TheEmperor

Everyone:

I am detecting some backlash towards me, perhaps a belief that I am somehow attacking H&W.

Please read the threads carefully. I am soliciting advice on how to best proceed for #2 (if at all), and am asking what people think about the result.

Originally posted by Ventuoguy:

Emporer-

 

I'm not sure what you mean when you refer to how Dr. Wong "cuts his grafts." There should be no variability in how the grafts are cut. The follicular unit is to be respected. Microscopic inspection and dissection should dictate the follicular units and you should have your 'ones' 'twos' 'threes' and 'fours' depending on what was contained within your strip. I am not aware that H&W violates this principle. Most of the 'ones' should be placed in the hairline to soften it. That was the problem with the old pluggy grafts-too many hairs/graft in the hairline giving the doll's hair appearance. Perhaps H&W might realize during the dissection and placement of your grafts that it would be better to cut some of the multi-hair FU's into single hair grafts. I believe they would have consulted you during your procedure to alert you of this recommendation?

Ive been on this forum for a few years and there are plenty of threads that debate what defines FUs. There are different philosophies in cutting them.

Go back and search for Pat's (moderators) arguments about slicing a pizza, circa 2005-2006.

I think there are definitely differnt philosophies on graft cutting. Some equally esteemed physicians, including Shapiro, use double FUs (say a 2+1 or 3+1), internally, instead of slicing them into separate grafts. Other docs might view these as single, larger FUs.

I am wondering if for a person whose hair is not thick, it might be best to preserve some of these as DFUs if there are already enough singles.

I am just trying to reason out the best approach for #2. Maybe Wong planted thin in the front and intended to go back in another pass. Maybe thats the best way to do it. I just dont know.

Originally posted by imissthebarber:

The Emp

 

I'm sorry to hear that this hasn't worked out how you'd hoped. Have you consulted with any other docs? You haven't got anything to lose and it would be wise to make sure you are really comfortable with any forward steps before you take them. Like you said the down time can be really tough - much more than people expect before they hit the chair.

 

Btw how old are you, and has your hair loss stabilised? I'm asking because I'm trying to figure whether FUE only might be a good policy for the future. Pro's are no risk of scar getting worse Con's are there might not be enough hair (this relates more to covering possible future loss rather than beefing up the frontal area.)

 

Also some other docs don't require you to shave the recipient which would likely improve your experience of the downtime for strip (considerably) or FUE (after several weeks when the hair grows back to 1.5 inches needed to cover your current scar).

I'm in late 30s. Loss has stabilized. I dont think FUE is an option now; I am not going to dice with anything that would compromise yield, although I recognize it may be of use in the future for touch ups (when density is not the goal).

Originally posted by hdude46:

I think for H&W, this is a below average result. With that said, another surgery should get you where you want. H&W will most likely be able to pull a lot more grafts than 2,000, and also excise the scar to make it smaller. SMG doesn't require you to shave down, but that may limit the number of grafts they are able to harvest. I agree with thana, you are once procedure away from a good looking mop. You dont have any loss beloe the crown so you should be able to fill the entire top. good luck

Yes, assuming everything grows.

It seems, IMO, that the problem is with the small singles in the hairline.

If you look at the analysis pics, you will see that inside the outer centimeter, the hair is growing well. This shows to me its not a physiology problem. I am guessing it has something to do with the way the singles were cut or placed.

If I go back to H&W, and the problem was a result of how singles were handled, I could find myself with a sub-par result (again).

I need to enter a dialogue about what happened before jumping back in the chair. I want to know why the front cm is so thin, and why the scar is so wide.

Originally posted by Raphael84:

Emp,

 

Primarily, great write up explaining both the pros and cons regarding your procedure and your eventual results, but also detailing the other experiences that you met along the way.

 

Viewing your images, I would say that you have undergone a tremendous visual transformation. In various photos, with the more generous styles your hair stands up. Having said that, your density issues are not unfounded. You express most concern quite naturally, regarding your hairline. However if the density was higher in other areas, maybe this would assist and possibly end your other worry, your scar.

