ThisOlHead

Donor is probably extremely limited after many HT sessions. I had read some on Dr Umar and will likely meet with him. What things stand out with Dr Mohebi's work? I am not so familiar with him, and see that I probably should do some reading as well.

There are so many HT doctors in LA, OC and San Diego, but can you suggest any that stand out for their success in doing repair of older work?

I was surprised as well. To me, the best advertising any doc can do is to do great work, and the word will get around. Future, You “highly doubt” what I stated? Frankly, your implying I’m lying is fairly insulting. I was aware he is recommended. Thats how I found him in the first place. My comment had nothing to do with him as a surgeon; it was his clinics approach to sales. Further, you can tell me all you want about medical concepts, but do not tell me how I should view a particular clinic. Simply, you do not have the experience. I have had strips taken, punch style donor, “line” grafts, minis, micros ... starting from not long after you were born. You have never gone under the knife, so you are not in a position to understand this, but a patient becomes far more discerning of clinics after they’ve been through the mill.

I am also in California and also sought a top doc. Initially I assumed that because of all the people getting plastic surgery in the state, that the doctors would be the best. After meeting with some and researching many others, I decided to go out of state for my HT. My guess is that in California, there are so many patients/clients for each doctor, that there is not as much driving the surgeons to be “top quality”. I am sure there are exceptions to this, but, its a hunch. On performing your search: do yourself a huge favor and do lots of reading on forums and meet with multiple doctors. You’ll see these comments often because they are so true. Finally, I can list one California doctor that I personally would not recommend. Dr. Siporin in Beverly Hills / LA. I made one inquiry and they’ve contacted me far more than all others combined. They even contacted me after I very politely, yet clearly stated in writing that I’d decided to go with another doctor. The more a HT doc advertises and uses “sell” tactics, the less I’d like to work with them.

To answer my own question (above), I'll post this comment from Dr. Rassman, just in case anyone had the same concern. "As long as you are pushing down on the scalp and not creating constant pull 24 hours a day, you should not have traction alopecia from this. Traction alopecia occurs when you keep your hair pulled or braided too tight constantly over the course of many months. Traction alopecia and scalp exercises are two different things."

What I'm thinking of is not a full removal actually, but just a reduction. I have some old grafts that are narrow, with around 6 - 10 hairs, and if FUE were done in the center, it would break them up so they would be less dense. I'm just concerned about the yield overall because I've heard that this type of procedure may (un-intentionally) damage follicles by transection.

Anyone that has had older mini-grafts reduced by FUE - - How was the yield of the grafts that were extracted? Did most of them grow in their new location? Also, did you notice any impact on what remained of the old mini-graft as far as growth? Meaning: did most of the follicles adjacent to the FUE site continue growing?

It really surprised my too because some of them showed doing this kind of work on their websites ... I believe it was different in my case because they planned on putting more, appropriate sized grafts in front of the old larger ones. They were thinking "camouflage". Also, my donor supply is soo limited, I think they were hesitant to remove anything thats growing.

Would that be considered FUE to remove those, being so small? I guess I'm not familiar with the details between "punch out" and FUE when its concerning very small grafts. And I ask because (I think) FUE is how some of my larger ones will be partially reduced in hair count. If there is a difference btwn FUE and punch-out of small grafts at the hairline, I wonder how the healing differs? for example, flatness or the redness you were inquiring about?

I wondered this too and I was concerned that it would be like redness at the donor incision. There it varies from person to person greatly with light skinned persons (like myself) taking many months to clear up. BigBill, Who is doing your procedure if I may ask? I've gotten four opinions from doctor consults now and 3 of 4 won't do punch-outs of older grafts. I personally would like it done because some at my hairline seem too big for just "camouflage". The fourth doctor was not even going to completely punch-out the grafts, just de-bulk them with (I believe) a FUE process ... which sounds good to me.

since writing the above post, I've met with some doctors for consultations. One answered my questions by saying that "things are pretty mature back there" and that the scalp would not tighten up again. This helps my situation [e.g. approaching mid 40's and many surgeries and scars later], though I still wonder about the younger patient and how their scalp would respond. - New question: I've read that one of the causes of hair loss is through mechanical means i.e. too much regular physical stress on the hair. Wouldn't the scalp exercises over-work the hair in the donor area? This topic is of particular interest to me, with very limited laxity and doctors suggestion to do these exercises for 4 months.

Well said. This is pretty much what I was thinking too. For another idea: I heard of one person that told his co-workers that he was changing bulbs in an over-head light fixture and the glass shattered on him.

Swelling I've heard is always gone around the 6th day. On redness however, I'm going to be the alternate view on this one. My skin held on to the redness for several months (grafts and donor line), which I've heard is somewhat common for some fair skinned persons. There are remedies for this that people report good results with. I haven't got a chance to try them yet, but I've seen Bacitracin, Graftcyte???, and other things mentioned. A search on this could be good. Like you, I also can not wear a hat at work. I am considering an excuse as well if I can't use existing hair and masking products to hide it. One idea: use the sensitive skin as the excuse and say that the material in a hat I wore caused a rash ... doc says it should be gone in several months.

I am not a whole-hearted supporter of HTs in general, however, you’ll want to keep some things in mind: 1. there are likely a lot of people here now because of further hair loss since HTs they had in the 80s and 90s. Back in ’92, when I started, a fairly common procedure was one hundred grafts ... the waste of follicles through transection must have been huge. Hence, the donor got used up with not that much to show for it. 2. The current quality HTs have only been commonly done for around 10 yrs, and some big name mills (e.g. Bosley) are still doing work that people are unhappy with. 3. If a person has, for example, a couple thousand FUs transplanted at age 25 for a hairline receding, yes, he’ll likely loose more down the road and need more work. And he may choose to continue having procedures as loss progresses. 4. The main thing to be careful about is that you don’t want to use all donor at an early age if you don’t know where it will progress to in the future ... and there is no definitive way of knowing as far as I’ve seen. Perhaps the best bet is on planning conservatively. Anyway, its great you’ve been doing the reading, you’ll have a much better chance of a good outcome, should you go this route.

Thanks everyone; excellent suggestions. ccexxp1, I looked at Dr. Bernstein’s info a lot, as well as some of your history. He really is heavily into repairs, and great results too. It looks like more often he (and other docs) will use camouflage rather than excision & re-use of older grafts, and so I wonder why in your case he was more aggressive? And I’m not questioning the approach ... just curious what tips things one direction vs. another. For my case, it looks like the limited donor supply is the main limiting factor in the decision. I’m gathering that the excision & re-use of older grafts results in more loss than a standard FUT session. The opinion I’ve heard most recently is that possibly just a small number of the pluggy grafts on top of my head would be revised. Bachstrad, Definitely, share with us details of your situation. Even if not many of mine get revised, others may benefit. I hear there are a lot of repair cases these days, but more often the blogs I see are starting from virgin scalp, so I think stories like ours are beneficial.