the B spot

I would NEVER allow that pink thingie to be put on my head under any circumstances. The patient likely needed 2 passes from the beginning...you cannot get overly aggressive in previously transplanted areas that experienced poor growth. The idea is to create the illusion of coverage first, make sure good growth is achieved, then go back and add some density and refinement. It is an individual choice whether or not to like or dislike a particular clinics work. But I agree, sometimes we can be too harsh in our opinions. I happen to think based on the previous poor work, this is an acceptable result, especially given the before photos that show how the patient had no options. My opinion of course. Cheers fellows! Jason

Hi Aaron, I got your message about 6 days after you left it!!!! My phone is screwed...I ordered a new blackberry today. Anyway, I am very happy for you my friend.... For those that do not know, Aaron is in the public eye and needs to be undetectable so we wanted to make sure he got the best possible outcome given his situation. Your going to look fantastic and be in good shape for any possible future work. Take Care, Jason

Hi Einstein, as others have pointed out, using hairloss meds can have severe short term effects...much like the experience pointed out by Severn. I have to reiterate, at 5 months post-op it is unlikely that more than 50-60% of the transplanted hair has broken the surface of the scalp. While I am certain you are experiencing difficulty, you must wait it out...there is simply nothing else to do. You are not experienced any side-effects, so perhaps in the coming months your hair will come back stronger than ever. At this point, there is nothing in your statements that lead me to believe your transplanted hair is lost/not growing. It is completely possible that you might have poor growth, but that could be from the extraction/implantation process. Take a breath and relax mate---it is a long process and your not even half-way yet. All--Generally speaking, Duta is hell on the hairline(from patient accounts)--but transplanted hairs generally stay, regardless---however, others have expressed shedding like this, only to regrow the hair later--I would say most duta users experience a higher level of shedding than Propecia users, but that is just an educated guess, not hard fact. I think Severn's experience certainly sheds some light on how using Duta can impact each of us individually. Take Care, Jason

Hi Hawk, if you consulted with us a year ago, we would not have been able to accommodate you as we were in the infancy stages of FUE. However, we are progressing nicely, and if you like you can re-submit your photos for us to take a look---- 1200-1700 grafts is right in our comfort zone these days. The work would be done over 2-3 days. Of course, choosing Dr. Feller is an excellent choice as well. I have no doubts you will have an excellent result should you choose to go with him. While I know a strip session is certainly an option, one of the benefits of properly done FUE is options for the future.....in this instance, doing a smallish fue session (under 2000 grafts) would allow those future choices. Take Care, JAson

Einstein--your likely experiencing some shedding associated with Duta--- At 5-6 months, you would not even be seeing 50% of the final result. It is more likely that the native hair you had in the area are shedding. At this time, you need to stay the course as your doctor suggested....there is nothing you can do and some fallout when starting hairloss meds is normal and should be expected. Getting a HT is a FULL 12-14month commitment before we see the true results, sometimes the hair itself continues to soften up to 20 months post-op. Relax, take a breath... continue to monitor yourself...stay the course and reevaluate at 10-12 months. Take Care, Jason

Great Job by Dr. Hasson----Joe did the patient express why he went this route? He still had quite a bit of native hair left.....? Anyway, looks like a homerun to me, and hope it prompts more just him to consider getting out from under the "rug" Jason

Hi Sprout, at 52 and being a NW2/3 you might able to be that aggressive and rebuild the frontal 3rd. I would have to have some photos to show Dr. Ron, obviously, but your situation seems ideal from what you have posted. Just send H&W and us at SMG your photos and compare and contrast approach/cost/travel/downtime. You will be fine regardless of which clinic you decide to go with. Take Care, Jason

Care to post some pics michele? It would be GREAT to see some good work. Also, make sure when you are consulting on a HT you 100% the difference between hairs and grafts. 2500 grafts is 1200-1300 grafts 5000 hairs is 2300-2600 grafts on average.

