GoForIt

Hello,

As you have looked at Bernstein's website - I would start there. He has good advice for dealing with scabs. Advice actually backed up by science.

I think the grafts are safe, but you could certainly delay healing or make any scarring worse by what you do now.

Good luck!

We see some pretty amazing mega-sessions here. I would view them like home-runs (to use a baseball analogy).

Regardless of whether you use FUT or FUE, I believe most of the time two 2500 FU procedures spaced over a year will give a better cosmetic results versus one 5000 unit procedure. Ignoring the technical challenges and time the grafts are outside of the body, the surgeon can see how the first transplant has grown in and then plan the second procedure appropriately; the hairline can be tweaked, whether or not to address the crown can be discussed, and the donor doesn't get too taxed with one procedure.

While it is really appealing to get everything done with one procedure, I think only a minority of patients, and a minority of physicians can successfully do this.

Hi All!

 

One trend that I've noticed on this forum as of lately is that many doctors are transplanting 4000-5000 grafts in one session via the FUE method. Many top doctors have a strict protocol set in place that limits the amount of grafts that can be transplanted in a day. We've also seen a lot of failed surgeries coming from countries like Turkey, where it isn't uncommon to see FUE mega sessions being performed in the same day.

 

There appears to be a correlation between poor growth and the number of grafts transplanted in one session. Technician/Doctor fatigue, extraction technique, poor blood supply, and dense-packing are some reasons for poor growth via FUE.

 

1) Is there a correlation between FUT mega-sessions and poor growth? In other words, are some clinics sacrificing strong growth when transplanting 5000-6000 grafts in one session?

 

2) Would you say that poor growth is more related to dense packing than the the total number of grafts transplanted in one session (FUT)?

 

3) If 5,000 - 6,000 grafts are placed over a larger area, we avoid the issue of poor growth due to dense packing. However, lack of blood supply to all of the grafts still becomes an issue. Is lack of blood supply really a common occurrence?

Believe me, you will not like hair loss any more in your 40's than your 20's!

Be really careful as you are doing and do not jump into anything. Whichever surgeon you chose should plan for future loss and make sure that whatever procedure they do can stand on its own. Propecia helps - but nothing is guaranteed to work forever.

Ironically when I look at the hairline from the front-on perspective, it almost looks like a female hairline rather than a male hairline. I think this is from how the temples were closed.

I hope is continues to respond and tolerate finasteride. This is a gamble, and only 30 or 40 years will tell. I have seen quite a few aggressive frontal restorations recently here. I wonder if in 10 years instead of talking about plug repairs we will be talking about repairing aggressive hairline and crown transplants.

This is really dependent on your first hair transplant. Most cases, with a well-placed initial incision, the scar is incorporated into the new procedure.

I'd think long and hard before having a series of parallel scars up the back of my head - so if whoever you see isn't going to incorporate the first scar into the procedure I'd get a few other opinions.

This is a really nice result! The point here is not about covering every bald area, but about improving appearances. To that end, this procedure is a great success.

While some clinics will do mega sessions, I think the best results I have seen are from several moderately sized procedures - that way the physician and patient can see what is important and tweak important areas like the hairline.

Great job!

if you want old school - there is always castration. I have not seen anyone post there results though . . . .

Nice pictures Spanker - though I think you should have gone with crayon! :cool:

the 3K difference by combining the approaches is huge in terms of coverage - that would be an additional 60 CM2 at 1/2 density (~100 vs. ~160 cm2 covered) - more if you had lighter coverage towards the back.

While the math is on - I think in practice most people would get a bit less than 2.4K grafts after being stripped out, but the pictures really show the idea well.

I think people forget the goal is maximum coverage with as natural look as possible, not to have a particular type of operation.

Spain. Agreed, it is a lot. But that seems to be European clinics want to do businesss. In cash.

There is always a wire transfer or a traveler's check.

Then there is always the suitcase full of small bills route . . . :rolleyes: (NOT A GOOD IDEA!).

There are legitimate reasons to prefer cash (no fees), but then there is also the issue of them not reporting the income and dodging taxes.

Reach back onto your head and pinch your scalp. Most people can pinch a roll of skin. There is some redundancy. When you cut out the strip, you essentially are doing a scalp reduction. You have some stretchback (which is why scalp reductions didn't work too well), but it isn't 100%. Think of it as a tummy tuck for your scalp - why would people have tummy tucks if the skin were to just stretch back to the original size?

