The Stand Alone HT

[NervousNelly]

The reason I am starting this thread is that with all of the research that I have done it seems like there is very little discussion about the "Stand Alone" HT.(B spot brushed on topic in other thread) What is meant by this phrase is that it is a HT that if done will look totally natural without future HT and if further native hair is lost.

 

I want to preface things by stating that I am not a big fan of any HT that is not stand alone. That is not to say that there are not certain circumstances where it is warranted to do a small session to increase density, etc., but there is definitely more reason for concern.

 

Possible situations where stand alone HT is not necessary in my opinion:

 

-patient is older and will likely not suffer any further hairloss due to MPB

-money will never be a concern in future for patient

-repairing scars, burns in someone. Still must however consider future hairloss

-had previous stand alone HT and doing touchup

-woman that don't follow MPB

 

Just curious what others have thought about the issue. I am sure you have all seen the photos of someone that had dense packing in frontal area and immediately you thought-"what happens when he loses hair elsewhere?"

[NervousNelly]

The reason I am starting this thread is that with all of the research that I have done it seems like there is very little discussion about the "Stand Alone" HT.(B spot brushed on topic in other thread) What is meant by this phrase is that it is a HT that if done will look totally natural without future HT and if further native hair is lost.

 

I want to preface things by stating that I am not a big fan of any HT that is not stand alone. That is not to say that there are not certain circumstances where it is warranted to do a small session to increase density, etc., but there is definitely more reason for concern.

 

Possible situations where stand alone HT is not necessary in my opinion:

 

-patient is older and will likely not suffer any further hairloss due to MPB

-money will never be a concern in future for patient

-repairing scars, burns in someone. Still must however consider future hairloss

-had previous stand alone HT and doing touchup

-woman that don't follow MPB

 

Just curious what others have thought about the issue. I am sure you have all seen the photos of someone that had dense packing in frontal area and immediately you thought-"what happens when he loses hair elsewhere?"

[MrJobi]

Hi NN

 

Good topic.. Difficult to see this situation because it isimpossible to determine how much hairloss will be in the future (especially if they are not on propecia). This is why I prefer a more conservative approach so you can reach the best look considering your situation with donor hair,future loss, etc.. Someone can easily get 6000 grafts these days and not consider future loss or a limited donor supply for future sessions..

 

I think your stand alone HT would have to be on someone who is a Norwood 6 or so where there is no native so they could not lose any? This way, whatever they have would be due to the HT..

Most persons on here with a HT or 2 are taking Propecia so they won't lose the native hair and are over 25 (of course there are no guarantees but my hairloss stabilized at 30 with Propecia).

 

A good outcome takes a good planed multi-faceted approach with strategy based on needs and the future considered

[NervousNelly]

Thanks for the reply Mrjb. I understand what you are saying and yes, definitely if the person is a 5+ they should be having a stand alone HT.

 

But look at Bill for example. (Hope you don't mind using you as an example Bill) After his 1st HT he looked perfectly fine. There was an obvious cosmetic difference and if he chose not to have further HT's he would look okay. Obviously there would be very limited density but the look was natural. He had a plan and wanted more density but otherwise he didn't have to. That is what I am referring to.

 

I understand that we never know when or if the native hair will go but the surgeon in many cases should plan for the worst scenario in my opinion so the patient is not forced into getting further HT's because they look odd otherwise. Just my perspective.

[Bill - Seemiller]

Nervous,

 

I don't mind you using me as an example . I think this is a very difficult topic, but a good one. I would agree that a "stand alone" HT is ideal, however, I don't think that everyone pattern of hairloss will allow for it.

 

It sounds like you are defining "stand alone HT" as an HT that looks natural according to the norwood scale even if all other native hair is lost. Your definition would also seem to include HTs with less density (like my first HT). That way, even if they look like a diffuse thinner, it still looksl natural. Whereas, if a doctor dense packed the first third of the scalp, but went completely around dense native hair, in the event they lose the native hair, they would be left with an unnatural pattern according to the norwood scale. As I stated above...I think the problem with this, is that it depends on the individual's hairloss pattern and how soon or late people want to start having an HT. If doctors would only deliver stand alone HTs, I believe this would limit the quality of work that can be done on patients with unusual thinning patterns. It isn't sensical to transplant grafts into an area of the scalp that already has a lot of dense native hair. Sure, they could lose some of it later and would need additional work done, but to me, that would be better than waiting for that patch of hair to fall out which may not even happen - and as MrJB pointed out, that's why using finasteride is a good idea to minimize that risk, though we know it's never a guarantee.

