Scheduled An FUE Session: Need Some Advice!

[HTsoon]

There's no way Dr. Feller will ever agree to perform FUE on you, if you've decided to go with Dr. Feller than you should abandon the notion of FUE all together. He's made it quite clear that he will only offer FUE for those he feels are candidates which is generally no one with moderate to severe MPB.

IMO you should research FUE more closely, can FUE be done on Norwood 5+? The answer Absolutely, I was a diffused Norwood 6 with more hair loss than you and I've only had FUE, now is every surgeon confident and competent enough to perform the procedure on individuals with moderate to severe hair loss the answer NO.

I would suggest doing a little more research before proceeding, look at video documentation, MOST importantly look at patient reviews, if possible meet with patients. I think with some time and research under your belt you'll be educated enough to make a decision DO NOT rush in to anything.

Understand that every surgeon has a philosophy and agenda, you will hear some surgeons say FUE should be used for small cases because the growth is poor and it ruins the donor area making it impossible to have subsequent procedures. On the other end of the spectrum you have some surgeons claiming FUT is barbaric and surgeons who suggest this procedure are butchers, my point being don't place all of your trust on one surgeon or any surgeon, it's important that you do your own research and use some critical thinking. Think critically about your goals both long term and short term and you'll be able to devise a master plan with a surgeon that is able to achieve your specific goals good luck.

[jschwartz]

Ooh, this is exciting!
I get my questions answered by the veteran Joey Tills
Please continue to be blunt, and let me know if I’m still way off base in my responses. Thx.

It is my opinion that starting out with 600 grafts to fill your temples, especially with a high forehead, is a bad idea especially with your already established position regarding minoxidil and finasteride. What happens if you are in a position where you can't have a second surgery? Your loss will continue and you'll have two horns sticking out of your forehead. I've seen it happen.

Well part of the plan is to have multiple surgeries (as most people who plan to have a HT should do). I wouldn’t put myself in a situation to only have ONE surgery.

RE: your comment about the two “horns sticking out of your forehead” situation…

Yes, this is something I had already thought of. However, I don’t think it would be a ‘forehead’ situation as my plan is to maintain a mature hairline and not to bring it down to 20 year-old levels (which would definitely create a potential “hair out of the forehead” look).

In your words, getting a “tangible sized procedure of 2000 to 2500 grafts that will address the front and mid-scalp” is a decent strategy.

I have thought of this in the past, but I question whether or not it’s a good strategy to subject my native forelock hairs with ‘shockloss’ for no real reason other than to simply “get it out of the way” with one big surgery.

Obviously, if I was getting STRIP surgery, then this would make sense. But with FUE, we can control and cherry pick the grafts (both the caliber and the count).

Don’t get me wrong…addressing the forelock and mid-scalp is still part of the plan. But instead of one massive 2500 graft surgery, I would be splitting it into two surgeries.

Because of the potential of shockloss to native hairs, I would think it’s better to address the loss when it begins to occur. Also, as an added bonus…I believe doing the temporal angles first (without shaving my head) gives me a ‘stealth’ recovery period where I can cover the transplanted area with existing forelock hairs as it begins to grow.

In the short term, temple work that is mature in six months to one year will be noticeably different than the hair behind the forelock. If you look at the forelock the hair is terminal which means it is healthy with a normal shaft diameter. There are some miniaturized hairs but overall this area will last a while. The hair behind your forelock is a different story. It is all miniaturized and fine. The hair transplanted to close your temples will be much stronger, terminal hair, with a thicker diameter. I feel that this may stand out and look unusual. This is based on the overhead photo in your collage.

This is true, but I don’t understand your point.

By your logic, my CURRENT situation is unusual. The hair that is currently behind my forelock is finer and more miniaturized then my forelock. All I would be doing with this first HT is fill the temporal angles so that I can effectively connect my forelock and sides of my head, with matching hair caliber and density (to eliminate the mohawk hairline).

