gillenator

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.

Hi Talonload, Welcome to this forum! I wore hair systems myself for nearly 11 years and had three procedures for a total of 4400 grafts. I wish you the best as your procedure grows in. Now hopefully you have not had the procedure yet. If not, you want to purchase a new system with a slightly larger template. That way the edge of the system will be attached a little bit lower in circumference so it does not adhere to any grafts. Obviously you would not any tape over any part of the recipient area. In addition, purchasing a new system will allow you to reduce the density of the system or certainly have your existing system(s) reduce density. This will help with the transition in appearance once you go from wearing it to not wearing it. I have found this out in my own experience and also working with other patients helping them also to transition out of hair systems. People get used to seeing us with high density in systems and is part of the problem with detectability. If you methodically begin to reduce the density over a period of time, hopefully your current system will better parallel the density of your fully matured transplant. The other thing to consider is having the surgeon situate your hairline a little bit higher say a full cm if you cannot buy another system. You can always have it lowered in a subsequent procedure once the first procedure grows in. Most guys who wear systems will want a second and even maybe a third procedure to achieve sufficient density, meaning "the illusion of coverage". If you choose to not purchase a new system, you can always go to an anchoring method instead of tape or polyfuse. Consider having as many grafts safely placed as possible without compromising yield. The reason is that you do not want to have to continue wearing the system once the first procedure grows in. You want to be able to go for the subsequent procedure as soon as the first one matures. Lastly, wait 8-10 days post-op before you begin wearing the system again. Be sure all of the crusts (scabs) have come off which usually takes a week or so. Consider utilizing a post-op healing treatment like Graftcyte to expedite the healing process. You may want to consider taking some time off from work to allow the recipient area to heal. I sincerely hope this has been helpful to you and best wishes.

Well if part of his donor scar is visible, possibly he had more than one procedure. Definitely sounds like he is enjoying an on-going, successful career. The guy I really feel sorry for is Tom Arnold and he was just on the Tonight Show. I know he had multiple procedures, but his transplants were situated so high that his hairline commences "behind" the front forelock. Everytime I see his side view it looks his hairline starts in the vertex area, but if he is happy with it, then he achieved his goals. Still I think he would look better with more grafts placed "at least" in the front forelock area to "pull" everything togethor. Then he would simply look like he has a very high hairline but it would at least serve to frame his face better, IMO.

Hi Bill, You are doing fine and yes there is more to come both in new growth and caliper development. At 4-5 months post-op you have approximately 50% new growth and then add another 10% for each month that passes thereafter. But it does take as long as 14 months post-op to achieve full maturation. Since caliper is the single most important factor in achieving the illusion of coverage, you really won't see the full visual benefit for a year or so. I went through it myself, especially after my third and largest procedure of 2400 grafts. I also had been using Toppik until that time. All the while though, I kept looking in the mirror and saying to myself "this should look like more coverage" and I could still see a little scalp until 14 months later. It was like one day I realized that I could no longer see my scalp once my hair was dry and groomed in place. That is when I truly could visualize the full benefit. You said you are noticing the new skinnier hairs, not as fat as the other ones. But a year or so later those new transplanted hairs will be as fat as the others and that's when you will notice the full benefit too. That is why I always advise patients to wait at least one year before their subsequent procedures. I mean who knows, one year later maybe you won't need as many grafts that you thought you might need looking in the mirror at say nine months post-op and trying to assess future needs. And everyone is a little different in their rate of growth, coarseness of hair, and hair characteristics like wave. One thing I know for sure is that you have more comin' your way!

