Jotronic

GO BRAVES! Sotired, You're preaching to the choir my friend. Two hack jobs, NW6, two bad scars... been there done that until my own path to salvation. Btw, check your pm.

Great subject, not enough information. Gorpy, you're right on with your continued education regarding lateral slits. There's more to it but you'll get it soon enough. You're confusing the issue here. There is no "lateral angle" for existing native hair. The term does not apply. "Lateral" refers to the DIRECTION that the incision is made with regards to the DIRECTION of growth for the native hair. Remember, it is all dependent on the EXISTING direction of the hair. If your hair on top flows in a direction toward the forehead (most likely) then the incisions are made in a lateral fashion to said direction. You can also replace the word "lateral" with "perpendicular". Regarding angles, if your native hair stands more vertical relative to your scalp then incisions can be made to match the same angle. Simple. It's all about matching the angle AND direction of EXISTING hair. Angle and direction are not synonymous but both are precisely controlled via lateral slits with custom cut blades. sotired, You happy now? You've got me posting twice on the same subject (albeit on differnt forums). Just ribbing you. Happy to do so. You need to take a moment to look at the merits of the lateral slit technique and filter out what's been said so far then put the pieces together. I can sense it in your noggin now, the wheels are turning and a light bulb is about to turn on Larger grafts via this technique are fanned out giving better coverage, graft for graft, than if performed in a sagittal fashion. Better overall coverage is achieved thereby giving the "illusion" (I hate that word but it's necessary) of better density, again, graft for graft. Remember, coverage is not an illusion but density can be. To take your analogy of a 4000 graft session, what do you think would be best? Shave or not shave? I simply don't see that there can be an argument stating that it's just as easy to see precise angle and direction of native hair at two inches as it is at 2 millimeters. Can you? Forget the angle and direction issue even. Just the mere difference in length should be enough for anyone to realize that a better job can be done if you have the opportunity to see the existing hair as clearly as can be. THEN add to the mix that the true angle and direction is revealed and the answer has now materialized. The doc can see better. The techs can see better (big factor), the angles are revealed, the direction is revealed thus reducing the chance of transection to nil. The only case where transection may be an issue is if a patient comes in with original density in the recipient area thereby not being in need of a hair transplant in the first place.

Glock, 15G will get you where you want depending of course on your expectations but they seem to be relatively realistic. The fee would average out to about 3.50 per graft for 4500 grafts including EVERYTHING. If you are traveling in from out of twon we will pay for two nights stay at the Granville Island Hotel and half of your airfare up to 400.00. The requisites for large sessions like you need are simple. Average to above average donor area laxity. Average to above average donor density and of course a clinic that knows how to utilize these characteristics to their full potential on a regular basis.

While it is a well known concept in science Hairhope it does not apply to the issue of HT photos. Science has a funny way of being considered "science" only if the conditions that define real science are controlled. The use of flash is the easiest way to control the outcome of photos. The problem with your angle is that I have not met a single patient that has a flash bulb going off all day every day while they go about their business. I doubt anyone else has either. What I have met are patients that on a daily basis have to sit under flourescent office lighting (pretty good indicator of what's really going on with the density) which is a good example of how to consider taking photos. That's what we do.

Pat, Too late Maki, My point exactly and I've been saying this for years now.

