Why NOT to get an FUE- Interview with Dr. Willaim Reed- by Dr. Feller and Bloxham

[tofur]

"Lmao you're a clown bro"

 

nek minit

 

"You really gotta lay off the personal attacks, makes you sound like a petulant little child. "

 

"You provide us with hundreds of 10k graft FUE cases and maybe I'll agree that it's something a man can count on."

 

nek minit

 

"I didn't say it's not a good procedure because it can't achieve 10k grafts"

 

"You conveniently ignored my pointing out of the study that showed guys are back at baseline after 5 years of fin,"

 

*Didn't actually point out a specific study

 

"You don't have the grafts to do that, starting the hairline that low increases the surface area to cover dramatically."

 

Despite the fact that 5500 grafts at 55 microns can give dense and full coverage on a norwood 6:

 

International Hair Loss Forum - Djeetee: 5500 FUE - Dr Erdogan - 27&28/09/16

 

 

I reiterate, you are not a smart person, and it seems not smart enough to argue with. You are a worm.

 

I called you a clown because of your personal attacks.

 

You were trying to push FUE as a realistic option for guys needing a lot of grafts. Still haven't provided even one case of FUE approaching 10k. That guy you linked still had hair in the transplanted region, he wasn't cueball and wasn't a true NW 6 since his sides were still tall and his crown is still weak afterward.

 

Anyone who's done even a modicum of research on HT knows that graft count alone is only part of the story. Hair caliber, number of multi-FU play a huge role in the final appearance so continuing to point out men that have thick dense hair to prove your point is disingenuous. I could point out NW 6 who get 5k grafts and look like shit but you'd just ignore it.

 

 

If you get a HT while relying on fin and didn't know about the 2002 5 year study on fin then you have no business calling anyone stupid. The drug buys you time, that's it.

 

[ThickGreenLawn]

Tofur, you have claimed that finasteride stops working over time. I don't think there is any evidence that shows that this is the case. By all accounts if it works for you in the first year it will continue to work for you long term. Hair counts may decrease slowly over time but it's still working as you will have more hair than if you never took finasteride.

[jjsrader]

Everyone takes their hair loss 'personally' and most look for best-case scenarios both now and into the future.

 

If you lose most of your hair from the top and vertex that is 50K hairs you lost (or are miniaturizing). 12.5K transplants, about 25K hairs brings you to 50% of normal.

 

The thing is a hair transplant, even at 50% of normal density is an illusion of density (under good lighting and extremely favorable hair characteristics). At around 70% of normal density is when hair really looks normal.

 

I don't believe that 30% of normal density is cosmetically acceptable (this is marketing by doctors). Finally, the contrast between very thick donor and transplanted region will ALWAYS be fairly obvious unless you FUE out the donor to a great deal.

 

For people like me (and probably nearly 50% of hair transplant USA patients) our hair density isn't super high nor is the caliber of our hair very thick. We basically have straight/fine hair.

 

It is obvious that most young guys who are savvy on the internet w/great results post the most/best short-term results. A doctor NEVER shows poor results voluntarily nor do even 5% (much less) of poor results from customers ever get posted. Duh!

 

Would I have just had another 5K fut if avodart (better than finasteride) kept working for me after 15+ years? Oh, my crown didn't start thinning until about 2010 - aged 43.

 

That was 8 years after I began dudasteride and after using finasteride for 5 years previous to that.

 

I'm happy for younger guys who get their 1st surgery and are tickled to death for awhile; that's a good thing. But if you are in your 20's and have crown thinning/balding but a solid hairline - don't girls find that unacceptable? Haha!

 

Frankly, hair transplantation should never have been invented; most guys after age 40 can deal w/hair loss (life goes on believe it or not) and it is natural.

 

I'm locked in and knew that I was back in the early 90's. I recommend to anyone I know not to do it. It is not necessary.

 

Having written all of that - like everything as one hits 35, then 40 & then 45 and 50 years old, NOTHING in your body works as well as when you are in your 20s' and early-to-mid 30's.

