gillenator

I also respect Dr. Patrick Mwamba and his talents with FUE. We both worked together some years ago when he was a tech in the US. I have watched him grow over the years from when he placed some of my grafts to refining his surgical skills as a HT surgeon. He is also very ethical and has the best interest of his patients in mind...

Out of all of the factors considered, hair caliber is the most critical factor considered when achieving the illusion of coverage. IMHO, we can easily get caught up with the density factor and although it is important, the attempt to achieve an ambiguously high density level is not a wise approach. Let me explain. We all have variances in hair characteristics and even hair quality. Ideally, every surgeon evaluates every patient's virgin density. If the density in a barren surface area can be brought up to 50% of original density, the area will "appear" restored. Further, none of us have enough donor to replace what is lost over a lifetime. Many docs will tell you that the upper range of proposed densities is not necessary to achieve a restored appearance. So why waste all of that precious limited donor knowing there will be more loss in the future? IMHO, this is a critical consideration for those individuals that have the more advanced classes of hair loss in their future, and in their family history. Even with average hair characteristics, achieving a level of say 50-65 cm2 will look good on most individuals. Increasing the level by another 20-25% does not make that much notable "visual" difference in coverage. So if an individual was to start there as the base goal, and then was not satisfied, the density can be increased in the future. Yet if he is satisfied with the visual results, you have more donor left to go around. Surgical hair restoration was never premised to achieve density. It was always oriented around the goal of achieving "visual" restoration. And there is a world of difference between those two approaches.

One other thing. It also matters how dense the recipient area is. If the existing density is somewhat low, the concern to cut down the area is not as great as if there is a fair amount of existing hair because obviously the more hair is present, the greater the concern of transection. The space between the individual hair shafts decreases and so each of the recipient incisions must be precise.

IMHO, it really does come down to the discretion of the surgeon. As Hairweave stated, his surgeon does not require the recipient area to be shaved, and some docs do not because of their own individual confidence to see the angulation of the existing hair. Then you have others who take extra precaution and want the area cut down. And then there's always the patient who won't allow their recipient area to be cut down that short. I should have also mentioned something about hair caliber. The degree of coarseness has a bearing on following the natural direction of hair shafts. In other words, the coarser or higher caliber the hair shafts have, the easier it is to see the angulation of that hair, as compared to fine grade hair. And a wide contrast in color also helps see the hair shafts. The loupe is a high powered magnification system with light and worn on the head which helps tremendously to see the recipient area as the surgeon makes the countless incisions.

The docs who want the recipient area shaved are concerned that transection of the existing native hair does not occur. And the more existing hair that is present in the recipient area, the greater the concern because the new recipient incisions must be done at the appropriate angles. Those new recipient incisions are made between the existing hair shafts and it is critical to note the angulation of those shafts as they protrude out of the scalp. Only by cutting the length down can those angulations be observed. When the hair shafts are too long, it can obscure the natural angles of the exiting hair. And this is the same reason why the donor zone is cut down with FUE. The surgeon does not want to transect the FUs during the extraction process so again, only by cutting down the length can the surgeon note the natural angulations of the hair.

Ryan, It certainly appears to me from your photos that you did experience some shock loss in the donor and at this point in time, it makes more sense that it occurred. I agree with Blake that it should thicken up after enough time has passed and the shocked hair grows back in.

You both make good points. There will always be varying approaches in the frequency and as long as we are consistent, we should have efficiency. I also take it every other day and take it at bedtime with other daily meds. That way I never forget and the active ingredient stays in my system consistently. I know some are of the opinion that the time of day makes a difference however there is nothing noted in the clinical trials that the manufacturer (Merck) conducts.

