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We have implanter pens and have had several kinds over the years. They still have to be loaded so they still are manipulating the grafts. In addition they become dull. Dr. Cooley uses either custom blades or needles to make all sites, both FUE and FUT. And unlike what REV 333 said, he does have a part in the overseeing of the preparation and in actually participating in the implanting. In our clinic not everyone can implant, it is a highly skilled part of the process. Each step in prep is important from the removal of the strip or FUE, slivering if FUT, to creating natural follicles (intact units of 1's, 2's 3's and 4's) trimming excess tissue, Each is crucial to that end result. If the grafts are mishandled they can be damaged and impact final results but in the idea of natural results, how the incisions are created, how large the grafts and incisions are and the placement will all impact the end result. Please do your research.

Have you seen a Dermatologist? You may also have low Vitamin D or even ferritin which is how your body stores Iron. Less common in males but it can occur. Do you eat well balanced meals? There is also a medical condition called telogen effluvian (TE) where the hair cycles become stalled in the shedding cycle. Another reason that shedding can happen is starting and stopping treatments, even over the counter things. What supplement were you taking? Was it a protein?

FUE into scar tissue works very well. And to give an illusion of hair you don't have to achieve the same density as the hair around the scar. I would also plan on several sessions to completely hide the scar. If you do smaller sessions you may not have to shave the donor area, that depends on the clinic and their requirements. Did you speak to your clinic about the scar?

The scarring is a result of the method of making the recipient sites and the extraction in the donor area. With ARTAS, the Robot is not making the recipient sites sites. With Neograft it depends on the surgeon if this is done with that instrument or another method. With a drill, this extracts or scores and then a tech working with the doc will gently pull the graft from the site. Each surgeon is going to have their own method for making incision ans some of this will also be related to how the grafts are prepared. In some clinics the harvested FUE grafts are placed as they are harvested. This means they may have some additional tissue around them. This would mean that the recipient site would have to be large enough to accommodate. In an earlier post I mentioned that Dr. Cooley believes that some of the scarring and vascular issues are from deeper incisions so he regulates the depth. We also trim all grafts under a microscope, not just strip but also FUE. All tissue is stored in special holding solution and all grafts sites are subjected to ACell. Before we did this steps, we noted the scarring and in observation of patients who have come to us for options after the results they achieved did not meet their goals, scarring was one thing that is always assessed. Sometimes it is referred to as ridging or tenting around the grafts. We do not see this using these steps. If there is significant scaring the are is compromised with thick tissue and less blood flow. This impacts density. In the donor area it can create a moth eaten look if very short hair is worn. Each doctor who uses one of the above methods can give you reasons they feel their method is best. Each will have pros and cons. Again, do your research and fine the method and the doctor who best fits your needs and goals.

Maybe I should preface that statement with an explanation that minoxidil is a vasodiolator, So it does increase the circulation and blood flow to the scalp. But that is not a bad thing because the hair lives in the skin and is fed by the capillaries. Some clinics including ours have in the past (some may still) have patients use this just in the post op period for this reason. For us, that was years ago and Dr. Cooley changed that instruction. Our post op spray is a special formulation and he does not want to chance inactivating it with a chemical. Hair from an FUE or Hair from a strip is going to grow the same. Styling (comb overs) are personal choices and do not at all go into the design unless a patient says this is their goal. Fue and Strip follicles are placed at the same density. In the past many transplants were weighted to the front for several reasons, if a patient was on medications, age, donor supply, degree of balding and family history are some. We have learned that if a patient is concerned about the crown ignoring it does not meet their goal so in order to have a happy patient you have to understand and address their goal REALISTICALLY. That means all the above issues have to be discussed and priority choices made. I still maintain that the same discussions are held regardless of the harvesting method, at least in our clinic. Dr. Cooley was one of the first to use ACELL so we quickly learned it is amazing in it's ability to heal. It helps to prevent that fibrotic tissue to be formed hence that removes some of the issue you are talking about. There is still some microscopic scarring but it is much less fibrotic and much more vascular tissue,

