Janna

Hi Bayer, I'm glad to see you are getting the recipient area treated. Most of the top doctors/reputable ht clinics are not looking at the statue of limitations. They all want a happy/satisfied patient. The hardest part about a ht can be the waiting. It's a long time before you get your final results. Judging from your immediate post op pics, it looks like you will most likely want more fill-in in the mid section since your doc only covered the frontal 1/3rd and your loss seems to extend to the crown. Hang in there. I think you've gone through the worst-it'll only get better from here.

Abdi, I think you've made a wise choice to shave your head and wait on the ht. You're pretty young to jump into having surgery anyway. It's good to have options and if you're happy with the shaved look, go for it. Propecia and Rogaine can do wonders too.

Well done, Bill. I'm sure this information will be helpful to many.

Hi Bill, Of course this is much too early in the game to see any results at 2 months post op. Your immediate post op pics look great. I think Dr. Cooley and staff performed an excellent procedure on you. It looks like you've kept some of your transplants, don't be worried if they still fall out. Your shock loss hairs at the donor should be coming back soon. It looks like you have a good foundation started with the 2700+ grafts.

Hey Folica, I think you've done your research enough to take the plunge by a trusted, proven ht doctor. With your surgery days away you are looking for support and validation of the doctor you are going to. Even though I'm not familiar with Dr. Alexander's work personally, many on this Forum seem to know him or his work. It sounds like you're going to a quality clinic. Best of luck to you. I'm looking forward to seeing your picture blog.

Hi Dan, Thanks for posting your experience with Dr. Charles. He's great. Are you able to post some before/after pics and also your sugery data, graft/hair count? Best of luck!!

There's couple things I'd like to add to my yesterday's post: 1) I'd like to make it clear about the "multi-bladed" knife as it can be misconstrued to mean multi-strip harvesting. Dr. Shapiro was mentioning to me today that he was part of group who studied multi-strip harvesting of 2-5 strips using 3 to 6 blades. Those multi-strips did result in too many strips with too many transections. This is not the case anymore when loupes, adjustable angles and a single strip is harvested. 2) Dr. Shapiro is currently perfecting the use of scoring the donor strip with a single blade or two blades before using the "Haber spreader" to gently spread apart the donor incision to eliminate any transections. The spreader is optimal only for the first time patients as the scar tissue is too strong to just pull apart. In anycase, whatever method is used for donor harvesting, skill and experience play a major part.

Aquarius, Most of the time Dr. Shapiro uses the multi-bladed instrument. The formal name for it is called the Vari-blade. You can adjust the width size as well as the angle of the blades. We put just two blades on the instrument to get one strip. Dr. Shapiro has 9-10 years experience using this very instrument. He'll use a single bladed scalpel if the occassion calls for it. The strip he extracts has very minimal transections. Because he uses highest magnification loupes during excision, he is able to adjust with each patient. Dr. Shapiro has never been one to sit back thinking he's got everything mastered. It's always been about improving every aspect of this procedure. Strip harvesting is very critical and in some hands, or inexperienced hands, detrimental. I've been to many surgery workshops with Dr. Shapiro, the top doctors share and compare their work with each other. Our doctors wouldn't be using the Vari-blade technique if it did not extract the best strip possible.

Andrew, Many doctors use free hand while others may use a multi bladed knife. The doctors I work for use a multi, which can be adjusted to the width they prefer for each patient. They actually have two ready for each patient. One may be set for 1cm width for the sides while another can be ready for 1.3cm width in the middle. Our "average" strip width is 1.2cm to 1.5cm width. The length can be anywhere up to 31 to 31cm long (depending on the size of the patient's head). Our "average" strip length is probably 26cm long. The width and length depends on the patient's laxity, elasticity, fu per cm2 to get the number of grafts desired for that particular case. There are some clinics where they have more than two blades (the # depends on the number of strips they plan to take out (2-4). This is a thechnique a doctor may use to not rely on a tech for slivering. Transection rates can be very high in these cases if the doctor is not trained well. Tension at the sides of the head typically is tigher than the center (the reason why your doctor was able to take a wider strip in the middle). It's fortunate for all that the center is more lax as it's also more dense in that region. You doctor may not have had to take a wider strip than planned. Your density may have just been more dense than they had anticipated. Or, the other reason may have been she did go wider to get more grafts than you both planned. It's a question for your doctor. There's some guess work involved when determining the strip size to extract.

Hi Andrew, Thanks for posting your graft and hair count info. I don't have an engineering degree of any kind, so I'm not able to help you in deciphering your strip widths. From my experience, the length is just short of the "average" size we take out. I take it that your doctor must of free handed the strip with a single scalpel to get such varying widths. I must say your donor yielded extreme density as I have not yet come across a patient with so many three's when you take your total grafts into account. I've seen some five hair fu's, so that wasn't a surprise. You'll be looking pretty hairy in about a year.

