Dr Blake Bloxham

Hey Willy, Congrats on the latest procedure! The scar is still inflamed and red-ish 2 weeks after the procedure. It will become less visible as all this calms down. You could also have some shock loss directly around the donor site, which makes everything temporarily more visible. Keep in mind that you also probably have some general thinning in the region from the prior FUE procedures as well. However, I don't think this is anything to be concerned about yet. Everything is still healing up. There is no reason to believe you won't be able to conceal the incision with a reasonable cut (I tell patients a 3 buzz/guard -- or higher, obviously -- and you're good) when things have calmed down. I hope you'll keep us updated! Happy growing.

Congrats, Pauly! Seems like a sound plan. I'm glad you're dedicating a good amount of grafts to the crown. If you're going to attempt a crown restoration, this is the way to do it. It takes a shocking amount of grafts to really restore a crown. A little thickening in the frontal/midscalp sounds pretty standard too. You should be completely restored after this. I hope you'll keep us updated!

I saw these pictures yesterday and thought the exact same thing! Touches on a very important point: thickness/density of your hair when you're younger has no bearing on whether or not you'll lose your hair or thin when you reach "male pattern baldness age." I see guys in the office all the time who say: "I can't believe I lost hair! It was so thick and dense when I was a kid. My parents and grandparents said I would never lose that hair!" If you look at pictures from the whole Twilight era -- and thank God we are moving past that -- his hair is DENSE. Definitely not the same as those pictures. Hopefully he'll stay ahead of it!

Wow! Congratulations. Thanks for the update!

"Hair greed!" ; )

Sure! Beard hair grafts, if I'm remembering correctly, also have an anagen phase that's closest to scalp follicles (albeit still shorter) and the most similar shaft characteristics (especially in guys with coarse hair). How many FUGs did you have extracted via FUE after you were "stripped out?" Seems like you're looking for more follicles?

Results of Dr Beehner's Study: Just for the sake of disclosure, I wanted to share the results of the Dr Beehner study: Dr Beehner's study, which looked at survival rates of skeletonized (IE FUE) versus "chubby" (IE non-FUE) grafts, found the following: Survival of skeletonized multi-haired FUGs was 68.7% at the 19th month mark. In comparison, "chubby" multi-haired grafts had an 88% survival rate. Survival of skeletonized single hair FUGs was 48% at 19 months. Survival of "chubby" singles was 98%. Averages (this is me doing the analysis here): Skeletonized graft survival: 58.35% "Chubby" graft survival: 93%

John, I'm not sure if you saw it, but I pulled a few BHT facts out of the most recent edition of the text. Here's an earlier post I made explaining: Thanks for sharing! You actually inspired me to go to the Unger hair transplantation text to get some exact percentages on body hair transplant success rates. The authors admit that studies investigating BHT are limited, but they do share a few interesting things: -Leg hair grafts yield the poorest growth results. As the density of transplanted leg hair on the scalp increased (from 24 leg hair follicles/square cm to 49 follicles/cm^2) yield decreased from 38% to an abysmal 4%. -The studies looking at back, chest, and beard were very, very small -- less than 200 FUGs examined altogether. -Based on the data, however, similar results were seen: the higher density the grafts were implanted and the larger number harvested, the lower the yield. -Technically, chest hair grafts had the highest yield in the study. But the size of grafts they looked at was too small -- in my opinion -- to really form an opinion (28 FUGs) -Beard grafts had a 63% growth rate and back hair grafts had a 47% growth rate -The authors note that the follicles did retain their donor characteristics -- with respect to cycling and hair shaft size/description -They also note that the most common complication was scarring in the donor extraction sites You also brought up the "food for thought" comment about patients who would otherwise have no other options without BHT. This absolutely does give them a shot, but allow me to play devil's advocate for a moment: Let's say you have a patient with poor donor and ample body hair supply. You are able to transplant 1,000 grafts from the scalp and 1,000 from the beard, axilla, and legs. Using some ROUGH estimates from the numbers I quoted earlier, let's say you got and average yield of 49%. (mean of 47% for back, 63% for beard, and 38% for leg hair -- which is the highest yield the authors noted for leg hair). You're now seeing slightly less than 500 of these BHT follicles growing. Now, the cosmetic difference 500 grafts would make in the scalp would probably be mediocre at best. Now, this wouldn't be that big of a deal IF it didn't expose the patient to scarring in the extraction zones. If he -- especially if he has darker-toned skin -- experienced decent subdermal fibrotic or superficial hypopigmented scarring in his face, chest, and legs, was the coverage obtained from the 500 graft yield worth it? So, again, this would be playing "devil's advocate" but it's all important discussion when considering BHT in a patient. Long story short, you're risking scarring in very prominent areas of the body (IE the face/chin/neck) for yields 30-45% that seem to decrease as density increases. Also remember that these grafts retain their native characteristics. Beard follicles cycle and grow like beard follicles in the scalp; chest like chest; et cetera. This is why I don't think BHT is realistic option for the vast majority of patients.

Alf, It's normal to lose 50 - 150 hairs daily. It sounds like this is what's happening when you touch the hair in the areas around your ears and neck. However, you can always have your scalp examined by a physician with hair loss experience. This will help you understand whether this is normal shedding or if it is caused by some sort of alopecia. Best of luck!

Redic!!! Thanks for the update, bud!

