@@hairtransplantchannel Hi Joe, This is Bruce from Houston. I call in to the Bald Truth periodically to talk with you guys. Yiu know my long history starting in 1995 with the famous place we all know from those days and today still. I recently, December had a 2426 graft FUT surgery with Dr. Arocha. Hairline and frontal 3rd. Down to earth salt of the earth kind of guy! Very caring. He listens and repeats back what the person says. So the 2 small procedures in 1995 and 1996, failures. Then south Florida FUT with ok coverage but still thin. Then 3 years ago I discovered you and Spencer. You probably remember I offered you 1k for a consultation a few months back! Lol! I was serious. I have missed some shows during the holidays and the Monday show recently thrown in the mix threw me off but I will get back on track with the live shows soon so I can call in and share conversation with you and Spencer. Also I recently received my order of grow MD and follicle spray. One last thing I want to share is I'm 54 years old now and have had 4 surgeries. I don't want to do this again for several reasons! From cost to the healing to results! If I can ever help you by sharing my experiences and help the younger generation understand these experiences please let me know sir! Please keep rolling brother!
I was in this situation almost exact...my thinning crown was just a little bigger...I tried the minoxidil and finasteride combo for years and had some improvements but nowhere near what I wanted....I did my first crown transplant 2500 grafts which filled in in nicely but could still see the spot ....7 years later I went to Dr. Scott Alexander in Phoenix...he specializes in density...he did another 2500 in the crown and after 5 months I have complete coverage...with another 7 months to go for final results....Changed my life as far as having a goal to get my crown back...I did have good donor hair and no real hairline problems....so I was lucky that way...All the best...and I love the RUclips channel...Keep it up...J
Great Video as always Joe! Happy New Year! Question: In this case, where there is a large area of loss in the crown, it seems difficult to know where to take the strip from, as its possible that the area of loss there might probably grow downward toward the back of the head. Second question, When consulting, do you ask if the subject has high BP? I started taking low dose oral minoxidil, and I also suffer from borderline to high blood pressure. Adding this to my regimen seems to have al least marginally helped my BP. Its still too early to tell whether it has had any impact on my area of loss. It does appear to have has some effect on beard hair though.
Hey Mordy, Happy New Year! I couldn't get into that as what you saw were the only photos I had to deal with but his donor area, for FUT, would be typical where the posterior incision line would be just above the nuchal line. Feel the bony protrusion along the back of your scalp and move up one finger width and that's about where most strips are removed. The lateral donor zones would be higher in order to allow for a continued fade cut and it should still be safe while staying in the traditional donor zone. The danger is going too far forward as I've seen donor scars, or the frontal tips of them, exposed from continued recession. I've only ever seen one patient whose lateral donor scars were visible due to downward creep from the parietal humps. I don't ask about BP as that is something for the clinic to ask. I would ask about it when I was working in clinic however and it is usually a part of most standard consultation forms.
Hey Joe. A great start to your new series of advice for us follicularly challenged. Excellent choice of a hair loss candidate to begin with. Thanks for sharing!
Thank you. I only want to send good pictures because a surgery is a really big thing that will affect me all my life. Thanks for your videos and educating us.
Hi Joe, This is Bruce from Houston. I call in to you and Spencer periodically on the Bald Truth Podcast. Have been for 3 years. You know my long history with 2 clinics in my past. I did offer you 1k one time on the show. If it weren't for you and Spencer we all would be screwed finding the right doctors in the industry. The timing lately has been hit or miss with the show. Especially the Monday thrown into the mix recently. Anyway I just wanted to drop you and others this message that I recently, December had a 2426 FUT graft surgery with Dr. Arocha! Great guy down to earth salt of the earth guy. Also recently I ordered and received my Grow MD shampoo and follicle spray! Loo
I'm actually in a very similar position to this guy. I'm 39 and from the front I still look like I have a full head of hair with only some very mild recession in the front, which isn't enough to really bother me yet. Hair loss has been a slow burn for me. I first noticed my crown starting to thin in my late 20s and remember looking into finasteride about 10 years ago, but got scared away by the posts online saying that if you take finasteride you'll never be able to get an erection again blah blah blah. I wish I had ignored that back then, but it scared me away from trying finasteride for about a decade. I finally decided that it bothered me enough to go on finasteride. I've been on a generic version of finasteride for about 3.5 months and have seen some mild improvement. I'm hoping that with another 3 to 9 months I will improve enough to not need surgery. If after being on the finasteride for 12 to 24 months it's still not enough improvement, I may try adding dutasteride into the mix once a week to see what happens. After that, oral minoxidil is also something that I may consider before surgery. Like you say, surgery should be the last resort after trying everything else has failed. I will say there are a couple treatments I have considered and rejected. One is topical minoxidil, because I know I'd never be able to apply a topical like that every day and let it sit in my scalp long enough to absorb. That would just be too inconvenient for me to maintain. And also because I have a cat, and I have read that minoxidil is highly toxic to cats even in small doses. The other thing I have considered and rejected is a dermaroller. I would be too worried about the cumulative scarring effect of continually puncturing the skin over the long term. I know people say it doesn't go deep enough to cause scarring, but if you're puncturing the skin, there has to be at least a minute amount of scarring taking place. And doing it over and over again for years probably isn't a good idea.
