After 10 years i am READY! How many Grafts do i need and how do we approach it.

[joelk]

Thank you so much for your feedback Dr Bloxham.

 

You have presented a very accurate description of my case.

Guys i thank you all for your feedback and believe me I absolutely get where you all come from.

 

It is very difficult to see my case in videos due to lighting and the fact that as DR.Bloxham mentioned I have definitely became a NINJA when it comes to hiding and creating the best possible deception with what i have.

 

Now, I have been diagnosed Male pattern baldness very early by dermatologist and endocrinologist. I come form Spain before moving to OZ in 2000 where we have excellent access to specialist etc.

 

My father and grandpa have the exact same pattern of baldness and neither did anything about it. we are also hairy as monkeys in the body! (but that another story)

 

in my fathers case he was gone by around 25yo and always kept a small funny portion of hair in the front\middle area that he growed long to have the all dreadful comb over of the 70s and 80s. he also got away with alittle more due to that front \middle patch he kept.

 

now at 72yo. the old man still have a strong back and around donnor areas and tinny evidence of the little patch of hair he still grows long (probably for sentimental reasons ) he never EVER did absolutely nothing about his HL other than embrace and move on (NOT ME \ US haha)

 

now you know why i acted early and survived so long. finasteride was prescribed to me after all other tests where ruled out years ago for hair loss hormonal etc.

 

I am definitely not narcissistic obsessed with false issues. if you meet me in person as 5 diffrent surgeons here in OZ have you will clearly see my areas.

 

still i will definitely will upload some pictures and one more short video in day light and you will see reality.

 

as i mention before about FUT and FUE. we all have done the research and draw our own conclusions. I know why I don't feel FUE is something for me. as i like to save my donor area for the FUTURE and just refuse to lose precious grafts to transgression when a proper closure and a skilled surgeon can definitely minimize the scar and allow surrounding areas to be useful.

 

also my latest visit to the dermatologist tells me that i have normal to good scalp laxity so i will start exercises pretty soon to improve it and prevent any possible complications in the donor area.

 

please bear with me until i can upload the next images.

 

another question for DR Bloxham and any other DR. that could assist me.

 

do you think that i would be able to have the procedure, say the aggressive option that you suggested, without having to shave my head?

 

reason is that my surrounding hair is strategically grown to cover any possible procedure wile the grafts come out etc. and with concealer to assist. at least during the first few months.

 

do remember that in my case, not a soul suspects i have a hair loss issue. and would love to keep it that way if i can.

 

again guys, i understand how frustrating can be for some that some dude that seems to have a full head of hair is looking for a procedure. but wit for the daylight images!

 

and believe me i refused a procedure in 2006 and in 2008 so you get and idea of the kind of surgeons that we can face out there! specially here in OZ

 

one of this magicians wanted to transplant 6000 grafts beck then and he use STAPLES to close the the strip!!! so believe me am not pretty boy looking for surgery if i could i would love not to have anything done.

 

but i am at a point that without concealer i just cant go out in normal day light believe me the patch is big now. let alone surfing which i do wearing a hat as soon as i hit the ground.

 

also after 2 years of so of the procedure i would like to drop finateride to once or twice a week only.

I would like to be less dependent of medication. am happy with topical minox, is cheap less risks and i use it as hair sculpting.

 

All feedback is welcome guys but less keep it positive.

[joelk]

ok guys some more images until i can do the daylight ones... sorry i am flat out at work and just get time now...

[joelk]

more... again wait for the daylight ones...

 

and you should see the crown area is more extensive than the videos allow to see...

[Dr Blake Bloxham]

Indi,

 

Certainly.

 

Before I explain, however, I did want to say the following: Although I would almost universally recommend FUT for a procedure of this nature, it does not mean that FUE is a "bad" procedure or doesn't have it's place in hair transplant surgery. In fact, we perform them quite frequently. In a scenario like this, however, I would recommend FUT for the following reasons:

 

First, I'm not sure how small of a procedure it could be (if the patient does end up going down this route -- and like I said above, it's not abundantly clear that he necessarily needs to). I'm not a fan of large FUE "mega sessions" because of lower graft survival rates when large FUE sessions are attempted in one sitting (both because of the techniques used to remove this many grafts at once and because of the greater out-of-body time the weaker grafts experience) and the damage it causes in the donor.

 

Which brings me to point two: I essentially always recommend a non-FUE approach for frontal work of this nature -- even in smaller cases -- because of the higher success rates with respect to both quality and quantity of growth. Like I said above, I don't want to seem like I'm purposely picking on FUE here, but growth rates are lower with FUE. By how much is a matter of heated debate.

 

Here's a study done by Coalition hair transplant surgeon Dr Michael Beehner. His studies indicate that FUE grafts, on average, had an approximately 30% lower growth rate compared to their FUT counterparts. You can read an overview of the study here: 2015 ISHRS highlights.. And it is important to note that Dr Beehner states that this is just one study looking at growth differences and more research is encouraged.

