Dr Tejinder Bhatti

London,

 

I wanted to clarify a few things:

 

Gabapentin and amitriptyline are two very different medications. Gabapentin (brand name Neurotin) is a neuropathic pain agent. This means that it is designed to treat pain associated with nerve damage. It often needs to be taken at large doses to be effective, and many patients -- even those with true neuralgias -- don't get much from it. Other medications in this class include pregablin or Lyrica.

 

Amitriptyline is a tricyclic antidepressant. It is a member of an old class of depression medications that have been replaced by modern antidepressants ("SSRIs," "SNRIs, et cetera) for one major reason: side effects. It's mainly prescribed today for neuropathic pain. However, it is generally associated with more side effects and is, therefore, usually second line after Neurotin and Lyrica.

 

What you're describing, unfortunately, does sound like "FUE neuralgia." Dr Feller describes this phenomenon here:

 

"FUE Donor Area Neuralgia. Also known simply as FUE Neuralgia as you almost never see it's counterpart in FUT surgery.

 

This is a condition that occurs after the donor area is harvested with a great number of FUE. It's symptoms are a persistent and deep burning sensation in parts of, or throughout, the donor scalp that is not relieved with pain tablets. This condition can last for weeks, months, or even years."

 

Here is a video he made for another member experiencing similar issues. He also does a good job explaining why this phenomenon occurs:

 

 

 

The depth we work in during FUE procedures is absolutely deep enough to damage nerves as well. The structures innervating the follicles, skin, and blood vessels in the region reside in the superficial subcutaneous fat and deep dermis, and these ares are absolutely affected in any type of hair transplant surgery. Even if the punch doesn't severe the nerves -- and it shouldn't be this deep -- they are still affected when grafts are delivered -- as the bulb of the follicle resides in the deep dermis/superficial subcutaneous layer as well.

 

Seborrheic dermatitis causes large, yellow, flakes to erupt on the scalp and often on the face as well. If you had SD now or before surgery, I think you'd see more of this than you would pain.

 

Here is an example:

 

 

I'm also not confident that steroids (hydrocortisone and triamcinolone) would help with the pain, as it's likely caused by nerve damage and not inflammation around any structures -- and steroids are anti-inflammatory agents.

 

How many grafts did you have removed via FUE? Have you discussed this with your surgeon? Also, who wrote the prescription for the gabapentin? You may want to speak with this doctor again. Make sure all of this is being followed closely by a competent physician familiar with your medical history. Feel free to ask additional questions.

Please follow this thread here too-

FUT is more popular than FUE - Page 52 - Forum By and for Hair Loss Patients

Thanks Dr Bhatti,

 

Looking forward to hearing your view on the following questions:

 

2) Does FUT really provide a greater number of lifetime donor grafts compared with FUE? 3) Is the transection rate on FUE higher than that of FUT? 4) Does FUE damage the donor region more than FUT? 5) Is cherry picking for FUE really a myth as you still can't really identify singles from doubles?

DOES FUE DAMAGE THE DONOR AREA MORE THAN FUT?

I would like to refer esteemed members of the patient community to the following video-

The doctor would like us to believe that CPR4 has pain and numbness in the donor area due to this being a complication of megasessions done using the FUE technique.

This is so far from the truth.

Most FUE sessions cannot harvest in excess of 4000 scalp grafts ( 4000 x 2.3 follicles) in the first session. Given the safe scalp donor in most people is 22 x 6 cms ( 132 sq cm), it comes to making 30 incisions per sq cm (4000/132) in the safe zone of the donor scalp.

Now, also consider the fact that the same doctor advocates upto 55 slits per sq cm in the recipient area while performing FUT.

The depth of each donor scalp recipient incision while harvesting a graft is the depth the punch goes under the skin- a mere 2.0-3.0 mm whereas the depth of the recipient incision is always the length of the follicle- 4 mm. Almost twice as deep!

Is the donor incision more harmful to the blood supply and the nerve supply than the incisions the doctor makes in the recipient area that are double as dense as double as deep?

