spartan13

I had about 2200 grafts done by Robert Haber in a FUT session back on Jan 10 of this year. I take finasteride daily and have been for almost a year. Also do minoxidil. I used to do the liquid at bed time, but have been doing the foam twice daily for the past month or so.

I went to great lengths to follow the post-op instructions to a "t", and don't have any physiological issues I'm aware of that would impede growth. I saw the clinic at 3 months and they just said "shock loss". My six month follow-up is in July, so I'll have more info for you guys on that in about a month.

I definitely realize I need to wait another 6 months to make a fair and accurate determination. The intention of this post was mainly just to see what people think about the different "plan b's" should it come to that. And again, any "plan b" wouldn't likely be until a year from now...a full 18 months post-op.

I'm disappointed to have to report that at six months I still haven't seen much growth. I'm generally where I was when I posted my 3 month pictures...ie, balder than I was before my January hair transplant. While I am certainly planning on giving this last HT a full year, I feel like I have to start thinking about what to do in the event the transplant is an abject failure.

I would honestly be fine with a normal thinning look, but here's my problem...because this last HT knocked out a bunch of existing hair, I now have visible pitting from a couple of old 90's HT's. Furthermore, the hair I have left in the frontal 1/3 are those old split, mini & micro-grafts, so it doesn't look natural without my previous native hairs to "soften" the look. Assuming the status quo by spring of next year, I was brainstorming some possible solutions.

1.) Some sort of laser scar treatment like Fraxel in my recipient area to try and remedy the pitting as much as is possible. Then laser out the bigger unnatural looking grafts and just accept balding.

2.) SMP in the recipient area to help hide the scarring while also providing some more illusion of fullness. I've been living with X-Fusion concealer the past three months, and it does help hide the scars...but I hate to think of using it very morning for the rest of my life.

3.) Consult with a good HT surgeon to see if this can be repaired. I should point out that I've had 4 HT's in total, so I'm not real eager for more surgery, and I'm not sure how much more I could realistically get anyway. Three HT's only came out of the back, while this last one took from the left temple through the back.

I managed to take a usable self pic tonight for comparison purposes. The one on the left is me 3.5 months post-op, and the one on the right is me no )six months post-op). While there is some improvement, I'm still at a net negative compared to where I started the year at.

I'd love to hear your thoughts!

What does the front look like? Unfortunately those scars can't be combined at this point, I have two stacked scars so I know how it is... crappy. FUE into your scars would be the way to go if you have the donor left, I probably wouldn't attempt another strip surgery.

I have a blog in which I've posted some of my pics at three months, which is my bottoming out point so far as that is when my shockloss finally subsided. I'll be posting monthly pics there, so I'll be doing 4 month ones next weekend sometime.

As you'll see from my picture of the back, I can still hide the scar pretty well, even from myself. I completely agree with you about strip. Even before this issue, I had resolved that this would be my final procedure to "bulk me up" a little and then not worry about my hair from then on. Because it isn't an obvious defect right now, I'm going to just let it be until at least Fall to see if there is indeed some shockloss that might grow back and mitigate it some.

Spartan,

 

Thanks for the photo it is a little unclear as to the extend of your scarring are you saying the 3 scars are around 1- 1.5 inches in total or are you saying that is the result of your last surgery?

 

You may still have some shock around the last scar that should grow back but it can take to around 7 months to fully recover. Were you aware the Doctor was taking a new scar above the two older ones that you had? If he made you aware of that then it would possibly been done for two reasons firstly you both choose that you wanted more grafts and were not concerned about the previous scarring or the old scars were simply too low and in the wrong place for revising.

 

As for a revision now it really depends on where the scar(s) are located if the first two are below the bump then you may not be able to improve them with a revision and placing grafts into them via FUE would be your best option. It also depends on what your donor supply is like and whether you wish to use grafts into the scars, do you require more work in other areas that concern you more?

