How to use BHT

[Curious25]

There has been a growing trend recently, of purposely over harvesting scalp donor, to maximise the scalp recipient area to its fullest aesthetic potential, and then later utilising BHT grafts to replenish the donor area. 

I must admit, I love the idea of this practice for a number of reasons;

-Scalp donor is always the optimum donor source for the recipient area, both for survival and aesthetic purposes
-Higher HGI in scalp donor 
-Longer anagen phase in scalp donor 
-Due to the positioning of the donor region on the head - greater illusions of density can be achieved, due to hair growth direction and the angles of light reflection, therefore reducing the need for such quality grafts to make an aesthetic difference - as opposed to the standard balding areas on the top of the head, where everything is alot more obvious and on display

My questions to the community, and hopefully to any surgeons who may be reading are:

How feasible really is this practice? Are there no implications implanting BHT into a donor area covered in scar tissue from prior FUT/FUE procedures? 
On average, how many extra scalp grafts would this be likely to create for a patient to be able to utilise? 
How long would one have to wait in between procedures of harvesting grafts from the donor - to the replenishing the donor with BHT? 
Is this technique just in its infancy, or has the concept and trials been happening for a long time now ? 

Thankyou,



 

[Melvin- Admin]

It’s something that interests me, but I haven’t seen it done. Some clinics call this donor-recharging.  I think most clinics wouldn’t purposefully deplete the donor, as it may reflect badly on them. Now, with the patients consent, perhaps, but if the patient ends up upset, it’s still on them, since they know better.

[Curious25]

I completely agree Melvin - I think this could have potential for being a new development in hair restoration, and possibly in the next 5 years with a little refinement, this will be more or less a universally approved method, that will help enhance hair transplants that one bit further, and take them to another level once again. 

Everybody gets hooked on hair cloning, and stem cell therapy etc - when in reality, if you look at how far HT's have developed in the last 20 years, tbh - even the last 10 years, it goes to show that 'the cure' may already be here for many hair loss sufferers, its just a case of the techniques and methodologies becoming better and better. 

[Al - Moderator]

I think it's much better to incorporate some body hair grafts into the original recipient area in the first place mixed in with scalp grafts. With your way you are transplanting twice. Once to remove it from the donor and again to replace the donor. Body hair grows just fine on the top of your head. Mine grows longer and faster than the native scalp hair. It will grow longer than 3 inches on me with no problem.

 

[Britanium]

36 minutes ago, BeHappy said:

I think it's much better to incorporate some body hair grafts into the original recipient area in the first place mixed in with scalp grafts. With your way you are transplanting twice. Once to remove it from the donor and again to replace the donor. Body hair grows just fine on the top of your head. Mine grows longer and faster than the native scalp hair. It will grow longer than 3 inches on me with no problem.

 

Totally agree. Why go through more surgeries than you need too? If you have a long term plan in place its not needed. 
 

[Melvin- Admin]

54 minutes ago, BeHappy said:

I think it's much better to incorporate some body hair grafts into the original recipient area in the first place mixed in with scalp grafts. With your way you are transplanting twice. Once to remove it from the donor and again to replace the donor. Body hair grows just fine on the top of your head. Mine grows longer and faster than the native scalp hair. It will grow longer than 3 inches on me with no problem.

 

I’ve always been curious about that, I have straight hair, but my beard is somewhat curly. Have you noticed the BHT mimic scalp hair in that respect?

[Gabreille Nelson Mukhia]

Planting beard and body hair into the donor areas for their reconstruction should be limited to patients who require to get it done for the sake of their donor aesthetics. For people who have a healthy donor/virgin and are planning for a procedure should avoid it. The body hair can easily be used as filler on the mid scalp. The available donor grafts should be optimised in their use by intelligent placement in the recipient area rather than planting more than required. 40 hair per sqcm gives a great illusion of density when 100% grafts survive. It is all about the intelligent placement of the multifollicular grafts in different areas of the scalp to give a full and dense look. 

[Curious25]

22 hours ago, BeHappy said:

I think it's much better to incorporate some body hair grafts into the original recipient area in the first place mixed in with scalp grafts. With your way you are transplanting twice. Once to remove it from the donor and again to replace the donor. Body hair grows just fine on the top of your head. Mine grows longer and faster than the native scalp hair. It will grow longer than 3 inches on me with no problem.

 

It's not 'my way', as I have never had this technique performed, or developed the methodology for mainstream use of it either - I am simply an intrigued observer, of a new concept that seems to be gaining some ground and producing some interesting results. 

I'm glad to hear you have had success with BHT scalps planted into your recipient - I have seen lots of results online where they have looked fantastic. 

My curiosity stemmed from the limitations that BHT grafts have (anagen phase, HGI tends to be 1FU, different texture to native scalp etc) - therefore wanted to ponder whether this was going to be a viable method to really enhance HT procedures, and allow for further donor depletion. 

 

 

[Curious25]

bump

[Curious25]

After seeing the great results @mustang has been experiencing at only 4 months on his donor replenishing journey - I would be really interested to hear from some of the communities surgeons on their thoughts and opinions on such a strategy. 
 

