Norwood 6 and an apparent poor donor

[Valentine]

Hi guys

 

New to the forum but have been lurking for a while.

 

A little about me....

 

I am 27 years old and a Norwood 6 in the making. I have recently started my search for a HT surgeon with the view to have surgery some time this year. Had 2 consultations this week, first with Rahal and second with H&W. Both pointed out that I do not have a great donor area, Rahal was particularly negative and said I was not really a candidate for surgery at this time (I have heard that he tends to be a little negative to Norwood 6 patients in general though?). H&W were a lot more positive and said that even though my donor is below average, I do have some positives - 1) I have very coarse hair and 2) I have a particularly loose scalp.

 

I would be keen to hear from anyone else in my shoes and what you think my best plan of attack might be?

 

Thanks in advance guys

 

Valentine

[tacolinowest]

I am 25 on the road to Norwood 6 and have poor donor and course hair and loose scalp, lol be4 I say anything I'd like to see some pics

[Valentine]

Thanks for the prompt response - I have attached some pics

[tacolinowest]

Idk your donor dosent seem very bad from the pic,, well the approach I'm taking is putting in around 5000 head grafts in the front and mod scalp then gonna fill the crown with beard hair and cheat hair and after that I will do some scalp micro pigmentation , I would say u have lots of hope for the future don't worry, the beard hair will save you although it's not exactlly like head hair it's good for crown coverage and in combination with SMP you will get a good result

[Valentine]

I was told that I have about 4000 grafts at best, would you agree? I am not expecting a miracle, I am realistic and understand I will never have a thick head of hair, all I want is the best result achievable.

 

Thanks

[tacolinowest]

Lol that's so funny they told be the same thing, 4000 with FUT then you can get another 1000 with FUE , while I'm no expert if 2 docs told you you can get 4k then I'd assume you would get slightly over that, not including fue at a later time ,

[Valentine]

They suggested starting the hair line slightly further back than it currently is in order to plan for the future loss and because obviously the further back you start the more coverage you can get towards the crown. I was happy with this, but how far back do you think 4000 grafts would get me and with what sort of density?

[tacolinowest]

Wow really they suggested that? Well idk I feel that your hairline should be where it is at now, any further back and I wouldent be happy, I would sacrifice some of the hair that must go into the crown and keep your hairline where it is now , if you keep your hair line where it is and use 4k grafts I think you could do the front and mid scalp and that's it,, no crown IMO but then Again who am I

[Valentine]

Appreciate you sharing your thoughts buddy. They did only say slightly back, perhaps a centimeter. If it means more density throughout, I would happily sacrifice a slightly higher hair line.

 

Who are you planning on going with?

[tacolinowest]

Dr feller,, what do you think about use ing beard hair? Later ofcource

[Valentine]

Yes, I would not have a problem with beard hair being used and also body hair if it was a viable option

[tacolinowest]

i assume you will be going with H&W?

[Davis91]

Dr. Rahal has never proven himself publicly with NW6 results like H&W has.That is just a fact as observed on the websites.

 

Nevertheless, since you are 26, I would consider just doing FUE and shaving down the sides as much as possible, supplemented with temporary SMP as a test and perhaps more permanent SMP in the future. You should consult with Dr. Ron or Paul Shapiro since their clinic offers FUE and temporary SMP combo experience.

[Mickey85]

Dr. Rahal has never proven himself publicly with NW6 results like H&W has.That is just a fact as observed on the websites.

 

Nevertheless, since you are 26, I would consider just doing FUE and shaving down the sides as much as possible, supplemented with temporary SMP as a test and perhaps more permanent SMP in the future. You should consult with Dr. Ron or Paul Shapiro since their clinic offers FUE and temporary SMP combo experience.

 

That is correct. Not saying he has never had successful results on NW6's but I have not seen many at all.

[Cant decide]

Dr. Rahal has never proven himself publicly with NW6 results like H&W has.That is just a fact as observed on the websites.

 

Nevertheless, since you are 26, I would consider just doing FUE and shaving down the sides as much as possible, supplemented with temporary SMP as a test and perhaps more permanent SMP in the future. You should consult with Dr. Ron or Paul Shapiro since their clinic offers FUE and temporary SMP combo experience.

 

Hmm. I know what your saying. H&W are clearly the NW 6 kings as they have the most examples. However, other than H&W, I can’t think of another doc that can extract as many grafts safely in one pass leaving a good scar than Rahal. By default, a NW 6 of course needs this high number so in that respect Rahal has more than proven himself. However, I agree that most of Rahal's presented results (At least on this forum) are on NW 4 cases or lower. The Rahal results of the guys over NW 4 that have been posted are impressive however. I think Rahal was posting allot more advanced cases over the least few months before that lame law in Canada preventing him from further posting. It’s a shame to because I think his reputation of not doing many advanced cases was finally starting to dissipate.

.

[Valentine]

Davis, Mickey, Cant - Hi

 

Based on the photos I have uploaded, what are your opinions on the best that could be achieved with an apparent poor donor area of around 4000?

 

Thanks

[Mickey85]

Davis, Mickey, Cant - Hi

 

Based on the photos I have uploaded, what are your opinions on the best that could be achieved with an apparent poor donor area of around 4000?

 

Thanks

 

I don't particularly think your donor is 'poor' really. I have seen poor donors where they are almost see through even when grown out or you can see the individual follicles when shaved down. I don't believe Rahal's assessment was accurate entirely. H&W are known to be more conservative than alot of Doctors(in a good way, they won't operate if they do not feel it is ethical) and if they say you have some redeeming features and are a candidate for 4,000 grafts, I would take their word over Rahal's.

