N-6

What have your docs recommended post-op regarding things like dermamatch, toppix, nanogen, couvre, etc . . . in the recipient area? Does anyone know if this can affect yield? Thanks!

I agree with orlhair1 about online consults in general but in this case, there are two docs with what seems to be very divergent views on how to approach his case. One has only seen photos and states he can get a significant number of grafts while the other (after personally examining his scalp) says I can get only 1500. That seems to be a pretty big difference. My online consult gave me a more conservative estimate than my actual in-person consult. Given the very differing views by docs on Fireman, if I were him I would arrange an in-person consult with surgeon A or another doc. Good luck!

Lorenzo, I don't see anything wrong with Hariri or anyone sharing his opinion regarding Rahal. If that's his opinion, then so be it. At the end of the day, its one person's opinion. To Haircare, I understand that you want at least 3000 grafts but what you want and what a doctor thinks is feasible are two different questions. Good luck. This site can be a great resource.

The issue for Fireman is does he have 3-4K as supply for this HT in this first place. It doesn't matter that surgeons can crank out 3-4K in one session. Every patient is different. We're talking here about Fireman as a patient specifically, not patients in general. Surgeon A somehow determined he had high scalp laxity without examining him (maybe on basis that this is Fireman's 1st HT?). Surgeon B examined him and thought it would be safe to just harvest the back and not the sides. It makes sense that by not using the sides, this would limit his available supply for this HT as Surgeon B alludes to. Maybe its not safe to harvest from the sides in your particular case because grafts from there will eventually fall out. I would schedule a personal consult with Surgeon A to come up with a specific treatment plan after a close exam of your scalp including your sides. You definitely need to be on the same page with your surgeon even if its the day before your scheduled procedure. Maybe even consult with Surgeons C and D.

An attempt at scar revision would be my first option. I would then consider micropigmentation or tattoo in the scar may be my 2nd option. FUE into scar is expensive and seems more iffy in terms of ultimate results.

I tend to favor a fairly conservative approach for my own head and I would make every effort to personally consult with surgeon A prior to committing to any procedure and to know what to reasonably expect before hand. I personally would not feel comfortable entering surgery with a certain set of expectations when the surgeon has not physically examined my hair in person. Maybe surgeon B saw something in person that wasn't revealed by the photographs you sent to surgeon A. This is matter of preference I suppose. As previously mentioned, staples versus sutures should be a non-issue as top doctors use both.

I have dissolvable sutures and staples. Once the donor area is closed via sutures and staples, I'm not sure if that's still considered an open wound, especially 9 days out. The angle will be tough for toppik but maybe the spray applicator can help. I also read couvre is good for donor area. No concealers though for recipient area, I'm scared it could give me less yield.

Has anyone used this with any success? I'm aware of dermamatch but wanted to know if anyone has used Toppik or Nanogen to conceal donor area. I'll be returning to work soon and the hair in the donor area won't be enough to cover staples and scar. Thanks!

Just had HT No. 4 last week. I'm not self-conscious about the transplanted hair but I'm self-conscious about the scar at times when my barber cuts my hair a little too short. Since I just had surgery last week and the doc trimmed the areas where grafts were placed, I now have an uneven haircut. I'll be going back to work soon so Ive got to figure out a fairly even hairstyle that conceals my eventual shedding and scar. These next several months are probably the most stressful.

Research and consult with several reputable HT docs. Let them evaluate you and recommend a treatment plan, if any. If youre committed to wearing your hair short, maybe consider the nonsurgical option of scalp micropigmentation. Its not for everyone but it may be right for you. Good luck.

That's scalp micropigmentation. I'm typing this from my phone. Sorry bout that.

I'm aware of 3 ways to help treat or help camouflage the scar. 1. Scar revision where old scar is taken out in an attempt to give you a thinner scar. No guarantee this will work. 2. FUE into the scar. I haven't seen any consistent results that this works either. You may or may not get growth of FUE hair in scar. I think one issues with this method is the blood supply in and around scar. Less than optimal blood supply in this area probably wont lead to good growth plus its expensive. 3. Scalp microtation or tattoo into the scar. Personally, I may try this if I don't like my scar after I'm done with my FUTs. I just completed number 4. I think its less expensive and cosmetic results I've seen are better. In the meantime, use dermamatch to conceal the scar. Do a search here on this forum for each of these methods.