 

Including your damned hair! If you are losing it early (25 years and under) it wants to all go away eventually.

 

Good luck!

[ThickGreenLawn]

Jjsrader I think your viewpoint is overly pessimistic. It's true that not everyone will be a good candidate for a transplant and ethical Doctors will rightfully reject those. Competent research from a prospective patient should also indicate to them if they're a good candidate. However, people are different and countless men, many of whom exist outside of the USA, can have a meaningful improvements to their lives from transplants. Anyway isn't the USA one of the most ethnically diverse places in the world? There should be a whole array of men with all sorts of different hair characteristics. Don't forget that women can also improve their lives with surgery. Instead of thinking that transplants should never have been invented, why not have the view that surgery is already improving people's lives and with new innovations, they can only improve in the future.

 

I think there have been a few overly negative posts about transplants in general, different methods and treatments recently. It should be realised that both FUT and FUE can be great for suitable candidates and treatments like finasteride can help a huge percentage of hair loss sufferers. It's true that some people have it in their genes that it will be difficult for them but places like this forum are a great place to educate people about what their best options are. People with knowledge and experience are in a position to help others in the best way they can.

[tofur]

Tofur, you have claimed that finasteride stops working over time. I don't think there is any evidence that shows that this is the case. By all accounts if it works for you in the first year it will continue to work for you long term. Hair counts may decrease slowly over time but it's still working as you will have more hair than if you never took finasteride.

 

No for sure fin is better then nothing, every guy losing his hair should at least try it and see if it works well for them and they don't get sides. It just doesn't truly stabilize your loss forever, it slows it down. This is totally logical, it isn't eliminating all of your DHT it's just knocking it down, your DHT sensitive follicles are still getting hit by what's remaining in your system, just not to the same degree.

 

My issue with it is when I see guys cutting up their heads on the premise that fin will forever keep their hair the way it is when they start it. There are many examples of men who switch to duasteride anywhere from 3 to 15 years into fin because they start losing significant ground and need more DHT suppression to maintain their hair. Problem with that is duasteride seems to have more side affects so it's a double edged sword.

 

Ultimately, we need something new to stop native loss. Shiseido/replicel's RCH-01 is the most promising upcoming treatment to watch for, shiseido's phase 2 results will be out Q2 of 2018.

[fortune11]

Everyone takes their hair loss 'personally' and most look for best-case scenarios both now and into the future.

 

If you lose most of your hair from the top and vertex that is 50K hairs you lost (or are miniaturizing). 12.5K transplants, about 25K hairs brings you to 50% of normal.

 

The thing is a hair transplant, even at 50% of normal density is an illusion of density (under good lighting and extremely favorable hair characteristics). At around 70% of normal density is when hair really looks normal.

 

I don't believe that 30% of normal density is cosmetically acceptable (this is marketing by doctors). Finally, the contrast between very thick donor and transplanted region will ALWAYS be fairly obvious unless you FUE out the donor to a great deal.

 

For people like me (and probably nearly 50% of hair transplant USA patients) our hair density isn't super high nor is the caliber of our hair very thick. We basically have straight/fine hair.

 

It is obvious that most young guys who are savvy on the internet w/great results post the most/best short-term results. A doctor NEVER shows poor results voluntarily nor do even 5% (much less) of poor results from customers ever get posted. Duh!

 

Would I have just had another 5K fut if avodart (better than finasteride) kept working for me after 15+ years? Oh, my crown didn't start thinning until about 2010 - aged 43.

 

That was 8 years after I began dudasteride and after using finasteride for 5 years previous to that.

 

I'm happy for younger guys who get their 1st surgery and are tickled to death for awhile; that's a good thing. But if you are in your 20's and have crown thinning/balding but a solid hairline - don't girls find that unacceptable? Haha!

 

Frankly, hair transplantation should never have been invented; most guys after age 40 can deal w/hair loss (life goes on believe it or not) and it is natural.

 

I'm locked in and knew that I was back in the early 90's. I recommend to anyone I know not to do it. It is not necessary.

