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What is Protocol for Hairline Design?


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Was wondering what are people's experience with their doctors pre-design plan. I found that process to be a little underwhelming in terms of what I expected. Meaning, a few quick lines are drawn (on the operating table) and then was asked -"is this what you want?"

 

It's pretty hard to gauge as layman customer what and how those lines will look out when fulfilled. Is there not digital software that can take your picture and then give you estimated computer imagery of what you can expect with different 'battle lines' and with different graft counts? I'm pretty sure this is standard with plastic surgery for the face -does this software not exist in the hair industry?

 

I see a lot of clients state that they are not happy with hairline after a procedure talking about needing to get another one to either add more density or square/lower the hairline again. I think with better pre-design the first time, it would save many from having to undergo the knife again.

 

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I think the good docs have been doing it for so long that they know instinctively, what will look best based on your facial features, head shape, loss pattern, etc. There are some rules that they follow such as most docs would never go above 7.5 cm from eyebrow to hairline as that would be considered too high. Also, temple closure and angles may have a general formula to them as well but again, most of it is the doctor's pure artistry.

My Hairloss Web Site -

 

Procedure #1: 5229 Grafts with Dr. Rahal Oct, 2010

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  • Senior Member
Was wondering what are people's experience with their doctors pre-design plan. I found that process to be a little underwhelming in terms of what I expected. Meaning, a few quick lines are drawn (on the operating table) and then was asked -"is this what you want?"

 

It's pretty hard to gauge as layman customer what and how those lines will look out when fulfilled. Is there not digital software that can take your picture and then give you estimated computer imagery of what you can expect with different 'battle lines' and with different graft counts? I'm pretty sure this is standard with plastic surgery for the face -does this software not exist in the hair industry?

 

I see a lot of clients state that they are not happy with hairline after a procedure talking about needing to get another one to either add more density or square/lower the hairline again. I think with better pre-design the first time, it would save many from having to undergo the knife again.

 

progress.gif

 

 

 

A lot of it depends on expectations. A patient with high expectations going into a completely bald area should be told that it may take 2 procedures to reach an acceptable density. I like your idea of a digital software, but there are just soooooo many variables, like caliber of hair, curl, contrast of hair to scalp color, etc. that it would be really hard to get down to an exact science. Plus you have to consider the difference in perfectly combed hair and a natural look. I think that procedures like yours are some of the hardest to do and make the person happy because the hairline is so obvious and I think you said that you do not have MPB, so there will be a stark contrast in native and transplant. A NW3 and higher are probably the easiest.

 

Hang in there buddy. Hopefully you get what you are looking for.

I am an online representative for Dr. Raymond Konior who is an elite member of the Coalition of Independent Hair Restoration Physicians.

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I am not a medical professional and my opinions should not be taken as medical advice.

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  • 2 weeks later...
  • Regular Member

 

Why did you proceed with a doctor giving you a shoddy pre-op plan?

Was it because you had already paid?

-From Shampoo renavigated from Hairguy350's thread.

 

Well I guess this is pretty hard to answer. I had indeed studied these forums as well as other sites for a long time to try and get a better grip on what HR really entails. I talked to various doctors at length over the phone as well met with a Bosely rep before I really understood to stay away from the chains.

 

Admittedly my main focus was that I wanted FUE, but doctors were telling me I didn't look like a good candidate due to my wiry, mixed race hair. My top was thinning but I was really only concerned with the advancing widows peak.

 

After talking with Dr Keene, repeatedly, she agreed to try FUE and for her price I could only afford 800 grafts as I had to cancel all my business and travel expenses were costly for me -on top of that a wife who thought I was crazy to spend that kind of money -lol.

 

Frankly, I was really worried about an FUT scar after watching so many gruesome videos, the thought of that mighty gash in my head vs pinpricks -well, lets just say the FUE looked far more up my alley.

 

Anyways, yes, they had me prepay and in all our phone discussions she just said that the 800 would nicely frame the face. I guess I just didn't know when the actual lines were gonna be drawn but I anticipated at least a short sitdown before the procedure started -that didn't happen..

