gillenator

Roach, I think the method of extraction does make a difference in a small case such as yours. Since the recipient area you want filled in is relatively small requiring the 100 grafts you mentioned, you may want to consider FUE versus strip to harvest the grafts you will need. Providing you have thick facial growth, you may also want to consider having the donor be extracted from under your chin for several reasons. First, the recipient area will potentially look the most natural grown out if the donor grafts also come from the face. It's the same hair. A smaller punch (.50mm) would potentially be used so there should not be much visibility of scarring under your chin after the extractions completely heal. Second, you may not want a small strip scar in the back of your head to get the grafts you need for your face. Should you ever want to shave your scalp one day, it may be worth taking the 100 garfts from your facial area by FUE as I previously mentioned. Now, if you should have MPB and think you one day might need coverage on top of your scalp, you might want to wait and have everything done togethor. You may also want to discuss your situation with several docs who are talented in both strip and FUE and who also may have done some facial restoration. Either way, I wish you the best Roach in your research and finding the right resolve.

Guys, Whenever business gets slow, complaints go up. Rather than go into a lengthy thread, I have seen this happen before over the years. Part of it can be attributed to patients seeking the discount doctor because more of them are running display advertising in their local newspapers. Some begin doing radio campaigns. You rarely see the top docs doing this marketing blitz to the unknowing public. The other thing I always notice and IMHO has become a trend are that more and more repuatble docs are going ahead with cases that are more marginal, meaning the patient does not make the best candidate for the procedure, "but has the money to do it". I suppose that can be hard for the best docs to refuse. Notice I said marginal. I also see a trend of younger men getting procedures having good success with hairloss meds like Propecia. Years ago, many of these same docs would have turned away these same young men. Now I am not saying that this is the case with the men that the first poster was referring to, and this is not so directly related to yield issues unless their doctors were imcompetent, but it does not sound like it was the case. It may not be so much a strip or FUE issue as much as we might think.

Possibly you are asking this because you have noticed some new hair growth in the recipient area past twelve months? If so, it could be transplanted hair that simply broke off during the growing cycle and is simply continuing to grow above the scalp line. Or could it possibly be exisitng hair that is recycling? Generally speaking, once the hair follicle has rested for 3-4 months, it resumes into its growth cycle once again and be in production for 6-8 years. Every once in awhile I get the dreaded e-mail from someone whe went to a unreputable doctor and is getting no yield from their HT procedure. I almost always tell them that if they have not seen any any regrowth for at least 6-9 months post-op, that it is a bad sign. I still encourage them to wait a tad bit longer just to be sure it was not an issue of massive transection or some other area of incompetence. I think most docs would comment to say that regrowth is not rocket science. Providing that transection was extremely low and the grafts were handled properly and prepared after harvest including implantation, there is really no reason for them not to regrow.

moro, The link you provided at angelfire is one of the most extreme cases of what never to do. The example is certainly not representative of the work being done by the top HT docs today. The type of surgery the patient had was open donor (plugs) and yes it the method often left the patient with recipient area scarring. FUE really is a micro-version of past open donor methods in harvesting hair. The difference today is that FUE extracts the FUs intact while the former technology did nothing more than "punch out" sections of hair. Either way, both methods do some level of collateral damage within the donor area but like in Sparky's case, the punches used probably averaged .50mm in size so that when the healing was completed, you can barely tell where the extractions were done. That's the level of proficiency that some class docs have come to, although they would tell you that they have not yet "arrived", and are still working at improving their tools for extraction. I want to believe that no one is doing the former archaic methods of open donor harvesting. There are a number of factors that can cause the pitting, discoloration, etc in the recipient area of old "plug transplants". The circumference of the punchout grafts were smaller than the recipient site created causing pitting, or the open donor plug was larger than the recipient site and caused ridging and large bumps. Todays top docs have the grafts microscopically cut and trimmed after dissection from the strip. Larger FUE grafts are at times diseccted into single hair bearing grafts or doubles, whatever the doc wants, and then implanted into the recipient site. Top FUE docs may still have some larger grafts trimmed down to size. The best docs have the grafts cut to the peripheral sizes of the micro-incisions they have created, many with custom-sized blades. Precise sizing of the grafts to their respective recipient sites prevent the pitting, bumps, etc and often heal without any appearance of scarring. Once healing transpires, the result is amazingly natural providing angulation was done to perfection. The industry has come a long, long way!

