Questions on BHT

[Dr Blake Bloxham]

Cali,

 

Thanks for sharing! You actually inspired me to go to the Unger hair transplantation text to get some exact percentages on body hair transplant success rates.

 

The authors admit that studies investigating BHT are limited, but they do share a few interesting things:

 

-Leg hair grafts yield the poorest growth results. As the density of transplanted leg hair on the scalp increased (from 24 leg hair follicles/square cm to 49 follicles/cm^2) yield decreased from 38% to an abysmal 4%.

-The studies looking at back, chest, and beard were very, very small -- less than 200 FUGs examined altogether.

-Based on the data, however, similar results were seen: the higher density the grafts were implanted and the larger number harvested, the lower the yield.

-Technically, chest hair grafts had the highest yield in the study. But the size of grafts they looked at was too small -- in my opinion -- to really form an opinion (28 FUGs)

-Beard grafts had a 63% growth rate and back hair grafts had a 47% growth rate

-The authors note that the follicles did retain their donor characteristics -- with respect to cycling and hair shaft size/description

-They also note that the most common complication was scarring in the donor extraction sites

 

I am glad you were able to share some examples. I've talked to Dr Bhatti a number of times over the years, and always found him to be very genuine and dedicated to helping others. Clearly his patients are no exception. Like you said, he absolutely tries to help these people out.

 

In the examples you provided, there are a lot of scalp grafts mixed in with the body grafts. This is clearly the right way to do it. However, it's also going to camouflage the true characteristics and yield of the body hair grafts -- meaning that the results will still generally resemble scalp hairs and the yield will be most dependent on the scalp hair grafts. It would be interesting to see what we would get from a case of pure body hair grafts.

 

You also brought up the "food for thought" comment about patients who would otherwise have no other options without BHT. This absolutely does give them a shot, but allow me to play devil's advocate for a moment:

 

Let's say you have a patient with poor donor and ample body hair supply. You are able to transplant 1,000 grafts from the scalp and 1,000 from the beard, axilla, and legs. Using some ROUGH estimates from the numbers I quoted earlier, let's say you got and average yield of 49%. (mean of 47% for back, 63% for beard, and 38% for leg hair -- which is the highest yield the authors noted for leg hair). You're now seeing slightly less than 500 of these BHT follicles growing. Now, the cosmetic difference 500 grafts would make in the scalp would probably be mediocre at best. Now, this wouldn't be that big of a deal IF it didn't expose the patient to scarring in the extraction zones. If he -- especially if he has darker-toned skin -- experienced decent subdermal fibrotic or superficial hypopigmented scarring in his face, chest, and legs, was the coverage obtained from the 500 graft yield worth it?

 

So, again, this would be playing "devil's advocate" but it's all important discussion when considering BHT in a patient.

 

As usually, Cali, thanks for sharing!

[California]

Hi Dr. Bloxham,

 

You are very welcome. Thank you for your kind words about Dr. Bhatti. They are highly appreciated.

 

In regards to the yield percentages that you have quoted, I would say that the success rate can go up and down as per the skill of the HT Surgeon. As we know, not every HT Surgeon takes on BHT and not every HT Surgeon that takes on BHT will have stellar results right away. There are no short cuts to mastering this skill. It can only come with time and experience. Dr. Bhatti has been doing BHT for many years now and has mastered this art.

 

Please note that out of the 4 Patient cases that I shared earlier today, Patient case #3 got 70% BHT and 30% scalp donor. (Total of 3187 grafts: 987 scalp and 2200 BHT). Now, if we go with the estimates that you have mentioned, an average yield of 49% would leave this Patient with only 1078 BHT and 976 scalp hair grafts, making a total yield of 2054 grafts. (That is assuming 100% yield from the scalp donor).

