Transplanting through existing hair?

[Guest tim]

I will probably be totally bald in the future if i do nothing. Im 28 years old and taking propecia and using minoxidil. It seems that these products have retarded my hair loss. I'm currently very thin on top but my curly hair does wonders in covering up the scalp. My surgeon has begun transplanting through my already existing hair.What are the pros and cons of doing this in light of the fact my grandfather is totally bald, and my pattern is following the same route?

[Guest tim]

I will probably be totally bald in the future if i do nothing. Im 28 years old and taking propecia and using minoxidil. It seems that these products have retarded my hair loss. I'm currently very thin on top but my curly hair does wonders in covering up the scalp. My surgeon has begun transplanting through my already existing hair.What are the pros and cons of doing this in light of the fact my grandfather is totally bald, and my pattern is following the same route?

[arfy]

My first questions is "who is your doctor?"

 

Does he use follicular units? This is a crucial question you should be asking before any surgery.

 

There is the possibility of shock fallout of your natural hair. Hopefully, if your hair loss has been halted, the drug therapy will prevent this from happening. Stay on top of this treatment, because it is crucial to keep as much natural hair as possible. In fact, you shouldn't assume that you will become completely bald. That may not have to happen. And a hair transplant on a completely balding head will not look nearly as good as one where you still maintain some hair.

 

Where are you on the Norwood scale?

 

Getting a hair transplant to "stay ahead of your baldness" is a big mistake, in my opinion.

 

Also, most ethical doctors will not transplant into the crown. There is a limited amount of donor hair, and it needs to be reserved for the front hairline and behind that. If you transplant into the crown, you may not have enough hair to do the hairline as well as you need to.

[Questioner]

I agree that the crown, as doctors say, should not be transplanted until and unless the front and the top extending toward the crown have been done.

 

There is some debate among the doctor as to where the crown starts though. Bernstein says it is 150 cm sq behind the front of the hairline. Shapiro says it is 90 cm sq behind the front of the hairline. Putting that into perspective, Bernstein transplants about 2.4 inches further back than Shapiro.

 

My impression always was the the crown starts where the skull reaches its highest point and where the hair changes direction from being going forward to going backward.

 

It's important to understand what we consider the crown and what different doctors do.

 

Any thoughts? Posters? Doctors?

 

-?er

[Hair Transplant Tech]

Arfy are you a Doctor? Because you seem to give lots of medical advice.

[Questioner]

Dear Transplant Technician or whomever,

 

Don't be so presumptuous as to think that just because Arfy is not an HT doctor or technician that he doesn't know a lot about transplants. He knows a little too much, unfortunately for him.

 

Shock fallout is a real problem, one that actual patients have complained about on these types of boards but that HT doctor websites either omit completely or downplay. There was a very good, serious discussion with Dr. Parsley and a poster (AP, I think) on that very subject.

 

Most of what Arfy says, whether I agree with how he says it or not, has come from research, his experiences, and the experiences of actual patients who post. People know he is not a doctor and that he is not a substitute for a doctor. This is, however, an industry in which many doctors have been less than forthcoming about the potential risks of the surgery. People like him therefore have a valuable role believe it or not.

 

I might add that your post added nothing to the substantive discussion of the thread, it was merely a one-line attack on a poster, who in spite of a horrible experience, still tries to help other people.

 

If you want to contribute to this forum, I suggest that you do it constructively rather than trying to take shots at posters trying to do good.

 

I sincerely hope you are really a technician for one of the better surgeons who can contribute positively to this thread and others. Good discussion is important and necessary.

 

-?er

[Hair Transplant Tech]

I never said that he didnt know alot about transplants,just wanted to know if he was a Doctor or not. Im not trying to bad mouth anyone here, there is enough of that on this site already.I agree there are clinics out there that dont disclose everything that could happen but on the other side of the coin there are good ones that do,just try to remember that and dont clump all the Surgeons in this industry into one catagory. There still are many Sugeons that are ethical and CARE about there Pt's.

