Q for Dr A - "Twin Hairline Approach"?

Hair Transplant
1

Hello Dr Arvind (and anyone else that cares to comment), I know you are very busy but could you please tell me would you consider performing the following or indeed have you ever done the following before (apologies for the long post but I can not post pics at this time to demonstrate my question in an easier manner).

The “Twin Hairline Method”.

Everyone here (the younger posters especially) would like to be restored to a early Norwood namely a NW1 or an early NW2. As we know our donor supplies are not limitless and thus anyone who experiences the early onset of MPB regardless of medication use and restores a dense low hairline runs the risk of exhausting their donor supplies in one small area and can look somewhat odd with a dense low hairline and nothing or very little behind it.

Now, I will throw some figures around now but they are arbituary and this method does not make mention of the financial costs involved.

Now…

Say someone was destined or is indeed already a NW5 (the majority of hairloss sufferers apparently do not go beyond NW5). Lets say with their scalp donor resources they could be restored (or appear to be restored) to a solid NW3. Many “older” guys would be happy to be a NW3 for life where many younger guys or those experiencing their first loss would not be - as they get a little older a NW3 hairline is fine (I hope I have not offended anyone).

Now what I propose is…

You have a “safe” donor area on the sides and back of your head - lets say for argument that this “safe” area extends 4cm up. (The nape of the neck is not considered as safe). Lets say that this 4cm extends around the side of the head too.

You can harvest grafts from this area and they are certain not to atrophy.

From this area you can build a solid NW3 appearance on a NW5 or someone who will be a NW5 (again arbitury obviously hair characteristics / finanance etc come into play).

Now, what you then do infront of this NW3 hairline, built from “safe” hair, you harvest a further 2000 - 3000 FUEs above and below this “4cm safe area” (I am not talking about going as high as the crown area - I can demonstrate with pics if you are unsure of what I mean) to build a NW1 or early NW2 hairline thus restoring a very youthful appearance.

Now this hair is not 100% safe - if is harvested from where you may recede into should you reach or surpass a NW5 - if you are on Meds then it could well be safe. If over subsequent years this hair begins to atrophy it will recede back to your defense line, namely your NW3 hairline but you may have been able to live the last 10 years as a NW1 or 2 thus buying you time to enjoy the cosmetic benefits but without the risk of having a thick hairline permanantly there with nothing behind it.

If you do not go beyond a NW5 then you have a NW1-2 hairline but without the worry because you have saved your “safe” donor hair for your line of defence namely your permanant NW3 hairline.

It seems to me that present HT methodology is based on 1) assessing what the patients hair characteristics are 2) determining hairloss histology and medication useage / genetic susceptability and 3) working out what finances the person has…

Couple all this and the hair restoration begins but usually with a conservative hairline. In a nutshell I propose that the above still takes place but… a semi permanent / potentially permanent lower youthful hairline be built infront of this but harvesting scalp FUEs above and below the “safe” zone - if the meds hold it great, if you never recede as far as you need to plan for (ie NW5), great.

Of course this would not work for strip.

Any comments?

2

» Hello Dr Arvind (and anyone else that cares to comment), I know you are
» very busy but could you please tell me would you consider performing the
» following or indeed have you ever done the following before (apologies for
» the long post but I can not post pics at this time to demonstrate my
» question in an easier manner).
»
» The “Twin Hairline Method”.
»
» Everyone here (the younger posters especially) would like to be restored
» to a early Norwood namely a NW1 or an early NW2. As we know our donor
» supplies are not limitless and thus anyone who experiences the early onset
» of MPB regardless of medication use and restores a dense low hairline runs
» the risk of exhausting their donor supplies in one small area and can look
» somewhat odd with a dense low hairline and nothing or very little behind
» it.
»
» Now, I will throw some figures around now but they are arbituary and this
» method does not make mention of the financial costs involved.
»
» Now…
»
» Say someone was destined or is indeed already a NW5 (the majority of
» hairloss sufferers apparently do not go beyond NW5). Lets say with their
» scalp donor resources they could be restored (or appear to be restored) to
» a solid NW3. Many “older” guys would be happy to be a NW3 for life where
» many younger guys or those experiencing their first loss would not be - as
» they get a little older a NW3 hairline is fine (I hope I have not offended
» anyone).
»
» Now what I propose is…
»
» You have a “safe” donor area on the sides and back of your head - lets say
» for argument that this “safe” area extends 4cm up. (The nape of the neck
» is not considered as safe). Lets say that this 4cm extends around the side
» of the head too.
»
» You can harvest grafts from this area and they are certain not to
» atrophy.
»
» From this area you can build a solid NW3 appearance on a NW5 or someone
» who will be a NW5 (again arbitury obviously hair characteristics /
» finanance etc come into play).
»
» Now, what you then do infront of this NW3 hairline, built from “safe”
» hair, you harvest a further 2000 - 3000 FUEs above and below this “4cm
» safe area” (I am not talking about going as high as the crown area - I can
» demonstrate with pics if you are unsure of what I mean) to build a NW1 or
» early NW2 hairline thus restoring a very youthful appearance.
»
» Now this hair is not 100% safe - if is harvested from where you may recede
» into should you reach or surpass a NW5 - if you are on Meds then it could
» well be safe. If over subsequent years this hair begins to atrophy it
» will recede back to your defense line, namely your NW3 hairline but you
» may have been able to live the last 10 years as a NW1 or 2 thus buying you
» time to enjoy the cosmetic benefits but without the risk of having a thick
» hairline permanantly there with nothing behind it.
»
» If you do not go beyond a NW5 then you have a NW1-2 hairline but without
» the worry because you have saved your “safe” donor hair for your line of
» defence namely your permanant NW3 hairline.
»
» It seems to me that present HT methodology is based on 1) assessing what
» the patients hair characteristics are 2) determining hairloss histology
» and medication useage / genetic susceptability and 3) working out what
» finances the person has…
»
» Couple all this and the hair restoration begins but usually with a
» conservative hairline. In a nutshell I propose that the above still takes
» place but… a semi permanent / potentially permanent lower youthful
» hairline be built infront of this but harvesting scalp FUEs above and
» below the “safe” zone - if the meds hold it great, if you never recede as
» far as you need to plan for (ie NW5), great.
»
» Of course this would not work for strip.
»
» Any comments?