I got the same issue as this guy too I started derma rolling once a week and doing minoxidil foam (the dropper is cheaper but also greasy and doesn't look good) i'm also 39 and started taking finasteride for 3 months I think I got some new growth in the front but it's hard to tell as for the crown i'm not sure yet. I have some money put aside for a transplant but would rather see how this treatment goes for the next 9 months, I might add the laser light therapy into the mix later on but that doesn't seem too promising
Great video Joe. Although this covers a specific, and fairly unusual case, it actually covers a lot of ground and answers a lot of really good FAQ's I get from patients on a daily basis pertaining to average cases. Really valuable resource for the community and looking forward to the rest of the series.
Happy NY to you JT I would use as many beard grafts as possible for the crown, this candidate seems to have a full beard maybe even 1000. Are his crown graft estimates so high because his hair is so dense in the front? 4000 for that area would be a a density of around 80 per cm2
Hey Joe, I have a question. Assume that the perfect slit is made in the recipient area. How much does the rotation (in the 360 degree plane) of the graft matter when it is inserted? Most grafts I've seen appear to be straight, but I've also seen some that are more curved. This is a new topic I had never heard of before and wanted to get your opinion on it, thanks.
Excellent question. In fact, it gives me a good idea for a new video:) I'll try to be succinct. It matters if there is a wave to the hair that protrudes below the plane of the scalp tissue as the goal is to have a consistent exit angle from one graft to the next. Some may compare it to a corkscrew inside of a cork, but this is a false analogy as the illusion is that the exit angle is always the same due to the characteristics of the situation that a cork and corkscrew presents. With a graft, the exit point is larger than the hair shaft as it is sized to match the size of the tissue of the graft, not the hair shaft itself so a better analogy is to consider the corkscrew as the hair shaft and the cork as the supporting tissue (the graft). It fits perfectly (if not a bit too snug) into the bottle so if you could rotate the cork itself you'd be able to orient the exit point of the corkscrew based on the rotation. I hope that makes sense. Keep in mind for tight curls, like those on patients with afro-centric hair, the rotation isn't nearly as important. This is more important with single hair grafts as multi-hair grafts, hopefully behind the hairline, do not benefit as much from this practice as long as the general angle and direction are consistent. With straight hair it still matters, especially if the surgeon is trying to achieve coverage with a minimal number of grafts, even with multi-hairs. This however also depends on the incisional tool being used. If a flat blade is being used, there is no rotation because you can't rotate something inside of a flat rectangular cut. If it is rounder, as one would have with a needle, then this can be done. The advantage to blades however comes into play when the grafts themselves can be surgically modified beyond simply being separated from the donor scalp and placed into an incision. If one has, say a four hair graft, it is somewhat round or oval in shape, both in the orientation of the hair shafts and the surrounding tissue due to the excision or separation process. If the clinic is skilled, they can make a center partial slice down the middle of the tissue so that instead of a round or oval graft, it unfolds and is now flat. This means that the hairs that were once bunched into a hay bale are now spread out laying side by side and once they're inserted into a flat incision, they give more coverage than had they remained in the hay bale. This isn't necessary for great coverage as a lot of clinics don't use flat blades and get excellent results, but my heart still prefers blades for this process if the clinic is skilled with them. I hope that answers your question.
@@hairtransplantchannel Complicated topic to explain but that mostly makes sense :) thanks for the detailed explanation. Double checking my understanding - if the graft is straight, and the incision is being done with a round needle, then the rotation of the graft shouldn't matter, right? Do you know what percentage of people have a wave to their grafts? What percentage of "top clinics" take this into account and adjust the implantation accordingly? It seems like accounting for this would take a lot more effort.
@@Max-ot1hh It is complicated, indeed. To answer your first question, more or less, yes. It shouldn't matter. When placing into incisions made with a needle however the primary aesthetic factor is the exit angle and if the incision is in the sagittal plane then better clinics may make the angle flatter to the scalp as the healing process tends to make grafts elevate to a higher angle than originally placed. I don't have the general percentages you're asking about but the percentage of top clinics that do consider this is small and most don't talk about it publicly as they may consider it to be a trick of the trade.
I've rarely seen it to be effective to the point that patients love it. It has also always seemed to be a pain in the ass for most patients as a stand alone treatment.
Joe whats your thoughts on fixing a botched hairline from previous surgery? Can relocating transplanted hair cause scarring? Is it better to just work with the existing hairline?
Very tough to answer. My old hairline was simply camouflaged. A lot of hairlines should be removed completely and rebuilt from scratch and there are two ways to do that. A strip for the hairline or FUE.
