DrWalterUnger

I am going to try to make something positive out of tracherat’s problems so over the next 2 weeks or so I will elaborate a bit on concerns he has had over and beyond his very real, incredibly severe (but thankfully, temporary) post-operative hair loss. Today, I’ll talk about his current grave concern with his hairline. The main reason he has this fear of an are on the left side of his hairline is because he “didn’t see” any sign of grafts having been put into this area even in the first few days after the procedure. Attached is a photo of one of my patients (on the left) the morning after his surgery. The entire frontal area, including areas where he had hair but where I thought he would eventually lose it, was transplanted. The grafts were placed evenly throughout the entire frontal area, but look at the areas that have no hair and are within the frontal ? to 1 inch. In most areas you can see varying degrees of scabbing over grafts. Scabs are the result of a small amount of bleeding over the graft. In some areas there is a bit more and some areas a bit less scabbing, but on the patient’s right side (“left” side in the picture) there are areas that have no scabbing at all, and while the skin in generally reddish, in those areas for some reason, the skin color is nearly normal. It would be easy for him to have thought I skipped those areas – and, of course, I didn’t because there would be no reason to have done that (also note that in the area that had pre-existing hair the graft noticeability is far less – an advantage to operating in an area before it is totally bald). You can see the same phenomenon on another patient (in the photo on the right 3 days after surgery), but the different degrees of scabbing are less clear because of the light coverage of his original hair. So, you have to look more closely. The second exhibit is a before and after photo of a patient with a very similar before photo to the one in the first exhibit (I don’t have the “after” photo of the first patient, but will look for it when I return to Toronto at the end of the week), but it will give you an idea of what he would have looked like 12 to 18 months after his surgery. Many of you will probably be very surprised to know that he was transplanted at “only “ 30 FU/cm2. The third exhibit is a before (dry and wet to clarify actual hair density) and after photo of another patient 10 months after a frontal area FUT done at “only” 30 FU/cm2. Food for thought for some of you who believe you have to have “dense packing” done to look dense. It looks as thick as it is because I have added hair to existing hair. When he loses the existing hair, he won’t be as thick but will be older and he will have a choice of either doing another HT in the same area or using it to do further back in a new area of hair loss or a combination of both. (If you look at my website, you will see what 30 FU/cm2 looks like when you start with very little or no hair so you’ll see what the patient I’m showing above will look like when he’s lost his existing hair.)

I have emailed Trackrat and will delay a further reply to this group until later this week after I have hopefully had a chance to talk to him and to urge him to at least wait until the results of the surgery are fully grown in another 6 to 12 months before he posts anything more. I will however add a few things to what I wrote before: Since sending the previous email I have gone over his chart, which I hadn't had the chance to do before Saturday. I operated on him on July 20, 2012 and transplanted 2740 FU. Although he alluded to a bad donor scar in his posting to this site, my notes of August 7, when I first saw him about the large amount of hair he was losing, included "Scar is superb". I do not use a word like "superb " easily. ( I had mistakenly thought the scar was simply less than 1mm wide but it was better than that) I have not seen him again despite many requests asking him to come back, but Dr. Jerry Cooley who is a recommended expert hair restoration surgeon on this site, did see him. He very kindly and quickly fit him into his schedule and emailed his report to me on September 13. It included the sentence: "The scar itself is just fine and should heal normally." Dr Elise Olsen who is a world expert on medical causes of hair loss and treatment, and who also saw him for another opinion at my request, also emailed me : "He obviously has a telogen effluvium but is resolving.... The transplants and scar look great!" There is usually a year or more waiting list for patients who want to see her, but she too did us the great favor of seeing him quickly. Maybe Trackrat will ask a member of his family to take a picture of his scar and send it to the site in case it widened after he saw those two doctors, though I think that it is very very unlikely that it would do that if hadn't by close to 8 weeks after the surgery. He is most disturbed currently because of a perceived asymmetry in his hairline though we chose it together and that's what I followed. It is not yet fully grown in so he thinks I have missed some areas, but if those areas are within the lines we decided upon..and we have pictures of them....I am certain that we will in time see hair there.

I had no idea that a flurry of more than 5000 hits dealing with me on this site in the last month or two was going on until the patient I was operating on yesterday told me I really should look it up and post something, and later in the afternoon one of my associates, Dr. Carlos Wesley, told me the same thing. Most or all of you probably recognize Dr Wesley's name as he is on the list of preferred hair restoration surgeons recommended by this site, as was Dr Rosenberg who is my associate in Toronto. By way of introduction to me, both of them did all of their training in hair restoration surgery with me before becoming associates in respectively my New York and Toronto offices. They have always also used the same technicians as I do, and their technique continues to be very very similar to mine. I don't belong to this site or others of a similar nature because I fortunately have always had sufficient referrals from doctors, hair stylists who have seen my results and mostly prior patients of mine and therefore it hasn't been necessary for me to do that; hence the paucity of information about me on this and other sites. If you want to know the facts about me, what I do or don't do and why, as well as what my results are like, you should go to my website (drwalterunger.com) or read a few of the 38 chapters I have been asked to write for some of the most important dermatology and plastic surgery textbooks in the world....the last three since 2012. The full list is on my website along with the five editions of my textbook and the various papers I have written and lectures I have delivered. I mention all of this only to convey to you that I can't be as bad as some of the members of this group might think. Having got that off my chest, I want to confirm that "Trackrat" is in fact one of my patients and not just the figment of the imagination of a competitor as sometimes happens on the internet. He represents the worst complication I have ever had in the more than 30,000 hair transplants I have done in my career (in the early days of transplanting the sessions were far smaller and we could do 4 to 6 surgeries per day, as opposed to the one per day that I have been doing for approximately 5 years now.) Fortunately the enormous amount of shock loss he experienced was temporary, his donor scar was only approximately 1 mm wide when I last saw him about a month or two after his surgery, (He won't come back for me to see him or send me photos for the last 4 months or so), and I still believe that in another 6 months, when a majority of the transplanted hair has grown in, that he will be feeling enormously better about his results. He probably will still be angry with me because I didn't warn him about a complication that had never been seen by me before, and whose severity has never been written about or been seen in medical articles. He also thinks I should have done some things I did, differently.....after he did considerable internet searches. I don't think he's right about that. What is certain is that if either of us had known what was going to happen, neither of us would have proceeded with the hair transplant. Nobody other than him and his family could feel any worse than I have felt since this happened to him. If he feels better by venting on this site, I am actually happy that he's doing that. It will cause me discomfort but far less discomfort than he has endured in the last 6 to 8 months. I will send a longer email including what I did after his troubles began, on Monday or sooner, so you will know that I took his situation very seriously and did all I could to help him myself and via specialists that I contacted to quickly get him get him the attention he needed while he was at school.