akuma

do you have any before pics of the hairline and the temples?

 

were the new grafts implanted into completely bald areas or into thinning areas?

 

the temple points look really good. were they moved in as well?

The frontal scalp was transplanted into bald areas, but also deeper into my native hair as well (just incase).

yes my temples were moved forward. Am very happy with the temples.

I can't recall your hair count. It may have been the case that the doctor needed to cut some one hair grafts out of two or three hair grafts for your hairline. Also, single hair grafts, whether they are "made" or naturally occurring, are the most susceptible to trauma according to some sources, including handling trauma by techs.

 

By physiological it could be the "x" factor unknown--for some reason the singles may have had their growth stunted for no particular reason or fault of anyone--i.e. a physiological reason that will not be determined.

but isn't the whole point of follicular unit extraction is to preserve the units how they are? And hence not to split the 2-3 hairs units into 1 hair units.

Even if the singles are required for the frontal hairline, splitting the units is bound to affect the hair growth. So why would doctors risk that?

hey guys. Today is 1 year, and 2 months and I'm afraid it hasnt improved much.

I've attached some pictures.

Again, I held the frontal hairs down to compare fairly to the temples, there is a big difference. The frontal has not matured up much at all. I dont think there is going to be any maturing from now on.

There are still hairs that are thin and wiggly. Looks like they are struggling to grow or something. All the thickened hairs are stiff and straight.

I guess this is my final result for my frontal scalp. I cant comb the hair back because the hairline isn't even and has some gaps.

Comments?

Not slice the base of the follicle off, but rather sometimes too much "supporting" material around the follicle/shaft is trimmed off compromising the follicle's capacity to grow at all or grow fully. Many HT textbooks show a photo of what an ideal trimmed graft looks like, and you can find more technical discussions about this topic on this website or others.

 

 

why would the doctor trim the around the follicle if they know it would affect its growth? to make space for the 2 -3 hair grafts doesn't seem to be a good enough reason.

upon close inspection i do notice that the 2-3 hairs have matured. But the single hairs at the front of the hairline are still thin and curly.

 

Mosts but not all, failure to grow lies with the technical team behind the transplant, presuming that you followed basic post op instructions. It is possible--though not definite--that a percentage of your frontal hair grafts were trimmed a bit too much (dividing doubles into singles for instance) and this compromised growth. Or, it could be physiological.

 

 

I did post op instructions to the dot. What do you mean physiological?

I would take some recent photos and stick it up here for additional commentary, and then consider if you want to keep working with the current doc or not.

I've added new pictures to my other thread. I'd like to get more comments on it.

I'm going to disagree. Working out has always caused my hair to fall out faster. I've never taken any kind of steroids, protein shakes, muscle building pills, etc. and I'm not on any medication. From back when I was 15 or 16 and just starting to lift weights in high school (I wanted t be a body builder) my hair fallout has always noticebly increased when I was working out. It would start maybe a week after I begin working out and the speeded up fallout rate would continue for a few months until I got so depressed that I'd stop working out. Then the fallout would slow down. This went on for years. I even stopped working out for several years and that was the slowest rate of fallout I ever had. Over the last few years I've been trying to lift weights again and of course the fallout increased again and slowed again when I stopped. At this point, I'm now 45 and don't have much hair left, so I'm more concerned about my body looking good since there was never anything I could do about the hair. I've been working out on a regular basis for about a year, which is the longest non stop time I've ever been doing it, and my hair fallout has increased ever since and has not stopped. I am completely convinced that my hair falls out faster when I lift weights or work out.

I agree with this. I've noticed the same thing with myself. BUT maybe it is just speeding up the hair cycles. The hairs that have stopped growing and resting (about to fall out) fall out sooner because new hairs are coming. The follicles sleep for less period of time.

There is something i DEFINITELY noticed. When I exercise, my beard and side burns hairline grow SO much better. I am guess this is to better circulation and increased HGH from exercise (HGH produces better hair). The beard and sideburn "hairlines" become quite thick and the line is very strong. When i dont exercise, the sideburns and beard hairlines become less sharp. And when i feel the hairs, it feels softer. And sparse (not alot). But I can definitely notice the difference. I've experimented with this many times and its consistent. I even took pics to check the before and after results. Exercises such as weight lifting and intense cycling helps my beard grow thicker and side burns grow thicker as well. Since these areas dont miniturise from DHT, from what i know, the beard grows thicker from the DHT. So the extra testosterone produced from doing weight lifting is making my beard thicker. And the better circulation making my side burns grow better (probably other areas too). As for the top head hair, i do notice a bit extra shedding when i work out. But as i said above, this COULD be just from speeding up the hair cycles. Because when i exercise, I definitely find myself shaving more often and getting hair cuts more often.

