seeker2014

Your situation sounds nearly identical to mine. Have you ever considered just filling the scar for now, shaving your hair short (which actually works quite well for someone with diffused loss), and waiting a few years to see how your hairloss progresses? Receiving any sort of transplant before 30 is somewhat of a risky proposition (from personal experience and looking at other cases) and this approach might benefit you in the long-run. It is easier for me to say this because I have reached the conclusion of only filling in my scar if I decide to undergo any other procedure(s). However, if you decide to proceed with the HT, either Konior or Vories would be an excellent choice (based on cases I have seen on this forum).

I am on my lunch break so typing fast (please excuse any grammatical mistakes). I think for this case you have to take into consideration the age of the patient. I would completely agree with the comments above if the patient was in his late 20s or early 30s with the eventual goal of achieving full coverage. With his donor characteristics, this would be a challenging (probably impossible) task. However, for his age, I think the result looks natural assuming the patient wanted some frontal hair to frame his face and some midscalp hair to create the illusion of density (which based on the OP from Dr.Charles sounds like what the patient wanted to achieve). I also think this case is also a good example of how much coverage can realistically be achieved with 2800 grafts considering the recipient area was very sparse. My only concern (since I can't really see the patient's entire back head) is the stability of the donor area and if the scar will eventually become visible since his sides seem to be somewhat thin. Dr. Charles, do you think this patient should be concerned about his donor area at all? Were there are any signs of miniaturization?

Thanks for the responses chrisdav and 1966kph. I really felt inspired to write this thread as I have lost my hair twice since high school. I experienced significant recession starting at 17 which I then largely recovered by jumping on finasteride/minoxidil at 18. I then experienced gradual recession starting senior year of college until undergoing the HT at 24, conceding ground once again to my present state. All in all, fortunate to escape with a manageable hairline and scar, but definitely the wiser from the experience. I really hope this thread will prevent younger patients from pursuing something that might might ultimately not be attainable with advanced early stage hairloss....or might require revised expectations once evaluating the severity of hairloss at the age of 30. I have been researching doctors for FUE into FUT and not committing to anything for at least another year and multiple consultations.

I want to preface this post by stating I will not be sharing the name of my doctor who is a recommended/coalition surgeon (however, he is rarely mentioned in threads). This post is meant to provide advice for younger patients considering a hair transplant...if you would like to PM me with a short list of possible surgeons, I would be more than happy to review it. I underwent my HT at 24 years old. I had conducted research about my doctor and felt confident he would provide me with an honest assessment of my situation. During the consultation, I shared my family history (early balding does run in my family) and my expectations for the procedure. The doctor recommended 2500 grafts concentrated in the first 2/3 of my scalp via FUT with a conservative hairline (at the time, I hadn't lost any hair from my vertex). I was satisfied with the proposed plan and set a date for three months out. The surgery occurred without a hitch and, fortunately, the scar healed up reasonably well (I can buzz my hair down to a 2 guard with some blending). 1 year post-op, I was extremely happy with the results. However, approximately 15 months post-op, I all of a sudden started to concede some significant ground. Despite being on finasteride (1.25 mg/daily) and minoxidil for six years, I started to lose hair from the transplanted area and vertex. Evaluating my current situation, I am probably heading towards a NW 6 or 7 (I am a diffuse thinner). Do I blame my doctor for what is probably a natural progression of hairloss?...no. However, in retrospect, I do assign a certain amount of blame to my doctor and the rest to myself: (1) I wish my doctor would have been more honest with me. During the consultation, he never mentioned the high probability of more procedures down the road and failed to address the unique complications of someone with a diffuse pattern of hairloss. On my part, I should have scheduled additional consultations for more expert input--this is especially critical for a younger patient since your ultimate hairloss pattern is harder to predict. I believe other doctors would have advised me not to undergo the procedure or, at the very least, wait a few more years. (2) For a younger patient, FUE is probably a better option than FUT. I am not trying to incite a FUE vs. FUT debate since I believe each technique has its merits. However, for someone who is young without a definite hairloss pattern, FUE presents a lower risk of observable scarring. Probably the best option is to wait closer to 30 when your hairloss pattern will be more established, choosing the technique that is best suited for your needs. (3) Think long-term. As a young patient, it is easy to fixate on correcting your hairloss NOW in order to restore a "fleeting youth". However, it is important to project how severe your hairloss might become and if you are willing to undergo multiple procedures. Even though I just turned 27, it has become easier for me to accept what is almost inevitable (an advanced NW stage since I am probably not the best HT candidate). This has helped me concentrate on what I can do later down the road to possibly improve my current situation (e.g. receiving a small FUE procedure to hopefully get down to a 2 guard without blending or, optimistically, a 1 guard). Well, sorry for my long post, but hopefully this will be of benefit to someone