@@hairtransplantchannel thanks. Dr. Wong suggested remove old grafts and relocate. Do a small session and see how it heals before proceeding. Then other clinics I spoke with said there's alot of potential of scarring. So just work with existing hairline and dense pack . Not sure what to do.
@Hair Transplant Joe Tillman Hey Joe i have a question about grafts per cm2.. My doctor said he likes to keep it around 20 for adequate blood supply... what's your take on this?
I think your question has more to do with the limits of surgical density. 20 is fine, but it can go higher. There is the law of diminishing returns however once one reaches a certain threshold but that threshold is a variable dependent on the tools used to make incisions, the size of your grafts, the vascularity of the area being treated, etc. All things being equal, I feel that 40 per cm2 is probably the sweet spot, give or take.
Hi thank you for being helpful and I would like to ask you I have the same issue hair loss in the crown and I’m using minoxidil for 5 months but to be honest is day after day or sometime I stop for 3 or 4 days and use it again I feel that my hair is regrow again but I can’t still use minoxidil for the long time ,so now what do I need to do if I wanna do hair transplant ? should I stop taking minoxidil until my new hair fall out or it doesn’t matter ,so I can do the hair transplant. I’m afraid if I do the transplant the area which is not active with minoxidil will grow normally after the surgery but what about the hair which grow by minoxidil ? It may cost me 1500 grafts but later on after I stop using minoxidil it may cost 2000 grafts so that’s my problem
He seems to be thinning a lot on the crown but there is no area that is completely gone, can't he get full density back if he is a good responder to finasteride and minoxidil? Isn't it too early for him to think about hair transplant?
Great video, my hair is probably just slightly worse than this guys and I have similar hair style. Hope I also win the contest! Edit: also not sure if I missed it but would you also recommend minoxidle to this patient?
Thanks, and you're entered now into the contest:) No, I mentioned that I don't recommend it as I don't think it is worth the time. This is referring to topical however as oral minoxidil has the potential to be more helpful. In hindsight, I could have mentioned that but I don't always remember to share the details since I don't write a script and everything is always off the top of my head:)
@@hairtransplantchannel thanks for the response! This helps a lot as I’m considering minoxidle and just didn’t know if it’s really worth the hassle. Thank you
Happy New Year Joe!! Glad to see New Content, great video as always! I was wondering if you would recommend dr. Rahal for hairline repair work or if there are any doctors that have good track records of repairing botched hairlines from previous HTs?
I think the best thing to consider is if there is a healthy amount of repair cases on any clinic's website and go from there. After you've found a few that have several cases that look good to you, reach out and ask to speak to repair patients and see what happens.
@@jayeshaw5705 Are you asking about the repair work on myself? You can judge for yourself by looking at my history on my website and then looking at me now. If you're asking about how he has dealt with other repair patients, I'll say he's one of the most creative and clever doctors I've ever met.
I'm not a doctor. As far as I know there is zero documentation showing that finasteride has ever caused an issue with conception much less being the cause of birth defects. However, it is best to discuss with your doctor or consider going off for a while and jump back on once conception is confirmed. Good luck, and have fun:)
If I was in his shoes I would go for 1800-2000 grafts. The physician should extract only grafts with multiple hair follicles. Diffuse placement of the grafts. Evaluate it after 18 months. After 18 months consider combining this area with an SMP so he can save his donor area for future hair loss progression.
I've seen great results where people with this pattern shave it down to wear a hair system but keep their natural hairline. So they get great coverage and a natural outcome. I don't think this is where he is at, he should wait for finasteride to work for him, but that would also be a non-surgical option considering his hairline is good.
Hey joe can you give me your protocol for stoping minoxidil? Been on it for several years but the side effects are becoming to concerning. I’m taking proscar 1.25 with zero side effects
Interesting video Joe, thanks for clarifying especially on the use of fin before undergoing a transplant. If you want to do something similar with someone who already had a hair transplant, feel free to use some of my material.
Joe tillman, do u have any opinion on cb-03-01 casiopia breezula? Its supposed to be fda approved soon as a 7.5% solution androgen receptor antagonist or topical anti androgen.
Special request. Do a consultation on African "kinky" hair. My research tells me that they naturally have less hair grafts than other races and have higher rates of transection among many transplant surgeons I've seen online. Plus there is much less b4 and after photos for African hair transplant online. Only one doctor I've seen with many African hair patients (seems to be a South Korean in America). So what's your advice? I watch you from Kenya. I'll find the time to send you my pics. I think I'm NW 5 and like you have a very dense beard.
Is there a good hair restoration clinic in Abu Dhabi or in Dubai that you could recommend? I live and work in Abu Dhabi, but other locations such as Dubai or other Emirates would be ok.
Agree that he should wait to do anything surgical and stay on propecia. He has a good looking head of hair from the front view. He has enough hair to use concealers in the crown for now.
Hi Joe what a fantastic video, it really was like my Hairloss condition and what I was recommended in Thailand. Like you said in your video, I'm back on micro dose of finastride and want to make sure prevention of more loss over the years.
