FFS and Hair Transplant with Facial Team.

[Meena]

Hello All,

New poster here. I have read the forums extensively for a couple of years but never posted before.
I am planning forehead modification with Facial Team- either later on this year or early next year and have a question regarding the hair transplants they offer.
I will be having forehead work (shaving and rounding off the forehead and orbital contouring topped off with a brow lift).
I have a low hairline but with some light thinning on the front and some slight recession on the temples. The surgeon has suggested (after I raised the issue of my hairline) that the strip of hair removed from the coronal incision be harvested for hair and transplanted in my hairline/ trouble spots. This sounds great but I'm thinking about a few things:

1) I am stealth in my day to day life. I have curly, shoulder length hair- how do I hide the fact that I've had a transplant?
2) How long does the redness/ scabbing from the transplant last? I'm thinking of taking a total of 3 weeks off work.
4) what will the growing-out phase look like? Will the regrowth areas look as if it has been shaved? How on earth do I hide that?
3) Cost- I have been quoted 6500 euros for the transplant- is it worth it? I'm not sure what FUE/ FUS goes for elsewhere. I know it is subjective but I'm asking any other women who may identify with my pattern of hairloss
4) Baldness and hairloss really are the only thing that make me dysphoric. I am paranoid that I have baldness in my head eventhough I started 'mones and anti-androgens quite early. This may sound funny but I don't want to see that strip 'going to waste' so I'm thinking maybe I'll get a transplant- but then I start thinking about points 1,2 and 3 Ha ha.
5) A more general question about transplants- does anyone know if it is possible to have a no-shave transplant (to the recipient site- I'm thinking the crown area here). Is this a thing? I'm wondering if I can ask the doctor to stuff whatever hair remains back into random parts of my crown.

Thanks all

[anjaq]

It will not be that easy to hide, I agree. Possibly you have to resort to changing your hairstyle - maybe get bangs or shorter hair in front for a while? There will be redness and eventually short hair which is of course visible. OTOH you can probably tell people you had a cosmetic procedure because you wanted to beautify your hairline - it does not have to be trans related.

The procedure with facialteam is expensive - there are much cheaper transplant options elsewhere, but they can charge the money because they do this at the same time as FFS, using hair that is already lost in FFS, so most people would feel sorry for wasting that hair, so they are willing to pay more for it than later taking a strip elsewhere and doing transplants. I do not know if there is another reason why they charge double the price.

Transplants almost always will fall out - so even if you could somehow do a transplant without shaving the hair in that part, the hair would fall out after transplant and regrow later on. Sorry.

Regarding bald spots - having a strip of hair removed at the top will create a scar on the top of the head - it may be that you need transplants later to fill that scar, unless your hair grows through the scar - something which FT tries to make possible, but I can imagine it still depends on luck and your bodys scar formation. Make sure your hormones are good and your nutrition is good, avoid medication like antiandrogens unless you really need it and habe a regular female hormone level to facilitate healing.

[Meena]

It will not be that easy to hide, I agree. Possibly you have to resort to changing your hairstyle - maybe get bangs or shorter hair in front for a while? There will be redness and eventually short hair which is of course visible. OTOH you can probably tell people you had a cosmetic procedure because you wanted to beautify your hairline - it does not have to be trans related.

The procedure with facialteam is expensive - there are much cheaper transplant options elsewhere, but they can charge the money because they do this at the same time as FFS, using hair that is already lost in FFS, so most people would feel sorry for wasting that hair, so they are willing to pay more for it than later taking a strip elsewhere and doing transplants. I do not know if there is another reason why they charge double the price.

Thanks for the info!

I think I'm going to have to try bangs. I have very curly hair though and that might be a challenge. Ugly bangs vs scars from hair transplant... hmmmm

I think the procedure from FT is so expensive because it is a different surgeon who does it and I believe he has 6 assistants helping him with the procedure. Heavens knows what they all do but I'm sure that has an effect on the cost. I really don't want to let that hair go to waste but I feel the cost is on the high side, I'm so torn. *sigh*

On the plus side, I don't need any other FFS operations. I'm getting to an age where I will start needing soft tissue age-related stuff (probably in 5-10 years) but I think there are other good surgeons for that,

[anjaq]