Now, I request you to take another look at this Patient's before and after pictures. (uploading them again for review). You might agree that there is no way that just 2054 grafts would give him the kind of coverage that he got. I don't have any statistical data to back this up but from what I have seen from Dr. Bhatti BHT Patients, the yield from BHT has been comparable with that from the scalp hair grafts. As far as the scarring issue is concerned, I have yet to see a case where the scarring was beyond an "acceptable" level.

 

You might also agree that without BHT, this Patient had absolutely no shot at getting his hair back. Turned out to be a win-win situation. At a young age of 29, he did not have to surrender to baldness for the rest of his life and also he did not end up with any visible scarring.

 

Best regards,

California

[HairJo]

it looks pretty good , good for you I'm glad you had a good outcome.

[Dr Blake Bloxham]

Hi Cali,

 

I have no doubt Dr Bhatti has honed his technique very well. Despite the skill of the surgeon, however, you'll never see "great" yields from BHT for two reasons: 1) the intrinsic forces FUE extraction puts on grafts, and 2) these forces being applied to FUGs that are much weaker to begin with. You could build a robot to perform the procedure -- and they have -- and still not see yields on par with other extraction techniques. This is simply because even when performed perfectly, this extraction method damages grafts. When this is applied to grafts that are naturally more fragile, like I said above, you'll see yields in the 30%-60% range like those quoted in the textbook.

 

As far as that patient is concerned: it's very, very difficult to tell the exact yield of a procedure just by looking. If I didn't have any prior information, I think somewhere around 2,000 - 2,500 grafts would have been a reasonable estimate. So maybe the rough average wasn't too far off. What's more, he's actually a good example of the type of hypopigmented scarring you see with darker skinned patients. Like you said, however, Dr Bhatti clearly knows where to extract to minimize the visibility of the scarring.

 

BUT, BUT all of this is really just semantics when you consider the following: if patients are in a tight spot and understand the risks thoroughly, BHT can be discussed. I still think it's something that should only be integrated after the traditional donor is exhausted and it shouldn't be put anywhere near the hairline. In the end, I'm very glad Dr Bhatti was able to help this patient and I'm sure he feels the same. That's what is important.

[HairJo]

I agree this should be the LAST resort I'm glad it worked out for him

[California]

Dr. Bloxham,

 

I think we should agree to disagree on this one. Our Clinic is a staunch believer of the huge benefits of BHT. We believe that it gives hope to hopeless cases. Scalp donor is one such thing that either you have it in abundance (if you are lucky) or you don't. If you fall in the latter category, then BHT has to be the savior. Also, we don't consider it as the last resort since we like to take the conservative approach of "saving" the scalp donor for future HT (especially in younger Patients with a progressive hair loss).

 

I respect your opinion. As is very well known, we are an exclusively FUE Clinic. FUE (scalp and BHT) is what we believe in and what has worked for us and thousands of our Patients for the last so many years. So again, with all due respect, let's agree to disagree on this one. Let time be the judge here.

 

Best regards,

California

[Melvin- Admin]

Hi Dr. Bloxham,

 

You are very welcome. Thank you for your kind words about Dr. Bhatti. They are highly appreciated.

 

In regards to the yield percentages that you have quoted, I would say that the success rate can go up and down as per the skill of the HT Surgeon. As we know, not every HT Surgeon takes on BHT and not every HT Surgeon that takes on BHT will have stellar results right away. There are no short cuts to mastering this skill. It can only come with time and experience. Dr. Bhatti has been doing BHT for many years now and has mastered this art.

 

Please note that out of the 4 Patient cases that I shared earlier today, Patient case #3 got 70% BHT and 30% scalp donor. (Total of 3187 grafts: 987 scalp and 2200 BHT). Now, if we go with the estimates that you have mentioned, an average yield of 49% would leave this Patient with only 1078 BHT and 976 scalp hair grafts, making a total yield of 2054 grafts. (That is assuming 100% yield from the scalp donor).

