Below are links to photos of my hairloss situation. I sent these pics to H&W for a virtual consultation to get an idea. I'm in California so wanted to get a rough idea before I actually fly to Vancouver to speak to the doc.

My goal is to do a repair of a shabby hairline ( rough and also pitted from previous hairline HT of 900 grafts ) and fill in the surrounding thinning areas behind as you can see in the photos.

The reply I got was that it was suggested I will need 3500 grafts. $5 first 2000, 4 for the remaining. That's $16,000. I know price should not be factored in necessarily, but damn! For my fairly light hairloss? It looks like I am thinning a bit in the crown on the side pics but I'm really not and do not want any grafts there. The top pic shows the crown area as it really is.

If you look at fallenstars recent procedure which was ( and warrants ) 3500, he is way more gone than mine is, almost completely balding up front/top. No disrespect fallenstar. Yes, I want fairly dense, and most of all natural, but I had no expectation of so many. I don't think I look like a 3500graft candidate. What do you all think? I've been comparing a lot of procedures of much less and I would think it would be more like 1500-2000 realistically to meet my goals.

Here are my photos...
Most of the hair hanging down on the sides is from the first hairline transplant. This will need to be covered up per say as it is messed up and a new hairline will have to be created in front of it. A softer, transition zone, as well as some inside the actual previous HT to help camouflage it.

Right side
Left side
Top Front
Donor

Rambler
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Rambler,

This is a tough question to answer without having all of the details. For example it would be beneficial to know your age, expectations, family history (sometimes relevant), where and what the previous work is, etc.


Would you be likely happy with less grafts? If you have no shockloss--probably. Would you be ecstatic with 3500--yup. I will be the first to admit that I sometimes have criticised H&W for what I considered too many unnecessary grafts, but let's face it, it certainly will give you a look of a full head of hair. It is very difficult to ever question their results which are definitely world class. You could get by with 1500-2000 and assuming no shockloss it will be a good improvement, but 3500 will create perfection and you could be a poster boy. My guess is that they are making an assumption that you will likely lose some of the native hair at the hairline especially. Hope that helps.

Also, 2000 FU would cost $10,000 so it really is not that drastically different and if putting yourself thru the trauma of surgery why not get as much as you can. Just some thoughts.

Hi Nervous,

I'm 46 and started thinning at about age 26. No family history of balding at all, but my grandfather on my mothers side thinned all over but never even receded. My father has a full head of hair ( wolfman hairline actually ). So I suspect I get the thinning I have from my mothers genetics.

My first HT, 10 years ago, was 900 grafts just in the hairline and a few planted in behind. I knew I would probably thin a bit more and considering the progress of thinning in 10 years has been so minimal I don't think I will lose that much more.

I also didn't experience any shock loss on my first one. Not that I noticed anyway and the healing process was picture perfect. Stubbles, they fell out, and started growing in at 3 months etc.. my donor scar is excellent as well. I can't even find it. I know that some have experienced more shock loss on teir 2nd procedures so nothing is certain I suppose. But most shock loss does grow back right?

Expectations? To efectively repair ( cover up ) the 1st bad procedure, it's pitted, and with that have the newly created hairline VERY natural. I would like the areas that are thinning behind the actual hairline to be filled in to be as dense as the mid lock. Ideally, I would like the whole area to be beefed up in general too, including the area where there is hair so that it all matches the areas further behind. Be nice to have it all filled in like that area, plus the hairline transition fixed.

I was just a little shocked at the amount of grafts suggested, but your reasoning makes sense. I disagree a bit about not much difference between 10,000 and 16,000 though. That's a big difference lol. After all the research and comparing others graft count to baldness ratios I was estimating somewhere around 1500-2000, or max 2500 to meet my goals.

Thanks for your input.

Rambler
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Rambler dont take the virtual consultation as gospel but as NervousNelly has said H+W are world class in performing HT's.

Send off your pictures to some other top clinics to get a better idea but you will probably find with all the top doc's there wont be too much of a difference in quotes...