As a corollary, should not all patients of hair transplant- whether done by an FUT surgeon or an FUE surgeon have unmitigating pain in their recipient area due to serious damage to blood and nerve supply?

Doctor, why does this not happen?

Why do you advocate only 700 FUE grafts procedure in FUE that comes to 5 incisions per sq cm (700/ 132 ) of half the depth when you advocate 55 incisions in the recipient area of greater depth?

Dr. Bhatti is on a Break in India and has asked me to post his rely to Dr. Feller's post.

 

"Dr Feller, I have stated what I had to state. So no, I do not agree.

The above forces you cite do not apply to my cases any more than the numerous bad strip results that are frequently posted here represent in any way your stated practice skills."

To the questions posted by lone parties, if time permits I can reply to them through private message. Otherwise there will be too much of cross talk."

 

 

Dr. Bhatti has not disengaged as Dr. Feller erroneously stated he did - but I have counseled Dr. Bhatti to get on with his business as usual. It's his choice if he decides to remain active on this thread.

On a weekend break with a weak net connection. I wish to remain a part of the discussion. Voxman has posted on my behalf.

Dr. Bhatti,

 

Thanks for chiming in with your initial thoughts. I hope this will be the beginning of an intellectual discussion and debate that is both educational and respectful. In your opinion, how have you either overcome or been able to work around the extraneous forces that Dr. Feller stated are placed on the follicle during the harvesting process. What improvements to the FUE technique do you feel have been made over the last 5 to 10 years or since its inception? What do you feel is the success rate versus the failure rate of FUE in your hands at your clinic? I think answering these questions will provide a good starting point for debate and discussion.

 

I look forward to your response.

 

Bill

A case that will fail happens only if the case has not been selected properly. Otherwise over 95% patients are happy with their FUE result at my clinic. Towards achieving this level of satisfaction we do rigorous counseling and almost 50% patients seeking the procedure are not found fit for the hair transplant and counseled accordingly.

The following are the Red Flags-

1. Extensive balding coupled with a less than satisfactory donor region- scalp, body.

2. Body dysmorphia

3. Young age group

4. Irrational objectives

5. Uncontrolled diabetes

6. Afro-textured hair with severe hooking of the root.

1-5 are the same as any FUT surgeon would keep in mind too.

Dr. Bhatti,

 

Thanks for chiming in with your initial thoughts. I hope this will be the beginning of an intellectual discussion and debate that is both educational and respectful. In your opinion, how have you either overcome or been able to work around the extraneous forces that Dr. Feller stated are placed on the follicle during the harvesting process. What improvements to the FUE technique do you feel have been made over the last 5 to 10 years or since its inception? What do you feel is the success rate versus the failure rate of FUE in your hands at your clinic? I think answering these questions will provide a good starting point for debate and discussion.

 

I look forward to your response.

 

Bill

The advances have been in skill, philosophy and technique:

1. Punches that are customised to the case- dull, sharp.

2. Finer punches aerodynamically designed of sizes 0.75-0.95 mm.

3. Efficient motorised harvesting systems- Jim Harris' Safe Scribe, etc.

4. Realisation of the importance of magnification- 4.5-6.0 x

5. Wisdom of harvesting zone- the safe zone, density of harvest, etc.

6. Collective skill development amongst the FUE community leading to ability to do megasessions.

7. Better Understanding of limitations of use vis-a vis FUT.

8. Better Understanding of extraordinary benefits over its sister harvesting technique.

9. ARTAS.

10. Its emergence as a solid standalone technique.

Dr. Bhatti,

 

Thanks for chiming in with your initial thoughts. I hope this will be the beginning of an intellectual discussion and debate that is both educational and respectful. In your opinion, how have you either overcome or been able to work around the extraneous forces that Dr. Feller stated are placed on the follicle during the harvesting process. What improvements to the FUE technique do you feel have been made over the last 5 to 10 years or since its inception? What do you feel is the success rate versus the failure rate of FUE in your hands at your clinic? I think answering these questions will provide a good starting point for debate and discussion.

