Blake Bloxham

Hi Guys, Just wanted to make a quick thread to let everyone know that I'm officially "retiring" my Future_HT_Doc account and screen name. Before you get too upset , I'll let everyone know that I will still be very actively participating on the forums under my new "Dr Blake Bloxham" account. I'm going to include a link in my new signature to my old account. It has all the content I've shared over the years. This should be easily accessible. I'm absolutely still available to answer ANY questions about hair transplant surgery, hair restoration physicians, hair loss in general, or just to talk and catch up! Feel free to send me a private message with any questions, comments, or concerns! Finally, I just wanted to truly thank you all. It's been a life-changing experience and I thoroughly enjoyed getting to know you guys over the years. One of the best forums on the web! No joke. I've LOVED the opportunity to help hair loss sufferers out over the past 5 years, and hope to keep helping these people out for many years to come. Again, thank you all!

Cali, I remember that bump! I think it was the first time in working on the forums that I actually saw a real case of a dislodged graft. For what it's worth, the image you showed will help many others understand what a slight bump with no dislodging versus real dislodged grafts look like. Plus, 16 right from the middle there won't make any noticeable difference in the end. Glad to hear you're feeling good as well! Hope you do get some early growth. Talk to you soon.

Ontop, Yeah, sounds like you've pretty much got the idea! It will definitely heal better than a strip scar in the sense that, well, there will be no strip scar. As long as the millimeter defects left behind by the mFUE punches are closed well and heal properly, the scarring should be very comparable to traditional FUE. By this, I mean that patients should be able to buzz down like they would with traditional FUE with no obvious scarring in the donor region (however, remember that all surgery does leave scarring). And remember, that we are getting strip quality grafts AND significantly reducing damage after extraction by greatly diminishing graft "out of body time" and dissecting them under microscopes so they can be placed appropriately and survive in the recipient scalp. We're all quite excited about it. Stay tuned for more content from all of us!

Hi Cali, Thanks for the update. You're in the doldrums of the toughest phase right now. Stay strong!! Haha. Can't wait to see the final result. Dr K is an artist!

Wibbles, We were obtaining approximately 18 FUGs per mFUE graft with the smaller punches -- which is actually the "medium" size of the punches we're experimenting with. I haven't experimented with the larger punches as much, but I would estimate approximately 24-25 FUGs per mFUE graft. Price is the same as traditional FUE. Timescale? Not quite sure what you mean. The procedure is actually much quicker than traditional FUE. It's closer to the length of a standard strip operation. The rest of the post-op timeline is the same as any hair transplant procedure FUSS/FUT.

Lieli, Makes sense! Like you said, both have their place and one procedure was better suited for your needs. Best of luck and thanks for sharing!

Interesting. Future hair loss treatments is a big area of interest for me. I'll take a look.

Awesome! This lady seemed like a perfect mFUE candidate; needed the yield and quality of a strip, but didn't want the scarring. I suspect she will heal very well. I think the mFUE grafts look excellent too. You can really see the lack of trauma and how healthy they look coming out. I did want to note, however, that Dr Lindsey is using the largest mFUE punches we experimented with here. Like I said before, we've experimented with a variety of sizes and this was the largest we were considering when taking graft quality and quantity per punch versus scarring into account. The size Dr Feller and I are considering using on most patients -- and will be posting a few cases of later this Summer -- is about 33% smaller. Much like traditional FUE punches, however, a variety of sizes can be considered. The goal is really to get the "FUE-level" scarring -- diffuse, minimally visible scarring throughout the donor area -- while still optimizing what we get per mFUE punch. Great video! Look forward to seeing her progress.

Stinger/Ontop, Sorry if it seemed like I was trying to make this thread about FUE yield or anything like that. I wasn't. I was really just thinking out loud as I was typing. FUE yield is variable. It can be excellent -- 90%+ or it can be not so excellent -- 70's%. I personally think the average is around 80%. I know most FUE practitioners say 85%+ is the minimum of what they aim for. However, my point was that this definitely could be affecting this member's overall result, but it could be fixed.

The young Dr L is such a champ! This is going to look awesome for medical school applications.

Very common. Nothing to worry about! Happy growing.

