Is extracting from a transplanted hairline a bad idea?

[starr]

I never thought I'd say this because I was very please with the work of Dr. Rahal in creating my hairline. Unfortunately, I wish I had been told "You might want to get a more recessive design and save your limited donor supply to fill in the crown when that time comes!"

 

Its a bit upsetting... no, its very upsetting that I was not advised about this, as I am now scrambling for hair...

 

So like I posted in a different thread, using beard hair is one possibility for filler. But Im not sure if I can get this done with fantastic results in Ontario. So, I'm debating whether to undo some of the transplants done by Dr. Rahal to move them further back where its balding too much. I've been told this would leave little scars, which is not something I think i would like, given the area that this would be in (unlike the neck where I would have other beard hairs and creases).

 

Should I leave the hairline as is, or take a chance and relocate the transplanted follicles that are closer to the sides and make my hairline of a receding type?

Good idea, bad idea?

[Spanker]

Can we see some photos pre op and post op? I'd like to see where you were at before and where your hairline is at now. I have seen this done successfully but only in small amounts. If you has really good growth, chances are that scarring will show.

[starr]

I've attached the post and pre op pictures here.

 

And you can see by my avatar the area I wish to cover with another HT + smp.

 

Doc thinks he can only get 1500 grafts.. but maybe I can get more with lots of laxity exercises (?). Still not a high number but yeah, concerned about changing the hairline he made if there will be scarring. I currently work as an actor so yes makeup could cover the scars I guess but... if its going to be visible everytime I look in the mirror, I may be no better off than seeing thinness in the back.

[hairweare]

A mixture of FUE scalp and beard hair for the vertex and crown may be your best option. I suggest you get an online consult from the European docs who specialize in this type of procedure. When randomly blended the difference in texture and wave pattern is often well camouflaged while providing fairly good coverage. You would appear to be a good candidate. Not sure I would risk a widened scar when you seem to have enough donor hair in you occipital and temporal zones for FUE.

[starr]

thanks hairweare for the feedback.

This raises up an important question... are you saying that I MUST have beard hair transplanted at the SAME time as the rest of my scalp donor, or is it OK to use beard hair as filler once a person has completely exhausted their donor area?

Also, I'm assuming that you are not advising a change in my hairline to harvest extra grafts?

Finally, can you give me a few names of reputable docs in Europe? I'm in Canada and there doesnt seem to be anyone qualified to do such a procedure...closest seems to be Dr. Umar in LA.

[hairweare]

Not must but rather can. Reputable docs in Europe will look at your donor zones under the scope and can better go over your options prior to the procedure. A trip to Europe even with a brief vacation and procedure will cost you much less than the alternative in CA and still leave you with change in your pocket.

 

Contact Bisanga, Lorenzo and De Reys. There may be others but I have undergone two scalp/beard sessions with Lorenzo so can speak from personal experience and the other two have good reputations on this site so at least you have a starting point.

[starr]

Wow, you did 2 scalp/beard sessions? How are you finding your neck? Are the scars noticeable when clean shaven? Whats the reason that 2 sessions were needed - is that typical?

[hairweare]

First was 300 grafts to hide my old ugly strip scar. The second was 500 mixed with 1400 scalp grafts to cover my thin vertex. No scars, dots on my face or neck, the extraction wounds heal very quickly, just don't touch your face or shave for a week. Normal washing is of course ok.

[starr]

You have NO marks whatsoever? Wow - thats impressive. Dr Rahal's clinic told me that if I decided to "move" some of the transplanted hairs in my hairline to the vertex or crown, I would have tiny dots/scars in that area of my hairline, which I obvsiously dont want.

 

I wonder why they would say I would have marks but you didnt. Dr. Rahal is a great doctor. Perhaps your Doc used a superior FUE technique?

[Spanker]

I honestly don't think you need to pull from your hairline. Your crown may have opened up done but it's not uncommon to get a frontal transplant that is successful and then get more sensitive about the top. How many total grafts do you have now? How many fue could he get?

 

I would say that it's a good hairline and not to aggressive. My advice, strip out, finish it with scalp fue, and then spread done beard hair if you insist.

[Spanker]

Also, I'd seriously consider finasteride. If not your sides may drop more.

 

On the plus side, it's very natural looking the way it is now. Be careful.

