Hair Transplant basics

[Mickey85]

Mickey,

 

As usual, great work!

 

My only suggestion would be changing some wording in the "methods of hair transplant surgery" section. While the terms "FUT" and "FUE" are commonly used to describe two different types of hair transplant surgery, they are actually two subtypes of the same procedure: Follicular Unit Hair Transplantation. This means that "FUT" is technically called "Follicular Unit Hair Transplantation via Follicular Unit Transplantation" and "FUE" is "Follicular Unit Hair Transplantation via Follicular Unit Extraction."

 

Granted, the terms "FUE" and "FUT" are well understood by patients, but just because you're writing such an excellent overview, you may want to throw that in there.

 

Again, great work!

 

Thanks so much for the kind words Blake. I will definitely make alterations as you suggested

[Mickey85]

Thanks Spex i will defintely look over those links. Ill be focusing on tge procedure and philosophyfor a while.

[Mickey85]

The plan is to have a 'wikipedia' for hair transplants all in the one thread.

[JohnnyDrama]

Nicely put together as usual Mickey!

[Mickey85]

Thanks Johnny boy

[1978matt]

Really Joe?? Really? If you are going to talk the talk at least walk the walk. Talk about contradiction:

 

Classic NW1. Not only did he have very little loss. Instead of 800-1000 grafts, Dr Hasson (Joe's employer) transplanted 1,999 grafts!! Is something a miss? I guess you could say I am way off as you guys felt content to implant 999 more grafts than my estimation.

 

As for the donor density. 99% of clinics on this forum use photos to determine how good the donor is. Are they wrong? Photos can be deceptive yes but it is a common standard used in the industry. Either most clinics are wrong or they are right. This is a basic guide. I strongly believe that patient has an above average donor. Comparing it to the average donor case makes it abundantly clear.

 

So about that NW1 that H&W implanted 1,999 grafts on?

 

I'm sure Jotronic will confirm but this guy looks like a NW2 or 3 pre-op. It's just the way he has styled his hair to cover the recession of the temples.

[Mickey85]

There are multiple preop shots that confirm he is a nw1 buddy. The hairline was not dropped very much at all. He had loss in the temples. Lol at a nw3....

 

Joe said my graft estimates were 'way out' but im pretty sure he can read the part that said they were 'vague and general'. Surgeons like Feller, Rahal, Bisanga etc operate on nw1s all the time and similar or more than 1000 grafts. Let's look at some examples:

 

836 grafts by Dr Feriduni. Listed as nw1 on Feriduni's site

 

1,441 grafts by Dr. Feriduni, listed as a NW1 on Feriduni's site

 

812 grafts, listed as nw1 on Feriduni's site

 

I'll take Dr Feriduni's word over Joe's.

Edited May 4, 2013 by Mickey85

[Bobilero]

Great post Mickey. Good informative information that will help the newbie.

 

All I dont see the point myself doing 'splitting hairs' over technical aspects re pictures etc. Every patient will be different with different characteristics. This post will be definitly be useful to give people new to the industry an initial general awareness of the landscape.

[1978matt]

There are multiple preop shots that confirm he is a nw1 buddy. The hairline was not dropped very much at all. He had loss in the temples. Lol at a nw3....

 

Joe said my graft estimates were 'way out' but im pretty sure he can read the part that said they were 'vague and general'. Surgeons like Feller, Rahal, Bisanga etc operate on nw1s all the time and similar or more than 1000 grafts. Let's look at some examples:

 

836 grafts by Dr Feriduni. Listed as nw1 on Feriduni's site

 

1,441 grafts by Dr. Feriduni, listed as a NW1 on Feriduni's site

 

812 grafts, listed as nw1 on Feriduni's site

 

I'll take Dr Feriduni's word over Joe's.

 

The first one looks like a NW1. He went from NW1 to NW1!

 

Second one looks more like a NW2 into NW1.

 

The 3rd one is NW2 into NW1.5 in my book.

