I recently posted a topic regarding the safe zone not being safe. I got one reply in which someone said that after their ht they lost more donor hair all the way past the scar in the back and down to the scar on the sides.

This has ALWAYS been my biggest worry regarding ht. Why doesn't anyone discuss this risk? Everyone discusses their concern regarding scarring, but to me this is BY FAR the worst case scenario. One could end up with a moat of skin wrapping around their head with some transplanted hair remaining on top and some hair on the sides and back. Not a natural result to say the least.
I have two basic questions:
(i) does anyone know what NW level one would have to ultimately become to lose the hair most doctors consider the safe zone?
(ii) does ANYONE have anymore information regarding this topic?

*Im very suprised to not hear anyone else (that I have read) discussing this topic. this is by far the worst case scenario regarding ht's and in addition, I dont see how any doctor can be certain that any of their patients will not end up in this scenario in the future as hairloss is unpredictible...Any thoughts?

Hey dude....

You are right, this does worry the heck out of me. I was told that transplanted hair lasts forever and its only after examining this site for months and months every day that i have begun to believe that it is not true at all. We've seen how old mens "safe zone" thins out considerably. Ive actually started paying attention and noticed this phenomena on men in their 40's too. Its too late now for me, I just have to go along with it now.......

Perhaps a Dr. can chime in here.....Dr. Feller? Dr. Epstein, Beehner? etc etc.....any opinions?

wanthairs: yeah, I know. this has always been my biggest concern. donor scar? big fucking deal. but, if Im left with some hair on top and a moat of skin around it, yeah that worries me. Why doesn't anyone talk about this more? Im not saying everyone will face this scenario, but how do we know who will?....

Yes - this is a concern. This is why HT is not for everyone. I am scared shitless of going further than NW6. I am 48 and loss has slowed down but who knows?

The lucky thing for me is that I seem not to have ever experienced shockloss during any of my procedures.

Permanent shockloss is scary as is the donor zone thinning over time. I probably wont give a crap at 80 years of age but do not want to look freakish either. Hell, just hope I live that long

Good topic.

I REALLY HOPE ALOT OF PEOPLE GET IN ON THIS THREAD, as Im curious to hear some answers.

Nobuzz: yeah if I could look good or descent until 55 or so it would be worth looking like a circus act at 80. What I dont get is how do we know when the balding has reached its full maturity? Take Jotronic for example, I think he had his procedure with H&W at around 33 or so? He was all skin on top and had a pretty good size crown. How do docs know if his balding is going to continue progressing? If it does or did much further than he would be beyond the safe zone. So is this all about recognizing the risk and then taking it if your willing? Because that is not how this is adressed and advertised by ANY clinics...

This is an interesting topic though I think it could be being blown out of proportion a bit.

There is a risk of donor thinning over time, but it's not the same as donor balding. As the donor thins, some of the transplanted hair may thin out too but most likely as you are well advanced in years.

Quality doctors are VERY careful where they take donor grafts from. The "safe" zone for the most part really is pretty safe or shall I at least say much safer.

Some doctors have been more risky in their extraction of donor grafts based on patient need and "prediction" of the future of hair loss based on family history of hair loss and in person evaluation of current native hair.

I know I have a "riskier" scar now as it goes well beyond my ears almost into my temples. This decision was made with my permission and based on Dr. Hasson's professional opinion as to where my hair loss is headed. Is it a risk? Yes!

Discussing the risks here as we are is important and clearly education will help patients make the right decision when it comes down to potentially taking greater risks.

Best wishes,

Falc

Falc: thanks for chiming in. So how do docs know if the patients balding pattern has reached full maturity or if one day they will progress to become (a NW7) or someone who is not a candidate for a ht? This is of special importance for people who are relatively young, such as myself (28) and Im sure this concerned you as if I recall correctly you were around 29 or 30 (?) for your first procedure.

Gentleman,

It is very likely that as we age a certain percentage of us are going to thin in the donor area. This is a fact. Look around at many men over the age of 60. Hopefully we don't thin so much that the scar becomes obviously visible, but for some it will happen. This is realistic.

Yes some of the recipient hair will also likely thin and fall out as not all hair in the donor area lasts forever. That is a stretch used in the marketing of HT's. But not all is something to panic about. As the hair thins on top it will thin at a natural rate as the donor area thins and will all be a natural look. It would likely look strange if the donor area thinned and the recipient didn't.

Just thought I would chime in and shed some light of reality on the topic. Ofcourse there will be a lucky few that never have any thinning of donor or recipient. Just hope that you are one of them. Again this all is reason why waiting as long as possible before getting a HT is a good idea and not jumping into things at 21.

NN

NN: thanks for chiming in.
I think people are misunderstanding my concern though. Im not talking about thinning in the donor area. Im talking about flat out BALDING.

Let me start in reverse: say a 58 year old man wants a transplant, but the doc refuses as he is one of those unlucky men who do not have sufficient donor hair. He only has a very thin area on his sides and back of his head.

If a doc performs on me at 28 becauee I have great donor hair now, how does he not know I will progress to become like the man in my story in 30 years? Im not worried about merely thinning in the safe zone, but the balding progressing to the point of one of those men who CANNOT have a transplant.

I got one reply from my safezone post from a guy who said he has balded in the back all the way BELOW his scar! that worries me. are these just extremely rare cases?

notgoing2gobald,

I was actually 27 when I went in for my first procedure.