[starr]

Hi Spanker, thanks for your advice.

My total grafts to create the front was around 4339.

According to Dr. Rahal, my scalp is tight and my density is light so he's estimating 1500 from another FUT.

 

And if I understand correctly, your advice is to do whatever he can with another FUT (strip), THEN do an FUE with scalp, and then beard.

 

Please clarify this for me, as I am a bit confused: If Dr.Rahal says he can get 1500 from another FUT, does that mean its the end of donor hair from the scalp area or is it still possible to get some thru FUE after? If I understood correctly, your advice was to do one more strip then do a scalp FUE, so this implies that another FUT is not final. Is this correct? Why would he be able to harvest more after a 2nd FUT if he said he'd only be able to get around 1500 grafts during this round?

Edited April 10, 2015 by starr
I wrote the incorrect amount of grafts!

[1978matt]

Fascinating to read Dr Simmons comments on here:

 

http://www.hairrestorationnetwork.com/eve/167454-significant-discrepancy-between-dr-simmons-dr-rahal-evaluations.html

 

It seems he called it right on this occasion.

[starr]

Fascinating to read Dr Simmons comments on here:

 

http://www.hairrestorationnetwork.com/eve/167454-significant-discrepancy-between-dr-simmons-dr-rahal-evaluations.html

 

It seems he called it right on this occasion.

 

Wow, you're like a human search engine to have been able to make the connection!

 

However I made a HUGE mistake... I just verified my documents and I got 4339 grafts from my session with Dr. Rahal.

 

I'm going to have to go and edit my previous posts! Thanks Matt for bringing this to my attention!

[starr]

Also, I'd seriously consider finasteride. If not your sides may drop more.

 

On the plus side, it's very natural looking the way it is now. Be careful.

 

I took finasteride for probably 6 years ... stopped in 2008. I think I felt something odd with my sexuality...

 

Personally I think Im too advanced to see any benefits from going back on that or dutasteride... are there any published cases on any forums where it halts the sides from dropping?

 

PS> I appreciate you saying it looks natural as is now, but the problem is I look 10 years younger than my age and I work as an actor. They dont cast young guys with hair loss problems...as long as I can conceal (with Dermmatch or SMP), i can get by. What did you mean by "be careful"? what in my plan makes you think I could create a disaster?

[1978matt]

Wow, you're like a human search engine to have been able to make the connection!

 

However I made a HUGE mistake... I just verified my documents and I got 4339 grafts from my session with Dr. Rahal.

 

I'm going to have to go and edit my previous posts! Thanks Matt for bringing this to my attention!

 

Haha, yes, there are often posts like yours (a handful of posts but joined several years ago). First port of call is to go back and do some detective work!

 

Maybe it would be worth getting a second opinion from Dr S again.

 

Probably 4 months of scalp exercises and one final FUT might be the way to go. The hairline looks ok where it is. After that some FUE above and below the scar could be possible, maybe another 1,500 grafts if you're lucky.

[hairweare]

Based on this additional info I would definitely not do another strip as your chance for a disfiguring scar seems to be quite high. No reputable docs particularly the ones I mentioned would use beard hair unless your scalp donor was or is nearing depletion. After 3 earlier FUTs, a long wide scar, and a pattern 6-7 baldness despite 5600 grafts, 3700 combined scalp/beard FUE has bailed me out of what appeared to be a hopeless situation. Dr. Rassman who was my original surgeon felt at best he could get another 800 by strip and then advised SMP to camouflage the hideous scar. I am glad that I went to Europe instead.

[starr]

OK so based on the answers of 1978Matt and HairWeare, my understanding is that even if I have a set # of grafts left for harvest thru the strip, there is still some donor hair available for FUE during a 3rd procedure, yes?

 

@Hairweare: You are advising strongly against another strip but Im not sure I understand why. First of all, my scar is nothing like the horror pics we see on the internet. Its long yes, but its very thin, and every specialist who has examined my head afterward commented on the good work. I asked Dr. Rahal is the scar would look worse after a 2nd FUT and I was told no. So maybe I'm not understanding something here... I also think its safe to say that I am considering beard hair because I AM near scalp donor depletion if you look at the area I still have left to cover.

 

What I might do in the interim of having enough $ to afford FUE is to get SMP so that its easier for me to live with my self-image. At least my crown wont appear to big.

