Hi folks,

I've been quoted as needing approximately 2000 grafts to restore my hairline. I'm toying with the idea of splitting that number into two FUE procedures.

Procedure 1 of maybe 600 grafts to strengthen my forelock (section 1 below) first to see how it grows. My forelock is in fairly decent shape, but there is some diffuse thinning which needs addressing.

If after 8 months things are looking good, then go back for 1400 densely packed FUE grafts to widen the hairline which is currently bald (sections 2 below).

Of course the numbers quoted for each procedure are guestimates on my part, but they're probably close. I figure I'd accomplish two things that way:

1) I'd see if I naturally yield good growth via FUE. If I don't, then it will be limited to a part of my scalp where I still have a decent amount of hair so hopefully it wouldn't be much of a change for the worse, and I would scrap FUE procedure 2. But if I do yield good growth, then I can go more confidently into FUE procedure 2.

2) I'm avoiding an FUE megasession which might help me achieve better yield overall.

Thoughts?

Thanks,

z

Zen, I think it is a good and safe plan. Very smart planning. Your idea of splitting it into 2 procedures 8 months apart is very reasonable and smart. To get the best yield, it may be the best route to take. 8 months apart and then you can add more safely without endangering your grafts. In the long run, it will probably help you conserve your precious grafts. But remember, there are important factors to consider and that is what methods the grafts are extracted from (manual, motorized, robotic) and the maximum amount of density you will place on your hairline. I like the design you drew as well as illustrating the hairline. Look forward to seeing how you approach this. As always, I enjoy your very valuable posts pal.

__________________
Dr. Rahal FUE 3016 Grafts
My Hair Loss Website

Sean,

Thanks for your input! I'm seriously thinking that's the way I'm going to go.

I may even have two different surgeons do the procedures. The first should be done by one who is exceptionally skilled at planting into existing native hair. The second should be done by one who is exceptionally skilled at densely packed and natural looking hairlines. If I can settle on a doc that's really great at both, then all the better, but I won't necessarily limit myself to one doc if I'm not confident that s/he can handle both approaches to the utmost.

Given your experience, which extraction method would you now prefer - manual or motorized? We don't have enough info yet regarding robotic extraction.

Regarding density, when I was quoted 2000-2200 grafts, it was with a hairline density of approximately 60 fu/cm2 in mind. Do you think that degree of density is too risky?

Thanks,

z

Hey bud, I think your approach is good. Honestly, I am in the middle when it comes to motorized approach. Some arguments I got included things such as, "The tool can heat up possibly & might create more trauma if not extracted properly". I don't know if that may have effects on yield. From my experience, I did have some long term shockloss on one side of my donor area where some grafts seemed to get stuck during extraction (not easily pulling out). Honestly, in terms of quality, I really can't comment yet as I am not there yet fully grown out. I still got till end of September to conclude a full duration of 12 months. However, I have analyzed tons of manual FUE results averaging 700-1000 grafts a session and amazed by yield. A lot of folks have messaged me and explained they prefer manual as they feel it is more hands on warranting the price they paid for fue vs quicker extraction at twice the cost. They also prefer doctor extraction vs technician extraction. The main argument some folks discussed with me were they would rather have lower number of grafts per session at a slower speed with more manual hand control versus faster motorized extraction resulting in higher number of grafts extracted through more machine control. It kind of makes sense.

For density, i think with the hair type you have seems reasonable(really fine to medium straight hair). If you had really thick straight Asian hair for instance, i wouldn't suggest high density since thicker hairs need more blood for nourishment and compressing such larger diameter hair grafts in a small area will really be traumatic and will probably naturally hamper your result. With our hair types, I dont think high density is much of an issue to begin with as long as it is done properly. The thicker the hair, the more challenging it becomes to dense pack under FUE. I had 65cm2. Some doctors can do up to 80cm2 successfully if you have the hair for it. So, you with 60cm2 seems reasonable and I do not think it is too risky, especially under your specific well thought approach. I have read so much into this particular subject since my transplant.

Watch the punch size used pal, don't use over 1mm punches as your hair type is suitable for .8mm-.9mm extractions since it is fine hair as you mentioned before. I know that for a fact.

