Tentpole91

Also, since I'm putting grafts closer together than they normally are with a first surgery, should there be any concerns at 3.5 months about avoiding activities/substances/etc? I can't find a lot of documentation online about repair surgeries, and whether the typical guidance found here and in post-op instructions from the surgeon applies 

Example: is it still possible for a graft to just ...die? Or is that almost always constrained to the first month (conservatively)

Hi all,

Any tips on how to measure growth if it's a repair to a previous surgery?

There is existing hair on the transplant site, so it's difficult to see -- even with a camera and mirror. 

Actually still waiting to hear back i from him if a pound a week is okay. I suspect he will green light it but always good to check with the forum  

JCT, what would you consider to be extreme dieting? And would you suspect that faster weight loss may have an impact during recovery? 
 

(2-3lbs per week is what I was initially targeting when I reached out to my surgeon)

Won’t reveal name other than it’s a top 3 clinic in NA commonly used by members of this forum. The reason I’m posting here is that he recommended caution with weight loss during the recovery phase, especially at a faster rate than 1lb per week. That caught me by surprise. 

Hi everyone,

I am just over 2 months post op and would like to go on a diet to lose a pound a week. Assuming I eat healthy, are there any concerns with recovering at a caloric deficit? Weight loss journeys take a while, so I’d rather not wait for full recovery before beginning mine (looking to lose around 40lbs). 
 

Ideally, if I stick with it, I’d hit the 12 month mark on surgery around the time my body is around where I want it to be weight-wise. That would be awesome. 

This was a fun thread to read. Being constrained by budget sucks, as others have stated you had a lot of area to cover with not a ton of grafts. 

The transplant isn't perfect, but as you stated at the onset, you weren't looking for perfection. I will say, your view from the front is pretty great, especially combed back. It's amazing how much of a difference lighting makes, though. From the same set of photos, it's hard to believe I'm looking at the same transplant. 

2 Photos From The Same Post (1 Year Out Exactly)

a

End of day, though, you got what you wanted and are happy. 

Edit: The only thing I don't really understand is the FUE/FUT combo. I can't see why it wouldn't work, but it's definitely not that common. 

It's been quite the journey, everyone. This will be my last post on this thread, and I apologize for not answering several PMs. I'm 5 days post-op from a 1337 graft repair that did not exceed any part of the region that was originally operated on. I'm not posting the name of the doctor who did the repairs, sorry.

Here's what I can say, and I hope some of you find it useful. This is a TLDR of what I've learned over the last 18 months getting quotes from 10+ doctors, and going through another transplant:

