Dr Blake Bloxham

Password, Thank you. He's very pleased. The patient is in his early 50s.

Wanted to share the 12 month results of a patient who came in to "finish" a hair transplant journey he started years before. The patient had a modern "frontal band" transplant at another clinic, but inadequate graft numbers were used and the density and definition the patient desired were not achieved. So I did another pass of 1,600 grafts to solidify the frontal band and finish his hair transplant journey. The patient has the right hair characteristics to pull off a very natural, feathered front, even with dense packing, and I think his 12 month results are just what he was looking for. Note: The patient just returned from a trip and is very tan in the afters compared to the befores. Here is a "quick vid" of his results: And here are just a few teaser shots. Watch the video for more (it's a quick one): Thanks for viewing. Dr. Blake Bloxham Feller & Bloxham Medical, Hair Transplant Institute

Thanks, Spex.

Thank you.

He'd be thrilled to hear that. I always thought Josh Radnor had excellent hair. Thank you for the kind words.

Wanted to present an update on a case I've shared before. The patient is a male in his 30's who underwent 2 "mini-graft" cases only several years back at a local clinic. The result of the two procedures was an unnatural look that only worsened as he continued to thin in the "frontal band" area. So I did a 2,200 graft FUT procedure (with true follicular units) aimed at naturally restoring the front and blending it into his excellent hair behind. He recently stopped by at 10 months and I was able to do an in-depth video (with dry and wet comb-throughs) and really evaluate how far he's come. I'm also linking to his case at around the 6 month mark; this may be interesting for those looking at how transplants mature. Video: Comparison Pics: And here is the link to his original presentation (a little under 6 months post-op): Dr. Blake Bloxham: 2,200 Graft "Mini-Graft" Repair | 6 Months Post-Op Thanks for viewing, Dr. Blake Bloxham Feller & Bloxham Medical, Hair Transplant Institute NYC Hair Transplant | NY Hair Restoration | Feller & Bloxham Medical

The biggest complaints I've heard from people on topical anti-androgens (RU and finasteride) is that those who switched from oral to topical to avoid side effects still experienced systemic side effects. As you pointed out, this is a double edged sword: this does mean that the medication is at least absorbing through the scalp, but it indicates that it isn't staying as local as one would hope. I do believe there can be big issues with stuff absorbing through the scalp and creating/utilizing the correct vehicles to get drugs across the skin has always been a big challenge in pharmacology.

Yes. The patient must understand that his hair loss is progressive and that he may want more in the future. We also have to start "smart" with respect to where we work, how aggressive we go, etc; and we MUST respect the donor and leave a good amount "in the bank" for future surgeries. But if this is understood, then it's not a problem from my perspective.

Castillo, He's in his mid-30s. And I agree 100% with your FUT comments. This is a perfect example of why I like starting with FUT. This patient has now done 5,800 grafts and still has at least one more strip. After that's done, he has the option to FUE all the virgin tissue around the scar. Most effective use of the donor for patients with progressive and/or aggressive loss.

RE: fin questions: To my knowledge, there was no switch and he was consistent with his usage. Some people just don't respond as well to it. More frequently what happens is that people do well for a while, and then start to see a decline. I believe the follicle develops more DHT receptors or the receptors themselves slightly change and the drug is simply less effective because the follicles are now more sensitive to DHT -- though this is just my theory. I usually see this around 7-10 years of finasteride usage. Seems like it was quicker in this patient -- if that is what occurred -- but I've seen it on a quicker scale as well. Preventive measures are still helpful for HT patients regardless.

Yes. The patient has been on finasteride for years -- even before the first procedure. Unfortunately, not everyone is a great responder and the drug does tend to lose effectiveness overtime. Another reason why I don't like the term "stabilized" when it comes to things like finasteride and/or minoxidil. While helpful and a definite point of research for any hair loss patient, androgenic alopecia is progressive, sometimes very aggressive, and rarely "stabilized." Thank you for your interest in the case.

Thank you for the kind words. I love the way the transplant works aesthetically for this patient. With the right density, his hair just has this natural style to it that really compliments his facial structure and overall style and looks great. So pleased I was able to help him out.

Stay tuned.

Excellent. Sharing this truth was the objective the entire time.

Gas, Regardless of what I post and how many times I genuinely have answered your questions, you continue to twist my words and post falsities. I never said detrimental forces don't apply when going slow. In fact, I said the EXACT opposite. I stated that the forces are always apparent during FUE extraction. However, the best way to minimize trauma is to go slow and focus on small cases. Do you really think you can't be slower and more careful when you have to remove 100 grafts in a set amount of time versus 2,500 grafts in a set amount of time? If I told you that you had 2 minutes to walk 10 yards holding an egg on a spoon without dropping it, do you think you would break less if you could make several slow, careful trips with only a couple of them; or do you think you would break less if I said you had to rush as fast as you can and move dozens of them? And sure you can extrapolate the same care with 2,500 grafts if you can do it with 100. All you need is about a month do to the surgery. I'm very disappointed in your last few responses, and therefore this will be my last one to you.

