Well this album contains a few pics of me.
You can notice that the one called what_s_the_trick.jpg, has been shot same day without any trick, no topic no nothing...just diffe rent light conditions...that s what make me feel a bit worry about picture we see on the net...
The album contains other pictures that really reveals the HT in contrast with the shading of natural hair...And Here i need your advices..
you can notice in explanation_of_previous_ht.jpg that zone 1 and 2 and 3 have been HT 6-7 years ago when at that time full of hear..The problem is that there are beeing revealed by the shading..
So first how many grafts do you think i will need in those zones.taking into account all the other pictures ?
Besides, if i want it to be a last HT, what should be the approach of the HT taking into concern that Zone 4 and Zone 5 have never been HT; and i wouldnt like to repeat this if those zone were to shade too...? In other words can we do at that stage HT in between the hair in Zone 4 so that to have a good amount of HairTransplanted in case the natural hair will shade...?
Is that a risk to loose those hair because of shockloss that might never gone if didnt bother them ?
In other words...please provide me advices...
Thanks so much for getting interested in my case...

Hi Mike2007,

Thanks for providing such a detailed accounting of your situation......makes it that much easier to assess your situation.

To better understand your situation, what is your age and are you currently using Finasteride or Minoxidil for loss prevention? I'll give you my ideas but, in your case, I'd strongly suggest you consult with a few of the coalition surgeons recommended on this site for an expert opinion. To me, it's a little more difficult since you have HT hair mixed with native hair.

In your situation, there's no real way to tell whether or not this can be a final HT for you. Your crown is "okay" but obviously thinning.............if you try to pack it full now you may lose many of the native hairs that are providing decent coverage for you at this time. You can always try to fill it in I suppose.

As for graft count.............again, tough to determine as I can't really tell from the zones you list what is HT hair and what is native? Assuming what I'm seeing in labeled zones 1-3 is mostly HT hair, I'd recommend between 2500-3000 grafts for the frontal 1/3.

Moving to the midscalp and crown, again, you still seem to be getting a good bit of value from your native hair located there. I would not want to risk permanent shock loss and try to pack it full at this time, but would rather opt to fill in with say 1500-2000 grafts. This should provide you with good density overall, with the possibility that you may need more work 5-10 years down the road if it continues to thin. Not knowing whether or not your using anything for loss prevention, I'd recommend you start as it will help you mostly in the crown anyway and you could be a good responder.

So, I'd recommend maximum grafts for you of 5000 at this point, minimum 4000, distributed between frontal 1/3 then going back to midscalp/crown. My opinion assumes you are old enough to have established a pattern of loss so as not to jepardize wasting grafts that you may need as you age. I'm sure some will disagree with me here, but, to take the approach I'm recommending, I believe you should be close to or over 30 years of age.

Hope this helps you!

Thanks for your advices...
However what is diffrenece between try to pack and fill in ? i don't understand the concept...in both ways you are having HT ?
Besides that...it is always said that after HT , natural hair are to fall, but then regrow..so why are you saying that it could lead to definite loss ?
Thanks in advance.

IMO..........dense "packing" of more than 40 grafts per sq cm could lead to permanent shock loss of native hair if the native hair follicles are on their way out due to MPB anyway. Plus, the closer together you dense pack, the more chance of follicle transsection of any native hair. This is why I would try and "fill in" toward the midscalp and crown area where you seem to still have a fair amount of native hair remaining.

Are you taking/using anything for further hair loss prevention? How old are you?

Actually i used to take at the time of HT minox, it was 6 years ago...but it didn t seem to give any good effect...or maybe.... worse when i ve decided to stop
I m in my thirties now and not taking any medicamentations...
I m really doubting...and don t know what to decide...indeed, diving into HT, is not only a matter of expensive cost, but also some spiral you dont want to get into.
Personnaly when 6 years ago i achieved my ht, i thought it would one for all i just didn t want to realise that it was just some kind of "never ending story"... except for Type Norwood 4 or more...since they can onlt add..
But for Norwood Type less than 4 it seems that it is a never ending story .
What do you say.
One last thing, when you compare picture : what s the trick and picture Closeup Outdoor, can u really think it s the same person !!? hard to believe...My concern is ... are the picture we see on all the sites reflect the REAL reality... i mean are they reflecting the whats_the_trick part of the reality or are they reflecting the CloseupOutdoor Reality...???

