TheHairLossCure

As previously mentioned, the donor scar will be a non-issue at work since the surrounding hair will cover it. The incisions in the recipient area should not leave any visible scarring in the long term. It should be noted, however, that once the scabs fall from the recipient area (takes less than a week), the skin will have a pinkish tinge. It does not look like surgery was done exactly, but it is noticeable like a rash or a sunburn. If you have natural hair in the recipient zone around which the grafts are placed, the pinkness should be hard to detect. If not, you may need to apply a bit of make-up to conceal the coloration. Otherwise just come up with a story to explain it away. The pinkness can linger for a few weeks to a few months but the incisions, since they are so small, will not be noticeable.

GMAN,

I am not sure if you are deciding between STRIP and FUE, or FIT and FUE.

But you mentioned single vs. triple blade, which leads me to believe you are at least considering strip. If you go for strip, SINGLE BLADE excision is the only proper may to do the harvest. A triple bladed knife will destroy many precious follicles unnecessarily (among other complications). As far as I am concerned multi-blade strip harvesting should not be a consideration.

BTW, I use "FIT" and "FUE" interchangeably. Dr. Rose termed his follicular extraction work "FIT" (Follicular Isolation Technique) and, while I think it is a better descriptive term, FUE is more generic. Ultimately every physician does follicular extraction differently. FIT vs. FUE is a matter of preferential terminology. In other words, look at the quality of the doc, not the "brand".

Excellent post. I think the preoccupation with numbers of grafts per session and numbers of grafts per cm2 comes from the fact that lesser doctors will sometimes do surgeries that commit patients to more work, for lack of density or coverage. It would follow that bigger is better, and denser is better. This is true to an extent, but one must consider that HTs deal with a finite donor source. Some patients will have the pattern, age, hair characteristics, and skin characteristics for ultra-dense packing. Others will need to take a more conservative approach for the best long term aesthetic results. It should also be noted that the number of grafts transplanted in a session does not tell the whole story of how much hair mass is being transferred. One transplant may average 1.8 hairs per graft, while another will average 2.3 hairs or more. Since patients have a wide spectrum of needs different approaches are necessary. Luckily, with a good surgeon and cutting edge technologies, which may aptly be referred to as "ultra-refined," patients can expect good coverage and a natural result.

I'm not sure if there is a conclusive answer to that questions. But, other than the fact that you will need a script for the 2%, there is no reason I can see not to give it a shot.

At 2 months, it looks like you donor scar is healing beautifully. Congrats and best wishes!

Shock loss in the donor area, while troublesome, is very rarely a permanent problem. You will likely start to see some re-growth after 3 months post-op or so. Hang in there.

gak,

Is all the transplanted hair miniaturizing?

It might be possible to break up some of the punch grafts and relocated the hairs into the donor scars. This would not entirely conceal the scarring if the head was shaved, but it could break it up a bit and hopefully draw attention away from the problem. This idea hinges on the premise that some of the old grafts still have viable hairs for redistribution.

As a young patient I'm sure it is difficult to hear people saying over and again that you should wait to do surgery.

The early stages of hair loss can be difficult but you may be a better candidate for medical therapy. The reason being that you are probably going to do small session to start with and, if that is the case, you may get a similar result from taking meds (if you are a good responder).

Many times older patients with a moderate to advanced pattern will get a better impact from surgery. The result can stand alone, even with additional loss. Even if there is some shock loss, the effect of moving a large hair mass to a bald or thinning area will usually give the patient far more coverage than if no surgery was done.

If you are just starting to lose hair (at a young age) is hard to plan long term. Furthermore, if you are doing small sessions, the risk of shock loss or progressive loss may put you on a transplant tread mill. In other words, you are adding hair and subsequently losing more. This is not the most rewarding scenario for the patient.

I think medical therapy can be a cheaper and better overall option for younger fellows. You might be a surgical candidate though. As Billoros states, this would be the exception and not the rule. I think this community is pretty responsible and empathetic when advising patients so, if you get some consults, you should definitely report back.

Good luck.

You can use a recommended list as a starting-off point. No list is perfect; otherwise no doc would be added or removed. It is a good way to narrow the search though.

You can use the forum, like you are doing, and ask more specific questions. There is also a private message function.