Thank you for the reply. Just to clarify: So the rate of grafts scored but failed to deliver was 4%. Just for the general audience reading, this means that 4% of the grafts were scored around with the FUE punch, but could not be pulled free with forceps (tweezers) so they were left behind. Which is par for the course. But, according to the above, this number does not include the transection rate -- which is the number of times grafts were cut in half cleanly through during the scoring process. Do you know what this rate was? So do you believe grafts are damaged during the extraction process and are naturally more fragile AND the pen implanter allows for an atraumatic delivery with acceptable growth? And if you do not believe grafts are damaged during scoring/delivery, then why is the pen advantageous? And do you believe those not using the pen are getting less yield? So you believe the growth rate for this case was 99%? Do you believe this is indicative of FUE mega session cases in general? Very pleased to hear the patient is happy. Obviously this was a traumatic event for him in general and it's good to know he was able to move past it. Again, thank you for participating. Look forward to your reply.

Just for the record ... I forgot to ask one question of Dr. Vories above and just added it.

Dr. Vories, Thank you for joining the discussion. A few questions if you don't mind ... You share a case where 100 grafts were extracted via FUE, re-implanted with an implanter pen, and a 99% regrowth rate was observed. I am not surprised by this data. As has been said many times before, slow, meticulous small FUE sessions are the best way to minimize trauma and maximize growth. Although forces are present on all grafts during FUE, it is truly the "brute force speed" utilized during FUE mega sessions that causes real problems on a large scale. Having said that: How many attempts were made to remove these 100 grafts? Meaning how many grafts were scored versus scored and successfully delivered? Do you have any data on the survival rate of the 2,500 graft procedure? If not, do you think it rivals the 99% regrowth rate you saw during the 100 graft test? Do you believe your average FUE mega session -- say 2,500 grafts or so -- grows at this level? 99%? Several members dismissed the findings of a published study by an FUT/FUE doctor because he only included 90 cases at that time. 90 was too small of a number and many member wanted more data points, so I'm curious as to whether or not you have more than 100 data points for comparison as well. Also, you have mentioned several times that you believe using the implanter pen makes up for damage during extraction and allows for good growth. Is this accurate? And if so, do you believe FUE-only doctors -- such as the last one to enter the discussion -- who are implanting with forceps are getting less yield/growth? And if not and they are the same, why use the implanter? Very much look forward to your reply. Dr Blake Bloxham, NY Feller & Bloxham Medical -- Hair Transplant Institute NYC Hair Transplant | NY Hair Restoration | Feller & Bloxham Medical

Incorrect on all accounts. Seriously. All of the aforementioned doctors came in swinging but left before any real debate could take place. And all left many questions unanswered. What's more, not a single one ever said they left or removed comments because they felt people were being "mean" or "unprofessional." If they felt this way, they likely would have said so.

Gas, I don't think these questions have ever been dodged. But just in case ... 1) Post random (=always changing) growth rates of FUE (and FUT) We have posted the studies from Dr. Beehner (two different ones) and Wesley multiple times. These numbers are slightly different, but they still show around the same: 70-75% growth yield on average for FUE. Industry accepted standard for FUT growth after multiple, multiple studies is 95-98%. 2) Not answering with clarification after being questioned about this numbers several times See above. Just because people don't like the data, doesn't mean they get to outright dismiss it or claim we aren't posting it. Studies in this field are light compared to others in general. Dr. Beehner and Wesley have studied in a controlled and respectable fashion and published the data. 3) Not backing them up with facts or not answering the serious questions to the few poor data which were given. If you have better data supporting your perspective, please post it. I don't have control over the number of studies that have been done on this subject. When I present my own, it's called subjective or biased. So all I can present are the objective studies done by others. If you have conflicting data, it's on you to present it. 4) Answer in another thread with an offensive video and title after finally another clinic had joined the discussion (who raised similar questions). You probably missed the first time this happened in the exact manner, but the clinic in question really didn't "join" the debate. They came in, admitted that detrimental forces on grafts exist, claimed they had overcome them but refused to clarify how -- even after a moderator asked for clarification, and then made some silly comments about people coming to train at their clinic, argued over whether something happened 15 or 17 years before, and then used a 12 year old post to try and end the argument before running from the debate. There was no evidence provided, nor was there any "entry" made. 5) Post “results” of a hollywood actor, who never admitted to have surgery, to promote FUT. You cannot know if he had FUE or FUT and on top he is probably using concealers/topic/partial wig etc. on this picture as it is from the Oscars event. I don't know who posted pictures of a hollywood actor to promote FUT, but I assure you it wasn't my clinic. 6) Not answering serious questions about negative aspects of FUT at all (like thinning in the donor) or even giving misleading answers. Again, this was answered; you simply didn't like the answer. There is a difference. Please refer to Dr. Feller's post. 7) Connect “damaged grafts” with existence of FUE clinics in the US Incorrect. No one ever stated that the poorer yields with FUE is not why you don't see FUE-only clinics in the USA. We stated, correctly so, that the practice of FUE tech mills is illegal (or certainly very, very risky) in the US (see case law in Florida and Virginia) and that is why you only see it in certain areas of the globe. I truly hope this answers these issues. Dr. Blake Bloxham, NY Feller & Bloxham Medical -- Hair Transplant Institute NYC Hair Transplant | NY Hair Restoration | Feller & Bloxham Medical

Mikey, Interesting proposition. But think about it another way: Some of the things FUE clinics do to make up for these lower yields and less dense results from FUE megasessions include: -Bringing patients back in multiple times over a short period and only posting the "before" and the final "after" as the result while minimizing the number of procedures. -Over-estimating graft count, over-harvesting the donor, and over-packing the recipient site area to the point where a patient may experience a real problem like necrosis. Have any members seen this?

