Do you think I could go from this to this

[Melvin- Admin]

Dr. Bloxham,

 

Thanks for your reply. I understand what you, Blah1982 and other posters are saying...getting a HT involves some risk, or the possibility of more HTs in the future. Although, if I react well to propecia and I stay on it, this risk could be eliminated. Do you agree?

 

Also, what do you mean by preserving the donor, and why would that require the FUT route. I would plan on FUE.

 

The theory is that you can get as many FUT or strip surgeries as possible whilst maintaining the surrounding hair virgin, in other words untouched so the you could FUE and get additional grafts, whilst this is fine in theory not really always the case, a lot of variables come in to play like skin elasticity, scarring physiology, 4,000 grafts extracted via FUT are gone forever regardless, in my opinion you'd be crazy to go FUT especially now, the probability of you balding significantly is high, so if you have surgery at 30 you may decide to want to shave it all off, well with every strip surgery you have you take the risk of your scar stretching significantly.

 

Now just so you know there is no surgery that is scarless, I'm sure Dr. Bloxham will repeat this 9 times, so just wanted to let you know, FUE will leave thousands of little dot scars on your scalp, but here's the thing, you are fair skinned with light hair, the absolute best scarring for FUE are with individuals with fair skin and light hair, why? Because the white dot contrast is not as obvious due to your skin already being fair, there's plenty of examples on this forum of fair skinned guys like sethticles who've gotten 4K+ FUE shaved down and the scars are barely visible. Also, I don't advocate doing FUE+FUT cause you run the risk of thinning the donor area and making the scar visible, that's just me though, if you don't care about scars doing that will probably give you the most grafts.

[Dr Blake Bloxham]

MJohnson,

 

No, I do not agree that Propecia "eliminates" risk. Propecia -- in good responders -- can absolutely delay the inevitable, but it can't truly halt hair loss forever nor do I think many hair transplant surgeons would design something aggressive because they believe a patient may do well with finasteride. There is still too much risk for the awkward flat, low "floating hairline" if you're overly aggressive now and continue to thin later.

 

Having said that, preventive medications may be worth researching and thoroughly discussing with a physician in your situation.

 

FUT leaves the donor in the best shape possible for future procedures. Aside from the small bit of fibrotic scarring right around the incision wound itself, all other areas in the donor are left virgin for future procedures. This allows you to go in and take large amounts of grafts at once, give them the best chance at growing, and still leave thousands of untouched and unaltered grafts in reserve. The same can't be said for FUE. FUE causes diffuse sub-dermal (under the skin) changes that can complicate future procedures (both FUE and FUT). This could leave you in a situation where you have substantial hair loss and want more surgery, but the donor isn't available because the grafts aren't delivering properly via FUE (because of the tissue changes from the prior FUE) and a strip isn't a good option because the harvesting region is picked over (meaning you'll take a full sized strip and only end up with several hundred grafts -- not to mention what could be an inability to cover the strip scar because the region was thinned out with an FUE harvest before).

 

If you came into my office, I'd tell you all of the above. Again, I think you could do something conservative WITH a long-term plan in mind; I would also highly, highly recommend doing it as an FUT.

 

However, I still do think a "buzz trial" is a first good step. Give it a shot! You may like the look and save yourself some time and money.

 

Best of luck!

[Dr Blake Bloxham]

M,

 

Here are a few images demonstrating what I was trying to explain with the FUE donor damage and how it complicates future procedures. These pictures came from a recent ISHRS (International Society of Hair Restoration Surgery) journal article on the subject:

 

In the first image, you see a strip removed via FUT from a patient who previously had FUE. You can see the diffuse scarring spreading further under the skin surface compared to outside the skin surface:

 

 

All of that white, shiny material you see around the follicles under the surface of the skin is scar tissue (caused by FUE).

 

In the next image, you can see that the scarring goes down 4.5mm. This is essentially the depth of an entire follicle, which means the scarring completely wraps around the follicles:

 

 

As I'm sure you can tell, all this scaring complicates future procedures. It significantly alters the way the tissue feels (and this feedback is key in good manual FUE) and responds to the punch while you're scoring (punching) around the grafts, and it holds on to it tightly and causing ripping when trying to deliver (pull out) the grafts. Not a situation you want to be in if you really need more surgery!

[gillenator]

mjohnson,

 

Low dose finasteride is the most effective hair loss medication to date and the only way you will know if it is effective for you is to get on it under a doctor's advice. This includes the potential of having side effects. You won't know untiol you try it. Even if you were to experience the side-effects, your doctor can potentially adjust the regimen.

 

But here's the thing. Propecia does not have much effect in the frontal core including the hairline. Although you do have some mild temporal recession, it is not advanced. And one of the risks of doing surgery around your hairline right now is that it can advance the rate of loss in that zone.

 

Even though you are concerned about the mild recession, you still have great hair mass and I would not do any surgery right now if I were in your situation.

 

For whatever it's worth, the average person doesn't does not see you as someone with a hair loss problem.