fortune11

Any update on your consults? Curious to see what differences were there in the different recommendations.

VERY popular misconception. It is tempting to think this, and it may even be true in cases where the transplants are placed right into very thinning areas. But what people forget is that by the time a patient has actually gone out of his way to seek out HT help he is already well on his way down the hair loss road. By the time he has an HT he has lost an alarming amount of hair. And by the time an HT starts growing its another 8 months down the road as well. All that time the genetic balding has been at work doing it's dastardly thing. In a case like the one I presented here it is just a matter of time that the forelock would be targeted and eaten away "pac man" style. Usually a bit longer, but perfectly within the norm. Hair loss is progressive and that needs to be taken into account in each and every patient which is why I usually opt for more conservative hairlines. More forward hairlines are very appealing to young men, but doesn't serve them well as they get older and lose more hair. Also, when hair is lost behind the transplanted front line, the front line looks a bit thinner. Better to keep the hairline a bit high and have the grafts necessary to "back fill" if necessary. That's what we did with this patient and why he is signed up for another small procedure.

 

Thanks for playing. More coming...

I respectfully disagree. I am speaking from personal experience , having been through transplants 3 times , first time in 2004 ,then again in 2011 and now in 2015 . All FUTs .

My speed of native hair loss picked up dramatically during the 1 year after surgery than the 1 year before it , and then it again somewhat slowed down after year 1 post op (or thereabouts) .

I did not think much of it back in 2005 until the same pattern repeated again around 2011 (2nd HT). Now granted , I did not conduct a scientific study and measure rate of change of hair density before and after . However, the optics of it , looking in the mirror and my prior photographs (since memory can be fickle) , convinced me that this actually happened .

It is always possible that even without the hair transplant , my hair loss progression would have picked up at around those times in 2004 and 2011, but why those two specific years as opposed to all the others. I think there is something to it ,

As I said before , the overall visual enhancement with the transplanted hair is much better since they are thicker and more lustrous than my thinning native hair so I am pleased with the overall results . Personally I don't care if the weak hair fell out in year 1 , 2 or 3 since they had to go at some pt anyways but hair transplant process did accelerate their demise , in my opinion.

Spanker - I strongly believe that hair transplants by themselves " pull forward " any pending hair loss in patients that have new grafts placed between or around existing hair . It has happened to me twice now . While I am happy with the transplanted hair , I certainly lost a lot of hair around it . Now mind you the transplanted hair quality (donor hair) is much better than the thinning native hair that was limpy and hard to style so the net effect is a +ve enhancement to appearance.

Really appreciate the candor. Super helpful. I didnt know much about Shapiro but I will add him to list. I think I've been a victim of loyalty to one physician who Im finding skews conservatively (which I dont care about with results) but added feedback from the board and docs will make this easier.

 

Can you describe the scarring/sensation? How long until you felt pretty good? I have a good tolerance for pain and most tell me its not bad. Scar I can hind.

 

But, I do rely heavily on masking agents and will until some hair comes in. I can take a month off if I need to.

The scar will heal within 2 weeks but the numbness will stick around for months , the first 2 times healing was faster , my third strip recovery was longer.

If you are worried about concealment, I was able to go back to work within 1 week. I just had to grow my hair long , over the scar.

Scarring was a big issue back in the day when transplants routinely failed and people were stuck w bad hair and couldn't shave down . Now , in the hands of a competent surgeon, risk of FUT failure is negligible. Coupled w meds, you will have a very good outcome regardless of FUT or FUE. Don't worry about it . Just pick the right surgeon.

Minneapolis is a just a short flight away from NY area. Do talk to Ron Shapiro, he is superb with hairlines , which is what you really need . I was in a similar boat as you back in 2004 , and he did solid work on the hairline that has stood the test of time.

Dr Feller is bang on with his comments . You are still young (in my book, and I am 40) and still balding. It is possible you may progress to a higher NW level in your mid 40s as the transplant (FUE or FUT) will "pull forward" the loss of any already thinning front scalp / mid scalp hair , via "shock loss" . This is something that does not get as much attention but is very important if you are transplanting around or between existing hair.

If you go the FUE route , you may get instant gratification in terms of having some hairline and no scar . But heaven forbid , if you end up as a NW5 or 6, you will kick yourself for not better saving your donor area .

As others have said, i would also go for a higher # of grafts -- 2500 at the minimum to focus on the frontal scalp and hairline.

blanc 1 -- I just underwent an FUSS 7 months ago . Around week 2 I also had a little inflammation near the same spot where you are having trouble. I consulted with Dr Ron Shapiro , my surgeon, and he told me that that area (right behind the ears) is the highest tension point across the entire scar length and hence more prone to things like this .

