MAGNUMpi

Some of the results are of people with essentially a full head of hair yet they want to lower their hairline a tad. While a result is a result I can't truthfully look at that type of result and say that it helped me make my decision. I'd like to see more people that are legit nw3/4/5 and the results that are achieved on that type of procedure. With so many procedures done I just can't get over that he doesn't have more examples or more patients don't post.

Good thread. My guess is that it totally depends on genetics and Finasteride usage and has everything to do with the individual. When will his hair around the HT thin out? When will his donor thin/etc.?

I do notice a lot of older men 50-60's with thin donor areas.

Gotta agree with KO on this one.

After 10 years on Fin I have almost no loss and some gain in my crown.

It SERIOUSLY stabilized my hair loss.

Most people do not get sides from it but all drugs have possible side effects. But we take them all the time anyway. For instance I am allergic to Ibuprofen. It give me rashes. I didnt know it until I tried and got the side, so I stopped. If a drug like Propecia can help you hold onto your current NW level for 10 years... its worth a try IMHO. If you get sides simply stop.

Ten years from now with the same NW level. Think about it. We are all here thinking about a HT and gambling on scarring/poor results/future OPs. I say use what we can in the fight and Fin is a great weapon against MPB. Ha!. I sound like a salesman. ... anyway Romperstomper29 isnt into it and that's his perogative so I guess the subject is mute here.

Thanks for the advice guys after the surgery when all healed I think I will give RU a go and see how it works for me. FIN is a no go for me. even though many never get sides the potential for them is too much of a risk for me.

I totally understand. I hope it didnt seem like I was trying to push Fin on you. I was just trying to relate the potential effects of having a HT without halting your loss. Hope it all works out well and you get the hair you deserve.

I can see those dots pretty easily, and with some sun they might seem brighter, but this is nothing like a FUT scar would look. Good to see this video. Anybody know how many grafts he had?

Do NOT take fin!

I don't care what anyone tells you here on the forums. That drugs has the potential to utterly destroy your life.

 

Here is what I'm doing. I'm 43. NW 3

Just had a 2000 FUE One month ago.

I'm going to use Rogaine foam, Ketoconazole shampoo, biotin supplement.s and let the chips (hairs) fall were they may.

 

Hopefully I can Squeeze as much life as I can out of my hair. If /when the native hair thins too much and the HT starts looking bad, I'm simply going to have ONE more procedure to reverse the FUE. Looking this time to the FUE recipient hairs and relocate them back into the donor areas from which they came.

the I'm DONE with hair. I'm out of the 'hair' game after that.

 

In my opinion I will have done everything within a reasonable acceptable limits of what I'm willing to undertake to preserve and maintain hair. I'm hoping to get maybe 10-15 years out of my FUE HT, before things start looking 'awkward', then I have to look into getting the reversal.

 

But definitely, Propecia/ fin can give you LIFELONG IRREVERSIBLE IMPOTENCE!! Is freaking hair worth rolling the dice on that shit!!!! Not in my book it's not.

Not to mention Fin can cause mental confusion and every carries with it a risk of male Breast CANCER!! The side effects are report in around 2-10%. Some people that were very unlucky with Fin and got severe irreparable side effects have even been driven into profound crippling depressions, resulting in career loss, divorce, and even SUICIDE!! It destroyed there otherwise productive and happy life. A s little as one single dose has been report to cause PFS!! So don't even try for ANY period of time. Not even once.

 

Hair loss sucks! I know! I've lost a good deal of mine. Buts be VERY cautious what risk you enter into on your quest for hair.

when the native hair thins too much and the HT starts looking bad, I'm simply going to have ONE more procedure to reverse the FUE. Looking this time to the FUE recipient hairs and relocate them back into the donor areas from which they came.

Anyway back to the OP. Sure, it's your body. If you dont feel like trying Fin then dont, but I would strongly suggest you do not get a HT at this point. If you are 30 and heading for a NW5 you might end up regretting the decision. Just sayin.

Easy. The old guy got the FUT and the young guy got the FUE.

..HA!

How old are you?

I would strongly suggest getting on Fin asap. You will lose those hairs that you mentioned. Fin can help you hold them for years longer.

Also you have to be REALLY sure you have the donor to get you looking good and normal for the long run. This is a LONG TERM decision.

