gillenator

Also wanted to mention that it is nice to hear that you have more realistic goals regarding your proposed level of restored density and the placement of your mature hairline. Hope everything works out for you harin...only you can define what is going to make you more happy and improve the quality of your life...

harin, there are more and more surgeons performing very nice FUE results as compared to a decade ago when FUE initially hit North America and Europe. You really have to do your own search and compare results across the board with other individuals' results that have the same thinning diffused pattern and hair characteristics as yours. In simple terms, you have many more choices and options with FUE. As far as scarring goes, that will depend on a number of factors such as what instrumentation the surgeon is using to make the extractions, specifically punch sizes and methods of extraction (manual or motorized), along with your own physiological attributes inclusive of the quality of your scalp tissue and how well you heal.

dreamer, For many individuals, the donor hair taken from the occipital zone has the most optimal caliber as compared to other donor regions of the scalp. If you were to add any more FUE to the same area, you want your surgeon to make some hair shaft comparisons to select some grafts that have a thinner caliber. That might help to soften the area. That's supposed to be one of the advantages of FUE. To be able to cherry pick grafts from multiple donor areas that have a softer texture, especially when creating a new hairline, etc. Also maybe try to grow the length longer in the entire area. Sometimes that helps, visually speaking. But in time, the transplanted hair will assume its original characteristics from where it was harvested from.

The average window period for stopping minoxidil pre-op is 2-4 weeks depending in who you talk to.

It all depends on the density of the hair. If the density is too thin, then combing it directly forward may not appear as full compared to pulling or brushing the hair backwards. Brushing the hair directly backwards creates illusionary fullness and volume and why many guys style their transplanted hair that way. I do this myself.

I know Dr. Paul Rose very well and used to work with him. IMHO, he does excellent work and worked with the Shapiro clinic in Minnesota for a number of years as well. Although I don't think he likes the cold winters up there... Dr. Rose is also very ethical and well respected by his colleagues in this field. He has been doing surgical hair restoration for many years.

Most of us who have been hanging around these forums for awhile probably know who you are referring to. Have you surfed all of the other major forums? You can also contact the doctor's office and ask for patient referrals who have had work done by him. Ask for ones that have similar patterns of loss and hair characteristics as yourself...

It sounds like you may be a diffused thinner. And if so, the transplanted hair is going to appear thicker in hair shaft diameter when compared to the diffusing native hair within the same area. That's not abnormal especially if you have a higher degree of coarseness (above average) to your terminal hair taken from the donor region. And if you have a wider color contrast, meaning darker hair color, then the differences in caliber can potentially be that more noticeable to the naked eye.

It also comes down to the size of the surface area being grafted and determining the proposed level of restored density. An arbitrary number is too ambiguous without knowing the dimensions of the recipient area. Also, the degree of coarseness is critical in producing the illusion of coverage. The greater degree of caliber, the less grafts needed and vice versa. Although 2,000 grafts may provide a start, you will undoubtedly need more work in the future. In addition, if the surgeon recommended putting some grafts in the lateral hump areas, then he may in fact see some diffusion and miniaturization going on which implies that area can recede and then pull down with additional loss in the near future. You will need reserve donor to fill in those areas otherwise you will develop a break/gap in visual coverage all along that area on both sides. No doubt anyone who has already reached class 6 has more progressive loss in the years ahead so none of us have enough scalp donor to cover the entire top of our scalp including the crown. Lastly, IMHO $10.00 per grafts US sounds way too high when there are enough talented FUE surgeons who charge less and still provide a great result...

If the hair follicle is not damaged, then yes it has the potential of survival. With FUHT, the strip should be microscopically dissected and the techs are able to see the follicles and the curl of each hair shaft. This alone can greatly reduce the rate of transection. If the individual must have FUE, then experience and skill is incredibly important!

On average, it takes roughly 7-10 days for the recipient incisions to heal. That's the key. Once the healing has taken place, it's fine to remove the crusts. Some individuals heal a tad bit faster, some a bit slower.

