episode4anewhope

Thanks, I'm trying. Someone above asked for update pics, so I've posted those.

Here are donor shots 13 days post-op. I buzzed my head with no guard 2 days ago. Not much visible improvement, if any, compared to day 7 photos (some of it could be attributed to shorter hair).

m0dthuspny, I'm sure you mean well. I'm not saying I was the perfect candidate. However, the doctor did "sell" me on a certain result, which was backed by multiple consultations with other well regarded doctors. As we know, there are many approaches and tools for this kind of procedure, and each doctor swears their combination is the best. If there was an agreed upon standard, then everybody would be using the same approach and there would be no questioning on whether it was the best fit for a certain case. Suppose you go to a car dealership, and get sold a lemon. The salesman might claim that there's nothing to be done, due to complications at the manufacturing process, but no one will let that fly, right? you would expect the dealership to make it right (at least in the U.S). Now, we're not even talking about purchasing a thing, we're talking about changing a person's physical appearance, and also dealing with pain, discomfort, and a long healing process. Unlike buying a car, which is a well understood process, you are putting all your trust in an expert to provide you with all the information you need to make a decision. You don't think that the surgeon has some responsibility, considering he promised one thing and delivered another? considering that when he knew he was not able to deliver the initial expected result, he should've consulted with the patient and allow him to make an informed decision? You can't just brush that off with "these things happen". That's not acceptable. Yes, hair transplant procedure carry a certain amount of risk - like some of the grafts not taking hold, and the total result being less than initially expected. However, what happened here falls way outside of that relatively well understood and explained risk, and in my opinion, the doctor has to share some of the responsibility and cannot place it all on the patient. Post operation, the doctor informed me of the results, and that the initial plan of doing 2 operations of 2500-3000 to get the promised result is now out of the question. He said he could do another operation of 1600 (using the same yield from this op as a guide), then a 3rd operation of 1000 - and that would max out how much he could harvest to avoid the donor looking damaged. The original planned coverage would then not be achievable (I'm not talking right now about the risk that some of the grafts won't take hold). Since he knew that when he figured what his yield would be - and did not give the option the make a decision on whether to continue - I think he definitely holds some responsibility. All this not including other things mentioned in this thread - excessive trauma to the donor region, incomplete hairline (which I mentioned in a few posts here), and extractions from outside the safe zone.

jkm - thanks so much for the encouraging words. Though I think your donor looks better than mine 3 days post-op, I'm glad to hear you've healed and that the skin surface became level again. hairweare - I completely agree. Small .9mm holes should not result in pitting scars. The holes you can see in my post-op photos are significantly larger in diameter - I would say 2-2.5mm. That also means a much larger surface area (as it increases squared to the radius). Still, recent days' progress and the encouragement of other members here on the forum leave me hopeful it will heal well.

Bismarck, thank you for the encouragement and positive outlook. This is why I visit those forums In my specific case, the doctor was only 20 minutes drive from where I live - we could've easily done a test if I had known about it and about the possible complications. I think what a lot of people in this thread might miss, is that I really don't fret that much about the results of the transplant itself. Having done much research, I knew beforehand that it's risk and not all transplants pan out. What I did not know, however, was how big the scarring risk to the donor was. This is why I opted for FUE after all, despite significantly higher costs - cause I wanted to keep the option of keeping my hair really short. Significant, visible scarring from FUE (thousands of concave scars due to large amount of skin removed at each extraction point), was not something that I even considered - all the post-op photos of FUE procedures I've seen had such minimal trauma to the scalp, that my post-op photos looks very scary in comparison. I've been talking to a friend today that has a nasty incident on his leg a few years ago, which left a large indent scar about 1cm deep. He basically had a crater in his leg. But it filled out over a period of close to a year - the reasoning he gave is that even though the skin is healed on the outside, the flesh behind the scar is still missing and healing, and once it is fully reformed, the skin resumes its normal, level surface. It made a lot of sense to me, and gave me much hope that I wouldn't end up looking like I am right now in a few months, even though on the outside it looks like the healing process is over. Also, I've been experimenting with several healing lotions and creams since day 7, after reading that Bacitracin does not really have much healing properties outside of preventing infection, and I think I have found something that works for me. More updates on that in a couple of days.

I have not consulted with Dr. Lorenzo. Perhaps I should - I have quite some time before I'll be ready for another operation, so I'll be sure to exhaust my options. Would you be willing to go another operation with a doctor that has failed to provide a good yield for you? whether my specific condition is really that difficult and rare considering my ethnicity and hair growth outside the skin, or whether the doctors skills and technique were not a good fit, remains to be seen. I only have his word for it, which is why I would like to have a small test with another doctor to confirm it.

