Month: January 2023

I know many doctors who are in the hair restoration field and do not have hair transplants or SMP and seem to be happy with their balding patterns. I have come to know them and they tell me (1) They are married and they and their wives don’t care, (2) the balding look is good for them and they like to keep their hair very short, (3) when they entered the field, the quality of the work in the 1980s and early 1990s didn’t meet their sense of quality that they would require.

I find the last comment concerning for those doctors who told me this, that they would do a surgery on their patients that was not good enough for them. What does that tell you about their moral compass?

Many men look good with a bald look. Jeff Bezos, for example, looks great with his balding and his hair cut short. Actors like Gene Hackman who has one of the best balding patterns to fix, has established a character for his balding pattern that brings on many roles in many movies. He is just one example of men who are satisfied with their hair loss fate (I never spoke to him so I am just assuming that he doesn’t care about his hair).

Has anyone tried being bald? from tressless

Your age has a lot to do with the drug decision. IF you are over 35, drugs are less important to hold on to your existing hair with a hair transplant. If you are 26, the existing hair is under threat of loss if your pattern is more advanced and you have not lost the hair that you are going to lose yet. These younger people do better on finasteride with a hair transplant because it holds on to the existing hair and prevents shock loss, which is a side effect common in men in their 20s who get a hair transplant.

We need to talk about good medical practices. Many surgeons believe that FUE works well provided that in a person with an medium hair thickness and an average donor density, has no more than 3500 FUE grafts removed to avoide a see-through donor area. 3500 grafts for such a person will cover Class 3, 3a, 4a, 5a patterns of balding relatively easily. Once you get into class 4, 5, 6 and 7 patterns, then an FUT may be a better answer either as a sole harvesting technique or combined with FUE. As the hair thickness gets finer (less and less hair bulk/mass), the maximum number of FUE grafts drops because by maintaining the same harvesting number in a person with fine hair, the see-through donor area may become a problem. With coarser hair (more hair bulk/mass) and an average donor density, more FUE grafts can be safely harvested. As the original donor density drops, the see-through donor area risk rises so FUT might be a better choice as a see-through donor area is a real risk for low density donor areas in many men. High original donor densities with medium-coarse or coarser hair are good candidates for FUE in the more advanced Norwood Patterns. If you combined higher than normal donor density with a coarser hair, this person can easily have most of his head transplanted with FUE alone. I have never seen an FUE result in a Class 7 patient with fine hair or one with significantly reduced original donor density and not have a depleted donor area (see-through donor area). I believe that there is a role today for surgeons to be skilled in both FUE and FUT and based upon the above factors and the surgeons preferences, the right harvesting method for the right reasons will be selected.

The doctor should discuss a plan when he/she intends to harvest hair outside of the donor area, as shown in this picture. A procedure with 4500 grafts and the harvesting FUE patterns shown demonstrate the problem. If his balding pattern increases, many transplanted hairs will fall out because many hairs/grafts were taken outside the safe donor area. FYI: The safe donor area is a 2 1/2 – 3-inch high area from the base of the skull around the side of the head above the ears to the temple peaks.

This is another patient who had his donor area over-harvested with a see-through look that he did not expect. He was never informed that this could happen. He wants something done about it and I recommended Scalp Micropigmentation for him (see: https://scalpmicropigmentation.com/scar-covering/#!) which should easily handle the appearance of the see-through donor area. His doctor should have told him that this could happen.

This is another Turkey patient who was over-harvested. The amount of hair taken from the donor area exceeded what the donor density would support, a common problem when FUE grafts are pushed higher and higher. To make matters worse, the non-permanent zone was harvested as well, so many of the grafts that were harvested are not permanent and will eventually fall out if they grow at all. The only solution, a good one for the donor area scarring, is Scalp Micropigmentation, but it will not address the non-permanent hair that was transplanted.