Again, with FUE, I am starting to believe less is more. The less you have extracted in one day, may enable you to have higher yield in the end. As a sufferer myself, I refuse to give you any advice that may put you in jeapardy so I really want to give an honest, based on research opinion. Please do take it slow as you are suggesting. A lot have people have advised me to do the same. Work in one area and move to a fresh area next. Do not work in the same area later unless there is a cosmetic issue.

So, my thoughts are that you are on the right track. I agree with your approach. If I could turn back time, I would probably approach it like that based on everything I have read today as well as what others said to me based on their own experiences. I learned quite a bit.

Keep us posted pal.

__________________
Dr. Rahal FUE 3016 Grafts
My Hair Loss Website

Hi Zenmunk

2000 FUE is not a mega session. I would go for a single session at 2,000 grafts and save the additional second trauma to the scalp 8-12 months later.

I had well over 2,000 FUE 10 weeks ago with no issues at all. The other patient had over 4,200, but they said they wouldn't go any higher in 1 session.

Both of us are seeing great early growth, no shock loss and no complications.

Rob

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2800 FUE, Istanbul with Health Travel International

Great Thread!
zenmunk- your plans sounds well thought out, and smart.

@Sean, who on earth wants to get drilled? Screw Motorized FUE. I only believe in the state of the art manual FUE where the real talent is.

@zenmunk, Very smart approach and planning. Most of FUE mega sessions in one day are failure, even it yields, it yields poorly. Browse the forum and you will know what I mean. Anything above 2000 grafts should be broken into two sessions. If I were in your place I would even break the 2000 grafts into two days in order to be in the safe side unless you are going with a real FUE doctor who does atleast more than 3 FUE surgeries a week.

__________________
Hairline Repair + Scar Revision via BHT FUE with Dr. Feriduni on July 3, 2013
Scar Tricopigmentation with Dr. Koray Erdogan on May 3, 2013
2500 FUT (Hairline Repair) with Dr. Rahal on July 26, 2011
My Hair Treatments:
1- Alpecin Double Effect Shampoo (Daily)
2- Keratene Alphactive Retard Capsules (Once a day)
3- MOPC world Minoxidil 10% + Azelaic Acid 5% (Once a day)
My Rahal HT thread http://www.hairrestorationnetwork.co...ne-repair.html

I think Sean and Harari both explained it better than I could. But some things you should be aware of:

-Shockloss in the existing hair. Due to the trauma of implanting into native hair, you will probably look worse for a few months until the hair grows back.
-It will probably be hard to gauge the growth in the forelock where there is existing hair. Monthly photos would help but would still be difficult to gauge the yield in that area.

I don't see any flaws in your method however. Good on you for thinking about the potential yield over the convenience of one session and one recovery period.

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Links:

Revamped Advantages/Disadvantages of FUE. Myths dispelled. Educate yourself

Everything FUE. Manual, motorized, ARTAS, NeoGraft, physician details and more

FUE Norwood 1-6 examples

Hair Transplant Basics. Must read. Constantly updated. Content loaded.

Sean,

Thanks a lot for your thoughtful reply. I appreciate you looking out for us based on what you've learned from your experience so far.

So, if I were to list your main points they'd be:

- manual punch may be the better way to go especially if I'm splitting the 2000 grafts into two smaller procedures 8 months apart,

- doctor extraction may be superior to technician extraction,

- A hairline density of 60 fu/cm2 would probably be OK for someone with my hair characteristics,

- punch size between 0.8mm - 0.9mm should be used if possible.

OK, if you were looking for top FUE surgeons who use manual punch; create densely packed and natural hairlines (up to 60fu/cm2); use 0.8mm - 0.9mm punch; accept international patients; extract grafts themselves; and, have consistently outstanding results, then who would make the list?

Have you heard of docs like Rahal, Feller & R. Shapiro using a manual punch if requested for smaller sessions?

z

Congratulations on your successful surgery, Rob.

Your points are well-taken. However, what constitutes an FUE megasession is not clearly defined. Some people say 2000+; some say 2500+; some say 3000+; and, so on. Also, not everyone does well with FUE (or even strip) regardless of the number of grafts.

My plan is to do FUE procedure #1 to strengthen my forelock, sort of as a test to see how well it grows. And, then take it from there. I realize it prolongs the agony so to speak, but I think it may be worth it. I'll be discussing my plan with docs and make a final decision after getting their feedback.

z