 

The first 2 are harder to tell without the side on shots.

[Mickey85]

Thats all cool Matt everyone has different perspectives. Feriduni does list all of them as nw1s on his site though. I do agree with the use of nw 1.5 etc or betweens. My graft estimates are a rough figure anywsy and heaps of docs work on nw1s

[1978matt]

Had a quick look on Feriduni's site and there are a few strange ones in there. Like the one attached who is also classed as a NW1

[Mickey85]

Had a quick look on Feriduni's site and there are a few strange ones in there. Like the one attached who is also classed as a NW1

 

That one is definitely off.

[Jotronic]

Mickey85,

 

Classic NW1. Not only did he have very little loss. Instead of 800-1000 grafts, Dr Hasson (Joe's employer) transplanted 1,999 grafts!! Is something a miss? I guess you could say I am way off as you guys felt content to implant 999 more grafts than my estimation.

 

 

 

Really? This patient was a "classic" NW1 before surgery? Then why isn't he a NW1 after surgery?

 

I'd still like to know what a NW1 is supposed to aspire to with 1000 grafts. Or is this for a NW2 to get back to a NW1? You weren't particularly clear on this.

 

As for the donor density. 99% of clinics on this forum use photos to determine how good the donor is. Are they wrong? Photos can be deceptive yes but it is a common standard used in the industry. Either most clinics are wrong or they are right. This is a basic guide. I strongly believe that patient has an above average donor. Comparing it to the average donor case makes it abundantly clear.

 

What do 99% of clinics have to do with your examples? Why is this even a point? Are you speaking for 99% of clinics that post on this forum? Did 99% of the clinics on this forum verify what you are saying? I'm not sure why you are using this "statistic" and I'm not sure why you feel it is necessary to preach to me about how clinics make recommendations. It is irrelevant to your initial post.

 

I'm well aware of how photos are used in this industry to make assessments. Our clinic was one of the first to have a comprehensive photo upload feature for online consultations, set up by me. I basically wrote the proverbial book on how photos should be taken and how they should not be taken. I've posted more about the subject than anyone and I've probably looked at and analysed (yes, analysed) more hair photos than anyone on the planet. I have spent many many hours investigating how hair photos are taken and why they look the way they look. I've forgotten more about hair photos than most people will ever learn. I know of what I speak.

 

You may strongly believe that the patient has an above average density in his donor zone but as I said before, I know him personally. You do not. I have examined his donor up close and in person. You have not. You want to argue with me about this? I can't imagine why because I'm trying to help your thread have more accurate information. Your response would indicate some sort of offence has been taken. If that is the case then I apologize but I can't for the life of me figure out why.

[Mickey85]

Joe, I find it funny that you only show the side-on view of the Norwood 2 pictures because it suits your angle but omit the ever important top-down Norwood 1 view

 

 

Note the juvenile and straight hairline(post op) when viewed from the front. Note the slight recesses in the temples(preop) when viewed from an angle that resemble the norwood 1 top-down. The patient is a norwood one pre and post procedure. My opinion. NW1's can exhibit some small loss in the hairline. The norwood scales are not set in stone and I have frequently seen Norwood 1 described as minor hair loss. Surgeon's have stated they treat Norwood 1. My graft estimate for Norwood 1 is for a Norwood 1 much like the Feriduni patients I showed you.

 

Do you think clinics do not operate on Norwood 1 patients? Is that what you are trying to say?

 

You stated photos are not good for determining donor density, I was debunking that(only to an extent, real life trumps photos) in saying that for most clinics, photos of the donor are sufficient to determine donor density. Sufficient does not mean perfect. I thought I made that pretty clear. Photos are really the only thing I can offer as a 'vague and general' guide champ.

