Nebulosity

6 minutes ago, bornwithhighforehead said:

I didn't know my scarring was so bad until I went for the 2nd HT. Kinda disappointing for a highly recommended doctor here. The density, the scarring simply makes it not worth it. I saw a few threads with the same plight as ours and all the doctor can offer is a complimentary session to "fix" the issue. I didn't take the offer since I wasn't really sure if it's worth travelling so far to get it fixed.

I doubt they’ll be offering me a free touch up, because the doctor has ghosted me, and his clinic has been sort of dismissive of my questions. Obviously I am a lay person, so I am waiting to see how the result turns out and the donor area heals. But the overall poor design and the lack of responsiveness from the doctor has definitely created some bad blood. Obviously I’ll do my due dilligence. But if it turns out to be as bad as I suspect (multiples in hairline, donor area depleted in narrow areas), I’ll take this up with the IAHRS, and post a very comprehensive report on my experience to forums and various social media networks. In say, 10 months, I’ll have a clearer picture. For those wondering who the doctor is, just view the threads started by someone else in this thread.

I received a total of three very brief replies from the doctor. I had around 7 or 8 clear questions, and he answered two or three. Then he stopped replying.

I asked his staff via WhatsApp about the donor area. Here is what they had to say:

22 minutes ago, bornwithhighforehead said:

Just to share my donor area after getting FUE from the same doctor. Photo was taken right before my 2nd HT to improve the less than desirable density from my first HT We both know who he is.

I can see areas where the scars run together. He probably did the same to my donor area. If you really think about it, considering he has decades of experience, he probably just wants to get it over with and collect his fee, and so he doesn’t really pay attention. I mean, as a lay person, I would try to space out the grafts better than that. He just does it as fast as he can. What I remember is that the last area he extracted from, he did extremely fast, as if there was a time limit. And that is exactly where you can see the most see through effect. At that point, though, what can you do? You can’t exactly just stand up and walk out, because there are still follicles to implant. The extractions were practically finished, so I just let him do his thing.

Thanks for the reply. I trimmed it a week before I took that pic, but I didn’t want to ask my gf to do it for me so basically the length varies all over the place. If I cover the top of the middle of the donor area - the “holes” - it looks much better. It seems likely that there is some shock loss in that small area at the least, and as with your experience the growth of the entire donor area may lag the surrounding areas. So there is some hope, but the next transplant will still probably need to correct the lack of artistry. I plan to grow out my hair to get through the ugly duckling stage. My forelock is kind of a bush, so that should help a lot and also cover up a lot of the imperfections. You’re right kicking back with a beer is not my strong suit but it’s probably a good idea now when all I can really do is wait.

I’ve reached out to schedule in person consultations with Dr Cooley, Dr Wesley, and Dr Nadimi this August. I’m also considering Feriduni, but starting to lean towards getting the touch up / repair done in the US. I chose those three because I think they’d all be able to do clean extractions along the hairline in case that is necessary. Not much left for me to do now except wait, eat my Biotin, apply minoxidil, and take finasteride.

Just a quick update. The recipient area is shedding and looking more and more like it did pre transplant. The donor area is unfortunately NOT recovering and appears overharvested. After the transplant, the doctor said - bragged, even - that all of the hair was taken from the safe zone. Well, I might as well have gotten FUT, no? As far as I know, a top doctor would have extracted from a much larger area and spread out the extractions more. I think the entire point of FUE is to make it so that the hair can still be short in the back. Yet this doctor made it a point of pride that he extracted from *only* the safe zone. It makes no sense to me.

I am 27 days post FUE transplant. Shedding is underway, revealing some irregularity in the skin of the recipient area. People said I seemed obsessed or that I had body dysmorphic disorder in another thread. While that may be the case, a separate issue is whether I have pitting. I’ll be going into business meetings with many people in the coming months, and I am wondering if my skin will continue to have these little divots, or whether they will probably smooth out / go away. Take a look, and let me know what you think. To me it looks like I have lots of little pits, which is not typical of the transplant pics I’ve seen.

Thanks guys. Actually you’re right I’m probably feeding my anxiety. By the way it’s 21 days post transplant, not a week, and I can still feel the roughness of hairs at each transplanted follicle wound in the small area where I shaved it, so it should be ok as long as I don’t shave again for another month or so.

