Blake Bloxham

Happy is right. This procedure was banned in the states. It causes a severe immune reaction in the scalp. Some of the images are quite dramatic!

Thomas, Unfortunately, it doesn't look like 3,000 grafts were implanted. However, it does look like a significant amount of grafts were removed from the donor region? I think a few things may have happened: Ideally, there are two steps to extraction via FUE: scoring of the skin and delivery of the graft. When the skin is scored but the graft is unable to be delivered successfully, the graft is lost to a phenomenon called the failed attempt to successful extraction ratio. I think there is a chance your skin was scored 3,000 times, but there was much less than 3,000 grafts delivered and implanted. This means you may have experienced a high failed attempt to successful extraction ratio, and could explain why it looks like there are many more extraction sites to actual grafts implanted. Another possibility is that 3,000 grafts were scored and delivered, but many were transected and, therefore, implantation wasn't attempted. Unfortunately -- and I'm not trying to bash the procedure -- both these are realities of FUE. Let us know if we can help in any other way. Good luck.

Very nice transformation! Thanks for sharing.

Cool case! Thanks for sharing.

Nice work! I'd like to see the donor region as well. I can't see the scar at all from the limited view of the temple regions.

Not a problem, buddy! Let me know if you have any other questions. Happy growing!

Hey Ezel, I know it's probably not what you want to hear, but it'll be more "watching and waiting" until the 12 month mark. Actually, it could take more like 14 for FUE. So Dr Feriduni seems right on there. I hope you'll keep us updated. Hopefully you'll see more growth in the next few months. Good luck.

So glad you were able to help this patient!

Hey Matt, Aside from cutting/scraping down into your scalp, experiencing a severe burn, or using corrosive chemicals on the scalp? No, not really. The grafts are permanent once they anchor. Try to follow your clinic's post-operative instructions carefully. You'll be just fine! Good luck.

Guys, Let's remember to remain civil. I think there are a few concrete points we can all agree on here: 1. Body hair grafts will always retain their donor characteristics. If you transplant thicker, coarser, wavy hair follicles on the scalp, they will continue to grow this way. This can sometimes be very hard to detect when used as filler. However, it is definitely more noticeable when utilized over a larger area. 2. Body hair grafts should be utilized -- en mass -- after the traditional scalp donor supply is exhausted. 3. Dr Umar has definitely helped many patients with these big body hair transplants. These were patients who likely had no other options. Altogether, I'm sure they are pleased. While the appearance may be slightly different, I'm sure these patients prefer it to where they were before.

Dewayne, Actually, not much new at the moment. A few interesting things potentially on the horizon: -Kythera pharmaceuticals bought the patent to U Penn's/Dr Cotsarelis' PGD2 patent and plan on creating a PGD2-based oral pill. If it does eventually come to market, I think it will likely serve as a maintenance medication with efficacy similar to minoxidil/finasteride. -Allergan completed phase 2B clinic trials for their bimatoprost (Latisse) hair loss product. They've been very quiet about the results, however, and some are uncertain they are moving to phase 3. Again, this would be more of a maintenance treatment. -Histogen is still looking for investors for their injectable growth serum. -Replicel is still doing clinical trials with their dermal sheath cup stem cell treatment in Japan as well. Both of these -- Histogen and Replicel -- would likely provide gains on the level of minoxidil/finasteride as well. -Dr Mwamba was working on hair multiplication/donor doubling techniques at his clinic. But he recently updated us on his progress, and it doesn't sound like he's researching it further. Frankly, I still think donor doubling has the most potential for a "future" treatment. Like Spanker said, not much new. I think we're starting to realize just how complicated androgenic alopecia really is. It's a very complicated condition, and I don't think you'll ever see a miracle cure. I may be a bit biased, but I think surgical hair restoration will give you the greatest results for the foreseeable future. Good luck!

Chaser, Thanks for sharing. It looks like you're a good FUE candidate. Look forward to updates. Let me know if you need anything!

Magnium gives some solid advice above. You need to weigh the "pros and cons" of both procedure and pick which is best for you. Really, it comes down to better yield (strip) versus less visible scarring (FUE). I wouldn't really let cost sway your decision too much. It's important, but don't let it be your only factor.

DCMB, The 5-a-reductase enzyme actually converts testosterone to dihydrotestosterone. It may have some affect on serum levels of testosterone, but it doesn't really create high levels of it. Diet may have some affect on testosterone levels, but it would be very minimal.

Beautiful results! Excellent documentation as well. Nicely done!