 

You know what you speak of. That's great. You know the patient saw the gentleman's donor personally? That's great, I'm not doubting any of this or saying it did not happen. But in my eyes the average donor density gentleman and the 'above-average' donor density gentleman are not in the same category. Sorry Joe, but I've been around enough to know that there are minor and major interpretations in everyone in the hair industry. I was told I had average density by one renowned surgeon while his rep said it was dense. I got told I had well above average by two surgeons while another said it was average. Sorry, your credentials are impressive, I'm not doubting that but I do not see two guys with average donor density. I also look at the whole donor because I am more interested in FUE. I can see great thickness and density from top to bottom, it looks dense. The average and the above average photos are lightyears apart to me. That's my sentiment.

 

If I take offense Joe, it's because you gave no feedback on the things I did right and delved straight into the things you thought were bad. It's a basic guide for new guys and is not meant to replace proper consultations and/or personalized research. The NW1 thing might be alien to Hasson and Wong because they focus on mega-sessions and don't do many small 700-900 cases, but many clinics do. Repeatedly I have heard surgeons or reps say to people "you are classified as a Norwood 1 you will need this this and that" etc. Feriduni has NW1 examples that were restored. Did you not read the part where I said it is a vague and general guide?

[greatjob]

Good thread Mickey! But I have to agree with Joe, I didn't see his initial post as harsh or inflammatory at all, but your response was overly aggressive. This is a good thread but it is at risk of being steered off course. I think what Joe was saying in regards to the donor is that you can't really tell if the patient has above average donor density from those pictures because hair caliber or characteristics could make average or below average donor density look above average. Good work though, I commend you for your dedication for taking your time to put these kind of threads together

[Mickey85]

Good thread Mickey! But I have to agree with Joe, I didn't see his initial post as harsh or inflammatory at all, but your response was overly aggressive. This is a good thread but it is at risk of being steered off course. I think what Joe was saying in regards to the donor is that you can't really tell if the patient has above average donor density from those pictures because hair caliber or characteristics could make average or below average donor density look above average. Good work though, I commend you for your dedication for taking your time to put these kind of threads together

 

Hehe thanks champ, much appreciated. I could have been much cooler about it, but for Joe to just say "why would a norwood 1 ever need surgery" when there are clinics that perform on NW1's daily perplexed me. I take ALOT of pride in all my threads to try and help patients and perspective patients and these threads are a labor of love. Instead of saying what he thinks was good and bad about the thread he just said what he thought was bad. Coming from someone like Joe, I take things like that pretty harshly as it was dismissive and left no room for ifs, whats or buts Hasson and Wong might not do NW1 cases but that doesn't mean others do not. I do admit I should have chilled for a bit though and I apologize to Joe publicly about my demeanor but still stand by what I said about the actual thread. But thank you again for the comments. See, I don't always bring up FUE hehe.

Edited May 4, 2013 by Mickey85

[greatjob]

Every time I see examples of NW1 guys with no loss getting a transplant I want to slap them, haha. Even when I was 8 years old I never had hair like they did pre-op, not fair.

[Mickey85]

Every time I see examples of NW1 guys with no loss getting a transplant I want to slap them, haha. Even when I was 8 years old I never had hair like they did pre-op, not fair.

 

I know champ hehe. The guy in the Feriduni case I posted really did not need a procedure but that's part of the obsession that some guys have that I don't talk about much. What some perceive as totally kickass is perceived as lacking by someone else

[Questionmark]

You know what you speak of. That's great. You know the patient saw the gentleman's donor personally? That's great, I'm not doubting any of this or saying it did not happen. But in my eyes the average donor density gentleman and the 'above-average' donor density gentleman are not in the same category. Sorry Joe, but I've been around enough to know that there are minor and major interpretations in everyone in the hair industry. I was told I had average density by one renowned surgeon while his rep said it was dense. I got told I had well above average by two surgeons while another said it was average. Sorry, your credentials are impressive, I'm not doubting that but I do not see two guys with average donor density. I also look at the whole donor because I am more interested in FUE. I can see great thickness and density from top to bottom, it looks dense. The average and the above average photos are lightyears apart to me. That's my sentiment.

