gillenator

Damo,

That all depends on what is in the recipient area right now compared to your virgin density levels. Since this will be your second procedure, are you having the same areas worked or are the grafts going intpo a new completely bald surface area?

Generally speaking, if your restoration can achieve 50% of original density, you should get good coverage. Possibly you desire higher density levels than that especially if you have straighter hair, not as coarse. Any wave or curl characteristic will help the visual for appearance of density.

Neil,

Glad to hear that new growth in the donor near the scar is coming along well.

Some things just take time and hopefully Lurker and Eric will see similiar results very soon.

It is extremely rare to see permanent shockloss in the donor area so the odds are in your favor guys.

Lightning1,

Glad to hear of your great experience with Dr. Rassman and staff. As you probably know, he has been around a very long time and does some very good work. He is credited a great deal for his contributions in FUT technology in the early nineties.

Thanks for your input and we will look forward to your results along with you. How many grafts did you have done and did you do a strip excision or FUE?

Have a good night's rest and wish you the best in your healing and future GROWTH!

Hi Bluesman,

I remember a few of your posts back in 2003, and I must say that the current pics you just submitted this month in March are absolutely awesome!! Everything has filled in very nicely!

Just curious why you want to add more to the hairline. Are you trying to lower it a tad, or are you going for more density and definition?

Dr. Shapiro was my first HT surgeon which was back in 1996 and my hairline came out so natural that my ex-wife thought my hairline was just growing back, and so did a few others as I kept it very secret. I was a Hair Club for Men client before that.

I am 50 years old and had a total of three procedures. I do not know how old you are but your recent pics show your full face and for whatever it's worth, I think the density looks great right now. Once I hit over 40 yrs old, I wanted to be careful not to add too much in the front because I felt that would start to look a little unnatural for my age. But that's me, not necessarily your thoughts.

The younger one is, the more critical it is to save donor for any future loss. Also, I have seen men in their late fourties and so begin to lose hair which seemed to be more evident in the crown. Is there any of that in your family history? I do not remember if you are on Propecia or not. From what I recall there is not extensive hairloss for you but feel free to correct me if I am wrong.

Hey, I saw that you are a guitarist so with a handle like the "Bluesman", you no longer have to sing the blues regarding hairloss! Best wishes to you.

Rashomon,

Whoa!!! Lots of good questions but I would suggest that you do some more reading and research. You mentioned that you do not wish to wait 9 months or a year for results but whether you initially embrace your hairloss with a medicinal approach (Propecia) or consider HT surgery, nothing is an instant fix, anything takes some time. I am not sure how old you are but I do know that it took some time for you to reach Norwwod 5. Propecia (finasteride) takes up to one full year to accurately evaluate its efficiency, and a HT procedure takes up to one full year or so to fully reach maturation. So either way, you have no other options than to wait for results.

Neither Propecia or minoxidil will re-grow all of your hair back. You may experience some re-growth but probably would be very little since you are already at a more advanced class of genetic hairloss. And remember, neither medications nor HT surgery will cure hairloss. They simply buy us time since genetic hairloss is progressive in our lifetimes.

Also, none of us here in the hairloss community can tell you that yes, you need a HT. No one ever "needs" a HT, but it can be something desired based on making an "informed decision".

Now it is not my intention to offend you in any way but rather offer you some helpful insight as I suggested to you on the other thread. You owe it to yourself and only "you" to get your questions answered by reading up on these subjects.

Once you have gained enough knowledge concerning the dynamics and implications of hair restoration, you will have the confidence to make the decision that you feel is best for Rashomon, even if it means you decide against the procedure.

Take a deep breath and do not try and absorb too much at one time. Many of us here know exactly how you are feeling and yes it can be overwhelming. Start at the beginning, understanding hairloss and then how it can be treated. Best wishes to you!

Smoothy,

You may want to read about Dr. Craig Ziering's "whirl" method of restoring the crown. I believe he was awarded recognition for this at one of the annual ISHRS conferences and I think it was the 2002 conference.