Thanks stevo, I am ready to get this done. Which means I have about 2-4 more months of research to do :-)

Rambler
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quote:

I would like the areas that are thinning behind the actual hairline to be filled in to be as dense as the mid lock. Ideally, I would like the whole area to be beefed up in general too, including the area where there is hair so that it all matches the areas further behind. Be nice to have it all filled in like that area, plus the hairline transition fixed.

This is likely the reasoning as to the high quote. The key is that you stated that you want it to "match the areas further behind it" plus they have to hide old work. This will take a lot of grafts in my opinion--3000+.

By the way, my comment of $10,000 not being too drastically different than $16,000 came out wrong. I guess what I meant is that for almost double the grafts and the chances of having essentially your old hair back, the $6,000 is a small price to pay. Not to scoff at 6 grand.

Rambler, I think that because of your age you would be completely satisfied with 3000+ grafts and not need another HT, but less and likely you will be wanting more. Just my opinion from what I see and your expectations.

Rambler,

Just to make sure you understand, the fee per graft is 3.00, not 4.00, once you surpass the initial 2000 at 5.00 thus making the procedure to me more around 14,500.00.

We are known for quoting more grafts on average than most clinics but that is because we'd like to reach the most cosmetically significant turn around that we can in as few procedures as possible. 3500 for one case may give good but relatively thin coverage while 3500 for another would give more density in a smaller area.

In your particular case, and only going by the photos you have posted, you appear to have good density in the areas on top of your scalp where you are not thinning so a healthy number of grafts are necessary to have a proper blending for the density of the new grafts.

If you ever want to discuss your particular case in more detail or talk about graft count options you can call me at the office anytime or you can even call me on my cell at 778.839.7996. I can even arrange for a phone conversation between you and the doctor. I hope this helps to clear tings up a bit.

Nervous,

No problemo, I totally get your point about the $$ difference and you make valid points. I stand corrected ( Jotronic ) about the price I stated. When I heard the amount of grafts suggested and the cost ( even at $14,500 ), I did have to pause and really consider whether I wish to pay this much and do a procedure at all.

Now before anyone says .. Stop .. You are not ready, don't do it with that thinking..

Yes I know what is said here about the general consensus .. geographic/cost when selecting a physician/procedure but, in fact, it does matter to a certain extent. Not so much geographics, but overall cost does matter.

Jotronic,

I think I will take you up on the phone call. How's tomorrow? I am still in research mode and exploring my options.

Rambler
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Rambler,

Cost is a huge consideration but ofcourse there are several other things that you could spend your money on that might not produce money for you.... What I mean is that you have the opportunity to fully restore your hairloss which many don't. This might increase your self confidence and indirectly change your life to a certain extent. Ofcourse I am over exaggerating things but you never know.

You seem like an intelligent guy. I don't want you to "settle" for less grafts because it is more affordable. Be cautious of this as you might be somewhat dissatisfied and short $10,000.

Rambler,

No problem for tomorrow. Call the office first and if you don't get me call my cell.

Hi

I spend about 18 for 3 separate sessions. Best money i ever spend hands down!! No doubt it seems like more when yo do it all a once..

AND----he has EVERY girl in RI after him...I can vouch!!!

The initial count and cost did throw me but it's not "just" the money. Big factor yes, but there are other factors to consider. I'm reading up on Dr. Bernsteins information and he states about dense packing on his website...

quote:

Although there is chat about "ultra-dense packing" on the internet, the very close placement of grafts requires significant skill and, more importantly, must be done in the appropriate patient. Dense packing allows the physician to accomplish the hair restoration as quickly as possible. However, as with any technique pushed to its limit, dense packing taken to the extreme carries risks that include poor perfusion of grafts (due to a compromised blood supply) and increased popping that can lead to graft desiccation (drying out of grafts) and crush injury from their re-insertion. These factors can lead to poor growth and a sub-optimal cosmetic result. It is always important to balance the desire to finish the restoration quickly with the requirement to use techniques that will maximize growth. In our opinion, the goal of achieving maximum growth after your hair transplants should never be compromised in order to achieve short-term goals.

