Dr Blake Bloxham

Hello everyone. 

 Bluebird, 

 I'm not sure what more I can say or add at this point. As I have been explaining and demonstrating to you for the past 3 months, your belief that you only received 1,700 grafts is simply untrue. You did, in fact, receive 2,700 grafts and I even went back in and extended the original length of the strip to ensure we achieved -- and even exceeded -- the quoted number of grafts. All of the other comments about things you believe may have been "off" or untoward about your procedure are, again, simply untrue. I have invited you back to the office many times so we can review all of this in-person; I still not only strongly recommend and encourage you to come in, but I will also (with that patient's permission) allow you to observe a live procedure and interact with the technicians and any observing doctors so you can see exactly what happens during an FUT case just like your own. You have declined these offers so far, but it stands in perpetuity. I will make myself and everything related to your case available at any time. 

I know you have now posted your concerns throughout the internet for other patients to review as well, but I further invite you to visit other reputable hair transplant doctors for a professional review of your case. You are more than welcome to put me on speaker phone during that visit should the doctor have any questions. I think you will find they agree with our assessment. Should you change your mind or find some time in your schedule and come to visit, you are more than welcome to video record the entire follow-up and put that online as well.

 I did just finish reviewing everything related to your case a final time and put all my thoughts in a letter for your records.

 Thank you, 

 Dr. Blake Bloxham 

Feller & Bloxham Medical, PC 

Drew, 

So, if I am understanding correctly, the doctor is afraid that weight training will shunt blood to the muscles being strained and, therefore, steal blood from the scalp and negatively impact the follicles? To combat this, he/she provided a blood thinner? Somewhat novel theory. I have not heard of this before. 

Hi JJ, 

No, I do not believe psoriasis or seborrheic dermatitis would cause this. I have had several patients experience flare-ups of both in the post-op, and it did not affect final yield. 

What I was referring to was specific types of inflammatory or immune-mediated types of alopecia like LPP, areata, etc. 

Pre-Screened, 

In theory, your logic makes sense; the longer you leave them in, the longer the wound has to heal without tension, and the better the scar. In reality, there will be diminishing returns for leaving them in past the recommended period. Eventually any benefit you may -- and may is the operative word there -- achieve by removing tension on the wound would likely be nullified by the increased inflammation caused by leaving a foreign body in for so long. I close the vast majority of my strips with staples, and 14 days is the longest I recommend leaving them in. I have had a few patients go as long as 20 days or so for various reasons, and I have not noticed any better scarring from leaving them in for a few extra days. I have, however, noticed increased inflammation and a greater difficulty taking them out at 20 days versus 14. 

Hope this helps! 

The "tagging" feature is neat. Thank you for bringing this thread to my attention, Melvin! 

AKC, 

I think you have received good advice thus far. Pustules like this seem to indicate some type of infection. The level of involvement (multiple follicles, skin, deeper tissues, etc) and proper course of treatment is difficult to estimate based on images alone. One question I do have, however, is how long ago you had the hair transplant? I was not clear on this. 

If I had to fathom a guess, I would say that you had the transplant within the last 3-4 months and the pustules are related to "ingrown" hairs penetrating through the scalp. If these were manipulated enough or things like oil were placed around them and created a nice environment for bacteria to grow, infectious agents absolutely could have infiltrated through the surface of the scalp and settled in various layers of the tissue. Depending on how deep the bacteria penetrated and how wide it spread, oral antibiotics may be a good option. 

This will all need to be determined by a knowledgeable doctor in person. It would be nice to get your HT doctor's input, but I would probably see your GP as well. 

Hope this helps. 

Every clinic has different requirements. I recommend speaking with your clinic and following their instructions as closely as possible. For what it is worth, we allow patients to return to full activity (both FUT and FUE) 10-14 days post-op without restriction. Always seems to go well. 

Good topic. 

Altogether, I think the stigma is decreasing. Doctors have told me that 25 years or so ago, patients would try to set up consultations during weird hours of the day and nearly run in and out of the office as to not be spotted anywhere near a hair transplant clinic. I think the fact that the surgery itself has improved so dramatically and people are becoming more open about discussing it online is really breaking down walls. I am always impressed when a patient allows us to use their full face in presentations or even refers acquaintances and colleagues to the office. I find it happening more frequently each year, and it seems to indicate that the stigma is decreasing. 