That's exactly what I'll be doing before undergoing this procedure, I did a lot of research and took consultation with about 5 other doctors, all highly recommended on this forum. Though I really shouldn't, I keep wondering whether results would have been different if I had went with one of them instead. This is the problem with making medical decisions as a layman - with as much research as we can do online, we are not experts - we have to put our trust in the doctors that give us medical advice. You can never tell who is right and who is wrong. I've already presented my case to one of the forum's favorites - Dr. Bisanga - and he suggested to do an in-person consultation when he visits the U.S and a 100 graft extraction test to ascertain the difficulty of an operation. As my experience with him so far has been very poor, I would be very reluctant to go to another operation with the same doctor that did the first.

Thanks for the explanation, Blake. The way I understand it, doctors inject fluids to make the extraction area swollen, so that the skin stretches and it's easier to make an extraction. If this is common practice however, how come all of the post-op FUE photos I've seen on the forums and on doctors website show much smaller extraction wounds? I'm assuming most of them use the same approach, or is this unique to this doctor? The doctor did not say anything about my skin being difficult to extract due to previous scarring. The only reason he gave was non-uniform angle of growth of hair follicles under the skin. Since it seems to be very rare, I have only his word to go by. When it is time for another operation in 6 months or so, I will be performing a test with about 100 extractions with another doctor, to verify this condition first (already being discussed). PupDaddy - the FUE consent form I signed says that in the rare case there is a high transection rate, the doctor will inform the patient. He does not need to do a FOX test - after about 100 extractions, he should know what his success rate is. He did not inform me until after the operation was over. To be honest, if I'd known that he would not be able to extract consistently, I might've aborted the operation as it becomes too risky, though it's hard to say in retrospect. As if to add insult to injury, there is another problem that is becoming apparent - the doctor did a nice job on the hairline on the left side, but on the right side he left a 4-5mm gap to my existing hair. This is becoming more pronounced as my hair grows longer, and looks somewhat unnatural on the right side (the left side looks good, merging the hairline with my existing hair).

KO - to address your question, I answered it in the original post, but here is the explanation again - the doctor claims my hair grows at varying angles inside the skin. He says that normally, hair grows at the same angle for caucasian patients, and once you figure out the angle, you can keep extracting with a high percentage of success. Since the angles in my case differ, he had to keep guessing and made many unsuccessful extraction attempts. Once you reach a certain number of attempts, you have to stop to avoid overharvesting the donor, and that's why he only got 1600 grafts (I'm assuming he made about 2200-2500 attempts). He did say most of those unsuccessful attempts would likely heal in time and regrow the hair. I hope that is the case.

Hi Blake, It is helping, and I do appreciate it I'm still hoping the extraction points will not form long-term concave scarring, as it now looks to be the case. Since I previously was shaving my head with a blade every couple of days, and were practicing in combat sports (BJJ), where abrasion to the scalp can happen, my skin has became very flexible and durable over time. I very rarely bruise or cut from hits or scratches to the scalp, and when I do it heals very rapidly. This is why I had reason to believe that with the normal trauma seen in FUE operations, I would have very minimal scarring. Do you think having a flexible and durable skin is actually a hindrance for an FUE operation? doesn't make sense to me. This is why those huge extraction points are so jarring to me. See for example, this FUE operation from a recent thread here. The extraction points are so small compared to mine, and you would expect scarring would be similarly minimal as well. Can you explain what you meant that the doctor uses a lot of tumescence in the donor? isn't tumescence a state of being swollen? I tried googling it, but couldn't find a good explanation to what you meant.

I will provide the doctor name when I have more conclusive results, you can ask me in a PM for now if you need to know. It is not Dr. Doganay. Regarding punch size - it does look very large to me, especially compared to other post op photos I've seen. Blake above suggested it is due to the use of tumescence in the donor region, I hope that is the case. If the doctor, in fact, used a larger size punch than he claimed, and it results in more scarring, I will be even more disappointed. The thing is, I have very good healing factors. I've been training in combat sports (BJJ) for many years, mostly with a completely shaved head, and I'm used to get bruised / scratched a lot in my scalp - and it heals very rapidly or doesn't even show up visibly at all. As you can see in the day 7 photos, I've healed considerably considering the amount of visible trauma in the post-op photos. Of course, pre-op I was hoping that with the normal trauma seen on most post-op cases I would heal very well. That makes it doubly disappointing to me.