 

To make matters worse when she first walked in she did greet me quickly but then just blurted out, "You can't do FUE! Look at your hair!". I forgot to mention that I had sent emails far before that asking for FUE -BUT, if it didn't work I'd PROBABLY just go for the FUT" -in which she said fine. As time grew closer, I became more worried about being forced into FUT and called the clinic again, I asked the nurse what would happen if we tried FUE and it failed -she put me on hold, asked the doctor, and then said I'd merely lose my deposit of $1000. I said fine.

 

Well, it wasn't fine. After meeting her and her telling me FUE was just probably just not going to work but she did agree to try 20 grafts. I said That if they didn't take, I'd most likely forfeit the deposit and walk away. this didn't sit well with her and she became visibly irate -"Well, we're just going to have to change our policy" and walked out in a huff to give me time to think.

 

Now remember, I was already freakin anxious over the whole setting and rushed feeling -now the doctor who could be cutting me soon was pissed at me -not good! Her very nice Asst. chilled me out and told me that with my amount of donar hair (NW2?), it would just be a small incision on the top left of my head -not the back. I finally agreed as not wanting to waste a once in a longtime opportunity and signed the paper.

 

After all that, the doctor came back in, drew two very quick circles around my forehead recession and said "You want like this?"........

 

The FUE failed and we did the FUT and they nicely added an extra 100 grafts. The problem is, how is that in any way considered a good gameplan? Im pretty sure the lines she drew encompassed a lot more space than the thin perimeter actually filled but now I can never no because

 

A. No design lines picture taken

B. No post op pictures taken

 

I had also asked if she could thread the grafts back a little more to the tuft area directly behind the perimeter but she said those area hairs were too strong and may promote shock loss. Now I see that area thinning and actually have space between old hairline new hairline in which I have to smear Toppik to cover.

 

At slightly over 5 months, I'm not freaking out and maybe the bare spot will somehow conceal itself better with more maturing but my overall problem is just the feeling that the whole thing was really rushed and too much focus on the money at my arrival. The Asst./'s were very nice but I also clearly remember them saying "See, if you had gotten FUE we'd all have to be here all day!"

 

The last point would be that I probably would have opted for more grafts with the saved costs (pre-payed) but that was never brought up or addressed. I just think that doctors need to remember that this is a BIG DAY for us and to really understand we may be overwhelmed by it all and need their support and patience.

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I see how it happened BlackAmish and I see how it can easily happen. You were not in a very good position that day. I suppose there is always a risk when a patient travels a great distance to be put in a similar position. I purposely flew to Vancouver from Texas a day early so my consult/pre-plan would not be on the day of my surgery, but if I had decided even the day early that I didn't like what I saw or there was a major problem, it would be costly for a patient to not go forward. I suppose that's a risk a patient takes when he does not fly for a consult before any money is exchanged. It would have cost me another $1000 to make my consult a separate trip, so I thought with Hasson/Wong's reputation I was willing to take that risk. Thankfully it worked out ok.

Dr. Dow Stough - 1000 Grafts - 1996

Dr. Jerry Wong - 4352 Grafts - August 2012

Dr. Jerry Wong - 2708 Grafts - May 2016

 

Remember a hair transplant turns back the clock,

but it doesn't stop the clock.

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A patient should never feel rushed through the pre-op process, especially when it comes to hairline design. In my initial consult with Dr. Feller we went over design and gameplan for about 45 minutes. Day of surgery we spent at least 30 minutes designing, taking pictures, etc.

I am the owner/operator of AHEAD INK a Scalp Micropigmentation Company in the New York area. AHEAD INK is a Milena Lardi trained clinic and uses Beauty Medical Tricopigmentation equipment and products exclusively.

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Thanks for your input fellas. I do want to say that my biggest worry -the scar -she did an expert job on and that in itself is a relief. The growth stage is still early, and my current feeling is that on some days with some toppik, it looks a lot better. other days it seems that I just really wish we could have broadened the hairline graft area some more and it would have been perfect (minus the half dime sized bare area that is).

 

If it comes out great in a few months, I will come back and give her full props for her work -I just wish she had spent at least a few minutes meeting with me and allowing me in the gameplan design a bit more.