Post-op 3-4 months, I use a hair stylist here in NYC who specializes in hair loss. He's great at cutting around a fairly fresh scar. Its nice cause he has a small studio and its usually just me and him and maybe another customer in the studio. After that 3-4 month period, I tend to primarily use a barber, which is less expensive. My latest barber, I initially told him I had (unspecified) surgery and just asked him to watch out for the scar. His response was that he sees this in a number of men. He usually does a decent job cutting around the scar since I tend to cut the sides a little short. I've got to admit that its a little uncomfortable when the barber shop is packed and he gestures at my head while discussing my hair/head with his trainee. Presumably, they're discussing my scar but who really knows cause I don't speak Russian. Btw-I'm now about 5 days post-op with Dr. Ron Shapiro (my 4th HT over last 15 years and 1st with Dr. Shapiro). Time to figure out a hairstyle before resuming work in early December!

Usa, I don't post much but I've been following this site for years now. I've undergone several transplants myself. Regarding whether you're a good candidate for surgery, my personal opinion is that you may be able to achieve a nice cosmetic result, although I don't think you will get full coverage. But, I'm not a doctor and many of the posters here are not either so we can only speculate based on photos. My advice is to go to a reputable doctor or two and have them personally evaluate you to get a sense of what they may be able to do for you. The fact that you may be a NW6 or NW7 does not mean you are not a good candidate for a transplant. It just means your expectations need to be managed. Reputable hair transplant doctors sites are replete with before and after photos of NW6 and NW7 which tends to undermine the claims here that you are not a good candidate. So hear it from someone who has a degree, experience and reputation regarding your treatment options. Best of luck.

Hey Multiplier, two recent consults with docs both indicated that it would be my last FUT. They were

Thehairupthere, thanks, I will consider Dr. True. However, I'm pretty skeptical about doing an FUE procedure at this point. I really want to maximize my grafts, since its my last go around.

Thanks for the response Matt. I'm considering undergoing an FUE procedure because I am likely done with strip after next one but the relative unpredictability of hair loss, the less than optimal yield rate and high cost, are making me have doubts about the procedure. It would really suck to pay all that money now only to lose FUE hair several years down the line.

Thanks guys. I'm looking for someone to maximize what I have. I've heard that T/D and Bernstein are fairly conservative, which is not a bad thing, just possibly incompatible with my goals this last time around. Is this not the a correct impression for me to have? I will definitely look into Cooley.

Hi everyone, my donor supply has probably one last strip left (according to 2 recent consults) and I'm looking to have FUT with nonshaving surgeon who will maximize my donor supply (but of course not to the detriment of my scar). Any recommendations? Guess I'm looking for someone who is not considered highly conservative. I live in NY but am willing to travel. Thanks all and Happy Thanksgiving.

Thanks for your responses. Thehairupthere, I'm not convinced that a doctor can predict the final balding pattern "quite accurately" of many patients. Your doctor's own site states that the balding pattern is "somewhat predictable". I take this to mean that they may have some idea but this isnt the same to me as "quite accurately". As a patient, predictability percentages (if they exist) would be informative. Also, don't meds lose their effectiveness over time? I don't see how we can say for sure that taking rogaine, propecia will greatly diminsh a patient's chances of progressing to a NW 6 or 7. Given all this, it just seems that FUE can be fairly risky for many patients. Are there any contraindications for FUEs in patients who may progress to NW 5-7?

thehairupthere, with what degree of accuracy can Dr. True generally predict the extent of thinning/baldness in a patient whose pattern has yet to mature? I guess this is a question for all physicians on this forum who do FUE. If a doctor cannot predict this reliably in such a patient, then how do we trust that they are properly identifying a safe donor supply? Of course, these questions dont apply to a 50 or 60 something year old patient whose thinning may have already run its course. I'm talking about patients in their 20's, 30's and 40's who show some thinning but the extent of which is not yet clear. 90-95% yield sounds nice but those seem to be short term results. We're talking about long term yield (15 years onward), does anyone have percentages as to that? Maybe not because it doesnt sound like FUE has been around that long in general practice. Thanks for all your responses. This is helpful.