Basically I think my transplant will be “ok,” meaning it won’t cause me much harm, but I will say it is a great inconvenience and I regret not going to a better doc with more artistry and pride in doing a clean job. Now I’m mainly annoyed that I’ll need to wait another 18 months or so before the results of a second hair transplant start growing in, and spend probably an additional 15k usd for an excellent result where I could have just spent 15k one time and expected a good result in 6 months.

I’m not going to mention the surgeon’s name until I get everything fixed the way I want it by a better doc with good esthetic judgement. But as someone mentioned, the work is actually recognizable. I should have known better. But it’s more of an inconvenience and a let down than anything else.

21 minutes ago, Shampoo said:

Amen to that Melvin.

With all due respect (because I actually like the guy), but I think it's quite possible that Nebulosity should have not gotten a hair transplant at this time.

Nebulosity seems really ill-equipped to handle the post-op journey and patient challenges that follow for months after almost all hair transplants. 

I am no doctor but Nebulosity may suffer from some form of body dysmorphia.

Obviously we all want to help Nebulosity thru his worries about his transplant, but I think it may be time for him to consider having a discussion with a mental help professional and discuss the possiblity that he has some form of body dysmorphic disorder. Look no shame in talking with a professional, I used to have panic attacks on airplanes, sought help, and have been basically cured of that worry and obsession.

 

Well to be honest, you might be right. Body dysmorphic disorder, yep I have that basically, or actually. Maybe some, but not all, of my questions are overboard. I don’t trust the surgeon who did my transplant, so all my questions go here.

14 minutes ago, txtransplant said:

Hey man. You are loosing it..lol.   Obsessing while the woulds are still fresh and shaving and such isn't really normal. Catch yourself before you really loose it.  I am not kidding.   But PSA aside, looks to be healing really well.  I had that chicken skin look on my temples too for a while after surgery. Think maybe 3 months. On one side it is still slightly visible if I use a magnifying mirror. But it's fine.  At the end of the day I always wanted the option of shaving my head if hair loss got so bad HT couldn't fix it. I am not sure even with a well done FUE that will ever be an option now. Buzzed down to a few mm would probably work though. As you will see posted 1000000 times here. There i no such thing as scarless surgery. 

You’re actually right. I am losing it. Are you saying you had minor pitting that looked similar to mine at an early stage?

I’m 21 days post transplant. I shaved a small section of my recipient area and it looks like I have a lot of pittiness along my hairline. I have taken some pics that make it look about as obvious as it does through a mirror to the naked eye.

Please let me know if this is normal. I mean, I have seen some pics around a few months after transplant from good docs with irregularity in skin texture. So I’m not jumping to conclusions. But some experience and insight could help me until the irregularity and redness subsides. Or, if it’s pitting or cobblestoning or whatever, please say so.

I also see lumpiness around my temple points. I saw that before and figured it could be inflammation of some sort. I don’t know how skin heals but I figure it will probably not turn into a horrible disfigurement, but honestly, I’m a bit worried.

1 hour ago, txtransplant said:

Quite obsessing. That's what you are doing weather it seems rational or not to you. To us here who are not emotionally invested in it or looking at a strange look on our head this is what I see.  Your hairline, the transplanted area anyhow is about twice as deep as it should have been give your age, facial structure, feelings and Density. Had they make it half as deep and by default, twice as dense, you would have had a really nice transplant.  You are correct that the density is not natural and won't look good when fully grown in. If you want that hairline you will fully twice the density you have now. I will tell you something you may not want to hear. The implanted area on many many people doesn't heal as flawlessly as nothing even happened. Maybe you will get lucky and heel so flawlessly your forehead skin in the transplanted area looks virgin. But there is a very good chance it will be slightly different looking. Works fine even if there is think hair covering it. But it is surgery and not completely scarless often times. I don't see terrible work here from a functional point of view. You ultimately decided on your own hairline and that is more on you than the Dr. But he should have pushed you to go for a higher hairline. None of us were there so we will never know what actually transpired when that was decided. But what is done is done and you don't have a bad hairline now. You truly don't.  Just not an ideal one considering all the factors. Moving forward;

 

1) Let it grow for 7-8 months. You really have no option there for at least a few months as the skin heels. Maybe after a while you can shave it. But if you wear your hair pushed forward the surgery you got will look fine and even with thin density won't look like a comb over. If that's a look you can dig, you are all set and take a year to digest what to do next. 