I dont shed alot so i cant say if its contributes hairloss.

I just work out enough to stay built and healthy. I do not take any steroids or workout as a body builder. I do think too much testosterone (from too much body building) does affect hair follicles more. More testosterone, more DHT. So I just workout enough to be healthy.

If I remember your case, you had some questionable results in the front hairline only? It could have been the single hairs were trimmed too fine for example. There was a similar case from Dr. Feller posted here a few years back. The next time the grafts were trimmed too keep more "fat" and more multi-units were added pretty soon after the new singles in the front of the hairline, and it looked much better. .

Yea just the front. I am not giving up hope yet, it could improve.

What do you mean the single hairs were trimmed? you mean the base of the follicle made thinner? slice the base of the follicle off? wouldn't that affect growth though? Please give more info on this.

I recall you had a pretty good head of hair to start, so you could always take a crack at beefing up the density a little without necessarily compromising donor supply

Yea I am thinking to take another shot at adding up some more density.

It really depends. If someone had 50 cm2 grow in, that would not be considered a failure. It is really a case by case basis depending on age and donor, etc. If a doc felt comfortable he may put an extra 15 grafts per cm2 just to beef it up a little more. There are so many variables that to answer a question like this you would have to go in a lot more detail.

So only around 15 U / cm2 can be added?

If 50 fu/cm2 grew, that is pretty dense for a hair transplant.

In most cases 50 Fu's / sq cm is enough to give good coverage. I suppose with very dark hair and light skin it may still look thin in certain lighting.

They grew, but the actual hair thickness has not reached full thickness (and i dont know if it will or not). Some hairs are wispy. So im curious how much more can a doctor add to a 50 U/cm2 transplant?

15 cm2 more?

What about blood supply issues? Would adding extra follicles to a 50 U/cm2 zone reduce blood supply ? due to crowding.

If on any event the first HT does not grow in well. And say the patient got 50 units per cm2. If he goes for another HT, how much can that fix anyway?

I mean with 50 U / cm2, its not a empty scalp. There are prior follicles still there, so when the new procedure adds new grafts, how much can really be transplanted? The area would already be crowded.

Im guessing not much. So the results from repair work isn't that great i assume?

Any insight?

I dont mean to sound negative, but how come she took the strip from a higher position on the back of the head?

From what i know, the crowns recede at all directions and the area she took the strip out from can be prone to hairloss/thinning.

Yeah, I think you should ask him for a free surgery if that's what its mentioned in his website UNLESS there is a small lettered terms and conditions for this offer but still I think you will be told wait 18 months :-)

Yea I am waiting the full 18 months though. Just cant help thinking what went wrong though.

Was so happy with my result at the temples. You can see how dark my hair is. This even gives me a strong temple result when compared to lighter coloured hair individuals. Was so excited waiting for the scalp result to come in.

I thought maybe the scalp hair are growing out at a slower rate (cm per week). But I snipped a baby hair all the way short, and saw that it grew out at a normal rate. It wasn't slow.

I think somehow the growth and sleeping phase of the hair has got messed up.

The scalp hairs had slept for heaps longer before it even began to grow in.

But all this guessing on what went wrong wont help...

I want to upload a recent picture but I think i'll wait. 5 more months till I hit the 18 months mark.

Dear Aukuma - thank you for replying to quickly! Yes, I think Dr Oravan quoted me 85 baht per graft too >.< Though she quoted me a higher price for eyebrow transplant...I'm wonder if I could write to her to ask for a discount? It really doesn't make sense to charge me a different price for eyebrows...

 

I think the Path's website promises that you could go back to him if your grafts don't grow in. I don't know what's the legal aspect of holding him account to his website promise though. That's the problem with medical tourism! Let me know and I hope you're doing better!

Yea I remember being charged more for eyebrow transplant. I think this is because its a more delicate procedure and takes longer to do.

Their website says..

DHT Clinic

"However if there is no growth which has never happened in our practice you may return for surgery free of charge. "

Would I get a free surgery if I dont get a reasonable result?