As some of you know I am adamant about taking photos without flash. It completely skews the image away from reality. While photos are not the best to judge results they are by far and above the preferred format in which most people perform research into hair restoration. Not everyone can travel thousands of miles over the course of several months to meet dozens of patients from various docs. Yes, photos are here to stay and video will eventually come on strong as well. With that in mind I have been a crusader of sorts to encourage not only clinics but patients as well to take the best photos they can. Some of you may have read my posts where I say that flash photography literally doubles the perceived density in the hairline. But what about the top and the donor area? It actually can have the OPPOSITE effect. While I noticed this I wasn't too sure as to why. I recently wrote to a friend of mine that is a professional photographer. He hangs out of helicopters and all kinds of crazy stuff to get the perfect shot and has been published worldwide. He is also a HT patient (not one of H&W) so he understands, and agrees with, my points regarding flash. Below is his description of why flash is bad. "Hey Joe, Good to hear from you. I have limited time as I am working on some pretty tight deadlines on stuff, but wanted to give an answer to your question. When dealing with light, the angle of incidence equals the angle of reflectance. That is why you are correct that a flash on the hairline will have the opposite effect as it does when it hits the top of the scalp or donor area at 90 degrees. The hairline is at a slope so to speak where the head begins it's curve back...so the light from the flash is hitting the hairline at say 60 degrees. Because of this the hair, if there is any, will cast shadows directly behind the hairline giving the illusion of more hair. Remember that these shadows are falling away from the camera at an angle, unlike the way they do when you shoot the top of the head or donor at 90 degrees. In addition, when shooting the top and donor at 90 degrees, the flash will reflect off of the scalp because of it's angle of incidence giving the illusion of less or more diffuse hair." In summary, what he is saying is that while the use of flash may make the image look better overall it is doing everyone a disservice by not representing was is present in reality, or in the case of some results, what is NOT present in reality. I encourage all clinics to stop using flash photography. It is misleading to the patients and can give a false sense of hope. When taking photos, do not use a flash in the before photo of the top or the back then use no flash in the after. The flash makes the image appear to show LESS hair in the before than what is really present thereby making the final result appear just that more impressive (density, coverage etc.). Do not take before photos of the hairline WITHOUT flash and after photos WITH flash. While this may show the real story before surgery the photo will show literally DOUBLE what is present in reality in the final result. Here is a hairline example. The pic on the left was taken without flash. The one on the right is the same patient about ten seconds later with flash. The difference is obvious. Both techniques have the same effect. More hair as a final result from surgery than what is present in reality. The above goes for patients too that are documenting their progress. I know it's hard to be 100% consistent. Our daily routines do not allow for this but the more you do to TRY and be consistent the better you'll be serving those that are following your progress. I know that this post will not eradicate the issue. Some will falter, some won't care but if some of you learn from this and apply it to what you see in photos perhaps it will give you a better sense of what is really going on and if some of you actually speak out about it then perhaps you can help to initiate change by getting clinics to pay better attention to their photos. Rant off.

I disagree with those that would encourage Cantona to move forward with getting a procedure. Cantona, as Pat mentioned, you have hair now that we all envy. I know that losing your temple points is stressful but you are simply experiencing the natural progression from a juvenile hairline to that of a mature adult male. Very few people actually keep this hairline throughout their lives. One thing that is not discussed very much on the boards is temple angle closure of the caliber that you seek. Here is the problem with this approach. Hairline reconstruction is permanent. The hair in your new hairline will be very healthy and of the strongest caliber. Should you even BEGIN to thin in the crown after having aggressive temple angle closure your profile will look off balance and front heavy. I am not referring to heavy crown loss, I am referring to even the slightest of thinning. I have seen it several times now over the past couple of years from meeting with patients that have had this type of procedure and while it took me a while to figure out what was not quite right about the work I was seeing it suddenly hit me and now stands out like a sore thumb. I liken it to trying to figure out what isn't quite right about someone wearing even the best of hair systems. If not 100% perfect then the eye will catch something that is "off". Some will argue that there are those that maintain their original juvenile hairlines but do thin in the back. I have been presented with examples such as Prince Charles, Al Gore and a few others. These are exceptions to the rule however there is one big difference. While they may have their original hairlines the hair in this area is miniturized and less dense than when they were young. In other words, the progession of the hair itself has over time matched the progression in the back, not so much with recession, but with overall thinning. This pattern is more prevalent with Southeast Asians or those of Persian descent. Orginal hairlines remain but they are very thin and diffused with accelerated hairloss behind, even to the point of full NW6. The rarest of the rare individuals that maintain their original juvenile hairlines are those like Ronald Reagan. His hairline was intact throughout his life until his untimely demise. He had NO miniturization in the hairline and NO thinning in the crown. Your hair is awesome as it is. It is very full, very thick and simply cannot be improved upon. Any doctor that offers an improvement should be the catalyst for an about face and a brisk walk toward the door. You are experiencing NO male pattern baldness. None, zilch, nada. If you must, for peace of mind, use medications such as Proscar and/or Rogaine to maintain what you have but do no more than that. If in fact your do begin to see signs of recession then and ONLY then should you move forward with your investigation into which clinic is for you. I work for what some would say is the premier clinic in the industry and I am telling you, do NOT consider hair surgery. Yours is the pinnacle of what we all strive to achieve yet will never be able to fully realize; A completely full head of hair. Enjoy it.

Boston, Finasteride has a shelf life of about two years so getting more than two year's worth is a waste. Also, Finasteride is light sensitive so if you are going to cut Proscar you need to do only one pill as needed and keep them in a dark cupboard or drawer. The more light exposure the more it shortens the shelf life. When using Proscar and dividing it into quarters you are paying only a few bucks on average per month. If you need to save more than this then you need to have somone look at your finances.

