TheHairLossCure

Carter, Well, it sounds like you didn't go for the procedure. Good for you. Enjoy your stay reading the forums here and good luck with your research.

This is a nice result. Dr. Seager was one of a handful of physicians that really took follicular unit graphing via single blade strip harvest to the next level in the 90's. I am happy to see this great transformation, Tumbleweed.

ahall, Is part of your goal to have more hair, or do you really just want to soften the plugs and be done with it? It might effect your reversal strategy and the method.

Rodfl, If you have a hyper-dense row (or rows) of plugs in the front line, a brow lift can be a fairly efficient option. With this approach you can remove a lot of bad grafts as well as scar tissue in a single long and narrow strip. You will be trading your old grafts for a linear scar though so, yes, a follow-up session will be needed to cover over the scar and build a nice, natural hairline. Individual graft removal might be an option too. Please Grow, Did you find that your old grafts were widely and irregularly spaced? If so, it would make sense that the grafts were removed one by one. Glad your repair experience was positive. Bill, Your observations are largely on point.

That is correct - FIT is NOT a new procedure. There is a reason Dr. Rose refers to his strip-free donor harvesting method as FIT. And it is not to imply superiority over another method or clinic. Dr. Woods was the Aussie physician who opened people's eyes to possibility of strip-free donor harvesting (years ago). The results were met with skepticism though, since Woods was so secretive about his work. Wood's procedure was not called FUE. I believe it was initially marketed as the "TOP-UP Procedure," then later referred to as the "Woods Technique." Later, Dr. Rassman published a paper where he described his version strip-free harvesting as FUE, or Follicular Unit Extraction. Dr. Rose was one of the first physicians in North America to really examine the possibility of the strip-free harvest. He called the procedure FIT, or Follicular Isolation Technique. Since this was back in 2002, there wasn't a generic name for strip-free harvesting. Apparently, over time, the term "FUE" emerged as the generic and over-arching name. I do not think there is any particular reason for that. I assure you Dr. Rose was not trying to reinvent the wheel only to call the something else. At the time, the procedure really did not have a widely accepted name. I personally feel that Follicular Isolation is a better description of the method. Ultimately, it is name we have lived with for a long time. Hope that clarifies the history a bit. There really is no pretense in the naming. But for the sake of clarity, I will try to refer to the procedure as FIT/FUE.

rodfl, Dr. Rose has had great success with scar repair and has developed and refined several techniques that can be applied to this very process. The Ledge closure is method where the epidermal edge of the donor incision is trimmed while leaving the growing part of the follicles intact. The wound is then closed with a single layer under minimal tension. The objective is to get the finest possible scar so that the hairs that have been trimmed of epidermis may grow through the scar line to camouflage it. This technique can be an effective method of scar removal and subsequent revision. FIT (Follicular Isolation Technique) is another procedure Dr. Rose has developed over recent years. This surgery, like the Ledge closure, can be effective in scar management and repair. As you probably know, FIT/FUE is a method whereby follicles are harvested from the donor region one by one with a tiny punch or needle. Grafts can be harvested and planted into scars to conceal the tissue. In some repair contexts, the Ledge closure and FIT can be used as complimentary procedures. A strip can be harvested to removed prior scar tissue and then the wound can be closed via the Ledge to create the best strip scar possible. Once healed, any areas of scar that may require additional coverage can be addressed via FIT grafting. There are multiple ways to improve donor scars. The best approach is largely informed by the extent of the scarring as well as the location of the scars within the donor zone.

Hairline contruction is generally safe. I tend to think it is safer than treating the crown area. The reason is that you cannot lose hair in front of your transplanted hairline while you can lose hair in and around your crown area. We need to keep in mine, however, that hairlines cannot be placed just anywhere (unless the patient is absolutely, 100% aware that certain designs may necessitate additional work etc.) One of the reasons for this is that hair loss can occur on the side of the face. So, if the transplanted hairline is built and tied into one's natural hair at the right location, one will not need to worry excessively about hair loss at the temple points etc. If, however, the hairline is aggressively built and tied into transient hairs, a patient may later find that additional procedures are needed to reconstruct the temples and fill in gaps. Experienced HT docs tend to have an eye for what will work long term. Some candidates can get aggresive, while others really should not.

I was actually wondering if some of the body hairs were used specifically in the temples to feathery them. Thanks for the scoop. One problem physicians sometimes encounter, even in follicular unit transplantation, is building a hairline and/or temple points on patients with thick or wiry donor hair. In many cases even *single* hair grafts from the donor area are too think in diameter for the frontline or temple points. Coarse single-hair-grafts can't look "pluggy" exactly, but they can stand out too much and look "not right" if improperly placed in transition zones. Often times this issue is overcome by assuming a slightly different pattern or density on the leading edge so to distract the eye. Other times physicians can slightly injure a small handful of single-hair-grafts for the front, or use FIT to pinpoint very fine hairs. Using BHT is somewhat of an extension of FIT idea. The draw back that I see is that BHT has some unknowns and the aesthetic result may not be as predictable we would like. I would really like to follow this case. The temple construction is interesting. You def got a good amount of scalp grafts, almost 3000, to provide some nice volume. Congrats!