• As others have said multiple times in the thread, my right side grew out to be pluggy and unnatural. Let's dive deeper here: what constitutes a pluggy, unnatural appearance?
  • The main factors in my case were the overuse of higher caliber hairs at the hairline, and unnaturally even spacing between the grafts. Those two things done in combination will never look natural, because it's not how hair grows. In nature, hair grows randomly, and you can see from my day 1 photos that the grafts were not implanted randomly. 
• My recent repair made Dr. Diep's extraction feel like 19th century technology. Yes, yes, I know it's all about results, but it's unbelievable how much faster my body recovered from the more recent surgery. You couldn't even see the extraction marks after day 4, and I removed my bandage in <24hrs with no subsequent bleeding. 
• When you're evaluating doctors, ask them hard questions. Things like:
  • How do you judge the depth and angle with which to implant a graft? What trade-offs do you consider when making that decision?
  • How many different extraction tools do you use on a typical surgery? Do you vary the size of your extraction tool based on the size of the folicule?
  •  What is, in your view, the most important outcome of a procedure?
  • For hairline work: Do you typically incorporate napes into your surgery? Do you find them valuable to extract, or too much work for the heightened risk of graft failure? When doing hairline work, how many napes would you say you extract on a typical procedure? 
    • If you're doing hairline work, I'd recommend finding someone who can give you a very thoughtful and detailed explanation of why they do or do not use napes. There are legitimate concerns when using them because they don't generally have as high a survival rate, but they can do wonders to soften a hairline. The answer to the question isn't important IMO, it's more how they answer it -- do they talk about the risks and rewards? Or just brush it off? Typically, nape extraction requires more effort, so that's one reason alone that some doctors won't use them. (Or if they do, not a lot of them) 
  • What's your average rate of graft loss? 
    • It's been a while, but I think doctors should know this, and the answer they give you should be realistic.
  • How many patients do you, personally, perform surgery on each day?
    • I would really, really only go with doctors that do one a day unless it's a relatively small procedure that can be done in a morning. What you don't want is a doctor "supervising" multiple large surgeries at once, because you'll get a lot less attention, and a lot more of your surgery delegated to assistants. 
  • How far out are you scheduling new surgeries?
    • Don't forget to ask this one. Sometimes you can get pretty far along with a doctor only to discover that their waiting list is 3-4 years. 
  • What's the average tenure of your assistants? Of your current staff, who has been with you the longest?
    • Good doctors hire good assistants, know their value, and pay them well enough to keep them around. If someone has an assistant they've been working with for 10+ years, that's a really good sign, because the assistants tend to do a lot of the work (depending on the doctor: graft separation, graft implantation, etc).  
  • What factors do you consider when determining whether a transplant requires multiple procedures? 
    • Good question to ask if you're higher on the Norwood scale. You might need multiple surgeries, but if you do, you should be getting them for the right reasons. 

If you are looking to learn from my mistakes, here are my top 3 pieces of advice:

• 1. Get at least 5 quotes from different clinics. You will be able to see pretty quickly which ones take their craft seriously based on the questions they ask, their general demeanor, and how they discuss the potential surgery. When doing the consultation, don't be afraid to ask a sampling of the questions I posted above (you probably won't have time for all of them + the ones you already have). 
• 2. Don't look at YouTube. Don't look at YouTube. Don't look at YouTube. There is no positive incentive for a doctor to upload a bad result. Trust what you see on the forums, because they are the real deal. I got sold by the YouTube videos, and you all know how my surgery turned out. 
• 3. If there is a doctor you're particularly interested in, PM a few people on HRN who got surgery there and ask them questions. I've found people here to be friendly and responsive to direct PMs, and people will be way more candid with you about the good, the bad and the ugly. 

Thanks to everyone who helped me along the way. It's been a long journey, and I still have a ways to go. 

Dr. Diep offered a free repair. There are several reasons I chose not to take that path, mainly donor treatment and ensuring hairs are placed in the right directions. There are other surgeons who are more skilled in both of these areas, and getting it right is worth the extra cost to me. I will be going significantly upmarket for this repair, and pay for the best. 

Oh, and one more thing: I haven't seen any notable growth since my last post. No late-stage growth of singles on the right side to save the day, or anything like that. It is what it is, and the best I can do now is to get it repaired as best as possible. 

Apologies for radio silence. I'm pretty much waiting for the year mark to schedule a follow-up surgery with a different surgeon for repair.

The main things I'm looking to address with follow-up surgery:

• Covering up the corn row appearance on the right side. I'm pushing my hair to the side to disguise this, but if I were to push my hair straight back, it would be obvious & unnatural. 
• Putting a layer of grafts in front of the transplant with a more natural angle and appearance. Right now when I grow out my hair, the directions are a bit of a mess: the transplanted areas stick straight up, while the middle part of my hair does not. 
• Explore doing SMP on the donor area, since there are parts of the donor that had too much concentrated extraction

Overall, my assessment of the surgery isn't changed since the last time I posted. I've gotten density and a hairline, but all of the other considerations -- angle, natural appearance, and donor management -- continue to be problematic and will require repair.