Maxwell1 bloody good question.I’d like to hear answer,too!

3

It seems to me that present HT methodology is based on 1) assessing what the patients hair characteristics are 2) determining hairloss histology and medication useage / genetic susceptability

Number 2 is almost completely unpredictable. Genetics play a role but hard to predict.

Your idea is quite interesting however predicting comes into play here again.

  1. Using hair above and belove the safe zone doesn’t provide a predictable zone what so ever. And if you use those hairs and if I understand your plan correctly… if those hairs fell out then you have a safe area yes. Well no one ca predict what hair might fall out using the hairs outside the safe zone. What IF you built your NW1 using outside safe zone hairs but some were also safe zone hairs because no one can identify either type of hair? Then you might have a patchy look. (BTW meds. are not a cure all… sometimes they work forever… sometimes they wane, sometimes they don’t work at all)

It is a gamble. We would need better predictability of safe/zone and unsafe zone hairs. And lastly, look at some of the pictures around this and other sites of FUE… I see clinics using unsafe zone hairs all day long. :wink:

4

Hairtech, I will explain but all surgery is a gamble somewhat - this minimising risks and apart from anything else, you could go for the “less is more” look with what is potentially permenant. I will explain…

Surgical intervention in hairloss could take place “earlier” in the hairloss cycle than previously ie younger patients could well go in for surgery at an earlier period in their hairloss with a lot less risk.

I will explain…

The top of the heard is divided into “zones” by many Doctors at the present time ie Zone 1 hairline, Zone 2, then Zone 3 being the mid scalp region etc.

I propose that the donor area also be divided into zones ie Zone 7d (what would be left if you were to become a NW7), Zone 6d (what would be left if you became a NW6) and so on (the “d” stands for donor zone).

Now, someone who starts receeding (could be a young patient or an older patient) - they want to remain as a NW1 or 2 for years to come ie while they go through school / university / club 18-30 holidays whatever.

The patients family history is say no more than a NW4. They are on the meds. Their hairloss is potentially stabilised or should not go beyond this NW4 figure (as you say hard to predict, yes, but you need to factor this somewhat or you could even go a NW lower in the examples that follow for safety). In the past hair would have been harvested from zone 7d (or 6d) etc for the hairline - where to place that hairline is always a compromise for the obvious reasons and it WILL be permanent hence not going too low as you need to fill in behind it.

Instead of taking hair at this early period of loss from say Zone 6d or 7d (see above) hair is taken from the nape of the neck (good for feathering) and say Zone 4d (or Zone 5d for safety - see above).

The NW1/2 hairline is built from hair from zone 4d leaving leaving zones 5d, 6d and 7d to build the “permanent” and sustainable NW3 hairline which as stated in my first post is your line of defence and your long term safety net.

Potentially the hairline built from Zone 4d could recede if you surpass your estimated potential genetic / family loss pattern BUT the NW3 hairline is there or the donor hair (from zones 5d / 6d and 7d) is available. At worse it has bought you a number of years with the look you want but without the worry that people with the early front loads have because you know at worse you will be a NW3 where as the guys with the front load know, the potential worse for them is a dense low hairline with not a lot behind it.

If someone said to me, you are going to go bald - what if I give you 5 - 10 years more as a solid NW1 or 2 and at worse you are going to be a NW3 when all is said and done - I would say where do I sign!!!

