win200

Thanks! Just trying to make it ever-so-slightly nicer.

Just an update--at 15 days, nothing momentous to report. The scabs were gone at about eight days and now the transplanted hair are starting to fall out. Staples came out at 12 days and the donor feels much better; regaining some elasticity so I'm less concerned about a stretched scar. I think the staples staying in increased sensitivity in the scar and created some "pull" in the rear scalp, and probably prevented the tumescence from going down a little. I'll add some pics in a week or two, but there won't be anything exciting to see for a couple months. Thankfully, having gone through this twice before means I'm pretty chill about the process and just have my mind on other things with the growth takes hold. I was a basketcase during recovery from my first transplant because I had no idea what to expect.

Small update--the tension in the closure is easing a bit as the tumescing goes down. Feeling better about that part; it's just natural that your risk of a wide scar goes up when you're on your third strip, so it's good to feel things loosening up a bit.

All of my photos are in the thread on my procedure with Rahal. I can't speak as to why the grafts weren't more densely packed.

I take .5mg/day Avodart and 1mg/day fin. I have mild sides--slightly reduced erection strength--but tolerate it just fine. I'd rather have a full head of hair and somewhat less-rigid boners. I don't even give it a second thought.

1,450 from Niedbalski, 2,200 from Rahal, 1,150 from Gabel (all rounding), so 4,800 total. So with thick native hair behind it, it's going to look great. It helped that between my first transplant at 29 to my third at 36, I really haven't had any additional loss; it's easier to go aggressive once you've aged a bit and have established that your loss will stabilize.

Thanks! I'd just gotten on with life (and gotten busier than I'd like), but glad to be posting again!

He's a great surgeon, and an incredibly nice guy. He'd given me periodic input and advice for five year prior to my surgery with him, all with no guarantee of me coming to him for work. He just cares a lot about the industry.

Hey, I wouldn't worry! The issue wasn't actually poor growth; immediately after the surgery with Rahal, I noticed that the grafts on that right side looked a little more spaced out. I think they all grew, just that they weren't as densely packed as they could have been. Rahal had to create a totally new hairline in a really big space, and the design was great. When you're creating a new hairline over a lot of forehead like that, sometimes it takes a couple passes to really punch up the density. Rahal is a great surgeon and I'm happy with his work. I've just wanted to work with Dr. G for a long time and was confident he would do well here. No knock on Rahal at all and you made a great choice; both of these docs are in the top five worldwide, in my opinion.

Yup, just kind of moved on after I got the hairline I wanted--people always tend to drift once their issue gets taken care of.

New thread is here:

