant, but is there some other reason that's holding you back? Happy to learn more about you, this is informative for me as well.
All my best,

Dr John Frank, MD

You might be right about this. I just think the main thing holding me back is that my true desire is to have not just an improved hairline but also my natural density back up top. Propecia has stopped my loss and I regained a little in the crown area, but my hair can still look pretty bad in harsh lighting or outside. Due to the current limitations of HT surgery I worry that I just won't be able to get what I truly desire. I would imagine none of the good doctors would implant hairs into my crown and vertex to add density due to the risk of shockloss. Certainly none of them recommended it in my consultations.

[Gandolf]

OP whats you ancestry? You look east baltic ie. Lithuania, Estonia, Latvia

Primarily Scottish on my dad's side and German on my mom's side. I am lighter complected than either or my parents though, but there are a handful of family members who have the extremely light coloring that I have (from my dad's side of the family).

[drybone]

Hey Gandolf

........the guy was dismissive about my concerns and thus there was no point doing it if it wasnt going to be what I wanted...............

Any doctor who refuses to give you what you want will NEED to tell you exactly why not.

A reasonable explanation would be that some guys who are 20 dont know if they will go totally bald in 10 years and we have to realize we will keep receding after the procedure.

Your doctor seemed instead to 'steer' you , almost over ride your own intellect like your wishes were not relevant in the real world.

That to me is insulting. Ive seen your pictures. There is no reason why you cant have a lower hairline but you have to have a little recede by the temples.

Ive seen tons of men 20,30 then 40 50 even 60 years old have full heads of hair but a little receding at the temples looks great. Women love a little recede as long as the middle is thick and full.

So go get a second opinion. Third, fourth. Dont worry, you will find a guy who will do it or tell you whats up.