Dr Blake Bloxham

Win, Yeah, sounds like you're all good! The studies done by Dr Bernstein in the 1990s essentially showed that the grafts are pretty good by day 3, almost invincible by day 7, and totally permanent by day 10. And remember that these studies were, from my understanding, done with larger grafts than what we use today (modern FUGs). This means modern grafts anchor and are permanent even sooner. We pretty much tell our guys they are fine on day 3 -- and this is with FUGs placed in custom lateral slit sites.

Wallace, I agree with Wwizz. If you want to get this many grafts safely in one sitting, it would need to be done as FUT. HOWEVER, this is assuming you have the donor to take this many grafts safely with a strip. Most, to be honest, probably don't -- and you would have to go too wide and risk poor scarring to compensate. Doing this as one FUE sitting raises a number of potential issues: 1) What had to be done to get this many grafts out via FUE in this short of a time period -- IE how gentle and meticulous was the extraction method? 2) How many attempts it did it take to get out 4,500 grafts at once -- if it took somewhere around 5,500, the subsequent subdermal scarring in the donor region is going to be an issue 3) How long are these grafts sitting out exposed before being implanted (out of body time)? Most would say that it's much better to split these FUE cases. There is debate about how large you should go before splitting, but I don't think anyone would argue with splitting 4,500 into 2-3 days. However, 4,500 in one sitting is really, really big regardless, and you may not have the physiology to do this regardless. Have you consulted with any doctors?

Esrec, You nailed it! At the end of the day, the patient is happy and he looks great! This is what matters.

Pauly, Good to hear from you! Sounds like this could be one of two things: 1) You've continued to thin despite the slowing effect of the preventive medications 2) Less compliance with the preventive medications has resulted in more accelerated thinning. In either scenario, I think the answer may be getting back to a more regimented medication schedule. This is of course assuming that you did well with the medications and they were recommended/prescribed by a doctor familiar with your case -- like the good Dr Mohebi! I've seen some impressive turn arounds with guys who "lost ground" like yourself while slacking on the preventive medications. I'd be surprised if you weren't able to thicken it up a bit with meds alone. And maybe you should pay a visit to Dr Mohebi and have him take a look? Like Spanker said, pictures will be helpful as well. Look forward to your reply!

Win, Congrats on the procedure! Sounds normal to me. A lot of how the scabbing/crusting forms and subsequently falls off has to do with post-operative cleaning. It sounds like you're following Dr Rahal's post-op instructions carefully and really going above and beyond with the aftercare. Because of this, I'm not surprised the scabbing process is proceeding quickly. I usually see two types of scabbing/crusting when our FUT guys come in for their staple removal at 10-14 days post-op: those who kept the recipient area clean and those who did not. Now, I don't blame the guys who don't keep the area as clean. The only reason they didn't clean it thoroughly after the 3 day mark is because they were afraid of damaging the grafts. Trust me, I get this! These guys generally experience the scabbing and crusting for longer. The guys who keep the area clean and wash as we recommend have little to no scabbing or crusting at the 10 day mark. Sounds like you'll fall into this group. No worries! Good luck and grow well!

Giant, A few things: 1) Remember that losing 50-150 hairs (depending on the source) a day is completely normal. Losing this amount of hair is natural and doesn't indicate any sort of pathology (IE androgenic alopecia). 2) Guys who don't wash their hair daily may see even more of a "shed" while showering because they lose a few days worth at a time during a wash. 3) It's difficult to detect whether a hair is miniaturized when examining it alone and without any sort of magnification. The difference between the girth of a normal terminal hair and a miniaturized hair is about 3 microns. The length may be more obvious, however, as miniaturized hairs generally break off or shed at shorter lengths. However, it's tough to tell if you're only looking at one or a few. Has a doctor examined your scalp?

Still reading and advocating the sticky! Hilarious stuff!

Done via FUT or FUE?

Great planning and strategic use of the grafts!

Home, Just to reiterate what I was discussing earlier, here is something taken directly from Dr Rahal's site: The Benefits of a Follicular Unit Transplant - A fuller, more dense look - More consistent hair growth - A completely natural result - Superior hair yield Follicular Unit Transplantation | Dr. Rahal

Home, I disagree. It it imperative to go to a top FUE doctor to maximize your chances at good growth -- just as it is with FUT. However, I don't think any of these top doctors would state that the yields are "as consistent." There is simply more variability and lower yields with FUE. How much is a point of heated debate, but I haven't heard any doctor with the ability to do both FUT and FUE claim they are identical. Otherwise, why would they offer both? And remember that popularity of a procedure does not necessarily equate to the most consistent results. It also has to do with the perception of it being "new," a perceived less invasive nature, different scarring, et cetera. Regardless, I'm very, very pleased you obtained good results with you FUE procedure!

