Dr Blake Bloxham

Thank you for the kind words. Per my records, he is not on any type of preventive therapy. Absolutely there is a lot of benefit from the native hair. He reported that it still grew well in the back, but he could not grow the hair out because the weaker frontal hair would not grow to any reasonable length. He is very happy now that he can grow it all and blend it together. However, he is also aware that the back will likely thin in time and he will probably want to do another surgery down the line.

Thank you.

Then I would definitely say it is a normal crown whorl. Try to check up on it periodically and keep an eye on it, but try not to let it dominate your thoughts. It is very easy to fall into the trap of "obsessing" over little areas like this you think may be thinning. Early intervention is great when it comes to progressive hair loss and you should check periodically to make sure things are not rapidly changing, but try not to get too "hung up" on little perceived differences in the short term.

Greg, Gillenator's post above , as usual, is pretty spot on: we typically do carefully reinforce thinning -- but not yet bald -- regions when possible. However, there is always a tipping point between an area you can safely invade and one you should not attempt yet due to the potential for shock loss. We require patients to trim for surgery and this, in my opinion and experience, cuts down on the potential for damage, so I frequently try to "reinforce" as many regions as safely possible during a transplant.

If you were my patient, I would probably try to advise you against it at this point. I know it seems like 7 months is an eternity, but the trauma is still pretty recent for your body and the skin is very much still healing. The peroxide is likely just a little too irritating. I honestly would not be as worried about the hair shafts, more the healing scalp skin. Again, however, definitely follow your own doctor's instructions. I am glad you reached out to them. Also, have you concerned a product that lightens with more natural ingredients? Sometimes dyes will use things like lemon juice to lighten the hair. This should be more tolerable if applied to the healing skin.

The patient in today's case is a young man in his 20's who initially presented to us with a pretty reasonable request: he wanted to grow his hair long again. He did not want his hairline lowered, he did not want his corners rebuilt, he just wanted to get away from constantly shaving his head like he had been doing since his hair loss became "bad." When the patient first noticed his hair loss, he tried to keep his normal, long hair healthy by taking Propecia. Unfortunately, he suffered side effects and had to stop. As his hair continued to "miniaturize" it grew shorter and shorter, and he eventually resorted to simply "buzzing" his head -- something he was not a fan of. He came to us restore the ability to grow his hair long. He reported always having a "higher" hairline, and he wanted to keep this. We used the remnants of his existing hairline -- starting behind these to take advantage of their irregular and soft nature -- to rebuild the hairline and pack back through the mid-scalp. He was okay to not address the crown/vertex at this point because he believed it was still strong enough to grow longer and blend with the transplants. We saw him again a year later and he was very pleased to have achieved his goal. Because we started as an FUT he still has plenty of donor left to address the crown in the future (which he likely will want to do), and he can always go a little more "aggressive" in the front once the top is completely stabilized -- though I will admit that I really like the longevity of a conservative front. Here are a few "teaser" images from the video. I only include these because I really encourage patients, especially young patients, to watch the detailed comb-through video. "Teaser" Images: HD Video: Look forward to the discussion. Dr. Blake Bloxham Feller & Bloxham Medical, PC www.fellermedical.com

Clerks, It looks like the main ingredient used to lighten the hair shafts is hydrogen peroxide. This may be a little harsh on your still healing scalp. I typically tell patients that hair "dyes" are okay pretty much any time post-day 10 or so, but things like bleach treatments or anything containing chemicals which may irritate the skin could be excessive. Did you ask your clinic?

Agrinch, It looks like a normal whorl pattern and not a crown affected by male pattern hair loss. How old are you? Are you seeing any changes near the hairline region?

Congratulations! Dr. Gabel is fantastic and I am sure you will be pleased in the end. Happy growing.

Placement with forceps is very a-traumatic and effective in the right hands. In fact, I personally believe there is no better way to place than with certain types of forceps in the hands of a trained technician with lots of experience. I have only seen one study which compared placement with forceps to implanter pens, and, from what I recall, the conclusion was simply that implanter placement was not inferior to forcep placement. There are absolutely some great doctors who use them and believe in them, but I do fear that some clinics use them simply to get around training and retaining quality staff. I also have some concerns about implanters which I have never seen answered conclusively. But, to answer your question more directly: no, forceps are not harmful for grafts.

Thank you. This plan is a very common one at our office and I think a very good one. I'm glad I was able to show a patient who utilized this approach successfully. I will definitely update the community if and when he does come back for the crown.

