JessicaWHTC

Typically, surgeons use hair from what is called the "safe donor area". This means that the hair that they harvest is safe from further hairloss. Hairloss is difficult to predict. You never know how much you are going to lose. The safe donor area is the back of your head, from ear to ear, and from the nape of your neck to the outside rim of the crown, approximately. Usually, when surgeons take hair from the top of the head, it is to repair a previous, poor hair transplant. I hope that helps --------------------------

Great information on PA's, thanks for posting it. I can vouch for Hoping's posts. I earned my surgical technology degree in Florida, so I am familiar with these laws and these posts are correct. However, not all hair transplant techs are Physician's Assistants. Some are Surgical Technologists, Medical Technologists, Medical Assistants, etc. Some have purely on-the-job-training. I think some of these rules apply to all medical professionals, such as presenting themselves in a way that is not "false, deceptive, or misleading." We need to choose our words wisely and present ourselves accordingly. ---------------------------

I like that Dr. Keene went with a lower density. Transplanting into areas of diffuse thining can accelerate hair loss. By choosing a lower density, it allows you to hold onto the hair you have a little longer. The addition of Propecia can help stabilize your loss as well. If you need more density later, you can always go for a second pass. Looks like nice work so far. ----------------------------

Yes, you can take hair out of any place on your head or body. May I ask about your situation? Where do you want to move the hair to? -----------------------------

I agree. I think that it will take a while. When they began to study hair, they realized that it is much more complex than was once thought. I think in the future, hair transplant will be a two step process - obtaining donor hair to multiply and cultivate, then returning the multiplied hairs for transplant in the traditional way. -----------------------------------

Oh, I see. There are a few different methods that have been publicized. I think the one that you are referring to only transplants "germination" cells to the scalp and waits to see if it grows. Two of the methods that I have seen include neogenesis and morphogenic switches. http://www.aderansresearch.com/pdfs/10CurrOpBio_08_05.pdf Now it seems that the most promising techniques harvest the main contributors, such as dermal papilla and epithelial stem cells, and cultivate them in the lab. When this method is used, it seems that there is not concern for the direction of hair growth. What do you think? I like the idea of cultivating the hairs in media or artificial skin before transplanting them to the patient, rather than injecting cells. --------------------------------

Although they are both SSRIs (serotonin reuptake inhibitors), Lexapro has a different mechanism from Zoloft. This means that it targets different receptor sites in the brain, so it may affect you differently. Lexapro is more selective than Zoloft, so the side effects are often milder. If it helps, I know two people, one with anxiety and one with depression, who both did much better on Lexapro than Zoloft. But, it is different for each patient. Keep a log of how you feel and bring this to your doctor so that he/she can adjust your dosage times, strength, etc. If it doesn't work, try not to get discouraged. Keep working on it. -------------------------------

Tan Gill, You are doing the right thing by taking medications to stabilize and slow down your hair loss. Please continue to do this. Your hair loss is progressing, and will probably continue to progress throughout your life. Keep that in mind when considering surgical options. For example, If you transplant into your crown, the transplanted hairs will remain while your native hair will continue to receed. This will give you an island of transplanted hair in your crown, and you will need another transplant later. There is nothing wrong with having more than one surgery, but it is something to consider and prepare for. There are conservative approaches that can help you to maintain a natural look as your hair loss progresses. Having consults with different doctors can help you to find the best choices for you. The good news is that your hair color and complexion make it easier for you to achieve coverage with fewer grafts. You also have nice, thick caliber hair (from what I can tell), which helps to achieve coverage as well. I hope this helps. Let me know if you have any other questions that I can help with. ----------------------------------

I love theoretical questions! But let me make sure that I understand your question. If we could clone/multiply hair follicles, what would be the advantage of growing them in an artificial skin environment vs. enriched media and petri plates? --------------------------------

I have to agree with Bill. Sure, Dr. Mwamba has versatility with adjusting to different patient characteristics and physiology, but to say that he offers FIT/FUE to everyone is not accurate. Many people have unrealistic expectations, poor scar healing, keloid history, genetic allopecia, insufficient donor, severe hair loss, endocrine imbalances, (the list goes on) which makes them poor candidates for transplant and/or FIT/FUE. For patients that have high laxity in the donor, strip is sometimes a better option, so that is what Dr. Mwamba suggests during consults. He tailors each surgery and each consult to the patient. Every patient is unique, so blanket statements typically do not apply to the medical field. ---------------------

