LasVegas2Orangecounty

Dr Meshkin mention that FUT would yield more growth.

Dr Meshkin mention that FUE would have a 50% success rate in my case.

Decided on FUT/FUE for 1500 grafts. He did mention about the safe-donor area as well. Future hairloss possible

After looking at Post op surgery pictures, I felt less than 1500 grafts were placed. Somewhere around 700-800 grafts. I calculate the number of FUE scabs minus the total of implanted scabs. I arrived at number of FUT and FUE implanted with some simple calculation. Accuracy---Very Accurate.

Dr Meshkin's office refunded the difference. 65-70% from FUT and 30-35% from FUE from my calculation.

So Dr Meshkin charged me for the 800 grafts.. (combination of FUT/FUE).....but insist 1500 were placed.

Informed Consent provided? Yes. Risk and benefit discussed. Yes.

I proceeded forward with all information provided. But if the risk outweights the benefit, should the surgeon even performed the procedure?

Fast Forward 1 year later:

After reviewing the pictures, was there some growth? Sure.

How many of the FUT/FUE survived? Not much as you can see from the pictures. Out of the 1500 (according to the provider), what you see is probably in the range of 100-150 grafts maybe. It's not worth evening counting.

Even if we did FUT completely, would the results in my case be any different? Probably not... Remember, the original 65-70% was FUT.

So I have to correct myself, and say there was some growth. Compare pre and post pic.

Nevertheless, Dr Meshkin did his best in my case. Dr Meshkin has achieved fantastic results in with other patients. I'm not here to crucify anyone. Just presenting the facts. FULL Transparency. Someone coming across this thread, will have something to think about.

I have friends that are ENT, Plastic, OMFS, etc...etc.. They have all experience cases that just didnt turn out right. Does it make them a horrible surgeon? Absolutely not. Every provider has different philosophy regarding treatment.

With that said, here some final pictures. I will stop by Dr Meshkin office when I'm back in the area..for him to take look.

In closing, my case could have been the extreme outlier. Given that other patient's have had stellar results with Dr Meshkin... One should only look at my case and understand that even with the best surgeon, the end result may not be desirable. The only thing to do is to refund the patient's money, let another provider manage this patient (which Dr Meshkin has done). One case with less-than-desirable result does NOT make the surgeon a bad surgeon. Multiple patients with the same outcome, THEN YES. So far, I am the only patient with sub-par results with this provider on this forum. I hope the next patient that sees Dr Meshkin for surgery will post pictures of fantastic results that will trump my case.....and it will demonstrate his ability as surgeon.

For the future HT candidate, use this post to educate yourself...before you take the plunge for surgery. It has definitely been a learning experience for me.

I wish you the best Dr Meshkin. Thank you for reviewing my case...and taking the appropriate course of action.

Thanks to all the members and moderators for taking the time to read my post!

the before pictures supplied by the OP are different to the before pictures supplied by the doctor.

The picture that Dr Meshkin post was the day of surgery. I had just cut my hair short...anticipating FUE procedure. Haircut completely 7-10 days prior. I went with 1/2 guard....in pictures

The picture(two pictures on the bottom row) I posted in the original post was about 7-8 weeks of hair growing prior to surgery.

When the hair is long..it tends to conceal and receding area.

Dr Meshkin pictures are accurate. My are accurate as well.

I requested FUE. He mention (which he wrote on my paperwork) FUE has only a 50% success rate. He recommended FUT. He saw i was hesitant about FUT..so he recommended FUT/FUT for a higher success rate.

1500 graft per provider.

Just got off the phone with Dr Meshkin. Relay my concerns. We discuss my medical hx. SH. Family HX.

He provided two options: full Refund or another session.

I elected the full refund. I may do another session, FUE only, in the future....or just live with what I have..

Yes, I now have a FUT and FUE scar.....so that's a risk with all elective procedure.

We both reach an agreement. Full refund. Which is fair thing to do.

I appreciate the support from all the members.

Thanks again

Had the OP had prior work done or was this virgin scalp? I think this matters.

Gram,

This was my first and only Hair restoration procedure. Virgin scalp.

The surgery was completed by Dr Michael Meshkin in Newport Beach, CA. He is on the recommended physician list.

Date of Surgery 14 Feb 2014.

Is FUT/FUE at the same time the standard of care?

Asymmetrical incision line?

1500 grafts per the provider. I say no more than 700-800 grafts

Donor grafts are gone forever.

I just find it hard to understand this procedure plan.

By doing a fut/fue combo he has taken away the advantage that one method has over the other and in such a small procedure I just don't get the logic behind this approach.