 

I look forward to your response.

 

Bill

Torsion- Torsion was a significant force on the FUE grafts till better instruments came in and surgeons practising FUE became more skilled at minimally invasive FUE harvest. Torsion can be prevented by controlling the speed of the punch as it enters the skin, using the dull punch and by properly centered cutting edge with minimal wobble. The Safe Scribe and the Harris punches have minimised this force in my practice. However there is an occasional graft that undergoes torsion and this happens when we go deeper than half the length of the follicle (more than 2-2.5mm below the skin). . It is just a feeling of “give” when the skin is breached and it can be appreciated after you have done several FUE cases. If we go further deep, the graft undergoes torsion akin to being wringed squeezed and mangled. Such a graft shall not grow. 2-2.5 mm minimal depth FUE incisions is why we call the technique as minimal invasive. On the contrary, in FUT, the knife has to reach just beneath the level of the roots (5-6 mm and more) always and everytime.

Traction- Follicles pop out effortlessly while harvesting and are gathered with special FUE harvesting forceps which are gentler due to special serrations which do not crush the bulge of the follicle when it is held. Furthermore, the “2-hand grasp technique” distributes the forces on the follicle while extracting. Theoretically it is agreed that more traction is exerted on the FUE follicle but as long as the graft grows where is the problem!

Skeletonisation- Yes the graft has less amount of surrounding bulk but since the bulge and stem cells are intact, it is unfair, discriminatory and derogatory to call our fashionable grafts “skeletonised”. I seek permission to call it “SIZE 0” (VANITY SIZE). Why have the extra fat when you don’t need it! However, there is no evidence that bulky grafts survive better if both are stored in ideal conditions and have an out of body time of lesser than 4-5 hours. In fact the more thin the graft, the more density can be achieved in the recipient area per sq cm which is an added advantage of FUE.

Compression- This is specific to the use of implanter pens and I do not have a lot of experience with this placement technique.

With winds of change sweeping the field of hair-restoration surgery, it had been postulated in 2011 that FUE shall be done in a majority of cases requiring surgical hair restoration in the immediate near future even in the USA. (ISHRS paper, ISHRS Meeting at Anchorage, 2011). With most centers in the world and esp. in countries outside of the USA offering only FUE as preferred modality of surgical hair restoration, we have reached a long way much sooner than was predicted.

FUE is a procedure which requires utmost concentration, skill, devotion mostly on the part of the physician, and, often overlooked, on the type of harvesting instrumentation that the physician chooses to use. However, though the technique is being hyped as a panacea for scarring in hair restoration, the mindless way FUE is being adopted and practiced has raised serious, legitimate concerns in the international hair-restoration community. It is alarming that, at my center in India, I continue to receive an ever growing number of cases of poor hair transplants done by primary surgeons without adequate concept and training in hair transplant. So is the case the world over. This has alarmed the patient community and physicians alike.

However, to blame the procedure across the board is unfair.

James Harris, Alen Feller, Lorenzo, Patrick Mwamba, and Lars Heitmann have done considerable work using this technique and have perfected individual methods of harvesting to perfection. FUE under high magnification, the use of motorised machine utilising the dull punch of Jim Harris, Feller’s ingenuous powered extraction tool, the unique and path-breaking ‘expanding needle concept’, Patrick & Lars’ laboriously pain-staking but perfect manual extraction method, Lorenzo’s refinements in FUE graft placement and my clinic’s ‘Rapid FUE harvest’ and ‘Golden Harvest’ techniques are increasingly making FUE technique more popular amongst surgeons and patients alike. The efforts of these FUE surgeons have so enriched the present day FUE technique that the method is on the threshold of being accepted as the foremost method of hair transplant today.

We have centers around the world today which are replicating successful cases one after the other- it is not by mere fluke that a center will produce consistently satisfactory and pleasing FUE results.

This is possible only when centers have successfully overcome the 3 forces that Dr Feller talks about. Are all centers producing consistently good results?- NO! But so is the case with FUT! There are far more FUT complications floating around than FUE even today.

