DrTBarghouthi

This is a very “hot” topic!! Thanks for bringing it up. I do think that a lot of the modified names are purely made up for marketing reasons. Hair transplant clients come in two categories: the really well researched and those who are not. The well researched would know the main difference between the procedures and the fact that there are several extraction and placement techniques that can equally produce great results. It comes down to what works well for the surgical team as a whole. As for the non researched group, (which is consistently growing as HT surgery is becoming more and more main stream due to some cost cutting providers) they will simply go after any name advertised. We often get enquiries asking for a HT procedure that I haven’t even heard of. This phenomenon of new names is made to target this segment. I dont think anyone on this forum belongs to this group.

Yes this does seem like the beginning of Male Pattern hair loss in the crown /vertex region. Your best bet is to slow down progression using at least one or a combination of approved treatments: 1. Finasteride 1 mg once daily (you can have alternated day treatments but this reduces the full effect of treatment) 2. Minoxdil 5% daily 3. Low level Light therapy.

Your attitude determines your altitude! Maintaining the trust that the client had in a doctor in the first place is priceless. Good clinics charge higher not only for the good work they do in the initial surgery, but also because they would usually provide excellent aftercare and followup. It is always important to convey the message to the client that his satisfaction and our satisfaction are mutual. Ofcourse everything should be documented and good photos help in establishing the reason for any lack of growth etc (whether lower than expected density or ongoing native hair loss). But in general, free touch ups or a free number of grafts is extremely normal in a justified situation. I know for a fact that such attitude pays off.

No harm in waiting. You can have time to do more research. Nonetheless, if you have your mind set on a certain surgeon, then my advice is to stick to that. Dont let waiting times sway your initial judgement. Besides, most would have a 6 month wait at least - which brings you close to your currently scheduled appointment. best of luck.

i certainly agree with what is being posted here. If the client clearly understands the importance of maintenance therapy and the surgeon is careful with the spacing of grafts then excellent outcomes can be achieved. In some of our post op photos immediately after surgery, the density work looks pretty “horrible” because some grafts are spaced out unevenly and if someone looks at it without knowing the nature of the case, they would think it is amateur work. But it is imprtant that no native hair is damaged.

You’re welcome and I’m glad I could help. We all value our techs, their experience and dedication. Nonetheless, at the end of the day, good reputation takes a lot of time to build and very little to destroy. So any good practice understands this and takes each graft seriously :))

A very interesting question. I do ofcourse understand the fact that cost plays a role in the decision for many people and so does the number of grafts that are on offer. Nonetheless, there is s bit more to it than these two things. I will share with you my point of view as a doctor. I will break down my answer into points to make it clearer: 1. I am a firm believer of the fact that if a client doesn’t trust that what we’re providing him or her in terms of graft numbers or cost is fair and appropriate, then there is some sort of lack of trust. In such a case, the client shouldn’t have the procedure done with that specific doctor. So if you think you’re not getting s good deal with the Doc you mentioned, then you probably have not reached the level of trust needed to undergo the procedure with him. Trusting you providing doctor is a must. Ofcourse, I am talking in general terms and do not imply this doc specifically. 2. Part of the higher cost of surgery with docs vs tech clinics is the continuity of care (in most cases). A doc is more likely to remain in his clinic and run his business for many years. Hence follow up and continuity of care has a price. I also do know that many doctors (including me), would always offer an incentive in the form of discounts for further procedures or even few hundred free grafts if needed for a touch up. You are more likely to get the level of aftercare that you deserve in a doctor run clinic. Doctors will also hold themselves accountable for the work done especially if they are the ones involved. 3. I agree there are always nice results in tech run clinics. Nevertheless, HT is a team based procedure. It involves a lot of tedious work, ethics and quality control. I do not mean any disrespect to anyone, but I do think that once things get delegated, some of these essential qualities could also begin to disappear. So I do suggest you do your research and see which one has better overall value.

Hi there. I meant if you can take some from the sides too below the jawline. But based on what you sent you can aim for upto 1500. Ofcourse having it shorter can give a better estimate as long hair always gives the illusion of a denser look. I tend to prefer staying under the jawline and can go down the neck if things are safe not to show any scarring etc as the skin tends to become slightly different and may scar differently as you go lower.

Thanks. Please send clearer photos and also some of the sides. Focus on the areas under the jawline as it is best to go for hairs under the jawline.

Absolutely. The photos shown do refer to a MPB with some hair hanging in. We usually refer to the NW scale but then specify that there is a mild, moderate or severe loss in that specific NW pattern. For example a NW6 with mild or moderate loss is what is being referred to here as diffuse thinning.

Great topic Melvin. Yes. Diffuse hairloss can certainly be managed. It is important to be on good maintenance therapy and to tackle the areas wisely. I always opt for a decent number (3500) over two days to cover the front and Mid scalp. How far into the vertex transition zone will depend on the degree of loss. All in all the aim will be to go back to a 3V pattern generally. If donor, age and other factors are favourable, then the crown can be tackled at another stage. With diffuse loss the main issue is to make sure that each graft goes in between the existing hairs so as to get the maximum benefit from the new and native hairs. Hopefully meds will hold as much of the native hair and the overall density looks good. I tend to find that these cases give a nice result as everything is already drawn by nature (I always follow the client’s existing hairline and augment it). Excellent choices with surgeons. The best of luck to you!

Congratulations on your hairline work and the baby ;)) I agree with some comments here that laxity might limit the option for another FUT. Nonetheless, you have what seems to be a good donor area for extracting a good number. Just be sure to leave some for the crown at some point if you think it might be worth. Can you perhaps share the laxity results with us? You can do this at home. Just place two dots over the scar and have both dots 5 cm apart. You then use both thumbs to try and push the dots closer to each other. From this you get a percentage which is basically your laxity index.

