Albion71

So after much deliberation, I decided to have a second hair transplant. Those of you who followed this blog before will know that my first HT was far from successful. It was a major decision to have a second attempt, because at the back of my mind, I wondered if I was fundamentally unsuitable due to my physiology. However, it seemed to me the only way I could establish this was by having another another operation, with a top notch surgeon. This time I took the advice of Spex, who many UK hair loss sufferers will be aware of, and travelled across the pond, for FUT surgery with Dr William Lindsey on 22 December 2011 (photos at end of post supplied by Dr Lindsey). My decision was partly influenced by Spex assuring me that Dr Lindsey would be prepared to operate even if I had an inch or so of hair in the recipient area (I will need to be fairly presentable for work by mid to late January). In the event, I think a little more hair was trimmed than I anticipated, and in any case, Dr Lindsey felt it wouldn't make much difference because of shock loss. We shall see. Dr Lindsey's plan I flew into Washington on 21 December, and had my consultation with Dr Lindsey the same afternoon. One worry of mine, having lost so much donor hair during the Transmed HT (Transmed billed me for 2900 grafts), was that Dr Lindsey establish how best to use my remaining donor hair, given that I may one day end up a Norwood 6/7 like my father. He estimated that I could get about 2500 with this FUT (we ended up with 2495), and probably 1800 to 2000 in another FUT, with FUE a further option in the future. With that in mind, and given that I am already fairly thin in the crown/vertex area, I was a little concerned that Dr Lindsey's plan involved covering just the front third of the head, and would pack a lot of the transplanted hair very densely at the front hairline. I wondered if it might be better to use this hair further back on the head to achieve a wider, if slightly thinner, coverage. I checked with Spex, who assured me this was good practice, so I went ahead with Dr Lindsey's suggestion. But it means, unless I can regain (excuse the pun) some ground with Minoxidil foam, which I am yet to try, that I will certainly need another HT to attack that vertex/crown area fairly soon. And it will be pretty challenging to use my remaining donor hair to cover all the bald areas, if I follow my father's hair loss pattern. The surgery We kicked off at 730am. Dr Lindsey took out the strip, and punched the holes in my scalp, and then the technicians set to work inserting the transplants. There were never more than two technicians working on my head at any one time, in comparison to four at Transmed in my first op. As before, there was very little pain, except from my lower back, from sitting in one place for so long. The operation took about two hours longer than my previous HT, though this was partly due to my recipient area not being shaved, which made the technicians' job a little more time-consuming. I was back in the hotel by around 5pm – a long day. Dr Lindsey and Spex are both very anti hat-wearing, so I faced the world with my bare, blood-spattered head. It wasn't so bad. The doctor reckons I will be ok to wear a loose cap by my flight back on the 26th, four days after surgery. He is otherwise pretty relaxed, and told me to have a beer to unwind if I fancied one. However, he was very strict about no alcohol or anything blood-thinning for 10 days in the run up to the operation. There wasn't much bleeding, so I guess it proved very sensible. (In contrast, Transmed only asked me to abstain for 48 hours before surgery, but advised avoiding alcohol and smoking for two weeks afterwards.) Reflections I am glad to have gone ahead with this second transplant. If this one doesn't work, I will have to assume that the failing is largely down to me, rather than the surgeon. But at least I will have given it a try. I am still no wiser as to why the first HT did not work, and Dr Lindsey could not say either. He reckoned that around 900 grafts had survived, which is more than my estimate of 300-500. Dr Lindsey, Spex, and others have all suggested that the technicians may be the most common reason for a HT to fail. Their thinking - it is all very well having an experienced surgeon to extract the grafts and punch the holes, but his/her technicians are doing arguably the most crucial part – inserting the grafts. Any lack of experience or expertise here is critical. As expected, the professionalism of Dr Lindsey and his team was top drawer. But I should say that I was treated exceptionally well by Transmed too; there was no difference in quality of patient service. One thing that struck me is that Dr Lindsey has a very firm view on how to approach hair restoration. His approach to packing the front hairline densely differs to other surgeons I have spoke to, but obviously he has a strong track record of success with this method and wanted to stick with it. I found it interesting that he was very sceptical about minoxidil and finasteride – he reckoned that only about 1 in 20 of his patients used either – and is unimpressed by other treatments such as saw palmetto. He has no interest in trying beard or body hair transplants, and does not believe he will see hair cloning during his lifetime. Which leaves me wondering how I will ever cover all of my balding areas with the donor hair I have left...? But for the moment, I begin the long wait to see whether this HT will be a success. Photos - front above before Front left before Front right before Marking out the reciepient area - note the frontal area to receive extra packing Inserting the grafts Front left after Front right after Front above after

