Pics for evaluation

[Gandolf]

Crown Too?

Hey Dr. Frank,

That's just it; I don't know. I don't know what it would take to make me truly satisfied which is why I'm waffling back and forth over this. I don't think an "illusion" of density is enough to please me, I want real density that will look good in all lightings.

I already have plenty of hair to have the "illusion" of density all over the top, as long as the lighting isn't bright and unfavorable, but in strong lighting my hair on top can look quite thin and see through. Maybe given that I already have a decent amount of hair in the crown and vertex I'd be able to get good coverage with a reasonable number of grafts?

But untimately I'm still conflicted over doing something now with the current technologies versus waiting for something better to come along. I'm holding out hopes that in the not-too-distant future we will have treatments that not only move existing hairs from point A to point B but actually generate new hair folicles. I know there are people who 15 years ago probably thought this technology would be a shoe in within the next 10 years or so, so there IS a risk to keep waiting and waiting. You might wait around so long that your best years are behind you.

Specifically, I am waiting to see what the hairloss community sees next with Dr. Coen Gho who is claiming 80-90% regrowth in the donor area with his technique where he essentially removes part of the follicle and claims that it will regrow in both the donor AND recipient site. Have you heard of this treatment and do you have a medical opinion on whether or not this would truly work? Obviously if his claims can be substantiated, this would be a game changer as it would multiply the donor supply but the fact that there aren't more doctors promoting this make me skeptical.

[drybone]

Hey Gandolf.

I know for me Im on a tight budget. I cannot afford to 'hope' the hairs grow in both places.

I am willing to trade off the fact there will be a line in the back when shaved for the fact the hairs WILL grow in the front.

When more and more doctors are practicing it as fact, then I will consider it .

[DAVE52]

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.

You will never get your natural density back

[Jotronic]

Gandolf,

I've just read this entire thread. Here are my thoughts. Leave your crown and vertex alone. The whole point of this procedure is to get a cosmetic improvement that is obvious. You have so much hair that I doubt you'd notice any difference regardless of how many grafts you get. I think most excellent clinics would turn you down for crown work for this reason alone. I know I would. Put all thoughts about surgery for these areas to bed. It is a waste of time not to mention hair and money.

[Gandolf]

Gandolf,

I've just read this entire thread. Here are my thoughts. Leave your crown and vertex alone. The whole point of this procedure is to get a cosmetic improvement that is obvious. You have so much hair that I doubt you'd notice any difference regardless of how many grafts you get. I think most excellent clinics would turn you down for crown work for this reason alone. I know I would. Put all thoughts about surgery for these areas to bed. It is a waste of time not to mention hair and money.

Hey Joe,

Thanks again for your input and I know that with the current methods, most/all of the top doctors wouldn't go in and work on my crown. I think the pictures I posted at the beginning of this thread show me in average lighting and don't do justice to how shitty my hair can look either in bright lights or outdoors. I've posted more pictures below to further highlight. As you can see, in the indoor picture I look like I have absolutely ZERO hairloss whatsoever in the crown but in the pics taken outside, it's clear that I have lost a significant amount.

While it might not be advisable to treat the crown, I have to disagree with you that there is zero room to improve it at all. Under bright lights my hair is somewhat see-through up top and adding to the hair count would lessen this, wouldn't it?

[Gandolf]

Some people would do anything to have your hair! But being a hair loss sufferer myself, I understand it's not pleasant to show early loss.

Where are you located? (It looks warm and sunny)

Dr John Frank

Lol, I know. There are probably people here who are NW 5/6/7 reading this and thinking I am mentally ill, but by the same token, I can point to tons of guys my age and older with zero visable hairloss so it's all relative.

I'm in Maryland, just outside of Baltimore. Those pics were taken this past Summer. It's a little more gray and dreary outside now (and COLD!) and I was just too lazy to get new pictures. Luckily Propecia halted my hairloss so I look exactly the same now as I did 6 months ago when those were taken.

[Jotronic]

Gandolf,

Your photos illustrate my point exactly. Your crown cannot be improved via surgery. There is little room to place new hair and there is no cosmetic benefit. You see something that bothers you. No one else sees anything that should be cause for concern. I certainly don't and I dare say I have one of the best eyes in the world when it comes to photos and hair. I'm not dismissing your concerns. I'm dismissing the option for surgery. Please heed my words closely because if anyone goes into that crown you are going to regret it.

[Gandolf]

Gandolf,

Your photos illustrate my point exactly. Your crown cannot be improved via surgery. There is little room to place new hair and there is no cosmetic benefit. You see something that bothers you. No one else sees anything that should be cause for concern. I certainly don't and I dare say I have one of the best eyes in the world when it comes to photos and hair. I'm not dismissing your concerns. I'm dismissing the option for surgery. Please heed my words closely because if anyone goes into that crown you are going to regret it.

I appreciate your advice, but if you read my words carefully in this thread I wasn't suggesting that I want a HT into my crown at this time. I am kind of waffling back and forth between going with the current HT options we have now which to me are less than optimal versus waiting for better options to hopefully come out. I understand that right now the only HT that would make sense would be one into my hairline and temple area.

You once told me on the phone that H&W has transplanted grafts as densely as 100 per cm^2 so to me it is clear that theoretically it is possible to make my crown denser than it is now, but as you say it would not be advisable due to donor supply issues. This is my dilemma, there is currently research being done to clone follicles, etc., which would remove the main drawback of HT surgery and hence the dilemma of acting now or waiting for better options.