Hey M1----Dr. Shapiro pioneered the "transition zone" where a hairline would mimic nature and start from fine lower density and graduate to a higher density behind it, thus reducing the "see through" effect. At the same time, this gradient approach removed the wall of hair or abrupt hairline that made HT's so noticeable. Matt Zupan our patient educator likes to say that when you enter a forest it is always less dense on the edges, but once you take a couple of steps in, it gets more dense. Ideally, you would want to start using some 2 and 3 hair grafts about a half cm behind the actual hairline itself which is made up of 500-600 1 hair grafts. I can tell you if you have hair characteristics like mine, thin + slight wave, a density of 55 is more optimal. I think strip + FUE used in tandem will likely yield the greatest results for those in need of higher graft totals. Myself personally, I have had 8000+ grafts via strip and FUE, and I still have a bald spot in the crown a bit smaller than a baseball---reason is, it takes so much more of my hair to make a difference due to my characteristics. Others could get much more mileage out of their hair, like Bill, who have thicker individual hair follicles. If a guy can get 6500 strip grafts, it stands to reason he should have another 2K via FUE, maybe more. Obviously factors like scar width and donor density come into play, but if a patient has enough density to yield 6500 strip grafts, the should be able to get 2K taking from the entire donor area. Previously transplanted hair is tough--- most of the time it is not shocked out, when transplanted by a top clinic, if it does happen, it will grow back in a few months. Forehead---it really depends on your characteristics, but a sold hairline of 30-35 followed by using 25-30 all the way back. Transplanting the frontal 100-120cm would take around 3000-3500 grafts, which MOST people should be able to take, without noticeable scarring or thinning in the donor. I think you should be able to use a 1 guard, but plan on using a 2 guard as a better approach... as there are no guarantees you can buzz to a #1. Take Care, Jason

If your in Canada, you should look at Dr. Hasson, Dr. Wong (H&W) Dr. Rahal, and Dr. Nakatsui---These doctors routinely turn out excellent results and there is no guesswork or unknowns concerning their practices. You would be doing yourself a disservice by not doing a consult with all 3. Good Luck! Jason

Congrats Mate! You'll be one happy bloke in the coming months!

No--I do not--I will update my procedure at 12 months as I am hopeful it will have been my last.I may opt to do some minor touch-up in the temple region, but it will be negligible and just me taking advantage of Dr. Ron =) Cheers, Jason

I agree that CaptO must fully commit to the idea of future loss, if you note, even in my 1st comment I mentioned future sessions, additionally I mentioned using a minimum # of grafts, and that he would have to be careful. After your comments I further qualified my statements by stating "if he must" in bold print in my follow-up response adding the need to do a qualified physician consult. I can certainly see your side of the debate, but I'm not sure how my comments could be construed as cavalier. The specific information he seeks will need to be determined as he moves forward. I will re-read the thread and as always seek to get better at communicating my intentions. For now, I agree he should certainly take his time and explore all of his options, one of which is to not do a HT at all. Hopefully he can look at the information given from different perspectives and make a better, more informed choice. Take Care, Jason

Yeah, the hair matters even when it is short---but do not discount the scalp to hair contrast either--it all works to a large degree to complete the "look"----thick coarse hair is just fantastic for covering the scalp. I (my opinion) think most guys have 3-4K available through FUE BEFORE the doctor must take a very hard, close look at the impact on the donor. As I have said, there will be freaks of nature who have unlimited donor resources and yet others who will be limited to 2-3K. The point is do 2000-2500 grafts, look at the donor and try to gauge any scarring, any gaps, etc... then proceed carefully. I think 5K can be done, just not in 1 session, and with the possibility of some gaps/white dots at a low buzz. Again, just like a strip scar is an acceptable trade off, this may be an acceptable trade off for those looking for FUE. I think if your doing smaller sessions, yes. Like 1200-1500 grafts---just by extracting properly from the donor, the average patient will yield mostly 2 hair grafts---if a doctor felt he/she needed 100 3-4 hair grafts for density, sure. You need to extract in an irregular pattern, and as low of a % as possible through the entire donor as to evenly take from the region, so it does limit excessively going for larger grafts. To add another point-- you would want mostly 1-2-3 hair grafts only to do the approach we have discussed. The idea is total coverage, specific density throughout, while maintaining a short/buzz cut look.... Cheers, Jason