Dr. Beehner, Thanks for the response. I know of one surgeon who claimed his post-op application bore an anti-oxidant to help retard the effects of ischemia reprofusion. I kept asking him if he was tracking the yield differentials but he never provided me a satisfactory response. Possibly there is some merit to his product and at least there was some effort in developing a retardent to promote graft survival. Independents do not tend to "stack" procedures on the same day. This takes place more with the hair mills and believe me it has and still exists. It is called itinerant surgery scheduling. You see some mills have the same doctor covering as many as three clinic locations in the states they are licensed. They then break-up the month with the doctor in one city for a few days or even a week. They stack all of the enrolled procedures for those few days and will do as many as 8-10 cases in two days. They typically have their surgical staff travel with them from city-to-city. The techs are jumping from patient-to-patient, from one OR to another to get the grafts cut and placed. Having the same staff start at 7:30 am and not quitting until 9pm or so. The staff is worn out and yet they come back the very next day and do it all over again. They work on quotas because they have increased overhead to cover, namely the satellite office and the traveling expenses of the doctor and staff, not to mention the huge media advertising costs. I still hear about it every now and then, but not as prevalent as over the last decade (nineties). Then the entire staff leaves until the next two weeks or next month and the only person left in the office is the sales rep who all along is selling as many procedures as they can for next month. No one there for post-op issues except the sales person who many times is more concerned about earning their next commission than post-op care of the patients. You may not be as aware of this itinerant procedure approach, but it has and still does take place. Hopefully this is subsiding but I feel there should be some some limitations on caseload per day in the interest of quality and patient care. Thanks again for your feedback.

Bill, Possibly you have also read that hair follicules fulfill a three-phase cycle throughout our lifetime. The first phase is anagen (growth) and averages approximately six years or so in duration. The second is telogen (rest) phase and typically lasts three to four months. Then the hair sheath disengages from the root and dermal papllia which is the catagen phase (shed) before the follicule re-enters the anagen phase all over again. It is true that re-growth in the crown can be slower. That can be related to the resting phase taking a little bit longer or the anagen phase coming in a little slower in the crown area. The blood supply in the post-anterior area (crown) may not be as rich as the frontal zone. The mid-anterior area (vertex) can be the same way and also can be more subject to shockloss as a result. Possibly these mid and post areas of scalp re-act more acutely to the trauma caused by the incisions. The finer white hairs you are noticing may be some weaker natural hair that are coming back or it's the beginning of terminal hair growing in or a combination of both. Either way, the pigmentation should begin to resume as the new growth matures. The area below the crown that you mentioned is starting to show thinning is the coronet area and can recede lower on those men transforming from a Norwood 6 to 7 in that specific area. Now it's a great thing you are on finasteride and I especially was happy to read your last post that the higher rate of shedding has stopped. You probably are aware that we shed hair on a daily basis which is normal. Yes finasteride can slow down the thinning in the post-anterior area and that is where finasteride is the most effective for genetic hairloss. However the chances of it growing back what you already lost are not very good. I wish I could say the opposite. Through the years I have noticed that approximately 40% of men between 19 and 25 years of age have "re-grown" hair in the post-anterior area. Patients over 25, the re-growth is almost non-existent or very minimal. Even those cases over 25, the re-growth appeared very fuzzy and typically did not achieve the length and caliper that it originally did before the ill effects of DHT causing miniturization. So from what I have seen from a clinical standpoint, finasteride helps more to "maintain" what is left. Are there exceptions? Of course, but far and few between. So if you do realize some favorable re-grrowth, take it to the bank! Give finasteride one full year to evaluate stabilization of hairloss and eighteen months to evaluate any re-growth. Just keep in mind that what is working today may not be effective over the long haul. I have been ingesting finasteride for about eight years and still quarter Proscar into four pieces. To date it has still been efficient for me so that is promising. Everyone reacts a little differently to meds especially over the long haul so it is prudent to plan restoration from a perspective of life-time planning, keeping some reserve for any future loss. Also glad to hear the bumps are going away which does take time. Soon you will notice the redness going away as well. Do not be surprised should you notice a few red bumps in the recipient areas as the new growth comes in. In-grown hairs which appear as pimples can be common especially at the stage of post-op that you are at. Hey, best wishes Bill!