The rash of bad cases at this phase of FUE's evolution is natural. When a technique grows in popularity, there will be complications, and they will be even more when the learning curve is rather steep- FUE takes time to learn. I learnt FUT in 2 months. It took me 2 years to master FUE. That is the one single factor which dissuades FUT surgeons going the whole hog in adapting this technique in their practice when they have very comfortable FUT practises up and running.

Did FUT not have complications in its inception stage? Of course it had.

Pure fue docs have had the opportunity to come on here from the start,let's hope we finally get a good debate underway.

I have had both and both are great procedures in great hands. But there are far too many docs out there not sharing all the flaws with both types .

Dear Dr Feller,

I appreciate your starting this thread, and as Bill suggested and many members wish, there should be a healthy discussion about the drawbacks and benefits of FUT methods- Strip and FUE.

We are both working in the best interests of potential clients seeking a surgical hair restoration by providing them evidence based informed consent about the procedure without inordinate personal bias.

As a background I would like to mention that I practised FUT rather successfully till 2010 following which, encouraged with my 3 year courtship with the FUE procedure, I took the decision to practise 100% FUE - it seemed to work very well in my hands and felt to me the right way to do FUT; and above all my patients goaded me with their utmost happiness with the results. A trained cosmetic surgeon, today I perform only FUE hair transplant and do not offer any other treatment in my clinic be it SMP, Lasers, etc. Like you, surgical hair restoration is my forte, and therefore I respect some of your impassioned threads.

There is nothing personal here and what might have been said by you or by me or by anyone else at the spur of the moment should not come in the way of future healthy arguments about the 2 methods in the armamentarium today. Since English is not my first language (it is my third language after Hindi and Punjabi) I would request you to bear with me if some statements seemed overly offensive. They were not meant to be.

Best wishes.

Dr Bhatti,

 

I think you owe me an apology for coming on to a public website and claiming that the topic I started in good faith, and one you chose not to participate in , is a "baseless rant". I will clarify the very minor point of your erroneous "representative issue" in a moment. But this is your very first post on this thread and you choose to attack me and my posts personally rather than to address the salient information.

 

First, I have no idea who Darlinglock's is. Never wrote he was a rep for you.

 

Second, I never said Sethicles was a paid representative. Read what I had written again.

But he does claim to represent you by invoking your name and commenting that he is your patient to support his vehement and often incorrect views of physiology and the FUE procedure. You have not bothered to counter or correct any of what he has written, though I see now you have been reading this topic.

 

You say Sethicles is not an official representative of you or your office. Good, thank you for coming on here to clear that up. But you may want to tell him that as his activity, to my mind, certainly says otherwise. He's acting as a representative for you whether you want him to or not. I can certainly see why you wouldn't want him to however.

 

Now that you are here, how about pointing out exactly where what I've been "ranting" about has been incorrect or false. This is a great opportunity for you to "set the record straight".

Dear Dr Feller,

You do not wish to apologise- well I cannot force you to. You are an honorable Coalition member of this respected forum and seem to have greater rights to space on the forum by wanting me to apologise for being on your thread - I will!

I am not responsible for the views of a patient of mine (Sethticles) who wishes to speak for himself. Please respect the wishes of an individual. You reside in a free country and so does he. The very fact that he carries my reference on his signature does not qualify him to be termed a "shill".

As far as reading this thread is concerned, I was pointed out about your comments by some well wishers and therefore I am here. Believe me, I would not have otherwise I seldom have time to go through my own e-mails let alone stalk forum threads. Now that I am here I have read the threads, I find many remarks by you to be disgustingly disrespectful to the collective conscience of this respected forum- the world's #1.

Meet me on a fair thread and I shall surely put some of your misconceptions about the effectivity of FUE to rest. It does have shortcomings, but so has FUT!

Dr Feller, If FUT were so popular, you would be devoting more time to your practice. Or did you mean it was more popular in your practice!!

