So after much deliberation, I decided to have a second hair transplant.

Those of you who followed this blog before will know that my first HT was far from successful.

It was a major decision to have a second attempt, because at the back of my mind, I wondered if I was fundamentally unsuitable due to my physiology. However, it seemed to me the only way I could establish this was by having another another operation, with a top notch surgeon.

This time I took the advice of Spex, who many UK hair loss sufferers will be aware of, and travelled across the pond, for FUT surgery with Dr William Lindsey on 22 December 2011 (photos at end of post supplied by Dr Lindsey).

My decision was partly influenced by Spex assuring me that Dr Lindsey would be prepared to operate even if I had an inch or so of hair in the recipient area (I will need to be fairly presentable for work by mid to late January). In the event, I think a little more hair was trimmed than I anticipated, and in any case, Dr Lindsey felt it wouldn't make much difference because of shock loss. We shall see.

Dr Lindsey's plan

I flew into Washington on 21 December, and had my consultation with Dr Lindsey the same afternoon.

One worry of mine, having lost so much donor hair during the Transmed HT (Transmed billed me for 2900 grafts), was that Dr Lindsey establish how best to use my remaining donor hair, given that I may one day end up a Norwood 6/7 like my father.

He estimated that I could get about 2500 with this FUT (we ended up with 2495), and probably 1800 to 2000 in another FUT, with FUE a further option in the future.

With that in mind, and given that I am already fairly thin in the crown/vertex area, I was a little concerned that Dr Lindsey's plan involved covering just the front third of the head, and would pack a lot of the transplanted hair very densely at the front hairline. I wondered if it might be better to use this hair further back on the head to achieve a wider, if slightly thinner, coverage.

I checked with Spex, who assured me this was good practice, so I went ahead with Dr Lindsey's suggestion.

But it means, unless I can regain (excuse the pun) some ground with Minoxidil foam, which I am yet to try, that I will certainly need another HT to attack that vertex/crown area fairly soon. And it will be pretty challenging to use my remaining donor hair to cover all the bald areas, if I follow my father's hair loss pattern.

The surgery

We kicked off at 730am. Dr Lindsey took out the strip, and punched the holes in my scalp, and then the technicians set to work inserting the transplants.

There were never more than two technicians working on my head at any one time, in comparison to four at Transmed in my first op.

As before, there was very little pain, except from my lower back, from sitting in one place for so long.

The operation took about two hours longer than my previous HT, though this was partly due to my recipient area not being shaved, which made the technicians' job a little more time-consuming.

I was back in the hotel by around 5pm – a long day. Dr Lindsey and Spex are both very anti hat-wearing, so I faced the world with my bare, blood-spattered head. It wasn't so bad. The doctor reckons I will be ok to wear a loose cap by my flight back on the 26th, four days after surgery.

He is otherwise pretty relaxed, and told me to have a beer to unwind if I fancied one. However, he was very strict about no alcohol or anything blood-thinning for 10 days in the run up to the operation. There wasn't much bleeding, so I guess it proved very sensible. (In contrast, Transmed only asked me to abstain for 48 hours before surgery, but advised avoiding alcohol and smoking for two weeks afterwards.)

Reflections

I am glad to have gone ahead with this second transplant. If this one doesn't work, I will have to assume that the failing is largely down to me, rather than the surgeon. But at least I will have given it a try.

I am still no wiser as to why the first HT did not work, and Dr Lindsey could not say either. He reckoned that around 900 grafts had survived, which is more than my estimate of 300-500.

Dr Lindsey, Spex, and others have all suggested that the technicians may be the most common reason for a HT to fail. Their thinking - it is all very well having an experienced surgeon to extract the grafts and punch the holes, but his/her technicians are doing arguably the most crucial part – inserting the grafts. Any lack of experience or expertise here is critical.

As expected, the professionalism of Dr Lindsey and his team was top drawer. But I should say that I was treated exceptionally well by Transmed too; there was no difference in quality of patient service.

One thing that struck me is that Dr Lindsey has a very firm view on how to approach hair restoration.

His approach to packing the front hairline densely differs to other surgeons I have spoke to, but obviously he has a strong track record of success with this method and wanted to stick with it.

I found it interesting that he was very sceptical about minoxidil and finasteride – he reckoned that only about 1 in 20 of his patients used either – and is unimpressed by other treatments such as saw palmetto. He has no interest in trying beard or body hair transplants, and does not believe he will see hair cloning during his lifetime.

Which leaves me wondering how I will ever cover all of my balding areas with the donor hair I have left...?

But for the moment, I begin the long wait to see whether this HT will be a success.

Photos - front above before

Front left before

Front right before

Marking out the reciepient area - note the frontal area to receive extra packing

Inserting the grafts

Front left after

Front right after

Front above after