Blake Bloxham

Harin, They are permanently lost. Regeneration in the donor area requires splitting the follicle and leaving some portion of stem cells behind while transplanting another portion to the front. This leads to regeneration in the donor region and new growth in the transplanted region. Unfortunately, it is all theoretical at this point. We've yet to find a reliable and reproducible method of "donor doubling" - the method you're describing above.

Mods, I think you would probably be a good candidate for an FUE procedure. I say this because of your age and stability on oral medications. I don't think you would need to really "lower" the hairline. This always sounds like a good idea, but it takes a significant amount of grafts. FUE tends to have a lower growth rate and a higher failed extraction rate, so most would probably recommend filling in the frontotemporal angles and strengthening the hairline. Sorry to use your thread as a soapbox here, but I think your case is a good example of something I talk about on the forums from time to time: The whole "strip vs FUE" debate is often discussed in too broad of terms. Patients simply ask "should I do strip or FUE." And most respond with "FUE." However, I think the more appropriate question is "Am I better candidate for strip or for an FUE-based procedure?" You're a young guy who may want to trim your side closer or buzz your head completely in the future. You are very compliant with stabilizing meds and have a solid amount of donor follicles to use. You are likely a good FUE candidate! If you were older, didn't have any desire to buzz, had a more questionable donor region, et cetera, it may be a different story. This is why I like looking at the debate in this sense. /rant ; ) Let me know if I can do anything else to help.

Wow! Very natural transformation. Congratulations, and thanks for sharing!

Dr Vories, Nice work! Also, can you share some information about your finasteride prescribing practices? It seems like a lot of your patients start on finasteride/Propecia after surgery? Do you routinely prescribe the medication post-op? It looks like a lot of your patients are good finasteride responders. We hear a lot about the dreaded sexual side effects from the drug on the forums as well. Do you ever get patients complaining of these after starting the meds post-op? Thanks!

Torn, I think happy's advice is spot on. Can you share some images of the plug grafts? We could probably offer more helpful advice if we could see the actual grafts. Look forward to your reply!

Kilimanjaro, It's actually a pretty unique story. My grandmother was diagnosed with breast cancer while I was still a pre-medical student at UCLA (University of California, Los Angeles). She was able to meet with a great team of oncologists and surgical oncologists, and map out a promising treatment plan. She was pleased with her cancer treatment itself, but one issue continued to bother her: what would she do if she lost her hair? Chemotherapy and radiation treatments were both discussed, so it was a real possibility. However, she didn't feel comfortable bringing this up with her doctors. I'm not sure if it is a generational thing or she felt scared or intimidated, but she just couldn't bring herself to discuss it with them. But, it was really causing her a lot of psychological distress. Even if the cancer was treated and she was generally healthy, she thought hair loss would still make her look or feel ill. I told her that my science and pre-med courses at school really didn't cover much about oncology or cancer-related hair loss, but I'd do my best to research it and see what I could find. I started doing some online research and found myself reading about hair loss on a site called the "Hair Restoration Network." The information was great. I was able to learn a lot and help my grandmother through the process. She did experience some hair loss, but was able to maintain a lot and actually regrow pretty much everything using Women's Rogaine. However, something else interesting happened during my research period. I found myself fascinated with the science behind the hair follicle and alopecia in general. The follicle is an amazing organoid, and alopecia is a diverse, complicated, fascinating subject. From here, I was hooked! I signed up for a forum account and started posting. I loved reading the hair restoration stories and reviewing the life-changing hair transplant transformations. A year or so after I signed up, Bill posted information about the moderator/editor position. I toyed with the idea of applying for quite some time. I was still a fairly new member, and wasn't sure if I'd stand a chance. However, I decided to go for it! And 5 years later, here we are!

Can't, Congrats! I hope you'll share some images? I've been looking forward to seeing some of SMP Look's work.

l9, Congratulations! The work looks excellent. Look forward to updates.