 

I would wait it out for the 1 year mark to assess your results and see what the scar is looking like then before making any further decisions.

The three scars together are a combined 1 inch, with the very right side of the scar creeping up closer to 1.5. What I was trying to get at was that I had never noticed any significant level of scarring in my donor region prior to this last HT. For some reason this last one seemed to magically expose everything else that had been done previously. It is sparse right under the newest scar, so maybe you are correct about it still being shocked, and that is why I'm noticing all this now.

At this point, I'm leary of getting cut anymore, so I may look to FUE some day to help fill things in. It will depend on how successful or not this last HT is. If I don't get any yield from it, then I will likely just look into undoing the 90's work if possible (pitting and larger grafts) and be happy with a balding head. If that comes to be, then I wouldn't mind using FUE grafts in the scarring area. If it produces some results so that I have a normal, mature looking front 1/3rd, then I might not want to use grafts in the scar.

Sometimes a surgeon cannot or will not remove previous strip scars if they are placed too low. That area is prone to stretching due to it being connected to the neck muscles and making the excision in that area again will most likely lead to the new scar also stretching. In cases like these, I think the surgeons should not recommend strip for a patient, because they will have more than one linear scar, but that is just my opinion. Sadly, I don't see how these 3 scars can be solved with a revision, stretchback is not uncommon even if a scar is placed right on the occipital region, let alone low on the donor.... You could look into grafting body/beard/some scalp hair into it along with SMP. Cases like this really make me sad..

I've been thinking about the body hair/SMP thing more most recently because I'm just not sure that I want my scalp cut anymore, even for a revision. My surrounding hair is still thick enough that it is relatively easy to hide as I've always worn my hair longer, so I feel like that gives me time to make an informed decision without the scar affecting me day to day in the meantime.

Are those three stacked scars?

They are. What's weird is that I still never had such a gap until this last surgery. So...is this beyond hope?

At 15 weeks its likely you will have some shock loss there so this may improve a bit over time. Who was your surgeon? have you contacted them for an opinion?

Dr. Haber in Cleveland was my surgeon, although the lower ones were from prior surgeries. I have not contacted him figuring I will wait until my 6-month follow-up as I'm not sure what he could tell me anyway. Frankly, I doubt I would go back to him if a revision is even an option for me.

I was hoping some of this would fill in, but now that I am closing in on 15 weeks post-op I've resigned myself to the fact that this is the best it will get and began researching scar revision. There's a ton out there, but many of the pics/videos I've seen that indicated a "wide" scar were still only about half the width of the empty patch I've currently got. The average width of my scar is about one full inch, though behind my right ear (the left side of the attached pic) it extends even farther...maybe 1.5 inches. Can this possibly be fixed?

I had the exact same thing 3-4 weeks ago (I am now 14 weeks post op), and I experienced it for maybe a week to two. I called my HT surgeon about it because I was worried it was related to a bad shed I was going through at the time. His explanation was that the prickling was very likely the result of my scalp nerves regenerating. If you guys had FUT as well, that could be the explanation.

Hair321, this is directly from my transplant surgeon's office post-op instruction packet:

"After five days your grafts have thoroughly adhered"

I even asked again when I was in for my procedure this past January and they told me that once the recipient area heals all up, the grafts would have to be surgically removed to fall out. So in short, I think your grafts are going to be fine this far out.

Spartan,

I don't know if you have a thread, but I hope you are able to start one. I would like to follow your progress. Good luck! The next 6 months should be good to you.

Hey Spanker. I do actually. I started a thread titled: "Introduction and Shockloss Question" under the Hair Restoration Q&A that this thread is in. There are also a couple of recent pics of mine in that thread as well. Unfortunately I didn't document things from the beginning, but at least you guys can follow my progress from "ground zero" forward.

I agree with the others so far in saying that 2500 would not be to many. I recently had a procedure of nearly 2300 all in the front third of my head, and I went in with a little more density than I see in your pics thanks to prior procedures.