Hi Dubhain: Your progress is looking good. Like Pepe mentioned, it seems like the hairs are definitely coming through. If you don’t mind me asking, what length do you have your hair in the picture? Are you still expecting on shaving it down to a 2 guard? Thanks for posting your progress…the information on this thread has helped me consider future options.

Hi Quasar: I want to preface this by saying I don’t have a medical background and my comments should not be construed as a medical diagnosis. Considering your T3 and T4 levels are normal, but your TSH level is high, this could translate to a mild case of hypothyroidism (if it were a severe case, your T4 level would at least be low along with the elevated TSH level). Have you experienced any other symptoms outside of hairloss? What did your doctor say about the elevated TSH level?

Considering you are only 2.5 months post-op, I wouldn’t be extremely worried at the moment. First of all, some people experience shockloss (almost always temporary) in the donor area(s). With adequate time, these areas should recover. In terms of the recipient area, it is normal for grafts to experience a shedding phase 2-3 months post-op. Additionally, it is not uncommon for some shockloss (again, almost always temporary) to occur in the recipient area. Also, is this your first HT?...for whatever reason, shockloss seems to become more common as the number of procedures increases. I am by no means an expert, but have come across a few threads about shockloss. If you are concerned, I would suggest contacting your doctor for an assessment of the situation.

***sorry for the typo with your username....I was trigger happy with the "r"

Hey aarron602: I have never heard of recell before…I have heard of some surgeons using Acell in conjunction with PRP in an attempt to stimulate hair growth and promote scar healing. I am not extremely knowledgeable about the Acell+PRP treatment, but have encountered a few cases on this forum where people were not satisfied with the results. Is recell a new technology that is intended to achieve the same purpose as PRP+Acell?

I second that advice. I haven’t really seen any conclusive results from fraxel lasers and have only read about negative experiences with Acell. Again, there could be users who did experience positive results with these two approaches, but I just have not encountered their threads. From personal experience, silicone gel does seem to help with scar healing. As dubhain mentioned, the concept behind dermarolling seems to make sense and I have read some encouraging testimonials about this device. Additionally, there isn’t a risk using the dermaroller because, worst case scenario, you are just out $20 if it doesn’t yield any results. In terms of the number of grafts, that is a tough decision. Some doctors might be quoting you a higher graft count in anticipation that some won’t survive (from what I have gathered, survival yields are usually 50%-70%). However, you also don’t want to dense pack the grafts since this could cause shockloss. I have read about people going in for one procedure and being satisfied with the results while other individuals need 2 or 3 sessions…this partially depends on how short you want to trim your hair.

Should have added this to my original post, but in regards to the process: (1) What was your approximate graft survival rate? (2) Did you undergo any another procedures (e.g. Fraxel lasers, applying silicon gel) beforehand? (3) How many grafts did you receive and did you have to go in for multiple procedures? (4) What guard were you eventually able to shave down to? Thanks again for your help!

Hi AB2000, Since a hair transplant is a service and not a product you are bringing back into your country of origin, you shouldn't have to declare it. One thing you do have to consider is any medication the doctor assigns...of course, you would want to declare an item like this so, indirectly, you might have to mention the HT. Hope this helps!

