Almost everyday I see men who come in wanting the vertex balding spot "fixed". At least half of these guys have recession of the frontal hairline, but they have seen a picture of themselves with a bald spot.

I do my own consultations, and I always listen to what the patient complains about and tell him what I would recommend, yet I let the patient make up his/her own mind; and if realistic, we proceed.

However, I try to explain to men, particularly with alot of loss in the front, that they should spend their finite resource (not money-but donor hair) in the front. Its like a car. If you have a dent in your car hood, its visible to everyone and you are likely to be pleased if its repaired. However, if you have a dented tailpipe, or your rear bumper has a dent, fixing this is probably not high on your agenda.

So spend your money and your hair where you receive the highest marginal benefit per unit cost. Its a nice pleasing change to address the front in a natural looking fashion and cover some of that extra "real estate" above the brows.

Finally, some men want to do both. Like the patient, I can't predict the future; so for a very young man with a family history of class 6 loss, I would tell him to skip the vertex, use camouflage, and return when the frontal region starts to thin. For a 45 year old with a fair frontal region and lots of donor hair who wants to do both front and vertex, I would likely say that is a reasonable plan.

The bottom line, plan for your head's future 20 years or more down the line, and have a thorough discussion with your physician.

Dr. Lindsey RESTON, VA

I agree with you Doc - Here is an article i have on my site also: (please not the articles were not written by me)

The Importance of the Hairline

The frontal hairline is singularly the most important feature of the entire head of hair. It is the aspect of our hair/skin interface that we, and others, see first. When we look in a mirror, or walk into a room, when someone sees us and makes eye contact for the first time, the hairline stands out. On a subconscious level, beyond the rational, it speaks volumes about our age, attractiveness, suitability as a mate, even about our health and vitality.

Why is the hairline of such significance? It frames the face. This simple statement belies the artistic and cosmetic impact of this all-important frontal zone. One of the reasons that many men with frontal balding instinctively go for the “comb-over” effect, is that it creates a hairline of sorts; it frames the face at the top and at the temples. The problem is that it is so patently obvious to everyone else as an attempt to disguise the balding.

Framing of the face is an artistic metaphor. Imagine a painting without a frame. It may be a pleasing image, but it is incomplete. Add a nice, tasteful frame and voila! You have a complete, aesthetically appropriate presentation. Similarly, frontal hairline balding takes away the frame; restoring the hairline restores the frame. The resulting appearance is one of youth, vigor and vitality.

Planning the Hairline

Often, hairline planning is a compromise between the patient and the surgeon. This does not imply that the patient does not know what is best for him, or that the physician is wiser. What it does imply is that people have a tendency to want the hairline too high or too low. The low, rounded adolescent hairline will look inappropriate on a 40 year-old man. In fact, it may lend a caveman or “Neanderthal” appearance to his visage. Young men in their early twenties may require repeated explanation of the reasons for not creating an adolescent hairline for them. They still remember quite vividly (unlike the middle-aged man) their own, low hairline at the age of sixteen. Often, they are rather distraught about their loss of hair, and do not identify with their future selves at thirty, forty, or fifty. This is where the ethical hair restoration surgeon must explain and counsel for the patient’s benefit, rather than playing on fears and illusions in order to make a quick profit.

Conversely, a middle-aged man seeking hair restoration surgery may fear that a hairline that is not adequately receded at the temples may seem unsuitable for his age. The fact of the matter is, that a hairline placed too high accentuates the balding, by focusing attention on the wide, high expanse of the forehead and frontal area. This concept may be easy enough to visualize if properly explained.

At any rate, if one must err slightly to the extreme, it is always better to start slightly too high, than with a hairline that is too low. One can always, in a second session, bring the hairline down by artfully adding follicular units in front of the existing border. Still, it is much more desirable to get the hairline right on the first try. After all, the primary goal of almost all first hair transplant sessions is to re-establish the hairline and frontal region, in order to frame the face. This facial framework achieves the most dramatic cosmetic and visual effect of hair restoration surgery


Info on crown also:

Crown or not..

Dr. Lindsey and Spex,

Great posts!

In my experience, I believe more patients are concerned about the hairline than the crown anyway however, clearly if we have enough donor hair, it would be nice to obtain full coverage and adequate density everywhere.

Personally, I'd rather have a bald spot than a receding hairline, but when I first started losing my hair, it was in my crown, and I was very insecure about it.

As I started to lose more hair however, everywhere, I started to feel differently wishing that I had ONLY lost hair in my crown. Now, after 3 hair transplants, I feel much better about myself, restored my hairline and a lot of hair all the way back. The crown is obviously much thinner but I'm ok with that.