I feel like we keep getting side tracked from this central issue into debates about overall quality — which are valuable, but not as important as figuring out what the hell happened to Violinist. 

Buffalo it sounds like you’ve made your decision, so I’m going to bring the thread back to the earlier topic. 
 

I really appreciate the folks in this thread who are pushing hard for the truth here. The story can’t end with just what the surgeon tells Melvin in a phone call. 

The photographic evidence needs to be addressed. This has nothing to do with the quality of Violinist’s end result, and everything to do with the way the donor was harvested + Dr. Diep’s response to the patient (as documented by @LonelyGraft)

I’m glad that Melvin has reached out about that specific issue. 

32 minutes ago, Buffaloboy said:

I emailed Dr Diep’s office and told them my concerns and requested to talk to the doctor prior to making my final payment.

They responded and said I can talk to the doctor in 2 months ... 1 day before my surgery. Payment is due 10 days before surgery. 

🤦🏻‍♂️

That is absurd. Cancel the surgery ASAP. Wait a bit longer, go with a more reputable surgeon, and thanks us all later for the rest of your life. 

Like, I’m not sure if you need a kick in the balls or something but just cancel it. 

3 hours ago, ADuckwithNoHair said:

Dr. Diep has achieved great results for patients in the past... That being said, everything I've seen recently doesn't inspire confidence at all (to put it very lightly). If an omnipotent being could view all your branching timelines in the future, I think 95% of the time you will have better hair in the ones where you choose Dr. Hasson.

Basically agree with this. Diep has some awesome results on YT, but he is riskier and you don’t get any do-overs in this industry. 
 

To be clear, I am someone who GOT surgery with him. I’m not just some random shill one the internet. I am actively seeking repair work right now for my February surgery. 

Doctors change over time and the results I am currently achieving with Dr. Diep have been described by a HW associate as “pre-2000s” in terms of appearance. Another surgeon said that I needed 1000 grafts to address the bad angles and grid like appearance. I can’t in good conscience recommend him. 

Yep, totally agreed. Mentioned earlier in the thread, but it really does feel like they were done by different doctors. No other way to put it.

Yep, it's definitely a waiting game. I'm excited to see how your results turn out. In the meantime, I will keep you all updated with my progress. 

@hybonix good luck, for what its worth I think you probably made a good call. Dr. Diep may well have given you an excellent result, but it's important to keep in mind that you don't get do-overs when it comes to transplants, and you really need to be managing your downside rather than maximizing the best possible result (especially with 3500 grafts). 

One thing that I've heard H&W do well is place the hair at more natural angles. This tends to be more difficult to do, but it has a pretty big pay-off in that it creates more of a visual appearance of density. People tend to talk more about hairline design and density, but I think it's important to also consider graft placement (not too uniform) and graft angle. 

@asterix0 When I emailed Dr. Diep with the above photos, he responded saying that he thought the area "looked fine" and scheduled a skype call in mid-October for further discussion (he bumped it up once Melvin reached out to him). I've discussed the results with three other well-regarded surgeons, and each of them identified serious issues with the placement pattern. There were also further flags around the angle of implantation and the types of grafts used. 

I do need to wait until the 12 month mark to make a final assessment, but one of the clinics I've talked to is already willing to schedule surgery for early next year based on what I've sent over. They feel that the issues are structural, and unlikely to be mitigated by a latent line of fine singles growing in. 

The main things I've learned in talking to other surgeons over the last few weeks:

• While density and hairline shape were originally the main things I cared about, placement technique and angle are also extremely important, and the second two are arguably more important in some ways
• Dr. Diep implanted my hairs straight up, which severely restricts styling options. Straight up is easy to style hair back, but it's harder to style to either side. If the angle was implanted closer to a 45 degree angle (like a natural hair), it would be easier to style. This is actually much harder to fix than pluggy/unnatural grafts, because you can't change the direction of a hair without pulling it back out (thereby burning grafts). This has been flagged as something that is unlikely to be fixed. 
• The placement technique (ie graft interlocking) is just as important as the density that you want to achieve. Again, some doctors are good at this, and some aren't.