There are many ways to contend with poor graft and plug work. Depending on where the hairline was placed, you can attempt to camouflage the work with follicular unit grafts. You can also remove the grafts (via scalpel or other utensil depending on graft size) and then suture the incisions. A variation on that idea would be to selectively remove natural follicular units within the grafts (via FIT/FUE), thus thinning them and hopefully softening their appearance. It should be interested to hear what the various doctors are recommending for your case. Good luck! By the way, are the grafts you are concerned with the result of open donor harvesting or strip harvesting?

Thanks for posting your post-operative photos. You had a very interesting procedure and the donor site looks nice. I have a couple of questions: What made you decide to use body hair? Also, in what areas of the scalp was the body hair utilized? Dr. Rose has done BHT on a limited basis but I think he feels, as do I, that the best results are typically to be obtained via STRIP mega-session w/ Ledge closure, Follicular Isolation Technique (FIT) for scalp hair, and/or a STRIP/scalp FIT hybrid approach. That being said BHT does open some interesting possibilities. That is part of the reason that I am curious what part of your recipient zone received what hair.

It is interesting to see the work from your initial HT procedure shaved down. Looks like the grafts are a bit large and too widely spaced. Based on the immediate post-op photo from the recent surgery, it looks like you have received far more elegant graft placement and hairline design. Congrats to you

By the way, I do not want to sound foolish optimistic about the field of hair restoration. There are a lot of sub-par docs doing sub-par work that is not going to deliver what I think of as acceptable density or naturalness. I trust you will check out a good handful of solid clinics and get a sense of work that is being done.

Naturalness is conquerable in hair restoration. I think it is fair to say, certainly for Dr. Rose and many of the excellent physicians you may hear about in this discussion group, that naturalness takes precedence. It is very reasonable for patients to expect an undetectable result from their hair restoration. In fact, patients SHOULD expect naturalness. With the technology and instrumentation available today it is possible to design and place a recipient zone without HT "tell signs" (i.e. ??“ pitting, visible scarring etc). Graft selection is very import too. Building the leading edge of the frontal hairline with exclusively single hair grafts is key. Then, you have the physician's innate aesthetic sensibility and eye for what looks right presently and what will look right in the event of additional hair loss. If you get top-notch hair work, you really should not be a slave to any particular hair style. With state-of-the-art Follicular Unit Grafting, the grafts are small enough and placed close enough together that you will be able to finish an area with natural results in a single pass. That's not to say that you are not going to want to treat another area of the scalp later or perhaps up the density slightly from the first session. It depends, but you should NOT *need* to do more work to look natural or acceptably dense.

Where are the photos?

I believe there is some soft data that suggests that 50% of original density will give the appearance of full density. It is sort of a broad statement and I do not know that I totally agree with it. Hair characteristics can work greatly for or against any given patient. Some guys with good donor hair characteristics are going to do great will less that 50%. Others with less than good donor resources are going to need to move a lot more hair to get a full look. All that being said, I believe a good cosmetic HT density in the frontal third is possible with most patients. The appearance of density is very subjective and it is good to check out live patients if possible. "But even at high densities, a semi "see-through" look in some angles/lights will most likely happen." I tend to agree here and candidates with very high expectation will do well to keep this in mind.

You made an interesting observation when you said that a (permanent) Norwood 2 frontal hairline may not look normal if you experience extensive crown loss. There certainly is a normal pattern in nature where a relatively low hairline is coupled with crown thinning or loss. The pattern is a Norwood 2V. However, the surface area of crown loss in a 2V pattern is typically not that big. If you are destined to lose significant hair over a large surface area of the crown, you might not want to be married to a low HT hairline. Post pics if possible. You might also want to send along photos to some well regarded physicians. I think you will find that most reputable docs will try to make you happy in both the short term and the long term. Therefore, if you are a reasonably good candidate for a lower hairline, there is no sense in being unnecessarily conservative. On the flipside, if you are a bad candidate for aggressive work, an ethical doctor will tell you so and give you other options.

The welcome is much appreciated, Bill

Great transformation! Glad to see it. Should be fun to see how things progress and mature over the next 6 months too...

If you are worried enough about your hair loss that you are considering hair transplant surgery, I would sincerely encourage you to jump on some medical therapy to slow down your loss. As mentioned by others, there is Propecia and Minox as well as some others ancillary therapies like Nizoral Shampoo, Saw Palmetto, Topical Spironolactone, etc. I find that sometimes patients are discouraged by the fact that medication may not always regrow hair. Just keep in mind that often times meds can coax some of the wispy, thinning hairs on your scalp to grow with a better diameter. This can give better coverage and improve hair volume.

Hairbank addressed a crucial point regarding head shaving. Some of the top physician's in the field are employing methods of hair restoration, whether with STRIP surgery or Follicular Extraction/Isolation, that enable patients to clip their hair very short without noticeable scarring. However, it is not reasonable for a doc or clinic to give the impression that patients are going to be able to shave their heads after surgery.