"What Happens When the Other Hair Falls Out?" |3,200 grafts | Feller & Bloxham

[Dr Blake Bloxham]

"What happens when the other hair falls out?"

 

"What will the transplants look like when the native hair falls out?"

 

These are two very common questions I'm asked by diffusely thinning or patterned diffusely thinning patients during consultations. What they want to know is what the results of their transplant will look like after the supporting, native hair we work though eventually thins and falls out.

 

And I tell patients that because modern techniques allow us to carefully work through instead of completely going around these native hairs, the transplants will stand on their own after you lose the hair around the transplants.

 

And that is exactly what happened with today's patient:

 

This patient is a very diffuse thinner with NW VI potential. I did a 3,200 graft FUT procedure on his frontal and mid-scalp in 2015 and carefully worked through his native hair at the time. He was worried that it would look thin when these hairs fell out, and I assured him the transplants would stand on their own.

 

Here is how he looked immediately post-op:

 

 

The patient came back 6 months later and looked great. At that point, all his native hair that we worked through came back and was working with the transplant to give a very full look. Here's how he looked then:

 

 

I saw him next two years later. He stopped by the office to discuss a planned follow up to address the crown. He looked great. In fact, he was sporting a "gelled and slicked-back" hair style that he hadn't previously been able to wear. At that time he told me that he believed the rest of his original native hair had shed. And based upon an examination of the transplanted area and the rest of his scalp, I agreed that the front was almost all transplants at this point and the back was thinner without any native hair.

 

Despite this, he looked great and he agreed that my original assessment was correct: the transplants will stand on their own when the native hair thins.

 

Here's how he looked at 24 months post-op, with loss of the native hair in the transplanted area, and with his hair gelled and slicked-back:

 

 

 

 

 

So for those concerned about what a thinning region that will be augmented with transplants may look like after the native hair thins, rest assured; as long as the native hair is carefully worked through the transplants should stand on their own.

 

Thanks for viewing.

 

Dr. Bloxham

Feller & Bloxham Medical, PC

[hairlossPA]

i’ve had the same question. i have a similar diffusing pattern...

 

this is a great result for only 6months post op. scar is hidden well. I am considering FUT but am nervous about the scar...

 

how did you reach 3200? did he or you suggest to wait to do the crown?

[Triple7]

This is a very nice result.

[Dolph1969]

Just shows, if you have reasonable density at the front and a hairline, you can still salvage a hairstyle.

[jjsrader]

Good work but 2 to 2.5 years after a transplant in terms of time is NOTHING. In fact I would venture to guess that 18 months to 30 months post transplant is when one looks the best!

 

Hairloss is progressive and we RARELY see patients that come back for another session 5-15 years later for another and then maybe another after that.

 

Again, good work but this is not a typical example of 'when the other hair falls out' after a transplant.

 

Nope - it isn't. That's why I am replying. Not deceptive but you are stretching it Doc!

 

; )

[Dr Blake Bloxham]

i’ve had the same question. i have a similar diffusing pattern...

 

this is a great result for only 6months post op. scar is hidden well. I am considering FUT but am nervous about the scar...

 

how did you reach 3200? did he or you suggest to wait to do the crown?

 

Hi PA,

 

Thank you for the kind words. His scar is good; 1-2 mm and easily hidden -- even with shorter hair. I have some pictures of it I can put up as well if people are interested. I definitely understand the hesitance with the difference in FUT vs FUE scarring, but FUT is still a much better approach for a big portion of patients and the scarring is typically very manageable in comparison to the huge potential benefits. I would not let the scarring alone completely deter you from researching FUT.

 

I typically suggest doing these full NW VI cases in two surgeries. In my opinion, The front/middle and then the middle/crown really deserve their own surgeries days. There are always those cases where you can knock it all out in one go -- and I've done it many times; but most people really need two to do everything from front to back. And that's how I like approaching a big case like this: do two big strips, knock it all out, then you can do FUE for any small touch-ups or if you want to put a little into the scar to wear the hair even shorter.

[Dr Blake Bloxham]

Just shows, if you have reasonable density at the front and a hairline, you can still salvage a hairstyle.

 

Nicely stated. I spend a lot of time explaining this exact same concept to consulting patients. People are often very self-conscious about the crown, but it is almost universally better to do the front/middle first. Having a strong frontal foundation provides you with a much more natural and cosmetically pleasing result, regardless of what happens beyond it.

 

Thanks for viewing and commenting.

[Dr Blake Bloxham]

Good work but 2 to 2.5 years after a transplant in terms of time is NOTHING. In fact I would venture to guess that 18 months to 30 months post transplant is when one looks the best!