When you decide to get a consult, send your info to more than one clinic ??“ compare the different approaches and get a feel for the doctor and staff. You might ask the consulting physician who he recommends for a second opinion. Also see if the docs can provide a list of patients you can call or email.

Again, use the list as a starting-off point and then research until you find a clinic you feel confident in. If you talk with enough people ??“ doctors, patients, posters, etc ??“ you will begin to see a trend.

Don't move forward with anything surgical until you are truly comfortable with the doctor.

Nice result thusfar. 1,500 fu's may be a relatively small number given the area, but I believe you will have a natural stand-alone result. Congrats!

.

1. Is my shock loss typical for those diffuse shedders who still have some hair in the recipient areas ?

-Shock loss is always a risk, particularly when grafts are placed amidst thinning hair. Total loss over an area is not that common though.

2. Will these hairs grow back .. or were they on their way out any way and just got pushed out prematurely with the procedure ?

-Shocked hair usually regrows along with transplanted hair. In situations where native hairs are on their "last legs", shock loss can be permanent.

3. As a diffuse thinner with mostly crown lost should I have just used Finesteride + Minoxidil instead of having a transplant ?

-Hard to say, either way. But at this point you should at least look at these medical therapy options. Obviously you will not want to do more surgery than is necessary, so stabilized your patterned loss is always a good thing when possible.

Aside from the sagital/lateral issue, shaving or not shaving the recipient area does alter the speed of the procedure. Placing grafts into incisions amidst long hair often involves constantly moving rows of hair around for better visualization. It means the placement process will take longer. This is not a great concern for small to moderate size sessions, but it can be a concern during megasession procedures.

I think one reason people are quick to recommend medication - particularly for young patients who are infatuated with the idea of transplant surgery ??“ is that the complications associated with meds are usually minimal as compared to those associated with surgery. Even a top quality procedure will involve healing time, scarring etc. For a young patient doing HT, it also can involve a commitment to multiple sessions as hair loss progresses. To me, that is not always an ideal solution if medication can treat or temper the problem.

We do not know the long to term ramifications of taking drugs like Propecia though. I think this is something to be explored and discussed. Hair loss meds are certainly not candy, so they should not be "offered" as such.

Good topic fellas.

Dakota,

"Ive been looking into the tricophytic procedures the last couple of days now and it seems to be a little like rolling dice."

Sure, but there is some risk with any surgical procedure. If you opt for a strip procedure, you will likely find that trico/ledge closure is the right treatment. "Rolling the dice" is bleak-sounding, considering the positive results that are achieved.

"it may work or it may not work depending on the patients ability to heal and the elasticity of thier skin."

Hair growth through the scar is very consistent, but the possible scar complications (or lack thereof) that apply to strips without trico also apply to strips with trico. Removing a strip of the proper dimensions will help ensure the closure can be done with little or no tension. This helps the overall healing and appearance/size of the scar. The Trico is only cosmetically consequencial if the donor scar is relatively thin.

" Has anyone had this surgery and if so how has it turned out?"

Dr. Rose has been doing his Ledge closure for over 3 years, and most of the other fine doctors we hear about on this board use the trico as well. In most (not all) surgical cases, there is no reason not to employ the technique. It only stands to improve the appearance of the donor scar.

Bill outlined the two main approaches. The third option is a combination of the other two. In other words, you can remove and minimized the problem strip scar, and then graft the thinner resulting line.

If your scalp is flexible enough that your surgeon can removed the entire length and width of the scar and close the wound with minimal or no tension, you have a good shot at significantly improving the appearance of your donor area. FUE might then be a consideration if some touch-up/camouflage is needed later on.

If possible, you should consider reducing the scar before FUE. While FUE can deliver great results, I think most doctors feel that graft survival in scars is not as optimal as survival is "virgin" areas.

You may be able to resurface the tissue with some alternative therapies, but this will not change that fact that the hairless scar is visible against the surrounding hair.

Many times a disparity emerges due to differing ideas on 1) hairline location 2) area of scalp to be treated and 3) grafted density.

If you have one doc that proposes a conservative hairline and another who wants to place the frontline a centimeter lower on the forehead, you will easily have two very different grafts estimates. Dropping the hairline, even 1 cm, can sometimes require 1,000+ grafts.