The doctor performs all of his extractions with a manual punch. Even though it's immaterial now, I've re-read yesterday the FUE consent form I was given. I'm quoting: (Capitalized in the source) I was not notified of this problem during the operation and was not given the option whether to continue despite the doctor's difficulty in extracting. To be honest, I don't know if I would have stopped mid procedure, but I would have liked to have been given the choice. Another thing I noticed, is that though on one side the doctor did a good job of connecting the new hairline to my previous temples, on the other side there is a small but noticeable gap between the hair line and the temple (about 3-4mm). It's becoming more apparent as the hair grows. I'm not sure what can be done at this point - I'll probably have to wait until the next operation to complete the hairline all the way to the temple. It's one disappointment after the other.

Thank you for your comment, Bismarck. The explanation provided to me by the doctor is that the angles of the hair under the skin is irregular in my case. He said normally, once you figure out the angle the hair grows under the skin you can repeat it for almost all the extractions. If the angle changes, you have to keep guessing resulting in unsuccessful extractions. He said it's rare to have so much variation in growth angle (even though outside the skin the angle is completely uniform). On the other hand, he said that most of the unsuccessful extractions were probably not transected, and will regenerate over time (since the angle was such that he did not reach the root). It remains to be seen how many of the unsuccessful extractions will regrow hair, if any, but he believes most will. I will have to wait and see, naturally. I was wondering if anyone who has undergone FUE operations (or seen them in the recovery process), can tell me whether indentation of the skin at the extraction point once it's healed is normal, and whether it smooths over time. Personally, I have not seen indentation at extraction points at any post-op photos I've seen - but it's also hard to see it from mine (you can clearly see it in person), which is why I'm asking.

Hi Blake, Thank you for the quick response and assuring words, it is very much appreciated. At this point, I'm not even concerned about the result of the transplant itself (aside from the unnatural look of a hairline with no hair behind it) - I'm more concerned about the donor area. While the donor area did heal, the extraction points left an indent (thousands of those). Since it is already healed, I'm concerned it will not reach a level surface again, and my scalp will always look like it was worked over with a cheese grater. Due to the shedding in the donor, the hair growth cannot cover it - especially on the sides, where the shedding was the worst. Is this indentation in the skin common in FUE operations? does it smooth itself out over time? what has been your experience, if you've seen FUE patients at this point of the healing process? Also, regarding the shedding itself - do you think it's temporary shock loss, or should I be concerned that due to the large level of trauma those areas are now deprived of blood supply and will not regenerate?

