Author: Dr. William Rassman

You were very fortunate to have a good strong forelock prior to your surgery which will give you a strong frontal hairline. These forelocks are great and if they last until the age of 35, they usually last your lifetime. Some of these forelocks have a different genetic code than the hair around them.

To find out how many grafts you need for the crown, there are a few things you need to know first:

(1) Thickness of the hair – fine, medium, or coarse (the thicker the hair, the less the number of grafts you will need)

(2) Character of the hair (wavy is better than straight)

(3) Color contrast between your hair and skin (brown hair on light skin often means more grafts, while gray hair requires less hair)

(4) The crown is the place where the direction of the hair changes.

If you want the swirl, you need to discuss this with your doctor. Your balding area is similar to mine, and I had 2,700 grafts placed into it over the past 25 years. So, if I were to estimate a range of grafts for you, it would be between 2,000-3,000 grafts, modified by the above.

You have obvious thinning. With the failures of PRP to effectively treat your hair loss and assuming that you have been fully evaluated for hormone and other deficiencies, you might want to consider Scalp Micropigmentation, which is an excellent cosmetic treatment for this condition. See here: https://scalpmicropigmentation.com/smp-for-women/

 

Hairline lowering procedures should not be performed on men because hairline recession is progressive and the scar from the procedure will eventually show up making the surgery evident to everyone, You will need a hair transplant to cover the scar and lower the hairline more appropriately.

 

 

 

 

 

 

 

This is the result of a single hair transplant. His smile shows his satisfaction

 

Men should rarely get a hairline advancement surgery because of the risk of genetic balding that can appear at almost any age and show the scar when that happens. There is no need for a balloon expander in your situation as a hair transplant is more than adequate to address your hairline issue and less intrusive and less disruptive on your life style and certainly far less costly? We do these every day with hair transplantation.

I’ve seen balding since I was 20, now 33M, NW V. I took intermittently min/fin for periods of no longer than 6 months, with noticeable results. Then skipped the treatments due to laziness. I now decided to go all-in for the very last time before I decide to get a hair transplant. I am doing religiously min, fin, biotin, zinc, saw palmetto and vitamin D daily; ketoconazole twice/three times a week; dermarolling 1.5 mm once a week. Do you think it will reverse?

At 33, the drugs rarely reverse a Class 5 pattern of balding.

These are pictures of Donald Kendall, President of Pepsi. The last picture was taken 7 years before his death at age 99. There are 30 years between these photos. When comparing these photos, it is evident that hair loss is progressive with age providing that you have the genes for balding. My maternal grandfather died with his juvenile hairline still present at the age of 102 which clearly shows that he didn’t have the balding genes.

When your original donor density is lower than average, 3000 grafts can be too many grafts harvested through FUE and this causes donor site depletion such that the donor area has a problem with a see-through look. The doctor should have measured your donor density before pushing large numbers of FUE grafts. For some people with very low donor densities, 2000 grafts could cause donor site depletion. It seems that in this situation, the surgeon could not get the entire 3000 grafts from the permanent zone, so the surgeon moved outside the permanent zone into the neck (which is not permanent hair) and possibly also above the permanent zone into another area that may sooner or later may bald. The only treatment for this is scalp micropigmentation, something we do all of the time. https://scalpmicropigmentation.com/ This technique can make your donor area LOOK normal but it will not put more hair there