Rogaine and minoxidil are the fertilizer if you will. The company promotes use of twice daily but if you look at the peak effect it is at 22 hours so once a day is fine. But it does not inhibit DHT, it only promotes hair that is resting to enter the growing phase ie fertilizer..... Proecia inhibits the conversion of testosterone to DHT. Sorry you were in small percent that did have an issue. Peak effect for this medication is at 72 hours so if you could even do 1/2 twice a week or even once there would be some effect. But, both of these products work on all areas. They do help to preserve the hairline. It is FDA mandate that if they want to promote this they would have to redo the billion dollar studies so they only say it works in the crown where it was tested. There is some evidence that topical caffeine products can also help. Hair Surge shampoo by Ultax labs has a lot of good ingredients and is one option. It can be ordered off the Internet. Another is Alpecian solution. It is not a shampoo. The supplement MSM seems to have some positive effects on hair. Ketaconazole shampoo and also even Head And Shoulders with Zinc have good properties and can help with scalp health.

Very nice result.

Great post Joe! and I could not agree more on your last two paragraphs and is/was the point I was trying to make that doing your research helps but you have to find the clinic that best fits your individual needs!

STOPPING THE MINOX IS NOT A BLEEDING ISSUE. It is a chemical and Dr.Cooley uses a special post operative spray that this could interfere with. Not to be redundant but I do not thing the harvesting method dictates where the grafts are wanted, needed or placed..... I am talking about both recipient and donor areas.

Scar5, I didn't "get mixed up". I simply disagree. That is what this forum is for, opinion and fact. The fact is there is no evidence that shaving avoids transection. I didn't make the statement, Joe did and while I respect his opinion, it is okay for mine to be slightly different. I am not a patient but having worked in this industry as a tech gives me a perspective from what I have observed in treating many many patients.I do agree that the term "shock loss" gets used for things that are not really shock. And if we "shave", it is really a long buzz because that allows Dr. Cooley to see the direction of the hair growth or pattern of growth. We stop minox from the procedure date and for 3 weeks after. Could this induce shock???? good question but in our experience it has not been an issue. As for the planting pattern, each provider is going to have their own opinion on this and on what serves them best. In our clinic, we designate the areas of the greatest need or greatest concern. This falls in the realm of realistic expectation as well but we do try! And many times if the donor is limited or perhaps it is a pocket book issue for the patient. Dr. Cooley may weigh more heavily down a part line or to that area referred to as the "magic egg". This often helps dramatically with the illusion of density. You do not lose evenly so many areas are more "needy" than other. I don't think that the harvesting method either strip or FUE is going to front load. That is patient choice and provider advise. Back to the "realistic expectations" and looking at the patient goals. Having said that, the crown is a deceptively large area and takes a lot of grafts to achieve true density. If they are a NW6 it may not be feasible to give the patient the idea that this will happen if they also want to restore the top and hairline. It is all compromise.... There is microscopic scaring or thickening of the skin even with small punches. Acell does an incredible job of helping to avoid this occurrence. It helps to prevent the body from making those think collagen bundles that are so thick. In older techniques with sties made with big instruments this was common. It is less common now with the smaller sites. It is the patient problem however because fibrotic tissue has a compromised blood flow, which in turn can impact potential growth. This can have an impact on density goals. I stand by, "do your research"! find a doctor who listens to goals and comes up with feasible options and has consistently provided good results.

Shaving down does nothing to stop shock loss. It just makes it less obvious. It takes longer for the recipient incisions to be made with longer hair but we do many females and I can't remember the last one that had any significant shock loss. I also cannot imagine them allowing us to shave the area! We do offer to shave and sometimes with FUE it is required if it is a larger session.

When you discuss shock loss there are a lot of variables. You have to also understand that if the patient has a large amount of native hair that is in fact miniaturized by MPB AND they are not on medication, this increases the "chance" of shock. It also depends on physician technique. Dr. Cooley uses very small custom blades or needles to make the recipient incisions. He also makes his incisions very shallow and they are not all the same size. In our post op care, we have the patient spray with Dr. Cooley's own post op spray continuously for the first three days. This helps to restore that loss of oxygen which is the issue with "nicking" the small capillaries. The more densely packed the new grafts are, the more trauma and loss of blood flow to the new grafts there can be. So, 20 years ago we discussed shock as something that would probably occur. Now, we seldom see it even with dense packing. Remember the first time into a given area best yield you will achieve.

