Please see below comment from Dr Arshad.
The Hair Dr Clinic
Dear forum readers,
Melvin has kindly brought this thread to my attention and invited me to leave a comment. I have waited until now to do so as I wanted the patients prior consent.
I can confirm this is my patient who underwent surgery with me in late May 2020. I think there are several issues here that might be worth elaborating on.
Growth of transplanted grafts
In relation to transplanted hair growth I completely agreed with the patient that the overall outcome is not what I would expect from the high standards we set ourselves. It is very disappointing for me personally to see that the outcome of surgery has not achieved the desired impact and importantly that the patient is not satisfied with the outcome. Despite following strict surgical protocols this is unfortunately a risk of surgery with any clinic/surgeon. The result is not guaranteed. However, it is important for us that the situation is addressed and action is taken by my clinic to try and improve the situation for the patient. Given this, after reviewing the result at 11.5 months (prior to this thread being updated) I did without reservation offer the patient a top up procedure, free of charge. I understand there is the inconvenience of undergoing a further FUE procedure, however, by waiving the fee we aim to make a gesture of good faith that we stand by all patients that we operate on.
In relation to the pictures the patient has posted on this thread, when I saw the result in person at 11.5 months post op it did not look as ‘sparse’ as some of the pictures (especially when the hair is parted). It is well recognised that hair transplant is the illusion of creating density and if one is able to grow and style their hair to cover the scalp then that is success, in my opinion. No hair transplant can achieve and re-establish native (non DHT affected) hair density. Having said that as mentioned I agree the overall yield is not what I would have liked to have achieved and the reasons for this can be multifactorial including but not limited to unknown biological/physiological factors. In my hands, I have a top up rate of 3 to 5%. I feel this is acceptable, I am open and transparent about this. I council patients about this prior to surgery and it is written clearly in my pre-operative consent form which every patient signs before proceeding.
Donor zone management
Donor area management is an imperative aspect of this surgery. I take particular care to try and plan in case of future hair loss or if top up procedures are required in cases such as this. With this patient, I actually advised him not to proceed with the hair transplant given his expectations, family history of hair loss, donor zone characteristics and reluctance to take finasteride. However, I did not refuse him treatment as he signed to say he understood what I explained to him and accepted all the potential outcomes. He was keen to have a fuller frontal forelock in this phase in his life and accepts that later in life with more hair loss he may need to shave his head or look at other non-surgical options.
There have been attempts to quantify the donor capacity and to calculate the extent the donor area can be maximised without it looking over harvested. In my experience, they are of very limited use in practice. The essence of hair transplant is moving hair from a region that is relatively DHT resistant to an area where there is hair thinning or loss. The hair follicles excised in the donor zone of course do not grow back, so in particularly larger hair transplant sessions I would advise all patients if the hair is cropped short in the donor zone they will MOST LIKELY HAVE EVIDENCE OF SCARRING AND THE APPEARANCE WILL BE LESS DENSE.
When the hair is grown out in the donor zone it looks more uniform and any evidence of surgery is more likely to be concealed, but this is only after the donor zone hair reaches a certain length. There are many examples on this very platform where patients have been to experienced surgeons for large sessions and in the donor zone (when the hair is cropped shorter) the graft excision points are clearly visible – Melvin is a classic example of this from having previously seen his donor area.
I understand that some people are strongly averse to their donor zone looking any different at all after hair transplant (even when the hair is cropped short) and to those people my advice is DO NOT HAVE A HAIR TRANSPLANT or at the very least keep the number of grafts transplanted to an absolute minimum. This in my opinion even applies to patients with above average donor density as the overall appearance of the donor zone does not always correlate with quantification methods especially when the donor zone is trimmed short. Factors such as hair to skin colour contrast, hair calibre/character, the angle of hair take-off from the scalp and the manner in which the donor hair is trimmed (scissors cut with layering Vs bad buzz cut) can all influence the appearance of the donor zone.
Sometimes the issue is confounded when I have patients that undergo large mega sessions and are actually able to crop their hair very short in the donor zone (or even shave it into a ‘fade’) without noticeable evidence of surgery – but this is an exception NOT the norm. Everyone’s healing and scarring physiology is of course different. Whenever the dermis is breached there will be scarring and subdermal changes caused by the healing/repair process.
Plan going forward
I have advised this patient that I feel a top up procedure can achieve his goals and that he would need to wear his hair longer in the donor zone, I also informed him that SMP in the donor zone is possibly an option if he wants to crop the hair in the future. I hope he takes up this offer as I am keen to see him with a good result that is more reflective of the work that we consistently produce.