Home | News | Find a Doctor | Ask a Question | Free

Dr. Cole - Class VI Scalp/BHT Combo - Results Pics


#1

Dr. Cole - Class VI Scalp/BHT Combo

This patient started with NW 6 class of hair loss. Dr. Cole transplanted over 12,500 grafts over three sessions. The body hair was mainly placed in the vertex of the crown, but also helped to thicken the frontal third. The combination of FIT scalp harvesting and Dr. Cole’s patented FIT farming technique helps to produce a donor result that allows the patient to wear his hair very short in the back, even after more than 5800 grafts are harvested. A full, thick head of hair is an unrealistic expectation for this patient as he had advanced hair loss and minimal scalp donor characteristics. However, we were able to offer him a medium to thin coverage through out with a natural appearance.

The totals are:
5843 scalp hair grafts
3559 BHT grafts
3077 FIT farming grafts

Techniques used:
FIT – Dr. Cole’s version of FUE. Individual follicular units are removed from the back of the scalp and transplanted to the area of hair loss.
BHT – FIT technique, but using body hair as the donor source. While BHT is a newer procedure with many factors still unknown, it is a useful tool in hair transplant to increase coverage and help to overcome scalp donor availability restrictions.
FIT/BHT Combo – The use of both FIT and BHT techniques to create more coverage than can be achieved with one technique alone. Typical Class VI baldness involves the loss of 18-20,000 follicular units. The available scalp donor typically only offers about 8,000 follicular units for harvesting. BHT can be used to extend the donor resources and cover larger areas of loss than ever before. The more predictable and better coverage of scalp hair is used for important areas such as the hairline and frontal third.
FIT Farming – Replacing a harvested scalp graft with a body hair graft into the donor. FIT farming is not required for normal FIT procedures; it is an option for those who want to push the numbers higher yet decrease the chance of over-harvesting. This patient had about 50% of his extracted scalp hair grafts replaced with body hair grafts via the FIT farming method. The body hair graft in the donor maintains circulation and pigmentation in the area of extraction and also provides some coverage.

Here are this patient’s most recent pictures. It has only been 6 months since his last procedure, so he still has some growing to do! He can look forward to more scalp hair growing in and maturing, and later his body hair will grow in. We will keep you updated as he sends us more pictures.

This patient’s evolution has been pretty well documented on our site, so for more pictures, discussion, history, and information, check out these links:

Additional body hair results from Dr. Cole and IHTI:


#2

Hi Jessica,

i am not sure of the storry here. There are three threads all of the same guy, I believe.? He had 6000 scalp FIT and 700 BHT on the crown. He also had an undetermined number of BHT into the donor area, is that correct.

This is a helpful case and one of the largest scalp FUE we have seen. I would ask that you comment as an experienced Tech having seen many patients. Is this the quality of result you would epect in terms of coverage with a strip?

1: When I look at 5000 or 6000 H&W they tend to look a lot fuller. Is this due to photos, quality of hair or FUE?

2: Did he have poor quality donor / poor density?

3: What would you have expected of the donor without FIT farming?

4: There have been clear alogations about the size of your punches (1mm vs 0.75). Would you state clearly if you use .75mm as a regularly or not. Would this make a difference to the need to FIT farm (I suspect not but a clear statement would be helpful).

5: Finally, what area do you think was covered.

Thanks Jessica!


#3

Thank you for the nice questions marco. :slight_smile:
I separated the questions to make it easier to read.


#4

“There are three threads all of the same guy, I believe.?” - marco

I am confused. Which three threads? There are several threads on forhair.com that document results along the way for this patient. Those links are posted below his pictures. On hairsite, he is on this thread and his donor is in another thread: http://www.hairsite.com/hair-loss/forum_entry.php?id=9977&page=0&category=2&order=time I separated the donor into a separate thread to facilitate discussion.


#5

“He had 6000 scalp FIT and 700 BHT on the crown. He also had an undetermined number of BHT into the donor area, is that correct.” - marco

The totals over the three procedures are: 5843 scalp hair grafts, 3559 BHT grafts, and 3077 FIT farming grafts. The first procedure was where 700 BHT grafts were dispersed throughout the frontal third and middle; 165 of those grafts were placed into an isolated area of the crown as a test before continuing with more BHT. I think that is where the 700 number is coming from.


#6

“This is a helpful case and one of the largest scalp FUE we have seen. I would ask that you comment as an experienced Tech having seen many patients. Is this the quality of result you would epect in terms of coverage with a strip?” - marco

The quality of coverage between Dr. Cole’s FUE and strip are pretty much the same. The harvesting method matters less than the hair characteristics in terms of coverage to the recipient. The main differences are the time it takes to perform the surgery (strip is much faster), and the effects on the donor.


#7

“When I look at 5000 or 6000 H&W they tend to look a lot fuller. Is this due to photos, quality of hair or FUE?” - marco

Every patient is different. You can’t compare 5000 grafts on one person to 5000 grafts on another person. There are just too many factors involved. This patient was not a good candidate for strip because he had an average to thin donor area to begin with and multiple strip sessions would be needed to harvest this many scalp grafts. The patient did not want the chance of strip scarring. If we had transplanted 6000 grafts via strip instead of FIT on this patient, there would be little or no difference to the recipient, but there would have been a considerable difference in the donor area.