Hi Bill, I don't mind that you disagree, but I will list my thoughts on why I feel FUE is the proper method here. He is a candidate because he has rather minimal loss. He is a candidate because he will likely thin further and may not have the inclination, finances or time to do more sessions--thus retaining the ability to maintain a short buzz cut. He is a candidate because he explained he suffered from sexual side effects of Propecia. Additionally, even the most experienced surgeon will not have an idea of whether a patient is of the small % of patients whose skin type or splayed/curved grafts render a patient not a candidate for FUE--until he actually starts extracting grafts. IF Capt.O must do a HT, then his best bet imho, is FUE--regardless if he did strip he would still be doing several smallish sessions. Because he cannot use meds, it would be a moderate risk to do a strip because we would have no idea how far his hairloss would progress. Being that he is almost 30, and still retains excellent temple points, a decent hairline, high sides and is diffuse in the frontal 3rd, the likelihood of his reaching a NW6/7 is reduced somewhat--so doing a strip would effectively reduce his options for the future. The argument that doing FUE first followed by strip reduces the efficacy of FUE is one I have made before and in certain instances, a solid approach. However, in certain patients, most notably those requiring 2000 grafts of less, there is no need to eliminate the option of stopping the HT cycle and walking away--- Finally, my comment that Capt.O is a FUE candidate is based on the factors listed above--and was not meant to be taken as definitive medical advice...obviously Capt.O needs to undergo a full consult before making a decision. I hope this better clarifies my comments Take Care, Jason

Bob! Settle Down!! I have to say that while 2500 grafts is a good start, it might be a good idea as Thana suggested to check around a bit as you may be a candidate for a session in the 3500-4000 range, which will have a much more dramatic impact on your appearance. Additionally, it may serve to please you enough to not do another HT. Absolutely nothing wrong with doing 2500 grafts, just offering another perspective. Good Luck! Jason

I would say 1200-1400 grafts is about right---you have some diffuse thinning, so you do not want to over transplant the area and lose the existing hair, you also do not want to set yourself up with a too dense hairline, only to lose further and look odd later on in life. Your a candidate for FUE, I would recommend you do FUE first, but know right up front that you will need to do additional sessions as you continue to lose. You have retained excellent temple points and have general thinning throughout the frontal region--you need to regain your look, using a MINIMUM # of grafts, but you need to keep some options open as you are not a responder to Propecia. That means you must be careful. This is the one main reason that I believe you should look only at FUE initially---should you bald further you can opt to exhaust FUE or switch to strip. Take Care, Jason

TC---the thing that patients of middle eastern descent have over most others is very coarse, thick individual follicles and most have very low hair to skin contrast. This makes less density necessary to achieve these results. For a Caucasian, with average hair characteristics with the idea of buzzing short, wanting a hairline to frame the face coupled with overall coverage for 100-120cm of coverage would be as follows(IMO) Hairline Density 35 single FU's followed by a density of 25 throughout and the final cm as one would go into the crown about 15. About 3200-3500 grafts for 120-130cm of bald area. My guess is this would be done with the idea of the potential for leaving the crown bald, unless #1--the patient is satisfied with the look after HT#1 #2 they have plentiful donor that allows the necessary 1500-2000 additional grafts to give the crown some coverage. I think if after a HT is performed, if the patient kept up a nice base tan--to reduce scalp/hair contrast---this would look fantastic. Jason

Hey 8! Glad to see things worked out for you buddy!!! Know you worked hard to find a great doc. I think if I had to guess, I would say another 2500 grafts or so would finish you off!!!! Glad to see your results buddy!!! Jason