Hi, all. I haven’t posted here much since my last procedure in 2015, but happy to share an update with everyone about my latest surgery. As background, I had my first transplant with Dr. Robert Niedbalski in June 2012. I was a NW 2-3, and he transplanted 1,450 grafts via strip to form a lower, but still recessed, hairline. I wanted a flat hairline, so I had a subsequent procedure with Dr. Rahal in October 2015, when he transplanted 2,200 grafts, again via strip. The hairline design was great, but the right side grew in a little sparse. Nothing awful, and I could’ve gone without addressing it, but I wanted to go back to the well for a fuller hairline. I just turned 36, BTW. I've been on Avodart and Propecia for six years and essentially no longer lose hair--my loss is fully halted. I use Rogaine but discontinued before surgery per instructions. Links to thread about my earlier procedures are here: https://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=2858 So, last week I drove from Seattle down to Portland for a third procedure--this time with Steve Gable. I’ve known Dr. Gabel for about five years and have really looked forward to working with him. He’s a precise, thoughtful guy, and I knew he’d be a great choice to refine my results. I left Seattle at 3am to check in at Dr. G’s clinic at 6:30. His clinic just moved to a brand-new facility, and it’s gorgeous--two ORs, a lovely lobby, and overall just a great, clean, attractive space. We sat down and discussed hairline approach, and agreed that we weren’t going to lower the hairline. I didn’t need it, and lowering it even a few millimeters would mean that I’d need to get in again to spruce up the density, and I wanted to be done. (My hair is still very dense and I want the hairline to match, so I don’t want to get stuck in a loop of chasing density in an ever-lower hairline.) We agreed 1,000 more grafts across the hairline--and concentrated in the right side--would do the trick. The procedure was very smooth. Strip excision took about 30-45 minutes and I didn’t feel any pain. Dr. G excised part of my prior scar, which ran from just inside left ear to above my right ear. He didn’t need to run all the way from end-to-end on the scar. He closed the strip with staples, which I hadn’t had before; he thought they’d do a better job at holding the tension and has had good luck with them recently. Once the wound was closed, he did the incisions--nothing eventful, and nothing painful. I didn’t bother to watch TV, but just spent the time chatting with Dr. G and his techs. If you haven’t met him, he’s a really personable, chatty guy, which was engaging during surgery. I had a Valium before surgery but didn’t feel it much, which was fine; I’m not the anxious type and was perfectly relaxed during surgery. I seemed more comfortable than my previous surgeries, but that’s probably due in part to the fact that it was fewer grafts so the sit was shorter. When we got to placing grafts, I’d estimate that Dr. G placed about 50%. He places grafts in all his procedures, and I was his only patient that day, so there wasn’t any need for him to pop out and attend to someone else. If you haven’t gone through a transplant before, it’s really disconcerting when you feel like a surgeon disengages from the procedure once the incisions are made and just turns everything over to the techs. Dr. G was omnipresent and was in the room for virtually the whole procedure. That’s not the norm. Of my three procedures, this was the smoothest and easiest. That’s no knock on Niedbalski or Rahal, but a huge compliment to Dr. G and his staff. The post-op materials were first-rate and included a calendar specialized for my surgery date so I didn’t have to count post-surgery days. That’s a nice touch that I hadn’t seen before. The recipient area was also very clean--virtually no blood or scabbing. They carefully washed it the next day and showed me how to shampoo. Great post-op hand-holding all the way, and Dr. G responded to an email same-day later in the week. Pictures are below, and obviously there’s not much to report in terms of growth. My scabs are falling off, but the recipient area is hardly noticeable because although it was shaved, I’m combing my hair forward. Hard to cover up the staples, but they’ll be out in another week. I’m definitely experiencing a lot of tightness in my donor area given that it’s been excised three times, so I’m trying especially hard to keep my head tipped back to keep tension off the scar. I’m a little concerned about a widened scar given that it’s my third strip, but I’ll keep everyone posted as that progresses. Please fire away with questions/comments; I’ll be checking in every day. Thanks! When reviewing pics, please keep in mind that the after pictures are both immediately post-op and then the next day; my hair is wet in both. Remember that the transplanted area contained both native hair AND previously transplanted hair, so the density will be much, much higher than the number of grafts you can see.

Hey, I actually just had a third procedure with Dr. Gabel--look for a separate thread with lots of pictures!

Was your doctor Robert Niedbalski? I ask because your post has "PNW" (for Pacific Northwest, where he practices) and that looks like his work--he uses the "pick and stick" method. He did my first transplant in 2012 and it was really solid work. This looks like it'll be a great result.

Just wanted to throw in my experience with the clinic in October 2015. When I booked my procedure, I was never presented with a choice of Dr. Rahal or Dr. Ross. Dr. Ross stopped by the guest house to chat when I checked in, and she was at the pre-op sitdown between me and Dr. Rahal when my head was examined, goals discussed, and new hairline drawn. She was incredibly friendly, genuine, and observant--she noted some sparseness in my right temple peak that Dr. Rahal hadn't caught and called it to his attention. She was not involved in the actual procedure. To be very clear, Dr. Rahal extracted the strip, made the incisions, and checked in on the progress of the implantations by techs. Her role was that of a collaborator of Dr. Rahal's, but without hands-on involvement in the surgery. There was absolutely nothing inappropriate about her presence or role, and the clinic never remotely tried to substitute her for Dr. Rahal in any part of the procedure or suggest that I should allow her to participate in the surgery. I was very glad to have her on hand and she helped me feel comfortable and attended to. That does not mean that her role has not changed, but I have to say that Dr. Rahal and his clinic have been candid, consistent, and above-board in every aspect of my dealings with them, including follow-ups. I would be very confident that they aren't indulging in the kind of poorly defined roles for dual-doctor practices that we've seen elsewhere; it just isn't Rahal's style.

I would wait. The red flag isn't the location of your hairline (which I understand is a little receded and totally empathize with wanting to do something about), but the fact that you are thinning throughout the top of your scalp. That indicates that advanced baldness is very likely in store. At 24, it's tough to tell how extensively your loss will be, and moving forward with a hairline procedure at your age could be a really devastating decision. The procedure shouldn't take more than 2,000 grafts--tops--but I would really talk to a surgeon and reassess. Are you on any medications?

I'm on board with the folks saying that the density is not up to par. The design is just fine, but this looks unnatural. When density is that low, it's because the hair is miniaturizing and it softens the thinness of the follicle spacing. You, on the other hand, have very low density but thick, healthy hair, which gives it that pluggy, unnatural look. I think even folks that aren't familiar with hair transplantation would instinctively feel that something is "off." That said, you have a good basis to work from and can easily add more grafts. You aren't a repair case and there is nothing to "fix," so there's no reason to believe that you can't improve this result.