Yes. FIT surgeons use instrumentation that is unique to them.. Surgeons must have permission to use the FIT instruments or to call their procedure FIT. Why? In the wrong hands or when used improperly, these instruments can cause damage to patients. If a surgeon wants to use these instruments, they must be trained and tested thoroughly. They must also agree to FIT standards, which are basically ethical standards of practice held by most upstanding surgeons. If a doctor wants to open their own FIT clinic, he/she must complete a residency with an FIT surgeon. However, this still doesn't mean that FIT is better than FUE or anything like that. Eventually, FIT instruments will be available to all. The doctors have chosen not to make them widely available yet because they are forever tweaking, adjusting, modifying, etc. Everytime they say an instrument is complete, a patient comes in with parameters that are outside that instrument's range of capabilities, and they start modifying again. Prototypes have been featured at conventions and meetings such as ISHRS events. Lectures have also been given about surgical findings, case studies, statistical growth studies, and FIT techniques that are ready to be made available to the public. Dr. Mwamba has a very good track record at these events. This is a common occurrence in other surgical fields as well. For example, if an oral surgeon (who mostly extracts impacted wisdom teeth), wants to offer his patients dental implants (permanent false teeth), then that surgeon has to attend courses, be trained, get approval from a board or directors, obtain a certificate, etc. before he can be allowed to perform the procedure or obtain the instruments and supplies. The field of hair transplant is not well regulated by the government. Any surgeon can offer hair transplants to their patients without certificate or additional licensure. Regulation has to start somewhere. How else are we going to offer more patient protection for the future? Until then, all we have are internet forums to drive the unethical and the uneducated out of business. -------------------------------------

Right. FIT is a variation of FUE. Neither is better than the other. Some approaches are more appropriate for the patient's goals. There is not always one surgeon or clinic that is best for the patient, but a variety of choices.

Right. FIT is a variation of FUE. Neither is better than the other. Some approaches are more appropriate for the patient's goals. There is not always one surgeon or clinic that is best for the patient, but a variety of choices. Sorry I didn't answer your question at first. I didn't know that the terms FIT and FUE had been so inappropriately used. Interesting. ---------------------------------

