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

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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

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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.

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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.

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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.

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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.

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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


Dr. Blake Bloxham is recommended by the Hair Transplant Network.

 

 

Hair restoration physician - Feller and Bloxham Hair Transplantation

 

Previously "Future_HT_Doc" or "Blake_Bloxham" - forum co-moderator and editorial assistant for the Hair Transplant Network, Hair Restoration Network, Hair Loss Q&A blog, and Hair Loss Learning Center.

 

Click here to read my previous answers to hair loss and hair restoration questions, editorials, commentaries, and educational articles.

 

Now practicing hair transplant surgery with Coalition hair restoration physician Dr Alan Feller at our New York practice: Feller and Bloxham Hair Transplantation.

 

Please note: my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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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.

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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 like JBL 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.

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

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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 .


---------------------------------------------------------------------------------------

FUT #1, ~ 1600 grafts hairline (Ron Shapiro 2004)

FUT #2 ~ 2000 grafts frontal third (Ziering 2011)

FUT #3 ~ 1900 grafts midscalp (Ron Shapiro early 2015)

FUE ~ 1500 grafts frontal third, side scalp, FUT scar repair --300 beard, 1200 scalp (Ron Shapiro, late 2016)

 

http://www.hairrestorationnetwork.com/eve/185663-recent-fue-dr-ron-shapiro-prior-fut-patient.html

---------------------------------------------------------------------------------------

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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.

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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.

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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 like JBL 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.

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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

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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...

Bill,

behind this little questions there is a lot more which is important for threads like this.

Is "good ol' Blake" posting here? Just like "JeanLuc(Bergmann)", "Dan(26)", "Gas(th?rer)" and many others here or are the post from the clinic "Feller and Bloxham"?

From their own posts (especially the content not so much the signature) it appears that both are here as representatives of the clinic and therefore claim that their “opinion” is superior than the opinion of other members. Also most forum members might/will see it that way and maybe rightly so (I am not 100 % sold, but partly agree myself).

If this is the case (both are here as “the clinic”) Dr. Bloxham might be more appropriate than “Blake”. However, this is just my two cents and not the important point.

The important point is: If I do speak with “superior authority” as a clinic in this forum, doesn’t this also come with a “superior responsibility”? E. g. Can a “clinic” decide only to answer questions (to their own statements) which they like in such an important topic or not?

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Bill,

behind this little questions there is a lot more which is important for threads like this.

 

Is "good ol' Blake" posting here? Just like "JeanLuc(Bergmann)", "Dan(26)", "Gas(th?rer)" and many others here or are the post from the clinic "Feller and Bloxham"?

 

From their own posts (especially the content not so much the signature) it appears that both are here as representatives of the clinic and therefore claim that their “opinion” is superior than the opinion of other members. Also most forum members might/will see it that way and maybe rightly so (I am not 100 % sold, but partly agree myself).

 

If this is the case (both are here as “the clinic”) Dr. Bloxham might be more appropriate than “Blake”. However, this is just my two cents and not the important point.

 

The important point is: If I do speak with “superior authority” as a clinic in this forum, doesn’t this also come with a “superior responsibility”? E. g. Can a “clinic” decide only to answer questions (to their own statements) which they like in such an important topic or not?

 

I think that's unfair. Dr. Bloxham answers a lot of questions and enters into a lot of debates that aren't just in the self-interest of his clinic. I think it depends on the personal relationalship he has with other people on the forum. Some will call him Blake and some, like me, will be Dr. Bloxham

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I think that's unfair. Dr. Bloxham answers a lot of questions and enters into a lot of debates that aren't just in the self-interest of his clinic. I think it depends on the personal relationalship he has with other people on the forum. Some will call him Blake and some, like me, will be Dr. Bloxham

 

Maybe my post was not very clear, as you missed my point. Of course it is up to Dr. Bloxham, how he wants us to call him. And of course I am not the one who tells long times fellows to user either name.

 

Also, you are correct that a lot of questions have been answered, in this thread and in others. Dr. Bloxham answered to me very detailed in several occasions (e. g. the mFUE Thread), and I publicity thanked him for this.

 

BUT: In this particular thread there are many critical questions unanswered which really leaves a bad taste in my mouth. You might disagree and so might Bill. No problem, I just happen to have another opinion.

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