Dr Blake Bloxham

Starting to come in nicely! Exciting. Congrats, Panther. Keep us updated!

FUE, The density should not decrease. The characteristics of the hair -- texture, width, length, maturity -- will continue to change from the 6-8 month mark forward, but the density (number of FUGs growing per square cm) should absolutely not decrease. Did you have native hairs in the transplanted area? It's possible these may have shed and caused the area to look less dense in general. When did you have the surgery? Any images?

London, I wanted to clarify a few things: Gabapentin and amitriptyline are two very different medications. Gabapentin (brand name Neurotin) is a neuropathic pain agent. This means that it is designed to treat pain associated with nerve damage. It often needs to be taken at large doses to be effective, and many patients -- even those with true neuralgias -- don't get much from it. Other medications in this class include pregablin or Lyrica. Amitriptyline is a tricyclic antidepressant. It is a member of an old class of depression medications that have been replaced by modern antidepressants ("SSRIs," "SNRIs, et cetera) for one major reason: side effects. It's mainly prescribed today for neuropathic pain. However, it is generally associated with more side effects and is, therefore, usually second line after Neurotin and Lyrica. What you're describing, unfortunately, does sound like "FUE neuralgia." Dr Feller describes this phenomenon here: "FUE Donor Area Neuralgia. Also known simply as FUE Neuralgia as you almost never see it's counterpart in FUT surgery. This is a condition that occurs after the donor area is harvested with a great number of FUE. It's symptoms are a persistent and deep burning sensation in parts of, or throughout, the donor scalp that is not relieved with pain tablets. This condition can last for weeks, months, or even years." Here is a video he made for another member experiencing similar issues. He also does a good job explaining why this phenomenon occurs: The depth we work in during FUE procedures is absolutely deep enough to damage nerves as well. The structures innervating the follicles, skin, and blood vessels in the region reside in the superficial subcutaneous fat and deep dermis, and these ares are absolutely affected in any type of hair transplant surgery. Even if the punch doesn't severe the nerves -- and it shouldn't be this deep -- they are still affected when grafts are delivered -- as the bulb of the follicle resides in the deep dermis/superficial subcutaneous layer as well. Seborrheic dermatitis causes large, yellow, flakes to erupt on the scalp and often on the face as well. If you had SD now or before surgery, I think you'd see more of this than you would pain. Here is an example: I'm also not confident that steroids (hydrocortisone and triamcinolone) would help with the pain, as it's likely caused by nerve damage and not inflammation around any structures -- and steroids are anti-inflammatory agents. How many grafts did you have removed via FUE? Have you discussed this with your surgeon? Also, who wrote the prescription for the gabapentin? You may want to speak with this doctor again. Make sure all of this is being followed closely by a competent physician familiar with your medical history. Feel free to ask additional questions.

Sean, All jokes aside, you do bring up a good point. Automation is only as reliable as the programming. My guess -- and I'm no software engineer or robotics expert -- is that there is some sort of fail safe in the software that would shut the machine down. But, it could absolutely cause an issue if he kept penetrating and rotating. You should see some of the other non-hair transplant machines they use to perform surgery. If these went haywire, you would REALLY have a problem. I've never personally heard of this happening with an ARTAS, but it is a very interesting question. Maybe a doctor who uses an ARTAS will come on and comment. Dr Feller is the guy you want to talk to about the engineering aspect of it though! He's a wiz with this type of stuff.

Wow, very much a literal tattoo! I'm thinking about going this route. Professional? Would you guys get HT surgery from a guy this extreme?

Now I'm going to have nightmares about an ARTAS murdering me in my sleep! Thanks, Sean!!! ; )

Jason, Haha. Love it. However, the tissue that really grips on to the FUE grafts and won't let go isn't muscle. It's more fat, dermis, and a few glands. Though technically there is one small muscle involved -- though it's cut during scoring. However, I will make sure to cut you in if we do experiment with your Botox method in the future ; )

Irish, That's the way I look at it too!

Irish, I thought he just had a second FUE to repair/augment the first? I'd be happy to evaluate him for mFUE if he's interested. Like you said, this is a great indication for the technique. I actually have a few guys in this exact situation coming in -- not happy with their FUE results, want a transformation similar to what they see from strip, but still not comfortable with the potential scar. I tell them about mFUE and they are in!

Irish, Yeah, it was actually really hard to break the news to him. Good that he now understands his hair loss a bit more and even better that he now knows NOT to jump into surgery, but still not as satisfying as doing a big procedure and giving him that "WOW" transformation. Know what I mean?

Understandable. Maybe Mirko will come back and comment.

Great hairline! Johnboy -- I think the color/texture looks a bit different because the length of his existing hair is longer. I bet if he shaved it closer it would be pretty undetectable. Nice work.

