The MOST important fact to remember!!!!

If you are bald hair restoration surgery will NEVER restore a full head of hair. For a dose of reality, check out the following image. I have used my pitiful Photoshop skills to show what a donor strip with approximately 4800 grafts would look like if it was just laid on top of a bald scalp. This is assuming a donor strip of approximately 30cm X 2cm and full density of about 80 FU per cm2. If this doesn't make the reality of this procedure clear, nothing will.

http://www.hairtransplantmentor.com/...g?i=1663604098

exactly.
Wait for Histogen and Replicel to announce their results first....

That's actually quite a kool look !!

Thats 4800 grafts ???
I mean whats the point then.. if thats 4800 grafts.. then it would take a million dollars if not much more for this guy to fix his entire bald head.

Good point Joe. Nice visual representation of the problem of donor limitation. I think the scale might be a little off though. My father is a norwood 5 or 6 and from where his hairline used to be to the top of the horseshoe in the crown is around 24cm, maybe 25cm. It's also varies width wise but I'd say he has a max of 230cm2 or at tops 240cm2 to cover. I think 240 is the number to plan for.

Some guys can get long strips. I could comfortably do a 32cm strip maybe more. I have heard that some of the lucky ones can have 3.5cm width extracted over 2 or 3 procedures. At a density of 85FU/cm2 which is probably about right for the average patient, and I'm going to say an extractable area of 32x3 (96cm2) over multiple procedures you're looking at 8160 FU. Of course some can get that 3.5cm width and some have big heads so they can take longer strips so they're total available donor will be higher. Plus higher donor density. I recall that NicNitro had a pretty long strip. Was it almost 35cm Joe? Sounds a bit ridiculous.

I've been told that the average patient has 8000-9000 available over a lifetime. Seems about right when pushed to the limit. Still let's go with 8160 for now and assume the 2.3 hairs per FU and average hair caliber.

240cm2 of baldness (norwood 6 land) and a native density of 85 pre mpb means 20400 FU lost. :(

However, in the first 65cm2 can have 45FU/cm2, the next 65cm2 can have 40 and the crown of 110 can have 30 for a total of 8825. Some could achieve that by strips and some might need another 750 FUE or so to get there. Sure that would mean a thin crown but I still think that's better than being slick bald.

Of course you do hear about people with around 10,000 available by strip and then another 1500-2000 by FUE. I'm looking at you Joe you lucky sod. 9500 with another strip of 1500-2000 and then another 1500 FUE left. :D It's good to have good donor.

As Dr. Feller says you can have all the money in the world but if you don't have the donor there's only so much the doctors can do. For the real freaks out there, 50% density restoration all over is just about possible. FDR out.

Imagine someone was norwood 6 or 7 and pulled out a 30cm strip and then cut out a strip of scalp on top and placed in the donor strip, plus a bit of FUE for the donor scar, for the mister T native density mowhawk. :D

I still feel very much puzzled with donor hair mystery.. essentially, we all should have plenty of side hairs to be moved to bald spots..

Every 20 something that has hardly any hairloss should look at that picture and understand that the clinics that do give them that unethical low hairline or do not plan responsibly by front loading too much density are in reality screwing them over and taking their money for some very temporary happiness that will come at a very painful price.

Same goes for the clinics that just use up grafts to load the crown because what the heck the patient is paying.

Responsible clinics explain the numbers and advise the patient on what is sensible because the clinic is in a position of greater knowledge, or at least we would hope so.

Great visual on the reality of donor and hair transplants.

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Originally Posted by topcat

Every 20 something that has hardly any hairloss should look at that picture and understand that the clinics that do give them that unethical low hairline or do not plan responsibly by front loading too much density are in reality screwing them over and taking their money for some very temporary happiness that will come at a very painful price.

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I agree.

I have looked at Alvi Armani's website and the results they show; the young men look quite good, but I'd hate to see them in another five years. Using up all of someone's donor for a dense NW1 hairline before they're even my age seems like a terrible thing to do.

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Originally Posted by StressedToTheBald

I still feel very much puzzled with donor hair mystery...

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You are puzzled by everything associated with resolving hereditary hair loss.

Alvi Armani are a disgrace. Disgusting unethical marketing. They seem to cake all their patients with makeup to make them slightly more tan and to be honest I'm not even entirely sure that they're not putting some dermmatch in the hair.

Their long term strategy for a norwood 6 is as follows (I copied this from another site):

Take someone such as yourself who has never had a procedure before, and Dr. Armani asses that he can harvest 8,000 grafts from your donor area over time.