Honestly I do not buy that part about a specialist and 6 assistants as a reason for why it is more expensive than elsewhere. I am pretty sure that elsewhere there is also a specialist there doing this and he probably will also have assistants. I think part may be that they are a bit under time pressure to do this while the surgery is still happening - but a big part probably is that they just can charge this and people are willing to pay it. Thats free market stuff after all - you charge not for hours and materials but you charge what someone is willing to pay.
Ok, one thing I can imagine is that the hair specialist is not resident of  Marbella and there are no others there, so they have to let him travel there each time they do the surgery with transplants - which is inefficient but maybe cannot be avoided if they have no trained person to do this themselves. Otherwise one owuld have to send the strip of tissue to the specialist by express or something like that and then one woould have to drive there on the next day or so to get the transplants? (I think they do take some hours to process the strip and implants are on the next day, right? Or do they do the implants right after the surgery?)

[Meena]

(I think they do take some hours to process the strip and implants are on the next day, right? Or do they do the implants right after the surgery?)

I think they start processing it while you are having your forehead carved up and then do the transplants while you are waking up from general anaesthetic. So the 6 assistants are probably needed to make quick work of that strip they take out of your head in order to have everything ready for when your head is ready for the next round of action.
It is expensive though- I guess I will go for it simply because I can't see my precious hair going to waste.

[anjaq]

Ah ok, that would make sense. Are you sure of that? Why do they need to hurry so much - other hair transplant people seem not to be under so much pressure with the time - maybe it improves the rate of survival of the follicles?

[Meena]

Ah ok, that would make sense. Are you sure of that? Why do they need to hurry so much - other hair transplant people seem not to be under so much pressure with the time - maybe it improves the rate of survival of the follicles?

Possibly. I think also most patients appreciate getting everything done at once so that they can just concentrate on the healing afterwards. There is something to be said for that convenience, I guess.
I was reading one of your other posts and you made a good point about hairloss at the incision site (or maybe it was someone else, sorry!) when one goes for the coronal approach. This is not something I had considered but it is an important factor. I do have hair, although the hair on my crown is sparser and I can't imagine much worse than shock loss of hair right there.
I wonder how common hairloss at the coronal incision site is.

[anjaq]

I did ask about this in a FFS patient group and it seems to be rather uncommon to have bald spots at the coronal incision site. But it happens. The way I see it - if there are problems with the coronal incision scar that result in hairless patches there, the scar is not healing good and the same thing then would happen if the same surgeon had done the same thing at the hairline incision site, meaning a bad scar would have formed there. The "cure" in both cases would only be a hair transplant a few months later to cover up the coronal or hairline scar. So I guess the best thing to do is to choose a surgeon that makes "good scars" and do good aftercare to ensure healing is good.

[Debra]

I haven't had FFS yet but I did have hairline transplants for my corners a few yrs back.

I will say I took a month or more off of work simply because I didn't want people to know or see. The doctor played down a LOT how bad I would look for how long.

The truth is, the area was an off shade of red/purple/blue for months and of course the hair took months to grow out as well. I was able to kinda cover it with my hair but was definitely self conscious about it

[Jacqueline]

Hello All,

New poster here. I have read the forums extensively for a couple of years but never posted before.
I am planning forehead modification with Facial Team- either later on this year or early next year and have a question regarding the hair transplants they offer.
I will be having forehead work (shaving and rounding off the forehead and orbital contouring topped off with a brow lift).
I have a low hairline but with some light thinning on the front and some slight recession on the temples. The surgeon has suggested (after I raised the issue of my hairline) that the strip of hair removed from the coronal incision be harvested for hair and transplanted in my hairline/ trouble spots. This sounds great but I'm thinking about a few things:

1) I am stealth in my day to day life. I have curly, shoulder length hair- how do I hide the fact that I've had a transplant?
2) How long does the redness/ scabbing from the transplant last? I'm thinking of taking a total of 3 weeks off work.
4) what will the growing-out phase look like? Will the regrowth areas look as if it has been shaved? How on earth do I hide that?
3) Cost- I have been quoted 6500 euros for the transplant- is it worth it? I'm not sure what FUE/ FUS goes for elsewhere. I know it is subjective but I'm asking any other women who may identify with my pattern of hairloss
4) Baldness and hairloss really are the only thing that make me dysphoric. I am paranoid that I have baldness in my head eventhough I started 'mones and anti-androgens quite early. This may sound funny but I don't want to see that strip 'going to waste' so I'm thinking maybe I'll get a transplant- but then I start thinking about points 1,2 and 3 Ha ha.
5) A more general question about transplants- does anyone know if it is possible to have a no-shave transplant (to the recipient site- I'm thinking the crown area here). Is this a thing? I'm wondering if I can ask the doctor to stuff whatever hair remains back into random parts of my crown.