In other situations you may find that one physician recommends grafting the frontal third, while another doc feels that grafting entire front half is in order (for example). Again, this will give a wider spread of estimates and recommendations.

Finally, some docs like to dense pack, while others tend to graft areas at a lighter density. Ultimately, you probably want to go to doctor that can pack at moderate to high density. Although most patients simply do not have the donor reserves for dense packing all over the scalp, most patients like to have at least decent density in the front zone.

I feel that Dr. Devroye and Dr. Bisanga are both good considerations for Eurpeon patients. Both seem passionate about hair and have trained or worked alongside some of best surgeons in the field (Devroye with Drs. Rose, Shapiro, Wolf etc. and Bisanga with Dr. Rose and others) Certainly worth checking these 2 clinics out.

Good luck.

Pretty much, you are going to take the same precautionary measures with an HIV positive patient as you would with an HIV negative patient. It is surgery after all. Still, it is always best to have a patient's full medical history available prior to a procedure.

PJ,

Glad to hear your post-surgical experience has been positive thus far

If we have transplants, will after a certain age some of the recipient hairs start to leave us? You have to figure that if naturally donor regions thin in many of us I would have to think that likely some of the transplanted hairs will fall out after a certain age. (maybe 60+)

Senile alopecia is a real phenomenon and many patients will experience some thinning in the donor area, as they get older. This thinning will impact transplanted hair also. Interestingly, gray and whites hairs give more coverage (for caucasians) than brown and black hairs. So going gray with age might temper (to some extent) the visual consequences of donor thinning.

I think it is ok to throw the Nizoral into the mix. Although it is somewhat of an ancillary treatment, you are not going have the same compliance issues that you might have with a product like Minox (which I also recommend, BTW). If you are going to shampoo your hair anyway, why not incorporate the Nizoral a few times a week. You can also get generic Ketoconazole quite easily for the same effect.

Heman,

I wouldn't get hung up on the prices just yet. Once you research the top quality HT clinics out there, I think you will find that we tend to offer a better service at a better price.

Do your homework and you will be rewarded!

The "Wong" way is indeed the right way in many cases Patients can, and in many cases do, go forward with a large session of follicular unit transplantation without shaving the recipient area. While this approach can be hugely successful, there are advantages to allowing your physician to trim the recipient area.

Many hair restoration patients wish to go forward with their surgeries with longer hair. Indeed it makes sense to keep the remaining natural hair in the recipient area long, as this hair can be combed over to conceal the scabs immediately after the operation. It would also stand to reason, if an individual is seeking hair restoration to address their baldness, they will not be inclined to buzz the precious few remaining follicles in their recipient area.

In some cases it is beneficial to partially or entirely trim the thinning hair in the recipient zone, as Dr. Wong suggests. A crucial factor in recipient site cutting and graft placement is visualization. The better the doctor can see the recipient area, the easier it is to design the site and place the grafts.

While it should be no problem for a qualified physician and staff to work in and around longer and uncut recipient hairs, the process is tedious and takes more time. This should not present a problem for a moderate-sized session over a large area of scalp. Assuming a skilled staff is handling your surgery, you should not be concerned with a decline in the quality of the result. On the other hand, there are circumstances during which the doctor and patient should consider trimming the recipient area. For dense packing and for surgical sessions with a large number of grafts, it can be a good idea to shave. When cutting many tiny slits within extremely close proximity, increased visualization may help with accuracy as well as minimize the potential for shock loss. Although studies indicate that well-stored grafts can remain out of body for many hours without comprising growth rate, it is advisable to place grafts quickly and accurately. Moreover, grafts will need to be placed rapidly during mega sessions just to finish the surgery within a reasonable period of time (for the staff and the patient).

Patients should discuss the pros and cons of different recipient area preparation with their physician prior to surgery to get a sense of the best approach for their particular circumstances. While shaving the recipient area helps the techs and the doctor the vast majority of patients do not wish to have the hair cut short. Obviously some professions prohibit patients from cutting the hair. These patients would prefer to hide the work.

Sometimes you need to give the Propecia 6 months to a full year before evaluating results. The real reason to stop the drug would be side effects. If you are not experiencing any, I think it is in your best interest to hang on until the year mark.