Glock08, You need to go big my friend. After looking at your pics and adjusting for the washed our issue on your crown pic I believe you most likely have a strong donor area of, at worst, average donor density. I could be wrong but I don't think so with your case. When I say go big you need to have as much in one session as possible, 4500 plus, to get the biggest impact and the most bang for your buck. If you consult with any docs that tell you this is not possible (in general) unless some fudgery is going on with the graft count then walk out the door. There are simply too many patients showing their results with DOZENS of good photos for this to be a charade. This is YOUR head and YOUR hair and of course YOUR money. Send your pics to ten different clinics. Get ten different assessments. Talk to patients via email, phone and in person. Your case is something that needs to be nurtured as far as what your expectations might be because you have been wearing a system for years. The density you are used to is something that you will not have with a hair transplant so you must take time to learn about this. As was mentioned above getting the face framed is half the equation so you need to make sure your chosen doc has a proven track record of this. Good coverage across the top should be possible with the crown most likely being left as an option for a second procedure. Many times this is discarded because the patient decides that the front and the top is good enough. On the flip side, many decide that round two for the crown is a requisite for their satisfaction and there are many examples of this online as well. Bill, Actually, H&W has hit the big 7 at least three times that I can recall. One is in our patient gallery with 7180 grafts in one procedure.

Glock08, Being a NW6, how many grafts were recommended?

wesley949, Thank you. I only hope my experience has shed some light on your situation. As far as an average, it is between 3500 and 4500 grafts overall but it's hard to be more specific or even sure. I feel this is a solid number though. Remember, averages being just that, we've routinely hit 5000 plus and on more rare occasions 6 and 7 plus thousand grafts but those are the most remote of rare cases. Don't expect this for yourself by any stretch.

Hairbank is correct, my donor was not that great to begin with because at the time of my first H&W consultation I had not one but two wide donor scars. This was a factor in determining that I was not the best of candidates. I remember it well. On the morning of my procedure Dr. Wong was reviewing my condition and told me that I'd have two scars still. I told him that Mike said that he'd be able to get both scars. He looked at me like I was nuts but when he tugged on my scalp he had wide eyes and a sly grin. "Yeah, we can get both of them". That was the beginning of a a great journey for me. Great laxity can overcome less than perfect donor hair. My hair was not great but not that bad either, and was about average I guess. Ultimately, what is satisfying to me may not be satisfying to Jrazz and the same could be said for the reverse view. It's all a matter of perception.

And now, a word from our sponsor... You guys are kinda right, but kinda not. Let me give it a go. What are lateral slits? Are they simply slits that point to either side of the scalp, like from ear to ear? While it may look like it this is not the case. The term "Lateral" in lateral slit is synonymous with perpendicular. If you remember high school geometry being perpendicular is being at a right angle, or 90 degrees, from the reference angle. Making lateral slits means to make incisions that are perpendicular to the direction that you are placing the graft or perpendicular to the direction of hair growth. Since the hair on top of the scalp tends to grow in a forward direction toward the forehead area the incisions are perpendicular in that they point to the left and right of the scalp, toward the sides of the head. If you had natural hair directions pointing toward the sides of the scalp then you would in turn have incisions that are pointing toward the back and the front of the scalp, again, perpendicular to the direction of hair growth. When I say "pointing" I mean the sides of the incision. If lateral slits meant only that the incisions are pointing to the sides then the crown work performed with this technique would look awfully odd. NikkiJ said that higher density is achieved with lateral slits because the grafts can be fanned out. Actually, by being able to fan out the grafts the end result is better coverage with X number of grafts than one would recieve with the same number of grafts from using needles. With better coverage however comes the illusion of better density. Be careful with the term "illusion" as they are not interchangeable when dealing with density vs. coverage. You can have an illusion of density by having better coverage but you cannot have the oppposite. It just doesn't work like that. The advantage of lateral slits for true density comes from not only the nature of the incision shape but also from the angle in which it is made. Either factor alone does not allow for the potential for high density but both combined do. Note that the incision itself looks like an envelope. Imagine holding an envelope in front of you with your hands outstretched. Imagine the broad side of envelope, the side where you right the address, as facing you. What happens when you stuff a letter into the envelope? It bulges, right? But where? Not on the left or right but in the middle or the side that faces and opposes your view. Now, turn the opening of the envelope toward you at about 35 to 45 degrees. Congratulations, you have just recreated a lateral slit (the right way). Observe where the pressure of the envelope is directed. It is vertical and does not radiate to the left or the right. Incisions made with needles exert their pressures to all areas around them no matter what angle they are made. When you have thousands of these incisions the pressures compound and when you have ever increasing pressures you have a restriction of blood flow. This is bad. It can also encourage popping of the grafts. When I say popping I mean the grafts literally "pop" right back out of the incisions. This, too, is bad. When the pressure is exerted vertically from lateral slits it does not affect the surrounding area so when you have thousands of these slits next to each other in the same manner they are not affected by their neighbor. Furthermore, when the incision is made at the angle mentioned, roughly 35 to 45 degrees you do not have to go as deep into the tissue while still maintaining proper insertion depth for the graft. These more shallow incisions mean less disruption of blood flow thereby decreasing overall damage to the vascular scalp. When you have less disruption to the vasculature and less pressures you have less popping of the grafts, greater control over angle and direction of the grafts and the potential to hit much higher densities without sacrificing graft survival. Also, blade sizes of .6mm are possible BECAUSE of lateral slits. They are able to be placed much closer together because of the reasons stated above. So, lateral slits are beneficial because... Better fanning of grafts equals better coverage with the same number of grafts as compared to other techniques. Better coverage equals the "illusion" of better density. Actual density is easier to achieve because of less damage to vasculature and less peripheral pressures being exerted on neighboring grafts. One will also experience faster healing as well. There are other benefits as well but my fingers are getting tired Hope this helps to explain it for you.

