TheHairLossCure

It is common sense, but no sun-worshipping and no burns. UV rays are not your friends

Getting other people's input, like you girlfriend's, is good but remember that hair restoration is permanent. So you need to make the choice and, more importantly, you need to do the research (lots of it). Don't get too excited about one option. Look at all the treatments that are available to you.

Ludwig patterns can certainly appear in men. The main thing you should think about is shock loss. You have thinning over your scalp, but no area of defined balding ??“ is that right? That - with a retained frontal hairline - would be pretty consistent with a Ludwig pattern. I don't think there is one right way to approach it but, since your doctor will be planting between thinning hairs, shock loss might be a concern. The stand-alone-surgery with a norwood pattern tends to work well because the hairline, which is lost due to MPB, can be rebuilt. And, since one cannot lose hair in front of a hairline, this approach often produces a result that a) stands alone and b) is a logical first step for a multiple-surgery restoration. This does not apply as much to the Lugwig pattern as you still have your frontline. You can certainly graft cosmetically thin areas of scalp. Surgery can cause shock loss, as previously mentioned, so your surgeon must strike a balance between transferring sufficient hair mass and minimizing trauma. This might mean grafting a low or moderate density in order to avoid damage. Consider this 1 step forward, whereas an aggressive surgery might be 2 steps forward and (with shock) 1, 2, or 3 steps back. Anyway, your pattern is far from a one-size-fits all. Multiple opinions, even if you have one doc in mind, are advisable I think.

BTW, I agree. My initial post was just about the beard hair topic, not about beard hair for treating chemo-related hair loss.

Beard hair, unlike other "body hair," seems to grow well when transplanted. I have seen results from beard hair, from years ago, that were actually ok (given the patient's goals and donor limitations). It should be noted, however, that the surgeon (not Dr. Rose) did strip, not FUE, to harvest the grafts. This would not be my recommendation but, since both of the patients wore a long beard for their entire adult lives, the strip scar was not a deterrent. Texture is an issue with beard hair. Growth, however, does not seem to be. It is not an ideal solution but it has been helpful in some (very) rare cases. Honestly, I think beard hair would be a bad choice for 99% of patients. I'm just telling you what I have seen.

Are you asking because the reality (or unreality) of hair cloning will have a bearing on your hair transplant decisions? Personally, I think patients should proceed with their HT plans with the expectation that cloning will not be an option. It will, but the whens and hows are ify. Some people don't do hair transplants because they are waiting for cloning. Not doing HT is fine, but cloning should not be the reason. Conversely, some patients wish to be very aggressive with HTs with the idea that, by the time their donor is exhausted, hair cloning can save the day. Again, the reasoning is flawed in my opinion.

Pain is pretty much a non-issue with the surgery (apart from those "bee-stings"). During the operation you will not feel much at all. In the following day and/or weeks you may feel some mild discomfort (or itchiness) in the donor and recipient areas. I would not call it "pain" though.

Trimox, Way to go! Things are looking great for just 5 months. I am really happy for you

"A HT is a BIG investment both financally and emotionally." It is pretty important to be realistic about (or at least have a handle on) the emotional aspects of the surgery. The way one looks, and feels, post-op is totally variable. Still it important to remember that patients are going for surgery so their hair will look better but, immediately post-op, their scalps may look worse. I am referring the scabs in the recipient area (which may or may not be shaved down) and the stitches and/or stables in the donor area. Patient often enjoy surgery as, at least in Dr. Rose's OR, the staff is very pleasant and accommodating. After that you need a week or two for the scalp to get back to normal...then you may look as you did prior to surgery...then, 6-12 months later, you have a significant cosmetic improvement. That can be a long/emotional time line for any person.

Spex's shock loss is an extreme example in FUE. From my own observations, shock loss is less common and less severe with FUE.

Dr. Mwamba and Dr. Bisanga do nice work in fue (and in general for HTs).

I find that odd, but perhaps it is the case. You got some nice hair though I am sure you have seen those charts from Shapiro's office (posted by Janna) were the doc writes in the patient's donor density. Also you may have read accounts from some of Dr. Rose's patients were they refer to specific donor densities. You can cut/clip very small portions of hair (in consults or pre-surgery) and use magnification (like a densitometer) to count hair and follicular units per unit area. If you do it in multiple areas over the donor zone you will get a good picture of the patient's average hair and donor density. From there you can calculate the dimensions of the strip. Now, on the other hand, if you wanted as many grafts as possible in a session, measuring density is not that important. If you pull more tissue you will get more grafts and that is the goal. Just remember, some guys are not going in for as many as possible.

If the ht work is not very good, then it is better to keep the hair a bit longer so the exit points of the hairs from the skin are not visible. Since, obviously, you are doing your research in order to get top results, I image you will get them. In that case, the recipient area will look fine, in terms of naturalness, whether the hair is long or short. As previously mentioned, the donor scar (rather than the recipient area) might be the deal-breaker in terms a very short cut.

I don't think that most doctors, at least the ones talked about on this site, are eyeballing donor density prior to donor tissue removal. You need to make donor-density measurements so that the strip yields (approximately) the number of units discussed during the consult/planning process.

