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Dr Blake Bloxham

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Dr Blake Bloxham last won the day on April 19

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About Dr Blake Bloxham

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    Senior Member

Hair Transplant Clinic Information

  • Hair Transplant Surgeon
    Dr Blake Bloxham
  • Hair Transplant Network Recommendation Profile
  • Hair Transplant Clinic Name
    Feller & Bloxham Hair Transplantation
  • Primary Clinic Address
    287 Northern Blvd, Suite 200
  • Country
    United States
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  • City
    Great Neck
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  • Provides
    Follicular Unit Hair Transplantation (FUT)
    Follicular Unit Extraction (FUE)

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  1. Hi Lenney, Thank you for the kind words. I think you are referring to the area in the frontal hairline I started behind? I like doing this when possible. The patient has a standalone transplanted hairline built behind it. So if and when he does lose it, he will not have a hole or anything like that. It will just look like the center part of his hairline is a little higher and in line with the rest. And you can see it is miniaturizing and will likely thin completely -- leaving him with the scenario I described above. In the meantime, however, we can use it to his advantage as it adds extra irregularity to the hairline and takes advantage of those very fine singles which are often even softer than those we select for the frontal line during a transplant. It adds an extra degree of naturalness to the result. You could use this tuft as the starting height for the hairline. However, I think it may have been a little low for his specific case. In other patients, no problem; for him, however, we want to err on the side of caution and start high with the hairline. Once everything is settled, we could always do some more frontal work and bring this down to that level. But remember: you can always go a little lower with a higher hairline later, but it is very, very difficult to raise a hairline started too low -- not to mention the number of grafts used to create it that low which are much better spent elsewhere and may not survive the "raising" and redistributing process.
  2. One of the more debated topics on the forum is whether or not "young" patients should undergo hair transplant surgery. The controversy revolves around the fact that these patients are very early in the hair loss process and have an unpredictable future ahead. Using too many grafts now or starting with an "aggressive" plan may set a patient up for a lifetime of multiple surgeries or deplete donor resources before acceptable coverage can be achieved. There is also controversy surrounding the donor area in young patients: Will it thin aggressively and end up only providing a small "strip" of safe donor in the future? Are grafts taken from the "expanded" donor area in a young patient actually safe or will these thin in the future? For these, and other, reasons, many hair transplant doctors do not like to perform hair transplants on "young" patients. While cutoffs vary, many do not like to take patients under the age of 25 and others want to wait until their hair loss pattern has really revealed itself -- which can often take decades. My philosophy on young patients is a little different. I frequently perform hair transplantation on appropriate "young" patients as long as a few absolute "musts" are understood and accepted by the patient. If the patient is mature thinking and accepts the "long term" reality of hair transplantation at a young age and the potential for future surgeries up the road, I feel like they do quite well. In order to successfully undergo hair transplantation at a young age, I feel a patient must acknowledge and really feel comfortable accepting the following: 1) We must start conservative with the hairline. Many young patients remember a very low, flat, immature hairline from only a few years prior. And sometimes it is hard to get them to understand that this is not advisable. If a young patient insists on rebuilding an immature hairline, I do not think they should have a hair transplant. However, if the patient understands that hair transplants are permanent and the hairline must "age well;" if they understand that starting conservative now will allow us to get coverage from front to back as they continue to thin and we can go lower later once things cool off and the majority of the scalp has been treated with hair transplants; and if they understand that the lower we go now, the more grafts we use in the front that we now cannot use in other areas, then I think they are good candidates. 2) We must start with FUT Not to stoke the flames here at all, but I insist on starting all young patients as FUT. Not only is this the only way to truly maximize the amount of donor grafts available over a lifetime, but it is also the only way to really take continuously from the small true safe donor area (SDA) zone. We never know how these patients may thin up the road, and grafts taken from even slightly outside the safest part of the donor area may be susceptible to hair loss and fall out in the future. We need to maximize donor potential and only work where we absolutely know it is safe until these patients are older. Then we can usually augment with FUE. 3) The patient must accept that he will very likely want/require more procedures up the road Androgenic alopecia is a progressive process and while hair transplants do thicken and restore thinned areas, the procedure does not treat the progressive hair loss. Patients who are thin enough to seek hair transplantation at a young age will likely continue to thin in the future. With a hair transplant plan "started" in one area, the patient will likely want more. We never design anything that would absolutely require a patient to have more surgery up the road, but chances are that you will want to address additional thinning regions at a later date. The patient needs to accept that this is likely not a "one and done" deal. 4) We really should (maybe not "must") start in the front and work back The frontal third (hairline, frontal scalp, and slight transition into the mid-scalp) is the most visible region of the scalp. It also is responsible for re-framing the face and really creating the appearance of thick, full hair from the perspective of how most of the world sees you (IE "front on" or from the sides). Furthermore, if this region is done properly the rest of the scalp can thin and still look natural. For these reasons, we really should address this area first in young guys. Many times younger patients are focused on the "bald spot" in the back, but starting in the front and working back if and when necessary creates the greatest cosmetic impact and prevents creating anything that may look unnatural up the road. To better demonstrate this philosophy, I want to share a case: The patient in this video is a young guy in his early 20's; he's in that transition between college and the rest of his life. He has aggressive thinning for his age and is likely to become a NW VI up the road. I discussed all of the above with him and he completely agreed and wanted to move forward. We did a 3,000 graft FUT and everything went very well. I saw him back at 6 and 12 months. The first video features an explanation of how I approach young patients (similar to what I wrote above) and a detailed 6 month result video. The second video is an update at 12 months. 6 month results: 12 month results: As a final note: I do think all young patients considering hair transplant should do their research carefully. If you do it as out outlined above, I think you will be happy for many years to come; however, there are some potential "pitfalls" for younger patients. So do your research, ask your questions, and remember to start conservative and keep the long-term in mind. Hope everyone enjoyed the presentation. Look forward to the discussion. Dr. Blake Bloxham Feller & Bloxham Medical, PC
  3. Dr Blake Bloxham

