There has been a recent debate on fue donor site pictures and the honest way to show them.
Dr. Sangay posted sometime back on this topic.
Namely, take pictures in good light. Do not wet/ flood the field with liquid when taking the pictures etc.
Also, if you are talking donor site sizes, its better to include something for comparison sake in the picture. It can be a scale or a standardised hypodermic needle.
When possible have a video too.
To illustrate these points, I decided to post pictures of the HT we finished today.
I do not claim perfection. So, if the readers and other clinics have any suggestions on how further improvement can be made, please chip in.
Try and post pictures in different sizes. Some patients like to see the large pictures and examine them. Respect their choice.
These are medium and large size version of the same picture.
No flash used and, need I say that these are immediate post op pictures of fresh extraction sites where a 26 gauge needle (diameter 0.45mm)is juxtaposed for comparison.
The following picture is of 48 hrs after extraction. The area you see outlined in blue was where the extractions were performed 48 hrs (2 days) ago. The decrease in hair density of the donor area v/s the untouched area can be appreciated by looking outside the blue margins.
I do have one suggestion. Rather than using a hypodermic needle to show the scale, it would be more helpful to use the punch used to make the incisions. Placing a needle in the pic gave me the impression that it was used to make the incisions.
I am almost scarred to ask but … what diameter is the punch used to make the incisions.
» Really great and informative pictures!
»
» I do have one suggestion. Rather than using a hypodermic needle to show
» the scale, it would be more helpful to use the punch used to make the
» incisions. Placing a needle in the pic gave me the impression that it was
» used to make the incisions.
»
» I am almost scarred to ask but … what diameter is the punch used
» to make the incisions.
Marco, a punch is not used (V correct me if I’m wrong and hi by the way) for these. The BHT and FUE are extracted using the expanding needle concept.
What was the percentage of hair removed in the donor areas by FUE in this procedure (30%, etc)? Also, I’m strongly considering wearing my hair shorter and noticed you (and every other clinic) leave a wreath at top and front sides of hair at original density. Is the reasoning behind this so that hair that at a later date might bald not be transplanted? OR That hair can grow out longer and provide coverage?
It would seem that for a shorter hair cut, it would be better to keep the density closer to the same as it might look slightly odd being thicker just at the official wreath. I think I have seen this done a couple times at consumer’s request.
It would accomplish 2 things:
give additional donor source (albeit small number of grafts)
provide less of a contrast between balding areas and wreath demarcation.
» Marco, a punch is not used (V correct me if I’m wrong and hi by the way)
» for these. The BHT and FUE are extracted using the expanding needle
» concept.
»
»
Thanks checkin but I am using the term loosely. Dr. A explained that a hypodermic ie needle (with a beveled edge) does not remove tissue so I am using the word punch to mean anything that removes tissue.
» » Marco, a punch is not used (V correct me if I’m wrong and hi by the way)
» » for these. The BHT and FUE are extracted using the expanding needle
» » concept.
» »
» »
»
» Thanks checkin but I am using the term loosely. Dr. A explained that a
» hypodermic ie needle (with a beveled edge) does not remove tissue so I am
» using the word punch to mean anything that removes tissue.
Dear Marco,
True a single jab of a bevelled hypodermic needle is not going to remove any tissue.
The expanding needle concept makes use of multiple strokes of the needle around the hair follicular unit depending on its architecture.
The easiest way I can explain is that the needle is used to dissect around the hair follicle under magnified direct vision. Its not as simple as plunging a punch and pulling the graft out, but once you get trained, its not too difficult either.
It is more work. However, it ensures greater safety for the grafts.
Moreover, we have a wide variety of tools and techniques that are used to tackle different hair types. Its not the instrument as much as the expertise of the extractor that uses it that matters.
Also, hypodermic needles are something the remaining clinics and interested readers can easily identify/relate to in terms of diameter.
Regards,
Dr. A
I can’t visualise the expanding needle concept in my head without it seeming very complex as a method.
It is clearly highly unique and whatever I can imagine the results shown in the pic demonstrate that it is a technique that can produce exceptionaly clean results … in the right hands.
I am very curoius about your technique. And again, I apologize for the mis-haps recently, so going forward I am trying to ask questions for educational purposes by your clinic.
I liked what you said about having to dissect around the graft with a needle. Back in 2003 when I first had to take grafts out after being punched, we tried everything… small cut blades mounted on hemostat, pulling them straight out without dissection… Then one day I picked up a 20 gauge on a syringe… and proceeded to dissect around the graft carefully. This technique went on until development of different techniques occurred. Still it was post punched grafts. So I am curious to learn your technique in the manner you have stated.
A couple of questions sir.
The expanding needle concept. Is it a concept? Or is it implemented as reality? In other words… Do you use the expanding needle currently?
Do the needles depicted in your pictures show the expanding needle?