Hi all, I had an FUE operation 7 days ago which didn't go very well. I'm pretty concerned about several things now, and the doctor hasn't been very responsive / helpful - I could only get his receptionists / office manager when calling the office. For now, I'll avoid putting his name here since it might turn out well in the end, but I'm hoping to get some feedback from members of the forum. I'm between a Norwood class 5A and 6, but the doctor (a very reputable and expensive doctor in NorCal) said that with 2 FUE operations of 2500-3000 grafts, he could give me a very nice result. I had consulted with multiple other doctors online, that said the same thing. The doctor has a very impressive portfolio of patients with similar hairloss and outstanding results, so I was convinced to go with him despite being the costliest option by far. The operation was set for extracting 2500 on the conservative side, and the doctor said he'll try to get as much as 3000 but he'd rather underpromise and overdeliver. The goal for this operation was to rebuild the hairline, and fill out the frontal third. The next operation should address the back and crown. I went through the operation on Oct 9th (exactly one week ago). The operation itself was painless and I even slept through most of it (I was given valium at the beginning). At the end of the operation, the doctor informed me he could only extract 1600 grafts. He said my hair grows at differing angles inside the skin, so he could not consistently extract. He used those grafts to build the hairline, but left the area behind it sparse (almost bald) as before. I should mention at this point that I'm Caucasian of European descent, with medium wavy hair, so this is very unusual. I'm not sure if I really have such a rare condition, or that this particular doctor skills were not up to the task. This doctor, by the way, prides himself on having much success with African American patients, which normally are considered much more difficult to operate on due to the curly hair. Obviously, this was very disappointing to me, as I was worried about unnatural density up front compared to the back prior to the operation, but the doctor assured me he would transplant in a gradient of density going towards the back of the scalp so it would like natural until the 2nd operation in a year. Having had only enough grafts for the hairline, he could not do so. So far, it's disappointing, but I guess that's one of the risk of FUE. Upon arriving home and taking a look at the donor area, I was surprised to see the amount of visible trauma it had. Having seen dozens of post op photos here on the forums before deciding on an operation, I have never seen a donor area so badly injured. Obviously, he made a lot more extraction attempts than successful ones, but having been told he used a 0.9 size punch, I never expected such large wounds. (See day 0 images attached to the post) In addition, as you can clearly see - the doctor made extraction attempts from outside the safe zone. When I inquired about it, he assured me it is not the case, but you can judge from the photos yourself. I have a few questions to fellow FUE patients and doctors who visit the forums: Can this level of trauma to the donor area with a 0.9 punch be considered normal? to me it looks like multiple extractions attempts were made at the same point, and some times too close to each other. It also looks like much larger holes than a 0.9 punch would indicate. I'm now 7 days post op, and all of the extraction points left an indent in the skin. Is that normal? will this eventually smooth out? I have not seen indents in other post-op photos here on the forums, but it might be due to the zoom level / focus. Do the indent eventually fill out, or did I have an especially bad reaction to the injections? I've had a lot of shedding in the donor area, I'm assuming due to the large amount of trauma. Can I assume this hair will grow back? I've tried finding information about it, but most suggest it's uncommon, and should be very minor in case it does happen. I'm shedding significantly from the donor every time I shower. I've had basically zero contact with the doctor since the 1st day post-op when I came to do the first wash, and he happened to be there (wasn't scheduled to meet me). I've been talking to his office assistants (mostly to settle the financial differences due to the lower graft count), and when I inquired about a check-up, she said there's no need - in her words, "After the operation, you're good to go". I will try and get in touch again with the doctor, but communications so far have not left me very hopeful much would come of it. So my current situation is - I have a hairline, but no density behind it. Needless to say, I would not want to grow my hair right now. Thousands of indents in the extraction points in my scalp, which are not really covered by my hair growth due to large amount of shedding in several places. So even buzzing after the grafts are firmly secure would leave me looking really bad. At least 6 months healing period before I could do another operation to fix the results of this one. I'm now pretty much committed to do it, because of the unnatural results of this one (hairline without hair behind it). Depending on whether the shedding in the donor is permanent or not, I might not be able to even do another operation. This is just my conjuncture, but since I'm afraid the shedding is due to the large amount of trauma to the donor, I have no idea whether that hair will grow back (blood flow has obviously changed significantly in those areas). Any answers to the questions above and advice on how to proceed would be welcome.

Actually, the way Dr. Diep does it in the video is the better approach. To minimize pain, you should make the injection as decisive as possible (speaking as an army medic here). If you notice when you do a blood test, they don't inject the needle slowly - you'll feel it much more as opposed to a quick stab.

Hi Bismark, I just booked an operation with Dr. Diep. I went with him despite having much cheaper alternatives because the body of work he has on display is amazing. Most of it is not on his site though, visit his Youtube channel - https://www.youtube.com/channel/UC6sNQeJV6BXUysaPHPR7Lug - which has a ton of results (as well as a demonstration of an FUE procedure that I found fascinating). In his clinic he has a huge book with before / after pictures, very impressive. I took an in-person consultation with him since I live pretty close, and he was, by far, the most elaborate on the technical and artistic elements of hairline design. The other doctors I talked to gave me mostly canned responses (granted, it was online consultation). After he explained to me the process in which he builds and personalize a hairline for each client, based on facial and racial features, baldness level, current density of existing hair in the safe zone and so forth - I felt he was the best choice if money was no object. I have not talked to the other doctors you mention, so I have no basis to compare, but Dr. Diep's work is very impressive.

No, I made it very clear I meant a razor blade shave and not a machine. Of course there are going to be scars, however, with time and exposure to sunlight, small scars blend completely into the skin. For example, I have a scar on the back of my neck from a big mole removal (around 0.8cm in diameter). You can't see it anymore, even though I can feel it with my finger - it just blended completely in the skin after several skin renewal cycles and some sun. The doctors I consulted with told me it's dependent on individual healing factors, but it's quite possible for FUE operation to be completely undetectable even on a 0 shave, unless you are looking for it. Of course, the size of the punch used to extract also affects this. Also, check the donor area on the patient shown in this thread - http://www.hairrestorationnetwork.com/eve/169499-pros-cons-fue-myths-dispelled.html - there's some redness, but no obvious white dots. I decided it's a risk I'm willing to take, and worse case scenario I'll just keep it buzzed on 0. Hopefully, after the operation I won't need to

Weird, since I got the opposite answer, from multiple doctors. All assured me I should be able to shave with a razor within several months after the redness disappears. Anyone here has any experience with shaving with a razor after an FUE operation?