 

Why are you with the understanding that you will not be able to reach more than 2000 grafts? Is this Dr Wongs prognosis? Obviously considering your experiences and thoughts regarding the downtime of a HT, you would be somewhat reluctant to undergo a second, yet with your questions, it is obviously on your mind. Have you expressed your concerns to Dr Wong at all? With a second HT, your hairline density issues could be solved, along with a denser appearance in other areas or attention to your crown (obviously depending on donor options).

 

I too would be somewhat dissapointed with the hairline if this was not an initial plan, whilst still maintaing the belief that you have undergone a great transformation. Maybe this is the possible "complication" of a famous H&W one pass procedure (in no way am I "dissing" H&W, for sure they are amongst the world leaders in HT procedures and their consistant results are indisputable, if I saw myself as a candidate it would interest me hugely).

 

Your first stop surely needs to be addressing your concerns with your Dr and evaluating his feedback. On the positive side, you are in a far superior position hair wise, than pre op, and your journey can still achieve greater success'! Good luck!

Thanks. The 2000 number was my semi-conservative estimate based on numbers I have seen from other patients on their second pass. Dr. Wong/ Joe did not give any estimates for number 2, and did not express any enthusiasm or pessimism about potential harvest.

The photos where my hair is standing up are an illusion. Mouse holds the hair up, but from the side I look bald because the hair is not layering on top anything in front of it.

I just wanted to show a variety of pics, good and bad.

Originally posted by thanatopsis_awry:

Hmmm. I'll start out by saying what I'd end up saying at the end -- I think you're one, relatively small session away from getting the "density" you're after. The 2k figure you mention, if put into your hairline, particularly the frontal zone, should give you a pretty good perceived-density, IMHO, especially since you have a really good foundation throughout the rest of your frontal 1/3rd and top.

 

The perceived-density that HTs give are delicate, if not fickle; once you reach the point of optimal grafts/cm2 to get your look, even if you have *just* enough, your hair can look mint.

 

I think your result looks pretty good, all in all. You had a solid chunk of baldness to cover, and while 4500 grafts is a good number, it's still a bit shy of that "sweet spot" I think you'd need to get the look you're after.

 

Your hair looks best in the pics where you did a quasi-combover, but I'm not sure you're relegated to that. If you get a good stylist to delicately layer your hair, texturizing the tips, I would think you could play off a fresh style where you comb the hair forward and work in some wax or clay for added texture throughout.

 

When you mention using MFUs or DFUs...do you actually mean *in* your hairline itself? I'm not sure of a clinic you'd be interested in who would do this.

 

I would weigh the degree and extent of the "annoyance" you will feel if you simply never make a change to your hair from here on out, vs. the "annoyance" of going through another, over the backdrop of the satisfaction and life-improvement that "2k" will do for you. One is, perhaps, an absolute, the other more intense, yet shortlived. Are you set on 2k? I realize your scar isn't ideal, but I'd still think you could safely squeeze more; curious what Hasson or Wong would ultimately say in regard to that.

 

Also, re: your scar. From the pics it looks like you have really low density in that entire region of your scalp. Was this always so, and the scar exacerbated things?

 

I would get a really good cut, apply some top-notch styling product, and see how you look. What do you estimate your yield at, btw? Have you looked into H+W evaluating you? I seem to recall them having a "growth guarantee" type of policy.

I spoke with H&W extensively after the procedure. I spoke with Joe many times and Dr Wong once in the period around 1 year out, and they have suggested an approach which boils down to shaving the front again, covering the crown and touching up the front. I do not want to say anything negative about them, and may return to them for #2, but suffice to say there was not a meeting of the minds regarding all things (at this point in time).

I am not trying to air any dirty laundry or point fingers. The results are what they are, I am showing them, and seeking feedback from other people on how to proceed.

Regarding the Multi FUs, I am not suggesting they are put in the hairline. What I am saying is that cutting more 1's will create a larger zone of low density in the perimeter. For people with thick hairs, this may be necessary for a smooth hairline, but for people with finer hairs, a large zone of 1's robs from density (may be complete overkill) and ultimately impacts yield if they dont grow to the same %.