I dont think you mean straightening the hairline out, right? That might make it MORE noticeable.

Im wondering if it is because you simply have thicker donor hair, so up front it doesnt look soft and natural enough. Im not sure they can fix that? maybe with some single hairs only and cherry picked so they are thin. (?) its a good question and one you should keep asking until you find a solution. Dont rush into the next procedure. Look for the doctor who does the best/softest/most natural hairlines and talk to him.

Look at a friends hairline that isnt losing any hair. Those hairs in the front are whispy thin.

Man. Interesting. Please do keep us posted on the journey.

Mav,

 

I'm not sure if I'm following the comparison correctly, but I would say the guy with the increased laxity has an increased risk of scar stretch (despite the number of procedures).

 

Also, thank you for sharing the above statement. I absolutely do NOT want to make it seem like I'm downplaying any aspect of the procedure. Patients need objective information from this site, and that's what I seek to give. I do apologize if it seemed like I was glazing over any details or looking at things through "rose-colored lenses!"

 

However, I do want to address the above: I think if you read through what Dr Lindsey wrote, we are actually very much on the same page. He states that statistically, most guys fall into the "first group and wind up with good scars." This is akin to my "normal healers" category I discussed initially. I still do feel like the majority of patients fall comfortably within this group. This people heal with the simple "line." If they do "stretch," it's usually 1-2mm.

 

What's more, Dr Lindsey actually described a few variables that always go through my mind as well: laxity during testing and ethnicity. As he said, these patients tend to heal with a bit wider of a scar, and this does reference back to the people I think we can somewhat identify as counsel appropriately.

 

He also does discuss those who surprise you or seem to heal up less-than-ideal despite okay characteristics and a good closure. This does have to do somewhat with physiology, which I touched on above, but I do want to state the following -- and maybe this is where I should have been clearer before: there will ALWAYS be a degree of variability and unpredictability with medicine and surgery. No way around it! Call it whatever you'd like, there will always be some patients who don't heal up as expected, some who don't grow as expected, some who experience more swelling than you'd expect; and then there are always the "nice surprises" that you wouldn't expect either: guys with grafts that never actually shed, people who look like they just had a perfect "buzz cut" on day 3, very early growers, and, of course, beautiful scarers.

 

Having said all that, I do still feel the following holds true: there are more ways to identify and classify patient scarring than we usually do read online; most fall into the "normal healers" category -- which I define as a thin line in good scenarios and a few mm when they "stretch;" and there are certain patients with certain characteristics that indicate they may not heal as well as others; however, I do believe these are a minority and good closure technique has a lot to do with keeping these guys in the minority; and I firmly believe limiting strip widths has a lot to do with this as well.

 

I hope this seems more direct! Like I said before, I don't want to sugarcoat any of this. That's not what our community is all about!

Thanks Blake. Good important info here.

Awesome transformation.

Would people be interested in some sort of rough checklist or scoring system they could go through to get a vague idea of how they may scar?

As far as laxity goes does someone with good laxity have a better chance of a small scar after 2-3 procedures compared to the same guy if he had a tight scalp (and normal "inner" laxity)?

Thanks.

The trouble Blake is that even after 20 years...I can't tell which group the lax scalp guys are in. Statistically most are in the first group and wind up with good scars...but a small percentage (white black middle eastern and asian patients of mine) are easy closure patients and wind up with a 3mm wide hairless scar from stretching...despite a perfect 2 layer trichophytic closure and a fairly narrow strip excision.

Blake, I'm sure you and Dr Feller get great scars in general but minimizing this reality (above) does a disservice to the community by potentially leading to some unhappy people who were made to believe they would get a "pencil thin" scar. I'm not saying you are doing anything wrong but your initial posts really hint that a stretched scar shouldn't happen with good technique etc. I don't mean to put you on the spot. Im just looking for the reality here

Dad gummit! Life saving stuff here. Dr. Konior, I have to say your results are always amazing. Keep up the great work.

I agree with Sethticles. Around 3,000 would make a huge difference and look great. I would suggest putting some time in researching different doctors here on the site to find one that gets solid FUE results/etc.

Also read a bunch of threads so you fully understand the procedure first.

Also you might want to start taking Finasteride. It will stop your hairloss where it is and give you some good years to work with.

