delancey

First of all, it is estimated that approximately two thirds of those who are losing their hair experience some level of retrograde alopecia. This is consequently the reason why many doctors avoid the areas commonly affected by retrograde alopecia. Second of all, indications allow professionals to draw educated conclusions, this is true. However, many times indications first present themselves beyond the age of twenty five - hence, there is no educated conclusion to make. It can be unpredictable, similar to regular male pattern baldness. Thirdly, I am of the philosophy that it is better to extract grafts inside the safe donor zone first and then reassess.

Millions of Norwood 5s have retrograde alopecia. This is the reason why there is a universal safe donor zone to begin with; there is no way of telling whether a 20 something year old will end up with retrograde alopecia later on in his life.

Perhaps the forum could integrate a system, which would allow each clinic to check a box every time a result is posted. That way, the forum staff could easily keep track of those surgeons who aren't posting results on a regular basis. That way reports could easily be generated without having to go through the hassle of investigating who hasn't posted in a long time. I find it surprising that more clinics are not taking advantage of their membership and posting results on a regular basis. It is a wonderful way of showcasing top-notch results to potential clients and allowing forum members to talk about your clinic. It would also be beneficial to implement certain presentation standards. We are in 2019 and some clinics showcase results that resemble what one might expect from a polaroid camera....

Thank you for the clarification. What is known in the industry as a micro-graft is what you are referring to as “MFU.” Is this assertion correct? You mention some advantages of using micro grafts above. I am also interested in learning about your clinic's philosophy about whether the advantages of using micro-grafts (MFU) in the front-central area behind the hairline outweigh some of the disadvantages of using micro-grafts. These disadvantages may include: 1. Longer healing time. Bigger incisions (as compared to follicular units) result in the wounds taking longer to heal. This may also increase the chance of an infection occurring. 2. Scarring. Micro grafts contain more skin tissue than natural follicular units, which may result in additional scarring. 3. Density and Coverage. Density and coverage obtained from a modern day follicular unit transplant often result in a more natural and dense hair transplant that mimics nature. Why not just dense pack the area using natural follicular units? 4. Angles and Direction. How natural do micro-grafts look compared to modern day follicular units when wearing a short hair-style? How accurate are the angles and the hair direction in the recipient zone compared to natural follicular units? Thank you for taking the time to explain your clinic's philosophy and use of micro-grafts (MFU).

Could the clinic please clarify what exactly MFU means in their practice? The clinic is separating between 4801 FU and 831 MFU. Please clarify as I think there is some confusion in the thread that was never clarified. Thank you.

I agree with Sean. Another point I like here is the hairline, it is conservative but it frames the face and makes this young guy look much better today and it will age well with him. This is top notch and it looks so natural.

What a natural result. Great job!

Exactly!

Hi WheretoGo, I cannot comment on extraction patterns used by the industry as a whole as each clinic implements its own protocol, which has resulted in extraction patterns varying to a large degree across the industry. Retrograde alopecia is however not uncommon, although not spoken of as much on the forums as it perhaps should be - especially now that FUE has really taken off. My personal viewpoint is that hair loss is unpredictable, including retrograde alopecia, especially on a patient who is as young as the aforementioned case. When grafts are taken right above the ear, it always leaves the possibility that these grafts may fall out later on in life. This is not to say that everyone develops retrograde alopecia, but the risk is always there. I started developing retrograde alopecia, albeit rather mild, in my late 20s. As each case is unique with its own set of advantages and challenges, perhaps your Doctor felt that your donor region right above the ear had few signs of thinning. This coupled with your age may have led the clinic to extract grafts in this region to get at thinner grafts for the hairline (i.e., to make it appear more natural), but this is really a question for your Doctor to answer.

Hi BHRClinic, Thank you for your response. It's an interesting extraction pattern removing follicles so close to an area that is susceptible to retrograde alopecia, especially in a younger patient who is only in his mid 20s. Just because "everyone" does not develop retrograde alopecia does not mean that some do not.

In one of the photos showcasing the extraction pattern of the right side of the patient's scalp, extractions were made right above the ear. Seeing as the patient is in his early to mid 20s, how can you be sure that the patient won't develop retrograde alopecia later on in his life and thus lose the transplanted hair that was taken from this area?

This is a very natural result. Good job!

I think you are on the right track with some of the surgeons that you mentioned above, i.e., Drs. Gabel and Konior. Drs. Ron and Paul Shapiro may also be an option to consider.

Hi mlc, You are quite right in assuming that one cannot expect a full head of hair from just 3000 grafts. In fact, the before image may actually be misleading when setting realistic expectations to prospective patients, as someone with a large recipient area to cover may come to believe that one can expect a full head of hair with just 3000 grafts. Moreover, there is a slight color difference in the last picture between the donor zone and the crown area - this may just be a result of the lighting, but it could also be due to hair fibers, one factor that should always be looked into when understand what surgery can do for you. Other factors that may impact the result include: color contrast and hair thickness. Each case is unique, with a different set of characteristics, so it is important to take everything into consideration when comparing a result to what you think surgery can do for you. If you look carefully at the before picture, you will see that the there still is a lot of hair in the recipient zone. 3000-3500 grafts should always be enough to cover the frontal third successfully, even for someone with skinny hair. This coupled with existing hair in the mid-scalp and crown would yield a result similar to this, imo. Also take into consideration that the average Norwood 5/6 case has a bald area of approximately 200 cm2. It takes approximately 50 fu/cm2 for a result to look full, however depending on hair characteristics, this may vary. But to be on the conservative side, this amounts to 10,000 grafts (50*200). Many patients do not have 10000 grafts available, so an emphasis is placed on the frontal region, with a lower density in the vertex and crown area. It is also important to take into consideration that some patterns look considerably worse than they actually are. For example, many examples with a Norwood 5A hair loss pattern appear very bald in pre-op photos, but as a result of having a significantly smaller recipient area to cover compared o a genuine Norwood 5/6 recipient zone, the results from a successful hair transplant are often stunning. I hope this helps and best of luck to you.

Do you have any pics to share with the community? Thanks!