ArochaHair

Parsia, You are correct, the lower density transplants don't prevent more hairloss just like transplants with higher density do not prevent more loss but that's not what is being said. If you have a high density, low placed hairline then it takes more grafts to achieve this type of result. The difference between this and a low density transplant is that with the low density transplant you have more hair in your donor area to address the areas where you'll lose more hair. Dense packing is not the only requirement for a natural result. If the hairs are carefully selected to avoid a plug appearance then even a low density transplant can look natural. The question becomes one of placement. Is a "NW0" hair transplant going to look natural as you age? This depends on many factors but it is generally accepted, even with the clinics you mention, that a NW0 not only is a bad idea I doubt that either clinic will fulfill this type of ideal result for you. Density is not very difficult but when we can place at high densities we are also in a position where we have to ask ourselves if we should place at high densities. In many cases the answer is "no".

This patient was seeking restoration of his frontal zone in order to restore a natural frame for his face. After a lot of research and discussion with Dr. Arocha the patient decided he wanted to have FUE. The plan was made and the surgery was performed. Dr. Arocha moved 2000 grafts via all hand held, doctor only, manual FUE. The results shown are at six months post-op.

Thank you for your kind words. We find that when patients have a nice result, it obviously means they're happy but it's nice to see how bolder hair styles coincide with the personality change as well. It enhances the result overall.

Today we'd like to present another case performed by Dr. Arocha and the team at Arocha Hair Restoration in Houston, Texas. The patient below presented with NW4A loss with residual diffused hairs still being affected by DHT. The patient discussed his goals and he and Dr. Arocha came up with a game plan to address the areas of need. The patient wanted to address the frontal zone but wanted to take a conservative approach with FUSS. If the result was to his satisfaction then he's be returning for more work if he felt it necessary. Recently the patient returned to show us his 18 month result and he is quite happy with the final result, to the point that he is happy to allow us the use of his photos. The photos below represent 2005 grafts transplanted via follicular unit strip surgery by Dr. Bernard Arocha.

I wanted to revisit this result to reiterate the point about density. This patient had a good head of hair when he came to us but his front zone could be described as a diffused NW3A in that the front few centimeters of his hairline lacked density. Dr. Arocha used this session to fill the gaps and refine the very front of the hairline. Sometimes, big numbers in small areas are not so easily seen as justified until you know more of the details were and what the motivation was by the patient. Dr. Arocha identified and agreed with the patient's motivations which is why he performed the surgery. Obviously, it worked out.

This is normal for many patients hat have strip. Give it time and the area will fill in and the indentation will flatten. Sometimes it is not 100% but it should recover enough to not be an issue.

Finasteride can and does work for thinning nape areas in some patients. We've seeing in our clinic.

The idea that blonde hair is finer is true for most patients and so of course finer hair requires more grafts to achieve a visual density that is acceptable and the contrast issue is not always a clear benefit.

I'd like to add that this patient did not require shaving of the recipient area prior to his procedure. Dr. Arocha remains one of the few premiere hair restoration doctors that can perform megasessions without shaving his patients.

Are you using a flash for your photos? If so, that may be the problem. Based on the photos you've shared it does look like you're experiencing early stages of thinning. A shampoo with Ketoconazole may be in order as it not only helps with dermatitis but it can also help with hair loss. Of course, finasteride is the gold standard but it is available only with prescription and you need to speak to your doctor about it's use first. If you start now you will potentially save yourself a lot of heart ache as it is precisely patients like yourself that see the greatest overall benefits (usually) from using medication.

Normally, 2000 grafts would also be follicular units, regardless of procedure with the average # of hairs per graft being roughly 2.3 hairs per graft for Caucasians and 1.8 hairs per graft for Asians. This means that if you are quoted 2000 grafts you can expect roughly 4000 hairs, give or a take a few hundred depending on ethnicity.

Happy Friday! Today we'd like to present the latest result from Dr. Arocha and the team at Arocha Hair Restoration. This 31 year old patient presented with diffused thinning throughout the NW6 region. He wasn't bald but the pattern was easily visible. Dr. Arocha approached this patient's case as if he were completely bald with the goal of establishing strong coverage into the frontal 2/3 of his scalp. This approach allows for a strong degree of not only coverage, but the illusion of density as well. The patient is extremely pleased with his final outcome and has the option to address the crown with a smaller second procedure in the future.

