Fue/fut Combined With Scalp Micropigmentation To Gain Density

[The Balding Boulder]

I was thinking about this: why isn't scalp micropigmentation (SMP) publicised more? For many people who are unable to achieve the density they would like via one or multiple hair transplants, it makes sense to consider SMP. I know that SMP is often used to mark out the linear scar that a FUT leaves behind, but you could go beyond that.

Couldn't you maximise your number of grafts in the donor zone if you cleverly utilised SMP? I'm not suggesting that you transplant every hair from your back and sides and then use SMP to fill in this huge area, but surely the advantage would be that you could take out a lot more grafts out of these areas and create the illusion that your donor zone is fuller than it actually is.

I'm certainly considering utilising SMP for my thinning crown whilst I use a FUT/FUE for the frontal areas.

Have a look here: http://fue-hairtransplant.blogspot.co.uk/2014/03/more-interesting-stuff-about-scalp.html?m=1.

 

[JeanLucBB]

Time and money. People get sick of dealing with this sh*t after it breaks a certain threshold of acceptability. If time, money and mental energy spent on this combo doesn't bother you, then good plan. You're better off absolutely maximising the potential benefits of transplants before you move onto SMP though, through multiple procedures. Obviously SMP is an ongoing commitment also, which means shaving your head again every few years, and everlasting financial commitments.

 

[The Balding Boulder]

Time and money. People get sick of dealing with this sh*t after it breaks a certain threshold of acceptability. If time, money and mental energy spent on this combo doesn't bother you, then good plan. You're better off absolutely maximising the potential benefits of transplants before you move onto SMP though, through multiple procedures. Obviously SMP is an ongoing commitment also, which means shaving your head again every few years, and everlasting financial commitments.

It's just that I have a thinning crown as well as a receding hairline. From everything I've read, surgeons prefer to work from front to back, saving any additional grafts for later on if the hair in the frontal and mid sections has thinned away. That means the crown is tricky. I've been on finasteride and minoxidil for about 21 months. The photographic evidence I have suggests there has been little difference in the state of my hair — that could be seen as an improvement in itself though.

Perhaps the most realistic option is to get the frontal area fixed after the first hair transplant and then wait 3–4 months to get SMP to densify the crown and anywhere else deemed thin on top.

Apparently SMP needs touching up every 2–5 years, although if it's being mixed in with hair, the effect may last longer.

 

[JeanLucBB]

It's just that I have a thinning crown as well as a receding hairline. From everything I've read, surgeons prefer to work from front to back, saving any additional grafts for later on if the hair in the frontal and mid sections has thinned away. That means the crown is tricky. I've been on finasteride and minoxidil for about 21 months. The photographic evidence I have suggests there has been little difference in the state of my hair — that could be seen as an improvement in itself though.

Perhaps the most realistic option is to get the frontal area fixed after the first hair transplant and then wait 3–4 months to get SMP to densify the crown and anywhere else deemed thin on top.

Apparently SMP needs touching up every 2–5 years, although if it's being mixed in with hair, the effect may last longer.

Pics of your situation? Chances are your donor can handle the grafts to transplant with your longterm requirements unless you're beyond a NW5 final pattern, in which case that would be the smarter option to begin with. If it's very small crown loss with miniaturisation but still has some density and you're not losing hair on medication, then maybe SMP is a better option, otherwhise transplant.

 

[The Balding Boulder]

Pics of your situation? Chances are your donor can handle the grafts to transplant with your longterm requirements unless you're beyond a NW5 final pattern, in which case that would be the smarter option to begin with. If it's very small crown loss with miniaturisation but still has some density and you're not losing hair on medication, then maybe SMP is a better option, otherwhise transplant.

Here you go. I struggle to tell what Norwood classification I am.

 

[JeanLucBB]

Here you go. I struggle to tell what Norwood classification I am.

