Question for Dr. Feller

[thewizard]

Doctor first let me express my gratitude in your active participation to this site. You definitely educate all of us with your numerous messages and you help bring important issues to the forefront. I have seen some photos of your HT patients and they look great and I know a few of your patients and they are very happy with your work. I do understand about dense packing of up to 30 -35 FU grafts per square centimeter in the front third of the scalp to achieve density. Are you then saying that a successful full transplant that is aestically pleasing to the eye would take approximately 6000 fu grafts. Since the average scalp area is approximately 200 square centimeters. If you front load the transplant with more graphs in the front than the back 2/3 area, how does that look aestically. I have seen some HT on men that have all hair in the front and hardly any in the rear and I must say it doesn't look that great, too much skin showing in the rear and crown area. No one seems to answer the question of how many grafts are needed to achieve decent coverage throughout the scalp that will look good for a Norwood 5 -6. Also, I have read alot about FU vs Mini graphs and agree that FU are the way to go in the front hairline, crown and sides but what is the drawback of using them on the top middle portion of the scalp, do you lose that much naturalness when Mini or micro graphs are used in this area. Thank You.

[thewizard]

Doctor first let me express my gratitude in your active participation to this site. You definitely educate all of us with your numerous messages and you help bring important issues to the forefront. I have seen some photos of your HT patients and they look great and I know a few of your patients and they are very happy with your work. I do understand about dense packing of up to 30 -35 FU grafts per square centimeter in the front third of the scalp to achieve density. Are you then saying that a successful full transplant that is aestically pleasing to the eye would take approximately 6000 fu grafts. Since the average scalp area is approximately 200 square centimeters. If you front load the transplant with more graphs in the front than the back 2/3 area, how does that look aestically. I have seen some HT on men that have all hair in the front and hardly any in the rear and I must say it doesn't look that great, too much skin showing in the rear and crown area. No one seems to answer the question of how many grafts are needed to achieve decent coverage throughout the scalp that will look good for a Norwood 5 -6. Also, I have read alot about FU vs Mini graphs and agree that FU are the way to go in the front hairline, crown and sides but what is the drawback of using them on the top middle portion of the scalp, do you lose that much naturalness when Mini or micro graphs are used in this area. Thank You.

[Dr. Alan Feller]

I won't front load a patient unless I know he is coming back for round 2, and am sure he has enough donor area for it.

 

With this in mind, front loading is, in my opinion, the way to go. I agree that having thick hair in the front 1/3 and being relatively empty in the back 2/3 is strange looking. In fact you just hit on THE major disadvantage of "flaps" (which I despise. I've seen them and bend over backwards for these patients). But this is not the case for my version of front loading. My distribution is over an area significantly larger than a flap.

 

I just don't want to go back into an area on a second surgery if I can avoid it. It is well known by now that the best transplant is the FIRST transplant. By doing it my way (which I picked up from Dr Seager by the way) I can perform a "first" transplant on the same patient multiple times! A change in paradigm, but a very effective and powerful one in my view.

 

Check out this patient of mine who just visited for his seven month postop followup. He came to discuss surgery number 2. A glance at these photos will show that he doesn't need to go back ito the front at all. We will focus on the middle third and stop there. To me, this was the most responsible way to perform HIS transplant.

 

Dr. Feller

 

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Dr. Feller

www.fellermedical.com

[Dr. Alan Feller]

 

[yalao]

Good work, but like you stated he needs at least one more procedure.

 

From the 'before' picture it seems the patient was a Norwood 7 or 6.

 

My question what shoud be the excpectations of Norwood 6/7 who is willing to use all the donor area given that he has average density?

 

Can a Norwood 6 move back to a 3 or 2? would you do work on the crown for these patients

 

Thanks

[Dr. Alan Feller]

Yalao,

Your question is far to general for me to answer fully, but I'll do my best.

 

In another thread called "success" you can see the results of a patient upon whom I placed thousands of grafts using most of her donor area in the process. She certainly felt it was worth it, but I wouldn't really know how to classify her now.

 

I don't classify POST OP patients in terms of Norwood scale. I don't think it is a valid method, and it can be quite confusing. For example, let's say that I had a Norwood 4 patient in for surgery and I filled in ALL the bald areas at 20 grafts per square cm. Is he still a Norwood 4 with more coverage? Or is he a Norwood 1 with thin coverage?

Get the point?

 

Dr. Feller