JohnArbuckle

I think the dead giveaway to an HT is not the FUT scar, but poor sparse and pluggy growth on top of a shiny bald head. The solution to that is finasteride though, which you are on.

 

So I think the more important question is how is the hair on top going to look like?

Well put. A shitty recipient area can be as visually disconcerting as a linear donor scar.

Dr Vories,

 

Now that we are on the implanter pens, I do have a few questions I've been meaning to ask -- if you don't mind:

 

As you may remember, I researched the implanter pens a while back and you were kind enough to exchange a few emails about it. I definitely understand the benefit of not handling the dermal papilla (DP) as much and why the most gentle placement technique for skeletonized FUE grafts would be very beneficial.

 

However,

 

1. With the hairs trimmed very short and the bulge stem cell region of the outer root sheath (ORS) of the follicle being closer to the epidermis, is there a chance that this region would be pinched and used to pull the graft into the needle? Technically, the DP, in my opinion, is more important, but studies show that hairs grow thinner and less consistently when the bulge is damaged.

 

2. Are the grafts really touched less, in general, when using the implanter pens? When I think of forcep assisted placement, I think of two points where it is "touched:" picking it up and gently tamping it down after it's placed in the slit. With the pen, isn't it touched once to pull it into the needle, once when it's implanted, and then again to tamp it down -- which seems to be more frequent with the pen method. Wouldn't this be 3 times? Granted, I do understand that it's protected by the outer portion of the needle while it's being placed, so this offers some protection that forcep placement may not.

 

3. How much force does the actual "clicking" implantation method place on the graft? And if the needle isn't placed properly, how much compression/"crumpling" damage can be done to a graft? Have you ever pulled one out after it was placed and looked? I haven't done this with forcep placed grafts, but it's something I've always been curious about.

 

4. What is the chance that the hollow core of the needle isn't perfectly smooth? I know this is something Dr L addressed when he helped design the Lion implanter. However, I can't see how there wouldn't be some small imperfections inside of the needle. Look at this microscopic view of a hollow bore needle here:

 

 

It seems like any of those small imperfections would snag the graft and cause damage. What's more, it would happen twice -- once as it is pulled into the needle and once as it is injected. During my research, I also read that these tend to increase the more the needle is used?

 

5. Is there anyway to damage the graft while it is pulled over the sharp needle itself during insertion into the pen?

 

I've been meaning to ask these questions since we first spoke. Like you said, research and answers to these kind of question is somewhat lacking in the hair restoration world. I appreciate the time and openness!

Bumping this old thread to note that this is an incredibly insightful post.

that's my story exactly...

I had my first FUT when I was 37 years old

I am now "stripped out"

If I ever need more...I'm told it will need to be FUE.

And knowing me....I bet I will get some FUE in the crown down the road.

Shampoo, can I ask, are you on meds (fin/dut, keto, minox) as well?

I read somewhere on here that your hairline should start after the part of your forehead that wrinkles when you raise your eyebrows, so as long as your surgeon does that you should be good.

Great thread topic. I haven't had surgery yet, but outside of that would have started taking dutasteride sooner. I wasted years being scared away by internet fear mongering.

However, surrounding follicles can be compromised in two other ways: 1) the scarring that occurs in a wide-spread manner underneath the skin can invade the unharvested follicles and make them very difficult -- and in some patients nearly impossible -- to extract in the future; 2) the wide-spread vascular damage tends to cause a miniaturization throughout the donor.

This is really fascinating. It almost seems like the vascular system underneath the scalp is like a large interconnected highway, such that when you close off one exit, traffic throughout the entire state slows down. Appreciate the insightful explanation.

There are interesting studies about a lot of what you described published in the ISHRS journal. However, most of these are in print and not online -- though the society is starting to move them over. I can try to transfer some over at a later point, but a lot of what you'll get will be explanations from doctors based on their experiences and observations.

If possible, could you kindly give the specific citations for the articles if you know any off hand? Perhaps I could dig something out of google scholar or pubmed.

