hair2stay

Here we go folks, back on the HT train! After speaking with H&W, Shapiro, Feller, Epstein & Bernstein I elected to go forth and entrust Dr Feller with the future of my follicular journey. H&W and Feller felt strongly about 1500+ grafts in and around existing mini/micro's with no excision. Shapiro responded the same, though gave me the option to excise. Epstein proposed a combo of excise + grafts in one surgery. Bernstein suggested full excision, reimplantation and another 800+ grafts requiring 3 total surgeries to complete the work. I did photo consults with all of them and visited Feller & Bernstein in person as well. For those of you who don't recall my other thread, with history, I was the victim of 2 surgeries of aprox 100+ each in '92-'93, by Dr Leonard of RI, who should have turned me away at the ripe age of 23. Another 2 surgeries of aprox 300 by Bosley in '94-'95 and lastly 950 by Dr Bernstein in '98. All along it was the "we'll stay one step ahead of your hairloss" sales pitch and, "come on back and we'll fill in the gaps" approach. Take a look at the photos and please comment... You'll notice Dr Feller shaved down the recipient area and went to work. I requested a few details... please do not create a straight line wall of hair, recreate a subtle widows peak, and don't let me see any of the old work when it is all grown in. The 4 day pic's you can begin to see the old HT hairs growing in, in Day 1 pic's they are most noticeable by white shaded areas. I have asked Dr Feller to kindly send along the photos taken from his camera, as well as all of the data regarding graft counts (single vs double) and size of donor harvest. The one photo I really want to see from him is the shaved recipient area prior to incisions. h2

I agree... my blanket statement certainly is a bit dramatic, a reflection of the emotion from myself as well as Occam and all others that have been through this. I would like to believe that there are Doc's that can dance the dance with a progressively receding hairline over time. I just feel that a Doc and patient should try to get to a place where they have observed the recession over time (a year or more perhaps), after drug treatment, and then make a decision about surgery. Many doc's are ready to have a go at it as soon as you walk in, and this often is a time where the patient really needs to step back and not make an emotional decision. Patients need to be reminded that this could be a life long process, not a one or two time stop particularly if they are progressively receding. I think we can all agree that going into a receding hairline that is progressing with HT surgery is very tricky. Plotting a long term plan for something that is by nature somewhat unpredictable presents all sorts of challenges. The key, like you said, is each HT surgery needs to stand on its own. Thus, if a quantity of hair is lost in the surrounding area that HT surgery better look natural with or without that surrounding hair. This is the bottom line and a great challenge. Occam and others like myself are told that their respective surgeries are going to be undetectable or not recognizable, afterall if a surgeon does not promise what patient would sign up, right? Every patient asks the doc, how's it going to look? The thing about Occam's case is it is very recent, within the last 5 years. And, he did good research going into it. I'm willing to bet he was told, it would look natural and stand on it's own. h2

Hey Occam, Welcome to the board. Man, I feel your pain and can totally relate to where you're coming from. I came out and posted my story and photos a couple weeks back, if you care to check it out just do a search with my name. Although I started in on this journey much earlier, '91-'92, I was in a similar situation with my hairline and where I was at in life. I too was playing in bands and very much part of the rock scene in my community and wanted to keep a hairline. Here's the deal... What I think based on my experience and this corresponds with yours as well, is that transplanting into an existing hairline when more recession is emminent is not a wise decision, it's risky, and the outcome is very unpredictable. I am going to go out on a limb and say that doctors should recommend NOT doing these surgeries, instead prescribe the drugs, and let time takes it course a whole lot more before considering surgery. If you look at all the greatest photos that doc's have on their website, they are mostly complete restorations of men or they're of men who have a state of recession that is further progressed or stabilized. I have lived this out over the last 15 years and you are now in the middle of it too. I've listed some observations below, perhaps others would care to comment on them. -hair density in a receding hairline is lower than the back of your head, and is progressively getting less dense. Yes that is why it is called "thinning hair". Trying to match this surgically is most difficult. -hair quality in a receding hairline is often lighter in texture and sometimes in color as well. In my case, the hair in the back of my head is darker and more coarse than the my native frontal hair. Mom thought I colored my hair because of appearence of the transplanted hair! -Transplanting hair into regions where there is a good amount of existing hair (receding hairline)is problematic. The trauma causes shock loss and based on my observations accelerated hair loss in the surrounding area. With this info, I believe that unless the doctor is going to do a complete hair line restoration the process is flawed. How does one approach this knowing that the density is changing as time progresses and that the transplanted hair is characteristically different? The scam I got sold, was "we'll stay one step ahead of time with your hair transplants" Well, yes I have hair and haven't gone bald but the net result is a checkerboard disaster of transplanted hair and native hair and I am married to the process for life. As you lose more hair in the receding area, the transplants become more obvious and back we go for more. I am looking at another 1500+ on top of the 5 surgeries I have already had just to keep up with the process. And at best, all I can do is put faith in the surgeon once again unsure of the net result. What happens in another 10 years??? In hindsight, I'd rather be bald! My guess is that Occam will require some course along these lines. A lot of hair up front to do a complete hairline restoration. His observation of grafts failing to grow is of great concern. I have always felt that doctors have been slow to admit that the percentage of growth in some patients is low, in my case I would venture to guess 30% failure. Now with digital photography it's easier to track. Occam, I wish all the best for you and hope that you can find peace in this in the future. You are going to have to visit with some of the best doc's and see what they have to say. It sounds like from your last post that you did talk with Shapiro and Hasson & Wong at some point, now it's time to revisit with them. As for me, I am off to Dr Feller in another week and will share with all the next step in my follicular fiasco, stay tuned! H2