Akuma, did you or have you ever tried Minoxidil after surgery? I know it's a shot in the dark, but it could possibly bring some hairs out of dormancy.

no i haven't tried minoxidil or propecia.

Hey Akuma - could I check w you how much you paid for your HT with Dr Path?? I'd just been to his clinic and I was quoted quite a hefty sum for 2400 grafts!!

I think it was 85 baht per graft.

My hair is improving I think, but i am not sure because it is soo slow. Maybe it not even improving at all. Hard to tell. I think something went wrong in my hair transplant case.

In the worst case scenario that my grafts dont grow in, what are my options?

Bill,

 

Do you have a source for these studies? I really would like to see these. I can't help but feel the 18 month thing is a little too long to see actual cosmetic change, but I may be wrong.

 

I also agree that he had a small amount of grafts placed for the area covered and would not expect it to look too dense, but would have expected it to be symmetrical growth.

Yea the growth is not symmetrical at the moment.

Bill, please look at my post number 27. I got that information from Dr Pat.

-------------------------------------------------------------------------

Right temple= 1 hair graft=50, 2-hairs graft=200 area roughly 12 cm2=23 grafts/cm2

Left temple= 1 hair graft=50, 2-hairs graft=160 , area roughly 9 cm2=23 grafts/cm2

Frontal scalp 15 cm2 not count thinning inside 1 hair=109 grafts,2 hair 442 grafts, 3-hair 187 grafts, 4 hair 92 grafts = 830 grafts

92 of 4 hair grafts were placed further inside ,therefore roughly almost 50 grafts/cm.

-------------------------------------------------------------------------

23 cm2 on temples compared to around 50 cm2 on the frontal scalp.

 

However, even after a year and a half, while you may have more thickening, you will not achieve a great deal of density remotely close to what you had before any signs of hair loss. I trust you are aware of this right? Honestly, you've had a minimal number of grafts transplanted in the front and while you may see more growth, you may require another hair transplant in order to achieve the density you desire, assuming you understand that no hair transplant will restore a "full" head of hair.

 

Also, according to Dr. Pathomvanich, even though fewer grafts were transplanted at the temple, it lays flat against your scalp. This overlapping effect creates a greater illusion of density compared to the top that's angled at 45 degrees. Furthermore, the transplanted area in the hairline is much greater than the temple areas and thus, the grafts may not have been packed as closely together.

 

 

Yes I am aware that i will not get the density of my native hair. I already mentioned that in my previous posts.

The transplanted area is greater at the scalp, but so is the number of grafts transplanted. Plus the scalp was transplanted at around 50 CM2 (hence packed together closely). And the temples at 23 CM2. Temples are at roughly half density.

I understand that the temples lay flat and hence look darker and denser. But I even lifted the temple hairs up and saw that it still looks better than my top scalp area.

Fully matured hairs can be seen along the temple line. My diameter shaft of a hair is thick. And that is just 1 hair grafts along the temples. It still gives a good cosmetic result. That kinda individual shaft thickness is very sparse on my top scalp hairline.

Plus I layed my top scalp hair flat in my pictures to fairly compare with the temples (since temples lay flat too), yet we can fairly see that the scalp is lagging far behind.

I even cut a hair from the scalp hairline and the temples. Look at post number 24. You can see the short, light hair from the scalp hairline. And the long thick one from the temples.

I believe its fair to atleast get the hair shafts to thicken to terminal hairs. That on its own would give a good result.

Akuma, you may be in a regular seasonal shed. That does happen sometimes.

 

Thanks for posting pics. I think your doc will take care of you. I do see that density issue you were talking about better by seeing the newer pics. Your temples do seem on point and good from what I am seeing.

 

I know it's hard but don't stress yourself over it too much. You may need another touchup in the front if you don't see any improvement in the time frame you have been given. Most people do get full results at the 12 month mark, then some do have improvement but from what I have seen it's not like a huge improvement after that time frame. I do hope you see a positive change in the next few months. Someone posted this in my thread,

 

3 months - 10%

4 months - 25%

5 months - 40%

6 months - 60%

7 months - 70%

8 months - 75%

9 months - 80%

10 months - 90%

11 months - 95%

12 months - 98%

18 months - 100%

 

 

 

RodG, I think you are right about the whole 40-50 cm density issue. I really think it comes down to hair texture/hair caliber in conjunction with density cm2 planted. Some may need 40-50, while some may need more if they have thinner hairs for the illusion of density. With very thick hairs, it is very hard to dense pack as well.

thanks for the reply mate. Seasonal shed? whats that?

