• Welcome to Hair loss Experiences hair loss forum.

    Free impartial hair loss advice, hair transplant advice, hair loss medications and hair loss news.
    You can contact us directly at [email protected] if you experience any problems.

What happens when the lateral hump area drops?

topccat29

topccat29

29 year HT veteran
Even when the hair loss pattern has become better known some clinics make the mistake of transplanting thin coverage all over the top of the head which looks ridiculous when the lateral humps drop. You can have thin coverage you just cannot have it in the lateral hump area. That area needs to have enough density so that it is not see through up until the point where it meets the bridge on top of the head and the hair direction changes connecting both sides. Regardless of if that bridge of hair still exists or not it has to reach that point. Once that is accomplished then coverage with the balance of donor should proceed. Ideally in the reverse pattern of the balding process. Fill in the bridge, frontal forelock, hairline, temple area then finally the crown. If you work the pattern the other way around and you don t have enough donor you will have planned inappropriately and have been ill-advised. Of course, this is my personal opinion.

Honest clinics will advise on the use of medications being necessary or planning as best as possible around your future hair loss pattern so that you don't start planting into the temple or hairline area if your sides are going to drastically drop.

If your sides do not drop you are a much better candidate for a hair transplant.


Lateral humps..jpg
 
bullitnut

bullitnut

4 awesome repairs with SMG
Great topic this TC, something that has to thought about when planning a HT because once they drop it screams transplant and looks awful.
 
topccat29

topccat29

29 year HT veteran
Yes Bulitnut I agree it is all about having information and proper planning and when a clinic says it s a no go there is always a good reason. I think this patient might have had enough hair to raise the lateral humps and connect the bridge with a thin amount of hair and maybe have somewhat of a forelock/extended forelock that connected back to that bridge. It would look normal and he would not be slick bald.
 
Bigmac

Bigmac

Administrator
Staff member
Good topic and one everyone should read.
 
Pete from Farjo

Pete from Farjo

Valued member
Scary stuff Topccat!

As you say, this is something that all reputable surgeons will take into account
 
topccat29

topccat29

29 year HT veteran
Yes Pete I agree. Very good for young guys to see what can happen as it is very easy for them to get caught up in the forum chatter from other young guys that speak of going to such and such a clinic because they prefer the aggressive approach as opposed to the conservative approach. They then fall into the trap of social proof thinking the right choice is doing what everyone else is doing.

An aggressive approach that makes you look worse off in the long run is a poor decision.
 
topccat29

topccat29

29 year HT veteran
Fred I'm sure the white hair helps.

I have seen this exact same look before in public from ht patients. The last one was at Home Depot the previous summer..................this guy had very dark hair and it was a noticeable of something not being quite right even for the general public not familiar with hair transplants at least in my opinion.

It is always sad to see someone who was not properly advised.

I still believe with very extensive baldness just connecting the lateral humps at the top and giving the patient a forelock while forgoing a hairline is a better option providing the donor even allows for that possibility. This Bruce Willis picture which I have posted in the past seems to make more sense as it looks normal.

[URL=http://s271.photobucket.com/user/topcat911/media/Bruce_Willis-2-16_Blocks_zpse3428b66.jpg.html][/url]


 
Last edited:
topccat29

topccat29

29 year HT veteran
Fred I don t know this person but a quick internet search would lead me to believe the lateral humps dropped after the hair transplant. It is also a good example of someone who should have been on medication or changed their end goal with future hair loss in mind. That is what an experienced ethical clinic would do in my opinion.

I still can't believe some of the forums where I read other young guys that know nothing advising others young guys on where they should go to get that aggressive hairline that will really frame the face well. It's hard to believe that this is still going on in 2014.

Personally I would prefer less hair and no medication. Others choose more hair, use of medication and going with a strip procedure. It depends on their end goal and as long as they are making a fully informed decision it really does come down to personal preference.


