TheEmperor

Dr Wong told me that my transplant hair would thin out in the future and that he had a patient who had to return every 3 years to stay ahead of the loss. He didnt say that I would have to return every 3 years, but I don't know why else he mentioned it. Wish this was discussed before the procedure so I could run like hell. My grafts from the second procedure (the ones that grew in) are significantly finer than the hairs from #1 or the donor hairs. From what I have read, they must have been damaged upon being implanted. OP, sorry to hear of your situation, but you have discovered one of the dirty little secrets of the industry. Press for a full refund if possible.

Yes. Absolutely. On a NW6 they are only planting at (like) 1/3rd original density, maybe a bit more in the hairline.

amanindia, I can empathize with your situation because I also was deemed a "slow grower" in my procedure with Dr. Wong. The thing that you must realize about Hair Transplants, and this is not clear until you have had one yourself, is that the "illusion of density" only appears when the hair is grown long on top and layered upon itself. At the six month mark, perhaps 80% of the follicles have sprouted, but the majority of them are very short. It usually takes until the 12 month mark for all of the hairs on top to sprout and grow to 3" in length. Also, patients with fine hair require the hair to grow longer to obtain the same illusion of density. Thus patients with fine hair often appear to be "slow growers." I am not saying that there is not a yield problem ( as there are not good close up pictures), but if you let the hair on top continue to grow in length over the next six months, you may begin to see what is referred to as the "illusion of density". Unfortunately, this is a limitation of the procedure that is not accurately communicated.

Joe, The photos were available in my blog for the better part of the past two years and can be seen from the link below. Many forum members have commented publicly and offline that my results were subpar based upon the very detailed photos I posted, including the ones from your office. Read the comments in my blog. You did offer a highly discounted second procedure, and you probably feel that lets you off the hook, but that does not avoid the fact that there are problems with the outcome. I am offering my support to NotHappy because I understand how difficult it can be to get your message across on the forums. You guys make mistakes just like other clinics and are not beyond reproach.

Google "stick and place hair transplant" and you can read about the benefits of this technique. THe doctors who use this method explain that with lateral slit, the incisions start to close up over time and this makes it more difficult for the techs to insert the grafts, which causes damage and reduced growth. I am almost positive this explains why the 1's in my hairline had poor growth (either didn't grow, or grew in with a finer caliber), yet the jaggie hairs all grew with their original caliber. Also the larger grafts (behind) seemed to grow well, likely because they were physically more stout/larger, and the slits themselves were larger and more easily opened by the techs. When I consider the poor yield I got in the most important part of the HT (hairline), I really wish I had chosen a doc without an assembly line approach. Two procedures of 3K grafts would have been better than 4500 + 2000 where there were yield problems with the many singles. I guess the take away is that session size is NOT the most important thing; buyer beware. The guys who get homeruns, either their bodies do not rapidly close the incisions (thus no damage when inserting grafts) or perhaps the grafts are larger overall and require larger incisions. This needs more investigation. Looking at it, I can see no reason why the surgeon shouldn't use stick and place to ensure best yield (even if it is only a % of his patients who will benefit from it), besides the fact that he can't be in two places at once, can't operate on two patients at once. So yeah, it will cut into his profits.

I think the % is higher than anyone is willing to admit. I have noticed that complaint threads do not have a particularly long life expectancy. If someone goes to the forums, they will see Bobman and Jotronic reposts all over the place, but complaint threads get buried and disappear pretty fast. You have to watch for forums to get a clear read on the signal to noise. Its clear that H&W dont have complete control over all the factors causing poor growth. THe most curious thing from both of my procedures is the "jaggies" that Wong placed in front of my hairline using singles. These individual hairs all grew very well, so well in fact that the jaggies are very visible and stand out. The hairs themselves are thicker diameter than the hairs in the hairline behind them. Also, they grew better than the singles placed between them in HT#2, so they are still visible! So how could this happen? How could certain hairs placed in one way grow so well, and others grow not so well? There were different technicians planting throughout the day, so that could be an explanation. It was an 11 hour procedure and there were at least four different techs. Maybe a master tech planted the jaggies at the end of the day? Another explanation, that I think is more plausible, is the fact that the jaggie grafts were placed so soon after the incisions were made, and this helped those hairs grow to their potential. I suspect this is the answer.** Most of the incisions made sit for an hour or more before the grafts are placed. I suspect they start to close up and this may impact the growth rate/thickness/yield. There are a few doctors who advocate the "stick and place" method and I suspect this will help give better growth, at least in my case. The assembly line approach of making 500 incisions and waiting two hours for them to be filled may not be optimal, but it cuts down on work for the doctor. Also worth considering is the use of needle vs blade. The needle docs seem to get more density per incision, imo, maybe for the same reason. All the jaggie grafts were placed within minutes of the incisions being made and they had significantly better growth that the majority of singles placed in my hairline. There are variations in doctor technique and even the "top docs" dont have all the answers. An assembly line approach like H&W will generally give more impressive results because more tissue is moved, but it may impact density and yield. The OP has every right to be dissatisfied. He had every right to take down the Toppik + Hairspray + low light pictures because they obfuscated what he was trying to communicate.