Hi Guys, Glad you enjoyed the story! Definitely a life changing experience for me. And one that led me to where I am today. Takebacks, Look forward to seeing you during the 6th month check up! Swoop, Thanks for the kind words!

Bass, Unfortunately, Dr Siporin passed away a few years ago. I don't know how this affects the statute of limitations. Let me know if there is anything we can do to help.

I can't speak for all hair transplant doctors, but I know a few who started to charge for consults because the request for consultations was unmanageable before. These doctors said they were getting an unsustainable amount of consultations when they were free of change. It was affecting their ability to actually perform procedures on their patients. What's more, many of these potential consults weren't serious about surgery. It's always nice to sit down and help these patients out. In fact, it's my favorite part of my current job! However, it isn't a sustainable model. By charging a small fee for consultations, these doctors were able to get the volume under control and consult with patients who were further along the process and truly ready for the consultation.

McCabe, Sorry to hear this. Let me try and explain what happened! The old adage is that hair loss "comes from your mother's father." Look at Mom's dad; if grandpa still has his hair, you're fine. Right? Well, not so much. Androgenic alopecia (male pattern baldness) is a very tricky and poorly understood condition. However, we do know a few things. We know it is "poly-genetic." This is a fancy way of saying there are multiple genes that contribute to male pattern baldness. It also means you can inherent some of these genes from either side of the family. We also know it has "variable penetrance." This is another scientific way of saying if you have any hair loss genes, you can express the genes in any conceivable pattern. This means if Dad or brother are a NW 2, you guys have some sort of hair loss gene in your family. In fact, you and Dad probably have the same gene. The problem is that the way this gene is expressed varies. Dad's body may choose to suppress the gene or only express it a little bit. This means he has a slight amount of hair loss. Your body, on the other hand, chooses to fully express the gene. This means he ends up a NW 2 and you end up a NW 6. Have you seen a doctor? You may be a candidate for stabilization with medications. Feel free to ask any additional questions. Good luck!

Walker, I'm on the fence. In some of those pictures, it does look like you're thinning in the donor area. If this is the case, I agree with Dr. Bhatti's assessment: you're not a good hair transplant candidate. Any transplanted hair could thin over time, and this just isn't fair to put a patient through a procedure that won't last. In other pictures, however, it doesn't look like you're thinning in the donor region. It looks like you suffer from more of a female patterned hair loss. This is graded with the Ludwig, opposed to the Hamilton-NW balding scale, and I would rate you around a Ludwig 2-3. This means you have central thinning with a semi-preserved hairline. If this is the case, you would be a hair transplant candidate. It would be a challenging case, but your donor area would be stable. Knowing this, I recommend two things: 1. Do not undergo surgery with with a doctor unless he/she has evaluated your scalp in person and feels comfortable moving forward. It's too hard to tell what's going on from those images alone. You need to be evaluated by a doctor in person. 2. If you are not already, you should speak with a physician about preventive medications. Patients with Ludwig hair loss patterns tend to respond pretty dramatically to these medications. This is because they are really tested for the midscalp, which is where you're really thinning. If you retained your hairline and restored the thinning regions in the midscalp with meds, you'd have a pretty good transformation on your hands! Hope this helps. Please feel free to ask any additional questions or send me a private message.

88, Congratulations! I like the hairline design. I wouldn't worry about this. You're still swollen, and this is probably exaggerating the small gap. It's also possible that you've experienced some temporary shock loss in the area. Like the name implies, this is temporary and will grow back. Hope this helps! Heal well!

Hi Vito, The post-operative appearance looks pretty normal. It's probably a little too early to say the scar "stretched." Wounds heal in a series of overlapping phases. Right now, your body is still mounting an inflammatory response to the trauma and starting to send cells to begin the true healing process. The best thing you can, for now, is follow your clinic's post-operative instructions closely. This is the best way to prevent unnecessary stretching. Simple answer: normal at this stage. Good luck!

Takebacks, Congratulations! Look forward to updates.