I would request Bill and Pat to close this thread and start a new one on the same topic under their entire supervision where we are not waylaid.

Best wishes.

I have a question for you HTsoon. Do you think Sethicles has monetary incentives?

Dear Dr Feller,

I had enough respect for you earlier.

However, your posting your baseless rantings and esp. the one claiming that “Sethticles” is my paid representative left me with no choice but to write this mail:

What made you feel “Sethticles” and “Darlinglocks” are my paid representatives?

I think you owe me an apology.

I am proud to announce that as of July 1, 2015, I will be the Global Online Representative for Dr. Tejinder Bhatti, Darling Buds Hair Transplant Center, Chandigarh, India.

 

In this capacity, I will continue to share my HT experience and my own philosophy of the industry in general. I will continue to also comment and advise fellow sufferers and potential patients to research, study, and plan for what it the best for them.

 

Naturally, if a patient chooses Dr. Bhatti, I will assist in any way possible to help them with their planning, their pre and post procedure and continued follow up.

 

Thanks for the support of the HRN behind the scenes folks (you know who you are) that gave guidance and helped me make this choice easy at this time in my life!

Voxman, we welcome you to the team.

Incidentally, the US representative of the Clinic, California, resides in your home town.

Personally I do not think much of this result at all. I think lowering the hairline/pushing temporal points forward of a 28 year old norwood 5 is borderline madness. Too few grafts were used (I'm certain the logic for using that number of grafts was probably sound, though) and the end result, in my opinion, does not look very natural at all. Not one of Dr. Bhatti's better showings.

 

That said, perhaps a far shorter cut would be more flattering and improve things.

 

*Edited for punctuation only.*

Thank you "thatoldchestnut" for your constructive criticism.

When we post pictures they are never run of the mill.The intent is to encourage discussion on a vast gamut of indications in various patient subsets. Every set of patient results that are posted carries a different problem, a different message about our practice - like in this patient. This young patient desired a strong youthful hairline but had very little scalp donor grafts available. Utilising a relatively small number of grafts, we have been able to meet the patient's objectives to a significant extent. This was achieved by the Golden Harvest Technique (anagen selective hair transplant aka FUE technique).

Don't suppose you have a date for London?

Sorry, not London this time. Will be there this year end.

Thanks a lot for updating.

Hi Members of the Forum,

I shall be available to consult with old and new potential clients in Europe this month on dates as under-

Prague- 18 May

Berlin- 20 May

Rotterdam- 25 May

Munich- 27 May

Please mail me directly at dearbhatti@gmail.com to book a time slot.

Hi "eternaldenied",

I have been following your posts and the comments of learned members of the forum.

Can well understand how devastating hair loss can be and esp. in situations like yours.

If you remember we have had a detailed discussion before your first procedure regarding the density and inability to cover the whole head. I have mentioned this earlier in a previous post. As "baldinginreverse" and "BUSA" have mentioned I am illusions of being a magician and can only move those many grafts as you possibly can part with in your donor area.

I have done my best and I do not think can do any more since your donor area, which was weak to start with, is now fully exhausted of grafts that can be harvested. All said, I am with you and wish you could come to my clinic and we can discuss your situation. Are you taking Propecia?

Appreciate it, fellows.

 

I'm a Nepali-American that's moved back to Nepal. And since bald/buzzed looks aren't really appreciated over here, I'm thinking real hard about getting a transplant.

 

I used to have great hair 3-4 years ago, not just in terms of volume. Then I started losing it and my crown is making me feel super insecure.

 

I'd visited Dr. Ak Babbar in Oakland 3 summers ago and he asked me to wait. He'd also told me that my decision to discontinue Rogaine due to added hairloss was a poor was because that probably meant it was working.

 

I went to see a local doctor a couple months ago and he prescribed finasteride and Minox - 10% (I don't know if its stronger/better than Rogaine 5% that I brought from the US).