If this procedure had been a success we would not know about it so the dr might well of used this approach many times with great results.

I think dr Karadeniz does fut/fue combos ( I may be incorrect ) and like I say I just don't get the benefits of it.One technique or the other is what most top drs do as the norm but as we all know fue was once not the norm but is now a standard procedure practice the world over with some outstanding results.

If this dr was aiming for a high graft number then it would be a little more understandable but 1500 grafts I don't get it!

It will be interesting to see what the drs response is to the result and it would be interesting if he were to come here and explain his approach in this case.

Hopefully the thread starter can get his money back because he paid for a result not a resulting scar and decrease in donor density.

Have a good day

Thanks 1966kph!

I spoke with surgeon today. He is going over my pictures. Pre-op, after surgery, and the recent pictures in my first post.

I will be posting the surgeon name by tomorrow. I know his office manager has post before and after pics here before. I hope this never happens to anyone else. He should never do this procedure.....

Full Transparency.

I will be requesting a full refund..once he views my pictures..and digest the information....he will realize that this case was an ultimate failure...resulting in loss time, money, and disfigurement/scar...with no gain. So I will have the final answer by next week...which is a fair time frame.

Thanks for the support

Very tragic. Hope your issue is taken care of. So, this is what a recommended doc chose to do?

 

FTC please review.

Yes. He's the surgeon, so I felt he knew what was best for me. He was pushing more of FUT. I prefer FUE. He recommended FUT/FUE procedure. I concur...believing it was the best option. He executed the procedure.

Looking back, I dont even think this is consider the standard of care.

Hmm.. I ain`t got the time for that, but considering the question how many grafts got placed, I guess you could simply count them based on the immediate after op picture(s). Just print a picture out and make a dot with a permanent marker/an edding or whatever on each graft, or do it in Photoshop or such.. Then you know, you know

 

I`m curious what other members and foremost the surgeon have to say in regards to this case in general..

I didnt mean for you to do it. That;s how I arrived at the number 700-800 graft. I did exactly that in my after surgery pic (counting dots)....and why I called out the surgeon on that. =-)

Do you know how many grafts he extracted via the strip, and how many via FUE?

He wasnt able to tell me.

More FUT than FUE looking at the pic after surgery. I counted the FUE scab from the donor site...subtracted from the possible placement of 700-800 (although he claim 1500). 300 FUE/400 FUT.

No text

Agreed. I`d like the physician to elaborate on the approach only :confused:

He was pushing for FUT. I prefer FUE. That's when he proposed FUT/FUE. Looking back, I should have walked out when he proposed this procedure, versus undergoing the procedure. If this is not the standard of care, it should have not been offer.

well, first of all the immediate after pics look terrible. looks like old plugs. u definitely did NOT get 1500 grafts but even if u did I wud highly doubt the graft survivability wud hav equaled 1500 grafts. either way its a failure. ur not the first and u won't b the last.

 

unskilled surgeons like whoever ur protecting for watever ridicules reason often transect many grafts while attempting to remove them either due to using the wrong instrument and simply not having the skill to perform it without damaging other hairs.

 

why the hell wud he do FUT and FUE with 1500 grafts? after hearing that u shud hav walked I mean RUN out the door. it just amazes me in this day and age that a surgeon cud be so incompetent.

 

sry bout the scars for nothing but thats the downside to FUT. I wud say next time do ur research and ask ppl up here where u shud go vs. deciding on ur own which can and obviously was a poor decision. hopefully u still have adequate donor supply.

 

ur certainly not too far gone. u need another 1500 grafts.

I'm waiting for the surgeon to respond to my email. After that I will named the surgeon. And go from there. I have lost all confidence in this surgeon's ability.

The whole combo factor of FUE and strip is very bizarre at 1500 Grafts?

Yes. 1500grafts.. I but believe no more than 700-800 was placed

do you mean 700-800 graft has grown ? or your all transplanted graft died?

and you saying your last 2 pics are your starting pic.do you mean these 2 last pics before fue ht?

I think nothing survived..and lost native hair as well. +FUT /FUE scar.

The last 2 pics on the bottom row...are my starting out pictures before any surgeries. Pre-op pics.

Who was your surgeon?

Hi Wazaam

I dont want put the surgeon's name out there yet. Still waiting for a reply from the office.

The surgeon is based out of Southern California.

Thanks

Who was your surgeon?

Hi Wazaam

I dont want put the surgeon's name out there yet. Still waiting for a reply from the office.

The surgeon is based out of Southern California.

Thanks

It has been 1 year

MD claim 1500 grafts

I called him out on it. Probably no more than 700-800

Combination of Strip and FUE.