Now, I request you to take another look at this Patient's before and after pictures. (uploading them again for review). You might agree that there is no way that just 2054 grafts would give him the kind of coverage that he got. I don't have any statistical data to back this up but from what I have seen from Dr. Bhatti BHT Patients, the yield from BHT has been comparable with that from the scalp hair grafts. As far as the scarring issue is concerned, I have yet to see a case where the scarring was beyond an "acceptable" level.

 

You might also agree that without BHT, this Patient had absolutely no shot at getting his hair back. Turned out to be a win-win situation. At a young age of 29, he did not have to surrender to baldness for the rest of his life and also he did not end up with any visible scarring.

 

Best regards,

California

Cali,

These examples you've posted have all been mixed scalp grafts and body hair, as previously stated BHT is a good weapon in the war against hairloss, however this weapon should be considered last resort, as the growth rate is lower, transection rate is higher, the characteristics remain the same prior to transplantation, below is a study published in Pub med, the study does confirm that chest hair holds the best growth rate least transection rate. I'ts my opinion that your donor should be completely exhausted before attempting bodyhair transplantation, it is a good source to add additional density particularly to the donor area, but it should never be considered as a standalone, it simply does not look good cosmetically. I've posted a result which in my opinion is not satisfactory for the amount of money and time invested in the procedure. However, I do applaud the gentlemen in the picture and I do hope his additional grafts has improved his result. I also do understand that surgical skill does come in to play when transplanting body hair, but the fact is that the body hair must be camoflauged within existing scalp hair to hold a good cosmetic result.

 

Pubmed article

Body Hair Transplantation: Case Report of Successful Outcome

 

Here is an example of what just a body hair transplant looks like

http://www.hairsite.com/hair-loss/board_entry-id-17258.html

[hopingforhair]

HTsoon, when you refer to good cosmetic result are you talking about the length that the hair will grow or just the look/ feel of the individual hairs? I am considering using body hair as I feel that my donor area isn't great and also I buzz and will be buzzing my hair even after the HT so hopefully in this case the cosmetic look will be similar to existing scalp hairs. Another reason is I don't want to have a lot of visible scars on the back of my head as I'll have it buzzed.

[gbhscot]

Really interesting discussion. Ideally, I would like to go for FUT where half of the grafts were BHT (I have more chest hair than you have ever seen on a young guy, a lot of 2/3 hair grafts in there). I have asked several surgeons about this, however the general response has been to exhaust my donor area on the scalp first. I believe, however, that assuming the complete exhaustion of the donor area will be reached at some point anyway, that blending the two techniques will have a better long term result.

 

My issue, I have blonde scalp hair, brown body hair and red/brown beard hair. If this was being implanted beside scalp grafts, would there be a noticeable colour difference? Also, out of curiosity perhaps Dr Bloxham or Cali can answer - Would FUT ever be considered for BHT, and would you expect it to have a higher graft yield/survival?

[California]

Really interesting discussion. Ideally, I would like to go for FUT where half of the grafts were BHT (I have more chest hair than you have ever seen on a young guy, a lot of 2/3 hair grafts in there). I have asked several surgeons about this, however the general response has been to exhaust my donor area on the scalp first. I believe, however, that assuming the complete exhaustion of the donor area will be reached at some point anyway, that blending the two techniques will have a better long term result.

 

My issue, I have blonde scalp hair, brown body hair and red/brown beard hair. If this was being implanted beside scalp grafts, would there be a noticeable colour difference? Also, out of curiosity perhaps Dr Bloxham or Cali can answer - Would FUT ever be considered for BHT, and would you expect it to have a higher graft yield/survival?

 

Hi gbhscot,

 

I don't think that BHT is an option in a FUT (strip) procedure. Can't imagine having cuts on face, chest and other body parts.......

 

BHT is definitely a viable option for FUE. In regards to your specific question about the color of the donor hair, I believe that the donor hair will retain it's original color. If the BHT color is different from the scalp hair color, you might end up with different shades after the BHT, in which case you might have to resort to coloring your hair.