He does have a relatively new website since he left MHR in 2003 and moved CLEAR across the country from NYC to California. I heard he was doing "tons of cases" in NYC and imagine he was making the big bucks so why he just picked up and left his market in NYC is surprising especially since he has been with MHR from their beginning days.

He is NOT anyone I would recommend however possibly there are other HT surgeons who approach crown restoration similiar. My guess is that other attendees at that conference may be able to also get you some information on his method.

You should find lots of answers to your questions just by reading the material. It probably will also generate questions that you may not have thought of. Welcome to this forum and best wishes on your research!

Hi JayJay,

Welcome to this forum! At four months you should begin to see the re-growth but it does take up to one year or so for the procedure to reach full maturation including caliper development (diameter thickness of original terminal hair). Sounds like everything is right on track.

Not sure how many grafts you had done but you are sure to see more comin!

The desire to wear a short buzz cut is one of the primary reasons why someone would prefer these isolated extraction techniques. Younger patients who do not have a known family history may find this technology helpful in case they realize much more dramatic levels of hairloss as they get older. They may opt out for the buzz cut later in life and not want any detection of a linear scar.

Now obviously there is some level of scarring in either method of harvest strip or FUE, but in general FUE/FIT/FUSE leaves less "visible" scarring when done by a talented surgeon. Yes there are cases where the "moth-eaten" or "white dot" appearance is more evident on some patients and not as pronounced as others. How a patient heals can have a bearing on the outcome and there are those types of differences between patients. And the more extractions that are made (larger sessions), the more potential to notice the white dots or spaces where the FUs were taken.

I've had many opportubities and still see patients who had basically the same amount of extractions taken from their donor areas, yet one patient may look more depleted than others and/or the visible dots so-to-speak. My perceptions are those differences relate to the size of punch used 1mm and .75mm, how close the extractions were made to each other, how well the patient healed, and even dark coarse hair with a very fair complexion, compared to blonde hair with a very fair complexion which can make the spots or missing FUs less noticable.

I've also noticed several patients who had the redness of scalp complexion in the donor area that seemed to linger on for awhile. This redness obviously can happen with strip excisions as well and not uncommon to take as long as a year or so to lighten up. The few patients who displayed these areas of lingering redness were very fair-skinned which was/is something I noticed. Obviously there are exceptions.

There are some very fine, barely detectable scars from strip excision and have seen some who buzzed their head and could barely see the scar up close.

So FUE/FIT/FUSE may also be great for the patient who desires a small session like mildly touching up the temporal lobe areas and hairlines. But since genetic hairloss is progressive in its nature, most patients will undoubtedly lose more hair and want more work done. Then what, more FUE? Will that not deplete the donor areas further and could it at some point leave a more depleted or moth-eaten look compared to a fine linear scar and wearing one's hair a little bit longer to hide it?

And I agree that there are very limited data published on transection and yield. It is not as complicated to monitor as some have suggested on other threads.

Dandare75,

Trust me. You were doing the right thing with the right doc which many, many patients can and have attested to. Dr. Shapiro restored most of my front hairline nine years ago and it still is growing and still looks as natural as ever. That was almost a decade ago! His work is simply indisputable and believe me, "you're gonna like what's comin!"

Hi Kienast,

Welcome to this forum! Since you are interested in strip excision or the FUT procedure, any reason why you are considering Dr. Jones for that? From what I have heard, he is doing more FUE cases than strip. Are you considering and/or researching any other docs? I am not a Jones patient but hopefully someone who is can respond here. Best wishes to you.

Hey Chris2b,

Yes, I do believe I remember your posts when you were asking for recommendations in Colorado right? And at that time you were still establishing your consultations.

Very happy to hear of your positive experience with Dr. Harris as I recommended you to meet with him. Good thing you're on finasteride and also glad to see you are approaching this carefully and methodically especially since you are young as you stated.

Now the fun begins, the growth! Keep us all in the loop and happy growing.

I would like to add that age and yes even race can play an important factor in determining a restoration plan. The symmetrical shape and size of the skull should also be considered especially when designing the hairline, with consideration to the level of density in various recipient areas especially the front forelock. Flatter hairlines and obviously lower hairlines use more grafts.