 

I think what's best still comes down to the individual patient. Someone like me who was thinning or balding everywhere could afford to get hair transplanted all over the scalp, leaving my transplant with a thinner yet natural look, even if all native hair falls out. Whereas other patients with different hairloss patterns may not qualify for such treatments and need to take a different strategy. So until there is a CURE for further hairloss or hairloss in general, I think Mrjb said it perfectly when he said, "A good outcome takes a good planned multi-faceted approach with strategy based on needs and the future considered".

 

Bill

[NervousNelly]

Bill,

Yes you have understood my definition of stand alone HT. I would agree with you that it will vary on the individual and there will be exceptions as I outlined above but I think that the docs need to assume worst case scenario with native hair.

 

Obviously there are the extreme cases of the 22 yr old getting frontal area dense packed and that we can all agree is not a conservative approach.

 

I also agree with the statement that Mrjb made about having a sound plan, but lets face it, an individuals scenario may change. What if the plan is to have 3 surgeries and after the first the persons financial picture changes and they can't afford another HT? OOps! I hope that it was a stand alone procedure. I would hope that this was thought about in the plan--this is part of my point.

 

 

No doubt that this is a difficult subject and there is probably no real black/white answer.

[hairbank]

Of course............back in the day (2-3 years or so ago), stand alone HT's were unheard of due to a "mega session" being considered 2000 grafts or more. Now, since the bar has been raised (or sent into orbit), and a person can get as many as 7000 grafts in one session (assuming many factors), one-pass or "stand alone" HT is a possibility.

 

IMO our expectations have been raised along with the bar. Before, many of the HT's you'd see were 1000-2000 grafts placed in front/midscalp combed back. Now, you see 3000-5000 midscalp and remaining grafts going into the crown for the "illusion" of a full head of hair. Totally revised approach as the technology became available to do the mega, mega, mega sessions.

[Eman]

NN-

 

I actually brought up this topic last week as well...HT: Possible in one pass

 

There are a lot of factors that go into a "stand alone HT", but after discussing this topic with many of the forum members and even speaking with Jotronic about it, I truly believe that one pass is possible (meaning happy with the results) with today's technology and session sizes. It really depends on what you are happy with and then the hair greed that creeps in after a good HT.

 

A good doctor will take into account miniaturization and i am sure other factors so as not to leave an "island" of transplanted hair on your head, after the remainder of your native hair goes.

 

I struggle with this too NN as I want a one pass session. I now believe it can happen and I would be very happy with it!!

 

Eman

[Bill - Seemiller]

Eman,

 

You are defining "one pass" surgery differently than Nervous is defining "stand alone HT". Just in case you didn't realize, I thought I'd point that out.

 

Many patients today can be satisfied with a one pass HT, especially with advancement in technology and methodology, however, a "stand alone" HT may or may not be different, depending on the patient. For people like London_Lad, they would end up being the same thing considering he really didn't have much native hair to begin with. Others however, who get HTs who may only be a NW3 for example, may get a nice one pass session, look great, but lose more native hair in the back and then LATER have to go back for a second pass. Therefore, the awesome one pass HT that looked great doesn't look as natural anymore since more hair was lost and would have to be filled in.

 

Therefore, I still argue that a "stand alone" HT isn't possible for everyone. I don't believe this is a bad thing...but it should be discussed in the strategy between doctor/patient when planning the long term.

 

Bill

[NervousNelly]

Thanks for the clarification Bill.

 

I understand the thought process that not all hairloss patterns can be good candidates for the stand alone procedure but I certainly hope that it is discussed in the plan with the doc. My only concern is for those that at the time of planning think that they can swing 2 or 3 surgeries but later on find out they can't. I would hope that the 1 surgery will look good on its own cosmetically. I think you catch my drift.

[Eman]

Thanks Bill--

 

I am a little dense (not hair wise ) sometimes, thank you for the clarification.