As far as reducing shockloss, I have never heard of those protocols you mentioned. I have heard finasteride, minoxidil, and even laser therapy mentioned as modalities to help with shockloss... either individually or all three together. My personal opinion on shockloss is that it is just the luck of the draw. In my prior procedures, I had very little such that I didn't notice any difference. This past one I got hit by the shockloss freight train, and my massive shedding only just stopped about two weeks ago (when I hit the 3 month mark). I have to say though that I seem to be in the minority with that, so I don't think my case is usual. Plus, at 29, I think your existing hairs are probably stronger than mine (I'm 40) and better able to withstand the trauma.

I went to Dr. Robert Haber who is very well regarded on this forum and in the industry. My expectations were to expect nothing until month six, so I'm obviously a long ways off yet. The shockloss/pitting issue I mentioned just has me a little extra anxious for results as I have an office job that I obviously can't wear a hat to. So...my morning routine now rivals my wife's with all the attention to hair. lol!

Not familiar with Dr. Feriduni, but I am relatively new here. Where is he located, and is he one of the network surgeons?

Hi gang. I'm about 3.5 months post-op and am riding through some pretty bad shockloss that has exposed a bunch of pitting from a couple of HT's I had back in the 90's. As a result I've been living under concealer for the past month to six weeks, but I haven't really hit on a good technique/product (and maybe there isn't one) yet.

I have dermmatch which IMO looks the best as far as disguising the thinning problem. However, it doesn't really do anything to disguise the pitting which really comes out when I'm under certain lights. I also have Caboki which is one of those fiber products you sprinke on. That does a little better with the pitting, but is hard to get even throughout. I'm hoping I only have to deal with this for maybe a few more months!

Has anyone out there had any success with concealers or concealer combos that have worked well hiding pitting?

Congratulations Octamus! That is amazing for such a short period of time! I am three and a half months post-op myself and can't hide my results either, except not in a good way. Massive shockloss has left me with little left in front except bigger grafts and visible pitting from a couple of HT's in the 90's. Hopefully I'm just a late bloomer and can post up some exciting news myself in the coming months. Who was your surgeon?

I've just started doing research into "fixing" hair transpant scars as I have noticable pitting and cobbling in my recipient area up front. I stumbled upon something that sounds promising called fraxal repair, so you may want to check that out. While it sounded like it might be good for my scaring issue, the majority of the commentary regarding fraxal treatment was for repairing the linear scar in the back of the head.

Yes, it was the frontal 1/3 where all the work was done. So if the transplant yields at least some results, I'm hopeful the extra density will mask all of the scarring once again. Just incase, I might start looking into fraxal repair to get a handle on costs and how the treatment goes. I saw in another thread that someone seemed to have good results with that in a similar situation as mine.

OK, finally got the picture thing figured out correctly, so here are two of them. One shows my hair combed straight back which is how I usually wear it. The other shows the hair parted in the middle to give a better representation of where my hair loss is at. Again, these are exactly three months post-op after a ton of shockloss. I'm kicking myself now for not taking pre-op photos, but I honestly expected this procedure to be similarly easy to my prior 3 so I never gave it much thought. Anyway, I've probably lost conservatively 50%-60% of the hair between the tip of my widow's peak to the crown in the three months after surgery. The front was thinning, but not nearly this bad, and the mid scalp was still pretty bulky. Such that when I combed my hair straight back I could totally make the thinning crown disappear. I don't mean to sound negative or alarming, but my attitude now is: forget improvement...I just want to look how I did four months ago pre-op.

You know what's weird...this is my fourth procedure, and the first three were almost a non-event. I find it ironic that my fourth and last procedure is the absolute hardest one I've had to endure. Even though this is nothing new to me, and intellectually I know what to expect and generally when I can expect it...it's just so damn hard not to be pessimistic. While nothing I'm going through at this stage could be considered abnormal by any means, I'm already starting to research fraxal repair for my recipient area pitting and cobbling which, pre-op, I didn't even realize I had because I couldn't see it through my hair then.