Hi Eyes, Altogether, you're okay. Let me explain what I mean. When we see threads like this on the forums, we -- members -- immediately think "disaster" case. This isn't what happened here. Your results probably aren't what you are expecting, but it still looks like you had okay growth and this can be augmented and/or fixed with more procedures. Also, keep in mind that FUE yield is never going to be the 98%+ we see with traditional strip. I would say that a 2,500 graft case would yield about 2,000 grafts (80% yield) on average. I'm still not sure if you had 2,000 grafts grow -- it's so hard to estimate accurate yield from pictures -- but you did have some growth and it can be augmented. Also, the graft placement and quality of the hairs that did grow look okay as well. Again, this is all good. Another question will be your donor. If your surgeon spread out the 2,500 extractions appropriately -- and didn't have a number of instances where the sites were scored (cut) but the graft was unable to be delivered (extracted) -- you're probably OKAY for a second pass with decent yield. Two passes with decent yield should get you about to where you wanted to be. Like a few others said, the best thing you can do is consult with a trusted doctor and get an inperson, professional opinion. Any thoughts on seeing someone else in the area?

Adoix, Glad you liked it. It's definitely an interesting topic that I think will get more attention in the upcoming years.

Mav, It all depends on how systemic it goes. If topical fin stays in the scalp, you shouldn't -- theoretically -- experience any of the systemic side effects of the hormone level changes. If it goes into the blood stream from the scalp, it will likely be about the same. It stands to reason that a topical solution applied directly to the scalp would have less distribution throughout the body than the same medication taken orally. I really believe that the only way to halt or prevent the androgenic alopecia process is to stop DHT from binding to the androgen receptors. This is what kicks off the entire process and causes a very complicated chain reaction that is EXTREMELY difficult to reverse. There are a few other topical anti-androgens people have tried. RU58841 and CB-03-01 are the two most popular. Experiment-ees reported side effects with the RU58841 and insufficient results with CB-03-01 -- though some think the vehicle (the formula of chemicals used to allow the medication to penetrate the scalp) is the issue. Other medications being tested are a BNP/Wnt pathway agonist -- a drug that promotes a very important pathway in the cycling of healthy follicles -- and the two prostaglandin drugs I mentioned earlier. This doesn't account for the other "future treatments" being investigated -- injectable growth agents, hair multiplication, and my personal area of interest, donor doubling. In an ideal world, the best "hair loss drug" would either be something that would completely eliminate DHT from getting into the scalp or a medication that could bind to the androgen receptors in the dermal papilla cells to prevent the DHT from binding. However, the first theoretical drug would wreak havoc on your hormone profile and the second would block all the androgen receptors in your body -- as the androgen receptors in the follicles are the same as the ones all over the rest of your body -- and be the theoretical equivalent of stripping the body of all androgen hormone! AGA is actually a super complex ailment and we still have many things to figure out! Frankly, I think finasteride and minoxidil will remain the predominant agents for quite some time. I also don't want to completely disparage finasteride or make it seem like I'm refuting scientific evidence. If someone is on finasteride and doing well on it without side effects, more power to them! However, I do urge those experiencing side effects to speak with the doctor who prescribed the medication. I also recommend any patient considering the medication to see a doctor EXPERIENCED with the drug to go over the pros, cons, and whether or not they think it would be a good med for you.

Mav, Absolutely not. We spend a lot of time reviewing protocol before a clinic is recommended here, and I feel very comfortable endorsing HRN clinics because of this. I wouldn't stand behind any clinic that utilized improper techniques. Neither would Pat, Bill, or Dave. However, it doesn't change the core of what I was saying earlier: research and ask questions until you have absolutely all the information you need. If something is different or doesn't make complete sense to you, figure out why. Also, remember that it's always best to double check everything you read first hand -- IE, talk to the clinics!

Spanker, You're right about "herd" symptoms and placebo side effects. However, there is no doubt that altering hormone profiles is serious business. I think many doctors are starting to feel less comfortable prescribing medications that do this in general. It's the same reason why a lot of primary care providers send patients to OB/GYNs, endocrinologists, et cetera, for things like estrogen therapy, testosterone injections, hormone pellets, et cetera. There are a few new drugs in the pipeline. The two with the best chance of making it to market are bimatoprost and setipriprant (may have spelled that one wrong) both now owned by Allergan. They are also both based of the prostaglandin theory of androgenic alopecia. One blocks an enzyme that makes a "bad" prostaglandin, and the other is a "good" prostaglandin. However, they are both in phase II (ish) testing and definitely act on a more "down stream" aspect of the AGA process. Who knows though! We will see.