So, yes, the mid-scalp area behind my forelock and temples (going toward the crown area) would continue to be fine and miniaturized, but so what?

I would simply look like a person who has crown loss only. There are many people who have this sort of hairloss pattern where the front of their head is not receded at all, yet they have crown and mid-scalp thinning (or baldness).

The great thing about this is that I could finally cut my hair very short, and the area that people most notice (the temples & hairline) would look nicely framed (which is totally not the case today). Of course, the area behind the forelock (and also the crown) would be less dense than the front of my head, but this is very common in regular people that you see every day..and it looks a lot better with shorter haircuts than it does with longer ones.

The idea that you can use body hair to fill the donor area after FUE has been discussed off and on for nearly fifteen years. To date I have yet to see a single case where donor recharging (as it has been called) has ever worked. Body hair is already a low yield donor source so when you add that to the potential low yield recipient that scar tissue is classified, the lack of results makes sense. Don't count on this. Dr. Feller is a very good hair transplant doctor but I would not believe he'd acknowledge your plans as being sound.

He didn’t, and I haven’t had my in-person consultation just yet. I’m not really considering BHT (I was reading up on it last night and it was stuck in my head as I typed this all).

I am only really considering SMP to fill any gaps in the donor area. I “think” that my donor is pretty good so I wouldn’t have to resort to this. But this is going to be determined at my consultation.

I could go on but you asked if your plan is too ambitious. I think it is because there are too many variables that you're hoping will be positive in your favor. Those are huge odds to bet on.

Well, it’s just the approach that is different.

My plan is no different than the standard plan that many people do, which is to do two BIG hair transplant megasessions (one for the front and one for the back).

I am simply just breaking it into three sessions (temporal angle HT, crown HT, and midscalp/forelock HT).

The variables (donor density, matching hair caliber, planning for future loss) are all the same.

The only other difference is that I am attempting to pull off some ‘stealth’ recovery process, which may or may not work, but it should not impact the long term results either way.

I think you should rethink your priorities and maybe not have a hair transplant. With so many small steps you're planning on and with the alternative treatments you're considering in case of bad outcomes, you're asking for trouble.
I made this video two months ago to help drive home the reality of hair transplant planning. Watch it, think about it, and move forward based on how you feel afterward.

Thanks for the advice. I’m glad you’re giving me the bad news instead of the good, but I still think that in a worst case scenario, I can still just buzz my head with FUE and use SMP to fill in any scarring or bald areas.

I still don’t see any bad FUE scarring photos from top docs like Feller, Shapiro, Rahal, Bisanga, etc which gives me confidence that any scarring would be minor. SMP is my only real question mark, as we do not have the forums and patient history of SMP results like we do with HTs, so it’s iffy when trying to find a top SMP tech.

Also, part of the reason I booked with Feller is that he’s very cynical in his online videos. He doesn’t seem like the salesman type who is trying to sell you a HT. This is good, as I think I would get an honest in-person assessment from him re: my donor and plan.


Joe, thanks for the responses. I’m looking forward to your responses to my above comments.

[Stevedawg18]

Few things to think about having to surgery:

1. You're going to look weird for a while (ugly duckling phase)
2. It's painful
3. You have to limit physical activity afterwards
4. You have the agonizing time of waiting for it to grow

I'd want to go through this as few times as possible. I'm 6.5 months out from a HT, it's good now, but don't want to go through this period again anytime soon.

[JoeTillman]

I agree with HTSoon. I didn't want to really say as much until I knew if you had a consultation with him or not. It is well known that he does not think about FUE the same way that most other well known doctors do. If he gives you an assessment that includes FUE as the only surgical method for the short and long term, I'll be shocked.

Well part of the plan is to have multiple surgeries (as most people who plan to have a HT should do). I wouldn’t put myself in a situation to only have ONE surgery.

I don't believe in one big surgery, either. My point was that by placing 600 grafts for the temples you are running the risk of the result standing out from the hair around it. Your hair is miniaturizing behind the temples and all over the top save for the central forelock region. The texture and diameter difference may stick out. That is my point.