 

Having written all of that - like everything as one hits 35, then 40 & then 45 and 50 years old, NOTHING in your body works as well as when you are in your 20s' and early-to-mid 30's.

 

Including your damned hair! If you are losing it early (25 years and under) it wants to all go away eventually.

 

Good luck!

 

I think we need more posts like the one here by jsrader .

 

I was an optimist in my late 20s when I got my first HT. Now in my 40s , things aren't looking so good and am much more realistic. Meds can work , they can stop working or they can cause problems after a point. Newly transplanted HT hair looks good until it also starts miniaturizing after a decade to two.

 

Ultimately law of averages catches up with you -- we like to think we are all unique individuals but we are not . Look at median distributions not a few outliers. And look at cases that have been in the making for 10+ years . How many of those do we see around here ?

[dan26]

Bro read the graph properly lol those people are still above baseline and thats not even the 10year study.

 

You shouldn't expect to keep your 'gains' on finasteride, but clinical evidence is clear that a majority stay above baseline. We still have to prepare for the event that we are a minority case that isn't so lucky so be proactive and do everything you can. Using all your grafts with FUE, going to a great doc who gives a solid yield, potentially throwing in some smp etc and at the very least having some great full head years followed by some less than perfect ones is WAY better than just getting rekt.

[dan26]

jjsrader you got FUT so obviously the prospect of eventually losing eveything and having to shave is a lot worse than those who got FUE from a DR with good skill and donor management.

 

Thanks for sharing your experience though

[dan26]

fortune11, according to your bio 4600 grafts were used on your hairline and frontal third. IMO that is too much and I know for myself as someone who is young and plans for worst case scenerios I would consider that bad planning and not conservative enough based on age and potential future progression.

 

Look at H&W FUT or Lorenzo FUE and see how much solid coverage can be achieved by 5000+ grafts. Def worth it if done properly. But I agree young ones should really proceed with caution when it comes to 'dense pack' hairlines and the such.

[Rappy]

I think we need more posts like the one here by jsrader .

 

I was an optimist in my late 20s when I got my first HT. Now in my 40s , things aren't looking so good and am much more realistic. Meds can work , they can stop working or they can cause problems after a point. Newly transplanted HT hair looks good until it also starts miniaturizing after a decade to two.

 

Ultimately law of averages catches up with you -- we like to think we are all unique individuals but we are not . Look at median distributions not a few outliers. And look at cases that have been in the making for 10+ years . How many of those do we see around here ?

 

Wait, what? Your loosing you transplanted hairs also??

[thatoldchestnut]

fortune11, according to your bio 4600 grafts were used on your hairline and frontal third. IMO that is too much and I know for myself as someone who is young and plans for worst case scenerios I would consider that bad planning and not conservative enough based on age and potential future progression.

 

 

Not to mention the fact that meds weren't used for the majority of the "ht journey" on a patient who's a diffuse nw6 thinner.

 

Seems like poor planning and poor decision making. A lot of confirmation bias going on ITT.

[dan26]

Not to mention the fact that meds weren't used for the majority of the "ht journey" on a patient who's a diffuse nw6 thinner.

 

Seems like poor planning and poor decision making. A lot of confirmation bias going on ITT.

 

ya fortune i looked at your log and 1) your hair looks pretty damn good considering age and never taking propecia until recently 2) would way rather be in your spot then fully bald 3) if you had taken propecia earlier you would have even better hair

[tofur]

Bro read the graph properly lol those people are still above baseline and thats not even the 10year study.

 

You shouldn't expect to keep your 'gains' on finasteride, but clinical evidence is clear that a majority stay above baseline. We still have to prepare for the event that we are a minority case that isn't so lucky so be proactive and do everything you can. Using all your grafts with FUE, going to a great doc who gives a solid yield, potentially throwing in some smp etc and at the very least having some great full head years followed by some less than perfect ones is WAY better than just getting rekt.

 

Yeah and which way are they trending? Time keeps marching on, for guys who still have a solid 50-70 years of life left 5 years is nothing. It's something you have to take into account before you permanently put hair on top of your head, that's all. There's no guarantee.