Milton, I'm thrilled to see your results at 8 months. You will see more growth in the next few months. Since I personally planted 80-90% of your grafts, I am dispaying an extra wide smile at seeing your results thus far. Hope we see more pictures as your results come in. Thanks for posting.

Bill, You're right, you don't look like computer geek. You're looking great.

Bill, you do have a way with words. Where you find the time to post such well thought out wisdom is beyond me. B, you know I think you're awesome. You posess a lot of knowledge and passion for this industry. I too know sometimes we can all be misunderstood, or make mistakes of our own. The fact that you're such a champion for hairloss sufferers is enough for me to back you any time. In reading the original post on this thread, I can see how it can be misconstrued as a "set up" to tout an unknown doctor. Hairbank, you're always another voice of reason, which I've come to appreciate with all helpful advices you give. Thanks for the good reminder and the tip on re-reading your own words. Andrew, I just wanted to comment on your pics since you're looking for some feedback on the work you received. In my humble opinion, the work looks very good. The incisions and grafts look to be refine FU work, and your recipient areas are nice and clean like it should be. I cannot see any reasons why you shouldn't be happy with the final results. Your donor sutures look very good as well. You are right that with big chain clinics, there are good clinics along with the bad clinics. It's a problem when you run so many clinics and different doctors, it's difficult to have quality control. I'm very happy for you that you got a good clinic. Best of luck and I look forward to following your progress.

Wow, no way Bill. I taught something to the great, wise one? I'm not even being sarcastic.

Hairfree, I think 455 singles in the hairline is most likely plenty for you. I'm a little perplexed as to why you did not receive any four hair grafts as your distribution falls within the "average" numbers. It seems odd that you'd have over 1000 three's with no four hair grafts. In my experience, those with no fours are the one with lower than average number of threes. It's like a double whammy.

"Jana, what would be a typical minimum number of singles you need to rebuild. I am sure this depends on the thickness, hair color etc, but , in round figures, what would be a minimum you would need?" Andrew, The number of singles needed for a good hairline also depends on the size of the head. I would say on the average, we probably need around 300-400 singles when you're establishing a new hairline. I also want to address that there are people who do not have any 4 hair grafts. Some people may not even have too many 3 hair grafts. There is, on a typical person, or on the average, a hair distribution of 14% 1's, 51% 2's, 29% 3's, and 6% 4's. If we happen to get a patient who needs 300 singles and he naturally produced only 200 singles, we will cut down some of the 3's and 4's to get the singles we need. Andrew, your suggestion about graft/hair count and measuring hair caliber for density/overall thickness--ha, ha, ha!! Let's get the hair count in place first.

PGP, I'm sorry the bulllet didn't register the first time. Sometimes you really have to konk my head good to stir anything in there. I do now recall your stories. You were great. PM or email me if you need anything. F355, I'm with Bill on what kind of help you need. Are you able to post any pics?

Thanks Bill for the clarification. I'm inclined to guess you're a lot of both -- see who's laughing on the floor now!

Andrew, At our clinic, we plant two hair grafts behind the ones. The hairs that we transplant will remain, so even if you lose more of your native hairs, you will keep the singles we transplanted (of course you keep the 2,3,& 4's too). People you see with receding hairlines still look like they have single hairs when you look closely. When a patient comes back for a second procedure and want to bring their hairline down a little further, we start over again with the ones, fill in the old front hairline with two's and so on... I hope I addressed your questions correctly.

Did you have sutures or staples? I'm glad to hear everything went well with your suture/staple removal appointment. I love the trichophyic closure.

We absolutely are selective about the single hair grafts. Not quite the reasons as you guessed. Picture peaks and valleys along the hairline once the incisions are made, we actually select the finer caliber singles to be placed in the peaks and one row in the valleys. If you looked at a person without a transplant, they have some wispy hairs right at the front. We then go right behind with average to high caliber singles for another 3 or 4 rows (don't take it literally when I say rows as it's all a bit staggered). You can tell especially with loupes on which hairs are stronger or finer. Good question, hope this helps.

Hey Bill, Please excuse my ignorance, but what does "ROTFLMAO" stand for?

Between the two doctors at SMG, we have everyday booked couple months out. Cancellations are very, very rare. There may be one or two techs who depend on the hours, so they may do some light office work or duties that pertain to surgery. Otherwise, the rest of us get a day off.

Oh I forgot, I'd be happy to send you your surgery data so that you can put your graft/hair count as part of your signature. I'm sure I can also provide your pre op photos as well. Let me know whenever it's convenient.

Even with my exceptional planting, I'm still going to doubt you are getting new growth That would be great if you were getting new hairs. I'd have something really great to tout about. BEST OF LUCK!!