You eventually need coverage from front to back, here is how it would be managed roughly:

Here is what is recomended to the patient
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Zone - 1: 2500 follicular units at 80% density
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Zone - 2: 2000 follicular units at 40% density
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Zone - 3: 1240 follicular units at 30% density
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Zone - 4: 2030 follicular units at 20% density
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Total grafts 7,770

This strategy gives a high density front with a full dense hairline with many styling options and a lower density crown with great coverage.

what will happen when replicel and histogen will be able to revive dead follicles.... all you people with hair transplants will look ridiculous :rolleyes:

Zone 3 and 4 are going to look pretty odd relative to the front. By all means if a patient is norwood 6 and strip out with say 55 or 60 up front which may be possible and they have nice coverage in the crown. They could always decide to add another 1000 FUE to the crown to boost density there by 10 FU/cm2 and they may even have some more for the front. However transplanting at 80% native pre mpb density without knowing how bad future hairloss will be is madness.

Dr. Rahal seems to be slightly more aggressive than most and he did work with the Alvi Armani outfit for a short time but the highest I've seen him go up front is 65% native density so the Alvi Armani approach is by far the most aggressive. At 75 or 80FU/cm2 I can't imagine the yield being very good. Such a waste.

Unfortunately there's some Armani patients out there that had work done back around '05 thinking that HM would be here now to take care of their future loss. :( Oh dear. They're in trouble now.

Great post !

the shape of zone 4 is an ` egg shape ` this shape should be put in zones 2 and 3 and grafted via fue ,with a side weighting to create the illusion of density , further down the line you can expand on this , donor and finances allowing , or retain the option to shave down and look ` normal ` .

There are a couple of Drs grafting with beard hair ,this is another source of donor ,that I think will come more to the forefront in the future , more so than , replicell etc ...

ejj

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Originally Posted by Jotronic

If you are bald hair restoration surgery will NEVER restore a full head of hair. For a dose of reality, check out the following image. I have used my pitiful Photoshop skills to show what a donor strip with approximately 4800 grafts would look like if it was just laid on top of a bald scalp. This is assuming a donor strip of approximately 30cm X 2cm and full density of about 80 FU per cm2. If this doesn't make the reality of this procedure clear, nothing will.

http://www.hairtransplantmentor.com/...g?i=1663604098

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This is actually what I suspected all along and is precisely the reason that I'm so against hair transplantation. I mean, if transplantation could give us a full head of hair back, I'd easily shell out $20,000, no questions asked. But to pay thousands of dollars for something that can't even give you close to a full head of hair, leaves permanent head scarring, and requires a lifelong commitment to Propecia and most likely more than one hair transplant, is something that I would never do. This really illustrates the absolute need for much better methods to regrow and preserve hair, and it's really inexcusable to me that we don't have better hair regrowth options today. But I give Jotronic lots of credit for being an honest person and posting this. Plenty of doctors and their representatives would never be this honest and admit to the limitations of hair transplantation and would blatantly lie about what transplantation methods can achieve.

And lastly, this is precisely the reason why we should be shooting for cellular hair regeneration as opposed to unlimited donor hair. Even if unlimited donor hair could be achieved, God knows how many hair transplants a person with significant hair loss would actually need to achieve anything close to a full head of hair. Surgical transplantation is just so limited and invasive (there just aren't enough hairs to redistribute from one part of the head to the other), whereas cellular regeneration (or just regeneration in general) could promise massively better results.

Do you think it's unethical to do super dense packing and low hairlines in the front of the scalp based upon an assumption that the patient will be able to maintain their hair forever on meds? I see a lot of the really good docs placing low hairlines and high numbers of grafts up front (for example, 3500 in the front hairline alone) in patients who are taking propecia. But it seems that at some age, maybe even 60 or 70, the genetic pattern is going to take over or there will be some reason along the way that the patient may need to stop the meds. Will these patients end up with a super dense front half and a bald crown and midsection?

I think this is a great post , I also think its an extreme , the picture shows it as ` black and white ` ..its brutally honest and fair in my opinion .

The variable would be a patients characteristics and Drs skill , alternative pictures `could` show Dr Bisanga`s patient rep who has had complete restoration via fue only, using beard and scalp hair , this was a norwood 6 fully restored ! , Dr Umar has some full restorations also using beard and body hair also Dr Woods , so I think my earlier post is relevent, fue procedure to the ` egg shaped` area and see how things go

regards
ejj

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Originally Posted by ryan555

Do you think it's unethical to do super dense packing and low hairlines in the front of the scalp based upon an assumption that the patient will be able to maintain their hair forever on meds? I see a lot of the really good docs placing low hairlines and high numbers of grafts up front (for example, 3500 in the front hairline alone) in patients who are taking propecia. But it seems that at some age, maybe even 60 or 70, the genetic pattern is going to take over or there will be some reason along the way that the patient may need to stop the meds. Will these patients end up with a super dense front half and a bald crown and midsection?

