*VIDEO* Feller/Bloxham- Hairline and Front rebuild- Great Neck, NY

[FellerMedical]

Hi Everyone,

This patient visited to book for a procedure, but he already had one with us before. 2500 grafts into the hairline and the front portion of the scalp. We will be doing his crown next.

Enjoy the presentation.

Tara

Feller and Bloxham Hair Transplants

Great Neck, NY

516-487-3797

 

 

 

 

 

 

Edited January 22, 2016 by FellerMedical

[mav23100gunther]

What about this topic Dr, you ever going to answer?

 

http://www.hairrestorationnetwork.com/eve/181941-%2Aphotos%2A-patient-didnt-pay-his-hair-worth-feller-bloxham.html

[TakingThePlunge]

Excellent result Looking forward to following his next procedure.

[Dr Blake Bloxham]

Mav,

 

Answered!

 

Dave,

 

Thank you. We'll keep the community updated on his crown procedure.

[Scottyboy]

Mav,

 

Answered!

 

Dave,

 

Thank you. We'll keep the community updated on his crown procedure.

 

Dr. Blake, isn't this an example of the front loading that Dr. Feller talked about? I mean it looks great, but i'm concerned about the front loading becoming a problem in future for him. what if he needs more hair?

[Dr Blake Bloxham]

Hi Scotty,

 

Good question. If you are curious about this, I'm sure other members are as well; so this is probably a good opportunity to discuss "front loading" and why it is an issue.

 

First, what is "front loading?"

 

Front loading is a term that refers to one of a few scenarios: 1) when a hairline is placed too low or designed aggressively flat on a patient who may experience progressive hair loss in the future; 2) when an excessive number of grafts are used in the frontal scalp (usually hairline) in a patient who may experience progressive hair loss in the future; or 3) a combination of both: a frontal procedure done too aggressively low or flat with an excessive number of grafts.

 

So why is this an issue?

 

Front loading is a problem for a number of reasons, but there are two BIG issues:

 

Problem 1: Aggressive designs in the frontal scalp are often done without taking future loss into account.

 

Many times patients request very low or very flat hairlines. In patients with stabilized hair loss and minimal recession, this plan may be appropriate. However, androgenic alopecia ("male pattern baldness") is a very difficult -- if not impossible -- process to predict. Especially in young patients. In older individuals it does become more predictable, but it's very rare that older patients want to fix minimal recession with such aggressive designs. It is very common, however, to get this request from young patients with very unpredictable loss.

 

So a young patient with quickly progressing hair loss wants a youthful, flat, low hairline. What's the problem? Well, the problem is that creating this hair line is a short-term strike in a long-term battle. Front loaded hairlines can look great for the first few years after a procedure. But what happens when the 20 year old patient who has 3,000 grafts placed into his beautiful low, flat hairline starts to rapidly thin behind it? I'll tell you because I've, unfortunately, seen it in person. They end up with a rectangle of thick hair in the very front with unnatural recession behind it.

 

Now, this happens in non-front loaded hair transplants sometimes too; so what's the big deal? Well, the problem is that this plan wasted far too many grafts in the front and now the patient does NOT have the donor to continue filling behind. Now we have a problem, and it cannot be fixed. This is especially true when the front loading is done via FUE, as this generally compromises the donor supply more than FUT (but that's a discussion for another time).

 

On top of this, the very low, thick hairline may not look appropriate when the patient ages -- even if they don't experience more loss. It's understandable why patients want this done, but it's much more advisable to plan for the long-term; start a little more conservatively in the front, save grafts in reserve, and refine the hairline later (if the patient even wants to) after the hair loss is more stable and we know we have the grafts to do it.

 

Problem 2: Putting too many grafts in one area not only wastes them, but it can actually create poor growth and lead to problems like necrosis.

 

Grafts need a good blood supply full of oxygen and nutrients to growth and thrive. The scalp, though blessed with an excellent supply, only has so much blood flowing to it. This means that each graft placed in the scalp is going to divert a little bit of the blood supply. The more grafts you place, the more the blood supply is divided up. If you place too many grafts into a certain region, you are dividing up and damaging the blood supply too much. This causes two things: 1) it means some of the grafts aren't getting enough blood and they won't survive and thrive well; 2) the blood will be diverted from other things it needs to supply. For example, it reduces supply from the skin and "skin death" or necrosis can occur.

 

This means that going "too dense" in an area can actually lead to poor growth, complications, and an overall less satisfactory transplant. The goal is increase the density up to a certain point where you achieve a true "dense pack," but back off before overloading an area. This is part of the "art" of hair transplantation.

 

So why is this case not an example of front loading?

 

This case is an example of a classic FUT "dense pack," but it is not front loading because it does not meet the criteria discussed above.

 

First, note the hairline design and the patient's age; it's age appropriate, future loss is taken into account, and the patient's hair loss is slightly more predictable due to his age. Second, the area in which the grafts were placed is appropriate for 2,500 grafts. We were able to dense pack it without overloading, and he had excellent growth without complications. Further testament to this being an example of appropriate frontal dense packing without overloading, the patient is now coming back for a crown procedure and he has plenty of grafts to steal via another strip and use to rebuild his crown.

 

I hope this was helpful. I think I'll actually make a video about this later this week. Much quicker and more interesting to digest the information this way.

 

In the meantime, here are a few videos you may find interesting:

 

Here is an example of appropriate dense packing in the front of the scalp without front loading:

 

 

And here is a video discussing strategy in frontal cases of this nature:

 

[Bill - Seemiller]

Dr. Feller and Dr. Bloxham, thank you for presenting this case, it's very impressive. Keep up the great work.

 

Bill

[Dr Blake Bloxham]

Thanks, Bill!

[mrkellymac10]

This is what I want. If I could only have this result for my hair line I would be so happy. Looking forward to visiting in New York. Keep up the excellent work.

[J2FreeMan]

Damn ... looks pretty good. Is this the fuue one where you pull the hair follicles out of the back or the strip one? Do you guys have any offices in the south east?