PupDaddy

I would ask your doctor about when it will be safe to start laxity exercises for your next FUT. Dude, you had surgery barely three months ago. It takes the body time to heal and adapt. Many people continue to choose FUT over FUE for a variety of reasons discussed in depth in numerous threads on this forum, some being: 1) more consistent yield with FUT, 2) much larger single sessions possible with FUT vs. FUE, 3) better quality grafts with FUT, 4) less transection of grafts with FUT, especially for patients with wavy or curly hair, 5) less trauma to each graft with FUT vs. FUE, etc. Also, "tightness" following FUT is a relative term and has different meanings. After having a 1-2 cm side strip of scalp removed form the back of your head, it is expected that you will feel snug (tight) back there for quite some time. The trick for the surgeon when doing large FUT sessions is in determining how wide a strip he can take without having to pull the edges of the tissue above and below the excised strip together so much to close the site that the incision is closed with excessive tension such that the oppositional pulling forces of the scalp itself, over time, cause the formation of a wide scar. Some docs are especially adept at planning and taking strips with really large amounts of grafts that nevertheless do not result in excessive tension on the strip closure. They use various techniques to do this, including varying the width of the strip at different areas of the donor, taking the strip in sections, etc., to reduce the tension in any given area. Considering that some clinics are now regularly taking 5,000 - 7,000 grafts or more in a single session without adversely effecting scar formation, I wouldn't think that your 2,800 strip resulted in undue tension on the closure. You're just naturally going to feel "tight" back there for awhile, but it will eventually pass. Keep your eye on the prize: a restored head of hair! I think you are panicking, which is understandable but unecessary. You are in the early stages of post-op recovery, and at three months you are about to see your transplanted follicles begin to sprout. Enjoy it!

The answer, I believe, is that even though strip patients will feel "tight" for quite some time, three momths generally is sufficient time for healing of the incision and development of scar tissue that the risk of stretching is minimized. Also, lifting weights doesn't put much, if any, direct oppositional pulling forces on the incision site. So once healing and scarring is well under way (3 months+), daily activities, including things such as lifting weights, are unlikely to adversely effect the formation and appearance of the scar. You wouldn't want to, for example, start doing scalp laxity exercises at this juncture obviously, but so long as you don't do things that put direct oppositional forces on the scalp above and below the incision, you should be okay. The feeling of tightness subsides over time (sometimes a long time) as the scalp above and below the incision site sloooowly adapts and relaxes. Or so I've been told by a couple of recommended docs.

All anyone need do is click on your pre-op photo and then on your 8 month photos to be blown away. Yowza!!

You got the result everyone contemplating a ht dreams of. You have to be very, very happy. Thanks for the update!

brobean, The main concern with a national chain marketing cosmetic surgery like a hair transplant or a face lift is that the procedure is sold as a commodity that, by implication, can be executed equally well with identical results by any number of interchangeable doctors affiliated with the chain. As veterans of this site know, that just isn't the case when it comes to hair transplantation. The result one gets from a national chain depends on the surgeon and tech team one draws, which is usually determined by the prospective patient's proximity to an affiliated office. Yes, all the docs are purportedly trained in follicular unit transplantation, but as a perusal of the results on this site posted by recommended docs and their patients reveal, there are differences in approach, aesthetic, technique, planning, etc. that fairly stamp the work of one ht surgeon vs another over time. Hair transplantation is a cosmetic surgery, not a commodity. Yet the befores and afters shown on the national chains' infomercials, web site, and promotional materials are non-surgeon specific, suggesting that a patient of the chain can expect the same result regardless of the doc he is directed to by the chain. That, combined with the pressures of sales quotas, commissions, upsaelling, and getting patients "in the chair" to cover the enormous overhead and advertising outlays create a situation that some say amounts to a crap shoot for the patient. This is not to say you can't luck out and get an excellent transplant from a doc affiliated with a national chain- you can, as a couple of posters here have shown - but generally speaking, I think most members here would agree that your odds of getting a satisfactory result are increased dramatically by avoiding the chains and instead conduct careful research of top notch, reputable, experienced independent hair transplant physicians such as those who are screened and recommended on this site, who post lots of their results and are individually accountable for their work.