Why not minoxidil for the crown Joe? I'm in a similar situation to this guy, although not as bad, and I've just bought minoxidil to treat the thinning scalp :/
Topical minoxidil is, in my opinion, one of the least effective options so I rarely recommend it. There is oral minoxidil which I may add to the mix as more data comes in. It's been around for decades but it is only now that more doctors are recognizing it's benefits.
@@hairtransplantchannel thanks for the input Joe. Im going to move onto a new product soon it is 5%minoxidil, 1% finasteride topical foam. It's supposedly the new way forward with 0 sideffects. I'm willing to give it a try anyway. Cheers
The yoitube ad for this video told me hair loss is not influenced by genetics, that alopecia and all the other names for it are down to the fact I'm not drinking coffee, wtf
Completely recoverable with dutasteride mesotherapy and topical dutasteride + a growth agonist. Hundreds of patients are successful with this protocol. Finasteride is not enough. He will at best maintain the same look as of now.
I understand why you'd say that but "hundreds" is an incomplete metric as I don't know the comparison to how many it has not worked well for. Finasteride may be enough as I've seen many cases improve between month 6 and month 12 and beyond so I disagree with your "at best" comment, but I do appreciate it. Thanks for commenting.
@@hairtransplantchannel What would be the point of patients posting about a treatment that did not work for them. Within the success stories on forums we have hundreds of positive ones with topical dutasteride and mesoterhapy. We also have successful stories with Finasteride. Very rare cases of regrowth. Mostly maintenance Now why would you give someone an oral 5AR blocker with the side effect profile it has inhibiting not only DHT but also allopregnanolone and dihydroprogesterone when you have topical alternatives without systemic serum reduction (topical dutasteride) is beyond me. Not only this, it actually reduces 80% of scalp DHT vs 50% of Finasteride.
@@testosterona7143 Links to studies showing this please. I deal with the greater standards, not fringe treatments. You said "topicial Dutasteride" but which formulation? There are literally dozens to choose from so saying "topical" anything is better than the standard that has been around for nearly thirty years is lazy science. I'm not against topical, or anything that can be a substitute of the standards as I routinely tell people that if they can't tolerate oral then topical can be a great option.
@@testosterona7143 please tell me a quality topical Dutasteride that you know is effective. I want to start that. Mesotherapy I plan to do this year too
He could, but then he's getting into the higher numbers and I think it best to do one section at a time, especially when one section requires so much attention.
Bangkok star i've had horrible side effects from minoxidil for at least 2 years. Pretty much ruined the quality of life for that time. What are the side effects you're experiencing from finasteride? Wish you the best my friend.
@@Dwolfmusic Ruined my whole life. worst possible sides are pelvic floor nerve damage. This drug changes your world upside down. Being treated at the research center of PFS now for over a year
Worth the wait. Great video!
Thank you!
@@hairtransplantchannel Hi Joe, This is Bruce from Houston. I call in to the Bald Truth periodically to talk with you guys. Yiu know my long history starting in 1995 with the famous place we all know from those days and today still. I recently, December had a 2426 graft FUT surgery with Dr. Arocha. Hairline and frontal 3rd.
Down to earth salt of the earth kind of guy!
Very caring. He listens and repeats back what the person says. So the 2 small procedures in 1995 and 1996, failures. Then south Florida FUT with ok coverage but still thin. Then 3 years ago I discovered you and Spencer. You probably remember I offered you 1k for a consultation a few months back! Lol! I was serious. I have missed some shows during the holidays and the Monday show recently thrown in the mix threw me off but I will get back on track with the live shows soon so I can call in and share conversation with you and Spencer. Also I recently received my order of grow MD and follicle spray. One last thing I want to share is I'm 54 years old now and have had 4 surgeries. I don't want to do this again for several reasons! From cost to the healing to results! If I can ever help you by sharing my experiences and help the younger generation understand these experiences please let me know sir! Please keep rolling brother!
I was in this situation almost exact...my thinning crown was just a little bigger...I tried the minoxidil and finasteride combo for years and had some improvements but nowhere near what I wanted....I did my first crown transplant 2500 grafts which filled in in nicely but could still see the spot ....7 years later I went to Dr. Scott Alexander in Phoenix...he specializes in density...he did another 2500 in the crown and after 5 months I have complete coverage...with another 7 months to go for final results....Changed my life as far as having a goal to get my crown back...I did have good donor hair and no real hairline problems....so I was lucky that way...All the best...and I love the RUclips channel...Keep it up...J
Does he do FUE or FUT?
go on topical dutasteride, trust me. It regrew my crown and saved my hair, no sides.
@@testosterona7143 please tell me the one you used. I’ve been trying to get on topical Dutasteride but there’s too many to choose from.
@@testosterona7143 please tell me the one you used. I’ve been trying to get on topical Dutasteride but there’s too many to choose from.