Today, I wanted to do something of a "PSA" about how the crown (vertex) progresses and how this affects transplants. Had a patient come to me (from the UK) for surgery in August of 2016. At that time, he was experiencing very classic male pattern hair loss: patterned thinning in the front, a stronger (but questionable) "bridge" in the middle, and an evolving crown in the back. And the patient made a very classic request: "Doc, I know you recommend doing the front/middle, but it's the back that bothers me! Can't we do the crown?" Here's how the looked the morning of the first surgery: Luckily Spex had already done an excellent job discussing the issues with transplanting the crown with this patient, so he had a pretty good understanding of what I would say the morning of surgery. But I told him that transplanting the crown now wouldn't be the best option. The front and middle are more cosmetically significant, and your crown is likely going to progress. We don't want to utilize a lot of grafts before we know what's really going on, nor do we want to fill it now and create an "island" of transplants surrounded by thin scalp as you continue to recede back there. He agreed and we pressed forward with a 3,300 graft transplant aimed at addressing the frontal and mid-scalp. Procedure went great and the patient reported excellent growth a year later. When he got back in contact, he confirmed that the crown (and some of the mid-scalp where the thicker "bridge" was located) had continued thinning and wanted to know if we could address it now. I evaluated everything and believed that we could. Here is how he looked the morning of surgery 2 (pictures purposely highlighting where I worked): And here is a picture of his FUT scar 12 months after a 3,300 graft procedure: But here is where the real "PSA" comes in: Here is how his crown looked only 12 months after the first operation: (note, the mid-scalp continued to thin as well and what you see there is a complete loss of his native hair and only transplants -- which were carefully integrated into his native hair previously -- remain). And here is a "side-by-side" for comparison: Had I done a dense fill of the open crown area before, the patient would have utilized precious grafts to now have a dense island in the middle of thinned area around it. This would not have looked natural, nor would it have been a good use of his finite donor. What's more, you can see how "doing the front first" always results in a natural appearance from any reasonable angle, regardless of how the patient thins behind. But after a thorough review, I decided it was appropriate to now address the crown (including working into the edges where it may possibly continue to thin -- though unlikely) and reinforce some of the mid-scalp. I performed another FUT harvest and removed an additional 2,500 grafts for the crown. He's now had a total of 5,800 grafts via the FUT technique. The patient can still undergo more strip harvest and then FUE the virgin donor around it if he wants more work in the future. Here he is in the middle of the second surgery: And here he is at the completion of the second surgery: So remember: 1) The crown is an highly unstable area and needs to be evaluated and intervened upon carefully. I definitely understand that it's bothersome, but it is constantly evolving in the active stages of male pattern hair loss and "jumping into it" can be tricky and isn't always the best use of grafts. 2) The frontal region is usually the more cosmetically important one and it's usually best -- in patients with loss in both -- to address this region first. 3) Utilize the donor carefully. It's a limited resource and must be respected. Hope you enjoyed. Dr. Blake M. Bloxham (Great Neck, NY) Feller & Bloxham Medical, Hair Transplant Institute NYC Hair Transplant | NY Hair Restoration | Feller & Bloxham Medical

Sometimes a little "tweak" is all it takes to finish a patient's hair transplant journey. And that's what I'm presenting today: The patient underwent his first hair transplant over a decade ago; a hairline/frontal rebuild and thickening. The procedure went well for him and held him off for many years. Eventually, however, some small things changed and he was faced with a tough decision: take the plunge one more time to really finish the journey, or let it be. Since he had invested already, he decided to undergo one more to slightly "tweak" the frontal hairline. Specifically, the patient wanted better "closure" in the corners and a stronger "left side." I ended up doing a 1,200 graft front band, with emphasis on the left corner/temple region. Below are some "before and after" comparisons at 6 months. Please see the video for more pictures -- including immediate post-ops. A subtle change, but an important one for the patient. PICS: VID: Dr. Blake M. Bloxham Feller & Bloxham Medical: A Hair Transplant Institute

Patient III posted: Dr. Blake Bloxham (NY): "A Day in the Life" Patient III: 2,500 Graft Frontal/Mid HT - Forum By and for Hair Loss Patients

Patient III posted: Dr. Blake Bloxham (NY): "A Day in the Life" Patient III: 2,500 Graft Frontal/Mid HT - Forum By and for Hair Loss Patients