NW4 but a NW5 pattern that isn't difficult to deal with, hard to tell for sure but your donor doesn't look bad either at least from that angle. If you're confident you're stable on medication I think in your circumstances you should opt for a large megassession with Erdogan for FUE or Hasson/Wong if FUT at around the 5000 graft mark. You'd likely get results you'd be happy with from that alone.

 

[The Balding Boulder]

NW4 but a NW5 pattern that isn't difficult to deal with, hard to tell for sure but your donor doesn't look bad either at least from that angle. If you're confident you're stable on medication I think in your circumstances you should opt for a large megassession with Erdogan for FUE or Hasson/Wong if FUT at around the 5000 graft mark. You'd likely get results you'd be happy with from that alone.

Isn't the danger with a megasession that the shock loss could cause many of the grafts to fail?

And is it better for my situation that I start off with a FUT to get the highest yield possible? I could get SMP on the scar if I was too bothered by its visibility.

 

[JeanLucBB]

Isn't the danger with a megasession that the shock loss could cause many of the grafts to fail?

And is it better for my situation that I start off with a FUT to get the highest yield possible? I could get SMP on the scar if I was too bothered by its visibility.

If you have no issues with getting an FUT or the scarring aspect and risks involved there then yes it a worthwhile option. Just from a basic judgement of your hairloss pattern,donor situation and stabilisation on meds I wouldn't consider it mandatory however. Look into some doctors and particularly their patient posted results on forums, email consult with a few clinics etc and figure out who you prefer. Regarding doctors who are most experienced with larger cases like yours I would definitely focus most on Erdogan for FUE and Hasson/Wong + Rahal also for FUT. I'd opt for the one with the most appealing results, conduct/ethics and consistency from your research moreso than the FUE/FUT debate however.

The risk of noticeable and permanent shockloss in the recipient is miniscule, I'd be more worried about this in the donor in terms of likelihood, particularly in the case of FUT around the scar. The first 4 months post-op of a hairtransplant aren't fun and you're better off going with a surgeon who can provide an acceptable, full coverage result in one go so you can avoid this again in the future. The less procedures you have the lower the risk of complications.

Also from your crown pic it definitely looks like its ready to be transplanted into, I would focus on a megassession around the 5000 graft mark first including crown work and after that consider the SMP, but you may not need it necessarily after 1500ish grafts in there.

 

[The Balding Boulder]

If you have no issues with getting an FUT or the scarring aspect and risks involved there then yes it a worthwhile option. Just from a basic judgement of your hairloss pattern,donor situation and stabilisation on meds I wouldn't consider it mandatory however. Look into some doctors and particularly their patient posted results on forums, email consult with a few clinics etc and figure out who you prefer. Regarding doctors who are most experienced with larger cases like yours I would definitely focus most on Erdogan for FUE and Hasson/Wong + Rahal also for FUT. I'd opt for the one with the most appealing results, conduct/ethics and consistency from your research moreso than the FUE/FUT debate however.

The risk of noticeable and permanent shockloss in the recipient is miniscule, I'd be more worried about this in the donor in terms of likelihood, particularly in the case of FUT around the scar. The first 4 months post-op of a hairtransplant aren't fun and you're better off going with a surgeon who can provide an acceptable, full coverage result in one go so you can avoid this again in the future. The less procedures you have the lower the risk of complications.

Also from your crown pic it definitely looks like its ready to be transplanted into, I would focus on a megassession around the 5000 graft mark first including crown work and after that consider the SMP, but you may not need it necessarily after 1500ish grafts in there.

Okay, you seem to be suggesting that I have as few sessions done as possible. But many surgeons prefer to spread it out a bit in 2–3 sessions.

How many grafts do you reckon I would need for the hairline alone? Maybe I could get the hairline done first and the gap behind the island and then 6 months later target the midsection and crown.

 

[JeanLucBB]

Okay, you seem to be suggesting that I have as few sessions done as possible. But many surgeons prefer to spread it out a bit in 2–3 sessions.