Great Video as always Joe! Happy New Year! Question: In this case, where there is a large area of loss in the crown, it seems difficult to know where to take the strip from, as its possible that the area of loss there might probably grow downward toward the back of the head. Second question, When consulting, do you ask if the subject has high BP? I started taking low dose oral minoxidil, and I also suffer from borderline to high blood pressure. Adding this to my regimen seems to have al least marginally helped my BP. Its still too early to tell whether it has had any impact on my area of loss. It does appear to have has some effect on beard hair though.
Hey Mordy, Happy New Year! I couldn't get into that as what you saw were the only photos I had to deal with but his donor area, for FUT, would be typical where the posterior incision line would be just above the nuchal line. Feel the bony protrusion along the back of your scalp and move up one finger width and that's about where most strips are removed. The lateral donor zones would be higher in order to allow for a continued fade cut and it should still be safe while staying in the traditional donor zone. The danger is going too far forward as I've seen donor scars, or the frontal tips of them, exposed from continued recession. I've only ever seen one patient whose lateral donor scars were visible due to downward creep from the parietal humps.
I don't ask about BP as that is something for the clinic to ask. I would ask about it when I was working in clinic however and it is usually a part of most standard consultation forms.
Thanks for creating this channel very informative . Look forward to more videos I will be visiting your website too! Happy New Year!
Thanks, Nelson. Happy New Year to you as well.
Hey Joe. A great start to your new series of advice for us follicularly challenged. Excellent choice of a hair loss candidate to begin with. Thanks for sharing!
Thanks, Oncall21.
Could you make more vids on PRP? Does it actually help? I've heard mixed things
Thank you. I only want to send good pictures because a surgery is a really big thing that will affect me all my life. Thanks for your videos and educating us.
This was possibly the most useful video I've seen you do! Thanks!
Hi Joe, This is Bruce from Houston. I call in to you and Spencer periodically on the Bald Truth Podcast. Have been for 3 years.
You know my long history with 2 clinics in my past. I did offer you 1k one time on the show. If it weren't for you and Spencer we all would be screwed finding the right doctors in the industry. The timing lately has been hit or miss with the show. Especially the Monday thrown into the mix recently. Anyway I just wanted to drop you and others this message that I recently, December had a 2426 FUT graft surgery with Dr. Arocha! Great guy down to earth salt of the earth guy. Also recently I ordered and received my Grow MD shampoo and follicle spray! Loo
Joe, very informative and insightful. Thanks to both you and the case participant.
Thanks, Leo. I've got more coming.
I'm actually in a very similar position to this guy. I'm 39 and from the front I still look like I have a full head of hair with only some very mild recession in the front, which isn't enough to really bother me yet.
Hair loss has been a slow burn for me. I first noticed my crown starting to thin in my late 20s and remember looking into finasteride about 10 years ago, but got scared away by the posts online saying that if you take finasteride you'll never be able to get an erection again blah blah blah. I wish I had ignored that back then, but it scared me away from trying finasteride for about a decade.
I finally decided that it bothered me enough to go on finasteride. I've been on a generic version of finasteride for about 3.5 months and have seen some mild improvement. I'm hoping that with another 3 to 9 months I will improve enough to not need surgery. If after being on the finasteride for 12 to 24 months it's still not enough improvement, I may try adding dutasteride into the mix once a week to see what happens. After that, oral minoxidil is also something that I may consider before surgery.
Like you say, surgery should be the last resort after trying everything else has failed. I will say there are a couple treatments I have considered and rejected. One is topical minoxidil, because I know I'd never be able to apply a topical like that every day and let it sit in my scalp long enough to absorb. That would just be too inconvenient for me to maintain. And also because I have a cat, and I have read that minoxidil is highly toxic to cats even in small doses.
The other thing I have considered and rejected is a dermaroller. I would be too worried about the cumulative scarring effect of continually puncturing the skin over the long term. I know people say it doesn't go deep enough to cause scarring, but if you're puncturing the skin, there has to be at least a minute amount of scarring taking place. And doing it over and over again for years probably isn't a good idea.
I got the same issue as this guy too I started derma rolling once a week and doing minoxidil foam (the dropper is cheaper but also greasy and doesn't look good) i'm also 39 and started taking finasteride for 3 months I think I got some new growth in the front but it's hard to tell as for the crown i'm not sure yet. I have some money put aside for a transplant but would rather see how this treatment goes for the next 9 months, I might add the laser light therapy into the mix later on but that doesn't seem too promising
Great video Joe. Although this covers a specific, and fairly unusual case, it actually covers a lot of ground and answers a lot of really good FAQ's I get from patients on a daily basis pertaining to average cases. Really valuable resource for the community and looking forward to the rest of the series.
Thanks, Scott. I've got a lot more coming:)
I thought this guy was just flexing on all of us with his hair until the back of his head was shown.
Great video, love this new format
Another excellent video joe, my opinion you know what your talking about and advise is great
Happy NY to you JT
I would use as many beard grafts as possible for the crown, this candidate seems to have a full beard maybe even 1000.