Agreed. Really, really nice! And I'll bet shoring up those peaks makes for a real cosmetic improvement with this fellow.

How long ago did you have your FUT? Were you before and/or are you now taking finasteride? It could be that you are simply suffering continued male pattern baldness.

Welcome to the forum, chicagobears. When you get a chance, you should read through as many threads on here as you can about hair transplants and what they can and cannot achieve, how they are accomplished, how hair is taken from the back and sides of your head (from what is known as the "safe zone" because hair there is generally resistant to the effects of DHT, which causes hair to stop growing over time, i.e., male pattern baldness) and redistributed to thinning or balding areas of your scalp, and how the transplanted hairs are carefully situated to create an illusion of density (but not actually as dense as it was before you lost hair there), and to understand that a hair transplant only moves hair from one location to another --- it does not multiply hair, i.e., you don't get additional or new hairs from a hair transplant. The very short answer to you your question is that in terms of quality and characteristics, each hair that is transplanted will, when grown out and matured, be the same as it currently is, just at a different place on your scalp. In terms of actual density, generally speaking a hair transplant (or sometimes two or even more transplants) can give you between 35 - 60 follicular units (1 hair, 2-hair, or 3-hair units) per square centimeter of scalp, whereas in your high school hair glory days you probably had somewhere around 90 - 100 follicular units per square centimeter of scalp -- so you might get half the density or so that you had in your best hair years, but top ht docs can get the most cosmetically out of the transplanted hair, through careful attention to hair direction, placement, and recipient site technique, to make it APPEAR that the transplanted hair is more dense (more follicular units per square centimeter) than it actually is.

Beautiful work as always from SMG and Dr. Paul. This gentleman look great, utterly natural, age and starting-point appropriate, and cosmetically flattering.

P.S. Prescription Ketocanazole shampoo leaves my hair the fullest after shampooing, followed by Revita and Regenepure. All three leave my hair looking healthy and full, although my hair tends to get "slicker" a little faster with Revita and Regenepure.

I alternate Regenepure and Revita with prescription Ketoconazole shampoo (2%). I have no opinion as to which of these Ketoconozole shampoos is "best," but I am continuing to use them for now.

srOd, Several things concern me about your case. First, your doctor advertises on her web site that she offeres FUE as an alternative to FUT (the only proviso being that you might not get as many 2-3 hair grafts, which can effect density). Yet is seems apparent that your doc doesn't really do FUE in a serious way and, instead, steers every patient towards FUT, just as she talked you out of FUE. This smacks of something of a bait-and-switch. Get 'em in the door by advertising FUE, then steer them to FUT. Second, when you posted that you originally requested FUE and weren't happy thus far with your FUT results, your doc's representative responded with the old, misleading scare tactics used for years by FUT shops that didn't or couldn't adapt to FUE: You end up with more scarring with FUE than FUT because of the hundreds or thousands of "open holes" on the back of your head resulting from FUE. No one forced your doc to advertise FUE as an alternative to FUT, but if she is going to do so then she should actually offer it, believe in it, and be competent to perform substantial FUE sessions. Your doc is not the only ht doc I've seen do this but that doesn't make it right or acceptable. Plus, the way her representative responded, by trashing FUE in general, after the fact, with misleading scare tactics, stuck in my craw. It would have been one thing to say you weren't a good FUE candidate for specific reasons (e.g., curly hair, "spongy" donor scalp that would make extraction of the excised grafts difficult, etc.), but instead your doc, through her rep, implies that any significant FUE procedure is dangerous, risky ("open holes"), and results in unsightly scarring far worse than any FUT strip scar. Third, for your doc to suggest that 100 FUE's would fix you right up in your current situtation is, well, ludicrous. (The same could be said for 200 FUE's, I'm sorry to say.) Personally, I would cut my losses and move on to a doc more comfortable and experienced with FUE to add some much-needed density. Even if you ultimately decide to go FUT again, I would try someone else based on the results you obtained the first time and what appear to be some shady marketing tactics of your current doc.