The "two horns" comment was referring to what it would look like if you were in a position that prevented you from getting more work done. That is an unknown. What is not unknown is your future loss potential. I hope that makes more sense.

But with FUE, we can control and cherry pick the grafts (both the caliber and the count).

I have yet to see a single case where a doctor has shown a game plan up front that includes this "cherry picking" we all hear so much about and then show off a result that benefits from this approach. The cherry picking that is possible is choosing to get mostly multi-hair grafts instead of singles when trying to add bulk and density. The idea that one can cherry pick singles that are finer than others is, to me, a myth. When you look at a follicular unit, say a single in this case, and it appears to be finer than the neighboring hairs, it usually means it is either DHT sensitive or it is coming out of a telogen phase and only recently re-entered anagen. No one can tell one way or another which is true for each follicle they are examining. Finer hairs can be taken from the nape, and they can be taken from above the ears, but sometimes they too are DHT sensitive. It is overall just an unreliable approach and was used in the old days to differentiate FUE from FUSS.

I think at a minimum you should consider more in the range of 1200 grafts to address the temple recession (mature closure) and the entire frontal hairline. Use the additional grafts to strengthen the entire frontal line so that you don't have to worry so much about the hair shaft diameter/terminal hair vs. miniaturized hair cosmetic disparity issue that I'm referring to. You won't have to worry so much about shock loss because the forelock won't be filled, just the periphery of it. I think your approach may sound safe but I think it is more of a piece meal strategy that could bite you in the ass.

This is true, but I don’t understand your point.

The point is that the work, no matter how natural, will stand out as a contrast to your native hair in the immediate vicinity of the work performed.

By your logic, my CURRENT situation is unusual. The hair that is currently behind my forelock is finer and more miniaturized then my forelock. All I would be doing with this first HT is fill the temporal angles so that I can effectively connect my forelock and sides of my head, with matching hair caliber and density (to eliminate the mohawk hairline).

So, yes, the mid-scalp area behind my forelock and temples (going toward the crown area) would continue to be fine and miniaturized, but so what?

I would simply look like a person who has crown loss only. There are many people who have this sort of hairloss pattern where the front of their head is not receded at all, yet they have crown and mid-scalp thinning (or baldness).

No, my logic does not dictate this. Your current situation is very normal. I see it all the time. My original point is that the temple work you plan on, by itself, might not blend the way you hope it does. This is a different look than what you're saying looks normal in nature. Yes, men lose crowns but keep their native hairlines. I've seen it many times but the finer points of those cases is beyond the scope of this particular discussion.

The SMP issue is another variable you can't rely on. SMP does not always work in scar tissue. Hell, it doesn't always work in healthy skin tissue, either. This goes for temporary or permanent. With scar tissue the result is less predictable. I've seen it disappear. I've seen it spread. No one can guarantee what it will do so you can't rely on this option as a reliable fall back.

And you should also reconsider your plan of "just buzzing" your head if your plan falls apart. In fact, you should contact any and every doctor you're considering, or will consider, and ask them if they guarantee that you can do what you are planning. I doubt you'll get the same assurances you're expecting.

[jschwartz]

There's no way Dr. Feller will ever agree to perform FUE on you, if you've decided to go with Dr. Feller than you should abandon the notion of FUE all together. He's made it quite clear that he will only offer FUE for those he feels are candidates which is generally no one with moderate to severe MPB.

IMO you should research FUE more closely, can FUE be done on Norwood 5+? The answer Absolutely, I was a diffused Norwood 6 with more hair loss than you and I've only had FUE, now is every surgeon confident and competent enough to perform the procedure on individuals with moderate to severe hair loss the answer NO.

I would suggest doing a little more research before proceeding, look at video documentation, MOST importantly look at patient reviews, if possible meet with patients. I think with some time and research under your belt you'll be educated enough to make a decision DO NOT rush in to anything.

