Good to hear from you. Thank you for the kind words.
The patient's hair loss is pretty stable; I actually saw him a few times for consultation (good time gaps between) and I did not note any changes. So I do not believe there will be aggressive thinning in the back, and his bridge looks great. However, he does have a small, isolated spot in the crown and has expressed interest in getting this filled. So I do not believe this will be his last transplant.
However, you never can be too certain with androgenic alopecia. I have seen "stable" patients who look great suddenly thin and need every graft they can get, and I have seen seemly "unstable" patients go years before changing at all. It is very unpredictable, so it always helps to hedge our bets a bit and leave the absolute most available donor for surgeries up the road. If he only needed 1,500 grafts or so, I would have felt comfortable starting with FUE because this level of harvesting (when spread appropriately) typically allows us to stay within the safe donor and does not impede the future too much. For the amount we were doing, however, I felt that FUT was the best bet at not only delivering the results, but also not putting us in a potentially bad situation if he did start thinning more up the road and we wanted to do more surgery.
Thanks, Greg. While healing is physiology-dependent and does absolutely vary between patients, I think some of the "fears" of FUT scars we see online are a bit overblown. With good technique and ethical harvests, the VAST majority of patients heal up with a fine line in the back that is easily hidden. I always tell patients that it will be anywhere from a "pencil line" that is hard to even appreciate if you are a perfect healer, to a "marker line" (1-2 mm of "stretch") if you are a bit of a "stretcher"; anything within this range is perfectly normal and can be easily concealed even with a shorter, cropped hair cut (typically a number 3 on the buzzer). And the trade-off for the scar is fantastic; thousands of the best quality grafts, minimal damage and maximum preservation of the donor, and the ability to do more up the road.
While FUT is not for everyone and I totally get that, I think many patients are best served by doing an FUT first and then switching to FUE down the road and I do encourage everyone to tune out some of the noise (which I myself have been guilty of making from time to time!) and really objectively research both techniques from the beginning.
Thank you for commenting.
Yes, I would say this patient is on the earlier side. As you noted, his 6 month images and video showed a result that was closer to what I would expect around 9-10 months. Still not the full thickness and naturalness you achieve between the 12-18 month mark, but "ahead of the curve" for sure.
Sometimes I hesitate to put up "early grower" cases because I feel like it propagates the stereotype that everyone should look great at 6 months or that you will not have a good result if it does not already look good at 6 months. This is not true. Remember that for the average patient, 6 months is the half way mark. If you do not look as matured as the "early growers" at 6 months, it is no reason to panic. We see a bit of bias with people who put up results at 6 month because if they are good, people will want to put them up. But please do not get discouraged if you do not look like this at 6 months. Everyone matures a little differently and "all's well that ends well" if you end up looking just as good at 12-18 months.