Adonix, I'm definitely not the only one making these comments here. Simply trying to clarify and urge all to do their research. I do find it odd, however, that you have 4 posts to your name and each one has been directed specifically at me. Interesting you mention marketing as well. Mav, Do your research thoroughly and you'll be good. However, just make sure you understand what is being charged and why. This site is the best place to do your research and chose a doctor. Period. AKA - no, our doctors are solid.

I'm not going to go into detail because it's just not a grenade worth unpinning, but I do have first hand knowledge that some clinics in areas of the world discussed earlier do not utilize proper sterilization techniques. These are standards accepted and taught in medical/surgical training in places like North America; I'm not completely certain what the accepted standards are in other regions, but I do know of some practices in areas that would not pass standards in NA. Do your research and make sure you know precisely why clinics are charging what they are charging. Period.

Sean, I think a number of doctors actually use the NeoGraft in this manner. Without the suction feature, it's very similar to a number of motorized devices available on the market. However, many believe adding vacuum suction forces to fragile FUE grafts can cause unnecessary damage. A lot of threads here do discuss physicians and the tools they use. However, remember that the doctor using the tools is what's important in the end. The fanciest tools in the world do not make an untrained or unskilled practitioner good. I'm not going to go into detail because it's just not a grenade worth unpinning, but I do have first hand knowledge that some clinics in areas of the world discussed in the other thread do not utilize proper sterilization techniques. These are standards accepted and taught in medical/surgical training in places like North America; I'm not completely certain what the accepted standards are in other regions, but I do know of some practices in areas that would not pass standards in NA.

KO, Unfortunately, you're right. Blocking the DHT from ever binding to androgen receptors in the follicle is the only way to truly avoid the AGA process. Like I said above, however, I think the newest consensus is that this may have more side effects than initially suspected.

Sean, Just to refer back to what I said earlier; of the clinics you just listed, at least 3 of them are all technician FUE, and 2 of them have multiple procedural rooms and see 3-4 patients a day (and all this information is from first-hand patient experiences on the forums). There is always a reason why the price is different. If patients are aware of this and feel more comfortable paying a lower cost to undergo a procedure with unknown technicians as one of multiple patients that day, then that's fine. However, it isn't accurate to say the same services are being offered here for different prices.

Eyes, Was this from a recommended doctor? You are currently speaking with them about the situation? Any proposed resolution thus far?

Joe, While I agree with the idea that high cost does not automatically equal high quality, patients should always remember: "there is no such thing as a free lunch." While all tools, techniques, and information is freely available, it still costs money to purchase these tools and properly utilize the techniques. Some of these "inexpensive" clinics make up for the costs of very low price per graft surgeries by not using -- or properly caring for -- the cutting edge tools, by using technicians to disregard the best techniques and instead remove as many grafts as possible in as little time possible, and disregard the best available information because it isn't in line with this hair mill model. Also, remember that we aren't talking about life-saving heart transplant surgery here. This is an elective procedure, and this needs to be kept in mind as well. A patient can easily spend more time researching, saving, and utilizing preventive medications -- whereas the same can't be said for patients traveling to other areas of the world for medical procedures. Cost is important; I get this. However, price shopping elective surgery usually isn't recommended and often times costs more in the end. There is a reason why surgeries cost different amounts in places like the middle east and India, and patients should know why and determine if this is worth the cost. This is proper consent.

Yonex, Just to quickly discuss the finasteride issue a bit further: I think the "sexual side effects" tide is changing. Hair loss doctors have prescribed this drug for almost 20 years now, and it seems like the consensus is that the percent experiencing sexual side effects is greater than the initial studies quoted (around 2%) and there is concern for long lasting effects. Endocrinology -- hormone medicine -- is one of my favorite topics -- specifically how it relates to alopecia. Altering hormone levels -- especially androgen hormone levels -- has serious consequences. This has been known generally for years, but it seems like more doctors are specifically looking into how this occurs with finasteride and the consequences it may have -- which is why you now have conditions like "post finasteride syndrome" (PFS).

Mav, No obvious reason why you could not take viagra on fin. However, you would need to see a doctor familiar with your medical history and current health before determining if viagra is appropriate for you in general.