Dr Blake Bloxham

KO, As usual, excellent points. I try to stress the "shave test" you brought up quite a bit. Any type of hair transplant surgery, be it FUE or FUT, will leave scarring. Because of this, you'll never be able to truly ever "shave" down -- the way it's discussed online -- without some indication of the surgery. With FUT, you can obviously see the linear incision line if you shave below around a 3 guard. With FUE, you don't have the line, but the scalp does have a "surgical" appearance when buzzed down below a 3. It's not glaringly obvious, but you can tell something was done. This is even more apparent in person. This is why, like you said above, anyone who is truly thinking about buzzing down to this level should do a "shave trial." If you can sport the close buzz, you've saved yourself tens of thousands of dollars and the surgical appearance in the back.

And I still do! I'll let Dr Feller explain his own philosophy as well!

KO, Very important points of clarification. Thank you for sharing.

Hey Cali, At 4.5 months, I'd say the average "maturation" rate is 25%. However, "average" is a bold term in this instance. Patients are all so unique that it's difficult to even put a general label on it. To me, it actually looks like you're a bit ahead of schedule. BUT! You still have miles to go! You'll see a big difference by 6 months. I have no doubt about that. Remember that you aren't really 100% matured until around 12-14 months, however. And I agree with Matt! it looks like you're on track for one of those killer Konior transformations!

The 5-alpha-reductase enzyme, which is inhibited (or a certain subtype of which is inhibited) by finasteride, is crucial in the development of secondary sexual characteristics (IE external genitals) during the embryological period. Especially the development of male secondary sexual structures (you get what I'm talking about here). Male embryos with a condition called "5-alpha-reductase enzyme deficiency" will not develop traditional male genitalia despite having the chromosomal makeup telling the body to do so. This is because the fetus doesn't have the DHT hormone (which is made by the 5-alpha-reductase enzyme) needed to form these structures. As you can probably guess, these children will be born genetically male, but will not have the traditional external organs. This is the theoretical risk with finasteride and pregnancy. And obviously this is why the manufactures are VERY persistent about keeping pregnant women completely clear of the drug.

Petchski, I think you nailed it: a mix between FUT and FUE (FUT results in the front, no linear scar in the back). And removing the "stress," as you stated above, placed on the fragile grafts is why we obtain the reliable growth in the transplanted areas. We'll definitely keep you guys updated!

Greek Guy, You were a true pleasure! I can't wait to see the results from the second procedure mature! Keep us updated!

Dest, I know! Fun, it's it? I think the difference in what Dr Feller said in another video has to do with the patient's age. If you have a 55 year old gentleman with a NW V pattern but a persistent forelock, there is a pretty good chance that this will be fairly stable. In this instance, you may be able to "count on it" somewhat and include it in the surgical plan. However, this is a very different story in a late 20s, early 30s patient. And this situation is a perfect example. These guys have very active hair loss, and it's very difficult to count on anything. And this was all discussed, in detail, with the patient while we created the surgical plan. So, how difficult is it for an HT surgeon to predict how someone's hair loss will progress? Honestly? Quite difficult. In my humble opinion, at least. However, we're not completely "shooting in the dark." You can always bust out the magnifiers and really do a miniaturization analysis of the hairs along the fringe and in the middle of the areas in question. You can also take things like the patient's age, medication regimen, and pattern along the rest of the scalp into account. Even with all this, however, it's still tough. And we have to plan accordingly!

Guys, Yes, we were surprised at how much he thinned in 10 months. Unfortunately, this demonstrates how unpredictable androgenic alopecia can be. ESPECIALLY in younger guys.