FUE, More objective science and rigorous study is always welcome. Setting up traditional scientific studies -- double blind, placebo, et cetera -- has always been difficult in surgery. This tends to create a lot of "long term outcome" studies in surgery. However, these, by definition, aren't released until years to decades after the techniques being studied are first trialed. But this does not excuse the need for studies. I'm pretty certain the ISHRS has grants available for studies. Perhaps you could contact someone from the ISHRS about the idea of looking at this further?

Trump, No need to panic now. The procedure is done. There is nothing you can do about it until it's fully grown out 12 months from now. The best thing to do now? Relax and grow. You'll see how it progresses and figure out the next best step 12 months from now. Best of luck!

Pup, Thanks for breaking that down! It really helps to illustrate the importance of this aspect of the debate. Matt, As usual, dead on! Thanks for sharing. London, Very excited to see you! If there is any procedure that you will be a candidate for, it will be mFUE. I've got a patient coming in the next few weeks who had 3+ strips and plug work done "back in the day," and we are still going to be able to steal RELIABLE grafts with mFUE. If we can do that for you, we will! No doubt. And this actually brings me to something I wanted to mention earlier: a few members were discussing ways to get around the 3 detrimental forces with an FUE technique. Frankly, this is what mFUE is. Obviously it's very new and we're still cautiously trialing it, but this is what allows us to get the "strip results with FUE-like (IE no linear scar) scarring." It's the fact that we score a much wider perimeter, do not twist or grab the individual FUGs, and cut below the bulb opposed to applying force until they avulse during delivery. This, in my mind, is the only way you'll get around the 3 detrimental forces without taking a strip.

Growing nicely, bud! For some reason, I thought you had less grafts. You purposely split it up though, right? And, by the way, I agree completely with that approach. What was the break down per day?

Mick, You nailed it! Give the patients the facts and true informed consent.

Cool case!

88, Sounds like he's being very meticulous. I'd expect nothing less from Dr Path! Sounds like you're in the "relax and grow" phase now. I hope you'll keep us updated on your progress.

Nice! We did a 1,024 graft mFUE yesterday. It was a blast!

Mav, Agree with your assessment of BHT. This isn't a viable option for the vast majority of patients, and the growth rate (30-40% with everything averaged) isn't worth the potential scarring in most cases.

Very, very interesting! Look forward to updates.

Fortune, Will do! People seem to really like the videos and clearly -- as evidenced by the "blooper reel" -- we like making them. If they help or educate a few people in the process too, that's a win-win! Thanks for watching.

Mil, Sorry to hear you're not satisfied. I think your options are: 1) A second procedure 2) A combination of buzzing and possibly augmenting with SMP The limiting factor with option 1 will be the condition of your donor after the first FUE procedure. FUE causes a diffuse, subdermal scarring that can make subsequent FUE sessions much more variable. If you had poor yield from the first procedure, this one may actually be less than the first. The other option, of course, is strip. But this does leave the linear scar, and its absence was probably your reason for going the FUE route in the first place. I think you'd have a much greater return from a strip procedure opposed to a second FUE, but both are technically options. As far as option 2 is concerned, you probably weren't looking to shave your head after your hair transplant procedure. And this may be an unacceptable option because of this. Feel free to ask any additional questions! Good luck.

I think the confusion in numbers comes from a few seemingly conflicting studies. The first study, done "back in the day," looked carefully and closely at how long it took for grafts to "anchor." The results showed the "7-10" day mark that we all quote today. The problem, however, is that the study didn't look at follicular unit grafts (FUGs). Remember how I said "back in the day?" Back then, micro, minis, multiple-FUGs -- however you'd like to describe it -- were used in hair transplant procedures, and this is what they looked at in the study. However, this data doesn't really apply to actual FUGs because these modern grafts are so much smaller and more physiologically normal. Drs Bernstein and Rassman followed up with a study in 2006. These studies were done on actual FUGs. The results? Grafts are unstable and non-anchored for the first 2 days. By day 3, the anchoring process was more matured and the chance of losing a graft via manipulation "decreased." Between days 3-8, grafts could still be dislodged with pretty severe manipulation. By day 9/10, grafts were -- for all intents and purposes -- anchored and permanent. So this is where a few of the conflicting points of view come from. As you can see, this is why some are more comfortable with 3 while others say 9-10. Now, the real question: why would anyone say less than 9-10 days? Well, the 2006 study was only done with "large" follicular units and incision sites made with 18 gauge needles. The study also looked at scabbing and how this influenced graft dislodging. The theory behind 3 days, 5 days, 7 days, is the following: when using smaller and smaller incision sites, like those made by custom cut blades, the anchoring process is quicker and risk of dislodging decreases. We tell patients they are anchored by day 3. And we use custom cut blades with lateral incisions and dense packs. But, I do usually throw in a few things I still don't recommend until day 7-10 or so. These aren't usually big concerns, but those FUGs are precious! But, do you want to know the real "moral of the story" or answer to this question? Just follow your clinics instructions to a T! If they say 10, they have their reasons. And I would recommend taking the necessary precautions during the first 10 days. Same story if they say 3, 5, or 7. This is a "win-win" for everyone involved! Reference: Robert M. Bernstein, MD, New York, NY and William R. Rassman, MD, Los Angeles, CA Dermatol Surg 2006; 32: 198-204

Irish, I was trying to nail "Blue Steel." What do you think? Did I pull it off?? ; )

Wow. Congratulations!! Look forward to updates.