Understand that every surgeon has a philosophy and agenda, you will hear some surgeons say FUE should be used for small cases because the growth is poor and it ruins the donor area making it impossible to have subsequent procedures. On the other end of the spectrum you have some surgeons claiming FUT is barbaric and surgeons who suggest this procedure are butchers, my point being don't place all of your trust on one surgeon or any surgeon, it's important that you do your own research and use some critical thinking. Think critically about your goals both long term and short term and you'll be able to devise a master plan with a surgeon that is able to achieve your specific goals good luck.

So...what I'm hearing is that you don't disagree with my approach, instead, you simply disagree with my choice of HT doctor?

The reason I chose Feller is because of his technique, his blunt honesty, and his use of manual punches (unlike other top docs out there like Rahal, who use the machines).

Yes, I assumed that he would be totally against a front-to-back FUE surgery, but I wanted to consult with his clinic anyway. I have a meeting with Dr. Bloxham, so we'll see what they say in person.

If they have a change of heart and say 'ok' to a plan that involves full coverage FUE for a NW6, do I get your blessing?

[jschwartz]

And you should also reconsider your plan of "just buzzing" your head if your plan falls apart. In fact, you should contact any and every doctor you're considering, or will consider, and ask them if they guarantee that you can do what you are planning. I doubt you'll get the same assurances you're expecting.

Hey Joe,

Just one question...

If you were a full blown Norwood 6, and had to do it all again...Would you?

..and if so, would you have done FUE?


I ask, only because it seems like you are making a strong effort in your videos and postings to discourage people from getting a HT, almost as if you regret it.


If I started this thread, and instead said that I was planning on having two FUE megasessions (one in front, and another in the back at a future date), would you have supported that plan?

[HTsoon]

So...what I'm hearing is that you don't disagree with my approach, instead, you simply disagree with my choice of HT doctor?

The reason I chose Feller is because of his technique, his blunt honesty, and his use of manual punches (unlike other top docs out there like Rahal, who use the machines).

Yes, I assumed that he would be totally against a front-to-back FUE surgery, but I wanted to consult with his clinic anyway. I have a meeting with Dr. Bloxham, so we'll see what they say in person.

If they have a change of heart and say 'ok' to a plan that involves full coverage FUE for a NW6, do I get your blessing?

Joe makes a good point, buzz your head first, I buzzed my head for a year before deciding on an HT, if you have it in your mind that one day you might wanna shave, do it now it will save you a lot of time and money and potential heart ache, buzzing is inexpensive and no risk, once you embark on HTs there's no turning back. I could not accept being bald I wish I could but I just couldn't so I had three HT's do I regret them? No but I've been lucky to have had good results not everyone is so lucky, no one can guarantee a good result keep that in mind.

I don't disagree with your choice of doctor, Dr. Feller is a good doctor that has a long track record, Dr. Bloxham likewise has been practicing a short period of time but what I've seen so far has been good. If you research a bit more closely you'll see Dr. Feller has made two things clear, you can not order which surgeon will perform your surgery, his clinic works as a team and you could have your procedure done by him or Dr. Bloxham you have no say in the matter. The other thing he has said is that you do not order procedures at his clinic off a menu like a restaurant, he will tell you what he believes to be the best thing (strip) and if you don't like it then that's it. I'm not saying that's a bad thing he doesn't try to hide this he's up front and honest.

One thing I noticed is that most of the doctors you mentioned are North American it is well known in the HT community that the FUE elite doctors practice out of Europe particularly Spain and Belgium. All of the doctors you mentioned are good doctors but none of them can be considered elite in the realm of FUE with the exception of Bisanga. Like I said research FUE a bit more closely, I would recommend looking at Lupunzula one of Joe's docs, look at Dr.Couto in Spain, take time to consult with several doctors don't limit yourself to the states or Canada.