Totally agree. I do think, though, that I'll do something about it if it doesn't resolve. It looks just fine with Dermmatch, but then again, I didn't go through two surgeries to have a permanent problem area that always needs to be covered up. Plus, a few hundreds grafts would do the job. If for some reason I lost significantly more hair, that many grafts wouldn't be a make-or-break difference. Plus, I'm on Avodart and Propecia daily with one 2.5mg weekly dose of Avodart, so I'm doing virtually everything possible to stop further loss. (There doesn't appear to be any difference in my hair since my June 2012 procedure, so if there is loss, it's very, very slow.) But either way, the Dermmatch does the trick for the time being, so I can make a decision about the right side in 3-5 months.

And here's a closeup of the troublesome area in the right side. All of these pictures were taken opposite a window, so there was fairly bright natural light illuminating the hair. There is no Dermmatch in any of these pictures, and no flash was used. I was on four hours of sleep, though, so I apologize for looking rough. :eek:

Hey guys, Sorry for the long time between updates. Work has been busy, and I've just been enjoying the new hair and keeping my thoughts elsewhere. Bottom line is that for the most part, the hair looks great. The design is natural and youthful, and the new hair is gradually blending in more and more seamlessly with the native hair. The only drawback is that, as I flagged before, the right side is relatively pretty thin. I still use Dermmatch on it daily to avoid looks/comments. You can still easily see the original hairline in this area, whereas it's totally invisible on the left side. At 7 months I doubt that this will totally resolve itself--there would have to be significantly more growth in order to mimic the result on the left side. But I'm not upset, and it's just part of the process. At worst, I'll swing back by Rahal's to have a few hundred more grafts popped in. This was the side that was more receded, so natural to expect that it would take more effort to get a fully acceptable result. Also worth noting that the scar looks significantly better than at one month, which is unusual. I think the issue is that at one month, the hair hadn't started growing through the scar. (The closure was tricophytic.) Now, though, there is hair growing through all of the scar. I keep my sides at roughly a 2.5 guard, and at that length you can see that there is *something* there, but it's not a bare scar area. The scar is visible almost only on the side, and due to the fact that the hair geometry on the side of the head is more easily disrupted by removing a strip; when you close the scar, some of the hair angles don't match, so there is a line where there is a clear change in the direction and "flow" of the hair. Plus, the hair that grows through the scar tends to do so at odd angles. Also, pay attention to the temple point on the right side--Rahal grafted that entire area, and it looks FLAWLESS. I was nervous about that, because it's such a tough area to match the angulation of the hair. I also had native hair all throughout there; he wasn't creating a new temple point, just reinforcing. Huge risk of shock loss, which never happened. I'm blown away by that work in particular. You can ever-so-slightly see that the grafted area is "darker" due to the fact that the hair from the back of my head is jet black and coarser than in the front, but there is no indication that he worked in that area. Interesting as well that the angles of the hair on the right side of my head point backward, whereas on the left side they point straight down. It actually makes it a little easier to see the scar on the right side, because the hairs run parallel to it instead of going straight down and covering it.

He's an incredible guy. I've met him a few times, and he's always been caring, thorough, and relentless patient-focused. He's one of the very, very best.

That's really not a bad scar. I've seen better, but it's no worse than average. Like Bill said, I really wouldn't do a scar revision. That's a roll of the dice, and I don't think a good repair doctor would suggest that route for this scar. Do some FUE into the scar and you'll get a really nice outcome. I've seen Jerry Cooley do really nice work in this regard. You could even follow that up with some SMP. But I really do think a scar revision would be ill-advised; there's a good chance that this is just how you scar and that you would end up with an identical result. (Especially given that this was a coalition doctor's work, which means the closure was probably very good.) Some people just don't heal in a way that results in nearly invisible scars (I'm one of them).

I met her when I was in Ottawa for my surgery. Extremely nice and caring, and helped with my pre-surgery consult. She had no part in the actual surgery beyond checking in. If she does perform transplant surgery, I saw no indication of it. She simply helped consult and examine my hair. She pointed out to Dr. Rahal some areas in my temple region that could use reinforcement. (He took her suggestion.)

This result looks great--with a fairly conservative number of grafts for his loss. I'd love to see more high resolution pictures of the hairline close up, but I'm guessing that's what you've asked for.

It's unacceptable that I can't simply sleep in the operating room.