Thanks all

Meena,

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[Sebby Michelango]

If you have plans to undergo a FFS, I think you should undergo the FFS before you undergo the hair transplant. When your face are done, it's easier to get a hair transplant. The new hair can covering the FFS hairline scar and the hairline would also suit your "new" face better. Often certain hairlines suits some facial features better than others, therefor it would look more natural. Some FFS surgeon do also lowering and feminization your hairline. They remove a bit space of your skin and pull your skin with the hair on lower.

It's hard to hide the redness and the new hairs that's shorter than rest of your hair. But if you're allowed to wear hats, perhaps that might be a solution. As people mention earlier in this thread, this isn't necessary trans related. Might be cis women who undergo hair transplant after a bit hair loss too, or because they undergo it for cosmetic purposes.

[KimSails]

Hi Meena,

I can't answer your first couple of questions, but I am adding my story to give you a data point for your questions 3 and 4.

I had FFS with FT last September.  In the months before surgery, I had gone back and forth over whether I should do the transplant at the time of FFS or get the hairline incision with scalp pulled forward.  I ended up scheduling the latter.  When I arrived in Marbella Dr. Simon and Dr. Capitan convinced me that the crown incision would be the better option for me.  At that point however, it was not possible to get the transplant surgeon scheduled.  So, I got FFS with the crown incision and no transplant -- with the express knowledge that I would need a transplant later.  My understanding is that the crown incision was just an incision for the forehead work -- No strip of hair was removed. 

If you get a transplant at the time of FFS, I believe the FT surgeons size the width of the strip of hair at the crown to support the planned transplant.  In my case that was zero.  If you get the transplant then the strip width will vary according to your hair density.  I was also told that they try to under-promise / over-deliver on the quoted follicle units in the transplant.  My transplant quote was 1500-1700 units.  I was told that I could reasonably expect 1800-2000 units in the actual transplant.

At this point I am trying to schedule a return to Marbella for just the transplant.  I compared the transplant quote from FT to one from a quality hair surgeon in the US.  In my case the quotes seemed very comparable.  I plan to go to Marbella, which is a much longer travel plan, for reasons other than cost -- I trust the people at FT, I enjoyed staying at Jenny's Nest, the people (both FT and Jenny's) are lovely, and Old Marbella is a beautiful little town.

I also did a follow-up check with two women I met at Jenny's that did get the transplant at the same time as FFS.  Six months later they both seemed happy with the their transplant outcomes (in addition to the FFS outcome).

Kim

[anjaq]

Dr. Simon and Dr. Capitan convinced me that the crown incision would be the better option for me.

FacialTeam always does crown incision. They very very rarely do a hairline incision, only in cases with severe frontal hair loss and if the patient insists on doing it. Frankly, if I wanted a hairline incision, I would choose a surgeon who suggests this from the start - always do what the surgeons suggest - if you want something done otherwise, choose a different surgeon instead of forcing the surgeon to do something he did not suggest (usually that means they either have less experience in that area or they see something in your situation that makes it complicated for them to do it or it is just their conviction that something else is better and so they are not doing the alternative procedure very often)

My understanding is that the crown incision was just an incision for the forehead work -- No strip of hair was removed.  If you get a transplant at the time of FFS, I believe the FT surgeons size the width of the strip of hair at the crown to support the planned transplant.  In my case that was zero.

No! And I believe they probably told you that in consultation - in any case it is also on their website.
A crown incision to get forehead work done always results in a strip of skin with hair removed. Accoring to Facialteam that strip is about 10x1 cm, maybe a bit longer and thinner at the ends. This is done to get the loosened skin at the forehead smooth again. As you remove bone, the skin will get loose. The strip can go to the waste or it can be used to pick out about 1500-2000 follicles (which is what can be taken from a strip this size) for transplants.