[drybone]

I would suggest concentrating on preventing further loss, toppik or other concealer, and styling of hair to suit your needs.

I did a hair transplant on my hairline. In my opinion, the hairline is by far the most important thing and 90% of the time what people see when looking at you.

I lost my full hairline when I was 20 years old. It started 'breaking up' but fortunately the thinning was very slow and the actual line did not recede much. But it sucked nonetheless to see other guys my age with their perfect hairlines.

But trying to do something about it at 20 -when i didn't know if I will be norwood 6 bald by age 30 , is not wise.

I forgot how old you said you were but take my advice, go do the homework on your grandfathers and see which of their hairlines you have. If neither of them, then look at your dad, uncles brothers .

Find out how fast you will bald. Figure out to a good degree of probability of what you will like at 65 (the age I have heard DHT is too low to burn out the hair follicles quicky) .

[Jotronic]

I know you weren't considering it now, but you were speaking as if you were considering it in general. Yes, I told you about the densities we can achieve but there are specific cases in which this is warranted and yours would not be one of these cases not to mention no one has that density in their crown to begin with. As I've said, there is no cosmetic benefit to altering your crown.

I'm glad you've not had anything done yet, to the front or the back. You have questions that need to be answered and you need to feel at ease about the future. I like that you are continuing your research so good on ya.

[35YrsAfter]

I agree, if he can multiply the donor it would really be a game changer. But it's obviously unproven and not something to try yet.

I agree with you that doctors should exercise caution regarding new treatments. On the other hand, I do feel that the art of hair restoration has moved forward at far too slow a pace. In speaking with Dr. Cole, one of his frustrations relates to the length of time it takes so many doctors to accept and adopt new technologies. During the early 50s for instance, New York dermatologist Dr. Norman Orentreich performed the first hair transplant in the United States. It was done on a man with male pattern baldness. Orentreich was heavily criticized for the procedure he had developed because the results looked unnatural. It wasn’t until the 90’s that some hair restoration physicians began using follicular units. It really shouldn’t have taken 35+ years for hair restoration physicians to realize the critical importance of a natural result. We have a patient in surgery this morning having 4mm shotgun scars and a strip scar repaired. In addition, if that weren't enough, we are working toward getting his hair plugs on top to look more natural. I asked our patient during what years he had his previous surgery we are repairing and was stunned to learn these surgeries occurred between 1990 and 1992.

Related to keeping on top of new technologies, Dr. Cole regularly keeps in touch with hair restoration physicians worldwide. According to our latest conversation, literal hair cloning is not yet a reality. Dr. Cole has contacted Dr. Gho's office and they have not yet responded. Doctors in many fields of medicine ARE having success with tissue regeneration using products such as ACell, so Dr. Cole believes Dr. Gho is on to something.

IMO, many hair restoration doctors are overlooking the advances in regenerative medicine. Dr. Cole is getting a range between 10% and better than 60% follicle regeneration using ACell. ACell IS a regenerative product approved as such by the FDA. The field of hair restoration has had more than its share of disappointments over the years. Disappointments often lead to cynicism. Although it's taken far too long for the art of hair transplantation to get where it is in 2013, things have really come a long way from the early 4mm open donor plug techniques.

It's interesting to search on "regenerative medicine" and check out the advances being made. To many, regenerative medicine sounds farfetched. It's a fact that regenerative medicine is a reality. I personally try to remain cautiously optimistic. We do need more studies and data.

- 35YrsAfter works at Dr. Cole's office

[Gandolf]

I know you weren't considering it now, but you were speaking as if you were considering it in general. Yes, I told you about the densities we can achieve but there are specific cases in which this is warranted and yours would not be one of these cases not to mention no one has that density in their crown to begin with. As I've said, there is no cosmetic benefit to altering your crown.

Joe, we will have to agree to disagree about it being impossible to improve the cosmetic appearance of my crown and no, I am not considering it with the current techniques. I am looking into the future at a point where it may be possible to clone hair follicles or get better donor regeneration (i.e. expand the donor supply) and thus if these breakthroughs even do come to fruition there is no reason to think they couldn't thicken up the existing areas of my crown. I fully understand that with the current technology of moving hairs from point A to point B that it would not be advisable and that no good doctor would be willing to do this, I even said this in one of my earlier postings.

I'm glad you've not had anything done yet, to the front or the back. You have questions that need to be answered and you need to feel at ease about the future. I like that you are continuing your research so good on ya.

Now this I agree with. I am not sold on the current surgical options so I either need to wait until they improve and meet my expectations or until I can temper my expectations and feel confident.

[Gandolf]

Related to keeping on top of new technologies, Dr. Cole regularly keeps in touch with hair restoration physicians worldwide. According to our latest conversation, literal hair cloning is not yet a reality. Dr. Cole has contacted Dr. Gho's office and they have not yet responded. Doctors in many fields of medicine ARE having success with tissue regeneration using products such as ACell, so Dr. Cole believes Dr. Gho is on to something.

It's really a shame that a well respected doctor in the industry would get blown off that badly by Dr. Gho and it's one of the reasons I am skeptical of his claims. I applaud Dr. Cole for working to advance the procedure and like you, I am cautiously optimistic that we will have some better options here at some point in the not-so-distant future.