forehead reduction VS hair transplant (no hair loss)

[uniform-experiment]

hi there everyone

I have a rather unique situation here which I was wondering if you could shed some light on. I am of Asian (Chinese) origin, aged 31.

To begin, I was born with a naturally very high forehead. To make matters worse, I was also born with naturally very fine/thin hair. So whilst others who have high foreheads and thick hair have had the luxury of using their thick hair to cover their foreheads, I don’t have this luxury.

In addition, I don’t have symptoms of hair loss or balding. Neither my mum nor my dad has had a history of hair loss or balding. My dad also has a naturally very high forehead, and also naturally very fine/thin hair, but no history of hair loss or balding (according to my mum and I would imagine that she would be in quite a good position to comment accurately on this). My mum says that my forehead and hair etc is almost identical to my dad (no surprises here I guess). In fact, looking at past photos (my dad was deceased at the age of 56) it clearly seems so too.

From asking relatives on both sides of my parents, it seems there has been no history of men who had hair loss, with the exception of my maternal grandfather, who was completely bald. But having said this, both the sons of my maternal grandfather, i.e. my mum’s brothers did not have hair loss and to this date (early 50s) have a full healthy head of hair.

Here’s a picture of myself to aid this discussion :
http://i44.tinypic.com/juy9z8.jpg

So obviously, as it can be expected, I am looking for a way in which I can reduce the size of my forehead. After doing all the necessary research I arrive at the conclusion that there 2 ways to do this, namely :
a) Hair Transplant
b) Forehead Reduction

I have a few questions pertaining to each procedure that I have not been able to obtain answers from either direct consultation with a local doctor or via research on the internet.

a) Hair Transplant
Q. How much hair density should I be expecting in the transplanted region? I know it is in principle an obvious solution which is to take hair from the back of my head and transplant it to an area of my forehead where no hair had grown before. However in consulting with 2 doctors, one concern which was brought up was that the density of the transplanted region could never be as dense as my natural hair. One doctor even estimated that the maximum hair density which could be achieved (regardless of number of sessions) was only about 25-30% max. Now this number is a little low. I am aware that there is a limit to which a certain density can be achieved because it would mean transplanting hair too closely in-between previously transplanted hair. But, from your experience, is this 25-30% an accurate ballpark figure as to the max density I can achieve?

b) Forehead Reduction
Q. Is there a reasonably accurate way to find out if I will lose hair and bald out in future? My concern here is that forehead reduction will leave a scar and obviously if I bald out in future the scar will be visible. I have some reassurance from my family history and the similarities between myself and my dad, but are there other ways to tell? I was reading up on hair miniaturization and also the HairDX test, are these sure-fire ways to tell?

Q. Is there a way to make the scar (post-forehead-reduction) less visible? Again this is the same concern that if I lose hair in future to the extent of being bald that the scar becomes visible.

Final Q. Which operation should I go for ? Hair transplant, or Forehard reduction ?

Thank you.
Sincerely,

[Mark]

Here’s a picture of myself to aid this discussion :
http://i44.tinypic.com/juy9z8.jpg

So obviously, as it can be expected, I am looking for a way in which I can reduce the size of my forehead. After doing all the necessary research I arrive at the conclusion that there 2 ways to do this, namely :
a) Hair Transplant
b) Forehead Reduction

I have a few questions pertaining to each procedure that I have not been able to obtain answers from either direct consultation with a local doctor or via research on the internet.

a) Hair Transplant
Q. How much hair density should I be expecting in the transplanted region? I know it is in principle an obvious solution which is to take hair from the back of my head and transplant it to an area of my forehead where no hair had grown before. However in consulting with 2 doctors, one concern which was brought up was that the density of the transplanted region could never be as dense as my natural hair. One doctor even estimated that the maximum hair density which could be achieved (regardless of number of sessions) was only about 25-30% max. Now this number is a little low. I am aware that there is a limit to which a certain density can be achieved because it would mean transplanting hair too closely in-between previously transplanted hair. But, from your experience, is this 25-30% an accurate ballpark figure as to the max density I can achieve?

Basically, you can achieve any density you want in the transplanted area as long as you have the available hair to transplant. If you have very dense hair in the donor area then you can achieve a great density in the transplanted area. Your doctor was correct that you might not be able to achieve the right density in one session, but if you spread out the surgeries over multiple sessions there aren't usually any limits to it aside from the amount of donor hair you have.

But that's the key, if you have low density in your donor area, you may simply not have enough hair available to move from the back of your head to the front. Perhaps that's what your doctor was telling you?

Also, the laxity of your scalp can be an issue too. If your scalp is very tight, it may not be possible to take as much hair out as if it were loose.

b) Forehead Reduction
Q. Is there a reasonably accurate way to find out if I will lose hair and bald out in future? My concern here is that forehead reduction will leave a scar and obviously if I bald out in future the scar will be visible. I have some reassurance from my family history and the similarities between myself and my dad, but are there other ways to tell? I was reading up on hair miniaturization and also the HairDX test, are these sure-fire ways to tell?

You've pretty much got the reason why forehead reductions are not usually done in men. If you end up balding, you'll have a huge scar in the front of your forehead. There really aren't any 100% positive ways to tell if you WILL bald in the future. You can have a genetic test to see if you have the balding gene and if you don't then it might be safe to do a forehead reduction type of surgery according to Dr. Rassman. If you were in your late 40's or 50's it might be a different story as your balding pattern would likely show by then. But being your age I doubt you'll find too many honest doctors out there that would do it for you.

Q. Is there a way to make the scar (post-forehead-reduction) less visible? Again this is the same concern that if I lose hair in future to the extent of being bald that the scar becomes visible.

Sort of. In the beginning you can get a hair transplant to cover the scar, but if you bald significantly that may not help. We did have one patient here who had a big scar on his forehead from (if I recall correctly) a motorcycle accident. To loosen up his scalp enough to cut the scar out, he had to have what is essentially a breast type balloon implant surgically placed under his scalp that was slowly filled up with saline over the course of a month or two. After that period, the implant was removed, the scar tissue was surgically removed, and his scalp was sutured back up.

He still ended up with a scar, although it was much smaller and less noticeable than the one he had previously.

As you can imagine, there is a heck of a lot of dedication required to go through a procedure like that.

Final Q. Which operation should I go for ? Hair transplant, or Forehard reduction ?

Thank you.
Sincerely,

Dr. Rassman usually recommends a hair transplant, but if you are negative for the genetic test for balding, you then might be a candidate for a reduction type of surgery which is done on most women. Although you will want to speak with your doctor to make sure that your scalp laxity and donor density is high enough to give you the results that you want if you undergo a hair transplant to accomplish your goals.

Do you live anywhere near the Los Angeles or San Francisco area in California? Dr. Rassman said he would love to evaluate your situation if you'd like to come by for a consultation.

Hope that helps!

-Mark