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The young patient (or those not extensively bald)


#1

Dear forum readers,
An oft faced delimma is – At which point in the hairloss process should the patient and the doctor intervene with a hair restoration.

There is a lot of variation. Patient’s awareness, his donor resources, commitment; the doctor’s skills and philosophy all have a role to play in making the decision.

There is the safe approach – Wait for the hairloss to stabilize. Once the hairloss has run its course, then is the safest time to go for a hair transplant.
Modern medicines, in form of Minoxidil and finasteride, have helped some people stabilise/stop their hairloss. It is wise to try them before deciding to proceed with an HT.

However, patients often protest, sometimes justifiably, that the safe approach has its disadvantages.

They need hair now.

My advise to them is to make sure that they know what all is involved should they go for a hair restoration surgery early in the hairloss process.
Be aware of the high graft requirements in case they proceed to higher Norwood levels.
Transplanting an ambitiously youthful hairline carries its own set of responsibilities.

Facial hair, BHT, FUSE/fue and Strip FUHT megasessions have opened up a much larger donor resource.
But it is nonetheless a big commitment.

It is better to dwell over the worst possible outcome (in form of continued hairloss) BEFORE starting the HT journey.

Regards,
Dr. A


#2

Dear forum readers,
The patient (nickname J1) went for 1700 scalp FUSE/fue grafts approx 15 months ago.

He has sent a photo update and plans to go for further hair transplants in near future.

His before pictures

His current picture (taken by J1 himself).

Regards,
Dr. A


#3

Maybe its just me but i think its such a bad idea to place grafts into a hairline like that, looks like he may end up a norwood 6


#4

kind of hard to compare apples and oranges shaved head tilting down
before

then grown out hair tilting up after


#5

Is it just me or the after pics are too dark, can’t tell much.


#6

» Is it just me or the after pics are too dark, can’t tell much.

its normal that you want your after pictures look as good as possible.


#7

» It is better to dwell over the worst possible outcome (in form of
» continued hairloss) BEFORE starting the HT journey.

How about adding to the worst possible outcome:

  1. Potential scarring
  2. Potential low yields.
  3. BHT has unpredictability growth altogether.
  4. Potential shockloss.

#8

I find it contradictory that Mr. Arvind would operate on this young man – while at the same time talking about being cautious in operating young people. Has the hair been checked for miniturization? It looks like this guy is going to wind up a Norwood 5/6…

» » It is better to dwell over the worst possible outcome (in form of
» » continued hairloss) BEFORE starting the HT journey.
»
»
» How about adding to the worst possible outcome:
»
» 1. Potential scarring
» 2. Potential low yields.
» 3. BHT has unpredictability growth altogether.
» 4. Potential shockloss.


#9

I brightened the pic a bit.


#10

I bet that eyebrow piercing hurt!


#11

» I find it contradictory that Mr. Arvind would operate on this young man –
» while at the same time talking about being cautious in operating young
» people. Has the hair been checked for miniturization? It looks like this
» guy is going to wind up a Norwood 5/6…
»

Dr. Arvind made it clear that he is addressing the ambitious patient with early hairloss, not early hairloss per se.

I think it is a very helpful topic to discuss because many of us who lose hair do not want to wait until we are NW5 before a transplant.

Dr. A has only transplanted 1700 grafts for this patient which is conservative compared with the kind of density that others use such as armani.

Regarding the pic, he also said that the patient offered the pic.

Dr. a was not cryptic and did not write the post using a secret code. what is the point of criticism without first reading the post???

For myself, I would like to investigate this issue in more detail since I also do not want to wait until I am NW6 but I do want a do-able surgical plan.

  1. It seems that Dr. A’s approach is to build a final hairline.

  2. perform a test BHT.

  3. leave the crown in needs be.

I do not agree with this approach but it is an approach as good or better than any other doc I have seen on this forum and at least he is opening it to discussion.


#12

The question remains: has this guy been checked for miniturization? If he winds up as a Norwood 6/7 he could very well regret getting a hair transplant with such a low hairline and high density in the front. Of course the guy can do whatever he wants, but I would’ve been more cautious/conservative if I were the doc…


#13

» The question remains: has this guy been checked for miniturization? If he
» winds up as a Norwood 6/7 he could very well regret getting a hair
» transplant with such a low hairline and high density in the front. Of
» course the guy can do whatever he wants, but I would’ve been more
» cautious/conservative if I were the doc…

Yep, I think that’s where the discussion begins. I have researched HT for ages. I have a remaining type I’ish hairline like this guy and it is difficult telling me that I must acept a higher hairline in my first HT but you make a good point and that is why I am trying to control when I go for the first HT. All things being equal it might be best to have a test BHT first so that the plan can be made more confidently if the patient goes to type V.


#14

Dr. A,

Would it be feasable to plan an international “BHT test session tour” at a price of something in the range of $2000 / patient for one or two hundred grafts. I would suggest that you would achieve 20 patients on a visit to the U.K and it would be good forward advertising. This is based on my comments above.


#15

Thanks for brightening the picture.

The earlier picture was taken by the patient and posted untouched.

Below is a larger size picture that I brigtened using the brightness - contrast function.


#16

» Dr. A,
»
» Would it be feasable to plan an international “BHT test session tour” at a
» price of something in the range of $2000 / patient for one or two hundred
» grafts. I would suggest that you would achieve 20 patients on a visit to
» the U.K and it would be good forward advertising. This is based on my
» comments above.

Dear Marco,
The UK requirements make it compulsory for foriegn doctors to first work in NHS for a period of 3 years, before being allowed to start their own practice.

Similar regulations exist in most countries, including India, when it comes to doctors from foriegn countries.
Regards,
Dr. A


#17

Dear forum readers,
The aim of the current thread is show actual cases where further hairloss following a transplant has necessitated further HTs.
We always impress the necessity of long term planning on our patients.
However, seeing actual case results, rather than just words, drives the point home more effectively.

I hope that prospective patients will benefit from the cases we wish to discuss on this thread.


No amount of testing can accurately tell how much more hairloss the patient will have and over what time span. Just as having dense hair at any age does not preclude the chance of extensive hairloss at a later date.

If one wishes to go for HT at an early stage in the hairloss process, one must keep the prospect of having to go for further HTs in mind.


One thing that the patient and doctor can plan is to get the transplant as close to a natural variant as possible.

Regards,
Dr. A


#18

Dear forum readers,
The following picture was taken by J1. It shows the top view and wherethe hair have thinned behind the hairline area.

This is something one has to keep in mind.


#19

» Dear forum readers,
» The following picture was taken by J1. It shows the top view and wherethe
» hair have thinned behind the hairline area.
»
» This is something one has to keep in mind.
»
»

Good news is this guy has thick caliber and curly hair. Bad news is contrast.


#20

Hi Mr. Arvind, good transplant work but I respectfully disagree with your following comment:

» No amount of testing can accurately tell how much more hairloss the
» patient will have and over what time span.

As you well know thinning isn’t detected by most people until 50% of the hair is gone or significantly miniturized. This is why mapping for miniturization is so crucial, b/c it outlines the likely future pattern of hair loss. This, combined with the Norwood pattern of other family members, provides an accurate way of predicting future hair loss.

BTW, here’s more info on miniturization:

So did you map this patient for miniturization? B/c it looks like he will easily end up a Norwood 5/7… I mean, a Norwood 5 at the least, but of course we can’t tell with the naked eye actual miniturization so he could wind up a Norwood 7. For his sake I hope he’s a Norwood 5, esp given the density of his new hairline.

All the best,
BB