 

 

 

jjsrader you got FUT so obviously the prospect of eventually losing eveything and having to shave is a lot worse than those who got FUE from a DR with good skill and donor management.

 

Thanks for sharing your experience though

 

Uhh you can't shave down with FUE either, it isn't a scarless procedure.

[Dolph1969]

Uhh you can't shave down with FUE either, it isn't a scarless procedure.

 

I regularly get my sides and back to a no 1 and its not visible after fue. The girl who cuts my hair can't see anything and there'll be no one up as close as your barber/hairdresser.

[tofur]

I regularly get my sides and back to a no 1 and its not visible after fue. The girl who cuts my hair can't see anything and there'll be no one up as close as your barber/hairdresser.

 

#1 is a buzz cut, I'm talking about the Bruce Willis approach to hair loss, razoring it down to nothing or no-guard clipper at the most.

[JayLDD]

Yeah and which way are they trending? Time keeps marching on, for guys who still have a solid 50-70 years of life left 5 years is nothing. It's something you have to take into account before you permanently put hair on top of your head, that's all. There's no guarantee.

 

 

 

 

 

Uhh you can't shave down with FUE either, it isn't a scarless procedure.

 

The study you showed shows hair above baseline for the average person for 10 years. That is a massive difference for someone who wants to have age appropriate hair in their twenties. In your 30s and 40s, having a bit of thinning in the crown if you run out of donor isn't as much of an issue, and quite frankly with good donor management on someone facing a NW5 pattern chances are they will be able to get full coverage long term with a slightly thin crown. Concealers can also aid in providing the illusion of more density.

 

Your argument is the equivalent of saying that you'll never be the worlds greatest body builder so there's no reason to go to the gym.

[Dr Blake Bloxham]

I've received several requests to comment on the study Tofur shared and his assessment in general.

 

To keep this brief:

 

Yes, I completely concur with the data on finasteride. As he noted, what needs to be observed is the trend with respect to the X axis (traditionally time). The efficacy of finasteride absolutely decreases overtime. I've personally noted that patients really start to return to noticeable progressive shedding after 7-10 years. And if we extrapolate the 5 year data, this makes sense.

 

As previously stated: there is no such thing as "stable" androgenic alopecia, even on a 5-alpha-reductase inhibitor. And while preventive medications, including finasteride, are very helpful in certain instances, it is a "kick the can down the road" type scenario.

 

This is why donor management is crucial. And there is no such thing as donor management when it comes to FUE megasessions and young patients. Sorry to be blunt, but no such thing. It's truly an oxymoron.

 

Don't kid yourself and wind up in a bad situation in the road. I'm already seeing this too much in the office.

 

Dr. Bloxham

[thatoldchestnut]

 

Yes, I completely concur with the data on finasteride. As he noted, what needs to be observed is the trend with respect to the X axis (traditionally time). The efficacy of finasteride absolutely decreases overtime...And if we extrapolate the 5 year data, this makes sense.

 

 

There is insufficient data provided to conclude the above, at least in the graph presented.

 

To make such a blanket statement would assume that all patients respond to finasteride identically, experiencing both the same initial and continued efficacy. We know this to be fundamentally untrue, both anecdotally and statistically. Consider the example in which several of the men who took finasteride over the 5 year period were poor, or even non-responders (due to age/progression of hair loss or other physiological factors); the data has now been significantly skewed in a self explanatory fashion.

 

I'm not categorically saying your statement is incorrect (frankly i haven't researched it enough to consider myself that well informed on the matter), but it certainly seems likely that it is. Regardless of the underlying sentiment you proffer, it is lucidly based on what appears to be a fallacious extrapolation of the data presented. Further, one need only consult the Rossi study for several examples of men who serve as a direct refutation of your conclusion. Therein lie clear examples of men for whom finasteride retained its efficacy for a period of 10 years.

[JayLDD]

thatoldchestnut said:

There is insufficient data provided to conclude the above, at least in the graph presented.