mikeey, Good question. Let me first state that there are variables and other factors that can affect the regrowth timetable so possibly I can just express what is the normality when the surgeon is skilled and competent. At 3-4 months post-op, the regrowth is just starting to break above the scalp line and very little new growth is visible for a large percent of patients. IMHO, that is attributable to the fact that a much larger amount of the transplanted hair follicles go into the telogen phase 2-3 weeks post-op and rest for another 3 months in that dormant phase. The nice thing about using high powered magnification is that it is possible to see the new hair bristles just starting to break surface and some that are directly below the surface, especially those individuals with dark hair color. No, it's just not true that almost all of the regrowth has sprouted about the scalp line and visible at 3-4 months post-op. It's just starting to sprout and that is for a much higher percent of patients across the board. It's really at the 5-7 month period that the regrowth is coming through on average 75% of the grafts and very visible. Exceptions? Sure. Let me explain. FUE surgeons who are very skilled with their manual extraction techniques can see two things improve. More of the grafts remain in the growth phase and yes the regrowth can occur faster because there is less overall trauma to the grafts. If the trauma can be reduced, then a higher percent of the follicles can potentially remain in the growth phase. And we hear this more often when guys say that some of their grafts do not shed as quickly and continue to grow immediately post-op. Some of the top docs are also coating or placing the grafts in cool solutions like ACELL that can reduce the volume of free radicals that can begin to fester and attach to the grafts once they are taken out of the scalp. This is true for both FUHT and FUE. The quicker that the graft tissue is placed back into the scalp, the better. Yield improves and so can the regrowth period. But it's hard to say what percentage because first of all, there are very few clinical studies or documentation being done to show/prove the variations. I consider Dr. Cooley to be one of the top and very few docs who are devoted to clinical improvements in this area, including the documentation to support it. It's also hard for me to say which docs go the extra mile in graft preservation because I don't work for them. It's in the result that counts...and after all, that's what we all want..

Yep, anything that can help reduce the inflammation is worth it...

IMHO, once the area has healed and not painful to the touch, you'll be fine.

You're welcome my friend. I don't think you'll need that much time off but certainly do what you feel is best for you. When they take the strip, there will be enough hair above the staples/sutures to hide them if you have at least 2 inches of length. And we are not viewed from the back side of our scalps so again, most people won't know unless you tell them. Wishing you the best in your journey agentharley, you'll be fine...

Asana, You should start feeling the pain level going down as you get 2-3 weeks post-op. The reduced inflammation is going to make a huge difference. The severed nerve endings will heal soon and regrow but will take some time, 60-90 days or so. I think once you get at least 30 days post-op, you will see more improvement. You might want to ask your doctor for a prescription for a higher strength of ibuprofen in the 600-800 mg range. Or your doc may suggest taking at least 400 mg (two tablets) six hours apart. Have you tried using a larger ice pack that covers the entire donor area? You can use a larger plastic zip lock type of bag and cover it with a thin cloth and lay your head against it lying flat on your back at bedtime. Fifteen minutes on and fifteen minutes off. Hope you get some relief soon my friend...

When you get to the 10-12 day post-op period, most docs will advise their patients to begin massaging the shampoo in the recipient area and start removing the dried-out crusts.

Yeah it was longer than I wanted however my surgeon advised this because again, my laxity was barely adequate for the 2500 graft strip that was taken. So IMHO, it was better that I endured the three weeks and the discomfort of having them removed so i did not have the scar stretch.

This is where the advice of a licensed physician specializing in this field is beneficial. They can potentially adjust both the dosage and frequency accordingly.

IMHO, pain narcotics would not be suitable at this point in time post-op. But analgesics, especially long acting ones like Aleeve may be of benefit since it is a 12 hour reliever. Ibuprofen also has anti-inflammatory properties and may help the inflammation as well. You may even find some pain relief in applying ice to the donor zone before you sleep, 15 minutes on, 15 minutes off. The "electric" sensations are related to the severed nerves from the numerous extractions and should subside soon. Hope the discomfort begins to subside soon and take care...

At this point in time post-op, the saline spray would not be of much benefit however any gentle shampoo would be fine as long as you gently pour a diluted solution over the recipient area and not rub your newly implanted grafts. Congrats on your procedure...

IMHO, it's definitely the crusts with the dead hair shafts attached that were inside the grafts. Nothing abnormal about it. Your transplanted hair follicles have simply gone into the resting dormant phase and as a result, shed the hair shafts. When the crusts are removed, the dead hair shafts come out readily with most of them. But your follicles are imbedded into the dermis layer of your scalp where the blood supply is. After those transplanted follicles have rested for approximately three months, they will re-enter the growth phase and you will start to see the new growth emerge above the scalp line.