Hasson and Wong cut grafts the way they cut grafts. Their techs are trained and thats the way they do it. If _my_ singles are living in the 50-60% range based on the way they cut and plant them, that has got to be cause to pause and reflect on what I should do for #2.

Please check out the pictures in my blog (link below).

First, let me say that Hasson and Wong are a top notch organization. They were on a very short list of doctors. I chose them primarily because of the high graft counts they typically pull, and also because of their exclusive use of the smallest grafts for naturalness. As a NW5, I knew that I would need all the grafts I could get.

Also, I feel better about my appearance than I did before the procedure. This is not necessarily the same thing as thinking my hair looks good, but having hair on top improves my self image and helps me avoid the "bald guy" stigma. I think it has improved how people perceive me -- in general people are nicer and I am not invisible to younger people.

I am glad I got the procedure and Im not sure another doctor could have done a better job than Dr. Wong.

That said, I have some mixed feelings about the result. Having seen all the amazing results on this site, I believe there are a few things that could have turned out better.

Given 4500 grafts, I think Dr. Wong employed a very good strategy. The hair angles forward and layers on itself. If he had gone lower in the front, there would be less hair on top and might look imbalanced. While the hairline design is not perfect, I think there is a good bit of wisdom built into it. Now onto the problems.

The problems are two fold: Hairline density and scar width.

The density in the hairline (perimeter of the front) is very low (see photos). I think that the large number of "1s" used in the first centimeter of hairline had a lower than expected yield, while the interior grafts appear to have grown well. If this was not a yield problem, doctor Wong should have planted at a higher density, IMO. Hairline counts show ~20-25 hairs cm^2.

The reality I learned is that the down time, the interruption to job and social life while healing is VERY DAMAGING. I cant keep going back to shave down and address the hairline.

The bigger problem, which may be out of Dr. Wongs control, is the width of the scar. It is already 3-4mm throughout the length -- looks as wide as some of the 3 strip veterans.

While I originally thought I would have a large donor supply, now I realize that my donor will be limited by the ability to keep a passable scar.

This changes things. If the scar goes any wider, I may be in the unfortunate position that it will be visible despite any efforts to conceal it.

Thus, I am conflicted on how to proceed. The "hairline" needs more hair, but if I go back for another procedure, I would not expect more than 2000 grafts. I am not sure this would make a huge difference. And at the risk of a wider scar, plus the additional downtime (plus more money out of pocket), makes it a gamble, IMO.

If Dr Wong cuts them in the same way, and there are a large number of 1s in the front, that have less then perfect yield, I have to wonder if perhaps going to a clinic with a different "philosophy" on graft cutting (that also employs MFUs), might give me a better hairline and density. Lets say insted of shaving off a small "one" into its own graft, another clinic might keep it part of a multi FU to be used interior. Thus the perimeter ends up with less 1s, is less see through, and overall density is higher. This is basically Pats pizza argument. Hindsight tells me that for someone whose hairs are not thick, a large number of 1s is not beneficial.

[i have the graft breakdown written down somewhere, I will post them later, but I remember there being a faily high % of 1s compared to some other docs.]

Anyway, here are the results. I am trying to figure out what to do next. I have told myself it may be best to do nothing despite the feeling that the hairline is sub-par.

Looks great!.

Originally posted by Pats205:

Chanyouze,

 

Dr. Armani has analysed your latest after pictures and compared them to your before pictures.

 

The assessment is as follows:

 

1- Alvi Armani worked in zones 1 and 2, and 4 for at total of 3000 grafts. Zone 1 at medium density and zone 2 at low density. We put 500 grafts in zone 4 for minimum coverage.

 

2- Alvi Armani did not work in zones 3.

 

3- Unfortunately you have continued to loose hair in the areas transplanted, the hair you currently see is what has been implanted.

 

4- Sadly in your case your hair loss is progressive, you may continue to loose more hair in the future which may require an additional procedure to thicken your result.

