Dr. Lindsey discusses "Don't do this" hairline too low in young man

[Dr. William Lindsey]

Its been a few years but I have a few threads discussing how there are only really 3 big errors to avoid in picking a hair transplant surgeon. And careful research BEFORE you commit all but assures you won't have at least 2 of these. Scarring (number 3) can be a little unpredictable but you ought to be able to minimize your risk of terrible scars too.

 

So just to remind readers.

 

Mistake 1 is big scar. Careful surgical technique and strip width management usually limits significant scarring. Doctors have so many cases, that the prospective patient ought to be able to see a few examples of the doctor's own scar results at the initial consultation if not before by viewing the doctor's work on his website, videos, or forums. Simply stated, if you can't find any examples...ask to see some. I am very vocal and have posted numerous times that each and every year I get about 8 perfect scars that you can't see with a #1 cut, about 110 really nice scars that are easily covered with a #3 or #4, and 4 crappy scars that need a #4 or 5. And I honestly tell people I just am not sure of who will get those 4 crappy ones...or I wouldn't do them... So in general, the prospective patient ought to have an idea of what scar ranges he might get after the initial visit.

 

Mistake 2 is too little hair over too much bald head. This takes the form of either spreading out donor hair so as to try to give a little hair all over, or "preventative" hair transplants which some doctors say will let the patient avoid a big case and it can be repeated with future thinning, or the budget conscious patient/clinic trying to fit a surgery to a payment plan. Hair is like sex and money...for many people. You have to have enough to make you satisfied...and that means pack the area you are trying to address. If one doesn't have enough donor hair to do everything, its far better to do the frontal third well than to sprinkle a little hair all over. About half of the patients we see at an initial visit have figured this out, of the half that haven't I can convince half of them of this reasoning. The forums are pretty good at educating people on this one too.

 

And mistake 3 is putting the hairline too low, particularly in a young guy who wants to look like all of his other 25 year old buddies, but who has the genetic probability of losing a lot of hair. I see this one all the time. You buy a HT to last you decades, so the hairline has to factor in your supply of donor hair, your best "guestimate" of future needs and hairloss pattern, and avoid leaving you with a hairline that looks cool at age 25...but looks goofy at 40 or 50.

 

This young guy walked in last week with a full head of hair. I said "what are you doing here, you have more hair than anyone I've seen this month..." and he laughed and asked for FUE into a scar on his head.

 

"So how did you get your scar?"

 

"I had a hair transplant 4 years ago."

 

Now the kid looked fantastic, he needed absolutely no hair and had a hairline that looked fine at age 25, 30, or 40....so I figured someone just sprinkled hair around his thick hair covered top... and yes indeed he had a 4 inch by 1/3 inch scar on his right donor region from an 800 graft strip. (Mistake 1).

 

Then I get close to his head as he explains that he had the hairline done with 800 grafts...and I put on my glasses...and yep, you can see lots of sparse hair follicles placed too low on his head. I asked him if I could get a pic.

 

So I think we can improve his scar but he has limited options on this too low hairline. He can simply shave it every morning like he's been doing..which works quite well cosmetically. He can FUE them out..but that is a lot of little holes and I think the scars from them will be noticeable on his youthful skin... He can laser the hair, since he has really dark hair and light skin..but that could hit some of the good hair at his hairline and cause new hairline trouble. And he can electrolysis the hairs, which painful and not cheap, but that is probably his best option.

 

Anyhow, you younger guys...DON'T get your hairline made too low...plan for the future, and if you do do your hairline (and we do lots of hairlines in younger guys--but they are hairlines which have temporal recession and should "age" well) put enough hair in the hairline to make a hairline. I don't think 800 were placed in this young man's hairline but that is what he said he got.

 

4 pics, 3 with flash to show the dark dots, one without flash that is a little fuzzy but he'd shaved this area 2 hrs before the visit. Look not at the nice hairline but at the dots below where his grafts were placed.

 

 

If we do a scar repair on him, I'll try to get a better pic.

 

Dr. Lindsey McLean VA

[BadBeat]

Great post Dr. Lindsey. Thanks for taking the time to post all of that. Very informative.

[ontop]

Great post Dr.

 

Its so, so nice when somebody like yourself can put it in such a way that we all can understand.

 

Can i ask you a Q...I know this a sort of Q like how long is a pc of string but

In your opion if a pt walks in to your clinic & only needs say the max of 2500 grafts, would you be more in favor of FUE over FUT?

Reason why I ask you is that this young man had a FUT with only 800 grafts & don't sound the correct thing to do IMO.

