Hair restoration surgeon Dr. Michael Beehner is recommended by the Hair Transplant Network. To view this discussion and other hair loss topics, visit our Hair Loss Social Community and Discussion Forums,
I am 29 years old and have been using Propecia (finasteride) for 3 years, Rogaine (minoxidil) for 3 years and had one hair transplant in the corners of hairline (temples?) of 1800 grafts 1 year ago. (See photo below)
Based on my photo, how many grafts do you think it might take to fully restore my crown? Who is the best crown doctor in your opinion? My donor is dense, hair is wavy, and hair diameter in thick (Spanish ancestors). No one in my family is slick bald. The only person with thinner hair is my mom’s dad but his crown is better than mine and he’s 65. My dad and his dad have Elvis hair.
In looking at your “top-down” photo, I can see obvious thinning in a 9-10cm diameter circular area in back. At 29, you likely have 50 years of life ahead of you in which male pattern baldness is going to progress. And unfortunately, the square area of the crown/vertex does not increase in a linear fashion, but rather in a logarithmic way.
The great majority of men at your age with your degree of hair loss do, in fact, eventually go on to the classical U-shape of a Norwood VI pattern. With such a future likely, the top of your head will always be the number one priority to save donor hair for. You mentioned that you have already had some work done in the front. I have seen at least a dozen men over the years who had the crowns filled in when they were younger, and who came to see me 10-20 years later with a 1-2 inch wide “halo” of bald skin around the dense hair in the center, giving it the appearance of a “bulls-eye”. And, unfortunately, this “halo” area couldn’t be filled in because the donor hair supply was exhausted and had shrunk dramatically with the advancing baldness.
One other word of caution is that you have been on medications, which is a good thing and I’m sure you look better now because you have been on them. My hunch is that, if you had not taken medication, you would see quite a bit more balding presently and actually have better insight into what is going to happen in the future. So these treatments, which are great for helping delay the eventual balding pattern, do in fact “mask” what would really be going on now otherwise and thus can make you a little more over-confident now that everything can be filled in densely and cover your bald area for your lifetime. I’m simply saying that, for the great majority of men who are going to eventually be Norwood VI patterns, the center of the crown/vertex is not where you want a bunch of dense hair.
Two final points: For many men your age with a thinning crown, I will fill in whatever is on the horizontal plane, which often is almost 80% of the circular crown area, as seen from that top view, but I preserve a concave curve at the rear of this transplanting (as seen from the back), so that if the “bottom drops out” with a large area of balding beneath it, I am not committed to chasing after it.
The final point is that I think, at 29, some light coverage with low density 1-hair and 2-hair follicular units is okay to do at this time in your entire crown because that will never look freakish later should you bald to a Norwood VII or advanced VI, and it doesn’t take that much donor hair to likewise transplant in a similar fashion to the area in which baldness advances.
My cutoff for transplanting the rear vertex is 35 years of age. After that, I feel it is possible to make a pretty good assessment of where a given male is heading and being able to see if there is a comfortable “cushion” of donor hair available so that the top and the vertex can both be filled in.
As always, the goal is to be as helpful as possible for the patient, but not to create short-term happiness now and misery and deformity later in life.
Dr. Mike Beehner, M.D.
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