[sorry this answer is so long, but its a complicated question! ] Firstly, any incision into the skin can cause a scar. Even a paper cut. FIT and FUE can only be called "scarless" when compared to the old strip scars. At the time FIT and FUE were first appearing, it probably seemed "scarless" in the excitement of the time. Since then, people have been taking a more in depth look at the effects of hair transplant on the donor. Thus the terms describing them are no longer specific enough. There is no need to take anymore donor hair than is absolutely necessary (you never know how much you might need in the future as hair loss is mostly unpredictable). There is also no need to create more trauma than is absolutely necessary with the advances in technique and equipment that are available today. For example, there is no need for 2-3mm punches anymore. They are obsolete and bad technique. When I talk about punch sizes, I am referring to the current technology available, which, depending on the surgeon's definition of "diameter" or "size" ranges from .5-1.5mm. This is not necessarily FIT sizes or Dr. Mwamba's sizes, just sizes that I have seen reported on the forums and other publications. Punch sizes are difficult to compare because not all punches are created equal. Some of them don't even look similar. As B spot points out, there is an inside diameter and outside diameter to the punches. So it is hard to tell which diameter a particular clinic or surgeon is talking about. And besides inside and outside diameter, there are a dozen or more other tiny details and aspects that can be variable in the punch design and technique alone. Dr. Mwamba uses a kind of instrumentation that is unique to FIT. He can change and adjust different parameters to customize the surgery, and more specifically the harvesting, or "punching" of the donor grafts. Hair characteristics, angles of growth, dermis thickness, etc. also change from one area of the scalp to another. So, he keeps making tiny adjustments to best facilitate the intact and complete removal of the graft as well as the donor healing and overall appearance of the harvested donor. Some, OK, many of the details about his punches and techniques are intellectual property and protected by law. (Which is a shame because I love talking about the technical aspects of FIT). The idea is to have the punch size and other parameters "fit" the follicular units. It is not about large or small. It is about the punch being appropriate. For example, let us simplify things by pretending that there is not inside or outside diameter and the scalp is a flat, two dimensional surface. The punch creates a circular cut around the follicular unit. At the epidermal level (on the surface of the scalp), the hairs of the follicular unit are close together, fascilitating a very small diameter incision. As you travel deeper into the dermis and subcutaneous layers, the hairs of the follicular unit splay out and travel in different angles. Sometimes they curve under the skin at nearly unpredictable directions. This necessitates a punch of larger diameter (not a large punch, but larger than the epidermal size of the unit). If a punch that is too small for the follicular unit is used, hairs and follicle sheaths can be damaged or destroyed. This can cause the death of the hair, shock loss, ingrown hairs, hairs growing in the subcutaneous tissues, and the need to punch out more follicles to complete the surgery. If a punch that is too large for the follicular unit is used, obviously, there can be more scar tissue created than necessary. It can also damage the neighboring follicular units, causing the same consequences as when a punch is used that is too small. There are also some techniques that maximize the safety of the follicles while minimizing the scarring produced. But that's another story entirely. Here is a link to pictures of Dr. Mwamba's donor results, pre-op and at 12 months post-op: http://www.hairrestorationnetwork.com/eve/showthread.php?t=149881 The patient's donor area is cut to a length of about 3-5mm long. The patient is looking down with his chin to his chest and the camera is almost resting on the back of his shoulders. This way, you can look up between the hairs directly to the scalp. There is not really visible scarring. At most, there is a gap between follicular units, which will occur regardless of punch size. ---------------------------

Yes. Some of the standards that exist amoung FIT surgeons are shared by other surgeons in the field. Many surgeons agree that 2 and 3 hair grafts don't belong on the hairline. Unfortunately, some still find it acceptable, and some are taking a while to come around. Its all about extablishing general standards, procedures, and instrumentation. Not every standard is unique to FIT only. It is just important to discuss with your surgeon the details of your hair, goals, and future plans. It is equally important for the surgeon to give the patient the best possible options for their individual case, unrestricted by the doctor's abilities. If the best option for a patient is a procedure that the surgeon doesn't perform, then the surgeon should give the patient a referal to another surgeon who does offer that technique. -----------------------

I feel a little differently about the difference between FIT and FUE. The basic, generic descriptions are the same. It is a hair transplant method that is defined by the removal of a single follicular unit from the donor area followed by the transplant of that follicle to the recipient site. The difference lies in the details, standards, techniques, instrumentation, and practice. The doctors who use the FIT techniqe agree on certain standards. They isolate and target flaws in hair transplantation and work together to solve these problems through the invention of new instrumentation, procedural standards, and patient care. It can be a simple agreement, for example, we will not place multiple-hair units on the frontal hair line because it doesn't occur in nature that way and thus has an unnatural appearance. Some agreements are more complex, for example, when a patient seeks our help with characteristics x, y, and z, we will agree to discourage surgical options a, b, and c due to increased risk of scarring, poor yeild, or complications that can arrise as the patient's hair loss continues through out his life. However, we will offer alternative options l, p, and q to meet his/her needs. Some agreements are greatly in depth and involve patent-pending techniques and equipment. These are intellectual property and are protected by law. Some aspects are not legal to divulge to the general public, thus the ambiguity around certain issues. Also, keep in mind that lot of the standards of FIT are centered around what the surgeon WILL not do, rather than what he CANNOT do. Standards are developed by taking a critical analysis of results, even if the results are the best that can be achieved at the time. For example, in the early 90's the goal was to get hair to grow in a bald area. Now it is much more involved. It must have a certain percentage of yield, graft survival, natural pattern, appearance, elimination of the "pluggy" effect, good donor healing, concern for the patient's future loss, etc, etc. You've been on the forums, so you are aware of the many criteria that are involved in judging a transplant "good" or "bad". Even with FUE, there are some distinctions. How many times have you heard "good FUE surgeons" and "bad FUE surgeons"? FIT is defined and seperated in the same manner, but the differences are more defined in their practice and standards. It's still ambiguous, I know! But if you can ask more specifically, I can tell you the approach that FIT takes. ---------------------------------------