 

Hairloss is progressive and we RARELY see patients that come back for another session 5-15 years later for another and then maybe another after that.

 

Again, good work but this is not a typical example of 'when the other hair falls out' after a transplant.

 

Nope - it isn't. That's why I am replying. Not deceptive but you are stretching it Doc!

 

; )

 

Thank you for the kind words. And very fair points all around. A patient 5+ years out would be a better example. However, I do believe he has absolutely lost a significant amount of native hair since the original transplant. An examination of his scalp revealed that the front is pretty much completely transplants at this point, and the crown -- where no grafts had been transplanted -- is much more bare compared to before.

 

But the points you bring up are very important and it's really why I made the thread instead of just posting this as a "before and after" result:

 

The hair loss is progressive; transplants must be designed and executed with the "long-term" in mind; and transplants can stand alone when the progression continues -- as long as they were thought out and performed properly.

 

Thanks for viewing and commenting. Good commentary and I really hope others get the chance to read it.

[hairlossPA]

Hi PA,

 

Thank you for the kind words. His scar is good; 1-2 mm and easily hidden -- even with shorter hair. I have some pictures of it I can put up as well if people are interested. I definitely understand the hesitance with the difference in FUT vs FUE scarring, but FUT is still a much better approach for a big portion of patients and the scarring is typically very manageable in comparison to the huge potential benefits. I would not let the scarring alone completely deter you from researching FUT.

 

I typically suggest doing these full NW VI cases in two surgeries. In my opinion, The front/middle and then the middle/crown really deserve their own surgeries days. There are always those cases where you can knock it all out in one go -- and I've done it many times; but most people really need two to do everything from front to back. And that's how I like approaching a big case like this: do two big strips, knock it all out, then you can do FUE for any small touch-ups or if you want to put a little into the scar to wear the hair even shorter.

 

 

I'd be interested in seeing more pics! And I like that strategy.

 

Thanks for the reply

[Dr Blake Bloxham]

I'd be interested in seeing more pics! And I like that strategy.

 

Thanks for the reply

 

It tends to work out very well for patients. You can really get solid coverage, a good scar, and the ability to then do FUE for any little improvements they patient may desire over the years.

 

Here is a picture of the scar. As I said above, it's about 1-2mm. I would consider this my average scar. I tried to blow it up big so you can really get a feel for what I'm referring to here.

 

This is the little "PSA" I give all FUT patients about the scar during the consultation:

 

Around 95% of patients fall within what I consider the "normal healer" category. Within this category, the scar will typically heal somewhere between a "pencil line" if you're a perfect healer (harder, thicker skin -- typically with less glide too) to a "marker line" of around 3mm if you're a bit of a natural "stretcher" (more rubbery skin, more scalp glide). Anything within this realm can be easily covered with any reasonable length of hair and most can go as low as a number 3 or 4 on the buzzer before it's noticeable.

 

This patient fell right in this category and as you can see, it is not affecting this ability to have a clean, cropped hair style in the donor region. And now he has another great strip left to do the back.

 

[forgotpassword]

Excellent work Doctor! Work looks fantastic. Both you and the patient should be thrilled

[alex84]

Great job and excellent understanding of HL (planing). As you said it is visible that he lost plenty of his native hair in his frontal patch but because of smart graft placement his looks are still intact...if i could have that kind of hair my whole life i would sign it now. Also, great job on not lowering his hair line, because, let's be honest, every HL patient would havehair growing out of his eyes, but that is just not realistic.

 

Many doctors show of with HT on pattern loss patients, and it does take a good doctor to fill completely bald areas, but in my opinion it takes an excellent doctor to perform a good operation on diffuse HL patient.

You can't simply make a pattern and plant hundeds of HF in straight line with same spacing between, you need to change your line with every HF you plant, working around native hair without damaging it and understanding which hair is kind of weaker or dieing...

 

It was not easy for me to find a doctor with many good results or even any results on diffuse patients.

 

I got some idea that the doctor who can operate on a patient without cutting his hair is a doctor that can do great results on diffuse HL HT. Does that make any sense to you?

[Markee]

Interesting My hair loss is very similar I just did a consult with ASMED and Dr Erdogan sent me back one of my pictures along with an email saying

 

After analyzing your photos Dr. Koray Erdoğan found that you have high percentile of miniaturized hair. The surgery at this stage can cause shock loss.

Therefore Dr. Koray Erdogan recommends Finasteride to give strength to your hair and increase density.