Overall, I'm getting the sense that Dr. Diep is good at designing hairlines and getting density. But the finer details that justify $8-10/graft prices -- such as interlocking, appropriate angles, using fine singles in the front, and having a more uniform extraction pattern on the donor, are pretty much all missing from my transplant.

I reserve the right to delete all of this later if I decide that I'm being too harsh. But want to make sure others are able to learn from my journey.

Sure thing. My hair stylist is aware of the transplant and actually cuts the hair shorter on the sides to kind of blend the line. So he makes it not look that bad. 

I'll see if he can do a normal 2 all around and take some photos. I have not gone down to a 1 in the back and do not plan to. 

Hard to weigh in on this one since I don't have medical experience. Definitely a question for the doctor

8 hours ago, hybonix said:

@Tentpole91If you knew the pattern would occur with Dr. Diep, would you have chosen Hasson instead?

I didn’t look at Hasson when I was making my decision, because I felt that his clinic was a bit too conservative in the hairlines that they design. Probably not a smart call in hindsight  

I chose Dr. Diep because I thought he would be a safe bet given the sheer number of people who have had transplants from him on the forums stretching back to 2015. I thought that if he was good enough for all of them, he’s probably good enough for me. I also was a fan of the density he is able to achieve, which I didn’t really see in other doctors  

Today, the pattern is pretty frustrating. It looks unnatural and I’m not comfortable exposing that side of my hairline. But then again, plenty of people are unhappy with their transplants at six months. I’ll have a better answer for you towards the end of the year once the hair has had a chance to soften, mature, and grow in any straggling singles. Otherwise it’s not super fair to Dr. Diep to call the results a success/failure before the hair has fully grown in. 

Now if the pattern remains prominent 6 months from now, then I would definitely cash in the hypothetical card to swap surgeons. Who wouldn’t? lol 

2 hours ago, hybonix said:

Thank you for your input. Once I get final pricing from Hasson, I may cancel my surgery with Diep. It seems like Dieps quality of work has gotten worse and that scares me. Only problem is Hasson is in Canada and we have to wait until COVID is over until I can get the surgery.

Note: I have emailed Dr Diep with my concerns on his pattern placement and submitted pictures of other patients. I am asking for his thoughts and opinion. If he is able to assuage our/my concerns and promise more natural looking results, I’m game and will stay with him.

If you sent over my photo, I can tell you what he will likely say: it’s too early to tell, and I need to wait another six months before making a final judgment. And he’s right; There is still a chance the singles at the front could grow in. I tried to make that clear in my post above,  but could probably have done a better job. 

As context, I have an ongoing dialogue with Dr. Diep about my current results, and it’s probably frustrating for him to see my photos popping up in his emails from prospective clients. So it goes. 

I totally understand the urge to do surgery now rather than waiting another 6-12 months. Keep in mind, though, that the results are for life! 

1 hour ago, Guy73 said:

I agree that guy has a killer result @Skyb but I think even he would agree in that whole pattern thing. He lucky to have thicker hair and probably many doubles and Triples to distract from the pattern. But hopefully we can all agree using a doll like pattern style implant draws the eye more to notice something is off. With that said your right no doctor is perfect, I am simply point out artistic ability which I guess is subjective. Your right he has many happy customers so I am not basing him just the technique. 

Thanks for articulating this so well. Basically summarizes my thoughts on the matter. There’s artistry which is subjective. But not implanting grafts in neat, ordered rows is more of a proficiency thing than a question of artistry 

What I have seen/heard anecdotally on the forums is that the row like patterns have been getting more prominent in recent work. Folks who did surgery in 2019 complained about a few obvious lines in the implant. The ones posted this year (myself and @Dadda) have patterns that are more prominent.