 

Now, say you have two different patients: one who needs a little fill in in the middle of the scalp and one who needs frontal hairline work. Both patients undergo 1,000 graft FUE procedures. And let's say the growth rate for the FUE in these two patients in higher than what Dr Beehner quoted; let's say it's somewhere around 80%. If the first patient only has 800 of the 1,000 grafts grow in the middle of his scalp, it will probably still give coverage and achieve the goal. But what happens to the hairline patient? What happens when he only gets 80% yield in the frontal hairline? I wouldn't get to choose which grafts don't grow (as you often can't truly tell which FUE grafts are damaged), and this could manifest as patches of poor growth OR even diffusely poor growth in the MOST visible region of the scalp. This is a problem. What's more, FUE grafts have a tendency to remain a bit coarser or "wiry" compared to FUT harvested grafts, and this is a problem in visible scalp regions as well. And, like I said earlier, I feel less confident about getting more grafts out of the donor to fix this problem if a larger FUE session has already been performed.

 

Hope this explains. Feel free to ask any additional questions.

[Dr Blake Bloxham]

Hi Joel,

 

No problem. Happy to answer. Sounds like you've done a lot of research and have been very proactive with the preventive treatments. This has clearly served you well.

 

If you did the more aggressive option at my clinic, I would shave down the region. You'll hear a lot of opinions on this, but we do require it. Now, this doesn't mean you wouldn't have enough hair around the area to still get away with a passable camouflage job, but you'll have to put a little more work into it for a while (and it still may be partially visible despite your best efforts).

[Dutchie]

Quick question dr. Bloxham, how does one protect the crown grafts after an FUE transplant to the crown while sleeping?? It would seem to me a neck pillow would offer little protection to the crown area

[Indi9]

Makes sense. But now I am worried why I underwent a FUE recently. In the beginning i felt the same about the fue grafts being 'wiry' n stiffer. Wish had your advice before taking the plunge

Fingers crossed ... Waiting for good results.

 

Indi,

 

Certainly.

 

Before I explain, however, I did want to say the following: Although I would almost universally recommend FUT for a procedure of this nature, it does not mean that FUE is a "bad" procedure or doesn't have it's place in hair transplant surgery. In fact, we perform them quite frequently. In a scenario like this, however, I would recommend FUT for the following reasons:

 

First, I'm not sure how small of a procedure it could be (if the patient does end up going down this route -- and like I said above, it's not abundantly clear that he necessarily needs to). I'm not a fan of large FUE "mega sessions" because of lower graft survival rates when large FUE sessions are attempted in one sitting (both because of the techniques used to remove this many grafts at once and because of the greater out-of-body time the weaker grafts experience) and the damage it causes in the donor.

 

Which brings me to point two: I essentially always recommend a non-FUE approach for frontal work of this nature -- even in smaller cases -- because of the higher success rates with respect to both quality and quantity of growth. Like I said above, I don't want to seem like I'm purposely picking on FUE here, but growth rates are lower with FUE. By how much is a matter of heated debate.

 

Here's a study done by Coalition hair transplant surgeon Dr Michael Beehner. His studies indicate that FUE grafts, on average, had an approximately 30% lower growth rate compared to their FUT counterparts. You can read an overview of the study here: 2015 ISHRS highlights.. And it is important to note that Dr Beehner states that this is just one study looking at growth differences and more research is encouraged.

 

Now, say you have two different patients: one who needs a little fill in in the middle of the scalp and one who needs frontal hairline work. Both patients undergo 1,000 graft FUE procedures. And let's say the growth rate for the FUE in these two patients in higher than what Dr Beehner quoted; let's say it's somewhere around 80%. If the first patient only has 800 of the 1,000 grafts grow in the middle of his scalp, it will probably still give coverage and achieve the goal. But what happens to the hairline patient? What happens when he only gets 80% yield in the frontal hairline? I wouldn't get to choose which grafts don't grow (as you often can't truly tell which FUE grafts are damaged), and this could manifest as patches of poor growth OR even diffusely poor growth in the MOST visible region of the scalp. This is a problem. What's more, FUE grafts have a tendency to remain a bit coarser or "wiry" compared to FUT harvested grafts, and this is a problem in visible scalp regions as well. And, like I said earlier, I feel less confident about getting more grafts out of the donor to fix this problem if a larger FUE session has already been performed.

 

Hope this explains. Feel free to ask any additional questions.

[Dr Blake Bloxham]

Hi Indi,

 

No need to be concerned yet. By any means! Keep an eye on everything, but try not to drive yourself crazy analyzing the results as they mature (easier said than done). Evaluate at the 12 month mark and see where you land. But no worries yet!

[Dr Blake Bloxham]

Hi Dutchie,

 

It's trickier with the crown grafts. We still recommend sleeping propped up at 45 degrees with a neck pillow or rolled up towel. The more you can get the neck support to flex your neck (without causing obvious discomfort, creating a scenario where you may fall forward in the night, or sleeping in a position where you could get fluid pockets in the forehead if other areas -- IE top and front -- were worked on), the safer the crown grafts will be. But I do know these patients worry about it more. With the above advice, I haven't had anyone really dislodge crown grafts while sleeping.

 

Hope this helps!

[joelk]

Thanks Doctor,

 

more picks "daylight" foggy day though hopefully this helps and please let me know if i could do more to show for now.

 

for an graft estimate.

video at:

 

https://youtu.be/N4W1FYc63lo

[ndubya]

Look up JohnnyDrama

 

Your hairloss pattern reminds me of his;)