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Amish,

 

The type of software you described used to be very popular in cosmetic surgery/medicine practices in the late 90s and early 2000s. Physicians would use the software to essentially photoshop new noses, lifted faces, new hairlines, etc, onto patients, and believed it was a useful tool.

 

However, it eventually fell out of favor because the results of surgery - even a successful one - are subjective and highly dependent on individual physiology, and patients were becoming upset when their result didn't perfectly mirror the computer's rendering of what they could potentially look like after surgery. Frankly, I tend to agree with this sentiment. Like I said before, surgery is very subjective, and while a generally idea of what one should expect after surgery is good, it should also be followed with an explanation about the unpredictability of patient physiology.

 

However, I think you bring up a good point with regard to hairline design. I think it should be a thorough, collaborative process involving both the doctor and patient.

"Doc" Blake Bloxham - formerly "Future_HT_Doc"

 

Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

 

All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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  • Senior Member
Was wondering what are people's experience with their doctors pre-design plan. I found that process to be a little underwhelming in terms of what I expected. Meaning, a few quick lines are drawn (on the operating table) and then was asked -"is this what you want?"

 

It's pretty hard to gauge as layman customer what and how those lines will look out when fulfilled. Is there not digital software that can take your picture and then give you estimated computer imagery of what you can expect with different 'battle lines' and with different graft counts? I'm pretty sure this is standard with plastic surgery for the face -does this software not exist in the hair industry?

 

I see a lot of clients state that they are not happy with hairline after a procedure talking about needing to get another one to either add more density or square/lower the hairline again. I think with better pre-design the first time, it would save many from having to undergo the knife again.

 

 

progress.gif

 

 

 

 

Fantastic Question Kudos to you that you brought up this question, Infact Even I had the same concern hairline design is such a imprtant point before you start the HT. I mean you can have a area filled up with hair but if it is not designed well, from the hairline perspective it all is useless.

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I think the good docs have been doing it for so long that they know instinctively, what will look best based on your facial features, head shape, loss pattern, etc. There are some rules that they follow such as most docs would never go above 7.5 cm from eyebrow to hairline as that would be considered too high. Also, temple closure and angles may have a general formula to them as well but again, most of it is the doctor's pure artistry.

 

I was wondring the same thing is there like a general formula on temple closure and how the angle has to be given near the temple and where should it end near the temple. I also kind of agree when you say most of it is doctor's pure artistry, I remember having a chat with Dr.Bhatti and he also concurred the same thing. Certain things I just cant explain in words, it is purely the Doctor's experience and Artistry, is what he said... But I strongly feel there should be a formula or a rule to the temple closure and the angle given to the hairline near the temple. I am a NW 2 or a 3 so for me the Hair Density does not matters as much as the Hairline design.

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Also keep in mind that hairline design differs across ethnicities. Africans have low, square hairlines, Caucasians have high, rounded hairlines, and Asians and Latinos are in between. Dr. Diep has a series of Youtube videos and explains this very well. There is not one formula for all people.

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Also keep in mind that hairline design differs across ethnicities. Africans have low, square hairlines, Caucasians have high, rounded hairlines, and Asians and Latinos are in between. Dr. Diep has a series of Youtube videos and explains this very well. There is not one formula for all people.

 

Can you please post the link to the videos of Dr.Diep you are talking about.

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Fantastic Question Kudos to you that you brought up this question, Infact Even I had the same concern hairline design is such a imprtant point before you start the HT. I mean you can have a area filled up with hair but if it is not designed well, from the hairline perspective it all is useless.

 

 

 

Yup!!! Try telling that to some clinics on here!!!

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The problem with hair is that it's much more complicated than other cosmetic surgeries; you're actually getting real, organic products implanted onto your body. Also there are more factors that come into play with hair transplant than other forms of cosmetic surgeries, such as caliber, contrast, and yield (which is in part based on patients physiology).

 

That being said, making a program would be great, but it could potentially lead to false hopes much more so than getting a nose job. It would be far too hard to take everything into consideration: light levels, yield, contrast.

 

Maybe I'm completely wrong; I know nothing about programming.

My Hair Loss Website

 

Surgical Treatments:

 

Hair transplant 5-22-2013 with Dr. Paul Shapiro at Shapiro Medical Group

Total grafts transplanted: 3222

*536 singles *1651 doubles * 961 triples,

*74 quadruples.