FutureHTDoc echoes my point - it seems that FUE can be a gamble in certain patients because thinning/balding pattern cannot be predicted with reasonable certainty. So you might have hair for several years after an FUE but this could ultimately thin out and fall completely because the grafts which were extracted during FUE were not DHT resistant in the first place. Dr. Feller, docs, what do you think about this?

Thehairupthere - "The hairs in the donor area are resistant to DHT that is why they are the donor supply as opposed to any other hair. If a doctor is transplanting from an area that is not in the desginated donor supply area, than that is an error and should not done" This sounds a little circular to me. To arrive at proper donor supply, a doc has to predict with reasonable certainty that the grafts taken from this donor supply will not thin or fall completely with time. Unless you're dealing with a patient who has an established balding pattern (probably an older patient), how can a doc determine what is proper donor supply outside the area where strips are usually taken? Doesnt the risk exist that FUE grafts taken from outside the strip area will simply thin substantially or fall? Just calling the area from where FUE grafts are taken a safe and permanent zone doesnt make it so. We can say that about strips in FUT because the procedure has been around a long time and even in NW 7 patients, the hair in the area where strips are taken tends to remain in tact. It seems that with FUE (which I don't think has been around as long as FUT), people are now extending the safe, permanent zone upwards to areas which may very well thin or fall. If that area above the usual strip area were indeed safe and permanent, then why aren't strips taken even higher than they are now? Maybe this discussion should be limited to potential NW 5's and above as the sides of those patients may drop and horseshoe pattern develop. Is FUE a riskier procedure for these patients in terms of long term yield? Doctor input is always welcome, thanks for your responses guys.

Thehairupthere, thanks for your reply. However, I do not understand when you say the following: "The FUE grafts are taken from the same area as FUT are, they are both from the donor supply and both are DHT resistant . . ." (I added the emphasis) I really don't see how this has been established by anyone with any certainty. Descriptions of the procedure from various clinics and photos of the procedure from these same clinics clearly show that grafts from FUE are not taken from the traditional strip area of the scalp. In actuality, FUE grafts are taken from above this area of the scalp, which may not be DHT resistant in many cases. So with FUE, we're not talking about FUT, which is a tried and trued method of taking grafts from an area that is generally safe from thinning (of course, with some exceptions). With FUE, we are talking about taking grafts from area which may eventually thin and fall anyway. FUE may seem ideal for a patient with an established NW 2, 3 or 4 but for a patient whose balding pattern is not yet established and could progress to a NW5 or above, it would seem like FUE is almost a crapshoot. You may get immediate gains from the procedure but the hair will ultimately fall out in the future because of progressive hairloss. If I'm missing something or not understanding this properly, please chime in, thanks.

"FUE should yield somewhere from 90%-95% of all grafts that are harvested. This number also depends on what instruments the surgeon uses, as well as the experience of the surgeon". This is a percentage I've heard before. While this might be the short term yield, what is the long term yield for FUE? I think this could be an important distinction. Grafts for an FUT is taken from a different area than FUE. We know that the strip in FUT is taken from an area that is generally considered safe and subject to minimal thinning. Therefore, the grafts taken from this area are essentially safe for the long term. However, FUE is not taken from this zone. Rather, its taken from areas above where strips are taken. Since it is not easy to predict the extent of hair loss of a particular patient, how are we, as patients (particularly younger ones), to be assured that FUE grafts wont simply fall or substantially thin after a number of years? It would be really helpful if clinics or physicians respond on this topic as I'm not really clear on the long term yield of FUE. Thanks.