Glad I'm not the only to find Dr Bernstein's recommendation strange, knowing that he was the last one to work on my head. Specifically, I asked him if we should remove the pluggy stuff back in '98 and at that time he said no. I asked him why the contradicting prognosis now? His reply was that "his thinking has changed" and he believed that complete removal was the best option for me now. He commented further on the advancements surgically in the past years have resulted in a complete rethinking of how to handle cases like this. Also with the amount of time elapsed since '98 he said he has seen long term results of similar cases, and insisted that this was what he believes what would be best for me. Nonetheless, this was all very hard for me to swallow. He also went on to strongly recommend that I get 2nd opinions, stating that nobody else will make the same recommendation as him because he has more experience with excision and reimplantation, and does more of these surgeries than any other doctor... Not sure if this validates his opinion??? My intentions are not to slam Dr Bernstein, I am just trying to categorically place his opinion amongst others and determine it's value. Again I value what everyone on this board has to say. Even though you all aren't Dr's, I consider you all peers who have real world experience. Comments welcome... And yes, good quality hair, thickness, dark hair on white skin these are all attributes that make the pluggy stuff stand out more... This is an additional challenge my case presents. h2

In response to plug size... What appears initially in the photos and upon close inspection is evidence of some rather large size plugs (ie 3-4mm). What in fact we are seeing is a number of things I believe. First off the initial 2 surgeries I had with Dr Leonard in '92-'93 were slit graphs in the frontal hairline. These were definitely the largest size graphs when considering all of the work done. I remember how excited he was to tell me that I was the recipient of such great new technology!!! By the way, when I later met Dr Rassman in '96-'97 he commented that in his opinion this was borderline malpractice. Just thought I'd throw this in to stir the pot a bit! Back to the sizes... So, what we are looking at is some larger slit grafts perhaps 6+ hairs. But in addition to that they are augmented by mini/micro & fu grafts placed in close vicinity. Of course the plan that the Dr's had from Day 1 is to keep going back in filling in gaps. So there are areas where there are some mini/micro & fu grafts tight to the larger slit grafts creating a net result looking like even larger grafts due to the still existing gaps here and there. Really, upon close examination you will see the density vary as you look throughout the frontal area where all of this work has been done. This concerns me, because part of what creates a natural appearence is uniformity in density. Even in thinning hair the density is for the most part uniformly the same throughout the thinning area. This is the beauty of creation! So now when considering tight packing 1500+, will the Dr's attempt to match the density that we are seeing within these larger appearing grafts? I would think that that would be the only way to essentially make the old work not noticeable to the naked eye. Is this really a realistic expectation? Compunding the challenge, behind the hairline where you see large areas of hairloss, the skin is scarred and there is vascularization. Dr Feller confirmed my hunch, that there were grafts placed there that did not take previously. He felt as though the incisions were to large in previous surgeries, and the only way to get hair to grow there will be with the most finite incisions possible. Another thing I should share, where the photos don't reveal, is ridging. The entire frontal area, to touch, is raised with definite ridging evident. In the right light your eye can pick it up too. Prior to the 950 fu's with Dr Bernstein in '98 I had cobblestoning as well. His surgery definitely reduced that, but the ridging remains. I think 1500+ grafts will contribute to the ridging, yes or no? Excision would alleviate ridging, perhaps, at the expense of scarring? Comments...