Take your time and read up. Good luck.

Hi Sam23, Yea its really the time to just give it time to grow. There are lots of people who look great after a HT and no one can tell they had anything done. That comes right after the "Ugly duckling" stage (the first 3-4 months). Your hair should be looking much better and you dont have to tell anyone about it, ever, if you dont want to.

can the skin back normal and smooth again ?

Excellent question. The point of the scalp laxity exercises is just that: increase the stretch in the scalp in order to take a wider strip on surgery day. And to an extent, they do work. However, it bounces back to what I said above: in our observations, decreased attachment to the deep layers (the first type of laxity) will allow you to take a bigger strip, but this may also increase your risk of stretch. What's more, we really have cutoffs for strip widths because we've found a "sweet spot" where we are able to maximize yield while minimizing scarring and really avoiding any issues with wound healing. So we rarely need patients to stretch themselves out more than the width we normally take. However, all clinics are different and I do recommend discussing this with your surgeon personally -- if you do go down this route.

Are you saying that laxity excercises help to take a bigger strip but may increase the chance for poor scarring? That kind of makes them useless right? Or am I misunderstanding?

It's good you found a forum like this. Take your time, and read a BUNCH of threads. You'll learn the pros and cons of the different HT techniques and youll find a doctor that fits what you are looking for.

Magnium,

 

No, I don't think Calvin went to a bad doctor necessarily. I don't know anything about his strip surgeon, to be honest! I was merely commenting on the importance of doing your research. I always recommend this!

 

You bring up two important points that I do want to address. Frankly, I think one deserves its own thread and I may make it in the future. But I'll discuss it a bit here:

 

1) Are bad/stretched scars a rarity or a common occurrence?

 

Frankly, I really should bounce this question to my good pal Dr Lindsey. He's a facial plastic surgeon and scar healing is a bit of an obsession for him. The man even grades his own scars and openly reports the winners and less-than-winners to the community! Impressive.

 

Dr Lindsey does a very meticulous layered closure and stands by the fact that somewhere around 28 out of 30 of his incision sites heal up nice and thin. He says the other two stretch a bit and he's not as happy. But I don't think I've ever seen him share a big disaster case -- and he's the kind of guy who absolutely would share it. And the ones that don't heal the way he wants ("A" grade) are still very easily concealed with the "3 guard" level I tell all my patients.

 

We close with staples and I believe get the same ratio/effect. The worse stretching I've seen thus far has been a few millimeters, and it's still very easily concealed.

 

Do I think it's the 25% Dr Shapiro claims, or closer to the 2 or so cases out of 30 Dr Lindsey claims? I suppose it's going to vary all over the place, but I see similar results to Dr Lindsey's assessment. I think if you limit the width of the strip (which sometimes means not doing the 6,000 graft HUGE FUT cases, and I know this isn't as sexy or fun), and close it up nicely, I usually feel very confident with the way the patients heal and give them the same speech about "fade cuts and 3 guards."

 

I also think the disaster scars we see online have something in common, and it brings me to your next question:

 

2) What role does laxity play?

 

I really should make another thread about this, and it's actually something Dr Feller and I are experimenting with at the moment, but there are two types of "laxity" and each plays a role in closure (and it's different than what you'd assume):

 

There are two types of laxity: the intrinsic stretch or laxity in the skin, and the "give" in the scalp caused by how the entire scalp is attached to the deep layers and the bony skull itself. Both are going to affect how the scalp will stretch during and after closure. If the scalp is loosely attached to the deep layers, the skin is going to have a tendency to separate further from the wound. There is also the intrinsic stretch in the skin (which has more to do with the collagen we discussed above). This is different than the first type of laxity, but still allows for more natural stretching.

 

So imagine the following two scenarios: You remove a 1.5 cm (wide) strip from two patients. One has a scalp that is very loosely attached to the deeper tissues and, because of this, doesn't stay in place when the strip is removed and, instead, tends to creep away from the incision site. This same patient also has a lot of natural laxity or "stretch" in his skin. When we close this gentleman, we have two things working against us: 1) the scalp doesn't have firm deep attachments and will naturally drift away from our staples. and 2) the intrinsic qualities of the skin itself let this happen! This isn't going to scar well.

