Dr Blake Bloxham

Abbie and Dr Umar, Thank you for sharing. Decimating the donor area with overzealous FUE harvesting is a serious issue that is rarely discussed online. It's something we see quite a bit in consultations and it's always so distressing to evaluate a patient who experiences the unfortunate combination of poor growth AND donor depletion from over-harvesting. Options for these gentlemen are really limited. In fact, it's part of the reason why we started working on new FUE extraction methods like our mFUE technique. Again, thanks for bringing this important topic up.

Great thread! Thanks for sharing. Really look forward to reading more about PRFM too.

Excellent work! Thanks for sharing.

Wwiz, You can absolutely still sport a "Caesar" hair style after a hair transplant procedure. In fact, it would make us hair restoration guys look like heroes because the style lends itself to a very filled, covered appearance! Haha. I'll tell you why you don't see it though: it's a style guys use to generally camouflage their thinning or non-existent frontal scalp. We see guys with a Caesar pre-hair transplant during consultations all the time. One of the most common things they say is: "I want more style options than just combing all the hair forward to cover up the thinning in the front." However, you absolutely can still chose this style if you want to. BUT, you don't have to if you don't want to. You should have a number of realistic style options post transplant. Hope this helps, bud!

Hey John, Congrats on the procedure! Like Feld said above, this looks very normal for 2 weeks. As far as the shedding and growth is concerned: you can expect the grafts to shed anytime between day 10 and the end of month 2. Some people are fortunate and get some growth of the grafts before they shed, and these patients seem to shed a bit later. Others seem to have a few grafts that, for whatever reason, don't seem to shed. Regardless, it has no effect on the outcome of the procedure. After they have shed by the end of month 2, the new grafts will start growing around month 3. You'll usually be able to see the new growth some time around month 4. Keep in mind that the hairs these follicles produce are very thin and wispy at first. They will continue thickening and shaping until around month 12. This is when you can expect to see the "final results." Although it can sometimes take up to 14-18 months to really appreciate the outcome. So everything looks normal for now. From here, it's all a waiting game. Nothing to do but relax and grow! Good luck!

Hahah! Thanks for the kind words guys, truly! It means the world to me! Dr Vories: we will definitely keep you updated. We actually have an African American gentleman coming in for mFUE in October (I believe), so I'll let you know how it goes. I do think it's a very good indication for the mFUE procedure! Thanks again.

Torel, An initial "shedding phase" during the first 3-4 months of finasteride use is very normal. In fact, it happens with almost all commonly used preventive medications -- IE nizoral and minoxidil. You should notice this shedding gradually decrease and then the hairs should grow back. Hopefully, they will grow back thicker and stronger. Remember that most experts recommend continuing the medication for at least 6 months before determining if you're seeing results. However, 12 months is almost universally accepted as the amount of time you should continue to determine if it's effective for you. The only caveat is the side effects. If you are experiencing side effects, you should discuss these with the doctor who prescribed the medication. Hope this helps! Best of luck.

London, Definitely looking forward to meeting you! Trust me, I want to do the mFUE just as badly as you want it done! If it can be done, we will do it. The time will fly by too. I'll ask Dr Feller his thoughts about the SMP tomorrow as well. However, it's not an issue to me.

Gill and Bill - heh, The average FUG is roughly 2.2 follicles, so 9,000 hairs (follicles) would likely be somewhere in the ballpark of 4,090 grafts. Frankly, this would make me concerned for permanent donor thinning even without seeing 7's thread. Tawa, It looks like you may have experienced permanent thinning in the donor region from aggressive FUE extraction. Unfortunately, this many grafts removed in one session general results in poorer yields because the scoring and delivery process (FUE graft removal) isn't gentle -- as there is simply no time to remove this many grafts slowly, methodically, and carefully in one session. And you, unfortunately, confirmed that the growth was poor. Have you had your donor area evaluated by anyone else? I'm hoping you would have some grafts left for a more conservative second procedure. I don't want to sound "preachy" or derail the thread -- and I agree that you should start your own -- but this is why many physicians recommend smaller, more conservatives FUE sessions -- like 1,500 in a day. When they work, the results from the big sessions look great! Unfortunately when they don't, they create a situation like you may be experiencing now; poor growth and a very picked over and scarred up donor. Start your own thread and we will help you get it figured out and see what your options are. Best of luck!

Dr Lindsey, I love cases like this. So glad you were able to help this young lady! Look forward to updates.

Dr Wu is pretty close in Taiwan: Wen-Yi Wu, MD, FISHRS Hair Transplant Surgeon in Taipei, Taiwan Seems very dedicated and ethical as well. May be worth a consultation!

Youngun, Definitely a significant price difference. When this occurs, I usually recommend that patients simply ask "why?" Is one clinic utilizing technician FUE while the other is handled by a surgeon? Does one clinic do 3-4 procedures a day to balance out the lower charge per graft? If so, does this mean extraction is rushed -- which you don't want with already weakened FUE grafts. So what do you think? Any reason why you think one is much cheaper than the other? If not, and everything feels okay to you, just make sure you know EXACTLY who is doing what during the surgery before you ever get to the chair. Good luck!

Bike, I still don't see how it could penetrate the scalp. Even if the size of the fiber was smaller than the size of a human skin pore, there are charges involved, oils on the scalp, hair shafts coming out of the pores, et cetera, and I don't see how it could get through. Scientists spend years researching ways to get drugs to penetrate through skin, and most of the time it still doesn't work well. They probably say not to use it after minoxidil because the scalp is wet. Minoxidil -- especially the liquid form -- can also cause irritation, and I suppose it would be bad to shake fibers onto an irritated scalp.

Receding, 8k, even - 10%, would be a very bountiful donor region. Patients may have this physiologically, but it doesn't mean it's what is available for harvesting. In general, you can only take approximately 50% of the donor via FUE before you notice generalized thinning -- some call this the classic "moth eaten appearance." Even if this patient did have 8k that could theoretically be taken, it would result in noticeable cosmetic thinning in the donor. Now, I did listen to a lecture by Dr E, once, where he spoke about a theory he called "homogenization" of the donor region. Essentially, he argued that you could purposely thin the donor region as long as the hair on the top of the scalp was thin as well. This led to a more "homogenized" appearance of thin top and sides, opposed to a theoretical look of thicker sides with a thinner top -- he called this a more heterogeneous look. However, this patient's top is so thick that I doubt that's what they were going for. So, like a few others were saying, this definitely is a more aggressive approach, but this is something Dr E strives for and his patients clearly appreciate it!

Now THAT is coverage! Excellent transformation for 2k grafts. Nicely done.

Hey Irish! Thanks for the kind words. Didn't know we would be seeing you in the UK? That's awesome! Look forward to it.

Dr Lindsey, Very interesting story! To me, this gentleman is the perfect mFUE patient. The subcutaneous scarring from the previous FUE procedures will make future (traditional) FUE extraction difficult. And yield will likely suffer. He doesn't want to consider a strip scar, but he NEEDS reliable extraction and strong grafts. What to do with a patient who wants the advantages of strip but won't consider a linear scar? mFUE! Look forward to updates.

Best FUE tool? (this is an older one I forgot to upload)

Cancer, chemotherapy, and hair transplant surgery? The most interesting question I've ever been asked:

Junior member???? That looks so sad compared to "follicular master!" Haha.

AND I'm back : )