Can you comment on this: "Also some of my singles were doubled up to add further density." I know that Dr. Shapiro does this too with the right patients. I wish Dr. Wong had taken this approach with me. I got a large% of singles and they just do not provide enough density when spread over a larger area. Its nice to see one of the doctors at H&W evolving their technique for a patient with finer hair. Getting a greater graft count means more $$$ and larger apparent surgery sizes, but a large zone in front with exclusively 1s gives pathetic density. 1s Are only really needed in the hairline, elsewhere they are a liability. Your surgery looks good. Be patient as your result comes in.

Amazing result! If I go for a third procedure, it will likely be with Rahal. For particular graft #s, he usually gets a great cosmetic impact, which suggests high yield, great cutters, great placers. Also his hairline design looks totally natural. I had 6500 grafts from Wong in two sessions, was not quite as bald as you, (less receeded down sides and back) and my results are no where close, and my hair characteristics appear similar. Really wishing I had gone with Rahal for #1/2.

This is going to be a fantastic result. Not only did he get a high graft count, but most of the grafts were 2+ hairs. I had a similar number of grafts over two procedures and a much higher % of 1s. Also the hairline looks very good to me. Symmetrical and somewhat broad/rounded at the front. The hairline does not come to a point like mine does.

I have had surgery with Wong and dislike the hairline. It is too assymetrical and does not match my forehead/face, in my opinion. This may be a result of poor yield; had the first procedure yielded more, he may have been able to slightly broaden the hairline in the second procedure. As it is, I dont feel the hairline will be age appropriate for another 15 years. Hopefully I will be able to find a FUE surgeon to make slight revisions to the shape that will still look good 15 years from now. The problem with H&W is that you pretty much are funneled to one or the other once you contact them. I have never heard of a patient having interviews with both doctors and then picking between them. I called without a preconceived notion of who to choose and was given Dr. Wong. I felt this was ok because Jotronic has a natural hairline and was a patient of Wong. However, Jotronics hairline was established by previous minigraft surgeries, so I have a feeling it closely mimics his original hairline, which is why it looks good. Jotronic is a "one off". Because he started out with a bunch of minigrafts, he ended up with better density than had he only had follicular grafts. In my research, there was a general consensus that Hasson does larger procedures (and has more youthful hairlines), although Joe claimed they do equal procedure sizes. Upon talking to the technicians while in the chair, they said they were happier working for Wong because he did generally smaller session, and it was not uncommon for them to be borrowed by Hasson for procedures that went late into the night. As both teams are generally independent, (they each have their own cutters and placers), it may be that one team gets better yield than the other. So whichever doctor you choose, I would urge you to do alot of ground work and research before calling them the first time, or they will place you with a doctor based on their own internal logic. In my case, Joe said he had shown doctor Wong my pictures and that "He was very excited to work on you" and "we expect great things for you." LOL

Before any hair grew in from my first procedure with Dr. Wong, I saw all these tiny pits and was concerned that my skin would have a pitted look. Over the following 6 months as hair grew in, I found that the skin smoothed out. It stands to reason that the smaller the incisions, the smaller the grafts, the less noticable will be any pitting. If you are concerned about pitting, you should seek a doctor that uses the finest grafts. However, larger grafts will provide more density and an ability to completely cover the scalp. I suppose it is a trade off: density vs naturalness.

I dont remember any crunching noises in either of my procedures.

ES, I dont think removing the strip makes the bald spot larger in equal proportion to the amount that was taken, but it does have an effect. IOW, my bald spot is not 3cm larger on each side. I would say it is more like 1-1.5. The grafts have to come from somewhere. Either the skin stretches locally to the incision, or the skin slides and moves so the wound can be closed. The skin can move upwards (from ear) or downward. I believe it is a combination of things. None of the alternatives are really good. If most of the stretching takes place local to the scar, then you would end up with a thin area around the scar. (I have this). If the skin stretches over the entire surface (ie skin moves) then the baldspot would have to be made larger, unless the strip is taken high and with geometry that would prevent it from stretching down. In that case, most of the stretching would happen under the scar. When you are healed up, do the scalp exercises and you will see that your forehead skin moves. Your entire scalp moves. Also, everyone may be different. It is probably not correct to say everyone is the same, I only know what happened in my case.

Only a bit of the incision goes up into the danger zone, imo. Those hair mixed in with the other transplant hair will cause a slight thinning if they shed.

One of my complaints from my surgery with Dr. Wong is that the act of removing strip will actually make the bald spot larger. The act of removing tissue, slides the scalp back and down. For someone who was a NW5 with a very small baldspot, a strip surgery can make the baldness evident from the sides and behind, where before it was not visible. I believe that Dr. Hasson is showing an evolution in strip harvesting to avoid pulling the hair down. Harvested this way, it is clear to me that there is much less tissue to stretch on top, and the majority of stretching and scalp movement will occur below the scar. This scar location also allows the patient to buzz the sides. My belief is that is would be much better to have a fine linear scar showing from the sides, than it would be to pull the rim hair down so that your baldness class is higher. If the fine linear scar DOES become visible many years down the road, it would be easier to transplant around the scar to hide it, than it would be to bring the whole rim up the amount that was lost. The rim hair is the difference between getting a full looking transplant and getting a wispy combover. For the most part, that is a superior location for the scar.