Three facts of life tend to compromise FUE results compared with FUT results when performed by equally competent surgeons: 1) More transection of follicles with FUE, which effects yield, 2) less "chubiness" of grafts excised via FUE, which effects follicle viability (yield) as well as maturation of follicles that do grow (hair quality), 3) fewer 2 and 3-hair grafts (especially 3's) can be excised via FUE unless a larger punch is used (thereby creating more visible punctate scarring, somewhat defeating the primary benefit of FUE), which can compromise density. I'm pretty sure these facts are why Spex, who represents top docs who perform both FUT and FUE and has seen hundreds of cases, says that cosmetic results of FUE generally are not up to par with results of FUT given the same hair loss and ht doctor competence. I personally think that because of the facts listed above, FUE is still best suited for patients with staight to moderately wavy hair suffering moderate, frontal hairloss. This is not to say that some patients who don't fit this category can't sometimes get a good-to-great cosmetic result via FUE, but the challenges inherent with FUE discussed above make it less likely and should certainly be considered. I also agree that smaller FUE sessions, separated by 8 - 12 months, provide a greater chance of an acceptable cosmetic result rivaling what can be achieved in one session for the same total number of grafts via FUT.

While you are at it, also consult with Dr. Carlos Wesley in NYC. He charges a $100 consult fee and is very knowledgable (and enjoyable to talk to, to boot).

ThinningTop, No offense, but are you just yanking our chain here? Three times you've asked about Dr. Gallagher and gotten extremely negative feedback and even now it is only "doubtful" that you will choose him? Same thing with Nu-Hart and Dr. Boles. You've asked about him and Nu-Hart here before and gotten negative feedback and warnings to steer clear. Is there a reason you don't want to consult with one or more of the Coalition physicians or other physicians recommended on this site? Several are in close proximity to Philly if that is your concern (although locale should never be a primary concern when considering the lifelong decision of a hair transplant). You do know that this site maintains a list of recommended physicians that you can search by locale if you wish, right? There is never a guarantee of success when it comes to a ht, but at least the physicians recommended on this site have to have a body of good work and meet certain standards with regard to their clinics, technicians, and practice -- and many post their results here so you can evaluate them. I really think that your odds of getting a result you will be happy with will increase significantly if you would consult with some of the Coalition physicians or other physicians recommended here.

My understanding is that the actual puncture tool used in ARTAS is Dr. Harris' motorized SAFE tool, which is well regarded. So that, plus computerized mapping of the donor/extraction sites and computerized precision of puncture angle and depth should make for an excellent FUE system in the right hands.

Wow! What a gorgeous hairline and utterly natural, dense result. Beautiful. P.S. This fellow looked closer to a NW IVA than a IIIA to start. P.P.S. This is one of the larger one-pass sessions I've seen from SMG. Thanks for posting it!

Thanks, Janna. I thought that might be the case. This patient got a lot of bang for the buck at SMG. Nicely done!

Janna, In this fellow's case, was the relatively small graft count relative to his Norwood scale the product of the patient's budget, his donor characteristics, or longer term planning? Many thanks!

Wow! I can't believe this fellow is only 6 months out. SMG's FUE results are rivaling its FUT results, which is saying a lot. Beautiful work.

I stand by my original assessment: This is a sensational FUE cosmetic result. If you showed his after photos to random people without asking them to assess them specifically as ht photos, I think most people would say, "That is a very handsome fellow." In fact, I did just that with a couple of female friends and they both said the same thing. We get so used to looking at ht photos that we can get an "ht eye" that keeps us from seeing the forest for the trees. In that regard, there have been a number of results posted on this board and on top doc web sites that received great acclaim for their density, which my non-ht enthusiast friends and acquaintances have reacted negatively to: E.g., "What's going on with his hair?" "Is he wearing a wig?" One thing to keep in mind is that this fellow now cuts his hair very, very short (and looks great doing it), which always makes transplanted hair appear less dense. If he were to grow his hair out longer, the illusion of density would be greater. But why should he? Most of us would kill at his age and hair loss starting point to look this great with a closely cropped hair style. If he had gone FUT, he might have gotten a bit more density but he could not have worn the short hair style that he wanted. Besides, would he look as good as he does now if he had gone the more conventional route for the sake of greater density, i.e., a higher, more receded hair line, without aggressive work to temple points and peaks? In this fellow's case, I don't think so. Cosmetic appeal is, of course, subjective. Personally, I think this result was a home run for doctor and patient.