 

Now imagine patient two: he's locked down to the deep layers, and taking a strip from one portion isn't going to affect the areas around it because they are locked down. He also has hard, "non-stretchy" skin that won't allow for pull away from the staples either. This guy's closure is like stacking cinder blocks. He comes right together and doesn't move a millimeter!

 

Now, most people are somewhere in between and therefore the results are somewhere in between as well. The scar won't be an invisible seam like it will be on the second patient, but it also won't look like stretched silly putty like the first (and I don't mean to make light of this issue here). It will end up being a thin line across the back of the scalp. Maybe 1-2 mm if he has one quality a little worse than the other? So in this sense, I think my opinion may differ from the norm. But I do feel like an increase in both types of laxity leads to increased potential for scar stretching.

 

Does this make sense?

Awesome and very informative reply. Thanks Blake. Yea, this does makes sense. I had never even heard about ""the give" in the scalp caused by how the entire scalp is attached to the deep layers and the bony skull." being a factor. Interesting stuff.

I will have to double check but I think in his video with a former poster who shall not be named, Dr Shapiro said one in four strip scars will stretch.

My former doc said high laxity equals stretching in FUT closing.

Thanks CalvinJR. Strange, I thought a tighter scalp would be more at risk. Good to know.

Blake: 1st FUT it stretched just as much as second. The second FUT was actually done as a FUT and scar revision. It was a VERY small FUT and he cut out the old FUT scar and made the line a bit longer (1st FUT maybe 8 cm long; 2nd FUT around 12 cm long) to take out more grafts for the front as well. Used TC for closure second time - not sure if that procedure was developed first time (2006). Scar stretched exactly the same again. Don?t remember what I was told about workout. Just to take it easy until stitches came out. I did deadlifts, squat etc. I have high laxity skin. You can see a picture of my scar in my thread.

His doctor should have noticed his skin condition and told him/suggested FUE.

What confuses me most is the amount of posters that have bad scars even from great doctors.

In your posts it sounds like stretched scars are a rare phenomenon that are controllable. Are they?

Also CalvinJR had good laxity. I, for instance, do not. My scalp feels pretty tight back there. Does good or bad laxity have any effect on a scar stretching?

If the strip taken was wider, then the potential for stretch could have been greater. In your example of 3,600 grafts, a wider strip would have likely been taken. We have pretty firm "cut offs" for width of the strip, and compensate by making it slightly longer. Long, thin incisions heal up nicely. Shorter, wider ones do not!

I think there is always slightly more potential for less cosmetically acceptable scarring after multiple surgeries. However, we do second strip procedure frequently, and I still think the scarring falls within the normal variation I described above.

Again this guy must be happy but most people would have a MUCH higher chance of a stretched scar because of the reality of 2nd/3rd procedures/more grafts needed etc.

Im not at all disagreeing with what you said but there is still mystery around the "pencil thin scar" -VS- the stretched scar that we all read about so often.

Thanks again for being so transparent and relating so much good info.

For 2603 grafts this is a nice improvement indeed.

TOharbourfrontm

 

I'm sorry to hear that you're not satisfied with your result. It's unusual for the clinic to not respond. I'm going to email Dr. Doganay and his rep and make them aware of your thread.

 

Please keep me informed of any development. You can PM me or email me at service@hairtransplantnetwork.com

The clinic has offered to due a repair for free. I'm just debating if It's doable for me to get there

Glad to hear it! Good luck and please let us know how things turn out if you are able to make the trip.

This is an awesome forum! Nice work David.

Very interesting Dr. Fellar and Dr. Bloxham. Thanks for debunking that old myth.

So basically collagen build-up, poor technique, and /or personal healing characteristics determine if a scar will be pencil thin or might stretch?

Does scalp laxity have any bearing on the outcome also?

How would a person determine if they scar well?

If you have had any scars stretch could you tell there might be a problem before the HT?

If this patient would have had 3600 grafts would the potential for stretching have gone up?

On a second procedure does the potential for stretching increase even in the hands of the best doctors?

Again, an interesting video. Thanks.

Sounds more like it was an unqualified doctor and his techs, not FUE itself. If they were any good they would have stopped, like you did, and consulted with him. Also they would not have told him his growth was ok and got him for more grafts after the fact.

Bad doctor. Not bad procedure.