Are his crown graft estimates so high because his hair is so dense in the front? 4000 for that area would be a a density of around 80 per cm2
Great video as usual, very informative.
Greetings Mr. Joe, Thanks for the video and thanks for the information.
What about 500mgs of saw palmetto and Rogaine? Do you consider Rogaine effective?
Hey Joe, I have a question. Assume that the perfect slit is made in the recipient area. How much does the rotation (in the 360 degree plane) of the graft matter when it is inserted? Most grafts I've seen appear to be straight, but I've also seen some that are more curved. This is a new topic I had never heard of before and wanted to get your opinion on it, thanks.
Excellent question. In fact, it gives me a good idea for a new video:) I'll try to be succinct.
It matters if there is a wave to the hair that protrudes below the plane of the scalp tissue as the goal is to have a consistent exit angle from one graft to the next. Some may compare it to a corkscrew inside of a cork, but this is a false analogy as the illusion is that the exit angle is always the same due to the characteristics of the situation that a cork and corkscrew presents. With a graft, the exit point is larger than the hair shaft as it is sized to match the size of the tissue of the graft, not the hair shaft itself so a better analogy is to consider the corkscrew as the hair shaft and the cork as the supporting tissue (the graft). It fits perfectly (if not a bit too snug) into the bottle so if you could rotate the cork itself you'd be able to orient the exit point of the corkscrew based on the rotation. I hope that makes sense. Keep in mind for tight curls, like those on patients with afro-centric hair, the rotation isn't nearly as important. This is more important with single hair grafts as multi-hair grafts, hopefully behind the hairline, do not benefit as much from this practice as long as the general angle and direction are consistent.
With straight hair it still matters, especially if the surgeon is trying to achieve coverage with a minimal number of grafts, even with multi-hairs. This however also depends on the incisional tool being used. If a flat blade is being used, there is no rotation because you can't rotate something inside of a flat rectangular cut. If it is rounder, as one would have with a needle, then this can be done. The advantage to blades however comes into play when the grafts themselves can be surgically modified beyond simply being separated from the donor scalp and placed into an incision. If one has, say a four hair graft, it is somewhat round or oval in shape, both in the orientation of the hair shafts and the surrounding tissue due to the excision or separation process. If the clinic is skilled, they can make a center partial slice down the middle of the tissue so that instead of a round or oval graft, it unfolds and is now flat. This means that the hairs that were once bunched into a hay bale are now spread out laying side by side and once they're inserted into a flat incision, they give more coverage than had they remained in the hay bale. This isn't necessary for great coverage as a lot of clinics don't use flat blades and get excellent results, but my heart still prefers blades for this process if the clinic is skilled with them. I hope that answers your question.
@@hairtransplantchannel Complicated topic to explain but that mostly makes sense :) thanks for the detailed explanation. Double checking my understanding - if the graft is straight, and the incision is being done with a round needle, then the rotation of the graft shouldn't matter, right? Do you know what percentage of people have a wave to their grafts? What percentage of "top clinics" take this into account and adjust the implantation accordingly? It seems like accounting for this would take a lot more effort.
@@Max-ot1hh It is complicated, indeed. To answer your first question, more or less, yes. It shouldn't matter. When placing into incisions made with a needle however the primary aesthetic factor is the exit angle and if the incision is in the sagittal plane then better clinics may make the angle flatter to the scalp as the healing process tends to make grafts elevate to a higher angle than originally placed. I don't have the general percentages you're asking about but the percentage of top clinics that do consider this is small and most don't talk about it publicly as they may consider it to be a trick of the trade.
@@hairtransplantchannel Interesting!
My hairloss is different from his but this was still very helpful, thank you. May I ask why you wouldnt suggest Minoxidil ?
I've rarely seen it to be effective to the point that patients love it. It has also always seemed to be a pain in the ass for most patients as a stand alone treatment.
@@hairtransplantchannel Ok good to know, thank you. I appreciate you.
Why do recommend against minoxidil?
Very interesting video. Great job.
Interesting to see the process
Joe whats your thoughts on fixing a botched hairline from previous surgery? Can relocating transplanted hair cause scarring? Is it better to just work with the existing hairline?
Very tough to answer. My old hairline was simply camouflaged. A lot of hairlines should be removed completely and rebuilt from scratch and there are two ways to do that. A strip for the hairline or FUE.
@@hairtransplantchannel thanks. Dr. Wong suggested remove old grafts and relocate. Do a small session and see how it heals before proceeding. Then other clinics I spoke with said there's alot of potential of scarring. So just work with existing hairline and dense pack . Not sure what to do.
Thanks for the valuable Insight Joe!
@Hair Transplant Joe Tillman Hey Joe i have a question about grafts per cm2.. My doctor said he likes to keep it around 20 for adequate blood supply... what's your take on this?