I am also a BIG proponent of evaluation of donor potential including isolated extraction methods BEFORE any decisions are made. Equal consideration given to the overall potential of genetic loss based on family history. Let's say for example a 32 year old male in a Norwood 4 class with potential to progress to class 6 and even 7, has less than average density with an estimated harvestable potential of 4,000 to 5,000 grafts. And lets also add that he has been on Propecia for 2 years with good stabilization in the vertex and crown although there is definite loss that did take place in the crown before he started Propecia. The patient further states that all areas of loss bother him and does not like the 5x5cm bald spot in his crown. He is happy that Propecia seems to have prevented the loss in his crown from spreading out.

Should a patient like this go for the maximum session of 4,000 to 5,000 grafts and just get it over with? Interesting question is it not?

Possibly a more conservative or better yet, methodical approach would be better for a patient with this profile. And yet the patient may want to do a mega-session of 4,000 grafts or whatever can be excised in one sitting. This is not untypical especially in today's environment.

The biggest problem I have is the lack of documentation on yields. What happens if this same patient talks his doctor into doing the 4,000 grafts and for some reason the yield is poor or less than was expected. But there is little to no donor left and possibly this patient feels regretful about the whole thing.

Yet if he approached it more conservatively let's say with 1700 in front and another 300 in the crown to dispell the bald surface look but instead produce a thinning look, there would still be future donor to use for adding density later. And since hairloss is progressive there would be some reserve for the front considering he is only 32 years old. If his hairloss ends up to be less than expected, he will save some money in his lifetime. But if there were less than expected yields, that would provide him with the option of not continuing and again save money.

Would it be wise to approach restoration aggresively or methodically approach it to evaluate both yield and future loss togethor? Certainly alot to think about.

Glad to see Dr. Bernstein come aboard in the Coalition! He undoubtedly is one of the finest HT surgeons around and respected by his colleagues. I have alot of respect for him and Dr. Rassman as well for their influence in FUT technology and raising the standards of HTs.

Hi Some Dude,

Welcome to this forum! Did you have a diffused thinning pattern before your procedure? 800 grafts is not considered a big procedure however if you had a considerable amount of natural hair left in the recipient area, it is probably being shocked out.

You are nearing the three month mark post-op so by the end of this month things should start stabilizing regarding shock loss. Ideally, if you could have started Propecia at least six months before your procedure possibly the shock loss would not have been as dramatic. Now that's no guarantee beacause some folks shock more than others and as you have probably been reading, it's very unpredictable.

The good thing is that I believe the worst is over and you can focus more on the re-growth! By the way, what Norwood class are you? Best wishes to you.

Eastcoast,

Have not heard of a "lighting blade", what is it, custom made blades?

I know some HT surgeons have there blades custom made to cut precisely the exact depth and width of their lateral incisions to minimize trauma, promote yield, and accomodate precise graft placement. Some attribute a large part of the success of megasessions by this approach, precise incisions with minimal trauma.

Hi Neil,

Sorry to hear of the dilemma. It was difficult for me to see the details of the scar from the four pics. But from what I did view, the area looks okay at this point in time post-op.

And as you gathered already, yes in most cases the re-growth in the donor area should occur. It also appears that you are wearing your hair long enough to ward off any detectability, especially at your event in April.

I read your comment about having four prior procedures and in case the re-growth in the donor is not as satisfactory as you want it, you can always consider having grafts inserted in the area in the future. Best wishes to you on your future growth!

I think it's more clearer now as to what Nile was referring to. This type of pitting was also more prevalent before the prominence of lateral or saggital slits. Lots of HT doctors solely used syringe needles with some of the gauges far too big or invasive. Then, as was mentioned, the site is much too large for the graft placed and thus the "pitting" result. Good experienced techs are very careful as to not place grafts too deep, but sometimes they are cut thinner than the recipient site. And the recipient sites are created before the grafts are placed so the tech who is placing has no other option but to place them anyway. Obviously they are not going to throw them away, or maybe that happens more than we know.