Of course money is not factored in the above scenerios and with harvesting outside the potential “safe” zone FUE can only be employed and this is obviously more expensive than strip BUT if you are intervening early ie 1000 -2000 grafts here and there, the costs could be incurred over a matter of years thus lessening the burden.

Maxwell.

5

My response will be later today when I get home. A lot to read and comprehend bro!:wink:

6

It doesn’t seem wise to me to take hair from outside the “safe zone” and gamble on meds.

But I’m no doc, just a patient.

7

I see your point. I understand your point. I believe that your scenario is possible, HOWEVER I have to factor in what I know as a tech. And I have to factor in what I know about this corrupt industry.

Now if all the planets lined up on the day of surgery. The doctor did exactly as you stated. The meds worked in absolute. Genetics were predictable to a T. THEN YES THAT IS A GOOD PLAN. Nice thinking.:wink: :slight_smile:

8

Dear Maxwell1,
The hair above the strict safe donor area can be used, as long as the doctor and patient are aware of the possibility of their loss as baldness progresses.

The correct way to use these hair is to program their placement in the hairline and temple areas. The central swirl areas can also classify in suitable cases.

The other benefit is in patients who wish to adopt the buzz cut look.

In them, the dense, non harvested zone above the safe donor area stands out in contrast to harvested safedonor area below. Depixelizing this area (aka hairytale) and using the grafts thus obtained in the abovementioned locations is possible.

Please let me know if you have any further queries.

Regards,
Dr. A

9

Hi Dr. A.,

I’m confused by this, “The correct way to use these hair is to program their placement in the hairline and temple areas. The central swirl areas can also classify in suitable cases.”

Are you advocating using from outside the safe zone (hair that may fall out) in the temples and swirl for an HT?

I wouldn’t ever want to experience loss in these areas twice in a lifetime.

Please clarify.

Thanks.

10

Sofarsogood said:

""It doesn’t seem wise to me to take hair from outside the “safe zone” and gamble on meds.

But I’m no doc, just a patient"".

Hi, on the front of it, it seems your statement is entirely correct but have a re-read of what I am saying.

I am basically saying that if you extract hair from your “safe zone” - there will always be a compromise of where to place the hairline. You can not go too low or too dense (depending on the usual hair characteristics) incase you should lose hair behind and have insufficient grafts left.

Now, if you divide your donor region into zones for extraction as per the above ie 4d, 5d, 6d and 7d. (the number determines what hair will be left if you become that NW level ie 4d means the the hair that would be left in the donor region if you are a NW4 etc).

Now, I am saying extract hair from the “safe zone” for a permanant conservative sustainable hairline (or save this donor hair, if you are in the early stages of loss). Extract from the “riskier donor area” ie 4d for someone whos family history is no more than a NW4 etc and build the lower hairline from that.

If this should recede and it could (it may well not either and factoring meds and family history will help here - not an exact science but look at some fue donor pics and you will see that many docs extract from here anyway but do not have any “method” behind where the grafts from the riskier donor area are to be placed) you have a NW3 hairline to fall back on. If it does not recede (and it hopefully won’t due either meds and/or family history) you have a youthful hairline but without the worry of having loaded up your front with your “safe zone” hair and having little left to sustain it.

At worse it could give you 5-10 years as a NW1 who slowly receeds and ends up as a NW3 at the very end. The best case is that you were never to go beyond say the 4d area anyway and thus are a NW1/2 for life but without the worry of the super dense super low “safe zone” hairlines. Or you have sufficient “safe donor” hair available to go for the less is more look by which time you may well be an older candidate where you feel a NW3 for example is perfectly acceptable.

Maxell.

11

» Hi Dr. A.,
»
» I’m confused by this, “The correct way to use these hair is to program
» their placement in the hairline and temple areas. The central swirl areas
» can also classify in suitable cases.”
»
» Are you advocating using from outside the safe zone (hair that may fall
» out) in the temples and swirl for an HT?
»
» I wouldn’t ever want to experience loss in these areas twice in a
» lifetime.
»
» Please clarify.
»
» Thanks.

I’m pretty sure I know the answer to this since I asked a similar question of Dr A. The reason he is talking about those specific locations for placement for use of hair outside of the “safe” zone is that is more of a natural balding pattern. In other words, it wouldn’t make sense to transplant hair outside of a safe zone into a completely bald area right on top of your head. In that case, lets say the hair fell out, it would look particularly odd to only be balding in that area. Balding in temples, hairline, and crown swirl are usually the first places one starts to lose hair so this would appear fairly natural.

Not normally a good idea to transplant outside of safe zone. The reason I asked this question of Dr A was that I might consider adopting the “buzzed” look. In that case, the edges of safe zone have not been harvested and look slightly thicker than the other areas where fue has been performed. Most likely I will extract roughly 10% of hairs in area outside of safe zone with knowledge that those hairs might eventually fall out. It would balance out the “buzzed” look slightly and give additional donor source that may or may not fall out.