From what i know, the hairs stay in anagen (growth phase) for 2 years. Why would recently grown hairs fall back out again? its well within 2 years right now.

My hair is thick, so if the transplanted scalp hairs just become full terminal hairs, the final result will be very very good. I do have realistic expectations.

I even lifted up my temple hairs to see what it could look like (temples are at 23 cm2), even if i get that hair diameter thickness at my scalp area, its acceptable.

Right temple= 1 hair graft=50, 2-hairs graft=200 area roughly 12 cm2=23 grafts/cm2

Left temple= 1 hair graft=50, 2-hairs graft=160 , area roughly 9 cm2=23 grafts/cm2

Frontal scalp 15 cm2 not count thinning inside 1 hair=109 grafts,2 hair 442 grafts, 3-hair 187 grafts, 4 hair 92 grafts = 830 grafts

92 of 4 hair grafts were placed further inside ,therefore roughly almost 50 grafts/cm.

Even though the temples are just 23 CM2, it looks wayyy thicker than my frontal scalp which is around 50CM2. I understand that for the temples the hairs are laying flat against the skin so hence the overall thicker, darker effect.

But I've held my scalp hair down as well to fairly compare with the temples, its still no where near my temple result. This all can be seen in the pictures.

My aftercare after the surgery was very good. I dont drink alcohol, no smoking, and eat very healthy diet. And I did not let direct sunlight on the scalp for weeks.

I dont know what to do now. I dont know if this is fixable or not.

i actually think that either the thickening has stopped or that some of the hairline hairs have fallen out. Its like the hair is struggling to grow and then falls out. Has there been any other cases of this?

the thickening is veryyy slow and I feel that I wont get the density that I should get. It has been 1 year and 1 month now.

I just dont know what could have gone wrong, My temples, eyebrow, and beard all grew in fine. Dont know what is causing the slow thin growth on the frontal scalp. The next 5 months are a anxious wait.

Here is the picture I forgot to add in the last post.

The long thick one is from temples. And the short thin one is from the hairline.

The hairline one has a very tapered tip, so its recently grown.

I am just wondering what is causing the delayed growth.

Here are the dry hair pictures. There were taken today. 1 Year and 2 weeks after surgery.

I am holding my scalp hair flat so it can be fairly compared to my temples. Can definitely see that the temples hair (base) is thicker than the hairline. But the yellow arrow areas have hairs that have thickened up. So I am hoping the rest of the hairline becomes like that. In the pictures you can see that the right side of the scalp has thickened up more than the left.

I even cut a single hair from my temples and one from the hair line to compare.

The long thick one is from temples. And the short thin one is from the hairline.

The hairline one has a very tapered tip, so its recently grown. If you look closely at the hairline, you can see mini hairs still sprouting.

I'm trying to stay positive and hope the rest of the hairline gets thicker.

Comments guys?

it may look like my hairline was brought down alot. It wasn't. My native hairline was shaved to transplant there as well.

I wanted a straighter V hairline instead of the zig zag one i had.

I've attached the pictures as you requested Bill.

Here i've attached pictures of me before surgery. Age 25.

I do not use any medication.

Just wanted to have better temples and lower the frontal hair line a little (had high hairline since birth). But wanted to keep as much donor hair left as possible. Hence the smaller surgery.

The "more forward" temples better frames my face. I am loving the temples.

Just the top scalp....

The dates show on the picture. Surgery date was 9th March.

1.jpg and 2.jpg were before surgery.

The blue arrow points to areas you can see that are thin. You can even see some baby hairs (transplanted ones) along the new hair line.

I can practically see through the transplanted scalp hairs. I drew arrows to show the transplanted area.

The yellow arrows point to thickened hairs. You can see it clearly that its DARK and thicker than the rest. Its become the thickness like my temples. I hope the other areas get as thick as this, would be very happy.

Would love your comments guys.

I'll post pics in this thread when I reach 18 months for final result.

thanks for the reply Dr Pat. I have full confidence in your work.

I have sent pictures to the clinic. I was told to wait 18 months for full result. I am doing that, its just that the worrying got me to post on this website. Just to get more opinions.