How many grafts do you reckon I would need for the hairline alone? Maybe I could get the hairline done first and the gap behind the island and then 6 months later target the midsection and crown.

The surgeons that will suggest that are the surgeons that don’t have the skill to do megasessions. There is absolutely no reason to do the hairline first and later on target the crown and midscalp. Not all doctors are equal and neither is their advice, look at erdogan and hasson/wongs success with 5000ish graft megasessions, they are as consistent as any surgeons in the world and collectively thousands of these cases are available to look at online.

Roughly 3000 in the front, with 2000 in the crown and midscalp.

 

[Pequod]

I'd suggest getting 3000 done on the first one to see how it looks. Do the hairline and move back as far the as the remainder takes it, then wait a year to see the result.

 

[The Balding Boulder]

I already have a clinic I am considering in London so I will have to discuss it with them.

With mega sessions, how long does it typically take? Would I have to go home after the first day and return for the next part the following day?

 

[JeanLucBB]

I already have a clinic I am considering in London so I will have to discuss it with them.

With mega sessions, how long does it typically take? Would I have to go home after the first day and return for the next part the following day?

Unless it's Dr. Ball don't go to any clinics in the UK or London. Pay attention to what I just said, you're wasting your time and money if you do. They are overpriced marketers and very much below par globally. For FUE it would be over 2 days and for FUT over one day. Typically you arrive the day before the surgery, they do consultation and basic analysis, the following day perform the procedure and you go home the day after that.

This is a serious surgery that especially in London is going to cost you a significant amount of money, don't treat it like a joke by not being willing to travel away from home for a surgeon that is competent, rather just a good self promoter with a nice website like 95% of the surgeons in the UK. Look to Belgium at least if you want to stay close, in particular Dr. Bis.ang.aa and Dr. Feriduni for FUT.

 

[JeanLucBB]

Have fun overpaying with your shitty doctor for shitty results then you naive f*****g idiot. Make sure to do it over 5 procedures with your greedy hack of a surgeon. As SMALL as possible.

Looks like you'd already been swindled and made up your mind you pea-brained mong. Enjoy sh*t results.

 

[The Balding Boulder]

Unless it's Dr. Ball don't go to any clinics in the UK or London. Pay attention to what I just said, you're wasting your time and money if you do. They are overpriced marketers and very much below par globally. For FUE it would be over 2 days and for FUT over one day. Typically you arrive the day before the surgery, they do consultation and basic analysis, the following day perform the procedure and you go home the day after that.

This is a serious surgery that especially in London is going to cost you a significant amount of money, don't treat it like a joke by not being willing to travel away from home for a surgeon that is competent, rather just a good self promoter with a nice website like 95% of the surgeons in the UK. Look to Belgium at least if you want to stay close, in particular Dr. Bis.ang.aa and Dr. Feriduni for FUT.

It is a serious surgery, and that's why I am willing to pay a bit more for the job locally rather than go to eastern Europe or India to get it done cheaper.

Location does matter to me. What happens if I need to go back because there are complications? Having to go abroad is not convenient. I'm not disputing everything you say by any means, but the prices I have spotted from a certain clinic seem reasonable without being too cheap — and it's based in London. They say they're fixed prices as well, so it's nice to know exactly the number of grafts I would be paying for.

You seem very dogmatic about everything. One thing I have realised is how much inconsistency there is in what surgeons and the hair loss community suggest. This is why I want to keep my options open by listening to different points of view and weighing them up at the end.

I will listen to you, but not exclusively listen to you. Thank you very much.

 

[JeanLucBB]

It is a serious surgery, and that's why I am willing to pay a bit more for the job locally rather than go to eastern Europe and India to get it done cheaper.