Generally speaking, at least 40 FUs per cm2 would be the threshold for most individuals. And as a general rule of thumb, if the restored density is at least 50% of the original density level, then the area should appear restored.

Yes I had one tryclosure yet don't think that was fair to judge the result as my strip scar still came out very thin and it was difficult to tell if much hair was growing through the thin scar. My staples were left in for roughly three weeks and as a result, several of them got buried under scalp tissue as the scar healed. It was very painful having them removed and one got buried and broke when my PCP was trying to remove them. She did not have any local anesthesia to numb the area either...:confused: I would have rather had a double closure technique but not sure if that was possible due to my laxity at the time. So although the staples were a pain, it was better than having a wider than desired scar in the end result.

I cut back my finasteride regimen to every other day and still experience good efficiency. Not an advocate of using dutasteride and it's astounding to read of the various side-effects that some guys experience from it. Some more extreme than others.

I think the other critical factor that you will benefit from is maturation of hair caliber from the grafts. For most individuals, the optimal improvement of visual coverage is seen once 12-15 months pass. IMHO, the degree of hair caliber is more of a factor in gaining the illusion of coverage than density itself. The bottom line is that the benefits of any procedure cannot be fairly assessed until both regrowth and caliber maturation is fulfilled...

Guys, There's no question about differences in individuals' regrowth and the timelines that support them. Parts of the equation are the variances in each individual's auto-immune system, follicle cyclical behaviors, other medical issues, age differences. etc, etc. Those are subjective factors and very difficult to track and/or document, and especially so if labs and biopsies are not used in the evaluation process. So we are left to notice the differences with our naked eyes right? Here's the deal. Regrowth from any HT procedure can potentially be charted and monitored if only the clinics would use the technology that is available today. Even as far back as fifteen years ago when I used to work inside the clinics, we used to take high density digital photos of the patient's recipient area and then downloaded the pics on a hard drive. When thumb drives hit the stores, we offered the photos to our clients so they had them ready and available to view at any time. We took before and after shots from varying angles and then the images can be magnified at any time in the future. We had the patients come back in the clinic at 3 month intervals for follow-ups and more pics. The individual patients could see the results or lack of them directly. It is also possible to note and chart sympathetic shock loss because with digital high density photos, you can distinguish between native hair and the grafts. You can track the regrowth and yield to a high level of accuracy. Yet clinics typically do not offer this type of follow-up service, some do but they are few in number. Some charge for this. Most clinics are too busy doing procedures that they do not have the support to track yields and I suppose it could also present some problems for the clinics when the yields are subpar. Think of what a can of worms that could be for any clinic. But my point is that the technology and/or the means to track and chart these type of things are available today and that would diffuse the ambiguous dialogue.

As long as you have 2-3 inches of hair length in your donor zone, the stitches/staples should not show. Is your present hair length shorter than that? Did you have lingering redness in the recipient area on your first procedure? Were you told that staples would be needed? If not, I would not recommend using staples unless your laxity is not accommodating the size/width of the strip specimen that would be excised. Yet we cannot make that determination since we are not the surgeon. I had staple closure on my last procedure and would never have them again...:confused:

nervous, I encourage you to do more research especially in follicle cycle behavior. If those are dead hair shafts, and they probably are since they are not growing, they will come out rather easily compared to plucking live hair shafts. But if they are dead, they really need to come out because your scalp senses them to be a foreign object and will eventually reject them. Not only is the graft density per cm2 a factor, but also the caliber of your hair shafts. If you have a coarse degree of hair caliber, then visual coverage will appear more pronounced. Yet the thinner degree of hair caliber, the more grafts are needed or a higher level of graft density to achieve decent visual coverage. One other thing. When the regrowth occurs, the hair shafts should be thicker in caliber and enriched with color as they grow in length. Peach fuzz growth is probably not grafts but your diffused native hair growing back in. Take another look at your hairline and you will see dark thick hair shafts which are the grafts. But as several of us have stated, you are still in the beginning stages of regrowth so give it more time and patience.