Scar, My thoughts on FUE were definitely not sudden. Like I explained before, they were a result of actually seeing and performing both procedures. This transition happened over 2 years. It also reminds us of something relevant in our entire culture today: the difference between what we read online and what actually occurs in real life. Online, FUE makes perfect sense. You see impressive FUE transformations and assume it's perfect yield without the linear scar. However, this isn't the truth. FUE, even when performed in the most expert hands, will always have lower yields. Let's look at some objective facts: In a 2014 review published in the Journal of the American Academy of Dermatology and the Journal of Dermatological Surgery, the manufactures of the ARTAS system found FUE transection rates as high as 29.4% in large FUGs in Korean patients and 32% in all FUG sizes in Caucasian, Indian, and Middle Eastern patients. The average transection with strip was quoted at 1.59%. Granted, the overall averages for FUE transection were not as high as 29-32%. However, the authors said the importance of these statistics is the fact that it's possible with FUE, but nearly unheard of with strip harvesting. Keep in mind that follicle transection is only one aspect of poor growth yield as well. It does not take failed extractions or growth yield of implanted follicles into consideration. Let's look at that further. This data comes to us from Dr. Beehner and Dr. Wesley. In it, they show us a few interesting things: 1. That growth yield with skeletonized FUE grafts is between 48 - 68.7%. Keep in mind that using smaller and smaller punches (0.7mm, 0.8mm etc) creates severely skeletonized grafts. 2. Growth rates improve when grafts contain an appropriate amount of supportive tissue. This means either taking more donor tissue and dissecting it under a microscope or using much larger punches - which will significantly increase scarring and thinning in the donor region. Dr. Wesley expands upon this further and explains that in a double blind, 16 month trial featuring 6 patients, he found that grafts harvested via a non-traditional FUE approach had a 45% greater survival rate than those harvested via FUE. I also wanted to include a side-by-side comparison of grafts extracted carefully with manual techniques compared to those dissected microscopically from a strip: This image (courtesy of Dr. Bernstein) highlights some of the reasons for poorer yield. As you can see the splayed direction of the individual follicles in the follicular unit is a result of traction during the delivery process. Not only does this demonstrate the amount of force placed on a very delicate graft, but it also shows us that the graft will undergo more stress and strain when trying to fit it into a small slit or pull it into an implanter pen. The image also shows us the skeletionization effect. Note how this is most obvious around the base of the follicle. Unfortunately, this is where the dermal papilla stem cells lie. This means damage or cellular death via dehydration in this region is detrimental. Now, I wanted to address the "economics" comment. I've said it before and I'll say it again now, FUE is much more lucrative and a much better business model for hair transplant surgeons. Let's look at some more objective data: I want to compare two different clinic models operating on the same patient. Clinic 1 is performing a 2,000 graft strip procedure on patient X, and clinic 2 is performing a 2,000 graft FUE procedure on the exact same patient. In this example, I'm going to use $5 (US) a graft for FUE (quite a fair price) and strip pricing from a US clinic: As you can see, the hypothetical FUE clinic made $1,400 more than the strip clinic operating on the exact same patient. When you extrapolate these results on a monthly and even yearly basis, the conclusion is crystal clear: it is more profitable for clinics to perform FUE. Period. So, why should clinics bother with strip? Well, like I've said before, I think these doctors don't feel comfortable offering patients a procedure at greater cost with less yield. This is bad for the patient, the doctor, and the highly important ethical reputation of the physician. Alright, fair enough. Right? Well, you'll probably ask, what about the scar? What about that blasted strip scar!!? The strip scar is the reason we are even discussing this today. And honestly, I get it. Patients don't want the scar. It's reasonable. So, what are we to do? Two options: 1. Wait until we've developed a procedure with strip-level yields and FUE-level scarring (more on this later ; ) ) or 2. Make sure doctors are properly consenting patients and performing the right surgery on the right patient. This means doctors need to share the above objective data with patients. They need to say that FUE is more likely to provide lesser yield - even in the best of hands. BUT, strip is going to leave you with a linear scar - even in the best of hands. If the patient is a 25 year old male who wants to buzz his sides short and sport an undercut or may buzz it all off in the future and struggle with a linear scar, he needs to be made aware of the yield issues and probably opt for an FUE. If the patient is a 50 year old NW 6 who wants to part his hair to the side and has no intention of ever buzzing his head, a doctor shouldn't waste limited grafts on a procedure with less yield. This gentleman should be made aware of the linear scar and should probably opt for strip. This is the ethical way to proceed. And I implore all patients to proceed as such. Make yourself aware of the objective facts above. Consult with doctors who will explain the pros and cons of both procedures and help you objectively pick the right surgery for you. And move forward confidently. Sorry for the long post. I really hope this helps. I think you're doing a good thing investigating this issue, Scar. And I hope this information helps explain my perspective!

Bill, Thank you so much for the kind words! It's been so great working with you over the past 5 years. Look forward to interacting for many more!