Hey Sam, Here's something I wrote about the donor region, and more specifically the "safe donor area" versus other regions around it, a while back. There may be some helpful information in it: The "safe donor area" (SDA) is actually a very controversial area -- no pun intended -- in the hair transplant surgery field. Let me provide a little context and explain how I believe doctors make surgical decisions with regard to the donor area and educate their patients about the permanency of their donor follicles: The SDA was first essentially discovered by Dr Orentreich when he first described the theory behind 'donor dominance' and revolutionized hair transplant surgery in the 1950s. At this point in time, he didn't really define a 'safe donor region,' but he did note that follicles from this region were 'permanent' and seemingly unaffected by the androgenic alopecia (AGA) process when transplanted to the front of the scalp. This is really what kicked off the 'plug' phase of hair transplant surgery. Initially, plug procedures were small. And these extractions were pretty safe with respect to safe donor. As time went on, however, they become larger and the idea of defining a safe donor became a more important reality -- in my opinion. Before this could really become too big of an issue, however, strip harvesting (FUT) really took hold and defining the SDA wasn't that big of a deal. This is because there should really be a truly 'safe' harvest zone on nearly all patients. Even those with some retrograde nature to their hair loss or the 3% who, very unfortunately, will hit the dreaded NW VII at a reasonable age should still have at least a narrow strip of truly permanent follicles in the heart of the harvesting area. This is essentially where strips were taken, and everything was seemingly okay. However, the follicular unit extraction (FUE) procedure began returning to prominence in the mid 90s onward and suddenly the SDA became a very important issue. It may not seem like it, but this is where it really became a 'hot topic' in the HT world. Most of what is published in hair restoration is released in the 'Forum International' journal through the ISHRS. There is a lot of good information in these journals, but it sometimes doesn't reach the online patient population. If you read these journals throughout this time period however, you'd find that there were actually A LOT of people looking into the SDA dilemma. One of whom was Dr Unger. He did a study in the late 90s or early 2000s (my dates could be slightly off here) to determine which regions of the scalp truly expressed DHT-resistant follicles and could be safely utilized for harvest. As expected, the region was the area utilized more frequently in strip procedures. So this put the issue to bed, right? Well, no. You see, many FUE practitioners had begun to push the limits of donor harvesting and started experimenting with regions outside of the zone re-defined by Unger. This led to a whole new classification of: 'Safe Donor Area (SDA),' 'pretty SDA,' and 'not SDA.' I don't recall the exact terminology off the top of my head, but it was somewhere along these lines and you get the general picture. Obviously, this stirred up more controversy. However, this is basically where we are today: with strip harvesting and small non-strip harvesting procedures, you can pretty much stay within the true SDA (as defined by the studies). In larger non-strip (IE FUE) harvesting procedures, however, you'll likely start to creep into the 'pretty SDA' regions. Now, what's important to realize is that harvesting in the pretty SDA regions isn't inherently wrong. BUT, this statement only holds true if the HT surgeon does a very thoroughly scalp examination, determines the safety of the pretty SDA region (which, I'll admit, is a bit of a scary task), and informs the patient of precisely where they are harvesting from and the potential fate of these follicles. In this sense, some less DHT-resistant follicles may be transplanted. Is this right or wrong? I think it's tough to say. Like I said above, it really comes down to professional judgement and full disclosure. What's more, all of above pertains to individuals with AGA. Other types of alopecia make this a very, very different discussion. I think this is an important conversation to have with your HT doc. Especially if you have reason to believe you may experience thinning in the 'pretty SDA' areas I described above OR if you're planning a large non-strip harvest session. Hopefully this will help a few guys out. And, BeHappy, I hope this didn't sound like I'm trying to skirt around any of the issues you mentioned. Obviously this is something to consider and thoroughly understand before 'taking the plunge!'

Cali, Exciting to see some new growth! Thanks for keeping us updated. Look forward to watching it grow and mature even more!

Bunsen, Yes, we use blades cut to the width of the patient's individual FUGs ('custom cut blades'). We also still close with surgical staples too. We feel this provides the best, and least visible, scarring in our FUT patients. The future treatments is a whole other discussion! Haha. All of the ones your mentioned are currently in different phases of trialing (both professionally and in groups online), so they aren't offered in clinics yet. But who knows what the future will hold!

Very interesting! Look forward to seeing more cases with and without. This will probably help you -- and the community -- figure out when it's best to integrate the PRFM!

No problem, HairJo! Glad it was helpful!