Completed by recommended MD on this page.

Negligence?

Technique?

Actions?

This was a waste of time and money. Now I have a scars with no results.

Last two pics are my starting pic.

Check my blog for pics after the surgery for comparison as well.

You are in "no-mans land" at the moment (time-line wise), my reading is you are looking for a bit of feedback and support. You are in a good place to get support here. In your case here, I would have been appalled beyond words just a few years back that they hacked your head open - a virgin scalp none the less - for the sake of so few grafts. But as an observer of this industry since 1988 you just get used to it, the casualty rate is so high. The good thing is that it looks like a short stumpy scar. These are far less a problem psychologically and technically later on; they don't look like traditional HT scars curving up over the ears. You might get away with it and you have tons of donor left

 

Well, the final consultation is always such a dangerous place to be.

All the research you have done, all the emails, the calls, the late-night doubts, the scenarios you have played out in your head dozens of times just preparing for the various possible problems and nosey antagonists that might come your way. Finally, in the very last consultation you hear the doctor use the "bait-and-switch" tactic that HT docs/clinics are famous for.

 

In your case, it looks like they got you into a strip frame of mind and watered it down by throwing in the FUE with it. Well done doc! and rep!! Take a bow!!

 

Just as a warning to others; In the final consultation *and Im not even sure our guy went down this way, be aware of the following (and more)

 

Likely list of bait-and-switch tactics docs use at the last curtain call;

 

1) I won't be dong your procedure today. Dr. (fill-in blank) will do it. He is excellent.

2) No, the extractions will be performed by the techs today. They are better than me! (said with smile and exclamation mark eyebrows.

3) After taking a good look at your situation, I think strip will be a better choice in the long run

4) No, I won't touch the crown today. You'll likely lose a lot of hair if we do. (Pateint, "But you said shock loss is not usually permanent") Would you like pizza? Or curry? How about curry for lunch?

SCAR5!

You nailed it!

I initially had plan the FUE...even in my email, I mention FUE.

Convince me of the FUT...by saying FUE success rate is only "50%"

Or do both FUT and FUE... I should have been more firmed.

Good thing it's a shorter scar.

Nevertheless, i have 2 other scars on my head, oblique and vertical.....due to a skateboarding accident when I was 12 years old.... hahah..

So my head is not sooo perfect.

Next procedure, I am going to be firm. Anyone mention FUT..I am getting up and leaving.FUE only from now on.. I may try Drs. Rassman and Pak next..

Dude.. Relax!

It's way too soon to be doubting the results of your HT procedure. You will drive yourself crazy if you analyze it everyday.. Just continue your life and let the hair grafts do their thing.

 

You posed some interesting questions, nevertheless, that for a second got me curious and paranoid- as I am looking into getting some FUE work done to target/augment 1 or 2 areas on my scalp; and I am in the same region as you (Orange County / Los Angeles). I had a consult with my physician today and brought up the issues you pointed out. My HT surgeon is Parsa Mohebi and he has done a strip (FUT) procedure for me in the past.

 

1) My surgeon feels that 50% is way too low (based on his experience and skill level).

That being said, I have seen sites on the next saying that for certain types of hair (ie. very curly, African American, as low as 50% is possible)- yours does not seem to fit that category. Maybe your physician was making sure to give you the worst possible outcome? In that case, I totally respect what he said.

 

2) Dr Mohebi also confirmed something from my experience post-transplant, which is that you (the patient) cannot guess the # of grafts the surgeon has implanted based on looking at the red scabs on your head after a transplant. Or for that matter, neither can we (the viewers who are looking at the pics you've uploaded). This is because not every transplanted graft has the scabs or dried blood on it.

 

3) Finally, and something I never thought of, is Dr Mohebi said that surgeons sometimes double up on grafts. For example, if the number of singles are more than what is needed for building a hairline, then they double them up to have more density.

 

4) Don't you need to get staples removed? Make sure to ask your dr if you have any concerns. Keep up updated. If your doctor was recommended on HTN, I'm sure you can be confident in his abilities. Did your doc's office ever get back to you - what did they say?

 

Also, in case you are interested in further reading , David (TakingThePlunge) had written (in 2009) a nice article regarding that 50% survival rate for certain FUE cases:

Is Graft Survival Lower with FUE Hair Transplants? | Hair Loss Q & A

Thanks for the link Paulygon:

You are correct that scab does correlate to the number of grafts place. Some of the scab could have washed away or gotten stuck to the initial pressure dressing.

Nevertheless, the number of scab does provide a semi accurate count of the number of grafts place.

