gillenator

Robert, Yes, you indeed are absolutely correct regarding the telogen follicules and you hit on an area that most of us do not think about. Both strip and FUE have their discarded waste and any way you look at it, there is more than 10% waste "thrown" out in the biohazard waste bucket! One of the big issues with strip is "time out of body", whereas the strip specimen is removed and then passed to the surgical team for dissection. A process known as ischemia reprofusion begins whereby free radicals begin to magnetize to the tissue which simply lies in saline to keep them hydrated. All the while and sometimes for hours, the tissue begins to deteriate and reduce potential for survival. The quicker that grafts are placed in the recipient area the better, however I have heard and seen the "assembly lines" where the clinic has multiple procedures that day, but few experienced techs who cut the tissue into grafts. Henceforth they jump from OR to OR and the tissue and cut grafts remain in the dish, sometimes for hours. This is not an ideal scenario so stay away from the assembly lines, and do not enroll with anyone who is more interested in how much revenue they can generate in one day in multiple patients. FUE is supposed to boost the yield because the extracted grafts usually are placed in the recipient area within seconds of extraction "unless" more single hair grafts are needed and then the extracted FU still has to be dissected. Robert, you are also correct in your reference to the angles and "j" formations at the base of the hair sheath in the dermis layer where alot of potential transection can take place. Does everyone see now why the 1mm punch is favored? In addition, the standard stainless steel punch does not allow the graft to slide out very easily so "crimping" of the grafts can take place. Some are so bad that they are often damaged when an attempt is made to remove them from the punch. Dr. Feller's punches have an interior wall which I believe can be removed allowing the graft to easily slide back out of the punch. Dr. Rose' dermal depth analysis allows his punches to precisely set the depth of extraction to minimize transection vertically speaking. I can only speak for myself Fabe, but yes from the many cases I have seen, and in my own personal experience of three strip procedures, cost is favored with strip, transection is far lower providing the surgeon and the techs who cut are good and they are properly staffed. Many FUE docs agree with this assessment as well including Drs. Rose and Feller. Dr. Rose has mentioned to me several times that strip is still the best yield when a patient is in the right competent hands. Most HT patients that I have experience with do not buzz cut their hair once it grows out, including FUE/FIT patients. The fine scar in my donor area does not bother me in the least because it is always covered and I never intend to shave off the hair that I so painstakingly waited to get back! I have had just over 4400 grafts in my lifetime and the last thing I'm going to do is cut it all off. That does not mean what is right for me is right for the next patient who may want the buzz-cut style. Either way, patients must understand that you cannot have your cake and eat it too with hair transplants. When you harvest hair from an area, the outcome is less hair either way you look at it whether there is a strip scar or the dots, spots, whatever. The recipient area gains coverage and looks better and more restored because it is indeed hair that covers the scalp. Most of us if not all of us get hair transplants to improve coverage where there is little to no hair left. That's the premise behind the procedure for most of us. Unfortunately there will be some level of scarring in either approach of harvest so each and every patient must think ahead and then decide which method best serves their goals. Smoothy, there are many, many patients who are on the sidelines with FUE. They just have not seen enough consistent results because as you said, it is still relatively new technology. If it were me as a new patient and needed lots of coverage, there's no question that I would favor strip to get the best yield and corresponding coverage. I could always go back and get hair placed in the linear scar as many FUE doctors claim a strip patient can do right? Still it is a personal decision for every individual. Best wishes to all!

Guys, All of you are right on target! And I do believe that the proliferation of dense packing hype is more marketing driven than clinical based. I have always encouraged patients to initially approach up to 50% density levels for adequate coverage. It is very rare that someone would need more to produce this "illusion" of coverage. Why over commit when the first pass has not even grown out and matured? Density can always be added to in a subsequent procedure. Can too much trauma to the scalp affect yield? YOU BET IT CAN! That's why I am not a big advocate of megasessions.

