The Following is a series of questions, statements and replies from another point of view
My Reply......
Ive unfortunately been around the block with this whole field and now feel the only way FUE should be done is by adding body hair as you remove a follicle from the donor.
I think the only way FUE should be done is to do a 1 to 2 ratio for the first 3000 FUE grafts then a 1 to 1 for the rest
In other words 1 body hair graft for every 2 FUE scalp grafts for donor recharging
Then a 1 to 1 for every graft after 3000 .....So in total the max amount of FUE's that should be taken from anyone without recharging should be 1500!
(However if this was the case there would be less candidates for the procedure as not everyone is gifted with the correct texture body hair to pull it off)
And thats only if no scars from past work are present!........If there are scars from past work then it should only be 1 body hair graft for 1 FUE scalp graft....!
Otherwise the whole FUE idea can be detrimental as the area will thin to the point of very shallow density in anyone with a norwood 3 and beyond.......
I also agree that there should be no or at least a minimal charge for the recharging technique......All FUE Dr's should follow this guideline in my opinion......
My Question .........Why aren't more FUE specialists offering this technique?
The Reply ¦ ¦ ¦ ¦.
Body hair transplantation is still only practiced by a handful of surgeons worldwide because it requires special instruments and techniques, is extremely time consuming, and the results and yield can be quite unpredictable. Though it would be wonderful, I don't foresee a point in the near future where doctors will offer donor recharging for free, or even at a minimal charge. In addition to the fact that many doctors don't have the experience or desire to perform BHT to begin with, even those who are comfortable working with it feel that there are many limitations to the medium, and find the extraction process extremely tedious and labor-intensive. For this reason, most BHT doctors discourage patients from using body hair unless it's a last resort, and when they do perform procedures with body hair, they charge a premium.
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My Reply ¦ ¦
Well its a shame that only a few Dr's offer this technique because FUE alone in my opinion will not work on larger norwood scales...!
And yes I know Cole's motto of "LESS IS MORE"
I personally use a rule of thumb that states each norwood scale needs around 1250-1750 grafts depending on the hair shaft diameter and overall density in the donor area
So in a nut shell ....
A norwood 2 would need 1250-1750 grafts
A norwood 3 would need 2500-3500 grafts
A norwood 4 would need 3750-5250 grafts
A norwood 5 would need 5000-7000 grafts
Ext......
So without recharging with body hair or some other means then how can any FUE doc feel they could help a norwood 3 and beyond BY fue ALONE!
If that many grafts were to be taken out of anyone's donor area it will at some point start to become extremely thinned out and wispy regardless of the starting density
Also If there is an existing scar in the donor that's well hidden what do you personally think will happen at that point?........Yes it will stand out like a sore thumb
Listen all im trying to say is I'm not an advocate of strip ether especially in the wrong hands but FUE can be the better option if done correctly (proper sized tools) and donor recharging
If it comes down to a Dr not wanting to do what should be done for the esthetic result and for the patient due to BHT being a more tedious and tiring procedure then he should think again!.......And that goes for all Doc's
Telling a future norwood 6 who is at a norwood 3 that he is in good shape with a 2500-3000 graph donor area is in my opinion being lied to.
Don't get me wrong this has nothing to do with Dr Cole personally as a matter of fact I think Dr Cole is extremely artistic and does fantastic work but if i'm not mistaken he only does CIT now ......and does not like to do strip anymore ether.....
And that's ok but he needs to fill the larger needed numbers in some other way
This should also go to all other FUE practitioners in the business...BHT RECHARGING IS A MUST WITH THIS TECHNIQUE!.........PERIOD!!!
Its just simple math!!
FUE HAS POTENTIAL TO BE A MUCH
BETTER TECHNIQUE BUT NOT AS IS....
The Reply
I understand what you're saying but I still think there are just too many limitations and challenges to using body hair for donor recharging for it to become more commonplace.
Men who are at later stages on the Norwood Scale, and opt for hair restoration surgery, simply cannot (at this point in time) expect completely pristine donor areas- whether they opt for strip or FUE procedures. However, even without donor recharging, I believe the donor aesthetic post-FUE harvesting is superior to strip because you are not dealing with the linear scar and distorted hair grow angles along the closure. Dr. Cole's objective in performing FUE is to achieve an overall appearance whereby the density on top of the head is similar to the back- he does this by thinning out the back subtly and uniformly, while improving density on top and up front. Whereas, with a strip procedure, you re clearing out a center section of scalp but leaving a dense section of hair above and below the scar- permanently limiting your hair length and styling options.
FUE with donor BHT recharging is fabulous in theory, and we have had great success using it on certain patients, but it is still too unpredictable of a procedure to be more widely adopted, or to be a standard part of FUE work. It is further complicated when we get patients who have already had strip procedures who want to hide these scars in addition to desiring further work in front or up top. We do a lot of scar grafting procedures but, again, grafts to not 'take' to scar tissue as well as they do to virgin scalp and it can therefore take more than one pass (and additional donor scalp or body hair) to achieve desired coverage.
So, essentially, there is not yet an 'ideal' solution which allows hair to be transplanted to the recipient area while still maintaining a 100% pristine donor area in the back (and if this is someone's goal, we'd advise them never to get started with hair restoration surgery). However, we have come a long way already and we continue to study how we can make further improvements with the use of new technologies, such as ACell.
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My Reply
What type of results can more or less be expected then?
Can you show some more before and after photo's from your clinic?
Im sure most on this site are interested in seeing more!
There are only 2 pictures of BHT on the site and only 1 of recharging....
My question is also if the idea is talked down to only a very very rare few why does the clinic recommend it the first place as a viable option on the site?
As this would be my procedure of choice at this point........Several smaller sessions of 350-500 scalp CIT with the same number BHT replenish .....So that's several sessions of 700-1000 grafts
The technique does work as Dr Umar is doing more and more BHT FUE and only started a few years ago....
Cole on the other hand has been progressing the technique for up to 7 years!
Unfortunately, In my case it would be the only way to go........ a 1 for 1.....
And I regret not using Cole as I think Cole does very good work on hairline reconstruction,,,....
As far as Acell Dr Cooley is doing some ground breaking research with actual follicle regeneration ....As of now its only single haired grafts but is starting to test larger numbers for scar coverage...
He's testing follicular plucking .....A hair would be plucked/tweezed then set in Acell then planted into a scar .........Acell has been shown to regenerate a complete follicle .....The end result looks like a FUE scar grafting session was done....Though its not 100% it seems like a great start.....