Anyways, I was told to apply some anti bacterial ointment and keep the area extra clean which I did . The inflammation gradually subsided over the following few weeks, but the ridge like appearance remained for a good 3 months before it flattened out. And now , that is the part of the the scar that is the widest . I am consulting with Dr Shapiro on ways to fix it but we want to give it a little more time to continue heal itself first.

Bottomline --- do take it seriously, and follow your doctor's instructions to the letter. I hope your complication is not as serous as mine.

I have had similar experiences to you Dave.

Usually I just go to the next door supercuts and rotate between 2 or 3 stylists. I have to ask them to do a layered cut around the scar since the HT#3 scar is still evolving and its only then that they realize that all the hair in the hairline and midscalp is transplanted .

It generally leads to surprise / shock and then the inevitable questions about where / when / cost . Some of those stylist ladies themselves have had other cosmetic work done and it is interesting to have them compare the cost of their (different) procedures with mine.

- Lorenzo's name is commonly touted on these forums like a garlic rosary to ward off naysayers that say the two procedures cannot be equivalent, and certainly he has impressive results, but he also has a conservative aesthetic, and frankly, no one has duplicated his work. His fans will say it's because he is so amazing, and his detractors will say it's because he is cherry picking.

 

 

LOL, I agree w the rosary analogy. He has great results , no doubt , but not everyone can go to Lorenzo. And frankly that website link (for Lorenzo) that was posted by someone else , was utterly dreadful. Probably created by one of Lorenzo's marketing people thinking purely from a business angle, facts and logic be damned. If I didnt know any better , I would think I was reading it off one of those Turkish hair mills websites.

I had a similar pattern when I was in my early 20s . I can see you are starting to "diffuse out " radiating from the crown. If I had to guess, eventual NW 5 for sure, NW 6 likely .

You may want to take meds to stabilize hair loss. At your age I was more concerned about the side effects and I chose not to.

You definitely need to plan conservatively if you decide to start down the HT path . Also know that transplanting into existing hair very likely to result in permanent shock loss of some existing hair around it, especially if you are not on meds.

Dr Lindsey ?

Any of his reps on the forum here ?

thank you

Dr Lindsey ?

Any of his reps on the forum here ?

thank you

Excellent point, Spanker, and seconded.

 

At the very least, if technicians are doing the extractions, then I think the doc should identify the extracting technician(s) for each published case and should permit patients to book their procedures with those techs specified as the extracting techs.

Excellent point , and agree.

Taking it to its logical conclusion, if doctors using techs for extraction are to be recommended , shouldn't the recommendation be for a particular "doctor-tech" combo, so to say. Otherwise how will the patients know which tech to ask for ?

Very interesting videos Dr Lindsey , good to see a well documented scar repair procedure like this. Looking forward to seeing progress on the 3-layer scar repair case . I am assuming you will post follow up videos as well.

I am actually in a similar situation as the OP where one 2-3 inch section of my scar is more pronounced than the others. Unlike the OP, I have had 2 other FUT surgeries in the past, both of which led to the typical 1-2mm scars (only the final scar remained obviously) .

This time with HT #3 (I am now month 7 post op) , there was a little bit of inflammation post op, in one section of the scar , which took some time to heal , and that same area is where the scar is about 8-10mm wide compared to 1-2mm everywhere else.

I have continued to apply Bio Oil in that section but don't think it has had as much effect, although i will say the initial , raised ridge like appearance that I saw in month 3-4 has now flattened out, at month 7, while at the same time the width in the problem section of the scar has increased from say 6-8mm to now 8-10mm. Rest of the scar has continued to thin.

Any thoughts here ? thank you

1978matt raises a very good pt regarding number of hairs per follicle being higher for FUE than FUT. One could say then FUE could actually work better for non hairlines cases (hairlines need more 1s than 2s or 3s) , notwithstanding the lower yield.

I am also intrigued by what Dr Bhatti said about SPEED of extraction being an asset to his procedure as opposed to a problem, which is the general negative impression I have from watching that video posted . Frankly, I have not heard this anywhere else, although people have certainly mentioned that amount of time grafts spend outside the scalp needs to be minimized . Do others have thought on this ?

I think we can all agree that visually at least , there does not seem to be much difference between results of top FUE docs and top FUT docs.

However, simple mathematics of it, majority of HT patients are not going to top FUE and top FUE docs given the bandwidth issues. Even there , I concede you will get the occasional failure which will be generally get blamed on the patient characteristics.