FUE is the abbreviation for Follicular Unit Extraction and FIT is Follicular Isolation Technique. Both technologies are based on a harvesting method which removes FUs independently from the donor area without utilizing the traditional linear strip harvest method. In other words, this is sutureless technology or so to speak whereas a micro-punch is used for the extractions. The result after post-op healing is supposed to be "no visible" scarring in the donor area. The technology is in some regard like the old punch-out graft approach except the punches are much smaller. Most of the standard punches used by FUE surgeons measure 1mm in diameter which is quite a difference from the larger punches of the stone-age plugs. Some FUE surgeons have tried punches at .75 mm and I even heard of an attempt as micro as .50 mm. I too have been keeping a watchful eye on this technology and I have seen many patients both in pics and in person. I have seen some great results in donor area healing and a few with in my opinion, not very good results or what Smoothy referred to as an over-depleted appearance. Arfy is correct in that the amount of donor rarely meets the demand side, if ever in a lifetime. I believe most FUE/FIT patients choose this technology over strip for the reasons Smoothy mentioned but also for the benefit of not having a strip scar that would show in the donor area if one were to cut their hair very short, number one guide or a shaved look. Anyone who had a bad result resulting in a wide strip scar can relate to this. As many of us know, FUE/FIT technology is being utilized more and more to implant hair into scarred areas where laxity no longer exists. Body hair extractions are being used to fill-in scars and to do other repair work. It seems whenever a FUE/FIT patient posts there pics, there are "varying" opinions. What one sees as magnificent work for post-op healing, another sees spots or redness, over-depleted areas, etc. Just read the comments whenever someone posts their pics and I was not necessarily referring to this forum. FUE/FIT may end up being the answer for the young patient over 25 years old who really has no idea of where his hairloss is headed and may end up buzz-cutting their head someday. Obviously he would not be able to do this with the linear scarring left with strip or could he? Could he later go back and have the linear scar(s) filled in with FUE/FIT? Or could the FUE/FIT patient who had 3,000 to 5,000 scalp grafts extracted and possessing a "wide" color contrast be able to shave their head and not have what appears as a patchy or moth-eaten appearance? Here's the burst in the bubble. Where are the clinical evaluations and findings regarding re-growth?!? Who is tracking the yield with some hard core proven reliable data? The biggest area of risk in FUE/FIT is TRANSECTION! In the hands of an experienced, skilled FUE/FIT surgeon this should be minimal and the good ones claim 10% or less. Based on what? That's the part we never hear or rarely hear about. I CAN tell you that punches under 1mm in diameter have proved to be disasterous regarding transection! Even the most experienced FUE docs like Dr. Feller will advise you that strip harvest WITH dissection of FUs under scope provide the lowest transection rates. And as Arfy pointed out, DONOR IS FINITE. Dr. Feller is continually looking for ways to improve transection and continues to improvise the instrumentation as is Dr. Rose with dermal depth analysis, and Dr. AP with donor area sealing, etc. All three of these FUE/FIT surgeons have produced some phenomenal results (scarring and yield) so like anything else, results speak for themselves. Drs Woods and Campbell also do very good work and pioneered the technology. FUE/FIT is very time intensive and typically costs twice that of strip so one has to really weigh all of the benefits of both approaches, strip or FUE including the cost implications. Dr. Poswal charges as less as $3.00 US per FUE graft and is located in India. He wrote me the other day and would like to do some seminars in the US however that will be some time in the future as more interest manifests in his work. Patients with what is considered as a "mushy" derm, DO NOT make good candidates for FUE/FIT procedures and are better off doing strip. Patients with a "tight" curl characteristic run a high risk of unacceptable transection levels. My advice on BHTs? Doing smaller cases seems to be the prudent approach especially when there is little to no published reliable data in this arena. BHT grafts can cost as much as $12.00 US per graft. OUCH! Can you imagine if the yield was poor? DOUBLE OUCH!! The patients must decide for themselves which approach, that being strip or FUE benefits them the most. I do believe this technology has its merits but so does strip and I do not believe it is a one or the other issue. They both have their place providing the patient chose a competent surgeon.

Some great advice from Smoothy!

Thanks Robert and Kez, I just hope Jenn gets a chance to read everyone's comments. There is a genuine comradre here at HTN that I as well as many of you appreciate. Thanks again.