Anyone who has done their research online is going to have their own list of best docs. Every individual really owes it to themselves to research the various online communities and then begin to see the same reputable docs recommended over and over again. Still, you need to see each doctors work on other patients who bear very similiar hair characteristics as yourself. As you begin contacting the doctors you feel could potentially give you the best result, you can get your pics to them for a virtual consultation or the ideal being an in-person exam and consult. After getting your questions answered and discussion of your life-long goals, you are then in a better position to evaluate which doc is right for you.

Thanks Spanker. I was about to comment on the yield issues with dense packing. In theory, it's a great idea and obviously more revenue for the doctor/clininc. I have not seen however many clinics that do it well, meaning survival rates or consistently high yields to support the idea. When we get into dense-packing we are talking about literally thousands of recipient incisions being created in one setting. And obviously the more incisions created and the more closer they are in proximity to each other, the more potential tauma that takes place, including swelling. Oh sure I recognize the improvement of using the tiny micro-blading to allow for closer placement of the FUs and depending on the use of saggital/lateral incisions, lots more hair can be moved with less overall trauma and swelling. But even starting with a completely bald surface, I never see the need of getting into 80 plus FU cm2 on anyone. And the better the hair characteristics and hair quality, the fewer grafts needed to achieve the illusion of coverage. I remember when dense-packing was the buzz in these forums about 5-7 years ago and it seemed to die out simply because very few clinics were able to pull it off with high survival and do it consistently. Generally speaking, whenever I have seen patients get above say 60 FU cm2, the corresponding yields go way down. Could that be why we NEVER saw any yields reported or even tracked with these "super sessions". IMHO, I would rather go in and get 40-50 FU done, let it all grow, and then come back for a second pass. Just my opinion.

Gupter, If I could add a few thoughts. Try to wait it out longer. Over thirty years, I have seen many, many heads losing hair. Most young men who progress to your level in your early twenties, generally leads to class 7. Most of these men have men in their family histories who have reached class 7. Yet at the same time their fathers, grandfathers never took Propecia. Yet you are taking it and having some good experience with it in slowing down the rate of progression. What I am suggesting is that you wait it out to see how you respond to finasteride Proecia over the longer term, meaning if you look pretty much the same at 30, then I agree that you could potentially keep a higher mature hairline without alot of density. Your building more definition and closing back the temporal lobe areas. Leave your crown alone for now. I would not even touch it if and when you might begin. You might even consider keeping your hair cropt short and producing the coverage but at a much lower FU per cm2. It creates the illusion of "less is more" with that type of hair style. You see alot of guys in law enforcement wear that style. If however you notice that your rate of loss has increased in spite of being on Propecia, then you might not want to even get started on surgery. We are throughout the day mostly viewed from the front and if you are 6' or more in height, most people won't notice the thinning in the bridge/crown area as much when viewed from the front. If your loss continues to stabilize, you want to start with very conseravtive goals seeking the advice of an established reputable surgeon. Best wishes to you my friend...