dhuge67, Six months is a good milestone but as you've already heard, you do have some more imrovement to look forward to. At six months most patients do see the majority of the results as far as new growth but the grafts you have will thicken in their diameter giving you an overall improvement. Your plan is wise to give it more time before you look at a new game plan. Stay on the meds and continue reading and participating. Your presence and documentation is helping others as it should.

Mrjb, Conservative is a relative term when it comes to hair transplantation. This term seems to be continuously pushed however as those doctors that were saying 2000 grafts was just too damned much and all of it wouldn't grow just a few years ago are now saying "Hey, 2000 is great and in fact may not be enough". I'm paraphrasing of course but you get my meaning. The example of using 5000 grafts is not an accurate one much less are megasessions in general. When doctors that can perform true megasessions look at a patient they are not contemplating how best to waste the donor area. Far from it. They are trying to figure out the best route to address the problem in one shot. Take a NW5 or higher. Of course, we want to get the most grafts in one session as is safely possible so that the patient need not have unnecessary downtime, scarring, expense etc. like that which he would experience with, say, three smaller procedures. I think that this makes sense to the majority of you and there is no argument. But what about the patient that has hairloss that places him at about a NW3? Any doctor that is worth his weight in grafts would NOT overdue it by putting so many grafts into the area of loss that it would compromise the future. A good doctor would place enough grafts into the area to get it done right the first time. The right density, the right coverage weighed against what is estimated to be left in the donor bank and weighed against estimated future hairloss. It is not an exact science but keeping all of this in mind the work will not be done so that if the patient does lose more hair the work will look odd. Hairlines should be kept high enough so that they are mature in nature without temples that are found on teenagers. There is always a chance that more work may be needed and anyone getting into this in the way of surgery must understand that they are locked in to the possibility of more work in the future. If they approach this correctly though, with a doctor that has a proven track record of cases like this, then they will be in the best possible position to get the results they want with the least amount of scarring, the least amount of downtime and the least expense. THAT is what megasessions are all about in the right hands.

Thank you all for the compliments. As far as cost goes, yeah, it's expensive, but this is a luxury item, not an emergency by-pass. However, as Bill said, the cost per graft does drop over a certain number of grafts. Also, in my case, if I were a virgin scalp I would have most likely been a two session deal and when the cost per graft drops on average to roughly 3.40 to 3.75 per graft it gets a bit easier to manage. I have nowhere near 32K worth of work done, at least not in dollars anyway. In emotional well being it is much more, like a million M&M, I know what you mean. I can understand the value of explaining what it means to a patient but it really is not as valuable as showing AND explaining. hairbank, Understand that the crown is thinner than the rest of my scalp. My results allow me to have enough hair around the crown to kind of cover it. I'm not bald in the crown, just thinner, and the extra hair I have allows me to have a full appearance front to back. The style I have now is something that I think suits me but I do have the option for others, like just over a year ago when I had the "Simon Lebon" look as someone coined it. Love it or hate it, it's still an option that I didn't have before.