 

Back to Dr. Bhatti's comment. I get it that he was being honest and I prefer honesty over delusional comments but at the same time, I was really disheartened by his email that said wearing a hairpiece or getting Scalp Micro Pigmentation was my only hope.

 

I have emailed Dr. Radha in India but I'm kinda skeptical because she only does FUT.

 

I also emailed Dr. Dua but I honestly don't have 10-12k to spend on hair transplant at the moment.

 

I'm not sure if I'm going to be patient enough to wait for another 6-12 months to see if Minox and finasteride will do the trick. I tried Rogaine on and off for 3 years and it didn't really yield any result.

 

It's a shame that I never knew of finasteride until 6-7 weeks ago.

 

Just the thoughts of attending my best friend's wedding in May with a buzzed hair makes me feel awkward.

Hi "thewalker431",

I can understand how hair loss consequent to genetic balding is upsetting. I too am a hair loss sufferer.

The following points need to be pondered before you proceed further-

1. You have generalised thinning as it looks in the pictures provided. This is not an indication for a successful hair transplant. A successful hair transplant is one which not only grows hair but makes the patient and the surgeon happy!

2. Trying to get the hair better with use of DHT blockers and then getting a hair transplant means that you shall have to sustain these planted hairs lifelong with the same medication; an arduous and at times an impractical task with possible adverse effects.

3. Lastly, what I suggested to you- a hair piece or SMP are just mere options you could explore if hair loss is affecting your psyche deeply. That is something I am not an expert in and you should consider after due research. these 2 options do not compare with the result a hair transplant can give.

I wish you the very best. And never hesitate in mailing me if you wish advice.

Any updates or answers?. I also think that to give naturalness to hairline it needed to be little uneven not a straightline, again just my thought. I am pretty sure there are plant to modify this in future settings sine Dr. Bhatti tells us that the patient has plenty of donor hairs left.

Hi sutureless: His hairline is natural with undulations created by micro and macro irregularities.This was not a concern of the patient at all and he felt the hairline is very natural. I make it a point to place single hairs in the first 2 rows of the hairline.

Dr. Bhatti,

 

Since you discovered significant miniaturization in his lateral humps during the first surgery, why didn't you transplant in the area to ensure that there wouldn't be a gap between the lateral humps and the top?

 

Thanks!

Hi delancey: Thank you for your concern.

Yes I did cover till the miniaturised hair and did feather into native hair with near natural density. Its only that his balding has now progressed rapidly and the area in the hump regions is visible. We have taken good care of it this time and I do feel his miniaturisation in the hump regions has reached its finality and he should not need any further filling in this region.

He hasnt got much of native hairs left on top of his scalp. Overall very good result from where he was before his HT. Dr Bhatti how much more grafts has he got left in his donor area? How many grafts are needed to cover his crown. Maybe add more grafts in his side parting?

Hi "Raj_Jayukdht",

He has undergone a 2526 grafts procedure for his crown area and dropped lateral humps a month back.

He would have another 1000-1200 scalp grafts available for another sitting.

Thank you "Spanker", "BUSA", "David-Moderator" and "KO" for your interest in the patient's result.

If you see the patient is wearing the clinic dress!

He came in for another session during which around the graft number you have recommended was done. This happened around 4 months back.

Yes, David, he is happy with the result.

Will post his result at the 6 months mark.

@ "delancey":

Yes, miniaturisation was there on the lateral humps.

However, the donor area was and still is very strong. He is well endowed in this department!

@"rawkerboi":

He complied with Tab Finasteride 1 mg once a day alongwith 5% Minoxidil for 5 months following the first procedure.

Hi "delancey" and" BUSA",

Thank you for sharing your concerns.

As you very well are aware, hair transplant does not stop balding. This patient represents what happens when with continued balding, the humps start to show due to receding hairlines. This case exemplifies how rapid it can be! If you compare his picture of 1 year before when he came for his first hair transplant, and study it alongside his most recent picture you may get to understand what I mean.

There is a disconnect between his receding hairline constituted by native hair and the planted hair which have grown fully over one year.