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It depends on a lot of factors (age, rate of loss, response to meds, available donor, etc.), but in most cases it strikes me as unethical.

The length of time an MPB sufferer can maintain his hair on medication varies a lot from person to person. Some people keep what they have for more than 10-12 years; some people start losing hair again only a few years into treatment.
If you use 3,500 or more grafts for the hairline on a guy in his 20's, what happens if finasteride loses effectiveness 24 months later? The patient still has decades of life ahead of him and only like 3 thousand grafts for his entire head...
Someone feel free to correct me if I'm wrong about any of this, but this approach just seems like a disastrous method of hair restoration.

And I agree with FDR about Armani's marketing and ethics.

3,500 in the hairline is of course ridiculous. However I can see a good argument for those with donor reserves of 10,000 by strip and FUE to go for up to 3,500 in the first 65cm2 or roughly frontal third. Assuming that number is available for maximum donor a norwood 6 can have the following:

3,500 in the first 65cm2 - about 54FU/cm2
3,000 in the next 65cm2 - about 46 FU/cm2
3,500 in the crown, 110cm2 - about 32 FU/cm2

I have heard of people with 11,000 available by all methods so they can reach just over 40 FU/cm2 even in the crown. Good results are still possible but if you don't have 9,000 available and are headed for norwood 6 you may not be satisfied.

Still there are some great successes. I really like this one. I believe the patient has used up 7,300ish of a donor rated at over 10,000. Plus as far as I'm aware he never availed of meds. I think the outcome is great.

http://www.baldtruthtalk.com/showthread.php?t=2326

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Originally Posted by ejj

...using beard and scalp hair , this was a norwood 6 fully restored !

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No it wasn't. Beard hair and body hair have different characteristics than scalp hair. This was just a cover that has the "look" of full restoration - but it isn't truly a "full restoration". Personally, I feel beard and body hair should be left for extreme repair and truma cases only. Not as a general practice.

Isnt that the goal , to achieve the look of full restoration , sorry if you took what I said out of context , we were discussing transplants I may of wrongly assumed that everyone understood my comments ,therefore I will re phrase it .." beard and scalp grafts via fue , have achieved the ..` illusion ` of full restoration "

I have had 1000 beard grafts, grafted into my scars very little difference re characteristics, so much so im booked in for more repair work in May , I think beard hair will become more of a valuable donor source as the traditional scalp donor runs out , more and more Drs are trying to use it with various results , i guess some are just better at it than others

regards

ejj

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Originally Posted by Follicle Death Row

3,500 in the hairline is of course ridiculous. However I can see a good argument for those with donor reserves of 10,000 by strip and FUE to go for up to 3,500 in the first 65cm2 or roughly frontal third. Assuming that number is available for maximum donor a norwood 6 can have the following:

3,500 in the first 65cm2 - about 54FU/cm2
3,000 in the next 65cm2 - about 46 FU/cm2
3,500 in the crown, 110cm2 - about 32 FU/cm2

I have heard of people with 11,000 available by all methods so they can reach just over 40 FU/cm2 even in the crown. Good results are still possible but if you don't have 9,000 available and are headed for norwood 6 you may not be satisfied.

Still there are some great successes. I really like this one. I believe the patient has used up 7,300ish of a donor rated at over 10,000. Plus as far as I'm aware he never availed of meds. I think the outcome is great.

http://www.baldtruthtalk.com/showthread.php?t=2326

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That's a lot of grafts. I wonder how common it is to have such a generous donor region.

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Originally Posted by 25 going on 65

That's a lot of grafts. I wonder how common it is to have such a generous donor region.

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I don't have a clue.

I do not like this thread.

A hair transplant will never provide 100% density. That is a fact and if it has not been made clear to you by your hair transplant surgeon, then you should not be having surgery with them.

Alvi Armani is a scam and I don't believe they practice in Canada anymore. They commit too many hairs to the frontal hairline.

Dr. Rahal's strategy (my surgeon) is to have increased density in the frontal hairline (60%ish) then decrease this density as you move back towards the crown. He also makes it clear that you will most likely have a bald spot at the crown at the end of all the surgeries because there just isn't enough hair.

I am completely fine with all of this. I had my HT done June 21st and I'm completely satisfied with the results (3,128 hairs in the frontal 1/3rd). I tried shaving my head and it looked horrible. Although my hair now doesn't look 100% like it used to, it is much better than it would look completely bald.

For all of you holding back on having a hair transplant done because you fear the results won't look realistic, sometimes you just need to have the courage and take the leap. The results may not be completely realistic but they're far better than doing nothing and moping about it for years.