May I visit your clinic to see first hand in the coming months. I have a friend from India in New Delhi I would like to visit… as well as a patient from Dr. Roses office I could pay a visit too for follow-up purposes. India has been a country that I have since childhood wanted to visit.
Also, I’m strongly considering wearing my hair
» shorter and noticed you (and every other clinic) leave a wreath at top and
» front sides of hair at original density. Is the reasoning behind this so
» that hair that at a later date might bald not be transplanted? OR That
» hair can grow out longer and provide coverage?
»
» It would seem that for a shorter hair cut, it would be better to keep the
» density closer to the same as it might look slightly odd being thicker
» just at the official wreath. I think I have seen this done a couple times
» at consumer’s request.
»
» It would accomplish 2 things:
» 1) give additional donor source (albeit small number of grafts)
» 2) provide less of a contrast between balding areas and wreath
» demarcation.
Dear Checkingin,
I understand what you are talking about.
The idea being to depixelize the denser areas and repixelize the thin/empty areas to create a uniform appearance.
You are correct that most of the times a wreath is left near the upper margin of the scalp donor area.
The reason is that this hair falls outside the safe donor area and may be lost. Happens in some people.
That will lead to a situation where the hair transplanted from this area may thin and even be eventually lost.
However, there are instances when we have used this hair.
In Hairytale’s HT, the exact same thing was discussed.
The upper zone was also thinned, after due deliberation.
This was because Hairytale’s aim was to be able to keep his hair buzz cut (with almost even density throughout). A zone of very high density in between the transplanted and donor would be distracting.
In my experience, if the patient is willing to use this hair knowing the potential chance of losing it, there are ways of using it.
This hair has to be placed at strategic pre programmed locations.
Use these hair to fill in, for example, the temple recessions or the swirl.
That way, even if this hair is lost years later, it will look as if the temples have receded (or crown has thinned) with passage of time.
I am very curoius about your technique. And again, I apologize for the mis-haps recently, so going forward I am trying to ask questions for educational purposes by your clinic.
I liked what you said about having to dissect around the graft with a needle. Back in 2003 when I first had to take grafts out after being punched, we tried everything… small cut blades mounted on hemostat, pulling them straight out without dissection… Then one day I picked up a 20 gauge on a syringe… and proceeded to dissect around the graft carefully. This technique went on until development of different techniques occurred. Still it was post punched grafts. So I am curious to learn your technique in the manner you have stated.
A couple of questions sir.
The expanding needle concept. Is it a concept? Or is it implemented as reality? In other words… Do you use the expanding needle currently?
Do the needles depicted in your pictures show the expanding needle?
May I visit your clinic to see first hand in the coming months. I have a friend from India in New Delhi I would like to visit… as well as a patient from Dr. Roses office I could pay a visit too for follow-up purposes. India has been a country that I have since childhood wanted to visit.
» Use these hair to fill in, for example, the temple recessions or the
» swirl.
» That way, even if this hair is lost years later, it will look as if the
» temples have receded (or crown has thinned) with passage of time.
»
» Regards,
» Dr. A
Nice idea. Can this be done with a strip too? I guess not.
» Dear Checkingin,
» I understand what you are talking about.
» The idea being to depixelize the denser areas and repixelize the
» thin/empty areas to create a uniform appearance.
»
» You are correct that most of the times a wreath is left near the upper
» margin of the scalp donor area.
» The reason is that this hair falls outside the safe donor area and may be
» lost. Happens in some people.
» That will lead to a situation where the hair transplanted from this area
» may thin and even be eventually lost.
»
» However, there are instances when we have used this hair.
» In Hairytale’s HT, the exact same thing was discussed.
» The upper zone was also thinned, after due deliberation.
»
» This was because Hairytale’s aim was to be able to keep his hair buzz cut
» (with almost even density throughout). A zone of very high density in
» between the transplanted and donor would be distracting.
»
» In my experience, if the patient is willing to use this hair knowing the
» potential chance of losing it, there are ways of using it.
» This hair has to be placed at strategic pre programmed locations.
»
» Use these hair to fill in, for example, the temple recessions or the
» swirl.
» That way, even if this hair is lost years later, it will look as if the
» temples have receded (or crown has thinned) with passage of time.
»
» Regards,
» Dr. A
I know that you probably find it amusing that I’m considering wearing my hair shorter after my initial reluctance to buzz my hair. I thought I looked like a freak, but got lots of compliments and the ease of the hair style is amazing. You were trying to paint a positive image when you told me I looked like a European soccer player.
I’m really only talking about removing 10% or so in those untouched areas so it would be just enough to more closely bring the two in balance. I like what you said about placement in the temples or crown. It certainly could also be used adding density to an existing hair line that may or may not thin later. One benefit I personally have is I’m 49 and I’ve been balding since I turned 21 (how the he-- could anyone say that is a benefit??, maybe I should become the poster Optimist:-D ). My balding pattern is much more defined and stable than say a 28 year old.
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