Home, FUE growth rates are simply more variable and yields are lower on average. This is because of the stress and strain the grafts are subjected to during the extraction process. Even in clinics with very established protocols, like the one you mentioned above, it occurs. This is simply a reality of FUE. If you look over anyone's overall track record, you'll see much more variation with the FUE compared to the FUT. You're going to get more reliable and consistent results with the FUT. No one is saying you can't get good results with FUE, but it's much more of a "flip of the coin."

Home, Based on my conversations with FUEguy, the instructions he was given were similar to ours and other established clinics. And he's a very compliant guy and followed them well. I have no reason to believe this caused any growth issues.

Seth, Yeah, no need to go back and forth for days here! Haha. I'll see if we do have any pre-FUE shots -- and maybe FUEguy will even share them himself. ... post continued below -- is HTN being "glitchy" for anyone else?? ... I do understand that you think he's a poor grower in general, but I'm curious as to why you think the FUT grew better? I noticed you were asking about some post-operative things and medications. Did you think this played a role?

KH, The general consensus is that doing FUT first followed by FUE is the best way to optimize grafts in the long run. I believe Dr Madhu -- a surgeon who offers both FUT and FUE, I believe -- will say the same. He's excellent, by the way!

Seth, I think it would have looked closer to 2,000 - 2,200 if some of the FUE grew in AND the FUT grew well. However, I just don't think much of anything grew from the FUE. And what did looked very wispy and fine, so it wasn't really providing any support for the growing FUT. Because of this, I think he looked like around 1,600 grew, meaning almost no growth from the FUE and good growth from the FUT.

Excellent work! Keep it up!

Yo, Gotcha. You think it looks like he only has around 1,200 total in the hairline, huh? I would have guesstimated closer to 1,600 if I saw him come in off the street. He is wet in that top down. And I did shave slightly into the back of the first FUT transplants to blend them with the second procedure a bit (though the goal on him was as much coverage as we could get!). So maybe this is making it look a bit different than the presentation photos? Regardless, glad to hear you think it's a good improvement overall. He's seriously an awesome guy, and I'm glad we were able to give it to him. At the end of the day, that's what it's really all about. And I'll check to see if we have any of his true "before" photos (pre-FUE). He has shown me some on his phone and to me he looked exactly the same as he did before the FUE. Just some wispy hairs hanging on throughout the front. I do think he's going to check in more too, so maybe he'll upload it -- or send it to us and we can do it for him.

Oh also, Seth: To my knowledge, really nothing different in the post-operative care. He also didn't make any lifestyle changes, medication changes, et cetera.

Seth, I'm a bit confused. You don't think his FUT grew well? Even if you think he may be a "poorer" grower in the first place -- which I don't think he is -- do you really not think there was a noticeable difference between the FUE and the FUT growth: Seems like you think he doesn't grow well in general? Correct? And if this is the case and his physiology just doesn't respond well to surgery (which I still disagree with), why were the results from the FUT so much more dramatic? Interested to hear what you're thinking here -- or if I'm even understanding correctly. Haha.

Hey FUEGuy, Dr Feller went through some of the pictures today and sent me this one; hopefully this is what you had in mind: He's alive! He's alive! Hahaha. Thanks again for being a good sport. Everything is looking great. Can't wait to see this grown out!

Bunsen, Thanks. Yes, he's very, very pleased with the results! He actually took the time to stop by just to show us! Stig/Seth, Hmm, very interesting! Haha.

Vox, Must have been asked that question 30 times in London! Hahha. No, we are not opening a UK clinic. However, we do have a number of patients who come see us from the UK each year and also have our representative, the one-and-only "Spex," working full-time in the UK, so we head over every few years to do consults and follow-ups with past patients.

I agree with hairthere; looks like normal post-operative "redness." It's such a strange phenomenon. For some guys, the redness will honestly almost completely fade away within days; for others, it's there for 4 months or so. I've never seen any correlation in how it affects the final results, nor have I found a reliable way to tell who will stay red for a while and who won't -- so I try to tell all patients that it could be "months." Make sure to double check with your clinic before putting anything else in the area -- just to be safe. Grow well!

Giant, I think it means something is happening -- meaning you are a "responder." Like I, and KO, said earlier, however, I don't think there is any conclusive evidence showing a correlation between body hair changes and how well it will work for you in the long run. But I do think it means "something is happening." And I also think the shedding means you will likely see a response in the scalp. I agree with KO: watch closely and see what happens! Best of luck!