mahhong, The most critical aspect to your case is the meds issue. Your father, grandfathers, did not have finasteride or minoxidil. But you do have them available and you stand the probability that it will slow down the progression of MPB, and hopefully to a great extent. Propecia works efficiently for a very high percent of men. I personally choose to cut Proscar into four pieces because it's much cheaper than paying the high price of Propecia. I must be responsible though to point out that Propecia was developed specifically for treating MPB in men and it is Propecia that is approved by the FDA, not Proscar. Did you ever ask yourself, "What would the men in my family have looked like if they had Propecia available to them way back when?" Not sure how much of this you already know, but be sure to do your homework on effective hairloss meds. IMHO, there are only three worth anything. It's finasteride, the active ingredient in Propecia (1 mg) and Proscar (5 mg). Then there's dutasteride which can potentially inhibit both Type I & Type II DHT. Guys who try dutasteride usually purchase Avodart prescribed by their doctor. Minoxidil is the third and usually recommended at 5% strength and topical through the most recent popular Rogaine foam product. The best way to predict the extent of one's hairloss including the potential "pattern of loss" can be best compared to one's family history. Your maternal grandfather hit class 7 and although he did not get there as quickly, you are probably headed there IF, and I repeat if you do not get started on finasteride at 1mg per day. There's no guarantee that it will save your hair but you'll never know without giving it one full year and following the daily prescription faithfully. You can purchase a densiometer at Radio Shack for under $20.00 US OR simply buy a magnifying glass with a handle. Then take samples of your hands strands wherever you think you may have any "diffusing" going on. Then take several terminal hairs from your donor region in the occipital (lower rear) area of your scalp. You then can tape the strands close togethor on a sheet of white paper. That way you can compare all other hair samples to the terminal hair to notice any changes in "hair shaft diameter". Hair caliber is another term for hair shaft diameter. Any decreses in hair caliber will imply that it is hair that is miniturizing from the effects of MPB. As the years go by, you may notice continued decreses in caliber until that hair becomes so thin that it loses color and turns vellus. The point is that you or anyone else will be able to examine your own hair samples over time intervals under high power magnification. A 30X empowerment is sufficient. If for example you continue to compare hair in the "sides" or "rim" area of your scalp, you will notice very little to no change signifying that that hair is terminal, meaning non-receptive to DHT. And most people do not lose hair in that area of their scalp. Some guys can thin out in the rim area and even the occipital area which is supposed to be terminal hair. Yet some guys will in fact lose hair in that region as they get older. That is also why I am more of a skeptic when using "nape" hair from the neck area because nape hair is not necessarily permanent. It can be lost. How do you know if it will happen to you? You have to again take a close look at family history. So if your maternal grandfather who turned class 7 has also thinned out in his rim, sides, or back donor area, then there's a good chance you will too. That's why the meds are so important for you in the equation. They can potentially buy you time. Hope this makes some sense my friend. Best wishes to you mahhong...

azjoe1, You ask a good yet controversial question my friend. From a clinical standpoint, it is anyone's guess who actually is harvesting the grafts during a FUE procedure. Years ago, when FUE was first introduced in North America, ONLY licensed physicians were actually doing the extractions. Why? Here comes the controversial part. It's because in most states in the US, if not all of them, only allow a licensed physician to "cut flesh or tissue". And in fact the period I am speaking of is late 2002 and into 2003, there were only several licensed doctors in the US actually performing FUE and they were new to it. There was one licensed physician in Canada doing FUE prior to 2003 and still doing it. Not that I am officially speaking for any of these doctors or clinics but this issue came up back then and the majority were also of the opinion that only a licensed physician could legally "perform" the extractions. Techs are not licensed doctors yet I hear about techs doing the extractions and/or a variation of the harvesting process. In some cases, the surgeon makes the inital cut with the punch and then passed the process to the tech to finish extraction. There was a clinic based out of Jacksonville, FL three to five years ago that was owned and operated by a tech and heard that he was doing 100% of the extractions and even did the recipient incisions. They apprently had a licensed physician "present" but the tech did the procedure hands down. I remember getting into the discussions in several forums and am still of the opinion that only a licensed physician should be performing any part of the procedure that involves "surgery". You mentioned that most of the docs place the grafts but the reality is that very few docs place the grafts. An extreme high percent of them are placed by the techs.

It really depends on the type of activity that you are doing and how frequent, how much tension is being introduced to the area like you would get from doing sit-ups. The other factors to consider are: how the patient has healed to date, could this be a subsequent procedure where laxity was somewhat tight to begin with, the closing technique employed by the doctor i.e., double-closure, staples, etc. Generally speaking, once you get beyond the three month mark, it is very rare to see a strip scar stretch.

First and foremost, go back to the post-op instructions that your HT doctor or staff provided you. You could easily call them if you cannot find them. The reason I say call your doctor back is because some doctors favor the use of certain post-op shampoo products like Graftcyte, Tricomin, etc which can advance the healing process. Otherwise, most clinics will advise you to shampoo daily by applying the suds to the grafted area, being very careful not to rub off your crusts too early. Simply rinse off by pouring room temperature water over the area. Do not use high pressure to rinse. For most patients, the crusts remain for 8-10 days post-op, then they are ready to remove by gently rubbing them while wet in the shower. After roughly three days post-op, it is very difficult to lose your grafts. Best wishes to you as you heal...