[scar5]

Starr,

 

You are limiting yourself in your way of thinking. About Rahal, and all the other strip docs who are smart and technically good, remember, they got you in this situation. That said, I think Can't Decide is almost home (and good luck to him) , but I think, crucially, he has/had more and better hair in the donor than you.

 

You are in a similar situation to the one I found myself in in the late 90s. I will tell you how I handled it - and I tried lots of things.

 

 

Same: 1) stellar hair line, big shock of hair I could comb back.

2) not taking meds because of concern with sides.

3) a thinning crown

4) strip scar

 

The differences: 1) My scars were much worse. My crown was much, much better.

 

Scar(s) Me: one ear-to-ear smiley (fair) + two half strips, above and

below opposing sides of the smiley, one of these poor and wide, the other

excellent and thin. All scars same doc

You: one 'excellent' thin strip scar

 

Crown : Me: Obviously thinning, and you could put a penny down there and not

touch any hair. Minaturized zone spread about and inch, inch and half all

around.

You: Your crown is pretty much gone. It is a big area and more concerningly, it

seems to have really eroded deep down into donor zone on the right side.

 

But essentially, it is the same problem. We both paid the price for getting a front loaded strip job. (I won't tell you how wrong I think this approach is!!, you know that, let's just move on)

 

 

First, there is no way in the world your crown will close with 1500 follicles, so you are right in assuming you'll have to combine permanent SMP (forget about temporary, you'll be going crazy with the 'floor' constantly disappearing).

 

You need the SMP to form the base, then texture it with a lattice of good quality head hair, fed by medications, augmented by beard hair to give yourself a fighting chance.

 

But what is the best way to get there? That is the question.

 

You also need an exit strategy, something to give you hope that, if it all goes south, you can buzz it down.

 

You are lucky you have a thin scar, but don't assume it will be excellent next time, and even if it is, that won't get you out of dodge.

 

Your exit strategy would include hair and ink in the scar.

 

Then you would wear a piece for your acting career and just be the cool guy with a buzz on the street. So what, no big deal. That is dignified.

 

 

I see two tracks

One

1) Meds

2) SMP

3) FUE

 

All done in three years

Piece(s) for the acting roles, fauxhawk (lowish) buzz for the street.

 

Adjustment options and prognosis: Good and solid going forward without that beautiful front on look you are now accustomed too. Best option if doubtful about meds. Looks Unbalanced? - take out a small number of front grafts and put them in the crown. Expect a 50% casualty rate. Expect scarring as you move away from the hairline. Fill it with SMP. At hairline itslef, scarring is better, but aesthetically worse. Remember illusion of density at buzz level. Check out Cant decide's pre-op two pics

 

Two

1) Meds

2) Strip

3) FUE

4) SMP

 

All done in at least five years.

Smaller Piece for the acting roles, fauxhawk (bigger, higher) and 'products' for the street.

 

Adjustment options and prognosis: I think you are married to comb-overs and products as you continue to lose hair. If meds start to fail, it will be grim, but having said that, if you have good self-esteem and inner congruence, you'll be more handsome than in option one. (Hopefully it won't rain)

 

I'd go track one, but I'm biased

 

A note about hair greed and the HT business

 

I don't want you to give any more of your money to Rahal or any strip doctor, but if you can't resist another whack at 'big hair' you could strip again, after the FUE. Both stripping first or last has benefits. Don't listen to any of their nonsense about strip being more difficult after FUE. They will still take your money. Let THEM worry about it. Your donor is in bad shape, so make sure you medicate first.

 

 

 

 

My experience

These days I am not good, but far from a disaster.

 

I have two choices. Fauxhawk or buzz. Believe you me. I am so, so much better than I was ten years ago, but it was a long road back. My experiences with trying to shift a front loaded HT to the back were like this.

 

I had a linear front excision, which basically removed 60% of my hairline, and had the hair redistributed further back. Scarring was excellent, result was ugly and poor. Poor clinic in poor HT environment, (seller's market) Not recommended.

