I'd rather not post pictures, but may do so if necessary.
Anyway, here's my story. Started thinning/receding at 14. Doctor told me at 16 that Propecia wouldn't meaningfully halt the balding process, and since the internet wasn't much of a thing back then, I didn't end up regularly taking the drug until I was over 18, and already at NW3 (I was seeing a derm for some other reason, and he told me it could definitely help). At 27, as a NW3 with some barely noticeable thinning in the midscalp and crown (guess that means I was NW3-V or even a 4), I finally had my first hair transplant. About 2,000 grafts were added within the preexisting hairline to create the illusion of sufficient density, and about 400 more were placed in the mid-scalp. I opted for strip surgery at my surgeon's recommendation, and don't really regret it (biggest downside is probably the pain, assuming you end up with a decent result, and I think most good surgeons deliver at least decent results if you open you wallet and start or continue with the meds on market). Essentially, I became a NW3 with presentable density moving forward in the future.
I suspect most of the thinning hair already present in my hairline was transected or otherwise lost over the next 5 years, before I had my second transplant at 32, with the same surgeon. The density nevertheless still appears to be pretty good, despite the use (I suspect) of only 30 hairs per cubic centimeter (I have wavy and fairly light hair). I wanted to do some additional work to round out and lower my hairline, and to put some grafts in the mid-scalp and/or crown to guard against future loss. This surgery didn't really work out the way I'd liked. Even though I supposedly have very good to great donor density and scalp laxity, only 1,800 grafts were taken out (in large part I think to ensure a pencil-thin scar, and at least that part worked out), and because I believe my surgeon is pretty conservative, he only added a few hundred grafts to the hairline, and placed the remainder in the mid-scalp.
I presume I have at least another 2,000-3,000 grafts to play with, and perhaps as many as 4,000-5,000, although it may be advisable to use both one more strip and some FUE to hit maximum utilization with minimum risk. I'd like to add somewhere between 1,000-1,500 grafts to move down to a NW2 or Norwood 2.5, with the remainder to be used to reinforce a crown that still basically looks fine to the naked eye, and to create some thin lasting coverage assuming no great advances are made over the next decade or so to allow for follicle revival or neogenesis. Does this seem reasonable? More importantly, how can I ensure that I find a highly competent surgeon that will actually listen to me and attempt to execute my treatment goals for the near future, instead of worrying purely about ensuring I still have 5,000 grafts "in the bank" at 50?
Anyway, here's my story. Started thinning/receding at 14. Doctor told me at 16 that Propecia wouldn't meaningfully halt the balding process, and since the internet wasn't much of a thing back then, I didn't end up regularly taking the drug until I was over 18, and already at NW3 (I was seeing a derm for some other reason, and he told me it could definitely help). At 27, as a NW3 with some barely noticeable thinning in the midscalp and crown (guess that means I was NW3-V or even a 4), I finally had my first hair transplant. About 2,000 grafts were added within the preexisting hairline to create the illusion of sufficient density, and about 400 more were placed in the mid-scalp. I opted for strip surgery at my surgeon's recommendation, and don't really regret it (biggest downside is probably the pain, assuming you end up with a decent result, and I think most good surgeons deliver at least decent results if you open you wallet and start or continue with the meds on market). Essentially, I became a NW3 with presentable density moving forward in the future.
I suspect most of the thinning hair already present in my hairline was transected or otherwise lost over the next 5 years, before I had my second transplant at 32, with the same surgeon. The density nevertheless still appears to be pretty good, despite the use (I suspect) of only 30 hairs per cubic centimeter (I have wavy and fairly light hair). I wanted to do some additional work to round out and lower my hairline, and to put some grafts in the mid-scalp and/or crown to guard against future loss. This surgery didn't really work out the way I'd liked. Even though I supposedly have very good to great donor density and scalp laxity, only 1,800 grafts were taken out (in large part I think to ensure a pencil-thin scar, and at least that part worked out), and because I believe my surgeon is pretty conservative, he only added a few hundred grafts to the hairline, and placed the remainder in the mid-scalp.
I presume I have at least another 2,000-3,000 grafts to play with, and perhaps as many as 4,000-5,000, although it may be advisable to use both one more strip and some FUE to hit maximum utilization with minimum risk. I'd like to add somewhere between 1,000-1,500 grafts to move down to a NW2 or Norwood 2.5, with the remainder to be used to reinforce a crown that still basically looks fine to the naked eye, and to create some thin lasting coverage assuming no great advances are made over the next decade or so to allow for follicle revival or neogenesis. Does this seem reasonable? More importantly, how can I ensure that I find a highly competent surgeon that will actually listen to me and attempt to execute my treatment goals for the near future, instead of worrying purely about ensuring I still have 5,000 grafts "in the bank" at 50?