I have been researching FUE grafting into a FUT scar and was wondering if there were any additional complications beyond potential low graft survival rate. For example, has there ever been a documented case where a patient experienced permanent shockloss in the surrounding recipient area post-op, making the situation worse? Also, my short list consists of Konior, Lindsey, and Rahal. If anyone has ever undergone a FUE into FUT procedure with any of these doctors or with another top-rated doctor, I would appreciate any feedback regarding the process. Thanks!

Hey KO: How are you? I just wanted to throw in my two cents. I agree with what fue2014 is saying above. Since it looks like you have NW6 pattern forming, you have to be extremely careful with where grafts are placed and what procedure is utilized. Even though it will be more expensive in the long-run, you might first went to undergo a small to mid range HT (maybe 1000-1500) just to see how you respond to it (in terms of graft survival rate and scar recovery). Speaking from personal experience and from a young-ish perceptive (currently, I am 26 years old), it is important to factor in the long-term planning for contingencies such as what happens if the result is not a success (which you already addressed in one of your earlier posts). Again, while FUT does offer benefits (i.e. potentially higher graft yields), it is a riskier proposition (in terms of concealing a potential scar) for someone who is higher up on the future Norwood scale. Again, this all comes down to what you plan to do long-term (e.g. would you be happy with a buzz cut?). For example, after going through a largely unsuccessful FUT procedure, I realize that I am probably not the best HT candidate. If I would have elected FUE, I could have cut my losses and just shaved down to a 1 guard. However, I now have to keep my hair at a 2 guard while blending in the scarred area at 1/2 inch. For the long-term, I have to look into FUE for my FUT scar…so I guess what I am saying is there’s nothing wrong with being optimistic about a HT, but also plan for the worst-case scenario. Good luck!

Hi Muscleheadofhair: I am currently looking into options to repair my FUT scar as well. As far as I have gathered, there are three primary options for fixing a scar: (1) FUE grafting into the existing scar: This is the option I am currently considering. Typically (based on other cases I have looked at), it takes 300-600 grafts to camouflage the scar. The advantage of this procedure is that the cosmetic impact of additional scarring is minimal, assuming you go to a reputable surgeon. However, there is the risk of the FUE grafts not taking since scarred areas are somewhat compromised in terms of blood flow. Therefore, from some of the cases I have seen, yield is typically around 50% so you might need to go in for more than one procedure in order to achieve the results you are looking for. (2) SMP (Scalp MiroPigmentation): This procedure involves a technician tattooing a series of small black dots on your head in order to replicate the appearance of hair follicles. I have not researched this option very much so there are definitely other members on this forum who could provide more accurate information. This might be a good option for you in terms of concealing the scar while providing a “five o’clock” scalp appearance. However, as with any sort of tattooing, you have to worry about possible fading. Also, you have to make sure the technician is highly experienced because the dot size is critical for creating a realistic effect. (3) Scar revision: This is when a hair surgeon excises or changes the direction of the scar in order to decrease its width. IMO, this is the best option for people with very wide scars and/or multiple scars. The major risk involved with this option is the scar possibly stretching back out (even becoming wider than your original scar) due to changes in scalp laxity/aging. Also, you mentioned bodybuilding in your post so you probably have a relatively tight scalp (at least the general rule of thumb is more active individuals do)—this would increase the probability of your scar stretching after the procedure. You can also consider Fraxel laser procedures, but, from what I have read, this does not really improve the appearance of your scar unless it is red/inflamed or hypopigmented. Also, to go through a full rotation of treatments is expensive considering the benefits you will probably gain from it. Again, I would definitely ask around as there are more experienced members than me who can provide you with better guidance. Hope this helped. By the way, what is your workout regimen?

Hi dubhain: Thanks for the response and sorry for the somewhat last response on my end The past couple of days have been much busier than expected. I have never received official measurements, but I would approximate my scar is about the same length, but a little less wide. Currently, I can conceal it pretty well blending the scarred area (which I keep around 1/2 inch) with the surrounding area (1/4 inch). However, I am hoping just to take everything down to a 1/4 inch which will be much easier to maintain long-term. Sorry for another question, but did Feriduni or Bisanga ever mention the possibility of any permanent shockloss to the surrounding area, thereby widening the scarred area? Like I mentioned before, it appears you have experienced some excellent yield so shockloss isn't an issue in your case. Additionally, I have never read about a FUE scar repair procedure where this happened as shockloss typically occurs with HTs involving a large number of grafts. But I was just curious if any complications (outside the FUE grafts not taking) were mentioned during your consultations...