The goal isn't to get FUE or FUT, but to maintain or create the fullest head of hear with the most coverage. FUE, FUT, and medications are tools

I'd recommend that you go to Dr. Bernstein's website, he's a forum member and he has a good discussion on this topic.

If you could look into a crystal ball and say where each individuals safe donor region was and harvest over the entire safe region with FUE then you could probably just go with FUE. The older the individual, the less the hair loss, the greater the confidence in the safe region to harvest from.

It isn't about 1+1 = 3, but about how you can move the most number of hairs which are safe without compromising the look of the donor region. If you have reasonable scalp laxity you can cut out a portion of the scalp and not affect the apparent density much (though you will have less surface area of hair-bearing scalp). With FUE, you don't decrease the surface area much, but you diffusely decrease the density.

Hey 1978matt, thanks for the reply.

 

When you say 3000-3500 - do you mean in one shot?

 

 

FYI - there are several Nusbaum cases on this forum.

Bernstein is conservative - you don't see any 'repair' cases generated by him, but he does plenty of repairs of bad hair transplants.

I visited with Bernstein - he will tell you what he sees as the best option, not what you want to hear. If you look through his website you can see he's thought about every aspect of a hair transplant and wants to maximize the cosmetic impact of a limited number of grafts.

Feller has a following on here - but if you read through some of his posts on here, I was not impressed with the way he responded to questions or criticism.

If you're in NY, why not visit with True & Dorin and Wesley as well.

You have fairly extensive hair loss, and you need someone who is going to make sure you look good 20 years from now as well as a year from now.

Good luck,

GFI

When I investigated going on finasteride I looked at several studies. You have more than a chance at stopping your hair loss. This study was not done by a drug company and followed 110 men on finasteride for 10 years:

Rossi Dermatologic Therapy, Vol. 24, 2011, 455–461

86% either had no further progression or even improvement in their hair loss. Only 6% had any side effects, and fewer men stopped because of side effects.

So, not 100%, but more than a chance. There are a lot of people who will go on about the side effects - you may get some, but most men don't have any.

Good luck!

There is a chance that you will stop your hair loss on fin alone adding Rogaine and Nizoral once or twice a week will increase your chances further. If someone has the chance to regrow some hair with fin it is you. Young and loss in isolated in the crown, there are no guarantees but that is by far your best bet.

Yes - local pharmacy. I live in New England as well. Pharmacies will vary in price a bit. Generic is cheaper than brand name. Generic 1mg finasteride still costs more than the generic 5mg. You need a prescription - my primary card provider gives me mine.

Why the price difference - I have no idea. Someone must be making money off this somewhere.

I split 5mg finasteride tablets into quarters. The cost is $15 for a 3 month supply. $60 a year.

Minoxidil - buy over the counter at most supermarkets and drug stores

Finasteride - prescription. Most primary care doctors will prescribe this - and some HT docs or dermatologists will. Cheapest way is to get 5mg tabs and quarter them. This costs less than $5 /month. It is not worth getting sketchy drugs over the internet. Brand name is proscar for 5mg or propecia for 1mg tablets. I just went to my PCP, we talked about the risks and benefits, and then he gave me a prescription.

If your hair loss bothers you, and a conservative doctor (like Dr. Bernstein) thinks you are a good candidate - you've minimized the risks.

It is worth it for the right person. One thing you could try doing to help make up your mind is to try one of the hair thickeners like topik. If you put it in, and you're happy with your existing hairline but with a fuller appearance, then you have an answer to the approach you should take.

All ethical HT physicians know that there is always a risk that the result will look unnatural if hair loss progresses. I think Dr. Bernstein looks at the worst case scenario for an individual and plans accordingly. Other physicians go with a more moderate worse case scenario.

If you are willing to take a greater risk, you go with a less conservative surgeon. If you want to minimize risk, you go with a more conservative surgeon.

Try looking at men's hairlines - but not men in their 20's - look at late 30's, 40's, 50's and see where they are - especially if their hair is a little thin.

Probably not helpful for you .

I think Bernstein gets a bad rap on this forum - he tells you what you need to hear, not what you want to hear. He's studied every aspect of the procedure to get the best yield, and also the aesthetics of graft placement, as well as the donor scar.

His thing is for the transplant to look good not only right afterwards but also 30, 40 years down the line.