Mue, Congratulations! Thank you for the kind words as well. It's great to hear the community is helping worthy members like yourself! Dr. Cooley is an excellent surgeon. I look forward to seeing your results. I hope you'll keep us updated. Send me a private message if you need anything else!

FUE, There are two types of shock loss: permanent and temporary. Temporary shock loss occurs where strong, permanent follicles are exposed to trauma. The follicles are "shocked" into a temporary resting state (the "telogen" phase) and return to normal function after a slightly prolonged dormant period. Usually, around 3-5 months. This happens most commonly in the donor area during hair transplant surgery. Permanent shock loss occurs when weakened, pseudo-miniaturized follicles are exposed to similar trauma. These follicles are already "on their last leg," and the stress pushes them over the edge. This causes "permanent shock loss" that does not grow back. This happens almost exclusively in the recipient area during hair transplant surgery. The zones surrounding the transplanted area are filled with these weakened, androgenic alopecia-affected follicles. The strain from the surgery is too great and the follicles simply can't bounce back. It's important to know that these follicles were going to fall out regardless. However, the shock loss simply speeds the process up. Follicles implanted during a hair transplant surgery fall under the first category. They are strong, androgenic alopecia-resistant follicles and will regrow after shedding. The only way to permanently lose these grafts would be by severely overwhelming the recipient area blood supply by "over-packing." Frankly, this is rare. I also don't think your surgeon would do it. Hope this helps! Good luck.

I agree with Funk. It really depends on where the follicle is transected. If you avoid the bulge region and dermal papilla region - in the bulb - it should grow back just fine. If you nick the bulb or certain areas in the outer root sheath where the bulge stem cells lay, it probably won't grow back.

Guys, Thank you so much for the kind words! It really means the world to me. I've truly loved interacting with all of you on the community over the past 5 years. Starting this next chapter is very exciting; but having your guy's support makes it all the sweeter! Dr. Lindsey, Dr. Feller is feeling great! He's just as pumped and ready as I am for this new venture. Hairthere, Sounds like a deal! Look forward to meeting you in person. Joe, I'm not sure if I will be at the ISHRS conference in Chicago this year. If we do attend, we will definitely meet up. SAD, Still finishing up a few things on the new site. I'll let you guys know when it's up and running. Look forward to loading it up with cases too!

As many of you probably know, I've wanted to become an "HT_Doc" since before even starting medical school. I was fortunate enough to find my position as an editor, moderator, and writer for the Hair Transplant Network, and learned a lot about hair loss and hair restoration along the way. What most of you probably don't know, however, is that I've also been training "behind the scenes" for some time as well. 5 years ago, I met Dr. Alan Feller. He was kind enough to provide advice and guidance on becoming a hair restoration physician. Several years later, he invited me to his clinic to observe a few actual surgeries. We ended up sharing a very similar philosophy with respect to practicing hair restoration. One thing led to another, and I was invited to formally train in hair transplant surgery at his New York office. After two years of training, Dr. Feller and I decided to continue our relationship and partner in a new practice: Feller and Bloxham Hair Transplant Surgery. Starting July 1st, 2015, Dr. Feller and I will be working full-time out of our office in Great Neck, New York. At this point, I will officially "retire" my "Future_HT_Doc" account and create a new "Dr. Blake Bloxham" account. Though I will no longer officially serve as a moderator of the community, I will always be on the network to share content, answer questions, interact with members, and contribute articles. After I've accumulated a number of cases, I also want to be considered for recommendation and hopefully join the ranks of our excellent recommended/Coalition doctors as well. Until July 1st, I will continue in my current role as a moderator, editor, and writer for the Hair Transplant Network, Hair Restoration Network, Hair Loss Learning Center, and Hair Loss Q&A blog. After that, I invite you all to stop by and check out the new "Feller and Bloxham" practice. I cannot thank you all enough for the past few years. Interacting with members, serving as a patient advocate, and helping hair loss sufferers restore their self-confidence has been so rewarding! Again, thank you.