For example, if only 1400 graft place instead of the 1500, its not an issue. If 1300 graft place...not an issue. Factoring in loss FU and transected FU units.. NO biggies.

But when the number is half place, then I have an issue.

I know some provider have a FUE machine that does actually provide a visual read out of the number of graft taken/place.

I factoring in the doubling which brings the number up to 775-800 grafts. Thats being generous.

I've sent him high resolution pics to show the FUE donor site. Counted each scab. Came out to only 175-200 FUE... when the agreed upon number was suppose to be 750-ish...

Counted the recipient site as well. High resolution pics.

I can understand some scabs washing away, to have 700 scabs wash away or 700 disappear in a certain area is alittle suspicious.

I dont have an issue with the quality (I'll know in 12 months)...just the agree upon number of graft. No difference than going to a dentist to have work done...and your insurance company gets bill for WORK NOT DONE.

So the take home message For EVERYONE READING THIS:"

1.Can the provider provide you with an accurate number of grafts placed?

2.Is there a second assistant in the room recording the number of donor removed and the number of graft placed.

3.Is there a machine that provide visual read out of the graft?

4.Take a POST OP PICTURE IMMEDIATE AFTER THE COMPLETION OF THE PROCEDURE BEFORE THE DRESSING IS APPLIED.

These are question I will ask when I have the next procedure in 12 months.

It unethical to bill for "X" numbers of graft and received "Y" numbers graft.

I know it's almost impossible to have 100% accurate count.. but you gotta be in the ballpark. Receiving 1850-1900 graft instead of 2000 is fine.

I WANT TRANSPARENCY!!!!!!!!

I spoke with the provider. He informed me that my concerns are valid.

I mention and confirm that the majority of the placement was in the anterior frontal region.. and some in the mid scalp. He could not give me an accurate number. (I FIGURE ONLY SOME IN MID SCALP...as it's pretty evident in the pics)

The Provider agree to refund the difference with my calculation. No hassle. Did not argue with me or anything. Very professional when I brought the issue up.

A 50% survival rate for FUE grafts sounds quite low. While FUE yield was lower than strip surgery in the past (and likely still exists in certain instances today), I don't think I've ever heard of a gap that large.

This provider informed me the 50 percent success rate is the norm. Still have worksheet with that written on it. Future HT...you have given positive reviews on this provider as well. Nevertheless..i will everyone updated when i talk with him tonight.

most likely i will need another session in 11-12 months...for mid scalp..... and hiding the fut scar.

1500 Grafts or not i really think you needed more. The area your covering with 1500 does not seem enough to make a decent improvement.

Considering your donor area looks good im suprised it wasnt all FUE. Shame to get a FUT scar for such a low number of grafts,

Thats what i was thinking. If i had more coverage in the mid scalp...then it wouldnt be an issue. which lead me to believe 1500 graft was not deliver.....not remotely close. i will be speaking with the provider tonight.. To have a scar for this little graft is not acceptable.

Really hard to say at a glance. But I'd never go to a doctor that was talking about a 50 percent survival rate, and have a hard time believing any recommended surgeon that any recommended surgeon would do fue and only offer a 50 percent survival rate.

The guy was listed on the recommended list. Not a coalition member though....

Some of his cases yield good results.. I guess they were are FUT... Now that I am thinking about, this provider shouldnt even offer or perform FUE....if the survival rate is 50%.....

50% was what he mention to me. He even wrote on the worked up sheet. I'll scan it and post it after I get reply back from clinic regarding actual grafts place.

1500 graft should not look like 650-ish....even with splitting FU.....

this is a very good question indeed! and i am sure that the answer would be interesting for any potential ht candidate, (well, at least for me). in particular, because i noticed that it is so easy to cheat with a ht. and i remember with all my research work that this potential problem was - and probably is still being - discussed in many threads (i can't remember whether it was this or other ht forums).

 

now the answer that i found for myself depends first of all on the type of surgery you have decided:

 

 

1. fue procedure

 

with fue it should be relatively easy:

 

since your head gets shaved before the surgery, the number of grafts that have been taken out can easily be spotted. so, if you take a picture of the donor site at least within days after the surgery, you just count the red dots in the donor area and which is equivalent to the number of grafts that have been taken out. at least in theory.

 

because, practically speaking, this doesn't mean that the same amount of grafts also got implanted into the recipient area:

 

not all the fue-drills are successful - eg. some grafts won't come out, some others might get lost due to transection; and the very first ones in the fue procedure often can't be used either. so, maybe there is a 2% loss of all extracted grafts (just to give you an example).