 

Thanks

[Dr. William Lindsey]

Thanks for the comments.

 

To clarify the FUE vs Strip question you raise.

 

I believe that if you take 100 FUE's done by the top 10 guys in the world and compare them to 100 Strip cases done by the top 10 guys in the world...same size cases, same hair quality, everything that you could make the same you do....that the strip results will be at least 40% fuller (once grown out) than the same FUE cases. Lots of people won't agree with that but as many of you all know I grew up farming, and have personally planted about 3000 trees of different sizes, ages, shapes in varieties of soil. ITS EXACTLY like hair work.

 

You take a well nourished thick tree with a big root ball and you can plant it anywhere and as long as you don't dry it out too much, it will grow, the same as or almost as well as it did where you dug it up. This is analogous to a strip case in a thick curly haired scalp.

 

You take a skinny tree with a tiny root ball and put the shovel around the base of the tree, down about 6 inches or so, then lift up on the tree's little trunk....and you avulse a good bit of the root ball off. This is analogous to FUE on fine hair.

 

That tree will NEVER grow as well as if you dug it up with lots of dirt and barely touched the root as if you were doing a strip case and told the cutters to be really cautious....

 

Those are facts with trees, and now at 19.8 years out from my residency having done lots of hairs, I believe its the same with hair.

 

FUE is popular due to people's concern about scarring. There are lots of crappy scars out there...we fix a bunch of them each year. I get it. And clever marketing of "scarless" surgery....

 

The fact is that strip just works better. Particularly in fine haired people.

 

FUE is however a good option for: 1. Guys who really need a buzz cut 2. Smaller cases 3. People for whom the worry of a scar would prevent them from doing anything..who are decent candidates with anything except really fine hairs

 

Now Dr. Feller and I have been working on a third option...strip, fue, and this modified approach for about 20 months now. I've done about 25 cases and I suspect he has done a similar amount. I think that Dr. Bloxam is writing this up for the medical literature...so stay tuned. In my opinion its an ideal hybrid of strip and FUE. Strip quality hair without a linear scar.

 

Dr. Lindsey McLean VA

[Blake Bloxham]

I've been so excited about this new technique that it's been a real struggle to keep my yap shut. Now that Dr Lindsey mentioned it, I can finally share some information!

 

Like Dr Lindsey said, he, Dr Feller, and I are working on a new FUE technique. Dr Lindsey does a good job describing it above as "strip quality hair without the linear scar." Another way I like to refer to it is "strip-level growth with FUE-level scarring." Some have probably noticed my remarks about FUE growth yield, the characteristics of the hair that actually grows from FUE grafts, and the issues with failed extractions and scarring in the donor region lately. Frankly, I think this new technique addresses and fixes these issues. We're all very excited about it.

 

That's all I'll say for now. However, I am planning on doing a formal "teaser announcement" next week. Stay tuned!

[Garageland]

Sounds exciting to hear about this new technique so look forward to the teaser next week.

[MAGNUMpi]

Great thread!

Excited to hear more about the new technique next week.

[wibbles180]

Is this a new technique or just fue with a high yield like the Europeans ie: lorenzo , erdogan are achieving ? Either way sounds interesting

[Blake Bloxham]

Thanks guys!

 

Wibbles,

 

With current techniques, even in the best of hands -- like those you mentioned above -- FUE yield is variable and usually quantifiably lower than strip. We can't readily achieve strip-level yields and strip-quality hair with current FUE practices. However, we appreciate the less invasive nature of the technique and know the lack of a linear scar is important for so many patients. So, we wanted to try and figure out a way to tweak the way FUE is currently performed to help us achieve the above. The technique is FUE surgery. But, it's a new approach to performing FUE hair transplant surgery that allows us to achieve the above while maintaining the level of scarring patients want.

Edited May 11, 2015 by Blake_Bloxham

[lakelife]

Hey Blake. Curious when additional details will be released on this new technique. Thanks!

[Blake Bloxham]

Lake,

 

Still shooting for the end of this week. Likely Saturday or Sunday. I'm planning on releasing more details than I initially thought, so I'm putting together a more extensive presentation. Taking a bit longer. I also need a few pictures too.

[LondonHTseeker]

That poor guy. Shaving still looks noticeable (like blackheads, actually) and must be a serious hassle to keep doing. Whoever did that surgery was a butcher.

 

My strip scar from Dr Feller a few years ago is a centimetre or two wide now, I don't know how that happened. Luckily I prefer my hair longer these days, so it's not noticeable under the length and doesn't bother me. My FUE operation in Istanbul 6 months after Dr Feller's last on me has resulted in visible thinning in the donor region, but again luckily the longer hair covers it.