Hi Jerry, 

Sorry to hear about this. I second the suggestion to have a scalp biopsy and determine whether or not this may be caused to an underlying immune-mediated process. You may have an underlying condition that is causing the body to inappropriately attack the follicles and cause them to fall out. Are you having any other symptoms? Redness or inflammation of the scalp? Any patches of hair missing from the donor region or any other hair-bearing areas of the body like your beard or chest? 

MrZ, 

If the doctor is recommending that you split it up, I highly recommend splitting it up into two days. This is not uncommon at all. And, in my opinion, it is a good thing. Speed is not a virtue in FUE. Typically taking a slower, careful, more considered approach pays dividends. This also equates to less graft "out of body time." Good things all around. 

Very good replies thus far. It absolutely comes down to skin type, how the patient heals, punch size, and the distribution of the extraction sites. For what it is worth, I tell all my FUE patients they can safely go down to a #2. There are obviously exceptions to all rules, but I think it's a safe generalization to keep expectations realistic. 

12 hours ago, jonzi said:

Incredibly natural result. Well done. The wet video is impossible to fake. Should be standard for all results presented by all clinics on these forums. Would be an eye opener I think.

Question: once you extract the FUE graphs, do your techs do any sort of "trimming" of those graphs before implantation? Cut away exessive tissue from the graphs in order to make it easier to implant with density. 

And finally, if you do NOT do any trimming of graphs in FUE, you do that in FUT, right? 

Thank you for the kind words. 

I am very big on comb-through video. Particularly wet comb-through video. As you said before, there is simply no way to "fake it." It is honestly not the most flattering way to present a hair transplant, but I do believe it is the most honest. Potential patients need to know what they are getting themselves into if they chose the transplant route. If they watch a video where the transplants are soaking wet and being combed back and they like what they see, pretty good chance they will be happy with the outcome of a good transplant. If they do not, then maybe it is not for them and they just saved themselves time, money, and stress. 

Yes, we trim the grafts under microscopes. The same scopes we use in all of our FUT procedures and by the same technicians (the members of the staff cross-trained for FUE specifically). The grafts are reviewed to make sure they grossly look okay (twice, actually), properly identified, and trimmed up. 

And yes, we absolutely trim all the grafts in FUT as well. 

On 8/12/2019 at 5:42 AM, BjornBorg said:

He should have @Blake Bloxham on the show to open his mind. Shoot him an email, Doc. Would probably be good for business too.

I am always up for it. I have done a few little TV interviews and things like that, and they are always fun. So many misconceptions still exist about hair transplants specifically, and I love to set the record straight. 

Genes, 

Good luck with the upcoming procedure. You may want to research saw palmetto if you can't tolerate finasteride. I have seen a number of patients do well on it. I am not convinced it is as effective, but a lot of patients want to throw everything they can at the hair loss; especially if they are having a procedure. 

On 8/14/2019 at 9:02 AM, LaserCap said:

It is not until the comb through that you realize the true density.  Keep in mind that hair in the middle and the front grow an an angle towards the front and shingles.  This is why an in person evaluation is so important.

Nice work.......

Doctor, from time to time, would you mind taking photos of the scars in the donor?  This comes up frequently either because the scars are terrible or because the patient is concerned about moving forward because of it.  Thanks.

Thank you for watching and commenting. Thank you for the kind words as well. 

Absolutely. I actually try to include a scar comb-through in all of my FUT videos. I did not film this one myself, so it looks like I did not get scar footage. I will share some if he comes back, and do look out for pictures and video in future presentations. 

35 minutes ago, Mycroft said:

Funny how much a clean and "solid" hairline seems to impact appearance. As you noted, the patient has quite a bit of hair everywhere else, but that eroded look right at the front kept drawing my gaze. Very different story in the after images.

Good observation. Sometimes these little "tweaks" can make such a difference. And framing the face with hairline work is always key. 

On 8/14/2019 at 4:47 AM, Dr. Sal said:

Looks great Dr. Bloxham!

Thanks! 

On 8/11/2019 at 8:16 AM, JohnCasper said:

Nice work Dr. Bloxham.  Looks very good.  

Hi John, 

Thank you for the kind words. 

On 8/11/2019 at 5:22 AM, ItHasToLookNatural said:

Do you use the "stick and place" technique when performing fue cases?

Also do you charge the same as Dr. Feller for FUE, which is if I recall correctly something like 10 dollars per graft.

Also, what is the best way to contact you? I admire your work!

Thank you for the kind words. 

