gillenator

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.

RMS, Minoxidil did absolutely nothing for me YET many patients do realize some good resolve with it. You'll never know until you try it yourself. The recommended application is twice per day. I personally use Tricomin Revitalizing Shampoo which contains a triamino copper nutritional complex. Procyte corporation makes the product which you can read up on the internet by doing a google search under Procyte hair products. This is the product that makes my hair feel healthier and stronger than any other product I have used. It retails for about $20.00 US per bottle but here is my secret. I first wash my hair with a good but much cheaper shampoo to get the oils and hair spray washed out. I rinse clean and then apply just a drop or two of Tricomin which lathers up tremendously. I allow the lather to sit on my head for 5 minutes before I do a final rinse. It makes the product last for a long time. I have been using the same bottle for over 2 years now! Allowing the lather to sit for awhile will allow the triamino copper complex to be absorbed by the hair cylinders which is then delivered to the dermal papilla inside the follicule. There are many other products that I have not tried but I tend to stick with what "does" work for me.

Mortimer, I think the spray works best and you should not have to rub it in. Bill, How long have you been using minoxidil? What strength are you using and are you applying twice per day? Your on Propecia too right?

RMS, That is correct, you can purchase it over the counter even at nineteen years old. Don't ever feel that asking questions about anything regarding hairloss is dumb because it is not. We all had to start the information process at some time so let me commend you on doing your research. We are your friends here!

RMS, Minoxidil and finasteride do not have the same potential side effects. They are very different. You can read up more about potential side effects regarding them on this Network. You can purchase minoxidil without a prescription at your pharmacy and even large discount retailers like Walmart, Target, etc. There are generic forms of minoxidil available which are far cheaper than Rogaine. There is not a generic form of Propecia and it is quite expensive. Some of us "quarter" Proscar (5mg) finasteride per tablet and then cut it 4 ways with a pill cutter which you can also purchase at your pharmacy. The cost is much cheaper by cutting Proscar. Finasteride in any form will require a prescription from your doctor so if you do go the Proscar route, be sure you explain your intentions to your doctor so they document your chart accordingly. Lastly, if you are over 40 years old, you will wamt to first have a PSA test done to evaluate your prostrate "before" you start finasteride. If you do decide to cut Proscar, BE SURE to keep it locked away and out of any reach of any females especially a spouse or significant other as it can have adverse effects on the genital development of a male fetus should they come in contact with the active ingredient and conceive. Best wishes!

Hello RMS, Glad to hear that this forum has been of help to you as it has with many of the rest of us. Everyone responding has suggested you to start a medicinal regimen with finasteride and minoxidil which are sound recommendations. Both of these ingredients may even regrow or thicken the crown area for you especially considering your younger age. If anything, you stand a very high probability that finasteride will slow down the loss in the vertex and crown areas. Neither minoxidil nor finasteride have demonstrated any clinical efficiency in the frontal region of the scalp which includes the hairline and temporal lobe regions. Ailene made a very good point about starting restoration in areas (like the crown) where you will have future procedure commitments to in order to maintain the aesthetic appearance. It is perfectly normal for men to have some recession or what I like to call adult movement of one's hairline with age. We expect to see that even with men who do not have genetic hairloss. It is a natural progression that comes with age. I myself wore hair systems for a decade so anytime I see a man over say 40 years or older who has mamouth density and a low hairline, the first thing I am looking for is to see if he is wearing a system. Even in the few cases when it is their natural hair, it still is not what we are accustomed to seeing so it naturally grabs our visual attention. So it is best that you wait it out until at least your mid to later twenties before you consider any surgery. If you have extensive hairloss in your family history, men who have reached Norwood class 6 and/or 7, your decisions regarding future hairline placement as well as the other areas of coverage become very critical. The crown area demands alot of donor so if you do have the potential to see class 6 and/or 7 someday, you may not want to be as aggresive in that area. As was mentioned 5,000 to 6,000 harvestable strip grafts is the average per patient unless you utilize FUE/FIT technology. Still the demand almost always exceeds the available supply for the advanced hairloss patient. Remember, hair restoration is a visual illusion. Most men do not notice scalp until they start to lose more than fifty percent of original density. The reverse is also true. Generally speaking, if a completely bald surface area is restored to approximately 50 percent of original density, and even a bit more, say 60 percent, you do not notice the scalp any more. Color contrast, cylinder caliper, and hair characteristics have a dynamic play in these equations as well. When you do reach an acceptable age for your first procedure, be sure to have several in-person evaluations done or at the minimum, a vitual consultation with pics. I wish you the best and lets us know how the meds work out should you chose to start them now.

Smoothy and Hairbethere made some excellent points regarding laxity and shockloss. The shockloss is probably the biggest factor as to why there has been so much post-op shedding. I just do not understand why ANY doctor would have done two procedures in such a short time. Restoring a different recipient area does not justify the other critical areas of risk so I believe there should have been "at least" nine months minimum between the two procedures. I think we all want to know who the doctor was so this does not happen again! Hang in there. Most of it should come back.

What pill or medication are you referring to?

Hi Lange, Well it certainly does not surprise me that you had a great experience with Dr. Feller. He continually is striving to improve HT techniques especially with FUE and it's instrumentation. Keep us in the loop on how your results go! Take care.

Dr. Theodore Katz is a former long-term surgeon with Bosley Medical and he was also with MHR for a short time after he left Bosley.