Thanks, dubhain, for sharing your story. I am in an extremely similar situation at the moment (received 2,800 grafts via a FUT procedure 2 years ago) and was wondering if you could address a few questions: (1) Your 2-month post-op pics look very promising. I am hoping to reach the same goal of shaving down to a 2 guard (possibly 1 guard, but that might be a bit too optimistic). Do you anticipate any further FUE procedures or did Dr. Lorenzo indicate the 400 grafts should be sufficient long-term? (2) Did you consult with any other doctors (specifically, in the States or Canada) and did they advise the same course of action (in terms of the number of grafts)? (3) How was the recovery process? How long was it before you could return to work? Thanks for your assistance!

Hey Tigerkat: Your case sounds extremely similar to mine....I also started to experience hairloss at 17. In terms of getting a HT, make sure you consider the long-term. I received a FUT procedure from a top-rated surgeon at the age of 24 (after being on finasteride and rogaine since 18) and within a couple of years experienced significant recession in the transplanted areas (still working with my doctor to discover the exact cause). I am currently 26 and, in retrospect, regret not electing a FUE procedure which seems to yield equivalent graft survival rates in the hands of a talented surgeon. Also, with FUE, you won't have to conceal a linear scar (which I have to do with some clever blending techniques) nor consider a future FUE procedure for scar revision (which I am in the process of researching). If you are still considering a HT, like mentioned above, try to stabilize your hairloss and forecast your future recession pattern by analyzing those of family members. Best of luck!

Hey Liamw: Your experience/mindset is almost identical to what I am going through at the moment. I have compiled a list of surgeons I am considering for scar revision (I still have to contact them for consultation), but was just curious if you have arrived at a solution yet? Any info would be much appreciated. Thanks!

Hey Kris: The placement of your grafts look very professional and will hopefully yield the results you are looking for. I have been very impressed with Dr Rahal's work (from the pictures I have viewed on this forum). If you don't mind me asking, how much did it cost per graft? Thanks!

Hey KO: Thanks for the response. I am definitely going to see a dermatologist just to cover all bases. My dandruff before being prescribed the DHS shampoo was not serious compared to other cases I have seen (my hair surgeon described it as "mild"). When I was on the DHS shampoo for three months, it took away the little dandruff I had, but with no improvement in hair growth. That would be great if my condition was just temporary, but I don’t think that is the situation.

Thanks for sharing your experience…it helps me understand my situation a bit better. From your experience, how can you distinguish between a grafted and native hair? I can tell you that I experienced the greatest losses in the transplanted area (approximately the front 2/3 of my scalp) with some crown recession. I noticed when I was going through this shedding stage, the hair shafts that fell out appeared thicker and longer than what I had observed before the procedure. My doctor remarked that he had never seen a case where someone had lost so much hair from a transplanted area in such a short interval of time. He was also confused since the grafts were removed from the classic safe zone (I had a FUT procedure done) and should have been DHT resistant. How was your doctor able to determine that some of your grafts were DHT sensitive?...did he run some sort of test? I think the only other procedure I would have done moving forward is a small FUE procedure to camouflage my scar so I can cut down my hair shorter. However, I don’t want to go through another procedure if the grafts prove to be DHT sensitive. I hope your procedure from March is working out well!

