I got my email consutation back from H&W today, but Im confused. They say Im a NW5a "diffused".
1. what is "diffused"?
I thougth that was when your hair was thinning EVERYWHERE (including the sides and back) and as such your not a ht candidate. But they said I could get a ht.

2. How could I be a NW5a if I still have hair on top? Is this their prediction of my final pattern?

IF ANYBODY HAS AN IDEA ABOUT THIS LET ME KNOW..
Im waiting to hear back from them directly as well.

Well, having never seen your head it is hard to say, but maybe they are seeing miniturized hair on top that likely are going to fall out anyway - leaving you a NW5a. Have you posted pics on the forum? NW5s are certainly candidates if they have stabilized.

thanks nobuzz,

no I havent posted pics and yes the hair on top is thinning, but theres still quite a bit there. I just got a short hair cut, today for example and if there is no product in my dry hair you cant really see any scalp.

WOW! I just got Jotronics response, that was quick. He said that diffuse simply means that I have a very discernible outline of having a NW5a pattern, given the hair on top that I do have is thinner than the rest.
thanks for the quick response Joe. great guy.

ntg2gb

Since you are diffusing on top...ask them if having a procedure will speed up the hairloss.....

From what you are saying I really would not have a procedure , or be very very conservative now, otherwise you'll chase hair loss and use you donor up and then have an empty midscalp....

good point by want hairs,

Are you using fin and minox? That may prolong or save some of that diffuse hair. I think shockloss is hard to predict, I do not recall ever having any but my procedures were smaller.

...just got off the phone with Jotronic. I was excited, but now after hearing your comments. Im a little concerned...SHIT!

wanthairs,
hey buddy!..thats my biggest concern.I dont want to go through with a procdure and end up looking the same with the exception of a lower hairline. But, I think as long as I adress the entirity of me head (i.e. not just the front) then I should be ok as far as not using up my donors goes, right?

Joe said that the hairs on my head are terminal and arent at risk for permanent shockloss. I hope hes right.

Nobuzz,

did you transplant into native hairs?


So, what do you guys think?

notgoing2gobald,

Diffuse thinners can be excellent hair transplant candidates but there is definitely a risk of shock loss. Finasteride and/or minoxodil 6 months to a year before your hair transplant can help strengthen any miniaturized hairs which will help minimize the risk.

The use of "ultra refined" blades to make recipient incisions in ultra refined follicular unit grafting also minimized the risk of shock loss since there is less trauma to the scalp.

Distributing and spacing apart the follicular unit grafts rather than extreme dense packing around native hairs can also minimize this risk.

Keep in mind however, that any hair that is "permanently" shocked would have fallen out anyway though hair transplantation may expedite this process for miniaturized hairs. "Temporary" shocked hairs, though unpleasant, will grow back between 3-8 months.

Make sure you discuss this concern about the risks with the your clinic as well and that you discuss your LONG TERM hair restoration goals. If you have a diffuse NW5A pattern - most likely you will lose the rest of that native hair anyway though medication can slow it down or stop it for some time. I'd suggest that you will eventually (in time) need a second hair transplant to add density if/when you lose more natural hair. Keep that in mind before you proceed.

Best wishes,

Falc

...fuck!...Im confused. Should I go ahead, when at the least I can lower my hairline, and know that the hair that is transplanted within existing natives will last a long, long time...and by the way, I was told that the native hairs will not be permanently lossed from shockloss as they are terminal. But it seems that many of you lack confidence in this claim (i.e. that permanent shockloss cannot be guarenteed with any certainty?) So, what does a diffuse thinner do? Only adress the hairline?....Sigh....then I have to go back in later to adress the rest of the top of my head. So I wait until Im totally bald?...not a reasonable counter position to take as well....I know Nervous Nelly and B-spot, you guys are conservative with respect to native hair, but whats the alternative if your a diffuse thinner on top?.....

natives always scalp foreigners....everyone knows this...

I am also a diffuse thinner yeah I know it sucks I have a surgery with SMG in Jan. I am nervous about losing native hair even though ive been on proscar a year by the time my surgery happens I will only be on rogaine the foam for 5 mos. I dont know if that is long enough time. Shaving your head for surgery will minmize shock loss, but for diffuse thinners that is not that easy to do. When your bald or have a lot of recession there is usually a bald scalp and shock loss isnt that much of a concern, but I guess you have to take some chances in life, for me Im just trying to stabilize my hair loss with the proscar and rogaine, and I am 36 years old so I believe I have age on my side. Good luck with your choice but keep in mind there are alot of diffuse thinners out there that had to have HT by reputable docs. Try to find surgeons web sights that show pic, thats what I have been doing. SMG has a few pics of diffuse thinners that turned out great according to the pics. Goodluck Jeff

NG2GB,

Check out my photos http://hair-restoration-info.com/eve/forums/a/tpc/f/2566060861/m/4171011482

It was estimated that I had 20-30 FU/cm2 of native hair in the frontal area and ofcourse I was concerned about permanent shockloss but at the same time I sought out a skilled physician and took appropriate steps to minimize risk.

I also wanted to keep some of the native hair so that I could go back to work in 10 days. It is about finding balance and trying to find out what works for you. In my particular case I elected to shave a portion of the native hair that would have the most grafts and also where some of the native hair was most fragile.

Yes, you are correct that in many cases it is more challenging for those of us with some existing thin hair. It is like an artist. They likely prefer a blank canvas to one that is already showing some work.

I personally believe that the native hair should never be ignored and attempts to keep should be made, but educated options explored.

Good luck.