Mike,

Welcome to my world. I went through the same issues that you are now facing however my loss was a bit more progressed. To answer your question about the lighting issue you can read up more in a thread I started a while ago. Revealing the tricks of the trade so to speak with photos is something that I value highly.

Click here to read about it. There are some things that are not covered but I can only type so much.

http://hair-restoration-info.com/eve/forums/a/tpc/f/346...141012852#5141012852

Hi Joe...
Waow Great article you put there...
Are the picture on Hasson/Wong respect the comments in this article...?
Do you have an album with your before/After respecting those criteria ?
Since you re working in a clinic... How could you help me by advising me best ... taking into accound my very situation...?
Thanks a lot...

If I understand your question you are concerned that you might have to keep getting more and more HT to reach your goals?

Firstly, you should probably get yourself on a good haircare regimine to keep your hair healthy and hopefully slow down the hair loss problem.

Second, whether you have to have several future HT is really up to you. It depends on your wants. If you look at some of the photos of guys that had 2+ HT many of them would look good with just the 2 but are looking for complete coverage or get "hair greed."

Many guys are just happy with having the hairline and frontal area restored. For this you typically need approx. 3000+ Fu transplanted to get a decent look and coverage. (ofcourse depends on individual)

There are some docs now capable of "mega sessions" where they can transplant 4000+ Fu at one time and you might just need one surgery to be satisfied.

I personally have always said that I would be happy with just the frontal area to be pefected and relatively dense, but my wife figures I should just go for it. It is really a personal thing and not always necessary to have multiple surgeries if you find the right surgeon capable of a decent size session.

Thanks NervousNelly for provding your advice...
In fact... in the frontal area (if you see the picture with the drawings)...you can see that just the very middle (zone 4) has not been HT. but zone 1 2 and 3 yes...
According to my thoughts, on these zones 1, 2 and 3 what remains is just HT...Now my concern is if i d go through a new HT to cover in density zone 1 2 and 3 ... knowing that i could nt cover that much zone 4 ... because there are currently natural non transplanted hair in this zone... what can i expect in the future ? if zone 4 is falling a bit '(hv('...then i d have Zone 1, 2 and 3 quite dense and zone 4 lighter... would it look natural..?
When people go through one pass of 4000 to 5000 grafts .. they generally start from B spot... so they now that they can HT wherever they want...
But other that don t have B spot,can not, since they still have hair in some area.
Thanks for sharing your views with me... It kinda help.

I think that you might be confused. With todays technology the surgeon can indeed transplant hair into areas where there is native hair with only slight fear of transection if density is not too high. For some reason many choose not to do so and it brings up your concern regarding it looking strange if native hair falls out and you don't undergo another surgery.

I recently sent Falcero a PM regarding that topic because it is my belief that more surgeons should be focusing on stand alone HT's, meaning that things won't look strange if native hair falls out and the individual does not get another surgery. I think this is what you are referring to partly?

Yes, the stand-alone hair transplant is something that is very rarely discussed these days.

Obviously, with large graft sessions, this is not a very common topic, but for diffuse thinners and those progressively balding, (like mike2007) deciding how to attack balding areas with respect to native hair can be a very difficult issue.

In this particular case, I honestly doubt any HT doc could guarantee a "stand-alone" HT, given the pattern of baldness and the degree of baldness.

So--- two ways to attack this

1. Shave down and allow a Doc to transplant your frontal half with about 3500-4000 grafts and plan on having the native hair "shocked out"
Go for a 2nd HT and attack the midscalp region and the crown with about 2500-3000 grafts (hopefully you have been taking Propecia and it strengthens the hair in the region)

This would be an aggressive approach, but would treat you like a NW 5-6 and any native hair that you held on to would add to your look.

2. Go to a Dr. who minimizes scalp trauma and controls blood loss, who can transplant 1800-2000 in your zones 1,2,4 and 800-1000 in your crown. This will not make you "thick" per se, but it will cover your scalp and allow you to possibly keep most of your existing scalp hair.

In addition, using 2600-3000 grafts will certainly allow you to transplant additional grafts in the future. I would count on having 7000 grafts and approaching your hairloss in this manner. If you end up having more, great.