Texas NW2, Well I am glad to hear that your donor scar is thin! Can you not simply allow adequate length in the back to hide it? If it is that thin, you should be able to get by with a number 2 cutting guide.

Dear Jenn-24, My word. Life is anything but easy. I really appreciate your post and I remember when I was diagnosed with Polycythemia approximately four years ago. When I first received the news and arrived back home, I started with the "why me?" scenario. First I was totally shocked, then angry, then depressed, and that left me afraid and scared of dying. I have so much to live for, my children, my family, my friends, the work I am involved in, and I especially wanted to be there for my only sister who was recently diagnosed with breast cancer. What changed my attitude? This condition I have requires routine therapy and I see ALOT of folks who do not have much time left whenever I have treatments or whenever I go in to see my hemotologist. Although my condition is treatable, it is not curable to date. Still there are so many individuals far worse off than my situation without hope. The key for me is to live my life's purpose and be true to myself. My purpose is to help those I can, be a true friend to those I am in friendship with and to live with the conviction that every human being has feelings and value. Life is very rewarding when we seek the best for others "and" ourselves. As tough as life can be for any of us, please do not feel that you are being selfish for wanting some hair back. And there is only so much we can do for others. Obviously hairloss has bothered and continues to bother many of us. BUT, as long as you are at peace with Jenn, and having the heart of gold that you obviously have, I think it would be great to do something for yourself. WHY? You are worth it because you too my friend are invaluable and so are your feelings. I really do not think people understand the psychological impact hairloss can have on those who lose their hair. My 100% proud Irish father whom I respect to the nth degree would comment to me, "there's nothing wrong with going bald, just be proud you are Irish!" My father of course has a full head of hair. I love him dearly, he just does not understand because he has not walked in my shoes. Many folks think that getting a hair transplant is vanity. I TOTALLY disagree. Why would wanting back what mother nature gave us vanity? We were established with hair and subsequently lost it. There is nothing wrong with wanting it back any more than an individual losing a limb and wanting it back. Jenn, if getting some hair back will make you feel more complete, GO FOR IT providing you are a candidate for the procedure of course. I bet if this man with the terrible burn situation was your friend he would say, Jenn by all means if you can obtain resolve, go for it. He of all people knows what it is like to lose something and I sincerely hope he has more potential for improving his appearance. Just be sure that you have the donor to fulfill your long-term goals. Well Jenn, stay in touch, you have many friends here. My mother had dramatic hairloss from an early adult age and so I can relate. Feel free to e-mail me anytime and I wish you the very best in life.

Hi Black_Hole, It is difficult to give you much feedback without having pics or more details about your case. What Norwood Class are you? What are your hair characteristics and just as important, what are your goals? The surface area you want restored needs to be measured once your new hairline placement is established. You mentioned having a "clean" head so I am assuming you meant no existing hair left on top of your scalp. How much of that area are you seeking to restore? There are many, many single hair grafts utilized in starting a new hairline with the larger grafts placed behind them so if you are in an advanced Norwood Class, count on several sessions providing you are looking for some good coverage. Have you started a medicinal regimen like finasteride to slow down future loss? If you do have some natural hair left in the vertex and crown areas, you may want to consider it otherwise you will undoubtedly need more work as you lose more natural hair in the future. All three doctors you mentioned do very good work so I am sure they would "fine tune" your graft count on the day of your procedure. They would more than likely refund you for any overage of grafts you enrolled for in case the count was too high. Obviously you have been doing your research based on your selection of HT surgeons which I commend you for!

Qvarnis, You mentioned that you had 2800 grafts already and it sounds like you want either additional coverage or more density to what is there now. Futzy has outstanding hair characteristics and remember you are looking at photos vs seeing him in bright light. Either way yes 5,000 grafts can do miracles in providing most folks good coverage. So if you want more, that is your personal decision and it sounds like you have enough donor for it. We can never assume everyone has the density and/or laxity to accomodate 5,000 harvestable grafts however most patients do have that many starting with a virgin scalp and having the work done by a good HT surgeon who will minimize transection. There are patients however who have already progressed to NW6 & NW7 and would potentially need more than 5,000 grafts but lack the donor to fulfill coverage front to back. In other words there are patients who have much larger recipient areas to fill in, but may not have enough donor/density to attain the coverage they would ultimately want. You want to get examined in person, have your donor density re-calculated, laxity re-tested, and then explain your goals to the surgeon. A good experienced HT surgeon will then provide you in what he/she feels is the graft count to achieve your goal based on "your" hair characteristics. And of course providing you have the laxity for it.