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Originally Posted by Locke

I
For all of you holding back on having a hair transplant done because you fear the results won't look realistic, sometimes you just need to have the courage and take the leap. The results may not be completely realistic but they're far better than doing nothing and moping about it for years.

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I like this comment, however sure it does not work for everyone. You seem to have had realistic expectations and I am working on mine. I am 1 months into a 2500 FUE - and looking forward to see the outcome in 12 months.

Happy to hear you are happy - Rahal is on most people's top lists or should be.

Still Researching, curious where you're from? Got any latest photos? I'm in Newcastle, UK and trying to decide on a transplant doc. Cheers :)

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Originally Posted by chrisis

Still Researching, curious where you're from? Got any latest photos? I'm in Newcastle, UK and trying to decide on a transplant doc. Cheers :)

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Hi Chrisis,
I am from Scandinavia, you can see my story and pictures in another thread on this site: http://www.baldtruthtalk.com/showthread.php?t=7446
Will try to update it monthly...

Cheers,

Thanks I'll check the thread :)

and good luck with your recovery! Maybe in a year's time I'll be where you are now ;)

Quote:

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Originally Posted by chrisis

Still Researching, curious where you're from? Got any latest photos? I'm in Newcastle, UK and trying to decide on a transplant doc. Cheers :)

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This is kind of off-topic, but over the years I've read quite a few claims online that the UK is a bad place for hair restoration surgery, and that British citizens should travel off the island for their procedures...
Do you know if that holds any merit? I don't understand why this would be the case in such a modern country. :confused:

Even if it's generally true, it seems like there should be at least a handful of reputable UK surgeons?

Yes 25, it's true. There is supposed to be one accredited surgeon not too far from me, but I've seen his photos and I've not seen anything as impressive as Dr Rahal and Feller's handiwork.

I suppose it might be something to do with our NHS and the lack of people willing to pay much money when it comes to health, and vanity especially.

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Originally Posted by 25 going on 65

it seems like there should be at least a handful of reputable UK surgeons?

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There's only one. Dr Farjo.

I'm also in the UK, and I've been looking at surgeons in the US and Belguim.
Just by looking at videos and photos, Dr Farjo is good, but I believe that surgeons such as Dr Feller, Dr Shapiro, in the US and Dr Feriduni and Dr Bisanga in Belguim are better.

I'm also in the UK adam.

I haven't seen much work by the doctors in Belgium, but that trip would be a lot easier for me... What has led you to consider those docs?

So far my wish list is Rahal or Feller!

I too cut out a bald area on paper and cut a strip and it covered about a quarter. Basically for total top head baldness you need your strip divided by about 5.

So your hair on top will be 5x thinner than it is on the side.

Quote:

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Originally Posted by chrisis

I'm also in the UK adam.

I haven't seen much work by the doctors in Belgium, but that trip would be a lot easier for me... What has led you to consider those docs?

So far my wish list is Rahal or Feller!

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I found out about the doctors from Belguim on this forum. Dr. Feriduni is acknowledged as one of the best FUE surgeons, he is also pretty handy with FUT. He is also a IAHRS member.

Dr. Bisanga, though not a IAHRS member also has an outstanding reputation. I believe he is not a member of IAHRS through his choice. He doesn't seem to join many organizations. So he is probably the only surgeon who isn't a member of IAHRS i would have no hesitation in using.

Its worth googling them both and checking them out. Below are their websites to get you started.
Bijan Feriduni
BHR Clinic - Dr. Bisanga

For such a small country Belguim is a hotbed of HT surgeons. I think they are as good as the top US surgeons.

Regarding your choice of Dr's Feller and Rahal. Both great choices. I'm seeing Dr. Feller when he is over here in the UK in May. If I was going to consider Canada I would also add Hasson & Wong to my list as well as Dr. Rahal.

Thanks for the info!

I'm also seeing Dr Feller in May! Might see you there haha :) would actually be cool to meet some other guys and share thoughts.

I'm counting the days down to May. Can't wait to get this done and get on with my life.

Think Spencer was saying he might well accept Dr. Bisanga if he applies a few weeks back on the show. Stephen's restoration is crazy good.

yeah and no scar !:)

ej

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Originally Posted by ejj

yeah and no scar !:)

ej

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Can't wait to see Still Researching's result with Dr. Feriduni too. He has a ridiculous number in his donor by FUE should he ever need them.

So is it fair to say that it is better for some to start balding in the frontal zone and hairline
Than it is in the crown.

That way you can give the appearance of fullness in the hairline when you look at somebody in profile by using more grafts up front so to speak .