Hopefully this serves as a reminder that planning for the long term is vital, especially for younger patients just starting to lose their hair and wanting it to appear that they have experienced no hair loss.

Falc

I think its a very important post made by the Doc

I agree Spex,
I think most want to restore full coverage and make the decision to get a transplant, and then we have that consult that lets us know what can be done!

Good post and reality check.

This topic seems to be addressing people with nw4 upwards on the hairloss scale where if i were that level i would want my face framing before anything else.

But there are lots of hairloss patterns and like mine which is a thinning crown and a normal receeded hairline with a few small gaps i want to get that damm crown filled in.I will sddress the hairline as and when it is needed as the meds hopefully will stop the need for that.

Chucky,

You certainly bring up some good points.

It is true that not everyone will end up a NW4+, and those are the blessed ones who will most likely be able to restore a lot more than an illusion of hair density.

The problem is however, determining who is "done" (if there is such a thing) balding and who will continue to progress.

For example, I ended up a norwood 6 however, when I was only 24 years old, I had only a balding crown with unnoticable loss in the front. If I had gotten a hair transplant then for my crown, dense packing it, I would have been left with the "halo" effect.

So certainly there are many factors that must be considered when determing which areas to target with hair transplantation.

Thanks for bringing this up!

Falc

Is there an average age when a guy is "done"? I turned 42 in February and I'd like to think I'm close to done.

Anyone know any history about guys continuing the thinning after 40? My dad was slick bald in the picture of him holding me as a baby when he was 30, fwiw.

quote:

Originally posted by Dewayne:
Is there an average age when a guy is "done"? I turned 42 in February and I'd like to think I'm close to done.

Anyone know any history about guys continuing the thinning after 40? My dad was slick bald in the picture of him holding me as a baby when he was 30, fwiw.

I turned 46 in January and looking at my dad who is now 69 and pics of my maternal gradfather it appears I was almost done.
My dad's hasn't changed much since his 40's but from pictures of them from their 40's it looks like I was due to drop a bit more on the top and last year I had the major loss in the crown area which is consistent with both of them. The crown came on sudden like, wham! Did dad warn me about this? Noooo...

As a very general guideline, many texts and papers suggest that significant hairloss affects about 10% of men per decade of age. So roughly 40% of men in there 40's will have significant hair loss and 60% of men in their 60's will have hair loss.

That is a very general rule and certainly genes, stress, and luck play a role too.

Also, just like with aging and wrinkles, sometimes people can really "go down hill" appearance-wise in a very brief period of time. This is almost certainly largely genetic when pertaining to facial aging and I suspect with hairloss too.

Lastly, what is significant hairloss??? I have seen people with full heads of hair paralyzed with the thought of the normal 200 hair shedding that they see in the shower daily, and I have seen Class 3V's who thought they have plenty of hair; and came to the office for something completely different bothering them.

So Dewayne, its hard to tell if you are done. Just like with everything in life, particularly taxes, when considering hair options, plan for the worst and hope for the best. (Don't spend your donor region when you are 20 on your frontal hairline, if all of your relatives are class 6 by age 35).

Dr. Lindsey RESTON VA

quote:

Originally posted by dr. lindsey:
As a very general guideline, many texts and papers suggest that significant hairloss affects about 10% of men per decade of age. So roughly 40% of men in there 40's will have significant hair loss and 60% of men in their 60's will have hair loss.

That is a very general rule and certainly genes, stress, and luck play a role too.

Also, just like with aging and wrinkles, sometimes people can really "go down hill" appearance-wise in a very brief period of time. This is almost certainly largely genetic when pertaining to facial aging and I suspect with hairloss too.

Lastly, what is significant hairloss??? I have seen people with full heads of hair paralyzed with the thought of the normal 200 hair shedding that they see in the shower daily, and I have seen Class 3V's who thought they have plenty of hair; and came to the office for something completely different bothering them.

So Dewayne, its hard to tell if you are done. Just like with everything in life, particularly taxes, when considering hair options, plan for the worst and hope for the best. (Don't spend your donor region when you are 20 on your frontal hairline, if all of your relatives are class 6 by age 35).

Dr. Lindsey RESTON VA

Thanks for the comments, and your general contributions to this forum. I'll be adding about 5000 hairs in about 18 hours so I'll be hoping I'm done.

I feel pretty good b/c my dad was at least a NW7 by the time he had me at 30; and now I'm 42. I'm going to get me some Propecia and Rogaine as well, to go along with all the other meds my 42 yr. old body requires nowadays.....