Total hairs transplanted: 7017

 

 

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@Blake & Nick: Yeah, without question getting a highly accurate prediction for something as unruly as hair would be a major hurdle. Interesting that it was once used though... I could surely see people blowing there lids while expecting 100% replication of the computer generated model. Then of course, you could even have false bait in a sense -Bosley may use a model that "predicts" better results then Dr.X -just to lure in more customers.

 

So I can see the difficulties, but I can also see the bonuses. First and foremost I'm after where exactly the hairline etc.. will be placed -on a 3d picture of me, right in front of me. If I can afford X amount of grafts -I would like to be able to sit in the 'war room' with the doctor and have them say "With 1500 grafts, I would place the majority here, here and here" as depending on your NW, face shape etc.. "Now with only 800 grafts, I would focus more on this area as to create the illusion of density..."

 

Hopefully you can see what I'm getting at. The prediction aspect of this pre-design is not really what I'm after though that could be a fun aspect of it with a HUGE disclaimer beforehand - results may very -lol!

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That's what research is for. You look at doctors who have good results for how much grafts used, you look at patients of theirs who have similar balding patters as yours, similar hair and skin charactaristics and look at how many grafts were used on that patient to make them look like they do in their post-op photos. It's a lot of work, but it's sometimes necessary if you want a good result.

My Hair Loss Website

 

Surgical Treatments:

 

Hair transplant 5-22-2013 with Dr. Paul Shapiro at Shapiro Medical Group

Total grafts transplanted: 3222

*536 singles *1651 doubles * 961 triples,

*74 quadruples.

Total hairs transplanted: 7017

 

 

Non-Surgical Treatments:

 

*1.25 mg finasteride daily

*Generic minoxidil foam 2x daily

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  • Senior Member

 

I suppose that's a risk a patient takes when he does not fly for a consult before any money is exchanged.
That is the answer. Must be done. All the doctors I am considering are in other countries/continents but I will have to make that extra trip. Hairline design is paramount.
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  • Regular Member
That's what research is for. You look at doctors who have good results for how much grafts used, you look at patients of theirs who have similar balding patters as yours, similar hair and skin charactaristics and look at how many grafts were used on that patient to make them look like they do in their post-op photos. It's a lot of work, but it's sometimes necessary if you want a good result.

 

Nobody's displacing the patient end need to research - but that doesn't negate the fact that some doctor's protocol for involving the patient in a thorough design plan beforehand. The more I look into it now, the more I can see that some doctors indeed do a very in depth battle line drawing of how they are going to approach it, while others (even of the higher pedigrees), have a much more minimalistic approach whereby seeming to rely more on their own artistic instinct and experience.

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That is the answer. Must be done. All the doctors I am considering are in other countries/continents but I will have to make that extra trip. Hairline design is paramount.

 

I agree in a perfect world....but realistically how many patients

are going to fly to multiple cities for consults only? I doubt many.

Dr. Dow Stough - 1000 Grafts - 1996

Dr. Jerry Wong - 4352 Grafts - August 2012

Dr. Jerry Wong - 2708 Grafts - May 2016

 

Remember a hair transplant turns back the clock,

but it doesn't stop the clock.

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  • 2 months later...
  • Senior Member
I agree in a perfect world....but realistically how many patients

are going to fly to multiple cities for consults only? I doubt many.

 

 

Exactly. U would think though most clinics would have the patients best interest in mind, but unfortunately that's not the case.

 

I seriously think some clinics shouldn't even be recommended on this site,

but that a whole different issue.

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  • Senior Member
The Asst./'s were very nice but I also clearly remember them saying "See, if you had gotten FUE we'd all have to be here all day!"

 

Very lame. Making the job of the doctor and her staff easier is absolutely, 100% irrelevant to you. Even if it was just a joke, it's poor form and unprofessional.

 

The doctor either does FUE, or doesn't. If she does, take the money and do it. Don't complain, delay, or make excuses to get out of it. Jesus.

 

It sounds like her initial FUE test failed because she... doesn't actually know how to do FUE?

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