The pictures are taken by the patient, so that adds variances in lighting, position, the way the hair is combed, etc. If he comes into the clinic again, we can take some better comparison shots for you. And this patient is pretty good about sending us updates, so I will share those with you too.

This is not to say that FUE is better than strip. It was just a better choice for this patient. H&W has some very good results, by the way. Jotronic rocks.


#8

“Did he have poor quality donor / poor density?” - marco

This patient’s donor hair has a slight wave, medium caliber, and average to low density. Considering that he had already lost about 20,000 follicular units up top, there is just not enough scalp donor to cover all that area, even if the characteristics had been better.


#9

“What would you have expected of the donor without FIT farming?” - marco

I suspect Dr. Cole would not have harvested this number without FIT farming. Dr. Cole says: “It is important to recognize that many people want to limit the amount of scalp hair removed. FIT Farming offers these individuals additional alternatives and solutions to their donor dilemmas…One of the goals with FIT Farming is to increase the potential hair we can move from the donor area to the scalp and still maintain a pristine-like donor area.” Keep in mind that FIT farming is not necessary for most FIT procedures.


#10

“Finally, what area do you think was covered.” - marco

A full, thick head of hair is an unrealistic expectation for this and many other patients with advanced hair loss. The goal here was light to medium coverage, and keep in mind that it is still growing. The hair line, frontal third, middle, and perimeter of the crown have been reconstructed and covered. The crown is typically saved for the last step. The frontal third and hair line are usually of higher priority as it frames the face and there are limitations to what can be restored based on the amount of available donor. We will see how his crown develops in the coming months. He might need one more pass of BHT to really thicken things up.


#11

i dont know if its a matter of growth or the other clinics use special camera angles and such but its dissapointing.


#12

» i dont know if its a matter of growth or the
» other clinics use special camera angles and such but its dissapointing.

I think that in this industry there is a lot of pressure on clinics to produce only pictures of results that are absolutely amazing and people who went from being a cue ball to having hair like Elvis.

The consequece of this trend is that some patients will have unrealistic expectations. I think it is important to show how far patients have to go in order to treat Class VI loss with less than optimal hair characteristics, but still be able to have a pristine donor area and coverage throughout - not thick, Elvis coverage, just coverage.

On the other hand, some patients are much luckier in terms of donor availability and genetics. So, it is easier to provide them with a thick head of hair. See Wassup’s results for example: http://www.hairsite.com/hair-loss/forum_entry.php?id=7327


#13

» Thank you for the nice questions marco. :slight_smile:
» I separated the questions to make it easier to read.

Thank you for the answers Jessica. You didn’t answer the area covered ie. Cm2 but I may not have been clear.

I have to say that considering you explain that he had over 10000 FUE to his recipient area and 3000 FIT farming totaling 13000 in total and at least $60,000 or more it does make me wonder if we are prepared to sell our souls for some (not a good coverage of) hair. As Greeks said, it does seem thinner than expected for 6000ish scalp FUE and 3000ish BHT. That is not a reflection on Dr. Cole necessarily and maybe it reflect the truth of HT. I don’t know.

As hairtec said I don’t feel that you gave an answer about the punch size. what does comparable to .75mm mean. On the face of it, it sounds deceptive.

If he had lost 20000 follicles then the 10,000 replaced are argued by Dr. Cole to give the appearance of a full head of hair. Is this not the case or did some of the grafts not grow?


#14

“If he had lost 20000 follicles then the 10,000 replaced are argued by Dr. Cole to give the appearance of a full head of hair. Is this not the case or did some of the grafts not grow?” – marco

The grafts placed are not all equal. BHT grafts provide much less coverage than scalp grafts, but they do help. The grafts placed also cannot restore the patient back to his original head of hair before he began his loss. This is an unrealistic expectation. It can, however, restore thin coverage.


#15

“I have to say that considering you explain that he had over 10000 FUE to his recipient area and 3000 FIT farming totaling 13000 in total and at least $60,000 or more it does make me wonder if we are prepared to sell our souls for some (no a good coverage of) hair. As Greeks said, it does seem thinner than expected for 6000ish scalp FUE and 3000ish BHT. That is not a reflection on Dr. Cole necessarily and maybe it reflect the truth of HT. I don’t know.”

This is a good point. This patient was never destined for full, thick coverage. Even thin coverage is expensive and requires several session. This is the honest truth for many patients with extensive hair loss - ie. Class VI-ish.

These observations of limitations - both financial and for donor availability - can also be applied to those with extensive scarring and poor results to deal with.


#16

» “If he had lost 20000 follicles then the 10,000 replaced are argued by Dr.
» Cole to give the appearance of a full head of hair. Is this not the case
» or did some of the grafts not grow?” – marco
»
» The grafts placed are not all equal. BHT grafts provide much less
» coverage than scalp grafts, but they do help. The grafts placed also
» cannot restore the patient back to his original head of hair before he
» began his loss. This is an unrealistic expectation. It can, however,
» restore thin coverage.

Thanks Jessica for all your replies. Much appreciated!


#17

“Thank you for the answers Jessica. You didn’t answer the area covered ie. Cm2 but I may not have been clear.” - marco

I will have to get back to you on the exact square centimeters. I need to look it up.