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Hairlines: Not a "One Size Fits All" | Dr. Bloxham | 2,400 Grafts | Feller & Bloxham

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I have heard them described as "snowflakes;" I have heard them described as individualized "works" like paintings; regardless of how they are described, one thing is for certain: hairlines are not a "one size fits all" type of situation. All patients are different. Things like hair characteristics, facial structure/head shape, level of loss, and projected future loss all come into play when designing a hairline. Some situations call for a lighter, more broken-up and irregular "transition" hairline; in other situations, patients may benefit more from a stronger, denser, more symmetric hairline. No two hairline should be alike and a doctor should customize the design for each particular patient. And remember, just because a hairline looks good on another patient does not mean it is the right one for you. 

Today's case is an example of a specific hairline created for a specific patient. The patient is a male with darker, coarser hair, and seemingly more limited and stable loss for his age. He requested a strong, dense frontal hairline (he was happy with the corners), and I thought this made sense for him. In his situation, a more striking, strong, less irregular hairline made sense for him. 

I performed a hairline rebuild, a dense frontal band pack, and also a little bit of fill behind it using 2,400 grafts removed via the FUT technique. He returned at 6 and 12 months, and was very pleased with the direction we took for the hairline. 

Here are a few "teaser" shots of his 12 month results from the video: 

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And here is his 12 month comb-through video, which features much more detail and also a look at his FUT incision line at 12 months: 

And here is his 6 month video for comparison: 

So I hope this helps explain that hairlines are not a "one size fits all" approach, and you must visit a clinic which will spend time creating a specific hairline for you and you alone. Make sure to see lots of examples of different hairlines from any clinics you are considering, and speak with the doctor about their hairline philosophy. 

Look forward to the discussion, 

Dr. Blake Bloxham 

Feller & Bloxham Medical, PC 

http://www.fellermedical.com


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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Great work Dr. Bloxham!


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

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Great job dr bloxham. Is this patient considered an early grower? It looks like he achieved most of his density already at 6 months post op.

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What an incredible result. Someone was on this forum the other day, talking about how terrible FUT scars are. 

I'd love to show them this result, what a great procedure. 

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2 minutes ago, Greg_Swanson said:

What an incredible result. Someone was on this forum the other day, talking about how terrible FUT scars are. 

I'd love to show them this result, what a great procedure. 

I firmly believe FUT is the better method, it's just that there are so few docs in the HT world that can do this at this level on a consistent basis.This result, amongst others, should at least give pause to the FUE advocates about what exactly is achievable in the hands of a capable surgeon. As I said previously ... 'what strip scar'

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So, I had a procedure w/Dr. Feller in 2004 (my 1st large strip procedure of 2,250 grafts).  Any really good doctor should leave a very small FUT scar on a virgin or near virgin scalp.

It's only 2.5K grafts.  It's when you are going for the 5K or 7.5K total of grafts where it gets tricky ('cause of less laxity).

Regardless, very nice 1st surgery.  Patient has very good hair characteristics and great donor and fairly limited hair loss overall compared to NW5 or NW6.

Still, if this was to be his 1st and last transplant he should have gone FUE because then he can shave down much lower if he desires in the back.

I don't know his hairloss history or if he is going to do his crown or vertex though?

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2 hours ago, jjsrader said:

Any really good doctor should leave a very small FUT scar on a virgin or near virgin scalp.

 

Sorry, but this is simply to true. Even the best clinics have wider scars is some patients. Not everyones heals the same.

By the way: Great result and good point abput the hairlines.

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While I do agree that everyone is different, there are certain rules that apply to everyone.  Da Vinci was and brilliant man that contributed so much to the world.  The rule of thirds seems to insignificant, but it truly applies to everyone. Research it and try it, you may love the geometry behind it. Look up Leonardo da Vinci's rule of thirds, facial dimensions.

 

 

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5 hours ago, Gasthoerer said:

Sorry, but this is simply to true. Even the best clinics have wider scars is some patients. Not everyones heals the same.

By the way: Great result and good point abput the hairlines.

my understanding its that is not necessarily about healing, (as while strip scars are prone to stretching they do not actually shrink), but it is very true that different patients might be suited better to different approaches, In this case the FUT scar is amazingly well done, and the patient seemed an ideal candidate.

Although I would be interested (if Dr Bloxham has the time) in what determines a patient for which method?

Given it would only take about 300 grafts FUE to conceal the scar the patient always has the option to shave his hair shorter in the future anyway

 

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Thanks to all for the kind words. I am going to jump into the individual questions below. 


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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On 7/15/2019 at 11:32 PM, jj51702 said:

Great job dr bloxham. Is this patient considered an early grower? It looks like he achieved most of his density already at 6 months post op.

Hi jj, 

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. 

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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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On 7/16/2019 at 1:51 AM, Greg_Swanson said:

What an incredible result. Someone was on this forum the other day, talking about how terrible FUT scars are. 

I'd love to show them this result, what a great procedure. 

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. 


