Will 1000 — 1600 FU grafts be sufficient to lower my hairline and bring me to NW1?

It's hard to say what to expect in relation to what your hoping to achieve. Upload a photo that has a hairline drawn so we know how to reference what you want to achieve.

This is hard to do on a picture but I will try.

I need hairline enough to reduce vertical length of face and make it look thick and angular so it is aligned with my sharp eyebrows and facial proportions.




Goal is to achieve the most youthful looking result and avoid "mature hairline" at all costs, since my facial characteristics do not look "mature" and never will due to youthful looking bone structure and lack of full facial hair. "Mature" hairline would not work in the industry I aim to model in and for my particular look.

Well, both of the hairlines you shared are lower than what your drawing represents. I'll say this upfront. What you want to do is risky for a few reasons.

1. You need to get a really high density so that the hairline isn't visibly thinner than your native hair.
2. High density means high numbers so that means that your 1000 to 1600 estimate might not be enough.
3. If it doesn't grow well, or if it does grow well but not to your expectations (do they align with reality?) then you'll be needing more work.

Personally, I feel that if you want your outline filled in, you'll be looking at 2500 grafts. It takes roughly 1500 grafts per cm of lowering but you also have temple point modifications to do as well. I would also suggest that maybe you should try this over two sessions to help reduce the chances of a negative outcome because of trying to do too much at once. When they work, high density single pass sessions are awesome. When they don't work, well, you're a repair patient.

Sounds good to me. I am willing to give this a shot. I might not need a hairline as low as the men pictured, because the rest of my face is longer and I need to balance it by proper facial thirds. I just can't have my forehead stand out from the rest of my face. Also willing to take dutasteride for the rest of my life to maintain and use any new treatments that might be discovered in following decade.

Doing it in two procedures sounds like a good idea. I could do the conservative procedure offered by the surgeon first and then after a year I could do another procedure if I feel it to be necessary to improve my facial symmetry (maybe it won't). If I go aggressive right in the start I might do too much and there is nothing preventing me from doing follow-up surgery.

You should probably just fill in the peak areas and leave the mid-frontal area alone. You should be able to do this with 1000 grafts. You might add a few hundred in the mid-frontal area without lowering it. One picture of your left temple point suggests recession. The other picture looks fine. Unless you have a great surgeon, don't invade the temple points because it will not look good.

Q for Joe and Dr Cole , so say this fellow goes through with the procedure and fills in the areas he wants done .
Not knowing his age , what happens if or when he starts losing the hair behind what he transplanted , will he not be chasing his hair loss for the rest of his life ?

I'm 30, I have maintained this hair for last 5 years with dutasteride and heavy regimen. It is unlikely i will lose hair after the transplanted hair. If I will I will just increase my dutasteride dose and reduce DHT even lower (I perform DHT blood tests to confirm it is low). I will also use any other new cutting edge treatment to prevent further hair loss or duplicate, clone hair.

I think Dr. Feriduni will guide you very well based on your own personal goal especially when you are in front of him physically so you can discuss options/numbers.
Regards
Spex

Yes, he will. All men and all women begin to thin at age 35. The average safer donor area has 15,400 follicular units in your 20s. By your 70s, this number decreases to 13,200. There is a progressive decline each decade after one's 20s. In androgenic alopecia, you will eventually have progression. In some it is much worse than in others. It's all an aging process of the hair follicles and stem cells.