But to your point, I honestly never gave much of a thought to any of my prior procedures once the donor area healed, and it was quickly back to life as normal. So perhaps for a number of guys, three years is no biggie. I'd have said the same about myself in the not-to-distant past. But yeah...I certainly couldn't imagine enduring the likes of this last procedure for multiple years. Yikes!

dont u think 100-110 days is too early for hair shedding cycle ?

Well, my "shedding cycle" was technically severe shockloss from the trauma of surgery, so no...I don't feel like it was too early. In fact, I posted about my shockloss in another thread and people were surprised that I was still dropping such large clumps of hair 90 days out from surgery. Fortunately it has stopped shedding the past two weeks (I mean beyond my normal pre-op amount), so I'm hopeful the worst is behind me. I just have to wait it out the next few months or so and hope that some of my shock-lost hair returns and that my HT takes.

@Spartan13

 

Hi. Have you any experience with Couvre by any chance?

A little bit. I tried it out years ago when my hair loss wasn't very advanced, and even then I found it to be a little thick and it did have a strong scent to it as well. Right now I'm just trying to replicate my pre-op look, which was some thining in the front, so my goal is just to "dirty up" my scalp a little bit. Couvre would make my scalp/hair much darker than I was originally which would look a little too off, IMO.

I am almost exactly 3.5 months post-op myself, and have experienced significant shedding as well, so I know how unsettling it is. I've found dermatch and Caboki to be decent concealers to help me get through this phase.

Yes, I've read that same thing quite a bit myself about HT's accelerating your MPB. I'm still holding out hope that at least some of my shockloss resolves itself, but I'm working under the assumption that how I look now is likely how I'll look by the end of the year. Any improvement over my current state will just be a bonus. Even though I was obviously not happy with my pre-op follicular count at the time, I'd love to have that back right about now. While thinning, at least I could have a conversation with people without having them stare at my hair the whole time. I know it's trivial compared to some people's problems, but God, does it take an emotional toll. At this point, I just have to stick with it and hope for the best.

Still can't get my phone to synche correctly with my computer, so I'm going to try emailing the pics to myself and get them onto my PC that way.

In the last week and a half since my last post I'm happy to report that the intense shedding has subsided. I'm not seeing even a visible amount in the tub's hair catcher, and I've only been combing out between 7-15 post shower. Hopefully this means the worst is over.

In speaking with my surgeon, he believed that the tingling and prickling sensations were a result of my nerves regenerating versus something like inflammation as I never experienced any redness or tenderness on my scalp. And while he didn't believe the laser comb had any ill effects, I still have not used in the past couple of weeks. I have gone back to minoxidil at night on my crown and continued the finasteride throughout.

Since21, I saw on a nother thread that minoxidil thinned out your crown and mid-scalp area. That's exactly what happened to me, but I was blaming it all on shockloss. Maybe a combination of the two.. I don't know. But at this point, I figured I might as well stick with it since the damage is done.

I had problems geting the pics from my phone to my desktop which is why I haven't posted them yet, but I will try again this evening. I cleaned up some programs I think might have been gumming up the works, so we'll see.

I'm not sure how long LLLT has been around (I just recently found out about it myself a handful of months ago - so I haven't used it before), but I believe it only recently received FDA approval so it is probably only just starting to get more serious traction in the hair restoration world. I checked with my HT surgeon and he gave me his blessing to undertake it and he did add he thought the modality had some efficacy.

That said, this LLLT is about the only thing different I've done this time around (other than twice as many grafts as my last one) as I had been on finsteride for several years before taking a 6-9 month break and starting again last Fall. Even today, the nurse told me the laser comb should be fine to continue with...but I'm with you. I'm putting it away at least until things (hopefully) turn a corner in the coming months. If I recover, then I'll think about using it again sometime in the future for maintenance.