 

I'm quite happy with the way my hair looks now on a day to day basis, that is until I brush the hair back and study the hairline close up. I want my hairline filled in with about 1000 to 1500 more grafts with another FUE then I'm done, but my donor area hair is heavily depleted and I'm worried about possible future loss on top. It's like walking a tightrope really, and so far I'm staying balanced...but maybe I should get on finistride...

Edited May 27, 2015 by LondonHTseeker

[HairJo]

I have seen with my own eyes someone who's hairline was placed way to low on his forehead and it looked awful he had to shave it everyday and he underwent laser hair removal . Most men including myself all want an 18 year old's hairline but we must be realistic we are going to age and we must look appropriate for our age.

[Dr. William Lindsey]

Hairjo,

Right on. Although I hate to think I'm getting old...it is happening. And will to you and all you younger guys too. Sucks!!

 

But you have to have a hairline that will look unremarkable as you age.

 

Of 10 young guys who come in regarding hairlines...I'd guess 3 will accept nothing less than a low hairline despite my warnings. Out of those 3...who leave...I'd guess maybe 1 will show up a year or 2 later with a disasterous low hairline, usually a wide scar...and more often than not...500 grafts sprinkled throughout their entire top... what a waste.

 

IF they have sufficient donor density, we can address the scar and frontal third, but its hard to do anything with the hairline without leaving little FUE marks where we try to take out those hairs. Electrolysis or laser is usually better in my experience, but the laser can "bleed" over and damage the hair they want to keep...

 

Best to plan for the long haul with women, money, and hair.

 

Dr. Lindsey

[Sparky]

Ahhh this thread is telling my story! I have a low hairline and a wide scar, so far I'm hanging onto the rest of my hair maybe with the help of fin, maybe through luck, but I do fear for the future.

[Blake Bloxham]

Sparky,

 

Sorry to hear about this! What's your next move? Let me know if there is anything I -- or any other mod -- can do to help.

[Sparky]

Don't think I have any moves left!

 

The hairline is 5cm high, and hairs in the recession areas grow in the wrong direction, at least if my hairline was higher I could graft in front of it, but that's not the case.

[Dr. William Lindsey]

Sparky,

 

I tried to get in your link and see your pics but was unable to open it. Possibly due to old computer system at the hospital where I work on Tuesdays...

 

Feel free to send me pics and I'll give you my 2 cents worth.

 

I saw your tag line about wait until you are 30 to get a transplant. That is not a bad suggestion for many guys who have little to no loss..and just a bit of temporal recession. But other guys with say class 3 hair loss who feel it is profoundly impacting their social lives, work, self confidence...I personally don't have a problem offering them surgery as long as they are willing to plan for the long haul, and opt for a hairline that will age reasonably well AND I strongly encourage younger guys to bring their parents---just as an extra set of fairly unbiased ears. Then I won't book them that day...they need to go home, sleep on it, and give a call for a date. That's far better than getting someone hyped up for an unachievable result, booking them, them then finding they can't "get out" without losing a bunch of money, proceeding with a poor plan, and then winding up worse off. I know I lose some business with this approach but its the way I'd want to be treated or have my kids treated were they in the consultation chair.

 

Dr. Lindsey McLean VA

[Sparky]

Sparky,

 

I tried to get in your link and see your pics but was unable to open it. Possibly due to old computer system at the hospital where I work on Tuesdays...

 

Feel free to send me pics and I'll give you my 2 cents worth.

 

I saw your tag line about wait until you are 30 to get a transplant. That is not a bad suggestion for many guys who have little to no loss..and just a bit of temporal recession. But other guys with say class 3 hair loss who feel it is profoundly impacting their social lives, work, self confidence...I personally don't have a problem offering them surgery as long as they are willing to plan for the long haul, and opt for a hairline that will age reasonably well AND I strongly encourage younger guys to bring their parents---just as an extra set of fairly unbiased ears. Then I won't book them that day...they need to go home, sleep on it, and give a call for a date. That's far better than getting someone hyped up for an unachievable result, booking them, them then finding they can't "get out" without losing a bunch of money, proceeding with a poor plan, and then winding up worse off. I know I lose some business with this approach but its the way I'd want to be treated or have my kids treated were they in the consultation chair.

 

Dr. Lindsey McLean VA

 

I totally agree with everything you say

 

Will send you some pictures, there aren't any on my hairloss website.

[ontop]

Dr L...

 

Sound Advice, y'all a Trooper.