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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On 7/16/2019 at 4:57 AM, jjsrader said:

So, I had a procedure w/Dr. Feller in 2004 (my 1st large strip procedure of 2,250 grafts).  Any really good doctor should leave a very small FUT scar on a virgin or near virgin scalp.

It's only 2.5K grafts.  It's when you are going for the 5K or 7.5K total of grafts where it gets tricky ('cause of less laxity).

Regardless, very nice 1st surgery.  Patient has very good hair characteristics and great donor and fairly limited hair loss overall compared to NW5 or NW6.

Still, if this was to be his 1st and last transplant he should have gone FUE because then he can shave down much lower if he desires in the back.

I don't know his hairloss history or if he is going to do his crown or vertex though?

Hi jj, 

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. 


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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On 7/16/2019 at 7:23 AM, Gasthoerer said:

 

By the way: Great result and good point abput the hairlines.

Hi Gasthoerer, 

Thank you for the kind words. Glad the point about hairlines makes sense and is resonating with the community. 


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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On 7/16/2019 at 1:01 PM, transplantedphil said:

Although I would be interested (if Dr Bloxham has the time) in what determines a patient for which method?

Given it would only take about 300 grafts FUE to conceal the scar the patient always has the option to shave his hair shorter in the future anyway

 

Hi Phil, 

I always try to make the time -- though I will admit that I am falling behind on answering private messages, and I do apologize to anyone waiting for a reply! 

I truly like being a clinic that can offer patients both FUT and FUE. And not just in name only. While I think I have made my reputation with FUT and I am a very vocal proponent of it, I perform FUE every single week. We have an OR specifically for FUE; we have a staff cross-trained specifically for FUE (who have been assisting in the FUE process since 2002); and I feel very blessed to have learned manual FUE from my partner, Dr. Feller, who was one of the first three to perform the procedure in North America (the others being Dr. C in Atlanta and Dr. Jones in Canada) and someone who has multiple patients and publications in early FUE development. So, long story short, I think we do have the ability to recommend and offer patients both. 

I do not think there is a strict, binary decision as to when a patient is a candidate for FUT versus FUE. From a strict mathematical and scientific standpoint, I absolutely do believe there are instances where one should be utilized to the exclusion of another. And in these situations, it will absolutely be my recommendation to use one versus the other. In the real world, however, patients have different long-term goals, different lifestyles, and sometimes what may be the best technique on paper is not the best one in practice. So I do my best to come up with plans and approaches using both methods when patients request it or ask for one above the other. When they simply ask for my opinion, I try to always be objective as described above. 

Here are some generalizations about when I think you should do one above the other or who is a good candidate for FUT over FUE

Start with FUT

-Young patients with uncertain futures and all but guaranteed progression 

-People with advanced hair loss 

-People with limited donor (as long as the limitation is not the density; in patients with very low densities, I actually usually recommend conservative FUE

-Patients who need critical hairline work and cannot risk yield (print models, film actors, etc) 

- Patients who are likely to want to do more surgeries up the road 

-Patients with hair types that I do not believe will do well with FUE: very fine, light hair (fragile follicles), certain ethnic groups, etc 

-Patients with a lot of laxity or very "stretchy" or "mushy" skin -- which I believe will either deform or distort and just not let us accurately score the grafts 

-Patients who want to do the most possible in a single sitting

Start with FUE

-Patients with obviously stable loss only requiring a small amount 

-Patients who must keep the sides very short (certain military guys; certain actors with crazy film/studio contracts; etc); however, you cannot undersell the scarring to these individuals because it is not a scar-less procedure 

-Patients with very tight scalps or very low density where the "scarring to graft number" ratio is just not good enough with FUT (IE: taking a 30+cm strip and only getting out 1,200 grafts because the scalp is so tight and the strip was thin or the density was so low) 

- Patients happy with their prior strip scar who just need a little more work 

-Patients with prior strips who cannot undergo any more 

-Patients requiring less than 1,500 grafts (which I now still split up into two days as I like doing everything manual and staying very involved with FUE procedures) 

- Patients who are not 100% ready to commit to transplants but want to "test the waters" a bit first (again, we need to be careful not to oversell anything to these patients) 

 

Surely I am forgetting a few here, and this list is not all inclusive; however, good generalizations. In patients who are not concerned with the scar or want to get as much as possible (the majority of patients) or just want to go with what I recommend, FUT is typically a great starting point. I also offer a "modified" approach to FUT where I break up the strip into smaller 2cm pieces, which are somewhat staggered and broken up. It allows patients to go a little shorter on the sides and the scarring, if it is seen, looks more like trauma than a telltale surgical scar, so it gives people a little more wiggle room up the road. I have probably shared a few of these cases on here before, and I will share more in the future. 

 

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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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So many great and detailed answers, Dr B. Thank you for taking the time! All your results as of late look fabulous too.

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1 hour ago, BjornBorg said:

So many great and detailed answers, Dr B. Thank you for taking the time! All your results as of late look fabulous too.

Thank you for the kind words. Glad they were helpful. 


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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