Good news travels much slower than bad news. If you are happy you may get on here and tell, or you may not..... you may tell your brother or best friend, or you may not...... IF you are UNHAPPY you would tell everyone! That is just human nature. I have seen horrible transplants using both harvesting techniques. I stand by my comment, DO YOUR RESEARCH! It is not just the doctor, it is the entire procedure and what will work best to achieve your goal. Don't allow anyone to "SELL" you. But go into the process with an open mind and understanding of what a transplant can give you. It isn't giving you more hair, it is simple moving hair to a more desired location! It is not a cure for hair loss, it is a treatment. Without maintenance you could continue to thin or lose hair. If you don't have realistic expectations you could be disappointed. Chose your surgeon wisely, chose your technique based on fact not on someone being unrealistic. Ask lots of questions about how and what is going to take place. Good luck!

There are a lot of unknowns here. We don't know where the transplant was done, or the doc? Did the doc do any of inplanting or was it only done by techs? Who were the techs and what was their experience? Touchy subjects .... Gillinator is correct in that the hair shaft will start to extrude around the 5 day time frame on some patients, this is highly variable and can take much longer to happen. Many factors can contribute to when this "extrusion" takes place, He is also correct in that if you "pulled" a seated graft out there would be bleeding. Many times if there is scabbing some grafts "look" like they are pulled out but at 3 days or 5 days there would in fact be a noticeable trickle of blood. The above grafts pictured are what are called "hooks". They are not what is considered great technique but it doesn't mean that they would grow from the "bulb" or dermal papilla which generally is what is being implanted. Hooks can occur if a follicle is placed in a recipient site not designed for that size follicle. Most are corrected with gentle manipulation. Don't panic, this does not look like "lost" grafts. Call the clinic and talk to them if you are concerned.

Hair Surge Shampoo has a lot of "good" ingredients. If you look at the studies on topical caffeine (which Hair Surge contains) it also has some impact on hair cycles and are very interesting. Topical caffeine is a stimulant so it helps the resting hair move into the next cycle of growth. This is similar to what Rogaine accomplishes. The small amount of Keto in it can't hurt. With any shampoo like this, Dr. Cooley tells paitents to use it as a scalp treatment and put a small amount on the scalp allow it to sit then wash it out with your favorite shampoo and conditioner.

Most docs do both techniques. MagnumPi is exactly on target, do your research and decide what is best for you. Dr. Cooley does both harvesting methods. In my opinion, if you don't plan to shave your head the method of harvesting is not an issue. And, I have seen many FUE proceduires that if the head were shaved would be obvious. Many things depend on the individuals body and the way it heals and the contrast between skin and hair color. If you harvest 3 to 4 thousand FUE grafts and shave the head, it looks a little diffusely thin at best and the small round white scars can be more apparent. If it is a small procedure, this is not usually an issue except the contrast question. Sometimes it is a matter of less expense with a strip but PLEASE research. This has to be a good decision for you that you can live with. Both will give you hair where you don't have it now! No doc can absolutely know how you will heal but most want the best for their patient.......

8 months is too early to totally determine the final result. Remember everyone heals and regrows differently.If you were in fact "slick" bald this looks like good growth for 8 months with final at or around 12. Remember the hair will also mature over the first year. It looks a little red in some areas. Are there symptoms? Sometimes redness is an indication that there maybe some inflammation that could be inhibiting growth. As Gillenator asked, without knowing the grafts count and expected density it hard to judge the result.

This is a complicated question and I would always recommend that you talk to your doctor. We do not prescribe 1mg finasteride at all. We do Prescribe 1mg Propercia or 5 mg finasteride. These are small pills and the part you have to understand is that they are not designed to be cut so there aren't any scores on them. What that means is the medication is not equally distributed. The difference in generic vs brand is the initial testing was all done under the brand. When the patent runs out, generics become available.the "fillers" are different, therefore the vehicle of absorption can be different. The 1/2 life for this medication is only 6 hours, so metabolized fairly soon BUT the peak doesn't come for 72 hours.... hense the change in dosing. If you look at the actual statistics there is very little difference in the efficacy with less frequent dosing but potentially less chance of side effects and of course less expense!

A key question here would be if you are on medications and treatments to inhibit future and ongoing hair loss?