Dr Blake Bloxham

Spanker, Exactly. He's looking to drop it around 3/4cm to 1cm. Tried to wipe it off as best I could in the last few pictures, but it stayed a bit. What do you think about this? Drop it or good height?

Hi Beldar, Good to hear from you! Glad to hear you are coming into the office as well. We'll get some images up so the community can weigh in too. And I definitely want to evaluate the size of the crown and the overall donor before recommending one way or another. I think your plan sounds pretty good if the crown area is reasonable sized. However, I would definitely want to be cautious with FUE in the donor area to make sure we don't compromise future procedures or create any visible thinning around the FUT scar. But, like I said before, it should be a reasonable plan if the size of the crown itself isn't too big. NOW, having said that .... You would likely still get more overall by doing another FUT. Even if it was a smaller one to cover the crown area. Better growth yield and a more reliable donor region up the road (because you truly never know what the future holds). And if the crown does require a larger number of grafts, I'll likely recommend another FUT regardless. As I'm sure you know, we are big proponents of slow, cautious, delicate, manual FUE; and this, by nature, usually means smaller cases. Look forward to seeing you in the office soon. Don't hesitate to contact if you need anything in the meantime.

Decker, Looking excellent! Thank you for the update. I really like the longer hair style too. Again, congratulations. It was great working with you!

Alundra, Make your first real analysis at 12 months, with the understanding that it can take up to 18 months to really fully mature. Timelines are extremely variable before that.

Stash, We started filming FUT scar "combthroughs" to help answer this question. Here are a few if you're interested:

Looking good!

Completely agree. Well said.

Wow. My heart dropped into the pit of my stomach watching that video. Unbelievable! I'd be very curious to see what he looks like a year from now.

So it's Spencer's fault! In that case, I think it's only fair he pay for the haircut. I'll put you guys in touch!

Yup, this one pops up every few years on HTN. I still remember seeing it for the first time. Those dilators ...

I really don't think the "average Joe" would notice anything. Especially on that right side. It's important to remember too that the scar "matures" in the same way the results on top "mature." Generally it is much redder, slightly wider (in my experience), and more exposed due to temporary shock loss up to the 6 month point. After this, any residual redness resides, more contraction occurs, and the shock loss (if you did experience it) really starts to turn around. So just because you can see something -- with your newly trained hair transplant eyes -- at 6 months with a #3 buzz, doesn't mean you'll be able to when the incision line fully "matures" down the road (like at 12 months). My guess is that you'll be able to pull off a #3 buzz without any indication at 12 months. But I think you're safe at this point.

Stash, Remember that RU58841 has not yet been reviewed and proven safe and effective for the treatment of hair loss. However, many have purchased it, created their own vehicles to help it absorb into the scalp, and used it with varying degrees of success. The most common complaint I've heard about RU is that many individuals who experienced side effects with systemic anti-androgens (IE finasteride) experienced sides with RU as well.

Hi Patrick, The simple answer is: when your clinic tells you you can. This is because almost all clinics have slightly different instructions when it comes to post-operative washing. I tell my patients to use the cup method for 3 days (starting the day after surgery) and avoid direct water pressure from the shower head during this period as well. Starting day 4, I tell them to start gently massaging with fingertips -- not fingernails -- to wash and break up any scabbing that is forming. I further tell them to use the scabbing as an indicator of how well and aggressively they are washing. If the recipient area looks like a clean "buzz cut" without scabbing, then you're watching correctly. If you have a lot of scabbing building up, scrub harder. However, sometimes you do get a few stubborn scabs, and its okay to leave these guys alone if they don't break up with reasonable fingertip washing. Shoot your clinic and email and see when and how they want you washing. But hopefully the above is a helpful "general" idea for post-operative cleaning. Grow well!

Great video.