Hair loss goes in plateaus. You stabilize and then you drop off the cliff typically. Then you land on another plateau, which you usually fall off of later on. DHT blockers do slow down the aging process. However, they do not work equally well in all individuals. Furthermore, DHT blockers alone are not the sole answer most likely. The hair loss process is quite complex. If DHT alone were the culprit, then all would respond with a full head of hair with dutasteride, which blocks most of the DHT. There are multiple pathways involved in the cell cycling process. Every cell has a limited number of cycles. Once a cell reaches the maximum number of cycles, stem cell populations are lost and the cell cannot replicate. In the hair follicle, there is an interaction between the secondary hair germ, which gives rise to the inner root sheath and the matrix, and the hair follicle stem cells of the bulge. BMP keeps the hair follilce in the resting, telogen phase. BMP suppression by noggin, produced by the secondary hair germ, causes the dermal papilla to turn off BMP expression and thus, upregulates Wnt/B-catenin from the bulge stem cells and induces the growing phase and gives rise to the outer root sheath. There are all kinds of BMP and WNT. Furthermore, there is Notch signaling is a downstream pathway can turn off anagen. Because cells have a limited number of cycles, the goal is to keep the hair follicle in anagen as long as possible. In androgenic alopecia, the percentage of follicles in the resting telogen phase is markedly increased. We want to keep these follicles in the active growing phase as long as possible so that they can have the longest possible life span. One does not want to start anti-aging medicine once you are old. You start when you are young. Once the stem cell niche is lost, there is no way to bring that follilce back at this time. This is why it is so important to attack hair loss from multiple pathways. DHT is only a single consideration. I have followed enough patients over 20 to 30 years to see what happens to them. They all lose hair, often to the point that hair restoration is no longer an option. In fact, it may prove to be a bad idea to begin with. For this reason, I am a very strong proponent of all newer modalities to improve the life span of the hair follicle. I am even more ardently supportive of maintaining the hair follicle as long as possible than I am of hair restoration surgery. Maintaining hair follicles is essential. Once you go beyond a NW 3V there is no hope you will ever get a full head of hair through transplantation using traditional methods alone. Thus, it is up to the individual patient to seek all potential modalities to maintain their hair as long as possible. I am hopeful that exosomes alone will be the single best option to effect this change in the life cycle alone. This is why I am offering exosome treatment in New York, among other locations at this time. I believe we will find that exosomes the key ingredient in all anti-aging modalities including PRP, CRP, amniotic membrane, and adipose stem cells (stromal vascular fraction). But time will tell. It could be that a combination of adipose stem cells and exosomes is the best treatment. What I can tell you is that amniotic membrane has a stronger influence on dermal papilla proliferation than PRP or CRP.

Don't get too comfortable with a single treatment nor that you will never lose more hair.

If I use dutasteride every day and measure my DHT to make sure it is extremely low, why would I keep losing hair?

Also, assuming within 10 years hair cloning will come true or better treatments I should be fine after 10 years or so, no? I mean, I have maintained this for good 5+ years and my hair was confirmed to gotten THICKER after dutasteride (by trichologist measurements).

Ok, but I will still have donor area left for another transplant 5, 10, 15 years down the line. 20 years down the line we should have hair cloning, no?

My main importance is to maintain a youthful, strong hairline for rest of my life. If the area after hairline recedes it is way easier to camouflage.

Every now and then, some guys do seem to maintain for a long, long time. However, usually, they don't. Plus, remember there are no long term trials on dutasteride. In the Propecia 10 year study, people gradually got worse but not as quickly as those not on medication. I hope it hangs in there for you.

As a side note, I've heard we will have hair cloning in 5 years for the past 29 years. Still waiting. It isn't as easy as it seems with two different embryological stem cell lines.

Good luck and be careful. I'll be cheering for you.

Thank you! Really appreciate your input!

Thank you for the detailed inquiry. Your native hair appears quite dense and as such would require a high-density transplant. A 1000-1500 graft estimate seems conservative in that regard. I would get a second formal analysis and opinion to compare graft estimates.

Moreover, as Joe points out, the style and flow of your native hair may not harmonize with such a drastic hairline reduction (shown in those other men’s photos). Go with what looks most natural and suitable for your face. It’s often hard to picture a new hairline when it’s just drawn on your face. Not until the transplanted hair has fully grown and matured does it display the full aesthetic impact on how you look and its relation to your bone structure.