Well dense packing is more than "chat" now but the concerns are valid. I can't afford another "sub-optimal" result. I also look at his photo section and see by comparison graft/baldness ratios.

I consider myself similiar to this guy who had only - 1600 grafts with great results. As far as can be seen by the photos. Actually I'm not quite as far gone as this even.
1600 grafts

By comparison, these 2 guys are considerably further balding than myself and had in the 3500 range, which is what leads me to believe that 3500 is just too much for me.

3523 Grafts

3579 Grafts

Rambler
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Rambler, I can tell you from my own experience with H&W that even after I paid for 3500 grafts and wanted all 3500 placed the doctor recommended only 2000 for me once he saw me in person. After I cryed like a baby, he managed to place 400 more grafts, and the clinic refunded me the difference! I was aware that the techs were getting off early but still had to be paid because of my smaller session, but the doctor still chose to do what was ethical.

Rambler,

I can honestly understand your trepidation going in for another surgery, especially when you already had one "sub-optimal" result coming in. I was in the same boat as you if you don't know that already.

With regards to the photos that you have pointed out, no question the results look good, but your links highlight something that has been a small crusade of sorts for the past few years. That is the deception, whether intentional or not, that flash photography introduces when judging density or the final result in general. I have written about this subject extensively which you can read up on here...

http://hair-restoration-info.com/eve/forums/a/tpc/f/346...1012852?r=5141012852

At the following link you can read how I suggest clinics/patients take photos of their results.

http://hairtransplantmentor.com/hair-loss-photo-tips.htm

So in summary, the patients you highlighted do not look like that in person. That I will guarantee. I'm sure they look good but just not as dense or full as the photos depict.

With regards to Dr. Bernstein's points that you quoted, half of them are remedied by simply having a competent staff. Drying out of grafts and graft crushing is something you see with an inexperienced or wrong experienced staff. Compromised blood flow is dealt with by technique and in our case it is with custom flat blades as part of the lateral slit technique.

We can go into more detail tomorrow when you call the office but I wanted to put some of the information online for others to read. Again, you are justified in having doubts and you are asking good questions. I hope to answer them and any others you may have when we chat.

its752,

So in the end, did the 2400 live up to your expectations? What was the deciding factor for less grafts? sufficient density w/2400? donor considerations? other technical issues?

Jotronic,

Good points about the flash. Photos are subjective for sure, I guess I was speaking in a broad general sense of comparison.

Rambler, I really didn't think that my HT would grow in like this! After two HTs in the past 4-5 years with weak results, I wasn't even excited about posting any immediate postop pics this time around, but at 3 months postop this time it started coming in and hasn't stopped! I am 6.2 months postop now, but I was already totally happy at only 4 months. The 2451 grafts that I received had nothing to do with donor supply or otherwise. The doctor knew that 2000+ grafts would take care of it pretty well and he was right!!

In regards to the lighting, It looks like this website has it backwards...

Near the middle of this page...

quote:

Phony Photos

Most product advertising that claims to produce dramatic results will show a photo of a balding person with thin hair next to a photo of the same person with thicker hair. Do these photos lie? Well, yes they do.

You can prove it yourself. Take a photo of a head with thinning hair using a flash camera and then photograph the same head without the flash. The photo with the flash will look like a bald head and the photo without the flash will look like more hair.

Rambler
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I agree on that Rambler,my photos with flash make my crown look terrible but without flash it isn`t that bad.
My girlfriend always says my hair is no where near as bad as it appears in the photo.
Having said that a lot of the photo album pictures are taken in the same lighting conditions and show great results,also the videos give a much better perspective.
Its true some will use this difference to deceive but in my opinion all the top docs dont do this as patient feedback backs up the results.

Hi Chucky,

Jotronic was making a point that in, I think, most cases the flash actually makes it look like there's more hair due to the shadowing effect of the reflection of the hairs upon themselves. I've done experiments here and also found that to be true.

Could be on crowns, in certain situations, the direction of the reflection and viewer eye level may make flash make it look worse.

Rambler
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