Hi SugarHighs, I might be inclined to get Dr. Rahal's okay to discontinue minoxidil completely for now. If you are having an allergic or idiosyncratic response to it (or to one of the inactive ingredients in the formula you're using), I don't know that assaulting your scalp and grafts with it once per day rather than twice per day would make a difference. I doubt that any of your grafts are minoxidil-dependent. So far as I know, Dr. Rahal and other ht docs who recommend minoxidil post ht do so only as a "boost" to stimulate the viable grafts to grow faster. It isn't the usual use for minoxidil, i.e., to re-awaken long dormant follicles that will thereafter require the drug if they are to continue their life cycle. If there was a risk of grafts transplanted from the donor area safe zone becoming dependent on minoxidil for continued viability, I doubt that ht docs would advise using minoxidil on them in the first place or advise discontinuing using minoxidil on them after one year. Same thing for previously viable hair adjacent to or surrounding the grafts. Just my thoughts.

SugarHighs, I must say, yours seems to be an unusual case. Notwithstanding that you have a beautiful head of hair as is, it does appear from your photos that some of the transplanted hair that was growing in at the 4.5 month mark has shed and gone dormant, and that some of your native hair behind the transplanted hair might have gone dormant as well. If one or both actually is happening (it is always difficult to judge from self-taken photos with different hair lengths, lighting, angles, hair product, etc.), I suppose the $64,000 questions are: (a) why, and (b) will this situation reverse itself? Some conceivable causes: 1. delayed shock loss of native hair 2. insufficient blood supply to support all the densely packed grafts, causing no growth of some and a slow, diffuse die-off of others (can that happen?) 3. temporary shedding/resting of transplanted and/or native hair due to minoxidil 4. allergic or idiosyncratic response to minoxidil I wonder whether Dr. Rahal might advise discontinuing minoxidil to rule in or rule out no's 3 or 4? If no. 2 is happening, either alone or in combo with 3 or 4, I would think that a density touch-up session after a 12-month resting phase would do the trick (although I would want to ask Dr. Rahal whether scarring in the recipient area would pose a challenge), and if no. 1 is occurring, I would think that chances are good that the native hair will return in time. Please do keep us posted about your efforts to solve this mystery. I am not at all surprised that Dr. Rahal has assured you he will take care of you. He will! It must be maddening not to have completely smooth sailing, but I have no doubt but that you will end up with everything you wanted from your ht. Hang in there! Regarding no. 1, I would think that the native hairs would return on their own.

To my knowledge, rsn, there are but two studies pertaining to the ability of an ingredient in some of these shampoos to impede hairloss, that ingredient being ketoconozale (kcz) 2%, the active ingredient and concentration in Nizoral 2%. As you know, Nizoral 2% is sold as a prescription antifungal shampoo with a high lipid content, which helps the ktc to rapidly absorb into the scalp. Other shampoos with lower concentrations of kcz are Nizoral 1%, Revita (1%), and Regenepure (1%). These shampoos also contain other ingredients that are believed to be beneficial to overall scalp health and follicular growth (e.g., copper peptides, zinc). Of the two studies in question, one was a rodent study suggesting that kcz increases hairgrowth in mice. The second study is a human study conducted in 1998 by doctors in the Department of Dermatopathology at the University of Liege, Belgium. That (small) study compared kcz 2% shampoo with 2% minoxidil for their antinflammatory activity as a treatment for alopecia. The results of this small sample study were that "Hair density and size and proportion of anagen follicles were improved almost similarly by both KCZ and minoxidil regimens." The conclusion of the study was that "there may be a significant action of KCZ upon the course of androgenic alopecia and that Malassezia spp. may play a role in the inflammatory reaction" but that "the clinical significance of the results awaits further controlled study in a larger group of subjects." I started using Nizoral 2% 2 - 3 times per week a month ago. I saw positive results on general scalp and hair quality from the outset. Whether it impedes or even reverses hairloss for me remains to be scene with longer term use. I also have been on finasteride 1% for 8 months and began supplementing that with .5 mg Avodart once per week in hopes that the possible synergistic effect discussed on this board pays dividends.

NHP probably got discovered as a hair model and is now traveling the world doing photo shoots, hanging with babes, and signing autographs.