I've seen one patient with poor grown with Dr. Bernstein on this forum - and the office did everything they could to help him. I've never seen a Dr. Bernstein patient complain about graft placement, or need a repair afterwards.

I visited a couple of physicians when I was looking at having a HT - some of them drew hairlines lower than I've ever had.

He is expensive, a bit conservative. What you're paying for is the fact he's studied objectively each step of the procedure to figure out the best way to have near 100% growth, a minimal scar, and a completely natural result. What you pay for is if 10 years down the road you can't take dutasteride any more, or it stops working - your result will look completely natural.

There are other surgeons like this - and pick the one you are most comfortable with. The only good deal is if you get a great result.

This is a really nice result - and accomplished the goals. He went from looking like he was in his 40's, to someone in his late 20's.

He may be a NW4, but you can easily see that in the near future he would have destined to a NW6. Being cautious with his grafts is really important.

Sure, with his hair pulled back it looks a little thin, but with a not fussy hair style it looks great. I would be thrilled if that was the outcome of my surgery.

This is not really a good example of a patient that you didn't have to shave simply because there really wasn't much to shave to begin with. The recipient area is anterior to the region of higher native density but even this area is questionable. Shaved or not the hair of the vertex behind the recipient area would be used to cover the front in most similar cases. Do you have any non-shaved examples of diffused thinners with a megasession?

A lot of well regarded physicians don't shave - Dorin, True, Bernstein, Beehner come to mind (in addition to Wesley). Some docs seem to prefer shaving, while others are perfectly comfortable working through existing hair. To each their own, but I think you can get a great result either way and it's more important what the physician you've chosen is used to.

1. No minimum age, but mid 20's seems to be many docs cut-off so they can determine the likely extent of hair loss. Also the hairline of a 20 year-old does not look good on a 60 year-old unless you have the density to match.

2. You can never be sure you will not want another transplant. Most good doctors will transplant in such a way that you will not be obligated to have another transplant if /when your hair loss progresses.

I would be really careful that anything you put on there does not harm growth. A lot of docs say it is ok after the first week or two - but again just be really careful with anything on your skin especially anything waterproof.

Most people will not say anything even if they notice it (which most will not).

If you do not want to tell anyone who asks you could just say you had an allergic reaction to a hotel's shampoo sample. If your hair is curly you could say you had a problem with ingrown hairs because of your curly hair.

You could also just mutter under your breath 'Darn Lice' and the word will spread and everyone leave you alone about it

Good luck!

Before and after photos display a completely different hairstyle. The post-op photos completely hide the majority of the area worked on.

That guy could not have had that hairstyle pre op. It looks great for the number of grafts. I would not think he had a HT is I saw him on the street.

I think we need to be a little understanding of patients' choices for their hairstyles - this is out of the physicians control.

Hopefully in our lifetime we will just have a few grafts punched out and all the follicular units we need - resistant to DHT cloned .

Until that time it is a personal choice with a right answer for each person based on the advantages and disadvantages of each procedure.

Speak with a few ethical physicians who do each procedure and make the right decision for you.

I don't think the stretching of the scar is as easy to predict. People scar to varying degrees and one big factor is how much collagen the body produces when healing. A lot of people who do scar aggressively don't actually know it either because... well, why would they. They're not doctors. They don't really notice or care... until something like FUT happens.

 

I had my share of serious cuts and lacerations... lots of stitches... but had no idea I scarred aggressively until a very serious accident a few years ago that almost killed me. Then it became apparent, and the doctors were sure to point it out too.

 

So I'm of the opinion if you scar aggressively you can do FUT with a top doctor, follow all the post op procedures, and end up with a 1cm+ scar after the stitches are taken out. Who knows for sure, but do I really want to find out?

With all due respect, this is a little scaremongering (or scaremongering). If you scar so badly that you get a 1cm scar from a 1.2-1.4 cm strip being removed, then you will likely form noticeable scars from the FUE extractions.

While sometimes difficult, meet with the physicians you are considering and make a decision based on the consultation. There are risks and benefits for both procedures

FUE is not scarless, you just do not have a linear scar. You still will need to keep some length to your hair, though not as much as if you had FUT.

There are a few very vocal advocates for one approach versus another on the forum, much of what is said is opinion. Speak / visit with transplant physicians. Every case is different, but if you are likely to become extensively bald or need a large number of grafts, be very careful about who you select if you chose FUE (or even FUT).