 

5- Please remember that you are not at your final result yet and that you have 3-5 months of further growth and thickening. We understand that waiting for your final result can be trying, but patience and following post op instructions is the best you can do at this time.

 

6- Please follow the post operative instructions exactly.

 

We wish you the best in your hair loss treatments.

Wow! I am stunned. He got maybe 25% growth.

You should be offering him a full refund. Thats the way to handle bad growth whether it was your clinics fault or not.

Can the USA tax money spent in Canada?

Looks good. Why did you not go back to Dr Wong?

Your head wont look "presentable" for up to 8 months after the procedure. There is a redness phase, and then after that as it is growing in, it takes quite a while for everything to come in.

Your co workers are going to notice and talk behind your back. It can make a job very difficult.

Your wife may have other concerns. Spending the money on yourself when it could go to the kids? Or perhaps she is comfortable with your diminished self esteem and thinks that when you look younger, you will want a younger woman.

This is not about being "fake". Hair modifications are page one of a woman's beauty playbook. Hair is a superficial, yet substantial part of one's youthful appearance.

Also might like to add that it sounds like your wife has been working on the kids to form their opinions. Kids are usually pretty open minded, where did they get their fears that its going to make you look like someone else?

Unsupportive wife is the problem. I would wear the pants and go through with it.

Turbo,

The doctor may not have closed the wound properly. My understanding is that the better doctors do a multi-layer closure, which takes a significant amount of time and contributes to thinner scars.

Also, stretching does not necessarily mean tight. You can probably get a scar revision from one of the best doctors and be much better off. If the scar is still visible, then fue into it.

Jim,

I dont know how old you are, but as you get older, the impact of hairloss is less and less.

If you can make it to your late 20's, its not nearly as painful as when you are in your early 20s. In early 20s, none of your friends seem to have hairloss, and many girls think its "weird", but by late 20s, and then mid 30s, its very commonplace.

No one needs a HT. It is something that you can work towards with your career, like a nice car and a house.

Originally posted by Sparse:

Emperor:

 

Psychologists have abundantly documented this sort of distorted thinking, and it turns out to be widespread. It results from something called the availability heuristic, a fancy way of saying that people tend notice vivid events (e.g., spectacular HT results) and bring them much more easily to mind than more average events (e.g., meh HT results) when predicting how likely a given event will be in the future. Thus, we become easily convinced that stellar HT results are much more common than they truly are.

 

To make matters worse, we then succumb to confirmation bias, which causes us to avoid and/or disregard any less-impressive results that don't match our overly rosy belief about how wonderful most HT results really are.

 

It's an all-too-human tendency, and one we all need to guard against!

Interesting.

The offshoot of this, after you have had a HT and you are not completely 100% happy, is to question if you have had a bad result. What went wrong? So after your first HT, you may end up in a psychological limbo, as I have.

I comb through my hair and take close up photos of "what went wrong". I am not sure if I should go back for another pass, find another doctor, or be thrilled I am not bald. THere are far worse results. My doc may have done the best HT in the world given my hair quality. I just dont know.

It seems that there are some areas in the hairline where it appears there was some lack of growth, but centrally, most of it grew. Even if 10-15% did not grow, that is as I would expect for an average procedure, so the reality is that with my hair type, I will never get more than thin coverage. If I desire more than thin coverage, then I will have to sacrifice planting anything in the crown. And by thin, I mean that if the wind blow wrong, or my hair is combed up, I look pretty much bald. This is not exactly the "illusion of density".

Its nuts. I am not pluggy looking and I generally look better, so I am learning to style every morning and just live with an imperfect result. Coming here makes me increasingly jealous of the results I see. I have to be a realist whenever I see a wow result. Like when you see a magician perform a trick you might say, "an audience member was in on it" or "there was a string pulling on it", etc. Instead I say, "he was only a NW4" or "he had really thick hairs" or "his head is alot smaller with less area to cover".

Originally posted by Sparse:

Ok, I found Shuffle's blog on H&W's site: http://www.hairlosshelp.com/websites/shuffle/

 

He required 2 HTs to get that impressive density: one with Jones for 2600 and one with Dr. Hasson for 5200.