Dan, No doubt what you are seeing are the crusts which are the dead and dried out tissue from the tips of the implanted grafts.

Sweat will not damage your grafts in any way...

The grafts go dormant for roughly three months before the enter a new growth phase so they are probably just beginning to sprout...

I can certainly understand the confusion. A couple of things... First, curly hair can indeed be more difficult to extract without transection because it is challenging to know the exact direction of the curly hair shafts in the underlying dermis layer of scalp. And the more acute the curls are, the more difficult it can be. In addition, transection is transection. Permanent damage to the graft. It is not really the damage to the root as much as the damage to the follicle which the root is attached to. If the clinic decides that a graft is not intact enough to place in the recipient site, than that's still a graft wasted anyway you look at it. This is why selecting a FUE surgeon who has demonstrated skill in the end result with FUE, and especially inclusive of a high yield (regrowth), is imperative. And for those individuals like yourself who have curly hair, need to require examples of that surgeons past work of other patients who have curly hair characteristics. Because if the FUE surgeon being considered does not have the proven results with curly hair individuals, the potential transection rate can be out of this world...:confused: Best wishes to you in your journey of finding the right FUE surgeon...

Some docs want to take a separate strip in order to harvest as many FUs in that strip specimen versus taking out the former scar with the secondary strip harvest. And removing the first scar does not guarantee that the secondary strip scar will come out more favorable. There can be a number of reasons for why a scar comes out wider than expected. It can be anything from surgeon skill including closure method, to lack of laxity, to the individual's physiology including how they heal especially in the event of a raised scar. Yet whenever a scar does not have a favorable outcome, the individual definitely wants to get a number of opinions/recommendations from other surgeons before any subsequent procedure. Because it may come down to only doing FUE in future procedures.

I remember more than a decade ago almost all surgeons/clinics would require their patients to start a pre-op anti-biotic before their procedure, and continue on approximately three days post-op. Then it seemed that it was no longer viewed as necessary. Some docs may feel that because the scalp is so enriched with blood flow, along with better sterilization, less invasive methods, etc., that using a pre-op anti-biotic was no longer necessary. In addition, some feel that if it does occur, most cases can be successfully treated post-op and rarely will impact the end result. Even though infections are rare, it's a debatable subject. IMHO, the patient should at least be counseled and offered the option of using a pre-op anti-biotic.

Probably the main sign to look for is that there is a combination of the various signs and symptoms that you mentioned. It's when there is an aggregate of bumps that have tenderness with inflammation and redness with white tips that can also ooze liquid. When there are post-op pimples, they are hit and miss, not lots of them and confined to patchy areas where there is corresponding inflammation, etc. Make any sense? Of course if you are suspect of folliculitis, "contact your surgeon as soon as possible".

Yep, no doubt that is a lost graft and that is exactly what it looks like when a graft comes out post-op. A trickle of blood that is unquestionably oozing from the recipient site. Generally speaking, the grafts are pretty secure after 3 days post-op. But let's say the individual does not clot properly, could there be a lost graft past 3 days? Sure. Or if there are issues of slower healing, etc. Good thing you did not lose more than one...

Thanks for the kind words guys... I have to say that in four decades of following this field, that I have never heard of anyone having an adverse result in their HT procedure due to being a smoker. But like I previously hinted, smoking in general terms is far more detrimental to one's overall health and life. The silent but sure killer...