How common is this approach by some surgeons, whereby they have a 'supervising role' during the HT? When I had my surgery at Transmed, Dr Kulahci removed the hair from my donor area, but only came in 2-3 times after that, with her assistants inserting the grafts into the recipient area. She just seemed to check what they were doing. How common is this approach? From consultations I've had with all HT surgeons, I was always given the impression that the surgeon would do EVERYTHING. It was only when surgery started at Transmed, that I realised Dr Kulahci would not be doing the graft insertions. It didn't strike me as an issue at the time. I assumed it was normal. But I ask the question wow because I'm still trying to establish what went wrong in my own HT, and wonder whether this could have been a factor. It may also be an issue for Lisco by the sound of it.

I can only second Jessie's comments - the questions you are asking should really be asked well before you book surgery. Most people who have had successful HTs will have spent years undertaking painstaking research before taking the plunge. As you've noted, my experience with Dr Kulahci was not a good one. However, based on the research done by Bill and the panel, I think she is the only Transmed surgeon who has coalition membership. Be careful before going ahead with any other surgeon.

I'm pleased to say that I have reached an agreement with Transmed which I am happy with. I won't go into the exact details but I think it reflects the outcome of the HT. I should say that Transmed have been very professional throughout this, and I feel sad that my experience with them was not all I'd hoped for. This brings to a close my blog of my HT with Transmed. Obviously I have not had the outcome I wanted, and I've lost a lot of donor hair. My quest now begins to find another surgeon who can provide me with a better HT outcome.

Apologies for not responding to this thread earlier. My experience with Transmed has been well documented here. Obviously I didn't have a good result, but in the end, the clinic came back with what I felt was fair compensation. It is hard to tell from your pictures how unsuccessful your HT has been, certainly compared to mine. If you are sure it has been a failure, get some good close-up pictures taken, and send them to Transmed, and ask how they compare to those taken pre op. Keep the dialogue reasonable and I'm sure you'll be satisfied with their response, based on my experience.

Our messages crossed there Bill - I've PMed you with a bit more info.

Hi all, I've had further discussions with Transmed since I was last on here, and we have reached a financial agreement which I am happy with. I won't go into the exact numbers but I think it reflects the outcome of the HT. I imagine many clinics would not offer any compensation to patients disappointed with their HT result, so I think it is a very impressive gesture by Transmed. I should say that Transmed have been very professional throughout this, and I feel sad that my experience with them was not all I'd hoped for. Also, thanks again to Bill for his support, and everyone else in the community.

I did get plenty of zits - but when I raised this at my consultation with Transmed they said it wouldn't affect the success or otherwise of the grafts. I think a lot of people have had zits as part of the regrowth phase and still had successful results. It's no different to getting zits when hairs in your beard ingrow.

Hi all, Thanks again for your comments. In answer to some of your Qs - I haven't decided my next move yet, it's something I'm going to take a lot of time over. But I will certainly have further surgery. I haven't heard any more from Transmed. I'm not sure whether it's right for them to contact me direct or post on the forum - I wouldn't want this thread to turn into a slanging match. I would prefer to keep all communications as rational and reasonable as possible. I would like to thank Bill for all his efforts to get in touch with Transmed regarding my case. Finally, I should say this forum has been a huge help in researching hair transplants. But my decision to go with Transmed was based on their coalition membership - and obviously I've had a disappointing outcome. Something for everyone to think about there.

Hi all - and thanks for your kind messages of support - both on this thread and privately. Transmed has sent their 'before' and 'after' pictures of my HT, which I have posted on my blog. They present a more positive outcome, but I don't feel they represent the true picture, as I have explained on the blog. Thanks once again for your comments, and I'll keep you posted with any further developments.