Therefore , for broad quality issues, for the market as a whole, what is important is the next tier down , here is where you will see the most variation and here is where you may see these topics being raised by Dr Feller regarding extraction and placement techniques as becoming more relevant, at least on a VISUAL level (not withstanding all the additional forces which impact FUE yield, etc).

I am not including the hair mills here who maybe considered as the bottom tier - but even there , despite the assembly line methods , you will get some good results , just from laws of probability (large numbers).

To be honest if no other FUE docs get involved in this thread I pretty much think it has run its course for providing any more useful information for us as patients, we all know Dr Fellers

stance on the matter and as laymen we can't in reality argue the case either way, all we know is our experience be it good or bad

 

Fair play to Dr Bhatti for for his input just a shame there weren't more doctors willing to participate I don't think its just this thread and it's content why they shy away I think most of them perceive getting involved in online debates leaves them open for attack in some way I suppose they just prefer to let their results do the talking.

Agree, involvement of other FUE docs would make it a lot more interesting at this stage. Wish there was some way to get Dr Lorenzo to post here.

mynameisrich--

I can sympathize w you as I was in your shoes when I was 25, thinning hairline and starting to form a crown bald spot. But I was starting to diffuse thin (density going down all over) as well. I had a hard time styling my hair every day, conscious of how it would look from different angles, etc.

The problem as I see it now (hindsight is perfect , as they say), is I had a wrong frame of reference. I was chasing who I looked like 5 years ago, the younger me. I didn't realize that I still had a head full of more hair than many men in their 30s , and I just needed to make sure it was styled properly. This is where cutting your hair a little shorter can help to see if you like that look. Also start to grow a beard or a stubble , depending on your face 's shape , it may give your face a little more length and make you look more mature and professional. Spend some time with a hair / image consultant to see if they can give you tips on styling etc . That few hundred bucks may save you spending thousands on an HT.

Then finally at age 28, I decided to get a HT -- focused only on the hairline , kept it high and mature (30s age look) . If there is one piece of advice I can give you to follow over everything else -- don't waste a single follicle of hair on your crown at this early stage , until you know your hair loss pattern. Run away from any doctor who says he will sprinkle a bit here and a bit there depending on whatever you , "the patient " wants.

As patients at that early age , we know jack s... t (pardon my expression) . We need the doctor to advice us based on their vast knowledge and experience . I won't mention my first HT doc here but you can look it up based on my other posts, he gave me very sound advice 11 years ago and one I am still grateful to him for.

Also know this -- once you start down this path , you will need more HTs . So be prepared for that. The first HT is always a big step, but then you get caught up in what we call here " hair greed " and also for others like me, a means to continue chasing progressive hair loss . As for me , I have been through 3 HTs over 11 years , and may still get a fourth one in a few months , which will hopefully be my final ( i hope).

Last point --- we are always more critical of our looks than others are. Other things in life like how you conduct yourself, how you come across, how much $$ you have , have a bigger influence on our circle of friends, acquaintances, and love interests . The only problem occurs when our self image starts to affect things like "how you conduct yourself, how you come across, how much $$ you have" . Hence if you want a hair transplant to boost your confidence and have the means to do so, go for it. Don't wait and let life pass you by. But go into it with your eyes fully open. Best,

"fortune 11", it is unusual that the forces are transferred that far. You seem to have a soft pliable scalp to have experienced this. However if it did happen and the wrinkles came back after 30 days, the stress was transmitted elsewhere- some other place bore the brunt- either the crown expanded a bit or the strip scar became wider. Forces get transmitted since the whole edifice of the scalp is based on loose areolar tissue which glides easily and hence any tension will be transmitted to areas far removed.

After a facelift a plastic surgeon conceals his scars behind the ear and in the temple area. These scars are along relaxed skin tension lines. This is the reason why facelifts need to be revised only after 6 years when skin folds reappear.

However, in the case of the strip, the scar undergoes maximum tension when muscles under the skin that are directed at right angles to the scar, contract to exert their pull.

In most tight scalps, the patient complains of a widening of the scalp after the procedure. Please do not misunderstand here when I say the crown stretches- not all crowns stretch. Also only 40% of the stretching force is transmitted elsewhere. That is what I said in my earlier post and what Dr Feller misquoted.

I request members who are undergoing strip surgery to measure their crowns before and after the procedure. That is when the truth will come out.

Take for example this patient whose procedure I did today after one strip surgery done at the clinic of a ‘recommended’ FUT surgeon.