I typically make the incisions and then place the grafts. Sometimes "stick and place" if there are unanticipated grafts or if I want to very carefully beef up the density in a specific area. 

FUE is $8-10 a graft at our office. 

You can use the consultation feature through the site here or obtain our contact information from our website. 

On 8/10/2019 at 3:16 AM, jj51702 said:

What would you say your survival percentages are between fut and fue?

I have heard most doctors quote 5-15% difference between FUT and FUE. I honestly think it is a little higher. Probably 20-25% on average. The best way to honestly describe the "difference" is in terms of variability. FUE is simply more variable. Some patients just have the right characteristics for it and their grafts will accept a little more excitement, and others simply will not. Some people grow excellent with it and you can barely tell the difference between FUT and FUE, whereas others get decreased yield and some even character changes to the hairs themselves. The trick is screening and being able to stop the case or recommend switching to a different method if you do not believe it is going well. And still even then, sometimes it all seems to go well and still just does not grow as well as I believe it would have with a strip. 

On 8/10/2019 at 1:28 AM, CosmoKramer said:

You’re welcome and thanks for the reply!

Yeah, I figured that for that amount of grafts doing so with manual extraction would be very tedious and tiring so it absolutely makes sense that you’ve since adopted to splitting up such type sessions.

Looking forward to seeing the update on 2nd procedure from this patient!

It absolutely is a lot of work. But, I believe it is worth doing. I really do think true manual FUE done slowly and meticulously like this gives the grafts the best chance. However, this does not mean there are not other good ways of doing it that may suit some patients well, and I am always up for trying new devices and techniques. 

53 minutes ago, CosmoKramer said:

Great work Dr Bloxham, looks natural and donor looks good as well.

Since you did the FUE manually, was this a 1-day session for the 1,500 grafts or over several?

Thank you for the kind words. 

I did this patient in one (long) sitting. Since then, I have actually switched to only doing 500 - 800 manual FUE grafts in a sitting. For any decent size case, I break it up into multiple sittings. I feel like doing it this way allows me to take that nice, meticulous manual approach without feeling rushed and resorting to speed over quality, and it also greatly reduces graft out of body time. 

Thanks for good question. 

Hi Everyone, 

Today's presentation is a nice little FUE hairline case. The patient is a gentleman in his late 30's with otherwise excellent hair aside from some classic hairline thinning. He was set on FUE and initially wanted to go very aggressive in the front. After reviewing everything, we decided the most natural, strategic approach was to start a little more conservative. So, we did a 1,500 graft case to rebuild his hairline. I removed all the grafts manually using a 0.9mm Feller Medical Punch (a punch Dr. Feller patented many years ago). Extraction went very well. I saw the patient back 12 months later, and both he and I were very pleased with the results. Since he grew well with the FUE and the back seemed to heal up nicely, we decided to do a little more and close in the corners a bit. I will update with the results of this second procedure in the future. 

Here are a few "teaser" comparison shots with both dry and wet hair. As usual, I include only a few of these because I encourage all researching patients to watch the result video, which features both educational content and a much more detailed "comb-through" of the results. 

And here is the video: 

Thank you for reviewing. Look forward to the upcoming discussion. 

Dr. Blake Bloxham 

Feller & Bloxham Medical

www.fellermedical.com

Interesting. I wonder if there is any data about this out there? Anyone who has objectively analyzed and compared the percentage of "balding" people in different generations. Could lead to some very interesting theories. 

Thanks for sharing. 

Great case! Kudos to Dr. Arocha and team. Smart planning from the get-go and good use of the donor. The patient must be very pleased. 

Good thread. 

Not to alter it too much or stand on a "soapbox" here, but this is why I often encourage younger patients who are set on surgery to consider FUT. Regardless of how far a patient progresses, an individual with true androgenic alopecia should always keep that safest part of the safe donor region. Even in advanced cases. The very advanced cases (like a NW VII) are often very familial and we see strong signs early, but even these individuals can still be conservatively served with what they have back there. If the entire donor area thins, then the patient likely has some other type of loss and should never have been offered surgery in the first place. But I do find this is pretty rare and typically somewhat obvious from an early stage. If a doctor has global donor concerns, he/she should advise the patient not to move forward now. However, we see too often today doctors taking from "safER" regions in the "expanded donor" on young patients. As mentioned several times here, this area may not be truly safe and only appears that way because the patient is young and early in his journey. So, this thread is a good reminder to act conservatively, treat the donor as finite and sacred, and maximize for the long-term.