Hey HT, Where did you read that the average non-AGA male has 100,000 follicular units (FUs)? The numbers I've always reviewed state that the average non-AGA male has about 100,000 follicles. With the average FU being 2.2 follicles, this would put the average at around 50,000 FUs for a total of roughly 100,000 follicles. The issue of donor becomes more confusing with the idea of an expanded donor for FUE. When Unger -- and a few others -- defined the "safe donor area (SDA)" years ago, they essentially based it off of someone with extreme NW VII balding, because everything in this area is truly "safe" if you assume the worst case scenario. Others have become more liberal with the model over the years (even in strip harvesting), but the latest data I've heard regarding available FUGs in the SDA is that Caucasians have around 10,000 with Asian and African hair types (fatter follicles) providing around 20-30% less. HOWEVER, this data may be based upon strip harvesting. Many have argued that only 3% of patients truly ever progress to a NW VII, so it's safe "enough" to use a donor model that is expanded based upon someone who is more likely to end up in the NW V to VI category. This is especially true for FUE (I do it with mFUE as well) because there are areas in this expanded model that are considered "safe" but you obviously wouldn't want to try to access them with a strip harvest. So what does this expand the donor to if you think about it in this model? Not sure. But I think most still assess the "thinning" factor based upon the original estimates. Meaning that if you're a Caucasian patient looking to do FUE, you could expect "thinning" if you went over the 5,000 graft level (50% of a 10,000 graft average) -- based on the original models. Interesting food for thought though. Should the averages be reevaluated if we buy into the idea that only a small amount of patients will progress to a NW VII (IE where you really only have that strip to safely take from) and most will show obvious signs around age 30? Or are grafts taken from this expanded donor area still maybe a little "unsafe?" Here's something from Dr Rassman about the donor capacity, just for reference: "The entire head of a Caucasian has 50,000 follicular units. The donor area has at leas 10,000 follicular units, that means by harvesting with fUE half of the donor area, that means that a person would get 5,000 FUE grafts with a depleted, thin looking donor area. If the number was 15,000 rather than 10,000, then a person might get away for 7,600 follicular units for 7,500 FUE grafts. An Asian is 20% less and an African American is 40% less in terms of maximum yield of FUE grafts. It is not reasonable at the staft of this process to think beyond scalp grafts for FUE for many reasons, poor growth cycles, etc..."

Looks like he's healing beautifully, despite his loose interpretation of your post-op instructions. Nicely done! Keep us updated on him.

Shampoo, They used to have a mechanism where it basically tied a knot underneath the skin after the implant penetrated through the skin itself. This way the knot was larger than the hole it made on entry, and it couldn't be dislodged.

Great reply from Mahhong! The general rule with donor "thinning," or thinning in general, is that it becomes apparent after 50% of the native density is lost. This means if you have 8,000 grafts available, for example, it would theoretically look thinner after having 4,000 grafts removed. However, it may be a little more complicated than this for several reasons: 1) If you are a bit of an FUE scar-er (and some people do have more noticeable scars than others), the appearance of the scars themselves may make it look thinner even if less than 50% of the available donor is taken. 2) Sometimes the harvesting isn't evenly spread, and you'll have patches that are hit harder than others. This is because you naturally hit "good" and "bad" harvesting patches while doing FUE. Sometimes some people take advantage of these "good patches" and steal too many grafts. If so, it leaves a thin patch in this area. 3) Remember that it is difficult to really estimate your entire donor supply. This is because FUE utilizes an expanded donor model to harvest compared to where a strip is taken from. If for some reason someone thought you had 10,000 grafts available and took 5,000, but then it ended up that you really only had 8,000, it may look over harvested. 4) There is something in FUE called "attempt to success ratio." What this means is that each "scoring" or cutting of a follicular unit graft may or may not result in a successful delivery of the graft. In plain English, this means that you may cut around a graft, but it doesn't come out as an implantable follicular unit in each case (because it rips or tears during delivery). This means two things: 1) it may take more than 4,000 cuts to get out 4,000 grafts (maybe 4,200 or 4,100) so you may have more scarring to get out the number of grafts you need, and 2) sometimes these follicular units grow back and sometimes they don't (depending on how it broke or failed during the delivery). If it doesn't grow back, this is one more area in the back that is "thinned" without giving you a graft to use. So if you had 8,000 grafts, you wanted 4,000, but it took 4,200 attempts to get that 4,000 and only 100 of the 200 failed delivery attempts ended up regrowing in the back, you could have a thinned appearance. Hope this makes sense! Just a few things to consider in your research.