Yes. What I said is that you shouldn’t opt for BHT for your hairline. 250 from your donor should be possible. Nonetheless, I do agree with the fact that it is a nice coverage that you achieved over the years and that it is now extremely optional.

Augustya, looking at those pics and video there should be no problem getting even more than what is needed. It looks very reassuring to be able to do the job. Yes it is a donor that is clearly extracted but the overall appearance with long hair is good. Shaving or even going between the long hairs to extract what is needed is possible without jeopardizing the area.

It is indeed a sad situation to break such bad news about the donor being depleted forever. What I find surprising is the number of times such patients are clueless about the finite nature of their donor. They often think that in few years they can come back and get it done. It just tells you what sort of consultation took place in such “shops”

The density isn’t great but it seems you have a good number of multiples. You do have a variety of exit angles but this may also look more pronounced because of the length that you have your donor in. A shorter shave may make things easier to see what angle the follicle is oriented under the skin. I think if you have an open mind about FUT but would like to avoid it, then it might be possible to start with an FUE and if the transection is high based on the first few grafts of each zone, then convert to FUT. Just an option that can be provided perhaps.

Yes I totally agree with Dr. Bloxham. Avoid body hair for your hairline area. I also agree that it is probably possible to get this number from your donor area. Will be nice to see your donor pics.

Hello. It will be nice if we could see some pics of your donor area please? It seems that what you need is a surface area of 5 or 6 cm2 which may require 250 grafts around. Some of these need to be single hair grafts.

Yes you can definitely climb up the Norwood scale in many cases. It might not be a huge jump but if properly planned and optimized medically then somome can go from a 6 to some variant of 4 or even 3. Managing expectations is the key.

Hello. Although the photos are not too clear, you do seem like a Nw6 with an average or below average donor area. Nevertheless, you do seem to have reasonable and realistic expectations of what can be done. Such cases (especially with a poor donor), are best done in stages. Your first procedure in my opinion should focus on restoring your midscalp. This is because you have some hair in the front and restoring your mid scalp will eventually guarantee a NW5 in the worst case scenario that you even lose your front and do nothing more. If donor is still good, and assuming you stay on maintenance meds for the frontsl zone, I would then consider restoring the frontal zone. I would be very reluctant to do any crown work in your case as it really wont be the best value for money sort of thing. If you can post clearer photos that would be great. Thanks for sharing.

Hello. You should really post some pictures for us to help. Furthermore, I dont see the logic behind focusing on the crown and only having little hair in the front. There is a risk that you won’t get the right coverage in the crown (not with those numbers) and yet it might not look like a 4a pattern, if thats what you’re trying to reach. It will definitely be helpful if you can share some photos.

Nice topic Melvin. I certainly deal with a lot of “victims” of black market HT. Just few things that I gathered from my direct interaction with clients coming to us for some help: 1. They bombard you with calls and texts before booking, but once you have the procedure, no follow up exists. Clients even call us to ask about aftercare instructions, which you would think should be discussed after having any procedure. 2. It is almost exclusively run by unlicensed techs. 3. Exaggerated number of follicles promised and all in one day sessions with multiple patients in the same day. Says a lot about quality control. 4. They attract clients with attractive prices, BUT most of them end up forcing them to buy PRP kits for the full year, products, shampoos etc that will cost more than the actual procedure. So clients end up paying double the advertised price. 4. They are creative in naming techniques. By that, I dont mean FUT or FUE (since they only do FUE anyway). But it’s also giving names such as ICE FUE, CHOI FUE, Sapphire FUE, DHI, etc etc. There is a new name almost daily. A lot of people fall for names thinking that this is the latest technology. They even claim to have robots doing the surgery despite the fact that their prices dont even cover the kit price of the robot per surgery. At the end of the day, you would hardly remember the price you paid for a good procedure, but you will remember the price of a bad one!

Thank you for the answers. Yes I agree that a second opinion is a good idea. Keep us updated. The biopsy as a process is very straightforward. Nothing to worry about there. It mainly is to outrule a specific type of hairloss. Let us know what happens and best of luck!

Hi Queelag. I just read your post but I think some details are missing: 1) Is there any female pattern hair loss in the family? Any sisters, mother, aunts, grandmothers with a similar or even more advanced thinning? 2) What blood work did you have apart from Vit D and iron? Generally, since genetic female hair loss accounts for only 40% of female hairloss, then it is usually advised to test thyroid function, zinc, magnesium, B12, Complete blood count and according to the case DHEA-S (androgens testing), ANA (autoimmune test) and prolactin (if other symptoms exist such as an irregular cycle). 3. Scalp biopsy is the only definitive test to check for scarring (Cicatricial) Alopecias which is a certain type of hairloss that causes scarring of the scalp. It has several sub-types but is mostly suspected clinically first and has certain characteristics on a magnifying dermascope. If these findings are present, then a biopsy is advised. Did someone check the scalp with a magnifying camera? It will be great if you can post some photos, as It certainly sounds like androgenetic alopecia from the pattern of loss you described, especially if it runs in some family members too.

Hi, In some cases hair treatments and styling products can cause some chemical injury and disturb the cycling of the hair follicle. This means that it could push a follicle in it’s growth part of the cycle (Anagen) to go into a resting stage (telogen) early and start to shed. This is called Acute Telogen Effluvium. Ofcourse it is normal cycling to have upto 100 hairs falling in any given day. If the number is higher, then Telogen effluvium is definitely a possibility and it usually wears out on it’s own and hair restores it’s normal cycling. Please consult a dermatologist or a hair specialist for a proper assessment and advice.