    Should I Go To A Cheap Hair Transplant Clinic?

    Always a good topic. Very good replies as well. As a few of the other doctors have pointed out, we are dealing with an influx of repair cases right now from "cheap" clinics. The ISHRS, as Dr. Barghouthi alluded to, has labeled this phenomenon the hair transplant "black market;" this label usually applies to a new, start-up, tech-run, FUE-only clinic. They pull out all the stops when it comes to luring patients in and then leave them out in the cold if and when things go wrong. Now, I think it is important not to stereotype or imply that paying a lot of money for a procedure automatically equates to a good result; however, I think almost any established clinic today can share at least a few sad stories of patients they have met who have been forever impacted by this new model. It is hurting patients and it gives the entire field a black eye. Something else patients MUST remember too -- and I do not think I saw it mentioned here previously: remember that the donor area is a very finite resource. You are only gifted with a certain number of scalp grafts in the donor area and once they are gone, you're done. One big FUE pass from a tech clinic and you can wipe out the entire donor. I have seen it with my own two eyes multiple times. And let me tell you, it is awful having to tell these patients who are there for repair that there is nothing you can do aside from removing grafts and referring to a good SMP practice (shout out to Erik at Ahead Ink!) because the "bank" is empty.
  4. Augusta, I pretty much agree with Dr. Barghouthi; I would estimate around 200 grafts total for that little area. This may seem a little high, but keep in mind that you are lowering the hairline there so it must be dense. You may also need some multis behind the tight packed singles to make sure the corner is nice and dense -- as you appear to comb from left to right. I would advise you not to use body hair grafts in that area. This will arguably be the most visible region on your entire scalp (with the left to right comb) and you want nothing but the highest quality scalp grafts there. Like Dr. Barghouthi said, please share some donor pictures if possible. I would be shocked if you could not steal out 200 or so more from your donor. I have taken 200 - 300 many times from donors patients believe were "tapped."
  5. Dr Blake Bloxham

    Fue or fut for me????

    Also ... Please do not rush into getting a procedure. I understand the urgency to get it done; trust me, I do. However, it is far better in the "long term" to take your time now and make the best decision possible opposed to rushing into a procedure and being dissatisfied or spending more time and money (and irreplaceable donor follicles) to fix or augment things up the road. It is a common tale we see and something that you should do your best to avoid.
  6. Dr Blake Bloxham

    Fue or fut for me????