I think your question has more to do with the limits of surgical density. 20 is fine, but it can go higher. There is the law of diminishing returns however once one reaches a certain threshold but that threshold is a variable dependent on the tools used to make incisions, the size of your grafts, the vascularity of the area being treated, etc. All things being equal, I feel that 40 per cm2 is probably the sweet spot, give or take.
Thanks for the information Joe
Any time!
Hi thank you for being helpful and I would like to ask you I have the same issue hair loss in the crown and I’m using minoxidil for 5 months but to be honest is day after day or sometime I stop for 3 or 4 days and use it again I feel that my hair is regrow again but I can’t still use minoxidil for the long time ,so now what do I need to do if I wanna do hair transplant ? should I stop taking minoxidil until my new hair fall out or it doesn’t matter ,so I can do the hair transplant. I’m afraid if I do the transplant the area which is not active with minoxidil will grow normally after the surgery but what about the hair which grow by minoxidil ? It may cost me 1500 grafts but later on after I stop using minoxidil it may cost 2000 grafts so that’s my problem
Such a great idea Joe. Time to submit my photos :)
Great video, thank you Joe.
He seems to be thinning a lot on the crown but there is no area that is completely gone, can't he get full density back if he is a good responder to finasteride and minoxidil? Isn't it too early for him to think about hair transplant?
With all the products for hair regrowth what is a good one togo with
How can I submit my pictures of before and after a surgery that went totally wrong, I need your consultation ;that would also help other people
Go to my website at hairtransplantmentor.com, register and fill out the form.
@@hairtransplantchannel thanks a lot.
Great video, my hair is probably just slightly worse than this guys and I have similar hair style. Hope I also win the contest!
Edit: also not sure if I missed it but would you also recommend minoxidle to this patient?
Thanks, and you're entered now into the contest:) No, I mentioned that I don't recommend it as I don't think it is worth the time. This is referring to topical however as oral minoxidil has the potential to be more helpful. In hindsight, I could have mentioned that but I don't always remember to share the details since I don't write a script and everything is always off the top of my head:)
@@hairtransplantchannel Do you have any videos talking about oral minoxidil? Also it seems hard to get it prescribed..
@@hairtransplantchannel thanks for the response! This helps a lot as I’m considering minoxidle and just didn’t know if it’s really worth the hassle. Thank you
Happy New Year Joe!! Glad to see New Content, great video as always! I was wondering if you would recommend dr. Rahal for hairline repair work or if there are any doctors that have good track records of repairing botched hairlines from previous HTs?
I think the best thing to consider is if there is a healthy amount of repair cases on any clinic's website and go from there. After you've found a few that have several cases that look good to you, reach out and ask to speak to repair patients and see what happens.
@@hairtransplantchannel Thank You Joe. How did you find Dr. Wong for repair work?
@@jayeshaw5705 Are you asking about the repair work on myself? You can judge for yourself by looking at my history on my website and then looking at me now. If you're asking about how he has dealt with other repair patients, I'll say he's one of the most creative and clever doctors I've ever met.
@@hairtransplantchannel Thanks again Joe! Your hairline looks amazing, so I'm sure Dr. Wong does great work. Appreciate your input very much 👌
been thinking of trying finasteride but worried about conceiving with my wife. any ideas whats the best way to go about it? Thanks
Don’t be on fin while conceive on fin, the half life is
I'm not a doctor. As far as I know there is zero documentation showing that finasteride has ever caused an issue with conception much less being the cause of birth defects. However, it is best to discuss with your doctor or consider going off for a while and jump back on once conception is confirmed. Good luck, and have fun:)
If I was in his shoes I would go for 1800-2000 grafts. The physician should extract only grafts with multiple hair follicles. Diffuse placement of the grafts. Evaluate it after 18 months.
After 18 months consider combining this area with an SMP so he can save his donor area for future hair loss progression.
I've seen great results where people with this pattern shave it down to wear a hair system but keep their natural hairline. So they get great coverage and a natural outcome. I don't think this is where he is at, he should wait for finasteride to work for him, but that would also be a non-surgical option considering his hairline is good.
Great video
Thanks, buddy.
Hey joe can you give me your protocol for stoping minoxidil? Been on it for several years but the side effects are becoming to concerning. I’m taking proscar 1.25 with zero side effects
Hi. Have you found this answer elsewhere?
Interesting video Joe, thanks for clarifying especially on the use of fin before undergoing a transplant. If you want to do something similar with someone who already had a hair transplant, feel free to use some of my material.
Great information
Glad it was helpful!
Joe tillman, do u have any opinion on cb-03-01 casiopia breezula? Its supposed to be fda approved soon as a 7.5% solution androgen receptor antagonist or topical anti androgen.
Last I looked into it, I wasn't impressed, but I've also not kept up with it. I may look at it further some time.
Brilliant video. Most of people would be jealous of his hair though :D
Thank you my friend.
Are you talking about joe’s hair?