NN

thanks guys.
NN,
I had never seen your pictures before. do you have any more recent? That is interesting that they measured your hair density per cm2 prior to the transplant. I wondered if they do this. Should this be expected from a top doc? People are always throwing out figures regarding their transplant (i.e. 45 hairs per cm2...) if I knew my current density rate then this would give me some frame of reference as to what can be expected from a transplant and would be a huge plus before going through with it.

So, did you experience any permanent shockloss from your ht? How does one really know anyway; can you tell the difference in the hair texture from native to transplanted?

regarding minoxidil: I was told to stop at least two months prior to a ht. it thins the blood out on the scalp and as a result the grafts keep popping out of the head during surgery, which is only a concern because it makes the surgery 50% longer to perform.

Hasson and Wong believe that permanent shockloss would not be an issue for me as my hair is still terminal and they would be shaving it for the transplant to minimize transection; but still, if your a diffuse thinner the idea of ANY chance of losing your native hair is concerning to say the least.

Im going to have to post pictures soon to get better feed back from you guys and hear your opinions.

thanks

NG2GB,

quote:

So, did you experience any permanent shockloss from your ht? How does one really know anyway; can you tell the difference in the hair texture from native to transplanted?

I did.

A lot of my natural hair was already pretty miniaturized and I wasn't on Propecia until a week after my first hair transplant. Would Propecia have helped? Maybe...but I can't guarantee it.

If the majority of your natural hairs are terminal, I agree that permanent shock loss should not be an issue for you.

Falc

NG2GB,

I'm not going to discuss your case specifically on this thread because that is between you, me and the docs...however, you stated something very important about this issue.

"That is interesting that they measured your hair density per cm2 prior to the transplant. I wondered if they do this. Should this be expected from a top doc?"

Unfortunately, the numbers that are thrown about as you stated are far too often of absolutely no relevance to the job at hand (job being the transplant). I know some clinics will perform densometer readings to measure your density by waving a wand over your head and allowing you to view the magnified areas of your scalp but this is, in my opinion, an attempt to "wow" you into thinking that this kind of information will benefit you and make the procedure more of a sure thing. Densometers are cool and fun to play with but I feel they are down right useless.

Why? Because when we shave the recipient scalp we simply don the loupes and find the gaps in between the native hairs. We fill the spaces on patients that already have a good amount of hair but not nearly as much as they used to. Shaving reveals all the details of the native hair the allow the doctor making the incisions to avoid transection. The precise angle and direction will be plain as day and the incisional instrument is used to simply match up with this angle and direction. Permanent shockloss of stronger hairs is caused by transection and shaving allows the doc to avoid it, period.

The reason why so many people are warning you about permanent shock loss is because they are not accustomed to the shaving requirement. There are a few naysayers on the boards that have no idea what they are talking either because they have not thought through the logic or they are simply repeating what they have been told. Several years ago there was only one clinic that required shaving of the recipient area. That was H&W. Since then, as the results have rolled out, more clinics have picked up on the idea and are now requiring shaving in at least certain cases. I noticed Dr. Shapiro has some patients on the boards that have stated they are going to be required to do the same thing. A few other clinics have also joined the club. The naysayers can say what they want but the truth is slowly but surely working it's way to other clinics because they are coming to realize the long term benefits of shaving.

NG2GB,

I was curious why it appeared like it was considered a negative that I was told what they believed my native hair density was--I asked them--they told me. If they were unable or didn't choose to give me a reasonable estimate I would have questioned that. I wanted to know because it gave me a realistic expectation of what I might look like with the new grafts should I retain my native hair or if it would leave me. I personally disagree with Joe and believe that it is an essential component of the planning process.

I am only at 9 weeks so very little transplanted hair as of yet, but I did retain some. I would have to say that I DID NOT experience any permanent shock loss. We chose to shave part of the recipient area where most grafts would be placed and my hair quality was the weakest.

Joe is right that Shapiro seems to be leaning more towards shaving recipient area as well so likely he has seen the benefits.

NN

Hi

I was a N5 diffuse thinner and now my hair looks great. didnt shave the area either. I think permenant shockloss is exaggerated because people think in extremes. Yes, you may lose a couple here or there ( which is why you should be taking propecia to help) but this doesnt mean you will lose all native hair.

NG2GB,

Have you had an in person consult with Hasson and Wong or a virtual consultation?

Joe,

Obviously the above answer will dicate the need for this question, but assuming he only had a virtual consultation, how sure can anyone be that all of the hairs left in the "diffuse" area are terminal and not miniaturized? As you are aware, miniaturized hairs are susceptible to permanent shock loss and is a legitimate concern.

I am skeptical to think that pictures can possibly reveal this information with 100% accuracy - though I don't doubt that some level of accuracy applies.

I'd like to know your thoughts on this.

Falc

Falc,
I had a virtual consultation.

What exactly is a "terminal" hair? Based off of your input it sounds as if it is a hair that has not been miniturized at all, but then that doesnt make sense because my hair on top is thinning hence the " DIFFUSED NW5a" categorization...

So? whats the deal?

Can you define the terms 'terminal' and 'vellous' for me and given the context of their reference to my thinning head how this plays out for concerns of permanent shockloss.

I dont want to beat a dead horse here, but this is my biggest concern (as it probably is for all diffuse thinners concidering a ht) and would like to know as much about this as possible.

anyone?

Native or terminal hair is the hair existing on your head.Vellous hair are the small fine ones.

The bottom line is nobody can tell you the degree of shockloss you will experience. You can take precauions though such as

1 -Take propecia prior to surgery
2 - Don't have a mega-session which provides less trauma

This is my view on it but others may have other input