Hi again NA, I do not think Dr. Ron Shapiro is doing that much FUE/FIT although I know he is broadening his skills in that area. His current demand is still in strip from what I have heard so I know he is very busy. Dr. Paul Rose spends about half of his clinical time working with Dr. Shapiro in Mpls, MN and Dr. Rose does incredible FUE/FIT procedures. Dr. Rose is teaching his FIT techniques as he and Dr. Shapiro are long-time colleagues and had a major influence on Dr. Shapiro getting in the HT practice so most of their past are strip procedures. He along with Dr. Shapiro are highly recommended on this forum and others. Dr. Rose does most of his FUE/FIT procedures out of his Tampa, FL clinic and offers patients some travel assistance. His pricing is at $8.00 US per FUE/FIT graft up to 1,000 grafts. He charges $7.00 US per graft thereafter. I am considering a FUE/FIT procedure with Dr. Rose myself and would have done it by now but I have other out-of-pocket medical bills that are keeping me from getting it. If you want to write to Dr. Rose you can e-mail him at paultrose@yahoo.com and his direct phone number is (612) 965-4247. Best wishes to you.

NA, Yes about 40 grafts per cm2 should do it unless your original density is higher. 80 hairs per cm2 is the "avearge" density. Did you ever have your donor density evaluated by a reputable HT surgeon? That is what you want to do ultimately and it cannot be done through pics. You will need to have an in-person evaluation. Unfortunately not all HT surgeons pre-calculate density so be sure you ask the HT surgeons you talk to about this area. DO NOT allow anyone to "wing" it and simply respond by stating you have enough donor. Stay away from doctors who give you this type of response because obviously those types of responses imply that they are not wisely evaluating the donor nor the recipient areas especially considering future loss and the need for subsequent procedures. A good competent HT surgeon will also examine for miniturization which can indicate those areas where you may sustain future loss and will want you to plan accordingly with the reserves you have, not what you do not have.

Hi NA, The average patient bears 80 natural "hairs" per cm2. If 80 grafts are utilized, that appears to attempt to double what mother nature established us with since the "average" graft bears two hairs. And generally speaking, if you can achieve 50% of original density, you should get some decent coverage. As was mentioned earlier, be sure to consider the other areas of future loss so you do not over dedicate your finite donor to any specific area. Plan for the future. Best wishes!

Tatoo needles can cause far more trauma to the scalp thereby increasing potential for shockloss to the area.

Hi TexasNW2, Really and I mean really give some careful thought about this area. Most patients I have seen in person "do not" get a satisfactory result with a tatooing approach. Most of them have regretted it later on. The reasons are that more times than not, more thinning occurs in the area later on which makes the area more noticable. Shock loss can occur post-operatively and the hair may not grow back making the area even larger which would defeat the reason of this approach and even put one in a position of having to do more. Tatooing does not camaflouge that well in bright light. The ink can change color and/or shade somewhat over the years. You would never be able to shave your head in the future in the event your hairloss would become more dramatic. I have seen several guys this has happened to and they ended up in hair systems because they could not shave their heads. My recommendation is to utilize Toppik or some other form of cosmetic make-up that will wash out and not leave any permanent marks. Now I realize that you were referring to your donor scar as my foregoing comments also referred to other areas like the crown. The problem with tatooing the donor scar is that scar matter does not absorb ink like tissue does and is very difficult to get a uniform result throughout the scar. Have you thought about a possible scar revision first?