 

If I take offense Joe, it's because you gave no feedback on the things I did right and delved straight into the things you thought were bad. It's a basic guide for new guys and is not meant to replace proper consultations and/or personalized research.

 

I only can emphasise these two last set-offs. To be honest I thought it was quite rude to critizise issues that imo are nearly (NW) or completely (donor) irrelevant to the purpose of this thread. For which reason? Why anyway pointing out that Jo knows the patient and his donor personally, when it actually is only for the newbies trying to inform themselves? I don`t think that anybody here would question the experience and expertise of Jo, so no need to have a go at each other, cause that`s what I feel is/was going here.

[KO]

Every time I see examples of NW1 guys with no loss getting a transplant I want to slap them, haha. Even when I was 8 years old I never had hair like they did pre-op, not fair.

 

This. If some of these guys thought they were bald enough to get an HT, I need to go jump off a bridge.

[Jotronic]

See, now you went and ruined my great response. I had it 75% finished then decided to take a break and enjoy the sunshine and now I get a public apology from Mickey and it ruins my witty retort. *sigh*. No worries, bro.

 

Seriously though, it is a good post and I wish you didn't take my comments as anything reflective of your hard work. I see things differently than most because I have micro-analysed, macro-analysed and investigated every aspect of this field for years. I still do and so sometimes my comments may be unnecessarily detailed. to the point where my message can be misunderstood.

 

Enjoy your weekend. We have our first summer like weather here in Vancouver so I certainly intend to enjoy mine:)

[Questionmark]

I think I understand both sides and it was the prime example of a misunderstanding, but that`s what makes the world less boring, doesn`t it:)

Let`s enjoy spring:cool:

[Mickey85]

See, now you went and ruined my great response. I had it 75% finished then decided to take a break and enjoy the sunshine and now I get a public apology from Mickey and it ruins my witty retort. *sigh*. No worries, bro.

 

Seriously though, it is a good post and I wish you didn't take my comments as anything reflective of your hard work. I see things differently than most because I have micro-analysed, macro-analysed and investigated every aspect of this field for years. I still do and so sometimes my comments may be unnecessarily detailed. to the point where my message can be misunderstood.

 

Enjoy your weekend. We have our first summer like weather here in Vancouver so I certainly intend to enjoy mine:)

 

Hehe all sweet Joe

[Mickey85]

Making tweaks, adjusting the layout into sections(recipient, donor etc) and adding new info!

[Bill - Seemiller]

Mickey and Joe,

 

Oh good, it looks like you two made up. I personally happen to think you both have a point in terms of Norwood 1 hair loss sufferers. Frankly, I'd probably recommend anyone who is truly a Norwood 1 (which isn't always easily determined by photos) to hold off on getting a hair transplant - especially if they're young. However, for those who are older Norwood 1 hair loss patients with no signs of aggressive hair loss to come (miniaturization), I see nothing wrong with a a hairline refinement procedure that may improve their self confidence.

 

Also, remember that the Norwood scale (and Ludwig scale for women) are man made scales to attempt to classify a person's hair loss. Very seldom does one fit perfectly into one single classification. Most patients are in between Norwood scales but are typically categorized/placed into a single class just as a frame of reference. Additionally, pictures showing Norwood scale classifications don't account for miniaturization of existing hair follicles in other areas of the scalp that may only be visible under magnification in real patients. Thus one could still be mostly a Norwood level 1 but signs of miniaturization could easily put them into a higher class in the years to come.

 

Mickey, overall, I think you did an excellent job on this topic.

 

Due to so many great topics with rich with quality information and content, I think we should consider creating an updated "Frequently Asked Questions, Answers and Discussions" sticky topic that links to many of your and other poster's excellent topics.

 

Informational topics like these that promote healthy debate and discussion are vital to anyone's research as they consider their hair restoration options.

 

Thanks to everyone for contributing their thoughts on this topic so far and thanks to Mickey for starting it.

 

Best wishes,

 

Bill