CPR, Several things affect survival in this situation: 1. Transection - Personally, I think manual FUE offers the lowest rates of transection. Using manual tools allows a certain level of tissue feedback not possible with motorized devices. There is also less torsion and heat. 2. Time out of body - FUE grafts are naturally "skeletonized." This is a fancy way of saying they contain less nurturing, protective supporting tissue. This is because they are removed with very small punches opposed to dissection under microscopes. This means they are more prone to dehydration. Dehydration is deadly to fragile follicular unit grafts. Undergoing multiple smaller sessions with less graft "out of body" time will probably increase yield. 3. Manipulation - Trying to remove and implant 4,000 grafts in one sitting will likely involve more rapid extraction and implantation. This, in my mind, creates the opportunity for more rapid, less gentle, more chaotic graft manipulation. Hope this helps!

1 heart attack???!?? Really?

Johnny, Sorry you're upset with the scarring. I'm glad Dave contacted Dr. Doganay and I look forward to his explanation. I'm not sure if it was discussed, but hopefully you're pleased with the frontal work? While I do completely sympathize and I do not want to trivialize what you're going through, but I think we can learn something from your case: FUE is not a scarless procedure. There is question of overharvesting and taking grafts outside of the traditional safe zone. Both of these increase the chances of scarring from an FUE procedure. Even when utilized properly and in the best of hands, however, it leaves scars. It's generally very minimal, but it's important to understand that all hair transplant surgery creates cosmetic scarring. Sorry to rant a bit in your thread, but I just felt like it was an opportunity to learn. Again, I look forward to Dr. Doganay's reply. If there is anything I, or any of the other moderators, can do to help in the meantime, please don't hesitate to ask.

Nice work. Thanks for sharing.

Nicely done! Thank you for sharing.

Nice work!

Big transformation! Nice work.

Awesome transformation! Thanks for sharing.

I'm going to temporarily lock this thread until I get a chance to go over it will Bill. Again, this isn't an attempt to censor anyone. The discussion is simply getting out of hand and I don't see it turning around. The decision to ban discussion is never a happy or easy one to make. We took our time making this decision, and I think this thread serves as a reminder of why we felt compelled to act in this manner. What's more, I've received 4 private messages from community members this morning saying they agreed with our actions and asking for intervention in this thread specifically. I thank you guys for the support. It supports my belief that this tough decision was made for the good of the community, and it's what our members wanted. To the OP: I'm sorry your thread was hijacked. If you have specific questions feel free to send me a message. All other members are welcome to do the same. Again, thank you.

66, The first link never worked for me. If you look at the HTML code from your initial post it includes the characters "archive." This means the thread was in the archives when you posted it. I don't know who moved it there, but it wasn't me and it happened before yesterday. If I moved it after you posted it, the link in your first post wouldn't contain "archive"in the link. It would have HTML code directing it to an active forum destination. I don't know what you saw when you first posted the link, but it was always in the archives. And this is exactly what I saw when I clicked in it last night. I assure you, I did not touch any of these links.

66, I'm disappointed to see you create a thread of this nature. The moderators have always been fair to you, and accusing us of things like this even after I said you were mistaken and gave you proof of your error is disheartening to say the least. There is no conspiracy against your clinic. They were banned for clear cut reasons and offered many opportunities to change before we were left with no other options and had to act. Acting inappropriately and taunting us to ban you doesn't prove there is a conspiracy. It proves that you know these actions are inappropriate and you're acting this way to try and create the appearance of foul play. Fortunately, the situation is much simpler than that, and you know it. Thanks.

So you're accusing me of moving the links even though I said it didn't work when I tried it last night, I said I didn't touch them, and showed you proof it was already in the archive before you pasted the link? Wow. The screenshots you posted show Charly's posting history. This would show content that was posted in archived threads that could no longer be accessed. The fact that you don't believe me after all the interactions we've had over the past year or so and think this is all part of some conspiracy is astounding.