I have seen "oval" appearing recipient sites but usually on a bad open donor (plug) procedure and there can be discoloration that is oval shaped and usually is red in appearance.

The results of these trials are astounding. It really then comes down to a gamble between longer mortality vs the occurance of growth of high grade tumors. I wonder if there was any distinction made in the core group of 19,000 men regarding history of prostate cancer in any of their family histories or if they were just volunteers for the trials.

Good point Robert. There is a tremendous amount of bacteria and germs under our fingernails, yet the natural reaction at times is to simply pop them using our nails. Everything sounds right on track!

Nile,

What do you mean when you say "oval recipient sites"? There are several causes for pitting.

Hi SustyGuy,

Welcome to this forum! It's nice to see alot of good advice was provided to you and others who may be in your situation as well.

Over the years I have witnessed some cases where there was large and even massive amounts of shedding in guys under 25 years of age. Not sure if you have this situation when you stated you were losing alot of hair at 20 years old. Did you begin to noticably lose hair several years ago and now at age 20 it appears as a pattern of genetic hairloss and/or recession? Or are you suddenly experiencing alot of shedding out of the blue so-to-speak?

If you suddenly are experiencing heavy shedding, it may be a temporary situation known as telogen effluvium. You can read up more about it if you have not already. It can be caused by a shock to our system i.e. stress, acute infection, etc. Normally about 85% of our hair is in the growth phase. With telogen effluvium it can almost completely reverse the phases with up to 70% in resting and 30% in growth. Obviously the result will be massive shedding but thank goodness it is temporary. By the way, this condition can happen to women as well and can be attributed to child-birth, ceasing of birth control, etc.

Back to the point regarding young men. I have noticed that young men who have a family history of extensive hairloss, like a father, uncle, grandfather in the Norwood 6&7 classes, sometimes also experience telogen effluvium in their early twenties. Most of the hair grows back (typically after four months), but in some cases it does leave a very defined pattern that can be equated to the Norwood scale.

Again, I was not sure if you are having some abnormally high shedding or if your hairloss has been methodical over time since your late teens. I too would highly suggest starting Propecia (finasteride) to see if you can slow down the loss and it is effective for most men. I have been taking finasteride myself for about eight years now and started it when I was a Norwood 5. There is no question in my mind that I would have eventually hit class 6 had I not started it.

As was already suggested to you, contact a good reputable HT doctor in your area, "get examined" for confirmation of genetic hairloss and ultimately get a prescription if you want to get started on Propecia. Then, "see if it works" which will take at least one year to fully evaluate any efficiency. Although some may not agree, I encourage you to not do any HT procedure until you are at least 25 years old. Believe me, if you are experiencing genetic hairloss that visible, that early, you'll have a much better idea of where it is headed if you wait another 5 years or so. Best wishes to you!

Spock,

You won't really notice normal growth rate of the new terminal hair until 12-14 months post-op.

It usually takes that long for the terminal hair cylinders to develop their original caliper. Once they achieve this they have no where else to grow but longer and that's when it usually catches up with the other hair.

To prove my point, be sure to get a haircut at 12 months post-op. Watch the rate of growth of the terminal hair to the natural hair not affected by DHT.

Some good advice provided guys! I just wanted to add that I have seen a good deal of the "guniea pig" patient especially military personnel who had the work done at Bethesda Naval Hospital. Since I live in the area, I probably have seen more patients from there than elsewhere, and most of them, if not all of them are desperately seeking repair work. None of them had to pay for their work because they agreed to be the so-called guinea pig.

Also, it is a common practice by some clinics, especially the hair mills to offer the patient a reduction in price IF they consider having their intern do the procedure. DON"T DO IT!!!

I can hardly tell you the many patients who bit on that bait only to end up needing corrective work, some with hideous scarring. Oh sure, there are always exceptions, but I would personally NEVER risk it. If a doctor needs to offer a patient the "blue light special", run for your life!

Talonload,

I just responded to your same question on the same thread you started under the Misc. category of this forum. Best wishes to you.