Thanks, hairweare, for the response. In terms of shock loss, it is my understanding that it typically happens almost directly after a procedure is completed. With the preliminary research I have done, there seems to be several causes for shock loss including the doctor using too large of an instrument in relation to the size of the graft, the doctor transplanting hairs that are already in the process of miniaturization, or a patient’s scalp is thin increasing the risk of damage to arterial vessels. I have no idea if any of these apply to me and I guess there is no way to prove it. However, I don’t understand why shock loss would set in 12 months after the procedure…I am not saying it is impossible, but I just have never read case where shock loss happened so long after a procedure was completed. In terms of progressive MPB, I just think it is too large of a coincidence that all my native hair would start falling out right after my hair reached its maximum thickness. I don’t think I included this in my original post, but prior to having the procedure I had been on finasteride consistently for 3 years with my hair loss remaining about the same. So I don’t understand why all of a sudden my MPB would just kick into overdrive, despite being on meds, returning my hair to basically its pre-op state within 4 months. It just does not make sense to me that a procedure that is classified as permanent would only last for 3 months followed by significant hair loss. Again, I want to thank you for responding to my post and in no way am I trying to attack you (I hope my post did not come off that way)…I am just trying to rationalize why things happened as they did. Again, my doctor could not really explain what happened so it is quite frustrating at the moment.

I posted on this forum awhile back under the thread “Hair Restoration Procedure Failing”. I meant to post earlier than this, but, recently, I have been extremely busy as I am working and completing my MBA at the same time. Just to provide everyone with a brief synopsis of my case, I went through a HT about 2 years ago. When I went in for my 9 month review, the doctor was very happy with the progress (and so was I). At the 12 month mark, I experienced peak growth. However, starting at the 15-16 month mark, I experienced significant shedding only in the area I had received the transplants. During this time, I had not my changed daily routine of Rogaine (5% solution) and finasteride (1.25 mg). At the 19 month mark, the thinning was extremely noticeable so I proceeded to contact my doctor for an appointment. During this first meeting, he noticed some mild dandruff and recommended a DHS shampoo to clear it up. However, he pointed out he did not believe this was the cause of my problem. I used the shampoo for 3 months with no improvement. At this meeting, I asked him if I had any signs of skin disorders like alopecia scarring. He assured me the only thing he noticed was the mild dandruff and requested I contact him for another follow-up appointment. At the second meeting (which was about a week ago), I explained that my situation was still the same and well below what I expected for 2800 grafts. He conceded the results were definitely less than satisfactory, but then proceeded to point out my scalp looked “red and inflamed” and instructed me to see a dermatologist for a possible scalp biopsy. As he explained, there was nothing wrong with the procedure, but something had changed with my scalp conditions post-op. To be completely honest, I feel like he is making me jump through hoops so he can avoid responsibility for a procedure that ultimately failed. Some family members looked at my scalp and remarked that it did not look red or inflamed nor have I ever noticed these conditions. I am going to see a dermatologist so my scalp can be examined just so I have more evidence to back my case. But, honestly, I don’t think I will proceed with the scalp biopsy as my insurance won’t cover it (the procedure costs $300-$500)…a dermatologist should be able to identify anything seriously wrong by examining the surface of my scalp. I was just wondering if anyone else has gone through an experience like this before and could provide me with some guidance. Next time I go in will be my last and I am going to request some type of refund. The doctor who did my procedure is recommended on this forum so has all the qualifications of a type rated surgeon. I would not like to reveal his name at this time since we are still in the negotiation process. Thanks for your help!

Thanks for the reply, Since21. It was a FUT procedure. Thanks for the reply, 1978matt. The grafts were primarily placed in the front 2/3 of my scalp (focusing on the middle). I see what you are saying with my hairloss pattern mirroring that of a NW6 case. Before I went into this procedure, I realized that later down the road (I was projecting somewhere in my mid-30s) I would probably have to make a decision whether to pursue additional HTs due to finasteride/minox only slowing down the inevitable. Saying that, I just find it hard to believe that my hairloss would progress this much in nine months (from 15 months post-op to 24 months post-op), especially considering I have not deviated from my finasteride (1.25 mg daily)/minox regimen for the past 4 years. Even though the picture I originally posted is not of the best quality, from an overall perspective you can see that (at the 15 month mark) I initially responded pretty well to the HT. I do appreciate you giving me an honest opinion about my current state. I agree with what you are saying…I plan on not pursuing any other HTs in the future since I am 26 and already expended 2800 grafts. The only thing I am investigating now is a quality FUE surgeon who can camouflage my linear scar so I can buzz my hair down a bit shorter (right now, I can get away with a 4 guard).