 

I had large misangled mini and micro grafts punched out and replanted from zones between the temples and the crown. Scarring was evident, many of the hairs were butchered in the extraction. Doctors wouldn't plant near the extracted zones. Excellent well rated doctors

 

Result poor. Empty red and white scarred zones, difficult to cover. Now I would not recommend this except, for two crucial differences you and I have. I wanted the hair re-planted nearby, but flat and they just wouldn't do it. You don't want that. You want yours put miles away, so it could work. And regarding scarring. That is where SMP comes in. It has helped a lot, although is far from perfect.

 

I had one of my strip scars opened up again - having had it already filled with body hair, to get more hair to fill the mid region, and plant in front of the blunt line left by the linear excision. Not recommended. The tricophytic scar, done by a AAA rated doc, was poor. It was made worse. Definitely not worth it for me. Should have just FUE'd around the scar.

 

oh....AND CRUCIALLY I WENT ON FIN< FINALLY!! in 2006

Edited April 11, 2015 by scar5

[starr]

Wow, thats alot to swallow! But Im very appreciative of your detailed opinion.

 

I have to admit I'm starting to reconsider meds.

 

I was really trying to avoid FUE due to cost, but now Im starting to really worry about my strip becoming thicker than before.

 

Exit strategy - well yeah, one way or another, I think ink ALL OVER scalp is what I should consider. Might as well boost the illusion of density everywhere in case I need to go really short. And I dont see why I would want to get temporary... from what I read, it fades after 8+ years so by then, I may be ready for hair cloning.

 

In terms of wearing a system, maybe once I'm amazingly wealthy I can combine but right now Im in a position where I must take a deep breath and make a choice on where I want to put my money: 500$ every 3 months for something I end up throwing out, or 500$ every 3 months to pay off an investment into rebuilding my own head. Its tough call due to the time off I would need to take away from being "seen", but unless I get out of the hair system money suck, I dont see how I can ever start paying off another procedure, whatever it is.

 

Getting a bit off topic but I have to keep in mind current logistics!

 

scar5 : did you get SMP as well? have you found meds made a difference?

[scar5]

 

I was really trying to avoid FUE due to cost, but now Im starting to really worry about my strip

 

keep in mind current logistics!

 

scar5 : did you get SMP as well? have you found meds made a difference?

 

Sorry about the long winded answer, too much coffee...I am particularly aware of your type of problem and the dilemmas, but not so sure about the perfect answer.

 

Please get this clear. FUE is cheaper than strip. You are worried about the scar, so why give your money to North American strip docs just because the laws and economics prevent THEM from doing FUE at your budget? Just get your ass on a plane...OK, planes are expensive, but it is not an excuse to get strip. There may be valid reasons to get strip, even so, but be brutally frank with yourself.

 

Yes, I've done SMP, and it is good if you have some hair. If you have a strip scar, you must have hair, so get yourself some!

[starr]

Are you saying that FUE is only more expensive than FUT in Canada/USA?

If that is truly the case, then yes I can see why a trip could be justified....

[KO]

Yes, FUE at some of the European docs is only marginally more expensive than or as cheap as FUT. If you go to a Turkey doc, significantly cheaper.

 

Eg, for a 3k graft procedure:

 

H&W (FUT): 13K CAD

Feller (FUT): 13K USD

Lorenzo (FUE): 12.5K EU

Bisanga (FUE): 11K EU

[starr]

KO, Im in Canada and based on your figures and XE.com, a 3K graft procedure with FUE done by Lorenzo or Bisanga would be approx 14000$CDN, so yeah, its roughly the same price as an FUT here. In my case, still a bit more expensive but not THAT much.

 

Questions:

- where in Europe are Lorenzo and Bisanga located?

- do we also save all the Canadian tax we would pay on the procedure if it was done here or do they charge a certain tax?

- can 3K grafts be done in a single session with FUE or would I need to stay over there for a number of days/weeks?

- do they all have experience using beard hair too?

[scar5]

I'll let Ko respond, but Bisanga and Lorenzo are extremely expensive FUE compared to the options you now have in India and Turkey.

 

Also be aware, Bisanga may try, rather his reps may try, to suggest strip.

 

But really, in your situation, money should not screw up the basic rubric you need to stick with. Recognize the situation for what it is, if you don't have enough money then accept it, but don't just give what little money you have to a strip clinic only to cause further future complications.

 

You saw Rahal, you got a typical front loaded North American strip job and now you are dealing with the consequences. But you have choices. Use them.