He complained that his crown became larger and just after one procedure.

To validate that I do not refer back to my library for such posts I have taken his picture alongwith today morning’s newspaper!

Thank you Dr Bhatti , the point about tension being transmitted along a different angle versus perpendicular (in the case of strip) is interesting.

I think one factor why patients feel their crown expands could also be because their hair on the sides and back continues to drop (progression from NW5-6-7) and thats also what may give the appearance of a crown stretching.

I do think scalp laxity is a very important issue when it comes to strip , especially when it comes to mega sessions.

Fortune,

I felt the same way when I first saw the video. I was literally shocked. And I've seen ALOT of surgery in my years.

 

Just like FUT, not all FUE doctors do the same thing. It is incumbent on every FUE seeker, if that's the surgery you are sure you want to have, to examine the difference between methods and seek out doctors who perform the one you wish to have performed on you optimally.

True. I have only had FUT so far and my main focus in those has been surgeon skill with implanting hair and creating the illusion of dense coverage. I could not have asked for a better hairline than than the one that was planned for me by Dr Shapiro.

As I research FUE , differences in extraction techniques and methods are equally, if not more important factors, it seems. A lot to think about .

Hairline looks very natural, great cosmetic improvement. What is the patients age and has the hair loss stabilized otherwise ?

I just saw the video as well and holy smokes , it raised my hair on its ends , no pun intended . I am considering FUE for my next procedure (no scalp laxity left for any more FUT) , but now I probably will need to check online videos for different surgeons and start comparing them. I really don't want to be subject to such a super sonic extraction procedure .

Pma -- how long (hours) did your 6000+ fue procedure wDr Lorenzo take ?

Marcopolo - My sympathies , and hope for the best. You have detailed in your experience a way that leaves no room for misinterpretation and no excuses need be made for what simply is a poor professional conduct . As to poor result, I will concede that maybe too early to pass final judgement although it does seem to be not going in the right direction.

When I compare your experience to the high level of professionalism and care I got at the hands of Dr Shapiro (and Dr Ziering) , it is like day and night . Being anointed by one of these popular forums may get you more patient referrals but it is not a free pass. They should continue to be held to the highest of standards.

My basic training is as a plastic & reconstructive surgeon and I wandered all over the United States from 1997-2001 trying to learn the pearls of cosmetic plastic surgery for which I visited Drs Sherrel J Aston and Daniel Baker in their Manhattan hospital, Dr Ian Jackson of Detroit to learn how to manipulate the skull, Dr Bhangoo in Buffalo to learn all the tucks I needed to learn and last but not the least I spent time with DrsTessler and Aronovitz in Southfiled, Michigan to learn the tricks of FUT hair transplant surgery.

I never knew all the principles of nips and tucks that I would learn would come to naught and have no meaning and set me thinking after your sweeping statement that skin does not stretch, Dr Feller.

Well, how does facelift, necklift, tummy tuck, body lift, and even scalp reduction work then?

Well if crowns won't stretch , can you please throw some wisdom on why they do not in light of above accepted principles of plastic surgery!

I was among those urging Dr Feller to address the "expanding crown " issue raised by Dr Bhatti and I found Dr Feller's explanation satisfactory.

When I posted on this forum in 2004 after my first HT (FUT), one of the highlights of my story that I was excited about was the apparent "facelift " that my forehead got and all the lines just disappeared . But alas , over the next few months my scalp adjusted and the wrinkles etc came back. So it was more the "rubber band " effect , only in slow motion. Same problem also exists with a lot of these nip and tuck surgeries , where immediate results look good but then over time skin sags / expands again.

That being said, I do think that scalp laxity is somewhat of a meaningful factor in terms of FUT effectiveness -- especially given Dr Fellers assertion (and one I agree with) that FUT is more suited for megasessions. Megasessions also require taking bigger strips.

On a side note, I wasn't aware of any "accepted principles " of plastic surgery . I live in an area in Southern California where every fourth person has had some cosmetic surgery type work done on themselves (non HT) and the results vary a hell of a lot , especially on aging bodies . Actually all considering , we HT patients (especially FUT ones) have a more remarkable consistency of results , relatively speaking, than some of these other procedures. Atleast from seeing the results posted on this forum.

Nice one Blake. In fact my first HT from over 10 years ago continued to show growth as far out as 3 years from the date of surgery . Please keep such videos coming .

people who are satisfied w 50% yield to avoid a scar better be sure that their hair loss will not progress beyond a NW2 or 3 , or better hope that their "fall back " clean head shaven look won't become hopelessly outdated in 10 years time.