Good questions. The punch is the focus of ARTAS right now and they've been working on reducing the size for a while. Yes, the punch can be switched out if a different size is seen as being necessary during a surgery. When ARTAS first started out, and for the first couple of years, the punch was really big and was counterproductive to the whole point of FUE ( non-visible scarring). The scarring wasn't terrible and was in fact difficult to see with shorter hair cuts but it meant that fewer grafts could be taken out before the donor area would be affected visually and the dots were more pronounced when the scalp was shaved. Now a lot of the work being done is below the 1mm threshold with sizes being mostly in the .9mm range and we're getting into .85 territory. By the end of the year it's expected that .8mm will be achieved which is as small as is necessary. Anything beyond that is in the realm of diminishing returns and serves only for marketing fluff. Keep in mind, ARTAS took a lot of heat for the punch size early on (justifiably) and in response they could have easily just switched to a much smaller punch to satisfy the critics and pushed out the marketing to reflect this. Instead they have worked to make each punch size actually work when being used by the robot. It's been a steady march and they have set milestone goals and achieved each one. The extracted grafts look great and they're growing just as well as you'll find with any manual or motorized extraction technique.

With all due respect to Dr. Bloxham, this result has nothing to do with the so called "pitfalls" of FUE. If it did then we'd be seeing a lot more of these problems than we do. This case is quite simply one of carelessness and inexperience. The grafts were placed without consideration of the hair and scalp color contrast nor for the hair texture. Lorenzo is correct in that the dark coarse hair on fair skin requires experience. I won't even get into the angle issue. I would also strongly caution against adding single hair grafts in front of the new hairline as that only lower the hairline more which would be a bad idea in this case. The best approach would be some sort of removal either with electrolysis or through carefully targeted FUE extraction then revisit once sufficient time has passed and evaluate the need for density. In other words, unfortunately, this is not a one procedure fix.

I respectfully disagree. There is an obvious fringe of miniaturized hair that could be improved with medication, including his parietal humps. Medication on cases of advanced hair loss with obvious perimeter miniaturization can mean the difference of a couple thousand grafts and in case like this, every graft counts. The updated photos show that the donor area has recovered from what was most likely some degree of donor shock. I was concerned with the four month photos but not any longer. Fortunately you still have some time to see improvements but with the spacing of the grafts I think it is clear that more work is necessary to at least improve the front but you should proceed with extreme caution.You are at the tipping point where, if the donor harvest is not performed carefully, you will have a depleted donor zone may look unnatural.

Hi Bardlebee, Can you update the group with photos?

After reading this entire thread, I'm impressed with the resolve and logical thinking. Waiting things out, continuing research, and of course saving more money is the best thing to do. However, I also believe that doing everything non-surgical that is possible to fight continued hair loss and to potentially thicken any miniaturized hairs should be the priority. An assessment today could be drastically different after a full year of medical therapy so I think you should keep the in person assessments to the end of your one year of research because regardless of what the doctors may say you will most likely continue with medical therapy to prevent even more hair loss in the future. By then, you'll know what works medically, and you'll know where you stand surgically which will dictate how you move forward.

I think it is incorrect to say that because some clinics do big sessions that it comes down to the ability to do so vs. not. No degree of skill can trump good judgement when talking about session size. This is why most top clinics that perform FUE will limit the session to 2500 or 3000 grafts. This is how the clinics in Europe do it and how the clinics in the US do it.

If you have any questions regarding the ARTAS feel free to ask. In fact, we may put the answer in our next video:)

Zidane has not had a hair transplant.

Vitamin E oil is a good alternative to consider but as everyone else has said, it will continue for a while but eventually it will fade to the point that it will no longer be noticeable.

You could also consider tricopigmentation with a specialist that shows a consistent track record of excellence. We have seen some examples of this and the results can be quite impressive. As Shampoo said, if three doctors have basically turned you down then this is a sign that you should not move forward with the surgical approach.

coursar8, Thank you for considering Dr. Arocha, have you made it in for a consultation? Please let us know if there is anything we can help you with.

Basically, if you are a NW6 then you need to consider your age. If you under 40 and a NW6 then that increases your chances of being a NW7. Look also at your family history, on both sides, and see if there are NW7's in your genetic past. If the outline of your pattern of loss has a weak demarcation where then this too indicates that miniaturization is continuing. Your use of medication can also determine the final outcome but if you are simply looking for answers regarding the genetic probability then these are the points that you should consider.

Here is a new video that we put together to give a short overview of how the ARTAS works along with a few results. We will be producing more videos in the future to share developments and updates regarding ARTAS technology from Restoration Robotics.