With that being said, I don't like the plan, I agree with Joe, only addressing the recession can be highly problematic in the not so far future, it's not where you are today it's where you're headed and you are headed towards Norwood 6. I do not condone mega sessions, I think there are to many variables with mega sessions and if you get a less than optimal result then you have little to no options left. However, playing catch up with hair loss and HT's can also prove to be problematic as you never really achieve a good cosmetic result, because by the time your HT matured then you've lost more native hair and you're back to square one looking like you did before.

I think most docs would first address the hairline completely including the tuft and work in to the midscalp, then depending on donor density see about doing the crown. DO NOT assume you will be able to achieve full coverage and density, many men who are Norwood 6 do not achieve full coverage and density, some do not get any coverage in the crown because their donor does not permit it. There are other things to consider head size, hair characteristics (curly, wavy, straight) hair shaft thickness (fine, medium, thick) etc. All of these things will have an impact on your overall cosmetic result, no doubt FUT+FUE will maximize your lifetime grafts should you want to go that route, but you're limited choosing just one, any how good luck with your consultation

[JoeTillman]

Hey Joe,

Just one question...

If you were a full blown Norwood 6, and had to do it all again...Would you?

..and if so, would you have done FUE?


I ask, only because it seems like you are making a strong effort in your videos and postings to discourage people from getting a HT, almost as if you regret it.


If I started this thread, and instead said that I was planning on having two FUE megasessions (one in front, and another in the back at a future date), would you have supported that plan?

You asked three questions, not "just one..."

1. If you were a full blown Norwood 6, and had to do it all again...Would you?

I get asked this question all the time. Knowing what I know now, no; I would not have a hair transplant again, much less would I have had eight more hair transplants, the third and fourth being with one goal which was to repair the first and second. To go further, would I change anything about my history and hair restoration? No, I enjoy where I'm at and what I've been through has made me the man I am today. Had a time traveling hair transplant patient advocate traveled back to 1992 and told me what lay in front of me I would have shaved my head and called it a day. I have a good head shape and my head looked good shaved before I had my first strip. I'd be a bald, tanned virgin scalp manning a dive boat in the South Pacific somewhere, completely oblivious to the life of a hair transplant patient.

2. ...and if so, would you have done FUE?
FUE was not available when I first started my journey so the question is moot.

3. If I started this thread, and instead said that I was planning on having two FUE megasessions (one in front, and another in the back at a future date), would you have supported that plan?

No, but I would not have been so against it, either. You are hoping to piece meal your multi-hair transplant surgical goals for the sole purpose of hiding your procedures from the world. By doing this you risk making it more obvious for the reasons I've stated. You don't have to have a megasession to do this right, just do enough so that the work itself does not stand out in contrast with your native hair.

And as HTSoon says, it is doubtful that Dr. Feller and Dr. Bloxham will agree with your plan. They will suggest one or two strip surgeries which I would not have a problem agreeing with. Just don't do a megasession strip, just like you shouldn't do a megasession FUE, either. The more you do in one session, the more you risk if it doesn't work out and the less you have to repair the damage, should any damage (poor yield, bad donor scarring, etc.) occur. I can tell you easily that, based on your photos, I would have suggested 4000 to 4500 grafts in one procedure via strip, when I worked for strip clinics. This would be pretty much a standard assessment given your area of loss and what appears to be a good donor zone. However, given that you are only seeking FUE work, it makes sense to find a clinic that specialized in your desired procedure and move forward with caution. Every clinic has screwups, which is why I always encourage a no surgery approach first. It is the only guaranteed avenue of safety. If you still decide to have surgery then hopefully you'll be better prepared if I made you think about the downsides more seriously and ultimately you'll be a better patient for it in the long run.

I ask, only because it seems like you are making a strong effort in your videos and postings to discourage people from getting a HT, almost as if you regret it.

I don't regret my surgeries. I just know that a lot of guys aren't equipped to deal with what I've been through. This is not to say I'm special, just that I've dealt with my troubles fairly well compared to a lot of guys I've met over the past fifteen years. Having bad hair transplant surgery changes you. It alters the way you look at the world when you realize that the steak isn't as good as the sizzle.