Bill got all the way up to 10,000?!? Wow. That's spectacular. Did not realize he was that high. And yes, you are right, he still has a good FUE pass left in him. But I agree completely: patients should not assume that they have this type of donor. Most people will be average and should remember that the donor is limited and needs to be utilized as wisely as possible. Very good topic. I am sure this will help out a lot of members.

I think we are in the minority here and, again, I must express that you should follow your clinic's own instructions to the letter; however, we allow regular weight lifting once the staples are removed starting day 10-14. I have done FUT on many athletes, weight lifters, fitness models, etc, and they all resumed at this point. I have not noticed a difference in scar quality compared to the guys who do not work out at all. Closure of the excised area is very important; don't get me wrong here. However, a lot of the way a scar heals is simple physiology. Some people could likely do crunches non-stop or "head bang" at a metal concert for a month straight and still heal with that undetectable "pencil line," while others may sit perfectly still for months and still heal with a millimeter or two more stretch -- more of a "marker line," if you will. Everything in this range is still normal healing and easily hidden with any reasonable amount of hair; I tell my guys they can typically go down to a #3 on the buzzer.

Thank you. Great eye! What you are seeing is the remnants of his native hair in front of the new transplanted hairline. I always like to do this when possible. When you rebuild a transplanted hairline behind native hairs, you get two things: 1) the benefit of the native hairs which are more irregular and finer and create an even more natural result in the front; 2) these can safely fall out without affecting the overall aesthetics of the front because we rebuilt a complete hairline behind it. He will eventually lose these hairs and the hairline will look more uniform. However, I love taking advantage of these when I can. As far as the yield goes, he seemed to do great (not unsurprising at all for FUT) and everything grew uniformly.

Thank you for the kind words. You are correct that Spanish patients typically have amazing hair characteristics. Dark, coarse, and wavy, but still typically look natural in the hairline. The best all around in my opinion. His were thicker and coarser than the average patient, but I have seen much heartier (like rope!) on other Spanish patients. So good characteristics all around.

Hi Everyone, Today I wanted to share another 2,500 graft FUT case. The patient is a Spanish male in his late 30's with pretty advanced and diffuse hair loss. He has been on finasteride for 5 years but continued to see a steady progression of loss. He came to us with the goal of densely rebuilding the frontal half of the scalp and strategically working into the mid-scalp. He plans to do another procedure to address the back up the road, but the front was the priority and he believed he could "manage" the back much better with transplants in the middle and front (and I think the way he is styling his hair as viewed in the "top down" shot shows that this worked quite well). We tackled this using 2,500 grafts via the FUT technique; he came back for a follow-up 12 months later and was very pleased with the results -- as were we. Below are some before and after comparisons and a video. As usual, I recommend that everyone watch the detailed video which features comb-through (wet and dry) footage of the result and his incision line (strip scar) at 12 months post-op. Look forward to the discussion. Dr. Blake Bloxham Feller & Bloxham Medical, PC

Mephesto, Clinic recommendations vary wildly when it comes to working out post FUT. While I have my own opinions on this as well, I think the best advice is the one given specifically to you from the clinic. Follow it as closely as possible. Having said that ... Most of the work-outs where people worry about stretching involve flexion of the neck or a lot of contraction from the large muscle groups which attach near or around the base of the skull -- namely the "traps" and the long spinous muscles. Exercises that will specifically flex the neck are activities like crunches; activities which may activate the muscles attached to base of the skull would be things like shoulder shrugs, trap lifts, possibly rows, and anything which may target those long spinous muscles (the "superman" position you see in a lot of work-out videos comes to mind). I will ask Dr. Lindsey to comment here as well. He is both an FUT master and a big weight lifter!

Great topic in general, and I completely agree with the above. I think we often see exaggerated numbers of lifetime grafts online. Particularly when it comes to doing FUE alone. I am astonished when I see patients in the clinic, evaluate their donor areas, and then hear the number of grafts some clinics tell them they can utilize via FUE only. The best way to maximize total number of lifetime grafts is to start with FUT, do FUT until the doctor believes you are "stripped out," and then switch to FUE to utilize the remaining donor area. In doing this, I find patients are typically able to get around 8,000 grafts or so -- though some may go a little more aggressive with the remaining FUE procedure and steal out a little more. This usually breaks down to 3 or so strip procedure of around 1,500 to 3,000 a piece (let's say the first is around 3,000; the next 2,000 or so; and the final maybe around 1,500, for a total of 6,500) and then a conservative pass of FUE at around 1,500 grafts (this is where I like keeping it). This gets you to your 8,000 and this should be "enough" -- though we all know a little more is always better! Remember that there are exceptions to every rule; some people have incredible donors and may blow these numbers out of the water; others have below average donors and need to tread very carefully. I think the most I have seen on a patient at our clinic is 10,000 or so over a combination of FUT then switching to FUE in the end. He actually had more than that in the donor but came in needing repair from a prior procedure -- which obviously stole some of his grafts from the get-go. We ended up putting FUE into his scar too when all was said and done.