Your concerns are valid which is why starting conservatively and keeping donor in reserve for future hair restoration is always advisable.

I posted this privately to you, but since it's valid for discussion, I'll post the majority of it here.

------

I can certainly appreciate your concerns and viewpoint. You do indeed bring up a valid concern and it's not to be taken lightly. So if my post came across as a dismissal, I apologize.

That being said...

This is generally why I believe a conservative approach for younger men is typically more appropriate or as long as some donor hair is kept in reserve.

Keep in mind also that the 58 year old NW 7 in your example may still be able to receive a decent hair transplant if his expectations are reasonable. Neither full coverage or great density can be achieved, but many NW 7s can achieve a cosmetically pleasing result with hair transplantation.

BUT...

As long as hair is taken from an appropriate "safe zone", even if baldness progresses as badly as a NW7, the transplanted hair would remain safe. In theory, hair should only be taken from areas that wouldn't go bald even in the worst cases.

As I said however, some doctors have been more "risky" with patient permission to take hair from areas that may not be "safe" in all patients. Doctors can not know with 100% certainty that these riskier areas won't go bald eventually but they can make a "prediction" based on family history of hair loss and hair characteristics.

For example:

Personally speaking, when Dr. Hasson evaluated me right before my third hair transplant, he told me that he'd like to take hair from the area past my ears almost but not quite up to my temples (see pictures below for my third HT). He also said that some people will be alarmed about the scar - because it's not typical and can't be done with all hair transplant patients.

He first asked about my family history of hair loss. As it turns out, my dad, uncle, and most men who have lost hair on top of their head had "high sides" like I do. When he examined the hair on my sides, there was no evidence of miniaturization. In his professional opinion, he did not believe I will ever lose hair there. But there is a risk factor there even if it's minimal. It's possible that I MIGHT lose hair in that area. So if I do, I could lose a few hundred transplanted hairs. The bottom line is, I trust his judgement, it makes logical sense, I was made aware of the risks and I was willing to take the risk.

I don't want to dismiss your concerns because they are valid and need to be considered before going into surgery. Starting conservatively may be the best approach for you.

Best wishes,

Falc

quote:

I got one reply from my safezone post from a guy who said he has balded in the back all the way BELOW his scar! that worries me. are these just extremely rare cases?

This is a scary thing. I don't know the details of this case, but it is true that some doctors have taken hair way too high that is completely out of the normal safe zone. So unlike in my case, there may be a danger that the entire transplant is in jeapordy. This is why physician selection is vital in ensuring a successful transplant.

Falc

i think that is an extreme case.....I wonder who his DR. was.....Im a NWD 6 at 35 years old, hoping to have full coverage with the 8000 grafts I apparently have available over 3 sessions.......I am hoping that in 20 years there will be far better meds out there to preserve what we have....

Falc,

thanks. I in no way thought you were dismissing my concerns. I just wanted to make sure you were understanding my concern. I guess I will have a better chance to understand this when I go in for a consultation (eventually).

I hope that is an extreme case...If I could have great results (or even an improvement of my current situation) until Im at least in my mid to late fifties, then I wouldn't be so concerned. I guess my main concern is looking like a freak show earlier on than this...

I am concerned about this too.
But I am also hopeful that:

a) with the meds I am currently taking I will hopefully not bald to that degree

b) that 15-20 years down the line there will be better meds, technology etc.

Notgoing, I believe what you are referring to is called separation, which results in an "island" effect on top of the head.

mm, Ive never heard of this term before. What specifically is it?

For what it is worth my Dad had hair plugs over 30 years ago and they still look like they did when he first got them - hope this helps. In other words the recipient area has remained intact.

quote:

Originally posted by mm:
Notgoing, I believe what you are referring to is called separation, which results in an "island" effect on top of the head.

right. What happens more often than losing hair past the donor scar is that a patient's hair loss pattern will lengthen and widen. You may think you are leaving a lot of donor in reserve, but if you lose more hair down the back of your head, not only do you need to fill in that area, you also have lost the area where you thought you had more donor area left.

I put together a picture to demonstrate.




If you get to #4, then you're in a position where you have to decide to either:

1. Try to get at least enough grafts to cover the sides and leave the balding back/crown area alone giving you an irregular look because the bald circle is not on top where a normal bald persons would be, but rather it is towards the back.

2. Try to get enough grafts to thinly cover the entire area with higher probability of leaving the scar visible because you won't have any remaining hair to cover it.

Sometimes patients go through several sessions over the years to cover the areas as they continue to lose hair. This results in eventually the hair loss running into or past the scar as the patient kept taking more donor hair away to cover the thinning areas.

BeHappy,

Pretty cool diagram!

Your post and diagram is a perfect example of why young patients with minimal loss should not be considering agressive hair restoration surgery. The conservative approach (which most likely includes WAITING to have surgery) is most appropriate for these cases.

Of course, this doesn't mean that one will be able to achieve perfect density and full coverage if one is going to end up a full NW7. But keeping a good bit of donor in reserve is important to plan for future loss.

I believe it is extremely important to plan for the long term so this type of situation can be avoided.

If you don't mind, I'd like to use your diagram and some information on your post on our Hair Loss Q&A Blog as an example of why planning for the long term is extremely important!

Best wishes,

Falc