Location does matter to me. What happens if I need to go back because there are complications? Having to go abroad is not convenient. I'm not disputing everything you say by any means, but the prices I have spotted from a certain clinic seem reasonable without being too cheap — and it's based in London. They say they're fixed prices as well, so it's nice to know exactly the number of grafts I would be paying for.

You seem very dogmatic about everything. One thing I have realised is how much inconsistency there is in what surgeons and the hair loss community suggest. This is why I want to keep my options open by listening to different points of view and weighing them up at the end.

I will listen to you, but not exclusively listen to you. Thank you very much.

"One thing I have realised is how much inconsistency there is in what surgeons and the hair loss community suggest. This is why I want to keep my options open by listening to different points of view and weighing them up at the end."

This is very much accurate, I would specifically say though if there was one take away I could give as a patient and someone who has researched the subject hugely (too much) it is to go abroad for surgery and look to different perspectives like you say. You're not going to get a better or even an equal result in the UK to elsewhere. Clinics worth their salt are set up to deal with complications. I promise you that you'd be making a mistake to opt for a surgery in London. Saying this because you seem very intent on the "comfort" aspect of doing it at home, the more important issue however is that if you're undergoing surgery to rectify an issue you take seriously you ought to focus on who is going to give you the best result, not the shortest drive.

Also focus on patient posted results, don't listen to what doctors tell you because its never anything but self-promotion.

 

[The Balding Boulder]

"One thing I have realised is how much inconsistency there is in what surgeons and the hair loss community suggest. This is why I want to keep my options open by listening to different points of view and weighing them up at the end."

This is very much accurate, I would specifically say though if there was one take away I could give as a patient and someone who has researched the subject hugely (too much) it is to go abroad for surgery and look to different perspectives like you say. You're not going to get a better or even an equal result in the UK to elsewhere. Clinics worth their salt are set up to deal with complications. I promise you that you'd be making a mistake to opt for a surgery in London. Saying this because you seem very intent on the "comfort" aspect of doing it at home, the more important issue however is that if you're undergoing surgery to rectify an issue you take seriously you ought to focus on who is going to give you the best result, not the shortest drive.

Also focus on patient posted results, don't listen to what doctors tell you because its never anything but self-promotion.

Many clinics seem to want to lure people. Is a free consultation a bad thing? Surely time is money, so I am a little skeptical about that. Some clinics I've come across online are charging like £50 for a consultation. Surely a proper discussion with you and a scalp assessment would take a good hour.

 

[JeanLucBB]

Many clinics seem to want to lure people. Is a free consultation a bad thing? Surely time is money, so I am a little skeptical about that. Some clinics I've come across online are charging like £50 for a consultation. Surely a proper discussion with you and a scalp assessment would take a good hour.

I'd only be sceptical if there was a very short waiting list on consultations. Some of the best clinics in the world require a years wait prior to a consultation, however very few charge for it simply because the clinics that cater to international patients in general don't have patients that want to travel for it, and will only have one along with the surgery. If the waiting list is shorter than 3 months for a consult I'd be worried.

At the end of the day a consultation for a patient is largely a waste of time, a surgeon isn't going to be able to tell you a significant deal more than I have or their website does. They're more specifically for the surgeon to collect data for themselves (donor density, laxity, hair quality, hair thickness etc) and engage in planning rather to inform you as a patient, also to provide a spot to deal with your desires on hairline design, what you want to achieve etc. which again is mainly for the surgeon.

 

[Pequod]

You're taking a risk with a FUT mega session, 5000 FUT like that is insane.

 

[JeanLucBB]

You're taking a risk with a FUT mega session, 5000 FUT like that is insane.

What do you base this stupidity on? Hasson and wong have been doing them for years and years more than once a week, they’ve even done cases up to 7000 grafts in a sitting. They’re probably the most overall respected clinic in the world amongst their peers. Common in the case of Rahal also.

You’re just fear mongering, if you’re not then show some evidence of a 5000 graft FUT case from hasson + wong that went wrong in some regard.