This is the reason the patient came in for the second procedure wherein this concern was addressed and the crown area was covered.

Will post his final result after 9 months in October on this thread itself.

His native hair, by then, may have receded more over the lateral humps though!

Hi Raj_Jayukdht,

It is always a good idea to undertake an anagen selective FUE hair transplant. Anagen phase hair are robust hair and grow better and faster and give an early result. Anagen hair can be selected either visually or mechanically (visual selection or mechanical selection). Those who harvest using 4.5 - 6 x magnification can very well distinguish an anagen hair from a telogen hair and target it (cherry picking). However, most hair transplant surgeons use 2x magnification which makes finer details impossible. In such cases shaving the chest 3 days before the procedure will ensure that only anagen hair are harvested. This is what is called mechanical selection.

The latter case should also apply to scalp hair and not body hair alone.

Use of proper magnification is rarely talked of but is an important component of a successful hair transplant procedure.

Hi dds,

Body hair is a boon for patients with meager supply of scalp donor hair or in patients who are coming in for a revision of a poor result. Besides rapid FUE harvest, BHT is presently my favourite field!

Though FUT is undoubtedly the Gold Standard of surgical hair restoration and shall always remain so, FUE rose in popularity due mostly to the fact that it has opened the horizons to a limitless supply of grafts by expanding the traditional donor availability. The other advantages may be debateable but this has no opposition even from die-hard FUT surgeons. Thanks to FUE the patient base has markedly increased in size. Repair cases and cases with extensive balding which were shunned earlier, can again think of getting back a “head full of hair.”

I have a very different approach to a client with balding which I feel shall be progressive in the long term. I goad all patients with a long term plan for their progressive balding to allow me to harvest beard grafts (besides scalp grafts ofcourse) for a better hairline definition and mid-scalp fill and keep their remaining scalp grafts as a rain cheque for future requirements especially in the crown.

For example, in a 25 year old with type 3 vertex pattern, I would plant scalp hair within the first 1.5 cm along the hairline, mix scalp grafts with beard grafts in a laid down optimal ratio till the highest point of the head. For the crown area I would encourage him to accept a low density preferably with chest grafts or chest grafts with a sprinkling of scalp grafts. I never use beard hair for the crown area. It is only to be used for the mid-scalp and just behind the hairline.

For me and my patients “only ABC is GOOD!” : I am not fond of using any hair other than beard, chest and axilla (in this order of preference) since leg, arm, belly hair, in my experience, take a long time to grow if at all.

(A- Axilla, B- Beard, C-Chest)

In darker racial group I do not venture outside the ‘shadow area’ of the beard which lies on and behind the jawline and above the Adam’s apple due to the possible risk of visible scarring).

Average amount of harvestable grafts (1st session) in diverse racial groups in my practice:

Caucasian Donor:

Axilla L&R = 114

Beard = 2554 (full beard)

Chest = 542

South Asian Donor:

Axilla L&R = 311

Beard = 585

Chest = 865

East Asian Donor

Axilla L&R = 32

Beard = 263

Chest = 212

Arab Donor

Axilla L&R = 286

Beard = 515

Chest = 926

African Donor:

Axilla L&R = 98

Beard = 102

Chest = 210

Given the fact that in a second session, you can harvest usually half the number of grafts again after a gap of 6 months, realisation shall dawn upon you that an average patient (except East Asian) has a large donor area just waiting to be harvested. This realization is fast becoming the game changer today in the field of surgical hair restoration.

Body hair, mostly alone, has been routinely used at my clinic for the following indications-

1. Extreme repair cases

2. Extensive baldness with a poor donor area of the scalp and,

3. Camouflaging wide FUT scars.

You can see some of my cases on this forum where almost exclusive BHT was done for want of healthy scalp grafts.

ddb 2000 chest grafts is not posible from the chest in one session in the vast majority. I have difficulty in harvesting more than 600-800 in one session those well endowed with hair over the chest. And I have been doing chest for over 5 years now.

If there be any questions you may have for me, I would be pleased to answer to the best of my ability.