Dr. Beehner, I applaud the posted findings of your clinical trials regarding yield and/or graft survival. This is the type of release we all appreciate and I for one have been insisting on this type of documentation for microscopic dissection methods of strip harvest and even more so for isolated extraction methods i.e. FUE, FIT, FUSE, etc. Since transection has always been one of the main concerns regarding yield for this technology, not to mention the higher graft prices, why do you think there are not more clinical documentation being released? Possibly there are very few tracking this on their patients. Your method is very defined by identification of recipient area in cm2 surface areas. Are you utilizing a video telescope to aid in the count? I also heard of some medicinal trials using an ink that was colorless and can only be seen with neon lighting so tatoo ink would not show. I know some docs use "dots" to mark the areas but just in case the patient were to shave their head one day? I wonder if you have heard of it. The yield results sound outstanding to me in the 90% and higher. Alot of us encourage larger sessions on the first procedure for the very reasons you pointed out (virgin scalp), and yet it is very interesting to read about the drop in yield when the number of recipient incisions are increased within the same surface area along with the decrease in subsequent sessions. How much of a factor do you believe the effects of ischemia reprofusion have on graft survival? In those large clinics where three or more procedures take place on the same day utilizing the same staff, and the specimen sits outside the body, sometimes for hours before placement. Some say it has a pronounced effect, others say it's not that big of an issue. Still the isolated extraction techniques provide the ability for quick placement (sometimes seconds) into the recipient sites unless single hair grafts need to be cut. Lastly, congratulations on the impressive yields and you have must have some very experienced and talented techs with microscopic dissection. Keep the data coming!

Rainman, Good to hear things are improving day-by-day. You will find that over the next several months, things will start looking and feeling normal. Now the best is yet to come, GROWTH!!! Keep us posted on your results when you can. Take care.

Rainman, You might also be experiencing a knot that does not seem to dissolve? That can be snipped and removed if so. Also sometimes there are ingrown hairs that can appear at the suture line and may have to be opened to allow the hair to come through. If you are close to your surgeon, possibly go in for a follow-up if you have any any discomfort in the area. Happy growing!

Hi TF, Welcome to this forum! I have heard of and seen your situation with the female version of MPB. Since women also produce testosterone and DHT hormones like men, they can be subject to this same type of genetic hairloss, and it sounds like you are doing your research which is very good. I have noticed this type of genetic hairloss in approximately one of three women and there is alomst always a genetic history of MPB on one or both sides of the family. Also glad to see you had the preliminary bloodwork done which is critical in ruling out the other potential causes of female hairloss which can be many. Now you mentioned loss "on top" of your scalp. Is it isolated to that region or do you have any retro-alopecia just above your ears and possibly thinning that is commencing up the neckline in the back of your head? If the loss is isolated on top, go back and view the "ludwig" pattern of loss and see if you fit into any of those classes. Either way, from your comments, it does not sound advanced at age 30 and yes the other changes you mentioned can cause or advance hairloss as well. You probably have heard of minoxidil which is the only FDA approved hairloss treatment for women. Have you tried that with any resolve? It comes in several strengths and as you may already know, can be purchased over-the-counter. There are other cosmetic products like Toppik which can work miracles visually speaking in hiding diffused thinning. Since you are in NYC, there are several reputable HT surgeons who can further evaluate your situation by exam and may even suggest a scalp biopsy which I doubt in your case, but that is a subject you can discuss further with the doctor. The two I often recommend are Dr. Alan Feller and Dr. Robert True, both MDs. Because you are open to travel, I would first compare some recommended doctors on this site as to their feedback addressing treating genetic hairloss in women. Ask them their clinical approach which includes transplantation, how many cases they have on females, how many female patient references you can contact, etc, etc. You may want to also consider someone like Dr. Sharon Keene in Arizona who is talented, ethical, and may have done more female cases. You can always e-mail you photos and background to any doctor out of your driving range and then begin to narrow your selection. Also read and ask about potential shockloss which can be prevalent in patients with diffused thinning like yours. The trauma to the scalp from the recipient incisions can shock out the natural diffused hair you have there where you are thinning. Shocloss is also unpredictable so do not let anyone talk you into doing a large session, rather approach it more methodically because you can always add to the density later. Make sure when you are examined that "your entire scalp" including the donor areas are examined for potential "miniturization". This will tell exactly where DHT is affecting your scalp. The HT surgeon can also examine the outer perimeter of the area that is thinning to evaluate future recession or loss in the future. That will provide you some additional insight for future planning when anyone considers their donor limitations. Lastly, if you find a doctor on the internet and are unsure of their reputation you can ask about them on this forum and hopefully receive more feedback. I wish you the best LF in your search for resolve and let us know how things go!