    Hi Wendell, Thank you for sharing. I thought this is what your donor may look like. Very classic for that type of hair we see in certain patients from the Dominican. These patients tend to have thick, coarse, hairs which typically equate to very large follicles. This usually means a decreased donor density because the large follicles take up more space and tend to be spread further apart. You appear to have advanced hair loss and a lower than average donor density due to the large, spread apart follicles. Now, the good news is that this type of follicle tends to give EXCELLENT coverage; the not as good news is that you are limited in the number of grafts you have available and scarring may be more difficult to conceal. If you came into my clinic for a consultation with this presentation, I would recommend two planned FUT procedures: the first to re-establish the hairline, densely pack the frontal scalp, and strategically work into the mid-scalp; the second would address the remainder of the mid-scalp and strategically address the crown. I see why FUE would be an appealing option with your donor area. While I think scarring from a 1,600 graft case would be reasonable if it were spread out properly, you will have noticeable "dot" scarring (especially with your nice tan skin tone) if you keep it very short, and I also think you are greatly reducing the number of lifetime grafts available if you start with FUE. Your hair type also tends to be a tricky one with the FUE approach. I believe you would likely have a fairly unpredictable curve to the follicle under the skin, and this can be challenging to get around. Doesn't meant that it cannot be done -- and some even have tools aimed specifically at addressing this issue; but it will make FUE even more challenging and the grafts will likely be a little more traumatized. As far as the estimate of 1,500 grafts to the crown: Keep in mind that I have not evaluated you in-person so I defer to whomever has; however, I have a sneaking suspicion that this amount may not achieve your goals in the crown. My guess is that to do the crown to the level at which you would like it filled, you are probably looking at closer to 2,000 grafts minimum, but likely closer to 2,500. I would also think about addressing the front first -- as it appears this region is thinning and will likely reach the level of the crown. I hope this helps. Dr Bloxham
  7. Dr Blake Bloxham

    Fue or fut for me????

    Wendell, Can you share a picture of the donor area on the sides and back of the scalp? This should be evaluated first.
  8. Great answers. One thing I would add: when you visit a clinic for consultation, make sure they can show you examples of different types of hairlines. Hairlines are not a "one size fits all" type of thing. Just because a hairline looks amazing for one patient, does not mean it would look right for you. Hairlines must be customized for each patient. Things like: hair type, facial structure, forehead shape, level of hair loss, and overall goals must be taken into account.
  9. Dr Blake Bloxham

    Few simple questions

    I find that patients are always understandably nervous as to how friends and family will react. However, I cannot think of one instance where they were not very supportive and typically fascinated by the process. Good friends and family just want you to be happy; once they understand that it is a good solution and it will help you, they are generally very supportive of a hair transplant. In fact, we often later see those very friends and family members for consults and surgeries once they see how it transformed their own loved ones.
  10. MrNuit, Are you combing or manipulating the hair vigorously while it is still wet? Hair strands break a little easier when they are wet. You will notice more hair on the comb if you run it through wet hair compared to dry hair. This is not hairs "falling out" or shedding, but the hair shafts themselves snapping off or breaking mid-shaft.
  11. PA, Kiwi, and Det, Thank you for the kind words. Glad you enjoyed the presentation.
  12. Thank you for the kind words. Great post. This is exactly what I recommend for my patients who I believe will be in this for the "long run." It is nice to know you always have FUE in your back pocket once you are "stripped out."
  13. It may be unsurprising to many long-time readers of the forum, but one of the most popular topics right now seems to revolve around FUT versus FUE. However, this topic is not an "FUE vs. FUT" debate, but is a very good question revolving around which technique a patient should start with and the best way to utilize both. Specifically, in patients looking to maximize donor potential and future surgeries, which technique should be used first: FUT or FUE? As many may know, I am an advocate of clinics who can offer and regularly perform both, and I typically advise patients who have uncertain or advanced levels of hair loss and may want multiple procedures to start with FUT. Because I am a "fan" of this approach, I wanted to share a presentation of a patient who went this route. The patient first presented to the clinic with classic frontal hair loss several years ago. He wanted to "test the waters" a bit with hair transplantation, so I did a very conservative frontal band procedure via FUT. He did very well and after seeing that hair transplant surgery really works, he decided to "dive in" and undergo a more aggressive hairline lowering and dense pack frontal band procedure. I did this via FUT as well. After two strip surgeries he was fairly confident with the scalp in general except for a small spot in the crown -- which had been static for years -- that he wanted to address. This procedure only required 500 - 800 grafts and he decided that since the bulk of the work was done via FUT and he was happy with the incision line (which was still very good after two harvests), he wanted to now switch to FUE. Because we started with FUT, I was happy to do a conservative pass via FUE and address the crown. Here are a few "before and after" comparisons after the two strip procedures: And here is a very thorough walk-through video I encourage all those wondering which technique they should start with to watch. Not only does the video include comb-through of the results, it also features a discussion about the approach, video of his incision line after FUT #1 and FUT #2, video of me performing the FUE procedure, and a post-op of the FUE crown surgery. Also, as a little "bonus" here: I have included video from his 6 month visit, just in case any members need reassurance that results do change from the 6 to 12 month mark: Thank you for watching. I hope this sparks some good discussion and I look forward to the conversation. Dr. Blake Bloxham Feller & Bloxham Medical, PC
  14. Dr Blake Bloxham