Hey Hoping, Good questions! Shampooing won't really change your hair loss. Dirty scalp, clean scalp; really won't improve or worsen the DHT attack on your follicles. Now, a clean scalp will potentially experience less clogged pores and less ingrown hairs and focal folliculitis, which may draw more attention to the scalp but still won't change the thinning. I've heard differing things about oil changing the appearance of the hair you have left. Some will say it makes it look thicker, others will say it makes it look thinner. It is worth noting, however, that androgenic alopecia can cause a sebaceous gland (oil gland) hyperplasia (growth), which may cause more grease to build up on the scalp. If this isn't something you want, frequent washing may be required. Most shampoos are very similar. If you do have a lot of oil, dandruff, or maybe even seborrheic dermatitis, many will recommend specialized shampoos -- such as tar-based washes. The only shampoo that really affects androgenic alopecia -- if you are considering a preventive treatment -- is ketoconazole-based shampoos (like Nizoral). It shouldn't really affect a transplant. However, you do need to keep the scalp clean after -- as this improves healing, decreases the chances of dislodging a graft with a scab (rare), improves appearance, etc, etc. You could have a smaller operation before undergoing a larger operation if you'd like. Discuss your plan with your surgeon. Hope this helps!

Tommy, Thanks for the kind words. I'm absolutely passionate when it comes to this field. It's something I pride myself on, and it's actually kind of rare to find people who are big "hair geeks" like I am. In fact, it's part of the reason why I chose to partner with Dr Feller. His passion exceeds mine. It's actually this passion that drives him to come on here and tell the truth when it isn't popular. As far as the BUSA situation is concerned, let me say the following: I was still a moderator when the issues with BUSA started, progressed, and ended. I can tell you with 100% certainty -- I was copied on all PMs and emails involving this issue -- that no doctor ever actually complained about BUSA. This includes doctors discussed in this thread. He was banned after MULTIPLE complaints from other members. None were affiliated with clinics in any way. Bill and Dave will tell you the same.

Ontop, I'm not the guy to ignore data. However, objective data is only relevant if it's collected correctly. I've recently been made privy to the way the ISHRS data is collected. And, like Dr Feller said, it's not research style data. Nor, as the above statement shows, does it pretend to be. It's a survey that is sent out to members and reported without verification. You could say that your practice is dedicated solely to FUE cases bigger than 10,000 grafts/daily and that's what would be published.

HairJo, "regular," "casual" guys ... this is definitely our style! Glad you like it too!

Bill, To add to what Dr Feller said: I personally think mFUE is really the only term that describes what we are doing. It isn't mini-strips. FUT via the FUSS method, by definition, involves removal of a strip of FUGs with a scalpel blade. The strip is generally at least 1cm wide and many cm long. The blade removal involves a number of cuts from multiple angles. Like Dr Feller said, taking a number of these types of small strips has been tried before. It worked better on paper than it did in practice. What we do is remove FUGs from the donor area with an elliptical or circular (depending on the patient) punch. It's larger than a traditional FUE punch, so the mFUE graft is divided into FUGs under a microscope. Because the punch is larger, the incision left behind is closed as well -- differing from traditional FUE where the incision is left open. Because the overall procedure is closest to FUE, this was the most accurate way to describe it. Many grafts removed via a punch leaving diffuse, minimally visible scarring in the donor region. Definitely a much closer relative to FUE than strip. However, it isn't traditional FUE so we further clarified by calling it a "modified" FUE approach.

I recently consulted with a very nice young man who suffered from scarring hair loss (cicatricial alopecia). He's been dealing with the effects of this dramatic hair loss for years and wanted to "fix it" before starting school at a new university in the fall. He was desperate for a solution and wanted hair transplant surgery. One of the best parts of being a hair restoration physician is being able to help these patients out. Men and women come to us after years of anxiety and stress, and we get to really fix their problem and transform their lives. It's a fantastic feeling and I love being able to do it! Unfortunately, that's not what happened with this young man. I had to inform him that he was not a candidate for hair transplant surgery. I did my best to explain, and he understood in the end. He was disappointed, but grateful that we didn't put him through a surgery we knew wouldn't work. He also mentioned to me that many aspects of his condition were not explained before. He was also never told he couldn't undergo hair transplant surgery. Because of this, I wanted to make a video to try and help others who may be in the same situation. Since HTN is the place to go for hair loss and hair restoration info on the web, I figured I'd share it here! Hope you guys like it! I also hope it helps someone else down the road:

FUE, Was there any blood on the pillow? How far out are you? Lost/dislodged grafts bleed pretty dramatically, and you would see it. The general rule is: no blood = no graft lost. Also, if you are more than 3ish days out, the chances of actually dislodging or losing a graft are rare -- as they are pretty much locked down and permanent by this point. My vote is for normal shedding.

Great video! And another very good use of mFUE. Thanks for sharing!

Great result! Also a very good example of short hair styling post-FUSS. Nice work!

Ontop, You're right ... I am pro follicular unit hair transplantation (FUT), whether it be via the FUE or FUSS (strip method) ; ) Which nerves are you referring to? The potential for damage is actually much higher with FUE because a much larger area is cut. Dr Feller put up a good video about this. I'll post it if I remember later on.

Magnum, We really do hope it helps "marry the two worlds" for a good number of patients. Excited with what we are seeing so far, and we continue researching and moving onto bigger sessions!

Jo, Very nicely said. You've summed up some of the more complicated issues very succinctly and eloquently!

This result gets more and more impressive every month. What a home run! Nice work, Dr G!