2)Have hairline moved back. You would have to have a few .7mm punch tests done by a good doc to see if removing the hairs on your forehead is feasible. If after a few months there is ZERO scarring maybe you can have the first 1.5cm of hair removed and re-implanted farther back. I think this is unlikely. You would need perfect healing from this surgery to have a flawless forehead and then have no scaring with the graft removal.  Other options are just killing the follicles by laser, electric or plucking for ages.  

3)Have a 2nd transplant and fill in this new hairline to a respectable density. The most sure bet I think in having a good result. You don't need to fill right up to the front edge. With it low, a gentle transition from front edge to thicker would be appropriate and best. Maybe 1800 grafts would suffice. Then you would possibly still have enough in reserve to fill if you loose more hair. And that is the real risk here! Your new hairline is OK. Not unnatural, though you are not used to it yet. But it isn't unnatural. I just posted on someone here who had a HT with an already forward hairine and went way too low...looked awful and unnatural. You don't have that at all. You just need to get used to it and PRAY you don't loose a lot of hair over the next lifetime. 

 

At the end of the day what is is what is.. You decided on this hairline, you may very well have some minor scarring that might look odd if you try and remove all the new hair. You are not seeing your new hairline from a unemotional point of view. It really isn't bad, even if not 100% ideal.  Best bet is to leave it for a year. Then fill in starting back about 1cm  from the new hairline till it blends in with the old hairline on the top. Temple points look okay density wise. Yeah, it sucks....had the doc and you decided to do this less aggressive with that same number of grafts you would be in a great place as the workmanship is passable, but the artistry is not too good. 

 

As for the back. Yeah, he took too much from a small area with pretty specific boundaries. But again, wouldn't stress about it as I think when your hair get's to about 1/2 long back there it will be impossible to see. Overall it isn't anything to panic over. Some guys would love your hairline and be super excited..and looking forward to the 2nd fill in.  You know what you want. But as a outisider who has never see your face before. You are just a guy who got a little to aggressive hairline, but not awful. The more aggressive side of acceptable in fact. No human being would look at your hair and think the low hairline looked weird. But it will need more grafts to look natural. 

Thank you for your excellent analysis. So if I fill it in about 1cm back from the hairline, it can be a smooth transition. I just hope it doesn’t cost too many grafts. 1800 sounds expensive (in terms of grafts and donor supply) at this point, although it may leave me with like 700 FUE grafts, and the option of FUT down the road. So, I should wait 8 months and get an in person consultation to plan carefully. If my donor supply including FUE and FUT is too low, I will try FUEing some of the frontal grafts and placing them further back, just to see if there is 0 scarring. That way would be harder (and more expensive in terms of dollars), but wiser I guess.

44 minutes ago, 1978matt said:

Unfortunately extractions were not spread out enough. 

For someone aged 40 and with mostly frontal loss, the doctor could have afforded to use a wider area.

That is what I think. It is like the doctor over estimated the donor density and over harvested from a narrow region. Also, the very middle is especially thin, which seems like exactly what not to do. If it was shock loss, it shouldn’t have been so apparent from the third day, right? I was hoping that when everything is settled after 6 months, I could buzz it to a number 2. It doesn’t appear that way at all now. It looks like overharvesting to my untrained eye.

What is the cause of the dramatic thinness of my donor area? Overharvesting? Shockloss?

3 days after procedure:

6 days after procedure:

Today, 15 days after procedure:

Thank you BeHappy.

Questions for anyone: As it grows in, is there any harm in keeping much of the recipient area shaved? How soon is it safe to shave it in this stage? I imagine that it’s better to leave it undisturbed for some more weeks, right? I’m at 2 weeks now.

3 hours ago, Baldrick101 said:

 

Why not mention the Dr's name? This isn't a case of slander or anything untoward. Nebulosity has simply provided the community with pictures and information of his surgery. I don't see the problem with asking, "Dr x did this transplant. Here are the pictures and my experience. What are your opinions?". That is just what I did for mine. Indeed, this is the whole point of the forum. The community can decide for themselves the quality of the work and make their own decision in the future. It would also give the doctor the opportunity to walk us through your case and provide explanations for his actions. In fact, an ethical doctor will have no problem standing by his/her work in an open forum for all to see. Taking this approach should have no bearing on whether you get a refund or something else.  

Eventually I will do a full report including doctor identity, results after a few months, etc. I am worried that by sharing his name now, I will have fewer options for recourse, due to the sparse and less than forthcoming replies he has given to my emails.