My point is that even with as many grafts planted at that density (8K on a NW5), most people still dont achieve near that fullness.

I think half of that fullness.

I received 4500 grafts and I look like im losing my hair and im still bald in the crown. Did most of them grow? Im not sure. I dont think I got 100%.

I suspect that most people dont get 100% growth, most people get between 60-90% growth. Then most peoples hair varies in thickness by as much as 3:1. A fine hair provides a third of coverage as a thicker hair.

So a guy like shuffle got near 100% growth and had thick hairs.

Most people will not get that, unless they are a low norwood, and they super dense pack at 60+ g/cm2.

I just want people to be realistic. Maybe I got a bad result? Im not so sure. I think a majority of hair grew, I just think the hair quality and other factors consipre to give less than a wow result.

This doesnt mean one shouldnt get a HT, just be realistic.

I DO see a trend that the guys with most impressive results, post more and their albums shoot to the top.. The guys with average results seem to disappear to the bottom of the stack. Lots of "meh" results out there. Look for them.

Originally posted by Julius:

Hi John I sympathise with you but just give it a little more time. Could I ask at what density is the hair in the transplanted area? I was also under the impression that a good ht should look good without styling or maybe just running a comb through it a couple of times. Results of Shuffle and the like certainly give this impression. I think a person in the early norwoods or a diffuse thinner could even have good hair after hours of styling which is something I don't want to do and is why I am looking at hts. All the best

No. no. no.

I went to one of the top docs and got 4500 grafts. "Shuffle like" results are the top 1%. Most people will not even get close, even with the same planted density.

Why is this? I think there are a number of factors. Foremost is donor quality. How fine are the hairs? What is the donor density?

Then on top of that you have to ask, what is the transection rate? What is the "x factor"? (Signifies how well a patients physiology supports growth. The technicians will not bat 1000 with all the follicles. Some will be damaged and grow in thinner, some will not grow in at all.

Then consider, how much supporting or "rim" hair there is. When hair grows from behind and from the sides, it supports the HT hair, provides additional density and coverage. This is hard to evaluate from photos because most people do not give straight on and side shots from 5 feet away.

Then consider the planting strategy and finally the styling.

I am so-so about my transplant. I think that probably 80% of the hairs grew; I can see some gaps in the hairline with lower density. That aside, the hair was reported to be "between average and fine" in density. I am guessing it is closer to fine.. perhaps the transplanted hairs are not growing with their original thickness because they are very fine.

In my favor, I have high rims and temple points. But when it comes down to it, transplanted hair is probably at 30g cm/2 overall. With fine hair, this is very see through.

So I thought I was going to get somewhere between jotronic and shuffle results (Jotronics baldness patern is greater than mine), but my result is somewhat worse than Jotronics. The hairline is planted a bit higher and I presume, the hair is finer. Just did not get a "wow result.

What I am saying is that you will be disappointed if you attach your expectations to some of these top 5% guys you see. And trying to make apples/apples comparisons is also very difficult despite the best intentions.

Expect a fine "barely coverage" result and you will not be too upset. If you keep going back, you may be able to get something more respectable over time.

Consult with a doctor. I am pretty sure the best ones will have you wait.

Its hard to say right now how your loss will progress. You have alot now, but at 22 the pattern is not established. If you can wait 5 years, then you will have a good picture of what to do.

Hmm... this is a tough one.

I had 4500 grafts in an area larger than that, but not as much supporting native hair from behind. I think your result should have been better, but I know how pictures dont tell the whole story.

I DO know that unless I let the hair grow to almost 3" and layer on top of itself, I have that same bald scalp look. But when grown to length and all styled the same direction, it looks like there is more there than reality.

The difference with your HT is that hair is growing "up" more than mine. If I comb my hair up or back, my result is not that differnt than yours.

I'm not in thrillsville about my HT, but on the other hand, it has made a positive change in my look and self image.

