HAIR TRANSPLANT FORUM

This patient desired a full, thick, youthful hairline. He was initially treated by strip method, but since 2002 has changed to the FIT method to increase his density and insure the highest yield of his grafts.

GT - looks good - what are the graft totals?

I dont' have the exact totals in front of me, but around 2,000 grafts.

I dont' have the exact totals in front of me, but around 2,000 grafts.

I think you need to give more detail on this patient to give us a better idea on how much FIT actually contributed to the final result. It'd be nice if there were pictures of his final result 12 months or so after his strip procedure so we can see how much FIT actually helped him. And it would also be nice to see how many FIT grafts and where they were placed. Also was his strip procedure done by Dr. Cole or was it by another doctor? Is that 2000 grafts total (strip + FIT) or just for the FIT?

I'm so glad you asked for more details! I think this is a very interesting case with many helpful points to elaborate upon.

Normally, Dr. Cole will design a hairline that increases in density gradually, with the least density on the frontal hair line and more density as you move further back. This patient expressed that he preferred a different style, where the density is very thick throughout. Dr. Cole is capable of many different styles of hairline design as long as the patient is a good candidate for such a procedure and expresses his preferences during the planning phases.

With a very thick frontal hairline design, one must exercise caution and consider fully the consequences that can occur as the hair loss progression continues. Should this patient go to a NW class 3, he would be left with an island of dense frontal hairline and little or no density in the frontal third behind the hairline. This would obligate him to another large surgery to retain a natural look. It would also necessitate the extraction of much of his donor reserves. Should this patient recede even further to a NW class 6, he would be obligated to more than one large surgery in the future, extraction of all the scalp donor reserves, and body hair would also be needed to fill the gap between the dense frontal hairline and the back of the crown. Due to these dangers, Dr. Cole is more likely to create a more conservative hairline because he has his eye on the patient's possible future hair loss.

This patient, however, has very little risk of progressing to these extents. Because of his hair characteristics, density, family history, current hair loss status, etc. Dr. Cole was willing to grant this patient the thick frontal hairline that he desired after being educated fully on his options and the possible risks.

A more conservative hairline would be positioned higher up on the forehead. It would be shaped so that it comes up higher in the temples than in the middle. The density would be lighter in the front and more dense farther away from the frontal hairline. Here is an example of a more conservative hairline design: http://www.forhair.com/hairtransplant/viewtopic.php?t=715&highlight=fit+results. As hair loss progresses, this type of hairline is easier to maintain if the patient recedes to a NW class 3. Another surgery might be needed to maintain a natural look, but it would necessitate less grafts. It takes less grafts to match a lower existing density. If a patient stands a good chance of receding to a NW class 6, then frontal hairline work is not advised unless the patient is willing to be obligated to future large session work.

This patient comes in for small touch up sessions almost every year to keep his hair loss in check and matching to his transplanted density. Small touch up sessions are a great way to maintain your look and also to tweak the hairline and make small adjustments as the patient sees fit. Meeting with your doctor for touch up sessions or follow up consults allows him to check on your hair loss progression and keep you up to date on new medicinal advances and treatment options that apply to your specific case.

Combining FIT and strip procedures can be advantageous to some patients in some cases. Consult with your doctor or clinic to determine what your goals are specifically, and which path is best for meeting those goals.

This patient had his first procedure with Dr. Cole in 2000. It was a strip. The FIT sessions subsequent to that were small touch ups with Dr. Cole. The bulk of the grafts were derived from the first procedure with Dr. Cole, which was a strip. The 2000 grafts are total from all procedures with Dr. Cole, strip and FIT.

Hey Girltech,
Thanks for the detailed explanation on the patient. I had a question though on how Dr. Cole determines where a person's balding will progress to? In my case, I never knew my grandfather from either side of my family and I have no pictures of them so I can't reference my family history. So in my case, how would Dr. Cole determine where I might progress to? And how accurate do you think Dr. Cole's predictions are? Finally, let's say Dr. Cole says I will progress to a NW3 or NW4 will that still allow me to get the frontal density that this patient has or something a little less (not necessarily lowering the hairline) if I'm willing to come in for multiple procedures? Basically I'm asking up to what Norwood can I progress to and still be somewhat aggressive with my hairline (not lowering but just having it be somewhat dense)?

That's a good question re: how gentic cards are dealt at birth. Both of my grandfathers are still alive and in their 80's. However, both of them have still kept the majority of their hair and looking back at pics of them when they were my age (26) reveals full heads of hair. My dad is 63 and although he was a nw2 to 3 from 25 to 55, he has progressed to a nw4 since. I think meds he takes for his heart condition play a part in thinning. My brother (40) is an nw4 as well. Their hair loss was slow and progressed over a period of 15 years but they never had access to meds like we do. Hence, I don't think it's always the granddad's that determine their lineage's hairloss...

There is no way to predict hair loss for certain. There are many factors that influence the speed of hair loss. An experienced physician can examine the amount of miniaturization present, familial history, current rate and pattern of thinning, effectiveness of medications, etc. to offer you an educated guess. It is usually a good idea to plan for the worst case scenario.
I can't really answer as to how agressive you can get with your hairline design based on the Norwood class you are probably headed to. It really depends on so many factors such as hair quality, density, caliber, color, etc. There are many options available, such as using body hair or FIT farming to extend the donor resources, when creating your sugical plan for long term hair loss. Having a consult is perhaps the best way to gather information about your current status, possible future status, and recommendations about what options are best for your specific situation.