I would be more worried about the trauma causing your strip scar to heal badly.

Thats normal. You did not damage any grafts. I think 1600 grafts will make a positive improvement in 9-12 months, but you may need another 1500 grafts in that area to get a full look. Good luck.

Yes, the doctors try to achieve the best result for their patients, but it is a HUGE sales job. I specifically asked if removing a strip would make the bald spot larger. I noted that pulling down the skin on the back of you head causes your whole scalp to move backwards. But I was told that strip surgery does not make the bald spot larger. Thats what I wanted to hear, despite logic telling me it wasnt true. (Incidentally, Hasson has a patient on HLH titled "Strip Scar Too High", and I honestly believe that guy is an evolution in strip. The way his strip was taken should leave much less scalp to stretch and because it is higher up, more scalp underneath will pull upwards.. It is much easier to camoflage a thin scar should the hair reced downward, than raise the whole rim up 2cm. Wish I had done something like that or maybe FUE.) I know that before the procedure, Joe was saying things like "Dr. Wong saw your pictures and he is excited to work on you." and "You are in the driver's seat" and "we expect very good things for you". At the in person consult, Wong said he expected my results would be better than Joe's. After the procedure, the tenor changed to one of realism and downward expectations. A week after the procedure I had expressed excitement about the coming growth, and how tightly the grafts were packed, and Joe cautioned me that it was not going to look full when the scabs were gone. Its like he has different messages depending on where you are in the process. I doubt he can remember the nuances of the thousands of conversations he has, so he probably just dispenses generic advice. The pre-op message is VERY optimistic. Post op message is sobering realism and patience.

The plug jobs were transplanted with all the supporting tissue around them. I think hypercutting of modern FU surgery has something to do with poor yield and possible early death of follicles. Basically the smaller the grafts, the lower the yield. (See Beehner study chubby vs skinny) I presume that skinny grafts will give up the ghost more than chubby ones. Doubt study tracked them long term.

Not for everyone.

I was really on the fence about who to go to for #2. I was looking at Shapiro and also starting to consider FUE. Because I was not butchered and H&W stand behind their work, there was incentive for me to return. Part of the reason was that if there was a problem with the scar, he would take responsibility and do revisions as necessary. I didnt want to get in a situation where two docs were pointing fingers at each other and blaming the other for suboptimal scar or yield. I feel that Wong will continue to stand behind his work if there is a problem, however after two strips and seeing what it has done to my donor and baldspot, I dont want to subject myself to that again. Having reflected on my experience with them, I feel that their assembly line approach does not serve everyone best. They dont use DFUs, chubby grafts, or FUE. They use skinny grafts and shoot for large strip sessions.

Yes, I feel a similar way. The first procedure did not live to my expectations, and the process of extracting hair really thins out an already fine donor area. It makes it hard to hide the scar. Also, the act of removing a strip makes the bald area larger. My two strip surgeries took me from a NW5 to a NW6. The baldness pattern was well established for 15 years, and the rim hair is strong. Despite assurances before and after #1, that the strip would not (and did not) make the bald area larger, I went for a second procedure. Now I realize the folly of this move, as no amount of grafts will be able to take me back to a NW5. Interestingly, the remaining hair in the back which used to grow forward, now grows upwards. This would help hide the bald area if I were to develop some sort of combover. There is good hair, bad hair, and WEIRD hair. I am venturing into the "weird hair" zone. Also, I was told my hair was between medium and fine, yet I think this meant the side hair was fine and back hair medium. I was also told my result would be better than Jotronic. The problem is that the fine areas (probably 2/3rds of donor) do not provide good donor and makes it hard to hide the scar. Every procedure I end up looking like I have less hair overall. I am through with strip. Should have gone with FUE for #2.

No, in my experience, hairs are not guaranteed to grow in with the original thickness. I feel that there is some % that technically grow, but do not thicken enough to become cosmetically significant, and probably die at some point down the road.

I think the scar is fine. It is on par with top clinics. If the hair does receded down, the line is vertical so very little of the hair transplanted will shed. That part is ok. The line in the back would cause me concern. I got something similar, but with 4500 grafts the line is back farther. I have a bald "spot" and I concede that if anyone looks at top of my head, this might give it away as a HT. Hopefully the hair planted in#2 will help hide this. I think the docs plant hair with the expectation that you will be back. If they make it perfect, you will probably have less incentive to return.

wb20 I dont think it is an issue of transection or direct damage to the follicle. It appears that adjacent trauma in the area of existing hair may cause them to thin temporarily or permanently. This may have something to do with competing for the same blood supply. Perhaps blood vessels are interrupted by the new incisions. I am not referring to a mass exodus of hairs, just an overall finer look. Emp