My concerns exactly... I know density will be lost, and I know scarring will be a factor, as well as additional hair loss from lost follicles due to transection and trauma. Dr Bernstein has a reputation of being conservative, not quite sure how 3 surgeries (his recommendation) is conservative! Other than the fact that perhaps we save donor hair, and we create a new look that is more suited to my age as I enter my later years???

Thanks for the opinions so far guys, like I said I value them. I know many of you here have seen quite a bit, and in the end although we are individual cases I think one can make a pretty good evaluation based on prior cases. Really that is what I am wanting to hear from the Dr's too. So many, even the best, tend to lean on the "well we can't say for sure, or we don't really know what your results will be" I find this to be BS partly, saving their respective asses if things don't live up to expectations. Come on, these guys have seen hundreds and thousands of cases they can make a damn good assessment of things. My age is 39, and my expectations are clear. I am not concerned with density, a wall of hair, nor do I have hair greed. From day 1 and until day all I am asking for is a natural appearence. Now, I have the same expectations, make it natural and undetectable! Long term I am willing to gamble that the drugs will keep my existing hair, and perhaps newer technologies will come along to improve my chances and future options as well. With that said, I am willing to use up whatever donor supply is necessary to make me "normal" now. Soooo.... to a achieve that goal can we really do it well with 1500+ dense pack grafts and no excision. This is the question I am wrestling with. I believe the excision, and reimplantation process is going to be traumatic and damaging to follicles and skin. The less trauma the better. However one way to get rid of the pluggy look for sure is to get 'em out! This we can be sure of. Grafting 1500+ with no excision does not guarantee that. I am putting all of my faith in the Dr to camouflage to his best ability. Here in lies a bit of unknown. All of my surgeries up to today were done on this same faith, and as you all see my faith was shattered. So can I effectively have faith in Dr Feller or Dr Shapiro or Dr's Hassan & Wong, all who have said no excision is necessary, or do I follow a path suggested by Dr Bernstein in which everything is removed and where I know for sure that the pluginess will be gone? I have seen Feller in person as well as Bernstein, their opinions are 180 degrees polar opposite. Shapiro and Hassan/Wong have only seen photos and both suggest it can be done without excision. Next stop is Shapiro in person... Keep the opinions coming, and God bless you guys!

photo album before and after Dr Feller repair

Hi all, First off, I have to say this forum is invaluable. If only this technology existed years ago! Well unfortunately the same can be said about HT technology and practices. I am here to share my story and seek others opinions. I am one of the many who got suckered in to HT at an age too young (24) with the promise of staying ahead of hairloss progression. Fact of the matter is the Dr's should have turned me away. At that age I was to immature to make the proper decision. By the time I hit 30 something all I wanted was the freedom to shave my head and forget about hair entirely. Well, guess what? That ain't an option now thanks to a whole lot of mediocre work and poor judgement on behalf of the 24 yr old sucker I was and the enterprising Dr's who saw dollar bills sprouting from my head. I had (2) surgeries aprox 100 grafts each in '92 - '93 by a Dr Leonard of RI. He is the grand 'ole chap who happily married me to this life long comittment. I then went to Bosley for (2) more surgeries of 250-300 grafts each in '93-'94. Yep, I thought this was the holy grail and I would be fixed! Silly me, suckered by the advertising. In '98 I headed off to NHI after seeing that they were truly changing the HT world. 950 grafts were placed by Dr Bernstein, with the advice that none of the previous grafts should be excised and a return for a 2nd would get her done. I never went back because I thought the results were a great improvement. Yet, I was not really fulfilled and did not think the work lived up to expectations. Fast forward to today. I have created a photo album with the same subject title "New to forum, not new to HT" Take a look at the pic's, they speak for themselves. I have consulted with all the best Dr's in the field now (all coalition dr's) and have received suggestions that run the full course from excising everything and starting over to excising nothing and filling in with dense packing. This is a tough time for me, deciding what to do next and trying to develop faith in the next process. My case is difficult, no doubt, and I am tired of the unknown. Perhaps I should do nothing and wait it out even farther? Propecia and 5% rogaine have curbed the loss, been on both since inception. Now it's time for all of you to chime in. I respect the opinions of the many people here. I have spent many days reading everything that is archived here. I've searched everything under Feller, Shapiro, Hassan & Wong, Epstein, Repairs, Bernstein, etc. So, please don't suggest that I search the board for answers. I want real opinions from real people! Thank you all and I promise to keep the photos coming when I make the next move.