I wouldn’t be here ranting if he had provided reasons behind the decisions he made during the procedure, specifically the density, the distribution of the grafts (density), the number of singles, etc. I’ll even accept blame for agreeing to a low hairline.

I don’t want to make this into a gossip session, so lets give the doctor a while longer to reply to my questions in more detail, before I post a full report on my experience.

1 hour ago, elduterino said:

I think this hairline design looks just fine

the density is low and a bit pluggy but you have a decent first ground work, then having one more FUE in a year to increase density will give you excellent results in the end, and no one will notice the multi hair grafts with added density

 

Hard to get perfect dense and wide results in one pass, given the limits in blood supply

 

 

I am glad to hear that. I am still tempted to electrolysis some of it off to raise it slightly. In case I do that, I guess I won’t need to add as many additional grafts, due to there being a smaller area, and that maybe a lower volume makes sense for a slightly higher hairline. Before I do anything, I’ll consider the opinions of top surgeons and informed individuals such as yourself. I appreciate your perspective on the hairline, and I will consider it in my planning. It also makes me feel better about my situation.

Update. Now I am getting worried about irregularities that may be caused in the skim due to this transplant. Please help by taking a look. The bloody pics are from the same day as the procedure. The clean pics are from right now - most of the scabs washed off with a few hours of pouring water over my head and gentle dabbing.

What I am most concerned about is that in the bloody pics the follicles seem to be protruding from the right temple. And in the clean pics you can see there are lumps where the grafts went. I am really worried by this. Someone who knows what they’re doing, please help. I don’t know what the ____ to do because I wouldn’t trust the surgeon to fess up to a botched procedure.

Please help.

14 hours ago, HT0416 said:

58 singles says it all really. i doubt this doctor spent extra time splitting the multis up to make more singles. Doctor should be named and shamed. When the result grows out its going to looks ruff and abrubt. Good styling and hair product will help you!

Yea, it’s sort of amusing. During the procedure the doctor mentioned that he only got 58 singles, and he mentioned splitting some grafts to one of his technicians. Then he told me clearly that they would split some grafts to produce more skngle hair grafts. After the procedure was completed, I read the discharge notes, and there was no mention of any splitting. I approached the doctor and asked him how many single hair grafts were implanted, including the ones resulting from splitting, and he said “I think there were two hundred something.” When I asked by email later, he said that there were 200 single hair grafts produced by splitting double hair grafts, making a total of 258 single hair grafts implanted. I had to ask very directly and confrontationally, by the way, and every time I asked him questions by email he was defensive and seemed incredulous that I had not asked everything before. He said the single hair grafts went into the first few rows (without being specific about what proportion of the first row grafts should have been singles), and the rest were distributed randomly. Actually, during the procedure he said something similar, but I didn’t take note of his exact grammar. I understood him to mean that the first row would entirely consist of singles. Looking at images of my result, it looks like singles were just randomly distributed across my transplanted area, except that the first few rows of my temple points (but no other areas) were indeed singles. It doesn’t seem like there is any excuse for that. It just seems sloppy. Believe me, I want to name and shame. But I want more info, and I would like compensation, however unlikely that is.

4 hours ago, 1978matt said:

Anyone who has spent a fair bit of time here will know the surgeon.  This is the type of 'work' he is renowned for.

It probably wont be a disaster but at the same time I'd put some money aside in a year's time as it may end up lacking a bit of density here or there and need some refinement.

Just set it aside for now. 

I don't believe it to be cobblestoning.  It's just dead skin that will eventually fall off.

My current understanding is that I’ll need electrolysis, and a repair transplant of around 1000 grafts. I’m not just setting aside money just in case. I am planning to completely fix it.

Here are some close up images of the transplant. I apologize that you need to see the crusts, as they are in the process of falling off.

Anyway, you'll notice that, along the hairline, the first row is almost exclusively 2's and 3's. In fact, I'm not sure there is a 1 in the first row in that image. The other two images show one square cm containing 29 grafts, and another that contains 22. I doubt a single square cm contains more than 35 grafts.

Although the hairs are thick, I think at this point I should prepare myself for having a large area of thin hair. Let me know if I'm wrong.

There are supposed to be 2469 implanted grafts, since 100 of the 2's were supposedly split for use as 1's, making a total of 258 1's implanted. I haven't gone through my images to do a count, but 2469 seems unrealistic. I mentioned this to the doctor, and he became defensive. I didn't accuse him of lying or cheating, but he insisted that they didn't lie or cheat. I was merely looking for an explanation for the apparent discrepancy, but received none. It's in the realm of possibility that there really are 2469 implanted grafts. I expected the doctor to keenly explain the graft positioning, density requirements, etc. Anyway, it would probably be good for me if fewer were extracted.