logo, You certainly bring up some valid questions and concerns that many guys are faced with as to whether to go with FUHT or FUE. And while I agree with some of the comments in the quote provided, FUE has come a long way with more doctors engaging with it and increasing both their talent and proficiency. Not sure when those comments were made regarding large sessions being difficult to perform, because that certainly is no longer true with those FUE surgeons who have increased their skill level including the size of each session. Albeit it true that some individuals have a more "mushy" scalp texture, the instrumentation has come a long way and more patients are viable FUE candidates than say, 10 years ago. The negative forces of compression, traction, etc., in the extraction process are becoming more manageable than they were a decade ago. But here's the deal. Whether we are discussing the merits of either method, the bottom line end result is largely dependent on the skill of each individual surgeon within his/her realm of competence. In other words, could the lack of growth from your prior FUE procedure be more related to a higher rate of transection than your physiology? So it's always possible that your last FUE procedure may have had a completely different end result with a surgeon who has a demonstrated high skill for manual FUE compared to someone with much less experience and proven skill. The same can be said for FUHT. There are in fact several FUE surgeons who have never performed FUHT and claim that they never will. So you certainly would never consider them for FUHT. Also be careful about using beard grafts as a stand alone donor source because there definitely are visual compatibility issues, growth cycle indifferences, and small graft sizes since an extremely high percent of BH FUs are single hair bearing grafts. So it would take many more BH grafts to provide the same level of visual coverage compared to multiple hair bearing grafts that only come from scalp donor. Beard hair works the best when it is mixed with scalp donor at a lower mix ratio. And I would also be careful using beard grafts on the hairline because of the visual incompatibility issues that I just mentioned. Beard hair is better suited for scar repair and in lower visual impact zones like the mid-scalp and crown IMHO. Lastly, we as lay folks could never give one another objective advice as to whether or not you are a better candidate for FUE or FUHT. That requires an in person examination and the competence of a licensed physician. Wish you the best in your situation along with the decisions in your journey...

With FUHT, the donor area where the strip is excised is indeed closed with sutures, staples, etc., immediately after the strip is taken and before the grafts are inserted. Possibly the doctor was telling you that the techs do all of the graft placement and after they are all placed, the procedure is pretty much completed. Still, what I don't like is that it is always possible that the patient may need more anesthesia before the procedure is finished and only a licensed physician should be administering anesthesia. That's the law in the land. In addition, what happens if the patient's vitals start failing? Then what? Although it is extremely rare but it can happen. Also, the surgeon should be inspecting what he/she expects. In other words, a responsible and ethical doctor would want to be routinely observing what his techs are doing and making sure each graft is placed properly both in depth and angles. A responsible doctor would look the entire scalp over before releasing the patient and also doing an exit interview which includes advice and addressing any post-op questions involving taking pain meds, etc. Could the doctor have a golf game he is trying to make later in the day? I just don't have a good feeling about this at all...:rolleyes:

Is your question more specifically addressing whether or not the inhalation of tobacco smoke is an issue? If so, just know that nicotine can still be delivered into the bloodstream as one's saliva can deliver nicotine to the stomach where it is absorbed into the bloodstream. The nicotine can then potentially cause restriction to the blood vessels that deliver blood throughout the body including the scalp. This can reduce the amount of oxygen to the grafts. Is it a big deal? IMHO, I don't believe so. I had 4 separate HT procedures and smoked cigarettes both pre-op and post-op and had no problems with my results. I have since quit smoking altogether including cigar smoking as I developed terminal stage lung cancer back in 2009 and yet survived it. I lost my right lung and the unfortunate thing was I had to almost lose my life to get serious about quitting and not smoking at all. My health is much better since I quit... Obviously I do not condone any form of smoking...

Your grafts should be fine. Your epidermis which is the outer layer of scalp was symptomatic and very doubtful that your grafts were impacted because they are imbedded in the inner dermis layer of scalp tissue where the blood supply exists. It is amazing how many chemicals and alcohol based ingredients are added to various shampoo products. Many of these alcohol additives can cause itching, redness, and even inflammation. Glad to see that you found a good alternative shampoo product...

First of all, you have a diffused thinning pattern and because of that, you run a higher risk of shock loss. So if it were me, I would never have that many grafts done. Remember, with FUE you can always add more grafts as you lose more of your native hair as time passes. And at your young age, you will lose more hair because MPB is indeed progressive. Not sure if you are on any effective hair loss meds. If not, you run even a higher risk of future loss. It is your scalp and your hair loss. Be more assertive and if your doctor is not willing to accommodate your concerns, I would find a new surgeon who will. Best wishes to you in your journey...