To me it’s a no brainer. If the accepted consensus is that BHT is used as ‘filler’ in the recipient zone (as stated by a clinic rep on this thread), why would it not be more advantageous to ‘fill’ the donor area - an area that is less demanding in regards to visual aesthetics, and then perfect the recipient, with like for like scalp multi hair grafts that have longer anagen phases ? 

[Al - Moderator]

Let's say you later get more hair loss and want to have another procedure to fill it. You have to either use (1) body hair or (2) scalp donor hair which is now actually a lot of body hair.  So either way if you ever get another procedure you will be using some body hair. Why not just use the body hair as normal donor from the beginning rather than continue moving it all around wasting time and money as well as sacrificing some grafts due to a percentage not growing after each move.  If you have a 90% survival rate, 100 grafts will give you 90 growing grafts. If you later extract those 90 grafts from where they are now growing to place them somewhere else you're down to 81 growing grafts. Why do that? And body hair grafts may have less than a 90% survival rate.

 

 

[Curious25]

48 minutes ago, BeHappy said:

Let's say you later get more hair loss and want to have another procedure to fill it. You have to either use (1) body hair or (2) scalp donor hair which is now actually a lot of body hair.  So either way if you ever get another procedure you will be using some body hair. Why not just use the body hair as normal donor from the beginning rather than continue moving it all around wasting time and money as well as sacrificing some grafts due to a percentage not growing after each move.  If you have a 90% survival rate, 100 grafts will give you 90 growing grafts. If you later extract those 90 grafts from where they are now growing to place them somewhere else you're down to 81 growing grafts. Why do that? And body hair grafts may have less than a 90% survival rate.

 

 

a) Scalp hair is like for like - therefore providing better coverage on the recipient. 

b) Under magnification, I assume it will be quite obvious for a skilled surgeon to determine which grafts are BHT and which are scalp (tend to be singles, tend to be thicker in calibre) therefore he will be able to continue to cherry pick native donor grafts for any further procedures

c) If the avg. donor provides 6000 -7000 grafts via FUE - donor recharging with BHT will allow the patient to have upto another 2000-3000 grafts extracted from his donor region, therefore 9000-10000 grown in grafts will provide sufficient coverage up top, to avoid having to undergo any further procedures. 

I believe this method will require smaller, and more frequent surgeries, therefore would potentially be a limiting for some patients who have time or cost concerns, however for many higher NW's - I believe it could be revolutionary in taking HT's to the next level in the 2020's. 

 

[Curious25]

Hi @sl

 

I thought I would bring up my question to you here as it is a more appropriate thread. 
 

Please could you explain BHR’s stance on the above strategy, and why in your opinion BHT is better utilised in the recipient as opposed to the donor ? 
 

Many Thanks 

 

[sl]

Thanks and no problem.

Our approach is to harvest carefully and as fully as possible the donor region with a small punch and good pattern and then tap into body hair for a further donor source. It can as said here be mixed with scalp hair and for the most part look pleasing with the right mix and positioning of the body hair, i.e not to hair line etc.

To exhaust a donor, let's say for argument 10,000 grafts taken, then you seek to improve the donor density by then placing beard/chest into it, you are in essence paying again for a surgery with it being done in two steps, take and replenish, rather than just take and place to recipient, but also placing into FUE scars is different to placing into a recipient hairless area.

A recipient area for large surgery is mostly bald, you have clear visibility and are cutting recipient sites close together for placing and giving the illusion you want. To place in a donor you have to then inject all again a "haired" area that has had a lot taken and the toll could also be some miniaturisation there, so you are numbing again the area and placing then according to the previous FUE harvesting and not a usual pattern for placing, so a lot of injections over the whole area to treat and then matching the angles etc of the donor that changes significantly from zone to zone as does the hair groupings. You are also placing into scar tissue that in itself can have vascular and other challenges.

Even if all this is done well, there is no guarantee it will look natural as colour, curl, coarseness etc all may be different, and in essence the recipient has had 10,000 grafts and you have in essence paid for a lot more due to the re-stocking.  If one has a donor that is depleted through poor surgery then SMP may be a better option and as said, if it happens by error and not by design.

So, it is expensive and no guarantee it will look any better or grow well and be better than a well planned and performed surgery that taps into both scalp and body hair. Some will combine FUT/FUE and then body hair and for me this is far better, more proven and cost effective than the other scenario

 

We have from experience more used FUE to then go into FUT Strip scars and as necessity due to the patient having severe restrictions put upon them by the scar, but less so to FUE patients who have had poor surgery and as said, probably now SMP is a good option.

 

Food for thought and by no means an exhaustive answer but aside from the sheer cost, it is not an approach we would go for.

 

 

 

 

Edited November 24, 2020 by sl

[Curious25]

Thankyou very much for your detailed answer - its great to have the interaction available on this platform, and hear different perspectives on this concept from different clinics/surgeons.

As you say - food for thought, and most probably a no one size fits all answer.