Hello everyone, sorry for the long silence, but not much happened in the last couple of months. I am now at exactly 3 months post-op and I'm happy to report that I can see many new hairs sprouting along the hairline. I can also see some new hairs behind the hairline, but the density seems to be much lower... Obviously, the new hairs are very very short (1mm at most) so I'm afraid none of this will be visible in the pictures below.

 

Not sure how to interpret the difference between the hairline and behind it. It may be that the hairs I'm seeing are mostly the ones I lost because of shock loss, so the difference may be due to the fact that pre-op I already had many more along the hairline than behind it. Or it may simply be a false impression, as it is harder to spot a 1mm hair behind other hairs. Anyway, time will tell. I'm staying optimistic.

 

As for the donor shock loss on my right side, as you can see, it is still very evident. Longer hair actually makes it more visible. Here as well I can observe a few small hairs sprouting. In addition to being very short, they also appear to be very thin — much thinner than those I see in my recipient zone — so I reckon it's impossible to see them in the pics. I hope that in a month or so they will be providing some coverage over there!

Thank you for the update. Happy growing.

I had FUT.... if I had been informed beforehand that it would take 2

procedures to get decent coverage I wouldn't have an issue. Pre-op

explanation was that I wouldn't have much coverage in the crown area.

I've seen worse but obviously could have been better, especially considering it was a strip. It seems like you have thin native hair. Thats a lot of acreage for 3500.

Get back on meds if you can.

John,

 

A lot of hair surgeons use PRP (Platelet Rich Plasma) as a storing solution for grafts outside of the body. But I assume you're talking about undergoing PRP as a stand-alone hair loss treatment?

Hi Bill,

Yes, I meant getting injections of PRP alone; I have some mild diffuse thinning that I wanted to work on. I just watched this video on PRP:

One thing that really stood out is how many individual variables there were, from needle size to whether or not they used lidocaine to how fast they spin your blood. It seems like the two docs here who have shown the most results are Cooley and Wesley, was just wondering if there were others who have taken a special interest in the procedure, particularly on the west coast.

Help! hey guys it's been a little bit over 12 month, the transplanted hairs continue to be great. But I am facing a big problem right now, which is my existing hair is getting worse sooo fast since I decided to stop taking fin 3 month ago.. Never stopped on Rogaine. Now I am back with fin again:( for like 1 month.

Things haven't got better yet!////

I can't understand why anyone would let a surgeon carve up their scalp, then ruin it by stopping a cheap medication with minimal to no side effects. I take Avodart b/c of the better DHT suppression and I am one of two in my entire extended family with any reasonable hair. Don't tempt fate brosef.

It seems like the majority opinion amongst surgeons for getting the most grafts over your life is to strip yourself out first, then to FUE separate areas once FUT is exhausted. Also stands to reason that you'll get higher yield just by virtue of using the higher yield technique first as much as possible.

FUE seems like it damages a lot of dormant hair follicles with each punch resulting in this ratty 'chewed out' appearance at the donor area (though you could say the same for the strip, the overall density just *seems* a lot better in the strip cases I've seen). Ostensibly you could strip someone that has been FUE'd, though with the greater (qualitative) density loss, you would reach your breaking point/graft ceiling sooner.

I know the argument has been put forward before that strip also "stretches" the remainder of the donor area, so you are getting some density loss with either technique, but aesthetically it just doesn't seem as obvious to me. Perhaps it's because lot of small holes just look more obvious than passive stretch. Also, seems like you can FUE different areas of the scalp that are not near the scar and buy yourself some real estate that way.

I don't know if there are any formal studies on this subject, just what I've seen Wesley make references to, but if anyone has seen any actual data about this would love to see it. Otherwise, any explanation seems a bit 'hand-waving' to me. Still, would be interested in the thoughts of others on this fine site.

I have seen a lot of results from Cooley and Wesley about PRP, but was wondering if folks here were aware of any docs that specifically specialized in this on the west coast.

Umar and Diep I assume would do it, but was wondering if anyone had made it their "thing".