EDIT: I figured out that this is just crusting. With a bit of extra water pressure, the fleshy colored growths slide off revealing smooth skin. You can delete this post or keep it here as an example of normal crusting that appears like excess follicle protruding.

If you’ve had a transplant, can you let me know if you had such bumpiness? Is it normal to have these kinds of fleshy growths around hairs 10 days after a transplant? Due to the fact that many aspects of my transplant seemed to have been below my expectations, I’m worried this is early manifestation of cobblestoning. I haven’t seen this in anyone else’s post op pics...

EDIT: Ok so I think this is just crusting. I didn’t know that it could be fleshy colored. I applied water pressure and the skin is smooth.

In my next post I’ll outline some quesions I asked the surgeon. Before we get to that, I want to ask you guys if this looks normal for 10 days after the procedure.

I see some raised bumps. It is really worrying me, because I do not want cobblestoning.

I asked a patient advisor and they said it’s normal and that it would be ok after the crust falls off. But I haven’t been well informed during or after the procedure by anyone, so here I am asking you guys. I can imagine everyone telling me “just wait, be patient” as the weeks go on so I want to ask now, is this normal? I haven’t seen this in any other images of peoples’ transplants.

15 hours ago, Triple7 said:

What a shitty situation this doctor put you into. I really feel for you and hope you can get things worked out. I agree that going to a top doctor like Dr. Cooley is your best bet and tell him your wishes and concerns and let him advise you on what to do. Keep your head up. You are not the first person who jumped into a bad decision. I think that with the technology/techniques that top doctors are able to perform, you will look fine down the road because you still have good hair behind your transplanted area. Good luck!

Thank you and I agree, I still have donor supply and enough money to pay for all the work it will take to fix this. I am becoming less confident in the work the more I observe. I’ll post some details below.

Let me change the topic of this thread to transplant hair removal and I’ll summarize what I’ve learned. If nothing else it’s kind of interesting.

There are several ways to raise a hairline, including 4 ways to remove individual implanted hairs. One way to raise the hairline is a brow lift, which in my opinion sounds gruesome. The other ways I know of involve removing or killing individual follicles: electrolysis, laser, FUE (with the option of skin micrografting to avoid scarring), and continuous plucking until there is no more regrowth. I’ve read a lot of conflicting statements about each one. For example, some people say that electrolysis causes scarring, others say it doesn’t have to, and some say that although it doesn’t cause scarring it can merely expose scars originally caused by implantation. Yet when I read about plucking on realself and other sources, many experts seem to indicate that it can eventually lead to complete hair removal without scarring, while yet others suggest that it could actually stimulate growth. Plucking doesn’t seem practical for more than a small number of hairs in any case.

My take is, maybe electrolysis causes or exposes tiny scars and what one would want to avoid is a contiguous pattern of scars, which would look unnatural. Trying it out on a few implanted hairs to see what happens is probably a good strategy. And before that, one might as well try plucking to see whether there is already a pinpoint scar (or pitting or cobblestoning) caused by the implantation itself. After that, one could perform electrolysis (or laser) on a few hairs and wait to see if there is scarring and how bad it is.

In the meantime, it is actually very popular these days for people with a NW0 to shave along their hairline, so shaving the parts of your hairline that you don’t like seems ok, even if it produces a 5 ‘o clock shadow.

I know there are docs that do FUE extraction along the hairline and use skin micrografts to prevent scarring, which may be a good option in limited cases I guess. I’m not sure if it would be practical or advisable for extensive cases. For extensive cases, I guess electrolysis is the best option, following the precautions I explained above. Dr Cooley seems to favor electrolysis. However, I think electrolysis would take many sessions to complete... so you would need to keep track of which hairs you want to remove. You’d sort of have to get to know each and every hair. Lol.

And by the way Shampoo, I am listening to your advice about not obsessing. I just think I need to get it out of my system.

One other thing... What do you think about the density? Isn’t this something that can be visually estimated based on the spacing of the grafts, the donor hair thickness and average hair per graft? In my original post you can read that I had around 6000 hairs transplantes (in 2369 grafts) - supposedly. I tried counting the implanted follicles and it really doesn’t seem like 2369 follicles were implanted.