[mmmmm]

in Marbella Dr. Simon and Dr. Capitan convinced me that the crown incision would be the better option for me...

What were their arguments?

Anja is right, a strip of skin, either at hairline or at crown (depending on incision) is always removed. How large is strip depends on how much extra skin there was.

[anjaq]

The standard arguments for FacialTeams type of incision is on their website. Basically they say that hairline advancement is not needed in most cases but rahter the shape should be changed - saying that a hairline incision is not really necessary - and then they say that a coronal incision is better hidden than a hairline incision as the scar is not as visible. Additionally what they told me was that if they do the incision at the top of the head, less nerves are damaged as they run from the front to the back, so cutting the nerves at the hairline affects bigger nerves than cutting more towards the back



This is basically why they never recommend hairline incisions - and I personally would not want them to do hairline incision if they never do this and have little experience doing this. As I said - always choose the surgeon who is very experienced and confident in what he is doing and do not let him do something against his usual technique and experience.

[KimSails]

What were their arguments?

Anja is right, a strip of skin, either at hairline or at crown (depending on incision) is always removed. How large is strip depends on how much extra skin there was.

They said that with my M shaped hairline I needed the corners pulled forward much more than the center and that the hair line generally reacts just the opposite in stretching -- I would have ended up with my hairline forward, but the M more accentuated than it was before.  They also said that with my hairline I would need additional transplants regardless of the original approach I took with FFS.  These issues combined, they said that I would be happier with my end-result outcome with the crown incision.

always do what the surgeons suggest - if you want something done otherwise, choose a different surgeon instead of forcing the surgeon to do something he did not suggest.

I agree with this! No matter how talented a surgeon, s/he will be be best at what they are comfortable with!

I felt good about my entire process with FT.  I always felt that the guidance I was given was based upon my best interests.  In my consult they told me the pro-cons of each approach as they saw it.  They thought I would be better off with the crown incision, but the decision was mine.  They said that they would do whichever approach I wanted.  I slept on it, and gave them my decision the next day.  There wasn't any "hard-sell".

I am not here to argue with anyone.  I am just providing my experience as one input to help others' in making a big decision.  Anyone contemplating FFS would be well served by getting as much input from as many sources as possible.  And verifying that input with each surgeon you are considering.

There are many people on Susan's that are very knowledgeable about FFS.  Anjaq and mmmmm are certainly two of them -- much more knowledgeable than I am.  I would take information here very seriously, but would still verify it directly with the surgeon.

Kim 

[Meena]

I did ask about this in a FFS patient group and it seems to be rather uncommon to have bald spots at the coronal incision site. But it happens. The way I see it - if there are problems with the coronal incision scar that result in hairless patches there, the scar is not healing good and the same thing then would happen if the same surgeon had done the same thing at the hairline incision site, meaning a bad scar would have formed there. The "cure" in both cases would only be a hair transplant a few months later to cover up the coronal or hairline scar. So I guess the best thing to do is to choose a surgeon that makes "good scars" and do good aftercare to ensure healing is good.

Ok so I had a consultation with the transplant surgeon and found out the following.
1) The strip they take as part of the coronal incision is usually around 1.5cm at the crown and going to around 1cm near the ear. This also obviously depends on how much bone they have to remove.
2) He said repeatedly that my hair looks good and that he would be able to do around 1500-2000 grafts if I have atleast 70 follicles per cm2. He was confident that I have more than this if not at the crown than at the side of my head.
3) My forehead is around 7cm at its widest part and I requested that it be brought down even more due to certain ethnological patterns of hair growth, the surgeon said that no more than 0.5cm would be possible.
4) with respect to thinning on the crown and transplants- there is a risk of damaging the existing follicles if you decide to have a transplant there so he suggested medication (Finasteride) rather than transplants. As mentioned earlier- I have minor thinning on the crown and my main concern is that having the coronal incision would make that thinning even more obbvious. Part of avoiding this will be good scar management- no exercise for a month
5) He said that I would experience hairloss at the incision site but that this would come back eventually. The transplanted hair will start growing in about 3 months.

So I am now leaning towards going with the transplants, tbh. I can use this opportunity to make some albeit minor improvements.