He suggested to first focus on rebuilding the hairline and filling out the frontal third. A second operation will then address the crown.

Sorry for the late reply - I read somewhere (don't remember where) on how to calculate the balding area - you put a piece of paper (A4) on top of your head, and draw in the area you would like covered in hair. Then you measure the area in sq/cm, and there you go. The doctors I assume went by photographs, and also used their baseline numbers for this level of balding (Norwood 5A). Too bad I threw the page away - I would've uploaded it. But you can do it easily yourself. To make sure I was getting accurate figures, I also used a string to measure exactly the distances from front to back and side to side, and compared it to the results on the paper. I've since went to an in-person consultation with Dr. John Diep in Las Gatos, CA, and after hearing his explanations on how he scientifically builds the hairline and calculate density, I'm leaning much more in using his services, despite a much steeper price. His portfolio of patients with a similar profile as mine is very impressive as well.

Thanks for the suggestion, I have a doctor's appointment next week and will ask for a prescription. Any thoughts on the questions raised in the post?

Hi all, This is my first post here, been a lurker for a while. Brief intro - I've been losing my hair since age 21, tried propecia for a couple of years without significant results, eventually gave up and started shaving my head at age 24 (the Bruce Willis look). At first with a machine and quickly moved to a razor blade shave, which I've had for about 8 years now (now age 33). My hair loss pretty much settled down on a Norwood 5A level. I was content to have this as my look going forward, as I have a decently shaped skull, but recently I've become interested again in hair transplant, as results seem much better than they've been when I started losing my hair. I did 2 consultations, one with Dr De Reys from Belgium, and one with Dr Bhatti from India. Dr Reys recommended 3000 grafts operation over 3 days. Dr. Bhatti recommended 5500 grafts operation over 2 separate sessions (first 3000-3500 grafts, allow the donor area to heal, then 2000 more). The encouraging part is that I seem to have a lot of doubles and triples in my donor area, even if it's not very large (I have a small head overall). After reading many patient reviews here on the forums on both, I'm leaning towards Dr. Bhatti. The cases I read about Dr Reys were all pleased with the results but complained about significant pain during the operation, while Dr. Bhatti approach seems more aggressive with restoration, and it seems his operations are relatively pain free. I think it has to do with the FUE techniques they each use (manual vs. machine assisted). Also, Dr. Bhatti operation is only 1 day as opposed to 3. I discussed the operation at length with both doctors and their assistants, but I have a few lingering questions resulting from discrepancies between the answers I was given, and I'm hoping veterans of FUE transplants here in the community could help me out based on their individual experience: Wait time after operation before shaving again Dr. Reys said it should be possible to shave after 2 weeks (I'm assuming he meant with a machine) Dr. Bhatti said 6 weeks before shaving with either a machine or a razor. He did say he does not recommend a razor until about 6 months, as donor sites will still be visible until then. That is quite a big difference. Not buzzing my hair for 6 weeks will leave me looking quite bad with my current coverage (even 2 weeks is stretching it). What do you think makes more sense? from what I read here on the forums, most people think it's viable to buzz after 10-14 days. Also, what is your experience with donor area scarring with FUE? obviously, there's variation, but do you think it's possible to be able to shave again with a razor blade eventually? I want to know if the option exists in case the operation doesn't go as successful, and in the future if I get to that point again. How did you wear your hair after the operation, if you could not buzz it for 6 weeks? Difference in the amount of suggested grafts Though they both think 1 operation should consist of around 3000 grafts, the Doctors have different ideas on how to use those. Dr. Reys believes I would be be satisfied with spreading those out on my entire bald area + crown, while Dr. Bhatti wants to use it just for the top area, and use a second operation with 2000 additional grafts for the crown area. I sent them both the same pictures. I feel the pictures might be a bit misleading due to the very close distance (tried to make it as high resolution as possible), as it makes my head looks bigger than it actually is. I tried measuring my entire top all the way to the edge of the crown, and came to about 115 sq/cm. Using the density numbers they gave me - 35 sq/cm from Dr. Reys, and 65 sq/cm in hairline all the way to 30 sq/cm in the crown from Bhatti, I feel the truth is somewhere in between, but that Bhatti's over-estimate seems more realistic for a satisfying result. Are there any advanced Norwood cases here that can share their experience? I've read many patient reviews cases on the forums, but looking for opinion on the difference in graft numbers. Any other opinions on the difference in numbers are also welcome. Thanks in advance for any and all responses!