 

To make such a blanket statement would assume that all patients respond to finasteride identically, experiencing both the same initial and continued efficacy. We know this to be fundamentally untrue, both anecdotally and statistically. Consider the example in which several of the men who took finasteride over the 5 year period were poor, or even non-responders (due to age/progression of hair loss or other physiological factors); the data has now been significantly skewed in a self explanatory fashion.

 

I'm not categorically saying your statement is incorrect (frankly i haven't researched it enough to consider myself that well informed on the matter), but it certainly seems likely that it is. Regardless of the underlying sentiment you proffer, it is lucidly based on what appears to be a fallacious extrapolation of the data presented. Further, one need only consult the Rossi study for several examples of men who serve as a direct refutation of your conclusion. Therein lie clear examples of men for whom finasteride retained its efficacy for a period of 10 years.

 

This is why I'm more than happy to criticise doctors who SHOULD know better than me, but clearly are prone to making sweeping generalisations that are less accurate than a high school science student would be expected to be in an assignment.

 

"And there is no such thing as donor management when it comes to FUE megasessions and young patients. "

 

So I guess that's why you will find hundreds and hundreds of Erdogan and Lorenzo cases over the 5000 FUE graft mark with no visible donor diffusion, and others get butchered by after 1500. Apparently in your world extraction technique, extraction method, punch type, punch material, punch size, doctor doing the extraction and field of extraction make no difference to donor management with FUE?

 

No Dr. Bloxham, what you said was a laughably inaccurate and ignorant generalisation, and quite frankly, a lie.

[dan26]

If their is uncertainty with finasteride in the long term that is just another reason to avoid FUTs

[fortune11]

It is easy to be passionate about one's own viewpoint and especially when it has worked in your favor. Let me address questions regarding what I have observed now and what I thought back then. Sorry but lengthy post below.

 

- Hair always looks better in pictures (especially those taken with cellphones) and I look quite decent in photos esp from the front but in real life, under different lighting conditions and when the wind messes up your hair, the gaps in coverage and those between native hair and transplanted hair begin to show. I know one is always more critical about self than what others think so maybe I have that bias but the amount of time I have to spend on styling my hair has increased dramatically compared when I would just towel dry my thick hair, brush it loosely and walk out the door.

 

- Using 3600 grafts on the frontal third and hairline (FUT #1 and FUT #2) is actually good planning especially when you are looking to frame the face and when you have a big head with a a lot of surface area like I do. This is why I wasn't too fond of the option of shaving my head back when I first started losing hair in my 20s.

 

The problem was , my HT #2 on the frontal third and midscalp, yielded somewhat mediocre results (despite being FUT) and the coverage on the frontal third wasn't as good as should have been. If you have a decent hairline but no support behind it , what ends up happening is you cannot comb your hair back as there is no support behind to hold them up and it ends up looking weird. I tried to correct it this time with FUE into those areas but so far not seeing any growth from FUE at the 10 month mark

 

- Meds -- I have not been a big fan of meds (esp fin) and am a reluctant user since I have experienced side effects like brain fog and a loss of coherency at times. I tried to find a balance with reduced dosage which seemed to help unto a point. Right now I am trying to maintain 1mg every other day, Also switching from oral to topical fin after surgery was a mistake (obviously in hindsight) and I have gone back to oral propecia now

 

I am not married to any strong opinions, just that decisions need to be evaluated in the context of other variables that affect your life. Would I get a hair transplant again knowing what I know now 15 years ago ? Absolutely . The advantage and confidence boost it gave me was worth the effort, But need to also acknowledge its limitations especially for those on the path to a NW6 - and many hair loss patterns ultimately end up here as you age and age.

 

As to FUT vs FUE. Comparing results

 

FUT, #1 was the best

FUT , #3 was decent

FUT, #2 was not as effective

FUE, #4 -- TBD -- if I get good results say after 6 more months , I will be the first to come back on these boards and admit that FUE worked for me as well as the FUTs .

[ThickGreenLawn]

There is insufficient data provided to conclude the above, at least in the graph presented.