Hairman, Even if that patch in the back expanded and you lost everything from that point upward, you still would not be a true NW VII. This is actually a pretty rare pattern, and there are typically pretty obvious signs of it apparent by age 30. If you were seeing a lot of thinning above the ears, thinning in front of the ears and a total loss of the temporal area, and retrograde thinning up the back of the next, then there would be more evidence showing you may become a NW VII. In the absence of that and based on what I see here, it looks like you will be a NW VI. Still an advanced pattern, but much more donor to work with.

As Melvin correctly stated, vitamins will not "stop" hair loss. Unfortunately, far too many companies make this claim. In fact, nothing will really "stop" the hair loss; it is genetic and somewhat inevitable for those with the right genetic "code." Some therapies may help slow it, but vitamins are not one of them. Vitamins can help the hair shafts themselves look a little healthier or maybe even grow a little faster (Biotin), but none of these will stop the genetic hair loss process. Patients who believe they may have a true vitamin deficiency -- which can manifest in many different ways -- should see a doctor and supplement as needed; all others should approach vitamins as they are being discussed above: something that may make the hair shafts (and nails and skin) look a little healthier, but definitely not a "cure" for anything.

Excellent replies in this thread. So nice to see a good balance of opinion and deference for both techniques on the forum! And thank you for the mention, Melvin! Interestingly enough, the President of the ISHRS just wrote an excellent piece this month on the importance of both techniques thriving and working in concert with one another to benefit the patient. I will have to share it here later as long as it is okay with everyone.

Random, I see no real evidence of hair loss in any of these images (and I evaluate scalps for a living!). The crown looks very healthy, and I think the only "thinness" you are perceiving is the natural crown whorl (which is often accentuated in patients with finer, lighter hair). You do have some finer hairs on the hairline which may be due to natural follicle cycling or may be some remnants of what was your immature hairline of yesteryear. Either way, these are not indicative of genetic patterned hair loss alone either. And remember that shedding 50-100 hairs a day is perfectly normal. Even people with no hair loss whatsoever shed this many hairs from normal hair follicle cycling. You may be noticing more on your desk simply because you are hyper-aware and looking for it. I think you are in good shape all around. Like Spanker said above: keep an eye on it to make sure nothing really picks up (as the earlier you can address this, the better), but try not to focus on it too much because it all looks great.

Interesting topic. I believe the most relevant issue with alcohol and hair transplant surgery is its (alcohol) affect on "blood thinning." You do not want your blood to be too "thin" before a surgical procedure or within a reasonable period afterwards while things are still healing up. We typically ask patients to refrain from anything that can thin the blood -- including alcohol -- for 7 to 10 days before surgery, and for at least 3 days after. By day 4, all surgical incisions/excisions should be pretty well sealed up and bleeding is less of a practical concern. However, this only applies to reasonable amounts of alcohol consumption. I think if a patient wants to have a beer at post-op day 4, it is probably okay; if the patient wants to go to an all day outdoor drinking festival at day 4, I may advise against it -- for a number of reasons. Having said all that, most patients like to be overly cautious and not drink for extended periods before and after surgery.

Spanker and Sean, Thank you very much for the kind words. Glad the community liked the presentation.

Hi Biceps, I reviewed the pictures of your scalp, and it looks like you have pretty advanced hair loss and will require a large number of grafts; probably somewhere between 5,000 - 6,000 (eventually) to fill everything with acceptable density. I am not certain you have this in the donor, and I would not let anyone recommend surgery who did not evaluate you in-person. As to your other questions: 1) FUT is typically better for weak donors because it allows you to take extensively and exclusively from the strongest part of the true safe donor area without causing any changes in global density. In other words, you can take nearly everything from a small area, create a very small amount of damage, and leave enough hair to always conceal the scar. The same cannot be said with FUE. In your situation, however, I am not sure FUT would be the best approach. With the spaces in the donor, I would not be confident that even a large strip would yield a satisfying graft number. If you came into my office and your donor looked the same as it does in those images, I would likely recommend doing very conservative FUE, combining it with SMP, and then wearing the hair cropped and short. 2) I think it is just a weaker donor in general. It does not look like retrograde alopecia; possibly DUPA, but my best "guess" -- based on images alone -- would be classic androgenic alopecia with a weak donor area. Hope this helps, Dr Bloxham