95% FUE? This seems higher than what he's posting online. Where did you get this info from? It'll be nice to get a confirmation as to what he's actually performing. Like I said before, I was under the impression he's still fairly split. FUT for larger NW cases and FUE for smaller cases and preferred for guys under 30?? UPDATE: I just looked at his site, which says it's content is current through 2015, and saw the following: "FUE (Follicular Unit Extraction) and FUT (Follicular Unit Transplantation) are two well-established and state-of-the-art hair transplantation methods. Which of the two methods is best needs to be decided on a case-by-case basis, with an experienced doctor weighing up the pros and cons, risks, costs and benefits and discussing them face-to-face with the patient." "An FUE is best for patients wanting to avoid a linear scar at all costs, and for younger patients only requiring minor treatment." "Patients with a Norwood V or VI diagnosis should choose a combination of FUE and FUT to attain the highest possible number of donor hairs." "Though both extraction techniques basically allow the same number of hairs to be extracted, there is one major difference. In an FUT, under good working conditions, 4000 - 5000 FUs can be extracted in one operation session. The corresponding figure for FUE is 3000 - 3500 FUs. Using the FUE technique, a second operation is generally needed to achieve the same number of FUs." "Extracted grafts [FUE] are vulnerable to dehydration. Moreover, continuing cell metabolism can lead to a sort of self-poisoning. This is the reason why the environment and handling that FUs are subject to between extraction and implantation are very important ... Generally speaking, grafts extracted vie FUE are much more sensitive, as the extraction technique leaves much less protective tissue around the hair follicles. This ultimately leads to a slightly lower survival rate. " This actually seems very logical to me. Also sounds like he still utilizes both when appropriate. Again, sorry for derailing GBH. I'll stay on topic from here on out!

Hi Johnny, I don't think washing it more would do anything. Maybe the opposite, in fact. The oil could be playing some small role. But it doesn't sounds too significant. If you're noticing more hair loss as your scalp looks greasier, I think it's a few things: 1) The AGA is progressing, and with this comes sebaceous gland growth and more sebum on the scalp; 2) you no longer have terminal hairs on the scalp to suck up the oil from the skin. Because of this, it all just sits there on the skin. Regardless, it sounds like a natural byproduct of the AGA. I don't think this will affect your hair transplant. Shoot Dr Lorenzo's clinic an email and see what they say. But I think you're okay. Good luck!

GBH, Let me know when you get that private jet up and running! Glad you liked the video. Best of luck with your research!

Hey Johnny, Congrats on booking with Lorenzo. I've always been a VERY big fan of his FUE protocol. You'll have to keep us updated on the results. I don't see too much on the scalp there. Are you putting any topical liquids, foams, salves, or creams on the scalp? Any different shampoos? Any dermarolling? Sebum overproduction can occur in androgenic alopecia (AGA). In many cases, the AGA process actually causes an increase in the size of the sebaceous gland next to the follicle and creates excess sebum production. Which, as I'm sure you can believe, causes an excess of sebum on the scalp. This can cause the "greasy" appearance you're describing. It really shouldn't change whether or not you're a candidate for surgery. It's a pretty normal part of AGA, and hair transplant surgery is a well accepted treatment for this type of hair loss.

Hey Swoop, It's my understanding that he does FUE on lower NW patients and prefers it on guys younger than 30. For the others, he may utilize FUT. As far as the numbers go, take a look at his HTN Coalition profile. This is automatically updated with results posted in the "Leading Clinics" section. In this section, he has 91 results displayed. 39 of them are FUE. This gives a ratio of 43% FUE and 57% FUT. Just rough numbers and doesn't say much about a trend, but I think it's probably the norm for those who can offer both; pretty much split because of the indications for both. And yes, his FUE protocol is quite refined. I believe he's used the same technicians for extractions for quite some time now, and it's clear he's dedicated to it. PS: Your results are looking great! Glad you're keeping us updated!

I've officially received two more inquiries about this issue, so I'm bumping this thread for easier reference! Don't worry blonde guys; you're all good!