Transmed has sent me some 'before' and 'after' comparison photos, which I've posted below. The before photos were taken in June 2010, just before the HT, the after photos were taken last week, on my follow up visit to the clinic. Firstly, I should say that they present a more positive picture, and actually I feel a bit better for seeing them. But - I don't think they tell the full story because: 1. My head is tilting forward further in the after pictures. 2. My hair is longer in the after pictures. 3. My hair was carefully combed forward by the photographer. Underneath the Transmed photos, I've posted one of my own recent (one month ago) photos with the Transmed before photo - the angle is slightly different, but I feel it gives a closer representation of the actual outcome. What particularly bothers me is the lack of density in the front, which is why I find it hard to understand Dr Kulahci's assertion that 90% of grafts have survived.

Hi all. I've updated my blog with an account of my follow up consultation at Transmed. In short, Dr Kulahci thought I'd had a good result - she said 90% of the grafts had survived. Any financial compensation is based on her assessment that only 10% of grafts had failed - so only 10% of my fee would be refunded. Alternatively, I could have a further procedure with Transmed at a discounted rate. While I appreciate the efforts Transmed have gone to in flying me out FOC for the consultation, I have to say I am disappointed in Dr Kulahci's assessment that I have had 'a good result'. I'm now mulling over what to do next.

So, just over a year on from my HT, I returned to Transmed for a follow up consultation. As before, the patient experience was excellent; my flights and accommodation paid for, a car to and from the airport, and to and from the hotel and Transmed, and excellent service when I was in the clinic. However, when I had the consultation with Dr Kulahci, her view - somewhat to my surprise - was that I'd had a good result. I had my photos taken, but there was apparently a problem downloading them, so we couldn't compare my before photo from last year with my new after photo, side by side on screen. Instead we had to compare last year's before photo with how I looked in the mirror, which wasn't as easy a comparison to make. (The next day, I got a call from the clinic to say there was still a problem with the photos, and could I come back in again to have another set taken. On this occasion, the photographer carefully combed my hair before some of the shots, presumably to present a better impression.) Dr Kulahci's view was that 90% of the grafts had been successful, maybe only 80% on the left side of the hairline. But generally she thought there was a big improvement on last year. Her view was that it was much better in actuality than in photos. I asked what caused some grafts not to work, and her general view was 'it happens'; it was nothing particularly to do with my skin type or anything else to do with me. The pimples, which I mentioned I'd had a lot of, were also not an issue in affecting regrowth, she thought. I got to see the scalp up close under the microscope. I could see the clear difference between transplanted grafts and native hair. This was a relief of sorts; at least some of the grafts appear to have survived, which gives me hope for future surgery. But I would still say that my personal estimate of how many grafts have survived still is no more than 30%-40% - and that's in the good areas like the right temple – while the bad areas like the left temple can only be 10%-20%. I did express my surprise at Dr Kulahci's view that so many grafts had survived, and brushed by hair back to show the (in my opinion) thin hairline. But she stuck with her view that 90% had survived. So where did we leave it? Dr Kulahci was fully prepared to do a second operation there and then, either FUT or FUE. I expressed my preference for FUT. She said this was possible, and estimated around 1,500 to 2,000 grafts could be obtained from the back of my head still. Which is good news I guess. For this, I would pay for the first 1,000, and the remainder would be 'on Transmed'. One interesting point Dr Kulahci made was that subsequent operations are always more successful – this is because there is more blood supply in a recipient area that has already received grafts, than one that hasn't. I don't know how true that is based on other patients' experiences. Anyway, I declined to have the operation on the spot, and said I would think it over. As to the option of a refund - well, the detail of this is to be confirmed, but because Dr Kulahci estimates that only 10% of transplanted grafts failed – itself within the margin of error – than I would be entitled to that much of my fee refunded, about £500. So now I have to decide which option to go for...

MRA13 - not sure your situation, but some people do respond very well to finasteride, and after a year on the drug, they have sufficient regrowth to be happy. You might want to wait longer than six months if you see promising early signs.

Johnboy, Most successful HT patients from UK have gone abroad. I went to Turkey but mine isn't a case to follow... I would recommend having a look at Belgium and the various case studies on this site from clinics there - it seems to be a mini centre of excellence.