@@Kostebe26 I was talking about the subject of this video, but Joe's HT is pretty good too :D
Special request. Do a consultation on African "kinky" hair. My research tells me that they naturally have less hair grafts than other races and have higher rates of transection among many transplant surgeons I've seen online. Plus there is much less b4 and after photos for African hair transplant online. Only one doctor I've seen with many African hair patients (seems to be a South Korean in America). So what's your advice? I watch you from Kenya.
I'll find the time to send you my pics. I think I'm NW 5 and like you have a very dense beard.
Is there a good hair restoration clinic in Abu Dhabi or in Dubai that you could recommend? I live and work in Abu Dhabi, but other locations such as Dubai or other Emirates would be ok.
Eugenix Hair Sciences is a short flight away in Mumbai and they come to Dubai regularly for consultations as of late.
Good video
Agree that he should wait to do anything surgical and stay on propecia. He has a good looking head of hair from the front view. He has enough hair to use concealers in the crown for now.
Hi Joe what a fantastic video, it really was like my Hairloss condition and what I was recommended in Thailand. Like you said in your video, I'm back on micro dose of finastride and want to make sure prevention of more loss over the years.
Is 0.5mg effective for fin doc
Good job
Why not minoxidil for the crown Joe? I'm in a similar situation to this guy, although not as bad, and I've just bought minoxidil to treat the thinning scalp :/
Topical minoxidil is, in my opinion, one of the least effective options so I rarely recommend it. There is oral minoxidil which I may add to the mix as more data comes in. It's been around for decades but it is only now that more doctors are recognizing it's benefits.
@@hairtransplantchannel thanks for the input Joe. Im going to move onto a new product soon it is 5%minoxidil, 1% finasteride topical foam. It's supposedly the new way forward with 0 sideffects. I'm willing to give it a try anyway. Cheers
why not Minoxidil?
Nice vid
Good information!
Great Infos. Thanke You Joe.
Thanks!
Hey Joe, when is the next live Bald Truth podcast?
Great
The yoitube ad for this video told me hair loss is not influenced by genetics, that alopecia and all the other names for it are down to the fact I'm not drinking coffee, wtf
RUclips "ad"? If hair loss was due to a lack of coffee, well, use your imagination:)
@@hairtransplantchannel like before your video starts RUclips puts random advertisements don't they, if you understand what I mean.
Completely recoverable with dutasteride mesotherapy and topical dutasteride + a growth agonist. Hundreds of patients are successful with this protocol. Finasteride is not enough. He will at best maintain the same look as of now.
I understand why you'd say that but "hundreds" is an incomplete metric as I don't know the comparison to how many it has not worked well for. Finasteride may be enough as I've seen many cases improve between month 6 and month 12 and beyond so I disagree with your "at best" comment, but I do appreciate it. Thanks for commenting.
@@hairtransplantchannel What would be the point of patients posting about a treatment that did not work for them. Within the success stories on forums we have hundreds of positive ones with topical dutasteride and mesoterhapy. We also have successful stories with Finasteride. Very rare cases of regrowth. Mostly maintenance Now why would you give someone an oral 5AR blocker with the side effect profile it has inhibiting not only DHT but also allopregnanolone and dihydroprogesterone when you have topical alternatives without systemic serum reduction (topical dutasteride) is beyond me. Not only this, it actually reduces 80% of scalp DHT vs 50% of Finasteride.
@@testosterona7143 Links to studies showing this please. I deal with the greater standards, not fringe treatments. You said "topicial Dutasteride" but which formulation? There are literally dozens to choose from so saying "topical" anything is better than the standard that has been around for nearly thirty years is lazy science. I'm not against topical, or anything that can be a substitute of the standards as I routinely tell people that if they can't tolerate oral then topical can be a great option.
@@testosterona7143 please tell me a quality topical Dutasteride that you know is effective. I want to start that. Mesotherapy I plan to do this year too
Hey testosterona. I’d love to know the topical Dutasteride you used. I’ve been searching a month to find the best quality one. It’s hard to know.
Joe I commenting just for yoy
Perfect for fibers.
Joe he should do a moderate transplant on crown n like 1000 in the hairline
He could, but then he's getting into the higher numbers and I think it best to do one section at a time, especially when one section requires so much attention.
Would love to send you pictures of my hair and get your opinion , I’m 20 and definitely have something going on 🙃
I can't guarantee it'll get a video as I have a lot of people sending in their info but feel free to submit your info on my website.
Sign me up to win the products 👍🏻👍🏻
I need hair
Dont even touch Finasteride. still suffering from its irreversible side effects.
Bangkok star i've had horrible side effects from minoxidil for at least 2 years. Pretty much ruined the quality of life for that time. What are the side effects you're experiencing from finasteride? Wish you the best my friend.
@@Dwolfmusic Ruined my whole life. worst possible sides are pelvic floor nerve damage. This drug changes your world upside down. Being treated at the research center of PFS now for over a year
@@Dwolfmusic what side effects did minoxidil give you ??
gret video I like Eugenix india
N he can use fibers for the back
True, of course.