GBH, It's interesting you bring up the blonde hair results conundrum. I get questions about this all the time and just made a video discussing blonde hair transplant results. Take a look: And here's the thread if you wanted to discuss it further: Blonde Hair Transplants As far as the price question: many of the clinics who offer FUE at lower rates do so because it is what I call "technician FUE." This means a technician, not a doctor, is carrying out the procedure. There are varying degrees of this. In some scenarios, a technician extracts and a doctor makes the recipient sites. In others, however, the entire process is delegated to the technician. Not making any comments about the outcomes, but this is one of the reasons why you see big price disparities. I can only think of one doctor who does FUT and FUE in Turkey. Dr Karadeniz. I'm actually a big fan of his philosophy and work, so you may want to take a gander. As far as other FUT surgeons in Europe: Dr Bisanga does about 50% of his cases FUT (and his work is meticulous) Dr Devroye Dr Feriduni does about 50% FUT as well (especially in higher NW cases and guys older than 30) I'm sure there are a few other great ones I'm forgetting -- and I do apologize for that! Take a look at HTN's recommendation list in Europe. And don't feel like you're in the minority for going FUT. Trust me, it's more common than you think ; ). Both procedures, FUE and FUT, are great in certain scenarios. You, just like everyone else, happen to be better suited for one above the other. It's been great talking to you. Feel free to ask any additional questions here or via email. Best of luck!

Sam, I just had a look at the Pantogar website. It looks like their formula consists of several vitamins and amino acids that promote a healthy scalp and normal follicle cycling. They also use a few other interesting ingredients I haven't seen utilized in hair loss products before. In my opinion, these compounds will likely promote a healthy scalp. However, I don't think they would necessarily halt progressive hair loss or re-invigorate any permanently resting hair follicles. It may be a good adjunct to other medical or surgical treatments, but I don't see it stopping the hair loss or altering the genetics of the process (as quoted above). But I'd be interested in seeing your progress -- if you do chose to take the medication. Keep us updated!

That's 5 months? Wow. Nice. Got to love those early growers! Curious, Dr L: did you use PRFM on this gentleman?

Natural, Thanks for sharing your story. And your questions are very reasonable, and I'm glad you're asking them. First, and without diving too deep into the issue, I'm glad you were able to read some of the pros of utilizing a non-FUE method (IE strip) in the hairline. Of all the regions we work on in the scalp, the hairline is arguably the most important. We must use the strongest, most reliable grafts here to build the hairline to the best of our abilities. The reason I bring this up is because you are clearly someone who wants the best changes of a thick, natural, result in the front, and FUT is what will maximize your chances of success -- in my humble opinion. Now, on that subject: I think it is very normal for a hairline to look natural after a hair transplant. As long as a few things are observed: 1) several rows of densely packed single hair FUGs in the micro hairline; 2) reasonable irregularity in the micro hairline; 3) densely packed multi-hair FUGs in the "marco hairline" (this is where the soft transition zone of the micro hairline really meets a wall of density and creates the soft, natural, but very dense appearance you need); 4) some slight irregularity in the macro hairline as well; 5) an overall design that fits your head shape and face As far as your other questions are concerned: Hair always looks a little thinner when it's wet. It sticks together and creates visible gaps between it. This same thing happens to non-transplanted hairlines too. It should blend with the native hair seamlessly. HOWEVER, this is something that must be done purposely in a transplant scenario. What does this mean? If you're a NW 2.5 with very thick, dense hair around the thinning areas, the restored area MUST be transplanted at a high density to achieve this assimilation with the native hair. How will the young 20 year old girl react when she pushes it back with her fingers? Well, I think you'll just have to keep us updated on this one ; ). Haha. Bottom line? I think you are doing your homework and going into this with your best foot forward. Keep asking questions until you're comfortable. However, it seems like you are absolutely going about this the right way. Hope this helps! Feel free to ask any additional questions, and keep us updated!

Beldra, Thank you for the excellent write up! Your description of how the day flows will be very helpful to those researching hair transplant surgery down the road. No doubt about that! I'm very pleased you had such a positive experience, and I look forward to updates! I probably said it once before, but don't hesitate to contact me if you need anything! Be healthy and grow well!