 

Here are what I think(opinion, I'm no expert) your options are:

 

4,000 graft FUT with a thicker density at the hairline and tapers out as it moves backward and then a 1,000-1,500 FUE session to fill in the crown. You could implement SMP(scalp tattoo, permanent or temporary) for added effect.

 

I would definitely consult with more doctors and maybe send them(and post here) some shaved down pictures to give us a clearer perspective of your donor. I would not rush into a surgery or give any deposits just yet...

[Valentine]

Thanks Mickey

 

I am actually speaking to Matt Zupan who consults for Ron Shapiro in a couple of hours. I will keep you informed.

[Davis91]

Can't Decide: Dr. Rahal is a gentleman and his staff that I have had contact with are fantastic. He is in expansion mode at the moment and his site is improving and he recently added a doctor.

 

But the ability to get a high number of grafts does not proves a consistent record with NW6. There are distinct strategies involved and H&W may have a very different philosophy on graph placement for the long term with an NW6 than Dr. Rahal--and H&W are superior in saying to the world--here are a bunch of our NW6 examples on the web with consistent photographs AND HD video--in essence they are setting themselves up to maintain this type of standard.

 

You know this inherently because you are now entering round 2 and you are already thinking about what you need to be doing to get a long term outcome and hence questioning: do I hit the laterals more? How do I build in a strategy for the future? I would dare say that you may even want to consult with H&W on your next surgery JUST TO SEE if there are philospophical differneces between the two practices. I have never met Dr. Wong or Hasson, but I have met Dr. Rahal. And he made comments indicating graft angle differences between his team and H&W. Also, I have noted differences in 1s vs. 2s and 3s in the hairline vs. the crown between his team and others. This is serious stuff as far as differences to approach that affect long term planning.

 

Valentine, my gut is telling me that you may end up dissapointed in the long term with a strip but I could be wrong. I believe strip is in fact more reliable in most docs hand but I am really wondering==-if you look OK with shorter hair==if you should not just go for 3,000 FUE with some front loading but over a smaller area, add some beard hair (maybe up to a 1000, think about termporary SMP and be done with it. This would leave you with a bald spot but it could be shrunk essentially, plus a good frame for the face the would span the test of time--again you are very very young. If you recede much further to an NW6 + or NW 7 you will then not feel as regretful, not deal with the strip scar and have a lower maintanence life.

 

See the example of Stephen from Dr. Bisanga (his rep) and case histor--he did FUE then Beard Fue. Good documentation. (He did have a higher average haird density)-- or the example I am specifically thinking about from Dr. Shapiro where the guy had FUE plus SMP (although I would avoid Good Look Ink personally):

 

http://www.hairrestorationnetwork.com/eve/165354-dr-ron-shapiro-fue-2194grafts-3754hairs-after-smp.html

[Cant decide]

I know what you mean about differences in approach, etc. However, Dr. Rahal did such a great job with me in round 1 that I really trust the guy. I mean he was able to place the grafts in such a way toward the back that I am still amazed at how he was able to know they would have the impact appearance wise that they did. At the time, I was a bit skeptical on some of the placement but it was 100% spot on.

[Valentine]

Davis, thanks for sharing your thoughts. May I just ask, why do you feel I would be disappointed with a strip procedure? I was favoring strip due to the fact I would get more grafts from it. Also, having a scar I don't feel would bother me that much, even if I did decide to go a lot shorter a few years down the line.

 

I also understand what you are saying about me being young at 27, but the way I see it is, these are the times in my life I think it is going to most bother me and I want to be able to enjoy it and feel my best while I am still youthful. You only live once!

[Davis91]

Can't Decide,

 

These types of discussions do not take place enough on this board. Can you elaborate on what Dr. Rhala did so specifically--what were you skeptical about at first? (Keep in mind your photos show a limited number of angles.

 

Valentine,

 

Another option could be try propecia/minoxidal for a year, see how it thinkens up your miniraturized hairs and donor hair, and reevaluate. As to your other question, I am going by my gut with you--ultimately you have to make the call. I agree you should be enjoying life but life does not end at 35--your appearance matters through your 40s, 50s and 60s, and as of now you haev a highly agressive balding pattern at 27. DO NOT ASSUME hair cloning or some other miracle will appear in your lifetime. I agree you will get more gratfs with strip but you may end up just buying yourself 4 years of happiness. You are doing the right thing by consulting widely. In your case, I think you need to consult REALLY widely, and I would also check with Dr. Umar in CA. who deals with advance cases as well and might provide advice.

[Valentine]

Thanks, I have just started taking propecia again, having been off it for 6 months (regrettably). I do plan on stabilizing my loss again for at least 8 months before any surgery, so I have September/October in my head.

 

Funny you should mention Dr Umar, I was researching him earlier today. Do you know much about him yourself? I see he does a lot of BHT which looks interesting.

[Davis91]

I have only emailed him a few times. Hi is a pioneer in body hair transplants and had a failed HT himself so he is a knowledgeable fellow. Where are you located if I may ask (I did not look at your profile). I ask because if I am you I spend the time and money to go in person to a bunch of places across the USA if not also Canada and Europe. At least do phone consults. In LA you could see Dr. Umar and Dr. William Rassman's offices--the later because he is always preaching the Master Plan and will does a miniraturization mapping on your scalp hair. I would get this mapping done now and meaure again in 6-8 months to see if the propecia has an effect.

[Valentine]

I am in London, UK.

 

Mapping? Nor familiar with that.

 

So far I have had a face to face with Dr Rahal, a face to face with a representative from H&W and my telephone consultation with Matt Zupan from Shapiro Medical was supposed to happen today but has been rescheduled for Wednesday.