"This is a 30 year old patient who wanted to rebuild his hair line.He usually keeps his hairs short and choose to go with FIT in our Brussels clinic. We build a low hair line (around 6cm).To give the impression of even lower hair line we rebuild a widows peak around 5 cm. Our team will be happy to share your comments and we will keep you tune with our progress in the old and beautiful continent. thank you, Dr Mwamba Patrick"

Hi, Tommy! Hope you are doing well, and that docs worldwide are taking advantage of your skills and expertise. The more we can spread good techniques and superior patient care, the sooner we can see the end of bad, pluggy hair jobs and scarring. ------------------------------ Bill, You have a great eye, and you are so well educated on hair transplants! Awesome! The whirl in the crown is hard to see in the immediate post op picture because it is more about the angle at which the site is made, rather than the overall pattern. I have added a pic with arrows showing the direction that the grafts are angled, thus the direction that they will grow. The dot is the center of the whirl. Beware the clinic that transplants crowns in straight rows! The idea is to mimic what growth pattern occurs already in nature. Dr. Mwamba uses the patient's own hair patterns to determine the route that he will take. The patient wanted to focus on the front. This was his main area of concern. Once we achieved his number one goal, we moved to goal number two, which was just a sprinkling of coverage to the crown. Because funds and donor hair supply are limited, Dr. Mwamba wanted to make the biggest impact with the fewest amount of grafts. In the crown, it is not about where the hair is placed, but the coverage that it will lend to the overall crown. With a clockwise whirl, most of the coverage comes from the patient's right side, so that is where we placed the majority of the grafts. The left side of the crown had hair that was offering some coverage, but they were fine, somewhat miniaturized, and susceptible to future hair loss, which has occurred here. A second pass would definitely give him great coverage in the crown, but keep in mind that this patient is headed for advanced class V. He will lose more crown hair. By adding minimal coverage at this time in his life, we can avoid obligating him to future surgeries. In other words, it will still look natural and good as his hair loss progresses. Hope that helps, Bill. Great observations and in all the right places! -----------------------------------

Sorry, Bill. These are the best and only pics I have for this patient. I am aware that some clinics, (who shall remain nameless at this time), do play with lighting and such to create the illusion of good transplants. No doctor should be judged by on pictures alone. For better pictures of Dr. Mwamba's work, see this post: http://www.hairrestorationnetwork.com/eve/showthread.php?t=146383 There are also more posts to come. -----------------------------------

Hello from Dr. Mwamba's clinic in Bruxelles, Belgium! Here are the before and after pictures for a patient formerly on the verge of Class V. We grafted 2739 FIT grafts to the hairline and frontal third and 770 FIT grafts to the crown for a total of 3509 grafts. At 8 months post-op, this patient can look forward to another 20-30% growth as the transplanted hairs continue to mature. I will let the pictures speak for themselves, but if you have any questions, don't hesitate to ask ----------------------------------- I am not a doctor. I am a surgical tech trained in hair transplant. My opinions are not necessarily those of Dr. Mwamba. My advice is not medical advice.

Hello from Dr. Mwamba's clinic in Bruxelles, Belgium! A patient recently sent us pictures of his 12 month results. We grafted 2600 FIT grafts to the frontal third to strengthen the hairline and add overall density to the front. As you can see from the before and after pictures, it made quite an impact! Perhaps if he comes in for a follow up visit, we can get even more detailed pictures. This patient had an average calculated density of 2.5 hairs per graft. This is the density occurring naturally in the donor area. Because this patient chose FIT, Dr. Mwamba was able to pick and choose the grafts to extract. This allowed the patient to increase his yield to around 13,000 hairs transferred to the frontal third. Another benefit to the flexibility of FIT is that Dr. Mwamba can choose the finest hairs for a very natural frontal hairline, and coarser hairs to add density throughout the front. ----------------------------------- I am not a doctor. I am a surgical tech trained in hair transplant. My opinions are not necessarily those of Dr. Mwamba. My advice is not medical advice.