Hi,

 

My understanding of hair transplant procedures is that 50 grafts per cm is about 50% of your normal hair density. You can never have the density that you had before you started losing your hair and when you wet your hair it is always going to be a bit thin looking.

 

I would suggest that you take Bill's advice and provide some better photographs and details of your hair transplant. I had a procedure with DHT Clinic in 2010 and they are very good to deal with. I'm sure that they can help with any enquiries that you make.

 

Good luck

 

Rod

Yes but the frontal scalp definitely hasn't thickened up.

I saw your photos, yes it seems like your temples have matured. However, you say that too much density may cause blood flow issues? I don't know about that. I had 65cm density transplanted on my frontal hairline by Dr. Rahal. I would consider that densely packed. However, like I said I am only 6 months out and I am still thin in some areas vs others.

 

Could it be delayed growth? I am not quite sure. But if you are still growing grafts, then the area may fill in, but I don't think it would be a massive filling. Is your hair wet in the pictures as well or do you have any product like gel on?

That may also make a difference in the appearance of the hairline.

so you got 65 follicular units per cm 2? That is quite dense.

Yes my hair is wet without any product like gel.

Even if I get my scalp to the level my temples are, I'll be happy. Because it will blend in very well. Any the moment it does not blend in with the native hair at all.

But from what Dr pat assistants have told me, My temples weren't packed as densely as my scalp. So my scalp area should provide better results than my temples for sure.

It has to fill in massively because if this is the final result it is very disappointing to say the least.

Akuma,

 

Thanks for presenting your questions and concerns about growth on our forum. In order for us to provide you with a better idea of where you're at, I'd also suggest providing us with more detail about your surgery and post before pictures. For starters, how many grafts did you receive on your scalp? In another topic, I see that you expressed similar concerns. You also mentioned that you had some eyebrow work done. How many grafts did you receive in the temple areas? What about your eyebrows?

 

Based on the pictures you provided above, your temples and hairline look pretty good already. However, without before pictures, it's impossible for anyone to make an assessment and give you an idea about growth. Moreover, posting pictures of wet hair is not optimal since wet hair always appears thinner as hair tends to clump together.

 

I know you're a bit worried, but some additional growth and thickening can occur between 12 and 18 months, albeit for most people, growth that occurs during this time is minimal but for slow growers, it can be a noticeable change.

 

In the meantime, I strongly recommend presenting some before pictures and current dry hair pictures so we can get a better idea of the kind of growth you've experienced. I also suggest providing us with a graft count breakdown of how many grafts you received in the hairline, temples and eyebrows. After all, there's a chance that you may have experienced more growth than you think.

 

Best wishes,

 

Bill

The eyebrows had grown in and thickened within 6-7 months after transplant.

I received around 800 FU on the frontal scalp. And roughly 200-300 on each temporal peak sides.

The temporal areas that got transplanted are shown by the yellow line i drew.

My temporal peaks were always not strong. This is something I had since I can remember. From age 12 even. I inherited it from my mum. So I just transplanted there to better frame the face.

My growth is definitely not what it should be. This is because I can clearly see that my temporal peaks have fully matured and i can see individual thick hairs now.

Whereas on my frontal scalp, there are some hairs that have thickened up, but there is STILL many others that are wispy and thin. And there are also new hairs coming up that are only 3-4 mm long and is very thin.

The area on my frontal scalp that got transplanted can be seen with the line i drew. Everything behind that line is my native hair. It clearly shows that the transplanted hair isn't as thick as it should be. Many wispy hairs cant even be seen in the picture.

I definitely know and can see that its not as thick as my temporal peaks or even my eyebrow hair. The question I have is, has there been a case like this where their temporal peaks grew faster than their scalp hair?

and did the scalp hair eventually thicken up fully?

most people say that doing heavy body building does not affect hair loss. I believe it does to some extent. Doing alot of weights increases testosterone in the body. More testosterone would mean more of it can turn to DHT which affects hair.

Its a well known historical fact castrated (testicles cut off) men dont go through male pattern baldness. Its because there is no testosterone from testicles.

I think since you took supplements, it increased your testosterone levels ALOT and meant more DHT to your hair. So heavy body building doesn't "cause" hair loss, but i think it can surely accelerate the process if your genetics are susceptible to it. And since you dont take any testosterone enhancing pills anymore, your hair loss situation has stabilized. And ofcourse the DHT blocker helps too.

Just my opinion and observations. I could be wrong.