Not a fan. If your balding enough to require a scalp reduction/flap your likely going to bald where the scar is supposedly hidden. Additionally, scalp reductions reduce overall scalp laxity and produce some very odd hair angles. The risk of stretching is high as well, even more so than a standard strip session. With current closure technology and FUE there is no reason scalp reductions or flaps need to be used whatsoever. Hair systems have improved to the point that those candidates have yet another choice, with 0% harm, of a crown piece in addition to covering the front of the scalp with HT's if they desire. For certain patients a brow lift may be appropriate-- in some patients who have had a poor HT with a hairline too low, it is possible to remove a small strip, pull the forehead tissue "up", then transplant a natural, age appropriate hairline. This is used when too many bulky mini-grafts/plugs were used directly into the hairline and cannot be disguised or are too numerous to punch out and recycle. I believe this procedure has a great deal of success in skilled hands. Those with aggressive balding are likely just not candidates, and at best may be candidates for FUE on a small scale to provide a limited or acceptable cosmetic improvement. It "sounds" like a good idea, but there is no need for these measures, with the exception of an extreme case described above. Again, for those needing some form of repair work, it may be an option, but never a virgin scalp as an option. My personal opinion, of course.

Hi Glenn--I think the scar repair approach is probably been exhausted at this point. Not to say if Dr. Shapiro saw you in person and tested your laxity --he could take some of the scar tissue out---the lower scar is a no go--- it is much too low and the best you could do is put some FUE grafts into it to disguise it. My opinion is that you allow a buzz right up to the major scarring all the way around. It will expose the lower scar, but only for a little while. We could likely get 500-700 grafts---- put 100-150 into the lower scar, and use the rest to hit the front hairline to help with your previous poor work. I'm thinking we could get a decent amount of grafts from right above the ears and around a bit--- we would have to be very careful and take the bare minimum from the back, but the sides look fairly thick and available. Worst case is about 2 weeks later you have some decent stubble--you could blend just a tad of concealer to cover any spots you don't like. My opinion of course---but I think we could help you out. Take Care, Jason

I have been looking for a patient that wants to maximize the donor, is a candidate for both strip and FUE, and has no aversion to a strip scar, but wants the max # of grafts they can get out of the donor. My main reason for this is instead of taking a huge donor strip, we could do a tension free closure say 1.25cm wide and get 3000-3500 grafts, then do 1500 FUE grafts to get a patient to 5000 grafts, without fear of donor stretching or pushing the envelope on the strip width. It is such a great concept. Anyway, I think TC is right--- if you do strip, the benefits of FUE are reduced--other than the difference in healing post-op. Strip is less costly, more proven and in the hands of top clinics, and is less of a risk. I think FUE works best for those with minimal loss, say 3000 or less grafts---and after that, there are questions as to impact on the donor, overall yield, and cost. This is not to say a person cannot do 5-6K, but you just have to be careful. I like the word choice TC used---freedom--- you can always opt to do strip, but starting with FUE gives you options. I like that. Take Care, Jason

Hey Baldilocks, FUE at SMG is 6.00 per graft with a 500.00 travel discount with both Dr. Ron and Dr. Paul. To answer your question directly, all HT's are a team process. The ONE doctor you mention has his particular philosophy concerning FUE and it has served him well. However, not all of us can afford 8K per day for 500-600 grafts, or fly to OZ---his results by all accounts are excellent. Again, a matter of choice. Do a search on a poster named Franklin to see his results. Dr. Feller has produced excellent FUE results for several years. If like Thana suggests you desire several grown out results of patients whose loss is near your own, then I encourage you to schedule your session with Dr. Feller who I am 100% confident will take care of you. At SMG we will eventually build a patient base that will allow people just like yourself to view our patients and make a better informed decision. At this time, all our patients can do is trust SMG's 10+ years of excellence, the support of both patients and peers throughout the industry, and the hundreds of happy patients that have shared their experiences on every forum. I would happy to discuss your situation over the phone or via email and as always, no strings attached and no pressure. Take Care, Jason

Thanks Wantego--- I am glad your experience with us has been positive-- we just do not do the high pressure thing, preferring to be patient orientated first. Things just seem to be easier that way =) Anyway, Janna is awesome and is a good friend. She will take care of you for sure Take Care, Jason

Regardless of the situation, for a virgin scalp, any minor work is 100% perfect for FUE---there is simply no reason to use another method, with the exception of cost. The idea is simple: less invasive, less healing time, ability to choose necessary grafts to target the hairline, and behind. This is not to be taken as an anti-strip post--I am 100% behind strip---but for these type of issues, FUE is perfect. Whether notsosure is a candidate for any HT is another issue altogether. Take Care, Jason