 
Last edited:
topccat29

topccat29

29 year HT veteran
Fred sometimes the numbers are just not there. I would like to ask you a question since I read a recent post by you where you state you donor is 37.5 fu per sq cm if I read that correctly, you even stated it was low.

If your donor area is approximately 200 sq cm and you harvested 20% that would give you 7.5 fu per cm for a total of 1500 fu. My question is first off are those numbers on donor area and density about right? If so how do some of these other clinics come up with higher numbers as mathematically is doesn t seem to add up? If you donor area goes down to 30 fu per sq cm that would be very low, so any shock loss would be absolutely devastating with the possibility of making the donor area almost bald. Have you give this any thought and is it a concern? Harvesting higher numbers for instance that 4500 that someone gave you would be almost 60% of your donor area providing the sq area I have given is correct, the number just does not seem to make any sense, what are your thoughts.

Not trying to be negative just trying to understand your thinking and it s actually a good learning exercise as far as understanding the numbers and I could be completely wrong on the numbers so please correct me if so.
 
Last edited:
Iniesta

Iniesta

Valued member
Great post. No matter how god doc you go till, he can never save you if you started with your HT-journey when you were young and then end up like NW 6/7. Sorry, but Before we have unlimited donor this business is nothing but a scam.
 
topccat29

topccat29

29 year HT veteran
Fred thanks for clearing up the number.

If your hairloss doesn't continue then moving forward slowly might be a good option. You know your family hairloss pattern so hopefully it works out well.

Also a good number for others to be aware of.............. approximately 50% of your originally density or less in a limited area. Hair transplantation can improve your appearance.............too many young guys unfamiliar with the procedure believe it can bring back their original density and they are the ones that need to understand the procedure better when the goal is an aggressive hairline.

Ineista this person pictured Michel Fugain could have had a much more pleasing result in the end. It's not the procedure itself but the advice given and when the advice is bad it gives the procedure and the industry a very bad name. So what you have is a very large percentage of the industry not caring much and giving bad advice especially in the long run as the money is easy and a very small percentage of those that care more about what happens in the long term. Those doing the wrong thing seem to be making more money which gives them a bigger voice so it does become hard to stop much like most of what we see in the world.

If anyone can speak negatively on the industry I would probably be a good representative but I can say with complete honesty it was a matter of consistently getting bad advice and just not knowing better. If I was given better advice at the onset the end result could have been fantastic.
 
Last edited:
Pete from Farjo

Pete from Farjo

Valued member
Some good points you make there Topccat.
Long term planning - not just two or three years down the line but ten, twenty years or more - is essential when devising a 'plan of attack'.
 
garageland

garageland

Valued member
This is a very good topic and I have been meaning to reply since I saw it.

Looking at the age of the guy and the what looks to be quite pluggy result he probably had this transplant 15-25 years ago of course we can't know for certain. Propecia wasn't probably even being spoken about then and donor management and future wasn't even considered. I hope that in most clinics this has changed since those days.

Maybe he used up all his donor and can't get further work to restore the lateral humps, maybe he is living in blissful ignorance that anything further can be done or that it looks odd to us. Or maybe he can do something but just doesn't want to however I am sure it was never explained to him at the time that this could happen.

It is a very important educational lesson for all those that have transplants fut or fue and don't stabilize their hair loss.

I would be in as similar situation for sure if I didn't do any further transplants after my 3 in the 90's if I had not of had further surgery to fill the gaps and had not gone straight on propecia. Between the two lines could be a gap now, this is a real possibility of having surgery at a young age ( I was 23) a high Norwood and not stabilising your loss.




Here's me now 8 years on.


 
topccat29

topccat29

29 year HT veteran
Garageland thank you for replying and I agree the transplant was more than likely long ago judging from the pictures.