Nice presentation. I completely agree with really pushing the cleaning. I know it has a serious effect on the final results. Glad the second procedure worked well for him!

Great case, and clearly a good decision to recommend the FUT above more FUE. Glad to see it worked out very well for this patient!

Gman/OnTop, Are you taking MSM with the biotin? I tend to see more breakouts from this than I do with biotin.

Thanks for sharing, Dr Wesley. I read this article earlier this month and thought Dr Beehner did a great job. And I think no matter where you fall in the "debate" his efforts need to be acknowledged. And it's great to have some objective data regarding this subject. What's more, I think Dr Beehner really went out of his way to standardize the experiment and reduce variables as much as possible. Surgical research has been plagued by variations in human operators for decades, but he did an excellent job trying to minimize bias in all forms. Another thing I like is that the primary investigator -- IE Dr Beehner -- doesn't really have any conflicting interests here. Just like it was tough to accept the findings of the doctors hired by Phillip Morris in the 1950s who claimed Marlboro cigarettes didn't cause cancer, it's tough to believe FUE has equivalent yield if the researchers who conducted the experiments own significant stock in robotic FUE companies or profit from the sale of FUE tools. Dr Beehner has decades of experience with all forms of hair surgery and he has the capability to offer both FUE and FUT. Obviously some have more experience with FUE and it would be interesting to hear their thoughts on the manner, but I think a doctor who can offer both, does perform both, and has no financial gain from recommending one above another is a fair and impartial experimenter here. And his findings are consistent with what I've personally seen and with conversations I've had with numerous doctors in private (including some who have done lots and lots of FUE). And I think your closing line touches on the most important point here: doctors should be proficient in both, properly inform patients of the pros and cons of both (and obviously FUT has it's own set of positives and negatives too), and offer FUE and FUT when appropriate. Again, thanks for sharing and participating in important hair restoration related research!

These "biological implant" fibers generally cause a very pronounced "foreign body" rejection reaction and LOTS of long-term scarring in the scalp. There are some companies claiming to have improved the implants and some areas where you can get them done, but I think most would recommend researching follicular unit grafting (IE modern hair transplantation) first.

Hi Mark, Looks like I gave my "two cents" over 3 years ago before you shared a picture. Based on the image alone, I agree that this does look like temporal triangular alopecia in and of itself. However, I can see some of the rest of your scalp in the picture, and it looks like you're suffering from hair loss in the top and front of the scalp as well. Because of this, I think there may be 3 possibilities here: 1) It is classic temporal triangular alopecia (TTA). If this is the case, Gillenator is correct in stating that this is very responsive to hair transplant surgery. 2) This is androgenic alopecia (male pattern hair loss) that is affecting multiple areas of the scalp. It may be affecting the frontal portions of the temple region here, and that is what is causing that patch to open up there. I've seen patches like this in male pattern hair loss before. 3) It could be a combination of TTA in the temple region there and male pattern baldness in other areas of the scalp. Most of the time the "simplest answer is the correct answer" in medicine, so this may be less likely. But you never know. I'd go see a doctor and get an evaluation in person. Best of luck!

Speegs, As usual, I agree with Gillenator. Definitely speak with your clinic before putting anything on the scar. Some have strong preferences about what to use and not use on the healing incision line. Having said that, I find vitamin E most effective.