 

To make such a blanket statement would assume that all patients respond to finasteride identically, experiencing both the same initial and continued efficacy. We know this to be fundamentally untrue, both anecdotally and statistically. Consider the example in which several of the men who took finasteride over the 5 year period were poor, or even non-responders (due to age/progression of hair loss or other physiological factors); the data has now been significantly skewed in a self explanatory fashion.

 

I'm not categorically saying your statement is incorrect (frankly i haven't researched it enough to consider myself that well informed on the matter), but it certainly seems likely that it is. Regardless of the underlying sentiment you proffer, it is lucidly based on what appears to be a fallacious extrapolation of the data presented. Further, one need only consult the Rossi study for several examples of men who serve as a direct refutation of your conclusion. Therein lie clear examples of men for whom finasteride retained its efficacy for a period of 10 years.

 

Furthermore, patients presenting themselves to transplant Doctors will be far more likely to be part of the group of the population who are poorer responders to finasteride. This should be self evident as people who do better with the drug are less likely to consider surgery. The sample witnessed by Dr. Bloxham would therefore have a large degree of selection bias and would not be representative of the population as a whole. I think in his post he failed to emphasise how effective the treatment can be for many patients, indeed a considerable percentage of patients according to the Rossi study you mentioned.

[tofur]

There is insufficient data provided to conclude the above, at least in the graph presented.

 

To make such a blanket statement would assume that all patients respond to finasteride identically, experiencing both the same initial and continued efficacy. We know this to be fundamentally untrue, both anecdotally and statistically. Consider the example in which several of the men who took finasteride over the 5 year period were poor, or even non-responders (due to age/progression of hair loss or other physiological factors); the data has now been significantly skewed in a self explanatory fashion.

 

I'm not categorically saying your statement is incorrect (frankly i haven't researched it enough to consider myself that well informed on the matter), but it certainly seems likely that it is. Regardless of the underlying sentiment you proffer, it is lucidly based on what appears to be a fallacious extrapolation of the data presented. Further, one need only consult the Rossi study for several examples of men who serve as a direct refutation of your conclusion. Therein lie clear examples of men for whom finasteride retained its efficacy for a period of 10 years.

 

The 5 year study was done with 1500 men and was double blind placebo controlled, it would take a lot of men to significantly skew the results.

 

The 10 year study was shit by comparison, only 118 men.

[tofur]

JeanLucBergman said:

This is why I'm more than happy to criticise doctors who SHOULD know better than me, but clearly are prone to making sweeping generalisations that are less accurate than a high school science student would be expected to be in an assignment.

 

"And there is no such thing as donor management when it comes to FUE megasessions and young patients. "

 

So I guess that's why you will find hundreds and hundreds of Erdogan and Lorenzo cases over the 5000 FUE graft mark with no visible donor diffusion, and others get butchered by after 1500. Apparently in your world extraction technique, extraction method, punch type, punch material, punch size, doctor doing the extraction and field of extraction make no difference to donor management with FUE?

 

No Dr. Bloxham, what you said was a laughably inaccurate and ignorant generalisation, and quite frankly, a lie.

 

Why do you keep latching onto these 5000 FUE megasessions as evidence of FUE being so close to FUT in donor management as to make it insignificant? 5-6k is the generally accepted limit to FUE'ing an average donor before donor issues show up, just because those guys look okay now doesn't mean you can get anymore appreciable amount of grafts out of that donor when they inevitably lose ground over the next 4-7 decades of their life. We won't even get into how far out of the true safe zone you have to go with FUE to get those big graft numbers and the risks that brings in the long term results.

[Bill - Seemiller]

Blake (sorry, I'm so used to calling you that because I've know you so long by your first name - but maybe I should call you Dr. Bloxham, at least for the sake of the community),

 

"And there is no such thing as donor management when it comes to FUE megasessions and young patients. "

 

Can you explain why you feel this way? I would say it's only as true as saying "and there is no such thing as donor management when it comes to FUT / strip megasessions an young patients"

 

In other words, I feel that it's not the donor excision method that makes donor management difficult, it's the age. But I'd like to hear why you believe this.

 

Best wishes,

 

Bill