I have seen some recent pictures posted to the forum one specifically of a repair patient where by all indications the clinic seemed to use way too many grafts in the hairline while if one looked very closely the gap in the lateral hump area nearest to the temple and the top could clearly be seen to be dropping as there already seemed to be 2 -3 cm gap, not completely hairless but definitely heading it that direction. This was a young guy and instead of using all those grafts to give the patient a super thick hairline a thinner more natural hairline would have been better advised while saving those grafts to raise the lateral humps as they were clearly dropping. Maybe this is what the patient wanted regarding the hairline but I think sometimes patients need to be shown why although something might seem like a great idea this is what is going to happen, speaking specifically in this case and sometimes a picture is worth a thousand words.

Maybe this is just all habit to me and why I don t really make a good sales person short term. I m always telling customers in some of the trade work that I m doing at the moment that no, no, no you don t want to do that and here is why, almost sounds as if I am being negative but really it s not the case ¦ ¦ ¦ ¦ ¦blah, blah, blah ¦ ¦ ¦ ¦..then they go hmmm ¦ ¦ ¦ ¦..yeah I didn t think about that but that makes complete sense. So I end up doing less work or no work at all for that specific customer but they always remember me and long term they always call me and tell their friends about me. If I am in a position of superior knowledge I have an obligation to inform them as one can easily see they are completely clueless and if I wanted to I could tell them anything ¦ ¦ ¦ ¦.double or triple the price but that is just not my style. Some clinics seem to follow the same approach while many head in the other direction not giving the best advice regarding long term planning, techniques, procedure size etc. Of course I like the clinics that do what I would do as we connect more to those that are like us.

Pointing out the potential gap in the lateral hump area regarding that recent patient would have been a good reply post in my opinion as it benefits the community and not the one individual and the community representing larger numbers of many who only read would have been the greater good in the end. But of course I didn t want to come off as being negative or if the patient was reading the post make him feel bad so although I wanted to inform others at the time I simply could not do it.

Seeing the picture Fred posted recently on another forum gave me an opportunity to address it as it was on my mind for some time. Most clinics hopefully know better than to do this and having more prospective patients aware of what can happen gives them something to think about when planning for the long term.

Thanks again for the reply.
 
garageland

garageland

Valued member
Hi Topcat,

I still see this going on which is why it is an important topic I have seen patients have surgery in the last few years with other clinics and these patients have been given totally inappropriate low hairlines on a Norwood 6 for 1500 to 2000 grafts not taking medication they have then lost all native hair and the lateral humps have dropped so there is a gap. In some cases there is just not enough donor hair to address all that they need to get them to a natural balding pattern again.

In these cases they would be best to fue out the low hairline and plant the grafts further back. Some patients are very educated and others are not in some cases I have had patients demanding these low straight hairlines with extensive loss and we will walk away.

So what do you do when you get a Norwood 7 patient in that has lost the lateral humps? You have to rebuild them or you just cannot tie the hairline to the sides or you would end up with a hairline like the line I drew in black on the patient below which is way too low. Here is an example of a NW7 patient when the lateral humps are rebuilt, he gets a natural mature look to frame his face and gets a significant cosmetic improvement.

Before front



After Front



Design Pre op








If you were to tie the hairline to the sides without rebuilding this is what the hairline could end up looking like.




 
Last edited:
topccat29

topccat29

29 year HT veteran
Garageland that is an absolute fantastic result for someone with that degree of hairloss.

Looks completely like a natural head of hair............more prospective patients need to see this........................and although many younger guys will not get it..........they better start paying attention.
 
Last edited:
garageland

garageland

Valued member
Hi Topcat,

Thanks very much, it is actually an old result hence the before photos are scanned from actual prints but are one that I show patients of advanced Norwood scales at my consultations. It demonstrates just how to provide a natural loss pattern on a NW7 a high hairline and coverage far enough back to into the scalp.
 
Bigmac

Bigmac

Administrator
Staff member
This is a very good topic for people who don`t understand the importance of donor management and expectations.
 
T

Todd

member
I can see how the lateral humps dropping could cause major problems some years down the line. If you`ve run out of donor, you`re literally up the creek without a paddle.
 
Top