I would recommend option #2. The graft numbers I estimate will most certainly bolster your overall look and give a good indication of the type of coverage your donor will give you.

I would not allow any transplantation into the front forelock.
Go around it on the side with fine 1 hair grafts and build behind it only.

I hope this helps and please keep us updated with your progress.

Nervous,

I did get your PM...sorry I haven't had much time to respond. I plan on doing it shortly. However, it does appear that many good responses have been posted on this thread already .

Falc

Thanks GSpot
NervousNelly was right, i was talking about Standalone HT, just didn t know how to express it :-)
Those are really good remarks...
And as you said, i think option 2 is best...
I guess we should try here to "advertise" on people progressively balding...that if they start surgery they will enter in an infinite loop...rather they should go on medication and wait and see...
Nevertheless, your advice sounds good to me...One thing remains though, i m living very far from Dc Shapiro, and having to manage trip+cost etc... twice is for the moment not doable.
But as NervousNelly said, you get for what you pay; so i might start saving...maybe HT price will go down in the forecoming month :-)
Thanks

GSpot???

Hey B, I guess recently I have deiked you a couple times here and there on different threads (all in jest ofcourse LOL) but this isn't my doing.

Are you known on other forums unrelated to hairloss?

Damn, I can never live down my reputation can I?

It follows me wherever I go.

What can I say, I'm a giver.................. LOL!!!!!!!

Sorry guys
of course i meant B spot :-)
Thanks for everything...
I ll try to update you on what will be going on

GSpot....Hahahaha! Hey B...I think you should change your name bro. ROTFL.

Falc

Mike2007,

Sorry so long to respond. This thread was a bit buried

With regards to your case, it is somewhat difficult to see all the details but from what I can see some of the work you've had in your hairline is too low on the sides (in front of what you labled zone 1 and zone 2). You may need to have some of this hair removed via electrolysis or laser. Then you will need roughly 3500 grafts (maybe more maybe less) to soften your hairline then fill in the areas of the front 1/2 of your scalp where it is obviously very thing. As far as your crown goes, it is doubtful that this would be addressed in the same session but if it were the graft count would be on the low end, maybe several hundred grafts just to help break up the bald spot(s). You may need to leave the crown alone for now if not enough grafts can be taken.

No doubt that you need to seriously consider starting Proscar or Propecia right now so that your loss does not worsen. You may have some regrowth but stopping your existing loss is a paramount concern.

As far as the photos on the H&W site go, yes, they follow as closely as possible the guidelines that my article mentions. While they are not perfect I believe them to be as close as can be to perfect. In fact, people that meet our patients in person that are in our gallery say they actually look better in person which is a good thing of course.

My photos on my personal website are taken under every condition you can think of; with flash, without flash, bathroom lighting, outdoors, etc. You can see them at www.hairtransplantmentor.com if you haven't already.

Good luck with your continued research. If you have more questions let me know.

Thanks JoeTronic;
Yes i ve already seen your detailed sites... Congrats it s well documented...
You scared me a bit by telling 3500...i thought 1500-2000 mx...
I m a bit anxious for both reason : i ve never had more than 300-400 hundred graft HT (i know it s a really small amount but at the time i did it 9 years ago that was not a small session..I have to admit , that i couldn t have a bigger HT either as i ve had plenty of hair... and i regret having done that at that time :-(
However past is behind...
If we take into consideration that zone 1 and 2 are HT, but the front Z3 is not, is there a risk by filling in density in Z1 and Z2 that it might trouble the Z3 ?
What is the rule (if there is any) according to shock loss in accordance to a zone Non transplanted , and according to HT zone ?
Thanks a lot all of you.

mike2007-

Shock loss varies from one individual to the next. In reality, as long as you go to a quality surgeon shock loss shouldn't be a concern because even if the hairs are shocked out, the will come back. The only way they won't come back would be in some cases where native, MPB susceptible hair that is on it's way out (and almost already gone) is shocked and doesn't return, or if follicles are transsected during surgery. With quality work, I wouldn't expect to lose any (or many) due to follicle transsection.

If you're transplanting around HT hair, the only risk of permanent loss would be due to follicle transsection.

Hope this helps.