DrTBarghouthi

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. 

Excellent answers by bsmith and lasercap. I would just like to add that a natural hairline is generally divided into a transition zone and a defined zone. The transition zone is usually where all single grafts should go and would have macro and micro irregularities or the zig zags that you generally see in pictures. This creates a natural transition between the forehead and the more dense defined zone which could have a dense combination of singles and multiples blending in with the transition zone. 

I also agree with the fact that microscope use is a must for inspecting grafts and making sure they are actually single hair grafts, but also to be able to trim more singles if needed.

5 hours ago, Bsmith_ said:

Single hairs in the hairline are most important for placement in the hairline for natural results. This is why physicians should have their medical staff evaluate the grafts under microscopes. 

I agree the yielded growth percentages are higher with the FUT than the FUE. One benefit of the FUE is you can choose the area where the grafts are extracted. Typically you have finer, single hair grafts closer to the nape of your neck. This can also be a con as much as it can be a benefit. Not many people talk about it but say for example you make extractions in nape area for the finer single hair follicles and later down the road, start to develop retrograde alopecia. You will most likely lose those follicles because you have started to thin in the area from where the extractions were harvested. 

IMO what separates good clinics from unexperienced clinics is graft trimming. When I say graft trimming I'm not meaning it in the sense of every graft being trimmed to say you got more grafts than the number of extractions made. I am meaning it in the manner of making sure you have enough single hair grafts you need to place in the hairline. With the FUT,  you do not have the luxury of defiantly knowing you are going to harvest the given number of single hair grafts needed to be placed in the hairline, so it would be optimal to take the given number of grafts you have harvested and only trim a set number of those grafts to give you the total amount of grafts (singles) that would be needed for the hairline. 

Why are single hair grafts important in the hairline? because who wants a 2 hair or 3 hair graft in the hairline that looks like a pluggy result! It doesn't look natural! As I mentioned earlier, microscopes are important!! A follicle might look like a single hair graft to the naked eye but without closely examining the follicle under a microscope, you could possibly mistake a 2 hair graft for a single. Quality control! This is not always practiced which is very unfortunate.

So I guess to answer your question, no, FUE does not allow for a better design in the hairline. A good physician will know how many single hair grafts are needed for the hairline and if they do not consider this to be important or needed, I would question their ethics. An experienced physician should be able to design a natural hairline regardless if it is a FUT or FUE procedure. 

That's my opinion on the matter! Hope it was helpful. 

 

4 hours ago, LaserCap said:

Bsmith makes a lot of valid points, good read.  But design is far more than just choosing the type of graft.  It all starts with symmetry,  measurements, proportions, and age and even ethnicity.  Let's take age to begin.  An 18 year old comes in and has a hairline in the middle of his forehead. He is starting to mature his hairline and one of his temporal areas is starting to recede.  He is freaking out. The doctor fills it in.  At that precise moment the patient is thrilled.  What do you think will happen 20 years later when he now has a horn worth of hair on that particular area?  So first consideration is candidacy.

Symmetry, measurements, proportions, they all go together.  Some doctors use the 4 finger rule.  They'll just put their hand on the patient's forehead, starting at the brow line.  Others use the rule of 1/3. I know of many that also have a machine that projects a light.  The key here, from the part of the doctor, is to consider if this particular design will serve the patient well now and in the future.  An age appropriate hairline, despite of what the patient thinks, is important.  All it takes is education. If the patient, ultimately, is adamant about a hairline in the middle of his forehead, turn him away!  A few other things to consider. Will there be some recession on the corners? (Will depend depending on the sex of the patient.  If male, sure.  If a woman, corners will typically slope down).  Lastly, will there be staggering of the grafts?  This will typically add an element of naturalness to the work.

With regards to ethnicity, typically African Americans like a sharp edge with an inverted U design.  0 recession.  Typically no blunting is discussed.

Now grafts.  Yes, in the old days the nape was considered.  But back then it was just FUT.  So, if you see older guys with scars way low, you know that this was early 90's work.  FUE from there? Sure, but they retrograde comes into play.  Now must doctors get the finer grafts for hairline work from behind the ear.  So, shaft diameter is important.  This is where the clinical staff plays an important role in all of this.  The doctor can instruct, but an experienced staff is invaluable.

FUT or FUE?  Makes no difference.  An experienced outfit can play with all the elements.  They can trim, dissect, and even place grafts at different depths.  Opinion wise? FUT is typically a more robust graft and allows the staff more options.  The FUE, by definition, is already minute by definition.  How much more can it be modified? But ultimately how the patient decides to style his hair will help figure out how to move forward.

Sorry to hear about your experience. I do think that there are few issues here. I do think the hairline can be raised a bit by extracting the grafts and recycling them higher up. You will need more singles in the transition zone. As for the donor, I think you may have a bigger safe zone than what was extracted but it will be hard to only judge based on photos. Nonetheless it looks good once hair is longer and could still improve. SMP is a nice option to hide the areas of scarring should you decide to shave closer. 

All the best!

Thank you

The point is: you can cause damage with any tool out there. I do favor making sites with sapphire blades regardless whether we use implanters or forceps for the case. I just think they create neat channels with no bevelling effect from the typical needle tips pushing the skin inwards. Ofcourse you should always transplant between existing hair and that has nothing to do with the needle type. It is something that the doc should take care of. 

Implanters are great tools in terms of graft handling and the learning curve is not as steep as forceps. While it has such advantages with graft handling, a big part of their marketing hype is geared towards being able to recruit new techs and get them working straight away. 

Hi there,

In hair restoration, the choices are really between FUT and FUE. Sapphire, DHI, Choi etc etc are names that emerge as marketing tools mostly to explain a specific part of the procedure- which is the implantation into the recipient sites. It is NOT a stand alone technique. I think what counts is mostly:

1. The best technique is the one that the clinic is delivering consistently great results with and that the entire team is happy and experienced with. Many clinics use forceps for implanting with great results. The rest use implanters and deliver great results too. Each case may also require a specific technique depending on that individual's case. Some types of grafts may require using a specific implanting method. 

2. Implantation is one part of the whole process. It is very important but all other aspects should also be equally important, such as harvesting method, graft storage, aftercare etc. 

Having said that. I do like the Sapphire blades for site creation. I do think they create neat sites with a good healing/scabbing outcome. 

Best of luck

Beard extractions will scar- just like any other incision. It is less obvious probably due to the location under the jaw but also because most beard hair is single haired follicles, sometimes two haired, so a smaller punch can be used in most cases and that could result in even smaller scars than the scalp.

Lots of interesting thoughts in this thread. Thank you all for sharing. 

I strongly believe that the right age for a HT is the age at which the following factors come into play together:

1) Developing an identifiable hairloss pattern with a somehow traceable family history. 

2) Being a well educated patient in terms of the need for strict maintenance therapy, and having an open mind about being conservative in your restoration efforts, as well as understanding the limitations of HT surgery.

3) Finding a doctor that will make sure you adhere to point number 2 and who will clearly try to meet any reasonable expectations only. 

I think if these criteria are fulfilled, then there will be no strict age for when a HT should be done. It is often agreed that 24/25 is an acceptable age in most cases, but you still could come across a 20 year old or younger who is NW5 or 6, with reasonable expectations and willing to stick to his medical therapy. He could still be a good candidate. 

I personally had an FUE as I would like the option of wearing my hair short. Although I ended up growing it once my HT succeeded :)))