Are you talking fin or dut? How long are you out from surgery?

Thanks for the interesting paper. It seems reasonable that you would damage the follicle, in addition to dormant follicles around it, with the individual punches.

Are there any other recent studies comparing the two techniques head-to-head that anyone is aware of?

Obviously as has been pointed out, specific surgeon experience with the two approaches is key, so was wondering if other surgeons had been as forthcoming with their data.

Briefly looking through pubmed, there are some 'in vitro' studies that show definite tumor promoting properties by increasing the blood supply to tumors through a growth factor called VEGF. No actual 'in vivo' trials that I could find.

In particular, who knows if the PRP gets into your systemic circulation at a reasonable level, and if its effects are only local, then you would presumably have to have cancerous/pre-cancerous cells already on your scalp, skull or brain (ie. skin, bone or brain cancer), which are relatively rare in younger folk. It seems, however, that no one knows for sure.

A lot of that "fade" may have to do with Turkey being a bit of a dicey tourist proposition at the moment.

 

I also think the lion's share of people on this forum are North American, and that kind of travel is largely impractical to them, especially given the quality of domestic doctors.

That's a good point for Erdogan, but Lorenzo is in Spain, right?

Nice dude, you are going through a real transformation. Keep us updated!

I am a physician and I have had hair loss for a couple decades. I did my research and finally got a FUT with Dr Steven Gabel in Oregon.

Thank you! If you get a chance, please show us some pics of how things turn out, always nice to see.

Comforting to hear some consistency in the responses.

Cuoto is a new name, and though their clinic reps have posted nice results, does he have any results submitted by patients? I will do some digging through the Spanish forums (Recuperar el pelo) as I am fairly fluent. If any one is aware of specific threads there or elsewhere that stand out, would love to hear them. Also, 3.5 years is kind of crazy, either he operates very slowly or has the greenest thumbs in Europe.

I was surprised to see less mention of names like Lorenzo, Erdogan, etc. and it seems that the clinics themselves are not posting results that much anymore. Is this just a change in their advertising market or has the hype about the European 'FUE gods' faded with time?

I am in the US, so I would prefer an American doc just because I feel they are more accountable just by virtue of being in the United States, but money is not an issue if someone is the right guy. I am also wiling to be patient as far as waiting list (ie. a year out is not a problem), though within reason (3-5 years out is just silly).

It seems from searching the old posts that this is a topic on which opinion has evolved over years, as older docs retire and new guys show up, but I was wondering, regardless of FUT or FUE, who are your top 3 as of 2017?

There are a large number of excellent guys on this site, but some of the names I am not used to seeing. I was wondering if folks on here had a consensus opinion about who their favorites were..

Awesome buddy. You've got quite a journey of recovery ahead of you. Please keep us updated!

This is amazing.

Wow what a journey. Really interesting to see how they did your facial hair and congrats on making it this far. Please keep us updated.

Probably the lack of concern/dialogue for the 30 year result. Most guys are still going to be in the workforce 30 years after their procedure. Even with all my research, I thought about 15 years down the road, but didn't give much consideration to 30.

There are a couple of comments like this in the thread from people who have had successful transplants, and it has been something in the back of my mind quite a bit as well.

I'm curious as to what your experiences have been. Are you guys saying that your normal hair fell out behind the transplants (as would be expected) and now you're running into issues with coverage because of insufficient donor supply?

It is a good point though, there isn't much info out there about long term planning. I guess a lot of people on the virgin end of of the knife are not interested in the 'later on', and it seems like most of the posts are at most up to a few years after the transplant. Might be a good idea for a subforum or dedicated thread.. a collection of long term experiences after the 10 year mark.

Jagged looks more natural. The Gabel pic above should answer your question as it's an amazing hairline result

Does it though?

Konior trained Gabel right? I don't see a big difference in how natural Gabel's hairlines look relative to the big K. Maybe they all do it to some extent, just Gabel actually marks it out..

This is another one of his more recent ones..

I assume they put more narrow caliber follicles along the front so it doesn't look as abrupt.