Hi all. I will be going to Transmed for a follow-up consultation this week to discuss the disappointing outcome to my HT. All flights and hotel have been paid for by the clinic. If anyone has experience of these sort of follow-ups, I'd be grateful for any advice about what to expect, questions to ask, etc.

Hi Jeremiah. I've been on finasteride for 12 years, tried minoxidil for a year about four years ago but it had limited impact and I didn't like the side effects. Good luck with your regrowth.

I can't say I'm impressed with the outcome of my HT with Dr Kulahci.

Hi HairToday. Yes, I am pretty angry about the outcome. I was given to expect that the 2,000 or so grafts in the front third of my head would provide sufficient density for a good covering in that region even if I lost all the remaining native hair. I distinctly remember Dr Kulahci saying no one would be able to tell the difference between the hair at the front and the hair at the sides. Feedback from the clinic has been poor, I have to say. The only response I had from Taner came at the 11 month stage, and he said to send pics at the 12-month stage and the clinic would assess the situation then. Well, I emailed him five days ago but haven't even received an acknowledgement yet. I hope you are right about the donor hair...

Hi Jeremiah. I hope your HT with Transmed proves more successful than mine. Since establishing that my operation has been a failure, I've been re-assessing my patient experience at the clinic. What you say about the operation seeming rushed chimes with what I remember. Similarly, Dr Kulahci was not present for much of my operation, which is worrying. How common is it for surgeons to use helpers to insert the grafts? This is surely the most crucial part of the operation, and if it is rushed and not supervised by the person with the right expertise, that is very worrying.

Not much density in the frontal hairline after three operations.

Thanks Corvettester. At least I know I'm not imagining it's a failure!

Hi all, My final blog post - one year on - there's been no real change in the last 2-3 months, so clearly a pretty major disappointment. I have sent my pics to Transmed, and will see what they come back with. I am prepared to be offered some sort of 'repair' surgery - but I've recently received a message from another Transmed patient who had two such 'repairs', which were both unsuccessful. I would be interested in hearing people's views on whether a repair procedure is worth it, when you're revisiting the same surgeon who delivered a poor outcome first time out. On a similar note, I'd be interested in people's views as to how plausible it is that physiology is to blame - as mentioned by a poster above. It seems unlikely to me. Thanks as always to everyone for their comments and advice.

So this is the final outcome. And it is a big disappointment. Not just the poor hair density. And the cost. But also the time investment I put into this – four months as a social leper avoiding my friends, changing my work behaviour. And perhaps above all else, the knowledge that those 2,900 grafts are gone for good – and that my chances of getting a decent coverage with my remaining donor hairs are greatly reduced now. So how bad has it been? I reckon I'm in a similar place to where I was pre-HT. I can see a few frizzy hairs, which I take to be transplants. I think they have effectively made up for the density lost through further native hair loss. But I reckon no more than 10-20% of transplants have survived. So what has gone wrong? These are the possibilities I'm pondering: 1. Surgical error. Dr Kulachi uses a team of assistants to insert the transplants – could this part of the operation have been poorly executed? It was all done and dusted in 3-4 hours – does that seem quick? My left side is noticeably less dense than the right – was someone less proficient taking care of that side? 2. Pimples. I had a lot of spots in the recipient area, which lasted for 4-5 months afterwards. Could they have damaged the transplants? Judging by the experiences of most people on this forum, I suspect not. 3. Physiology. This was suggested to me on a forum thread. The suggestion was that 1-2% of patients are not very suitable to a hair transplant due to their physiological make up. It is the first I have heard of it, and I need to do more research, but it seems an unlikely idea to me. I have sent my photos, and a link to this blog, to Transmed and I await the feedback. After the last set of pics I sent, they mentioned 'compensation'. We shall see. Thank you to everyone who has commented and provided me with support and sympathy. Interestingly, I have received messages from other Transmed patients who did not have a good experience. Front Top Vertex Front close Front left Front right

No side effects at all. But I wouldn't recommend dutasteride if you value your libido! I now get my finasteride through a GP, as I think some drugs I may have bought in the past may not have been legit. He was good for advice too - didn't think it a problem going 1.25mg a day, and said that coming off for any period to stop your body getting used to it was pointless. He said that even if its effects reduce with time, it will still do a job for you at delaying further hairloss.