    Sun Exposure

    Hi SprayPaint, All clinics have slightly different recommendations. It is important to follow your specific clinic's post-operative instructions as closely as possible. In my office, I recommend that patients be "careful" in the sun for the first 3-6 months (usually putting more emphasis on 6). Now, this does not mean you need to avoid the sun; we have many patients return to sunny Florida or make a "recovery" trip to the Caribbean right after surgery; but what it does mean is that you need to avoid a sunburn or excessive sun exposure to the scalp. 15 minutes walking to your car is not going to hurt anything, but six hours laying in the sun on the beach could. A good rule of thumb to use is: if you are putting sunblock on and have a concern about burning the rest of your skin, it is probably a good idea to protect the scalp -- if you are less than 6 months out from surgery. Just bring a hat with you; if you are in the sun and you feel things heating up, put it on; if you go under an umbrella or go inside the beach bar, you are free to take it off. No need to avoid getting a transplant around Summertime just because of this. Just be a little more aware and cautious and you will do fine. I have heard varying explanations as to why this occurs. Some seem to believe it has to do with adaptation based upon where the donor follicles come from; some believe it has to do with the melanocyte cells that surround the base of the transplanted follicles; others seem to think it has more to do with follicle stem cells being closer to the surface in the first few months after a transplant before things really mature; regardless, it is probably a good idea to just be a little careful and protect your investment. Hope this helps. Dr Bloxham
  15. Good replies from Melvin and Sean. Yes, you can remove grafts via FUT after having an FUE. The issue is not so much getting the grafts out of the strip. As Sean stated, it can make dissecting more difficult but a trained FUT staff should have no problem with this; the issue with doing FUT after FUE is simply that you will get a lot fewer grafts out of the strip. Let's say you have a virgin density of 80 graft/cm^2 in the donor region. If I take a strip of 30cm x 1 cm, I will obtain approximately 2,400 grafts (remember that this is just a simple example and not precisely reflective of nature). Now let's stay you had an FUE first and a responsible doctor took around 25% of the grafts throughout the area which will be strip harvested later on. This means your density now dropped from 80 grafts/cm^2 to 60 grafts/cm^2 -- because in FUE you have a drop in grafts without a change in surface area; and keep in mind that this would be a responsible harvest. So if we now took a 30cm x 1cm strip after the FUE harvest, you would only yield 1,800 grafts with the same incision line scar (IE damage in the donor). The other issue would be if the first doctor was not responsible with the FUE harvest. When this happens, the yield from the strip becomes very low and there may be issues with covering the incision line because the donor has been significantly over-harvested. The beauty of strip is that you remove both grafts and surface area in one attempt, so you do not reduce the global density of the donor. This is what allows you to do multiple strip procedures with a minimal amount of scarring and then still do good FUE harvesting from all around the incision line (assuming you are not going to be an extremely high NW patient). It is typically best to do it this way -- FUT and then FUE -- if you are looking to do a combination of both. You absolutely can start with FUE, but just make sure you are not harvesting too aggressively and reducing the benefits of a potential strip up the road. Hope this helps. Best of luck with your decision. Dr Bloxham