I had asymmetrical regrowth on all four of my HT procedures. That's why it takes at least one full year to not only have the transplanted follicles begin growing again, but to also gain some length considering the average growth rate of 1/2 inch per month. I think you will be just fine once you hit the one year mark. Happy growth to you...

Out of curiosity, what did you find in your search?

TP, Your welcome. Sounds like the variance in how you healed especially the epidermis. That can happen. Have you thought of having hair grafted into the scar which would ultimately be less invasive yet may help in covering the scar? You may want to do a small "test" or pilot session to see the results first. Best wishes to you.

AndersUK, Yes some patients do have coarser hair characteristics in that region and sometimes utilized when doing facial restorative procedures. I believe this is one of the arenas where FUE (isolated extraction methods) can be very practical to allow the surgeon to selectively pick the best hairs to transplant.

Clint, The results have been varied quite a bit from feedback I have received. Would like to hear more over time before any concrete conclusions are made.

Hey Packers! Hey it's great to hear that things are progressing well for you!

All three doctors mentioned do GREAT work and cannot go wrong with any of them!

EastCoast, Have you considered implanting some hair into the linear scar?

Brav989, Right now I am probably at 40-45 cm2 with semi-coarse hair, slight wave and a wide color contrast. It is very difficult to see my scalp in the frontal to mid-scalp regions unless my hair is wet. I figure am at about 50% of original density and happy. There will be some variances depending on your own individual hair characteristics.

pete68, Hang in there my friend 'cause the best is coming! You will want to give it a full year to fairly evaluate the end result.

Powerplay, Are you by chance a hockey fan? I like your handle and BTW, nice to hear of your positive experience with Dr. Charles!

Hi Galevin, Welcome to this community! I too am in the 50 club, had three strip procedures in my lifetime and very happy with my current look. I had three different surgeons and only somewhat dissatisfied with the second doctor. The first and third procedures were very good. Really there are a number of very talented HT surgeons specializing in state-of-the-art ultra-refined FUT procedures. IMO there is no such thing as "one" doc being the best. WHY? A fair amount of happy and satisfied patients will tell you that "their" surgeon is the best based on "their individual experience" with that surgeon. And one has to somewhat respect that admiration especially when the work IS very good and aesthetically pleasing. Look up hairsurgeons.com where you will find a Coalition of Independent Physicians dedicated solely to state-of-the-art procedures. Best wishes to you and keep us posted on your progress!

rsanders36, Wow, another story all too familiar. Have you started a medicinal regimen, specifically Rogaine (minoxidi) and Propecia (finasteride)? You really owe it to yourself to research and consider these two primary meds that are the most effective in treating MPB and the only two approved by the FDA. Yes genetic hairloss is progressive over a lifetime and you are probably noticing this more in your father since he is older. That's why surgical hair restoration requires "life-time planning" when dealing with a prudent and responsible physician. And there is a "world" of difference in this planning depending if the meds work efficiently for you or not. If not, one has to consider their own individual donor reserves in terms of grafts (FUs) and where they will be placed since there is never enough to cover the entire balding area. That's why so many ethically responsible physicians will want to start their younger male patients on Propecia for at least one year before ever considering surgery. I admire the one doctor who wanted you to wait rather than taking your money. For younger men with more advanced levels of MPB in their family histories, hairlines should be more conservatively placed. If not the patient is then committed to filling in behind the transplanted hairline which may be too low for the limited donor reserves. And many, many patients experience an advancement of their genetic hairloss from a procedure as was stated by many posters. You then are committed to filling in behind the low hairline as you lose more natural hair leaving less and less donor for the mid-scalp and crown. A fair amount of younger patients also experience a permanent shocking out of their natural diffused hair from each procedure. I at times wonder if some of these docs do it on purpose just to keep the patient coming back over and over and then they are told they need more grafts over and over. It can be like a broken record, never ending. But now you are doing the right thing. RESEARCH! I commend you for sharing your story with us which is not easy to do by any means. You have a world of resources available to you in this community and many of us to encourage you along in your journey. Keep reading, keep asking and know you are on the right track!

And over time it takes an immense amount of money to pay for all of those immense amounts of maintenance!