 

to be sure, i would suggest to also take a picture of the recipient area and what you have already done. now if you count the incisions the amount should normally be less than the the amount of the dots that you counted in the donor area for the reason that i just mentioned. there is just one exception:

 

sometimes ht surgeons split bigger grafts into smaller ones, "officially" for the reason to have more smaller grafts available for creating a natural hair line with single hair grafts. however, i also remember this created a lot of controversy within the ht world as being highly unethical:

 

as everyone can easily imagine this approach is first of all much more lucrative for ht surgeons as it artificially increases the amount of grafts and as such the money that surgeons can charge their patients. to give you an example:

 

say, you got a total of 1,565 grafts extracted and which would equal about 3,600 hairs if we apply the statistical average size of 2.3 hairs per graft. now if you initially agreed to pay, say $5 per graft, this would then come to $7,825. normally, if there is no splitting involved. because there have been cases when it turned out that the average graft consisted only of 1.5 hairs and which you can easily achieve by the above described procedure. so, in our example the surgeon could also create 2,400 grafts and which would come to a total bill of $12,0000 for having transplanted the same amount of hairs. not bad, isn't it.

 

to avoid this costly scenario, i would therefore recommend you first of all make the doc confirm before the surgery that he doesn't split grafts. this way, you can be sure that the incisions that you counted in the recipient area is the total amount of grafts he can actually charge. additionally, you should also ask him to count each and every graft while he is extracting them.

 

 

 

2. strip procedure

 

this is the much trickier one if you want to make sure that you don't get cheated but only get charged for the actual amount of grafts:

 

it is very very very easy to split natural grafts into smaller units while dissecting the original slice of skin that was cut out of your head. to get round this i would suggest a multi-stage approach to be on the very safe side:

 

a. pre-op consultation

 

make sure that you know your donor density beforehand. i remember in one of the other threads "1 EURO PER CRAFT STRIP, 2 EURO - FUE" the relevant surgeon used a densitometer to examine the donor area. the magnified fu's were then shown on screen so that the patient's fu's per cm2 could be calculated precisely. furthermore, you can also check the percentage of miniaturised hair and which shouldn't be used for ht (see also the other thread: "transplantation of miniaturised hair?"); finally, you can also have a look yourself what the average size of your grafts is.

 

once you have got these figures, you can calculate very precisely the length and width of the sliver that is needed. say, your average density of usable fu's is 80 per cm2. in this case, if you wanted to have 2,400 fu's transplanted, you would then need 30cm2 of skin.

 

 

b. surgery

 

when it comes to the surgery, just take a picture of the cut out skin. when you later view the image on screen it should be possible to count the fu's on screen provided your camera allows for close-ups in the first place and that your image is sharp. additionally and to be on the very safe side, you can also place a ruler when taking the picture so that also the total area of the sliver can be calculated. in any case, you should be able to easily check whether the number of grafts that you have been charged is correct. or not.

 

 

 

ps: from an ethical strip ht surgeon i would agree before the surgery that he provides such a documentation of his surgery so that the number of transplanted grafts can always be double checked - either by providing a photograph of the cut out skin as just described or, even better, by providing a relevant flatbed scan and which also only takes seconds!

 

from an fue surgeon i would agree before the surgery that somebody of his team would count the fu's including their relevant size while they are being extracted. as soon as the extraction procedure is finished, i would then expect to receive a copy of the tally list.

Wish I found this thread sooner... Now I am having that dilemma right now....Trying to ascertain whether 650 or 1500 grafts were placed on my head,,

:confused:I just started a hair blog.....documenting my journey to a fuller head of hair.

But wanted to share something with community for feedback.

I recently had hair transplant surgery completed on FEB 10,2014 at 2:30pm

Follow the instructions 1 day post surgery. FEB 11,2014. Return to the surgery for post op pic and changing of the dressing

Today is FEB 12,2013. I decided to take some post op pictures...

Initially I requested 1500-2000 graft via the online consult..

When I met the provider, I decided to go with1500 FUE. I was informed of the pro and con. "50% survival rate for FUE".

Provider recommended that I do FUT. Better yield. I was hesitant. I decided to go with half FUE and half FUT.

1500 graft. Provider verbalize understanding.

Well, looking at the post op pictures..it doesn't appear 1500 grafts were performed. More like 650-ish.

I've sent and message to office. Waiting for their response.

I am not naming the providers name yet, but he was found on this website on the recommended list...Southern California. He had great reviews.

I based my decision on the cases that he has done...and on this site.

Now I am having second thoughts... .

Here are the pictures. Please chime in and let me know what you think.

Do you believe 1500 grafts place?

Thanks