Hi Qvarnis, Terminal hair grafts can indeed be harvested from the sides of the scalp however only FUE/FIT should be considered in harvesting that area as laxity can be far less in the sides vs the back area. There is little to no visible scarring utilizing FUE/FIT extractions. And that in fact is the reason most surgeons are reluctant to pull a strip from the sides as the potential for a wide scar is increased quite a bit. JoeHT, Good comments and I could not agree more. Most juvenile hairlines commence from the frontalis area. "Adult hailines" generally are situated approximately four finger-breadths above the eyebrows and even higher if a patient desires a more uniform coverage approach as you mentioned. Just getting a frame back in the frontal zone can make a tremendous difference in detracting away from a bald appearance. If all goes well, the hairline can then begin to be slightly lowered in a subsequent procedure(s). Best wishes to all!

Greenpanther, It really sounds like you will need to keep your hair longer in the donor zone which should cover the appearance of the scar. As HBT stated, give it more time to improve, and let us know how the recipient area comes along. I hate and I mean hate hearing about these experiences and thank goodness there are many other good HT docs out there that can help.

Cleanhead, Thank you too for your nice comments my friend. I think everyone who has posted on this thread wants the best for you and none of us would like to see anyone regret any decisions whether it involves hairline placement, density, or really anything without being "fully" informed. There are many veterans on this site who wish they had the foreknowledge back when they were younger and so there is a wealth of information that we can share with each other. Life's blessings are the richest when we reach out and help each other. So my friend, I wish you the very best in all of your informed decisions and always know you have genuine friends at this network. Keep us in the loop! Hi trspl, Thanks for the encouraging words and I wish you the best as well! Take care.

Hi Needrepair, Are you having FUE/FIT extractions done for your hairline repair? There has been some significant success with this regarding the thinning of plugs, removing badly angled hairs, mini-grafts, etc. With an experienced FUE/FIT surgeon, there is more potential for less visible scarring which is especially important in a high visual impact area. Best wishes to you and Gregg.

Hugh, What an incredible difference in coverage from your first photo to the most current one! The scar looks very thin and in good shape. It looks like very nice work and I too can hardly wait to see your pics down the road! Congrats!

Arfy's correct. I turn 50 in January and do I still care about my appearance INCLUDING my hair? YOU BET! In fact I hope to have one last procedure and I do not plan on dying any time soon. I have six diseases I am battling every day of my life. Uncontrolled diabetes, arthritis, degenerative lower disc disease, cardio-vascular disease, acid reflux, and polycythemia vera which is an incurable blood disease. I "have" to take medications and do special blood treatments every month just to maintain my health. I do not take life for granted. It is what we make it as individuals. No one plans on dying, especially pre-maturely. You would possibly think someone like myself would not care anymore, but it's not true. When one's life flashes in front of one's eyes, you really take inventory of how valuable life really is. It's when we really stop and smell the roses that life itself comes alive! Think about it. I remember when my hemotologist advised me that if the theraputic phlebotomies did not lower my hemoglobin, I would have to start chemotherapy, my first reaction was, "will I lose my hair?" Thank goodness that has not happened, but it could in the future. I will hold onto my hair as long as I can and maintain a positive outlook every day I am granted one more to live. My life has never been fuller! By the way, the oldest patient I had ever enrolled for a HT procedure was 79 years old. In the beginning I kept encouraging him to think things over as I thought he was too old and had better things to spend his money on, yet he kept coming back wanting some hair back. As I became more and more acquainted with him he finally shared with me how he had lost his wife five years earlier and all he wanted was a little more enjoyment in life and possibly meet someone special. That floored me because this retired man was absolutely sincere and had more left to offer in life. He felt a little hair would give him the confidence to at least get out and socialize again which he ended up doing. I have stayed in touch with him and guess what? He just got re-married in 2002, sent me a photo of him and his new bride, and he looks ten years younger! Was it his new hair that changed his life? No, it was his new attitude and confidence that helped him overcome his hidden thoughts that maybe he WAS too old and all he had left was to wrinkle up and die like an old prune. It is never too late to start living again, any of us, even if our time is cut short. It's all in how we view and value life that makes the difference!