 

Dr. Bhatti tends to be conservative when it comes to donor hair, especially for our younger Patients. The more scalp donor you can "save" for the future use, the better.

 

I wish you all the best.

 

Best regards,

California

[gbhscot]

Hi gbhscot,

 

I don't think that BHT is an option in a FUT (strip) procedure. Can't imagine having cuts on face, chest and other body parts.......

 

BHT is definitely a viable option for FUE. In regards to your specific question about the color of the donor hair, I believe that the donor hair will retain it's original color. If the BHT color is different from the scalp hair color, you might end up with different shades after the BHT, in which case you might have to resort to coloring your hair.

 

Dr. Bhatti tends to be conservative when it comes to donor hair, especially for our younger Patients. The more scalp donor you can "save" for the future use, the better.

 

I wish you all the best.

 

Best regards,

California

 

Hi Cali,

 

Thanks for the reply. Yeah I get that. I guess it's probably never been attempted, but I think it would be interesting to see if there was a difference in graft survival. Personally, I would be much more keen on having a linear scar on my chest than across my head...

 

Interesting you say that about Dr Bhatti...do you feel he would be more receptive to the idea of using BHT from the beginning before exhausting the donor area? I'm 26 an probably around NW4 or 5, I'd much prefer to get work done now and get as thick coverage as possible whilst keeping the donor intact for later procedures which I will most likely require. I've actually approached him before for an online consult but had to postpone doing anything for financial reasons. He's definitely on my short list of surgeons I would consider though.

[California]

Hi Cali,

 

Thanks for the reply. Yeah I get that. I guess it's probably never been attempted, but I think it would be interesting to see if there was a difference in graft survival. Personally, I would be much more keen on having a linear scar on my chest than across my head...

 

Interesting you say that about Dr Bhatti...do you feel he would be more receptive to the idea of using BHT from the beginning before exhausting the donor area? I'm 26 an probably around NW4 or 5, I'd much prefer to get work done now and get as thick coverage as possible whilst keeping the donor intact for later procedures which I will most likely require. I've actually approached him before for an online consult but had to postpone doing anything for financial reasons. He's definitely on my short list of surgeons I would consider though.

 

Hello again,

 

I would recommend emailing your hair loss pictures to Dr. Bhatti (dearbhatti@gmail.com) and see what he says. I am pretty sure that he will be receptive to tapping into BHT to save the scalp donor for future use. At 26 years of age, you would definitely need to plan for future hair loss possibilities and remedies.

 

In regards to having a strip taken from the chest....even the thought of that makes me shudder.......

 

Best regards,

California

[DancesWithHair]

This is exactly the type of information I have been looking for. This was a great read. Thanks

[Melvin- Admin]

HTsoon, when you refer to good cosmetic result are you talking about the length that the hair will grow or just the look/ feel of the individual hairs? I am considering using body hair as I feel that my donor area isn't great and also I buzz and will be buzzing my hair even after the HT so hopefully in this case the cosmetic look will be similar to existing scalp hairs. Another reason is I don't want to have a lot of visible scars on the back of my head as I'll have it buzzed.

 

It's not a good cosmetic result as a standalone, but body hair mixed with scalp hair gives a natural good cosmetic result, but if your going to just use body hair it's not gonna look good, your head will basically look like a hairy knee cap, the problem with using just body hair is that the follicular units per centimeter is no where near that of the hair on the scalp, so it will never look natural, if you buzz your head I recommend using all of your donor hair available then using body hair to add density, and if need be transplant some body hair to the donor area to camoflauge the scars.

[wylie]

Cali,

I also do understand that surgical skill does come in to play when transplanting body hair, but the fact is that the body hair must be camoflauged within existing scalp hair to hold a good cosmetic result.

 

 

Well, duh! This has been the accepted wisdom for years. You won't find a doctor practicing BHT on this forum who does not understand this most salient fact of using body hair.

[Dr Blake Bloxham]

HT,

 

I agree: tap out the scalp donor first!!