[pdm68]

HairTransplant Tech --Who do you work for ??

[arfy]

No I am not a doctor. If I was a doctor I wouldn't be posting under a nickname.

 

What "medical advice" am i dispensing? This is all common sense stuff anyone can pick up, from reading the comments and scientific papers from the doctors themselves.

 

"Watch out for shock fallout." Most doctors don't mention it unless you bring it up first. Even then, many doctors and their salesmen (I meant "consultants") dismiss the whole thing as a "non-issue". Including Matt, Dr. Shapiro's consultant, who tells patients it is nothing to be concerned about.

 

I also tell guys to try to keep as much of their natural hair as possible. Since this should be a "no-brainer", I'm assuming that you probably object to this cutting into your bottom line.

 

Since you are a technician, maybe you can post the available data on the occurence of shock fallout, for all of us to read. I'd be curious to see it. Thank you in advance.

 

And I promise not to lump in all the bad transplant doctors with the good ones. I agree that the dozen or so "good" ones deserve to be in a special group, kept apart from the 3,000 crappy ones.

 

And by the way, what do you think the purpose of this forum is? This is a place where PATIENTS can share information. If you pay attention, you will see I have almost never posted anything in the forum where questions are directed to doctors. (Two posts, one was to a "Question for Doctors and Patients". The only people who have a problem with patients sharing information and learning from each other are the sleazy doctors. The good ones welcome the idea of an "informed patient". Only a shady doctor would have any reason to resist the idea of an educated public. Even though I am happy to stay out of the doctors' forums, they still feel free to post in the patient's forums whenever they please.

 

Why don't you tell us who signs your paycheck? I'm sure he's a real winner. Maybe he can help you find that shock fallout data.

 

[This message was edited by arfy on December 12, 2001 at 08:03 PM.]

[Dr. William Parsley]

I enjoy Arfy's comments and would not like to see him back away. However, I am not sure Hair Transplant Tech's comment was meant to be as negative as it was taken. It is easy to misunderstand someone's printed text so I give them the benefit of the doubt. Personally, I would have considered it flattering that they asked. Even though I don't always agree with anybody, Arfy seems to have a good handle on the present information and is well worth reading. Knowlege is the best way for anyone to avoid problems. You have every right to question the clinics as to their techniques. Regardless of what many think, transplanters have plenty of disagreement on the same topics I see debated by potential patients. But the physicians I know are far more conscientious than are portrayed here and would be more than happy to answer any questions.

Forgive me for getting off thread, but I would like to take a bit of Lou Holtz's philosophy in order to advise someone as to how to pick a doctor or clinic. There are 3 things you should always ask yourself: 1) Are they competent? 2) Are they committed to their trade? That is, do they attend meetings, interchange with other doctors, keep up with current techniques,etc.? 3) Do they care about me? If any of these are "no", keep looking.

I may be different from some of the other doctors, but I feel shedding is a big concern. First of all I worry about shedding because I realize that some of the shed hairs will not return. I feel the baldness has to be progressed enough that real gains can be made without the backsliding caused by shedding. Secondly, some of this hair may be salvageable with medication. I personally don't know of any good studies on this problem. It needs to be done but will be very difficult. In my opinion, shedding is a major cause of dissatisfaction with transplantation, particularly the first session.

I frequently see people in my office with early hair loss ready to start transplanting. This is an area where real caution should be exercised. If there is a reasonable chance they can be satisfied without transplanting, then they should wait and try medications. If a person is a good candidate for transplanting, they will still be a good candidate 3 yrs or 6 yrs later - no need to rush.

Once the decision is made to transplant, realize that shedding is not predictable. Use of minoxidil and GraftCyte can help. More questionable are finasteride and lysine. Surgical technique is important - avoiding transection, not overly dense packing, possibly reducing epinephrine concentration, etc. But the best way reduce the problem of shedding is to make sure that there is enough hair loss before embarking on transplantion so that shedding is not able to detract significantly from the positive gains.

Dr. Parsley