Cleanhead, It sounds like you have some very realistic goals and expectations. The other thing you have going for your self is your age now that you have shared it with us. I am 49 soon to be 50 and I have an "adult" hairline placement. You will always have the option of lowering it a tad after your procedure reaches maturity if that is what you really want. A hairline can be lowered in a subsequent procedure but very difficult to raise so it never hurts to be a little conservative especially when post 40 years of age. Congrats on getting some hair back!

Hi Sweetlittle, First of all I want to say that it's great to hear of your positive experience with Propecia (finasteride) in slowing down your hairloss. Typically at 90 days from ingestion is when finasteride begins it's inhibition of Type I DHT. That is when most men start to see it's effects which do in most cases include potential sexual side effects. Chances are if you were to experience any sexual side effects, that probably would have started to happen by now. I am happy to hear that is has not, but could it come a little later say at six months or so? Maybe, but I doubt it. Even if it did occur later, Merck reports that men who continue taking the drug often find that the side effects resolve on their own. Some physicians will recommend taking it every other day to help resolve any present sexual side effects. Now for your concerns regarding the residual of finasteride contained in semen. Please go back in this same forum and read the thread "Breeding while on Propecia" which was started by a forum member, MyPrecious. Just keep scrolling back and you find it on page two of this Post Your Own Topic category. There you will find two posts of mine dated 9/7/04 and 9/8/04 where I provided Merck's findings in their controlled clinical trials regarding finasteride's effects in semen to vaginal absortion issues. I hope this has been helpful as obviously your questions and concerns are very important to anyone in your situation. Best wishes to you.

Borderline, With FUE/FIT the donor area in most cases needs to be shaved down especially if it is a larger session. You are having a strip harvest right? If so, most surgeons do not require the donor area to be shaved or even buzzed. The ideal situation with strip is that you have enough length to hide the appearance of the sutures. I left no less than two inches in my donor area on all three of my strip procedures and the sutures were never visible. Why not call Dr. Epstein's office back and ask before you get any haircut? At least you'll know for sure beforehand. Hey, congrats and best wishes Borderline!

To my understanding, no one outside the surgical team is allowed in the OR room according to federal OSHA regulations. Does that mean it never takes place? No. I have witnessed spouses, significant others, even friends allowed in the OR to view, offer moral support by their presence, etc. It is understandable but probably not very prudent. In some instances, the non patients were not even capped or gowned! I even heard of pizza being delivered to the OR. What next. I think the best way to convey live surgery viewing is by window view with the patient's authorization of course. That way it allows for a more sterile environment in the OR. Some clinics video tape the authorized procedure for latter viewing. What really concerns me is the commentary on the doctor's temperament and disposition! This is an entirely different yet paramount issue altogethor and something we rarely hear about nor incorporate in our qualifying criteria when choosing the physician who is supposed to have our best interest at heart. I wonder if a surgeon with a bad disposition or unpredictable temperament has any impact on the potential quality of the procedure? If the surgical staff(s) are "walking on eggshells", might that affect graft placement, focus, dissection of tissue, counting, etc, etc? YOU BET IT CAN! I hear this type of feedback too often and even one instance is one too many. Hairloss is a "very personal and sensitive" issue for any hairloss sufferer. Thank goodness there are some good HT surgeons today who have good ethics and empathy for their patients. Those are indisposable character attributes which all of us should demand in our clinicians or it's best to go elsewhere REGARDLESS of their academic backgrounds and clinical achievements. Possibly an entire new thread should be posted encouraging attention to this part of the qualifying criteria. Best wishes to you Laxlox as there are some other good doctors to consider and I am sure you will find the right one for you.

Gregg, It is situations like yours as to why waiting adequate time is CRITICAL. And really, you make a good point in waiting a full year to regain enough laxity. A few may regain enough a little earlier and some can take even longer than a year. Scalp laxity needs to be tested by a competent surgeon for "every" procedure. Subsequent trauma to the scalp too early will definitely compromise adequate blood flow and can adversely affect yield as you pointed out. If you don't mind my asking, did you ever have your strip scar revised or do you have enough laxity now to accomodate a scar revision? Thanks for earlier sharing your own personal experience.