Guys, Thanks for the input and comments. All of your suggestions will be considered, especially yours, Gorpy. The biggest reason the light was low was because it was later in the evening. I had wanted to do something like this for a while as well as several hundred other video ideas I have and this one just hit me. When I get the bug to do something, nothing stops me. In this case the light was just a bit lower than I would have liked but this was of course an experiment. Also, with the zoom shots, I was the only one working the camera so I didn't think anyone would want to see my closeups with my eyeball taking up half the screen every few seconds as I try to line up the shot Also Gorpy, thanks for the video tips. I'm a newbie at this (much more proficient with the photos) and I exper (hope) to become just as proficient with video. I was hoping someone like you would chime in with experienced advice. I don't know if I can switch to manual from auto as the camera is just a low end Canon DVR. Regardless, I do have some nice software that can make the outcome better but I just have to learn to use it. Maybe you can give me some more tips if you email me your phone #? Thanks again all. Look forward to more videos more frequently. This IS the future and it can only benefit the industry. I intend to be a part of it

I just got some time recently to start playing with our video set up and decided to use myself as a guinea pig. Please disregard that I showed my scalp twice (you'll see what I mean) and the spot on my nose. I don't have a makeup department. Also, it wasn't scripted, just an ad-lib so forgive the lack of luster. Hair Transplant Video

I just got some time recently to start playing with our video set up and decided to use myself as a guinea pig. Please disregard that I showed my scalp twice (you'll see what I mean) and the spot on my nose. I don't have a makeup department. Also, it wasn't scripted, just an ad-lib so forgive the lack of luster. Hair Transplant Video

Midiman, Unless you're using more saline than you are water from the shower (depending on Dr. recommendations you should be using it full bore) I seriously doubt you'll drown your soldiers.

Hairbank, Your progress is looking really nice. Always remember that in general the crown takes longer to show the same improvement that you might see in the front or the top. No one really knows why this is but it was certainly the case for me after Dr. Wong hit my crown in round two. As you can see in my six month update for round two on my website the growth was obvious but it continued to get better over the subsequent few months. You're on track for a great result and I'm really happy for you. Been there done that

AJR, Unfortunately hair loss is progressive and does not actually stop. It may appear to do so from time to time but it can easily resume from an imperceptible advance to a very perceptible advance. Although the back is nearly gone as well is the top like you say the sides of the top can drop to just above your ears and the crown can continue to expand outward and even down. You need to seriously consider the use of medication to prevent further loss. If you are absolutely against it, which some are, then you need to understand that one procedure, no matter how satisfied you may be with the results, may wind up being the first procedure of two or three total that are undertaken to fill in the gaps as they develop.

Midiman, I think Hairbank said it best. While there are a lot of options out there for your post-op treatment we have found that there really is nothing the has proven to be consistently BETTER than mother nature. We feel that the use of sprays immediately post-op can help to actually spread infection. If even one recipient site were to have even a slight bit of infection then it "could" spread from any liquid being applied or sprayed on the recipient area as it runs. While this is not really likely to happen it is a possibility.

Pat, It was nice chatting with you via our live chat service. I was surprised that my hunch was right when I saw "Pat" online out of south Florida I hope that everyone finds our new site to be more user friendly and smoother in operation. While it has been up for a few weeks now we have been performing constant fine tunings to it. It will be updated even further over the following weeks and months so keep checking back for new features and the ever expanding patient gallery and media center. We have a few features not found on other sites (as far as I know). For instance you can search our photo gallery by NW classification to find those patients that more closely resemble your own hair loss pattern. Also, you can search the entire site for certain keywords you are interested in. The live chat feature has turned out to be a very useful feature for patients so far. It allows questions to be answered immediately as they occur while surfing the site. I've had overwhelmingly positive feedback so far regarding this feature. Finally, with regards to the overall design, we wanted something that was modern but didn't fall into line with all the other web 2.0 designs that are the current rage. We hope you like the modular cell design that we came up with.

JTB, So he's saying his 1000 were equal to or better than 3000? Doubtful. You're most likely speaking with a doctor that still utilizes mini/micro grafting. Most of the patients you are referencing have had follicular unit grafting where the grafts are simply the bundles of hair as they grow naturally in the scalp, in groupings of 1 to 4 hairs (average 2.3 per bundle). This doctor, using mini/micros, determines the size of the grafts by including multiple bundles in each graft. Errr, no. Not good. Besides, you should get as much as possible (toward your goals) in one session or two max instead of several. Less downtime, less scarring, less expensive, better growth. Glad you asked the question. Now ask more so you can get a handle on what a great hair transplant doctor can do for you. Oh, and welcome to the forums.