Wow! I just noticed these updates. For an advanced class 6, this is very fine result indeed

Bill, Just so you know, Dr. Rose does not ask patients to post or advertise. I am sure you know that, though. But, I agree that details etc. are obviously very helpful for readers.

"Keep in mind too, that if one hair transplant won't meet your goals, you are going to want to develop not only a long term hair restoration plan, but a long term financial plan to cover all that you will need done." You know, that is good point to mention. If one is going to need 2-3 sessions, there must be a long term financial plan that corresponds to the long term surgical one. Nobody needs a drawn out and unexpected financial burden.

BTW - Dr. Harris is a proponent of using the sharp punch to score skin and the dull to cut around the graft. Dr. Rose has partially adopted that approach in conjunction with the FIT/FUE punch and slot punch. As I am sure you know, using the dull punch can reduce the risk of slicing through follicles during extraction. It also means that, in some cases, a smaller punch can be used. So, there are ways to do your .75 - .90mm punch FUE. Still, I wouldn't wants to unnecessarily limit the surgery by totally ruling out the 1mm.

Hmmm B-spot. I think you are reading an adversarial tone into my post. Please don't hit me! To address the punch issue though, I think there is a problem with using big tools and the reason is simple. When virgin scalp patients look at FUE they are probably concerned about scarring. So there is no good reason to up the risk of creating white spots. Still, you and Bill correctly bring up the issue of follicular destruction. That really is not a huge issue if the doc and/or patient are flexible in terms of a) extracting smaller grafts or b) using (slightly) larger tools for big grafts. Now, that is not to say a doc should pull 90% singles because he/she wants to use a super tiny tools. Conversely, the doc (in my humble option) should not use 1.1s and 1.2s to get big grafts either. Those 1mm+ tool don't really serve a purpose anyhow.

"HLC... would you agree that .75 to .9mm punches provide a broad enough range to tailor punches to the needs of the patient?" I can't agree or disagree. Dr. Rose uses the .75mm as the smallest punch and 1mm as the largest punch. There are cases during which the 1mm is never used at all and other cases where the 1mm is useful. I will to need confirm this, but I believe that extracting 3 and 4-hair follicular units with a .75mm sharp punch can be very difficult, particularly if the hair-splay is wide. Getting intact grafts - if the groupings are large - is much easier with a 1mm. If a patient only wants a .75mm and a .9mm like you described, he/she may have to expect only 1-, 2-, and some 3-hair groups. Damaging large grafts can be a factor with small sharp punches. So one can either opt for smaller punches and smaller grafts or larger punched and larger (but naturally occurring) grafts. (Another possibility is "blunt" FUE, but that may be a discussion for another time. If a patient wants lots of hairs per grafts and is a good healer, I think using the 1mm in conjunction with smaller tools can be fine. If the objective is to use the smallest punches possible, use of the 1mm can be avoided.

Nice review. Glad to hear things turned out well. How many grafts?

As far as I can tell, most reputable doctors are not using punches greater than 1mm in diameter. Also ??“ and don't for get this part ??“ most reputable doctors are not using punches smaller than .75 in diameter either. The recent "online backlash" against large punch FUE has certainly raised some awareness about the procedure. At the same time, I think it has created some misconceptions too. For example, in this thread very thread posters have mentioned the use of .6 and.7mm punches as if it is standard practice in FUE. It is not. I am sure if you asked most seasoned FUE physicians, they will tell they do not use punches this small. (Disclaimer to Bart: I am not saying the .7mm is necessarily bad or evil since I wouldn't know. It is just uncommon.) .75mm ??“ 1mm is common in FUE. Many surgeons feel it is difficult to remove intact grafts with tools smaller than .75. Many also feel it is unnecessary (and risky) to use a tool bigger than 1mm. That is my sweeping-generalization-FUE-rationale Nobody can predict who will scar with what punch. It is up to the surgeon to use tool big enough to remove a full follicular unit...and no bigger.

Spex, That is what I thought and of course I have seen the sort on white dot scarring in the donor area that can result from "big" FUE. Still, it occurred to me that, for patients with densely growing donor hair, FUE'ing double-follicular unit groups can be a possibility...a very real one particularly if the surgeon is using punches bigger than 1mm. Hence my question about pulling larger grafts. (That is my little disclaimer in case the initial question seemed off-the-wall...)

Dr. Feller, I was interested to read where you described 1mm+ FUE as "baby" plug work. Many people contend that, since 1mm+ punches are not necessary, they must not be used. That is sound reasoning in my mind. Still, when I see you mention "plugs," I start to wonder whether or not you've seen some 1mm+ FUE results where the grafts were obviously too big. In other words, they looked "pluggy." (?)

hairdude83, I think the fact that grafted hair can thin - particularly in old age - is sometimes a good thing. It can be somewhat graceful actually. If your hair loss accelerates and/or your donor area is thinning, a thick crop of locks in the frontal third may create an imbalance. On the other hand, if your transplant "moves" with the overall appearance of your hair, the result will age naturally. That said, I do not wish loss of transplanted hair for patients! Still, if a patient suffers from an odd condition, senial alopecia for example, it is nice to know that the transplant will, to a degree, behave like the rest of the scalp. It is just more natural that way.