This 26-year-old male has reversed his corner recession around what appears to be a persistent forelock with a combination of 1mg Fin oral every day, 5% minoxidil topical once a day, and microneedling 1.5mm once a week for 1 1/2 years.  Many doctors would have transplanted this man; however, the issue may be one of continued treatment and how long the treatment will hold up.  With the transplant alternative, I can state that once it is done, it is done (without maintenance other than possible finasteride to avoid the further progression of the balding pattern).

When estimating the number of grafts a person needs, I always want to know the hair thickness (hair bulk) of the donor area. Hair bulk is not hair or graft density.  I initially saw the graphic at the bottom of this post on Reddit.com. For a visual representation, the graphic artist kept the number of hairs the same and changed the thickness of the hair shafts to show the value of hair thickness in producing coverage.  Dr. Sharon Keene nicely demonstrated this with real hairs and got the same result as the graphic demo below. So you see, if your hair is fine, it will take a lot more hair to get the fullness of a person with medium-weight or coarse hair.  This is why people with fine hair often get a second hair transplant. Fine hair is clearly better than no hair, but when a person with fine hair gets a hair transplant, they should accept that they will never have the look of Brad Pitt’s hair, while a person with thicker hair shafts, a Brad Pitt expectation may be realistic. The chart below shows the value of thicker hair shafts very nicely.

Let’s drill down on an example:  Look at the chart below; let’s suppose that a balding man has medium hair (50microns thick).  His friend had a hair transplant and had fine hair in his donor area, with a hair thickness of 30 microns.  His friend had a hair transplant, and it doesn’t look like he has a full head of hair after the transplant despite getting 4000 grafts. He is concerned that he might not be happy with the type of results his friend had.  If he does the analysis, he will find that he has 7.1 times the hair bulk as his friend with fine hair whose donor hair thickness had 30-micron hair shafts (50/0.7 = 7.1).  I would tell him that if I were his surgeon, he would get much fuller-looking results than his friend, not because I am a better surgeon than his friend’s surgeon but because his hair thickness will produce more hair bulk than his friend’s fine hair gave him. The amount of hair bulk is a simple math calculation reflecting the area of a circle [ Pie (r)²  ].   If you want to run the calculations, you will know the value of your hair thickness, and everyone having a hair transplant should do this to establish realistic expectations. 

In my 35 years performing hair transplants, I have transplanted many men with fine hair. They were generally pleased because they got back the hair they always had, which was fine hair.  A fine-haired man getting a hair transplant for balding doesn’t have the expectation that his hair would look like Antonio Banderas’s hair because they never had it. 

In the late 1980’s. Dr. Manny Marritt had a light-skinned Caucasian human volunteer with black, medium-weight hair (~50-micron hair thickness) agree to have half the hairs on one side of his head plucked out.  Then, Dr. Marritt brought in independent observers and photographers to see if the lower-density side could be detected.  The answer was NO!  That told me that in the worst situation possible (black, medium-weight hair on white skin), 50% density produced the same fullness as 100% density. With that being the case, a person with medium-weight hair that is blonde with a blondish skin color or a brown-haired, brown-skin colored man would require less than 50% of their original density to get a full look from a hair transplant. I have found that to be true, and that is the art of what a good hair transplant surgeon offers. When the hair transplant surgeon combines this knowledge with proper hair distribution, the best results are produced with the least amount of hair and cost to the patient. 

For those readers who want to know where they stand about hair thickness, to get some realistic expectations for a hair transplant, you can purchase a micrometer for under $25 on Amazon, cut 10 of your donor area (back of your head), and measure the thickness by averaging their width of those 10 hairs.  Use the chart below to understand the measurement and consider Dr. Marritt’s simple experiment. The micrometer can be purchased here: https://www.amazon.com/dp/B09964YBMF?ref=ppx_yo2ov_dt_b_product_details&th=1

 

 

The illustrations below show the same number of hairs, but the hairs are thicker.  Please note the HUGE visual difference between fine, medium, and coarse hairs regarding the fullness each group produces.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You can contact me at williamrassman33@gmail.com

I had a condition that showed plaques behind the hair. This is Psoriasis, and plaques often appear on other body parts.  

I, too, have shared your problem, almost exactly as you have shown yours.  I have treated the Psoriasis as you should.

This is an unusually good view of the permanent zone, especially in the back of his head. I can’t tell why his graying isn’t more uniform. The arrows show the donor zone as it wraps around the head. 

Sometimes it is unfair that some people get a great hairline regarding genetics. I believe Stalin might never have succeeded as a dictator had he been bald! A full head of hair gives great confidence to those with it. Look at Bill Clinton’s hairline as such an example? Men’s Fitness did an article some years ago reviewing the political ramifications of not having hair. Since Eisenhower, there has not been a bald president in the United States. Donald Trump knew this and tied a perception of good hair with a lace hair system (a wig) to build his personal confidence. The public doesn’t know Donald Trump is bald because they know him as a hairy man with a strange hairstyle. 

Response from Reddit poster: I had this happen to me firsthand from 16 until 24. I ran a community in the mountains of Ohio, and year after year, we were gaining more and more followers. I could Stockholm syndrome a beatiuful model, even a wealthy businessman in no less than 3 hours. Then baldness struck, no new members, all my wives left me for one of my enforcers who had beatiuful luscious hair, but I guess the hair loss saved my ass the feds raided the community like a year later. I’ve been saving up for a $30,000 for graft treatment, so maybe one day I can create another community

This young man went on finasteride, minoxidil and microneedling.  Within 6 months, many of the elements of his juvenile hairline returned.  I have not seen this before.