You are faced with the dillema to work with physician who may have done something wrong, or find someone else and relinquish any assistance. Docs dont give refund unless nothing grows. They offer touch ups. The smart patients go to other docs. Chekc out H&W. You need 4K more grafts for the youthful look.

Unfortunate,

I am sorry that your result did not turn out great. It is my opinion that you were not a good candidate for surgery, given the large balding area, the apparent tightness of your scalp, and your age.

That you are having scar problems from the second surgery, and for only an additional 1400 grafts, is horrifying. My #1 did not turn out great, and I hesitate for #2 because scar is already wide.

WHY did you go back to Feller after your original experience? Did he work a deal with you? I am in a conundrum about my first doctor and do not know if I should find someone else.

Originally posted by PD:

thanks juanc, imissthebarber.. i am counting on my curly hair, and about the discussing with a surgeon, i am hoping i will be obliged with all the detailed questions.. as you can see, i disect this thing a lot more than many out here, it looks like :-) but, thats me!

 

HairHope, TheEmperor, thanks for the input.. I didnt think I would need 4K+ for just the frontal.. Man, I was hoping i could getaway with 3K for just the frontal, the problem is the more i picture myself with about 4k, i less motived i become to get the HT done... i am hoping some good surgeons recommended here can achieve reasonable coverage on the frontal with 3k, with all the lateral slit techniques and so on..

 

Check these two, the second patient had chosen coverage over density, i understand... either way, i probably need at the very least 3500.

 

1st: ( 3.1K )

 

before:

http://www.hairtransplantnetwo...opyID=1395&WebID=689

 

after:

http://www.hairtransplantnetwo...opyID=2629&WebID=689 (some pics have both before and after in the same image.)

 

2nd: (3.2k)

 

before:

http://www.hairtransplantnetwo...opyID=1647&WebID=750

 

after:

http://www.hairtransplantnetwo...opyID=2265&WebID=750

Its good to see you doing your research. The first patient will obviously need a second pass. The second patient got a good balance of coverage and density and may be finished. My coverage is not unlike the second patient, although I have 4500 grafts to achieve similar coverage.

I think these patients both represent realistic outcomes.

Originally posted by HairHope:

The front 1/3 to 1/2 will take about 4000 grafts minimum to give reasonable illusion of density given the advanced hairloss you have.

 

You will do yourself a favor to do at least that amount on the first pass.

 

Best of luck.

Yes. 4K will only do frotn half and you will want more density.

My front was done with 4.5K grafts and density is low. If spread out any further, would be a total mess. If packed tighter, would also be a disaster becuase it wouldnt be connected as well on top.

Its a balancing act. Only get 4K+ done, period. Only a few docs do this regularly. Even with that many grafts, you will want more.

Given future loss, chasing the crown can be a very bad idea.

Oh crap. .. I was hoping that it was just my natural healing tendency.

If taking 4500 grafts put too much tension, then the prospects for getting good graft count in a folllow up without stretching are slim.

My scar is on the wider side, 3-4mm and is pretty easy to see unless hair is combed the right way.

The scar did not stretch, and I did not feel any tension after the operation, but the scar is still wide.

When I run my finger over the scar, it feels like the scar is "thinner" that the surrounding skin. Like there is a depression or ridge in the middle of the scar.

I am trying to figure out why I got such a poor scar. This was tricho from one of the best doctors. The only scars I have seen that are worse from a virgin scalp are stretched scars.

Mine was always wide. At first red, and then when redness faded, now white. No tricho hair growing within.

RWS,

I think you are in trouble. Money and how you manage it is an important part of relationships. It can also be a source of stress and breakups.

Hair Transplant vs. wedding? Good luck. If you wear the pants, you may be able to force what you want, but probably not a good precedent.

You want her to buy into postponing your wedding so you can have 15K of surgery before you walk down the aisle. Imagine if she came to you and said, I want lipo, boobs, and lips before we get married. We need to postpone the wedding for a year.

What if it does not go as planned? HT seldom goes exactly as planned, especially with FUE.

I think you know that once you get married, the HT will get harder to justify.

This situation is difficult and unfortunate. Does anyone need hair?