washingtondc

No, not recently. Still deciding how to move forward.

Well I've crossed the year mark. No increase in density or improvement in appearance or anything in the recipient zone since February or so... obviously. No change. What has happened, starting since perhaps April or May, is (what I'm really hopeful and somewhat confident) is a recurrence of the telogen effluvium I experienced shortly before and after my first procedure (from March 2021 to maybe around the end of the year). There's been a bunch of what seems to be diffuse shedding on the entire top of my scalp, and seemingly the sides as well (outside the region that's traditionally affected by DHT) in a period of just maybe 2 or 3 months. My actual MPB loss to this point has been veeeerrrrryyyy gradual over more than a decade, mainly from the front working its way backward, and this seems very different from that. (Fingers crossed; this would be the equivalent of like... a grenade going off out of nowhere in a campfire that's been burning for a very long time if it's actually AGA). This happened before, as mentioned, and everything did seem to recover months down the road, in addition to any transplant shock loss coming back in. My overall scalp (minus the hairline recipient zone of course) was at a density that was good in April; now just 3 months later there's a ton of diffuse loss that allows me to see the scalp in the middle of my head in lighting from some angles. From everything I understand about MPB, the mechanism is a very gradual loss, with the follicles being attacked by DHT, shrinking, dropping a hair as normal, the next hair coming in slightly smaller, over and over until the last miniscule hair falls and the follicle is totally dead. Not a sudden mass exodus over a couple of months that's diffuse across the top and sides of the scalp. My current theory is that this is (hopefully) an "echo" of my previous telogen effluvium. I experienced a traumatic trigger which pushed an extremely high percentage of hairs that had been in anagen prematurely into telogen. All of those hairs, all over the scalp (enough to make me absolutely freak out at the time) fell out in a period of a few months. They came back in, but now, a little over two years later, because they all came back into anagen in the same artificially-condensed timeframe, they've all synced onto relatively the same cycle, and are once again mostly all hitting telogen at around the same time. If every single one of your hairs followed the same schedule, we'd all be completely bald for a few months every few years. My thinking is this is hopefully not some Pearl Harbor of AGA, but the "echo" of that incident that pushed a large percentage to telogen all at once. This has been (unsurprisingly) extremely discouraging to experience. At this point in time I'm not going to post photos because my hope and thought is that this is something unrelated to my procedures, and photos showing the state of things regressing would be unfair if that's the case. It's kind of funny in a sick way; I spent the early months of this year trying to make peace with the fact that my hairline was just going to look weird, and that I wasn't going to do any more procedures right now, and I was really pretty close to accepting that as a plan by the time it was April. Then, just about the moment I made peace with things, it all fell apart in a seemingly completely different way. I won't know until probably the end of 2023 what the actual situation is (to give enough time for things to recover), which I feel like means it would be a bad idea to consult with anyone on a procedure now, as the current state of things is up in the air. When I spent months researching on this site and elsewhere prior to the first procedure, I felt very confident the odds were good that it would be a significant problem eliminated from my daily life about a year later. It's crazy to me that I'm in the back half of 2023 and still right in the fray of things. Depending on what actually happens, I may consider another procedure. I wish I could get the ball rolling now, but it just feels risky to do a consult in a time when I'm unsure what's going on. Tagging people who asked, @Rolo @stephcurry30 @Melvin- Moderator @BaldingEye

Well here I am, at 8 months. These pictures are in softer lighting than the last set I took, which was 6 months. I also used a fine-toothed comb before taking them to distribute the strands as evenly as possible. I will say again that the HDR or whatever on my phone does increase the contrast in photos a little bit beyond what the human eye sees. I also spoke on the phone with Dr. Wesley today. He mentioned the fact that transplants with too much density/a thick band of hair can look bad down the road. He also insisted again that no assessment can be made until the one-year mark, that FUE can take longer to come in than FUT, that the texture may change slightly. I really don't see much difference between this and 6 months, personally. A part of me thinks that maybe just a few staggered rows of a couple hundred grafts a little bit behind the hairline and filling in some gap spots could improve things. He told me that things could perhaps be touched up some, but that I would have to wait for the year mark to assess the result before that decision could be made. I'm considering doing that because starting this whole process over with someone else just sounds so exhausting at this point, and because I've already shaved 6 spots into my head for the second procedure, and I'm really not sure I can do that again and still successfully have my hair cover the spots and not look weirdly thin in the back volume-wise. I want to trust people telling me to wait but I also kind of feel like this doing that:

You can hash it over. I don't really have any wisdom to impart I don't think, it's really up to what the clinic does, in my limited experience. A part of me thinks a good portion of the situation can be remedied with some relatively small changes, so I'm going to try to see what my options are.

Yeah you can private message me but I haven't talked to the clinic or anything yet so I'm not going to have much insight beyond what I've posted here. I also am quite sure there's not going to be any significant progress for the last 5-6 months because there wasn't last time, and there are no visible bits of stubble at this point; all hairs that have sprouted now have some length. Thanks for this unbiased assessment. Unfortunately, I *did* take my time doing research for the clinic, and I *didn't* agree to 400 grafts. I don't remember ever being told the number of grafts (though if I had been I probably would have agreed, as I'm not a surgeon who does this for a living). I was just told that the problem would be addressed, and when I tried to get an idea of where the density would be after the second procedure I was told that grafts would be added where they were needed to make it look good aesthetically and that density would increase "50-70% in areas." The whole situation is just so disheartening. I guess I'm going to contact the clinic and let them know how things have turned out for the second time (if people think that's worthwhile). I'm not even entirely sure what I might stand to gain from that but I guess it makes sense as a first step.

@Rolo @ALittelTeal @ALittelTeal you could try tagging the clinic or something, no clue if they'd see it or respond here or not.

Apologies for the delay. In truth I kind of put off checking the 6-month update point to avoid having to come to terms with where the situation stood. Minimal change. I want to make sure I'm being unbiased and fair. I'm going to post photos in a variety of lighting. It would be helpful if anyone/everyone could chime in and say whether you think this is what an HT from a world-class surgeon is supposed to/expected to look like 18 months after the first procedure and 6 months after a second to improve density. Bathroom mirror: Strong overhead lighting: Backlit: Frontlit: Dark room: Sitting at work: Different bathroom mirror: Maybe I have unrealistic expectations? Maybe I take pictures in a way that's more revealing than most people? I don't know. I just want to make sure I'm being fair in my assessment before I decide what to do next. If you're reading this, please let me know if you think this is how one should expect things to look. Thank you.

Even if I had the money, don't people always insist you wait a full year to not interfere with the current results?

I don't have the money to do this again. I don't have the time to wait another 18 months to get to where I thought I was going to be 5 months ago. I don't have the space on the back of my head to shave more spots without having to cut 4 years' worth of hair growth. This is so soul-crushing. I did a lot of research and thought I was setting myself up for a great result. I cannot believe things are where they are after not one, but two procedures. How can this have happened

What's the sea salt spray? I personally don't really like the idea of using fibers or that sort of thing to mask stuff, it feels slightly dishonest/a misrepresentation to anyone who doesn't know the truth to me (that's just my own personal opinion and probably stupid, no shade to anyone who uses them). The idea of paying thousands and thousands of dollars to rectify things was kind of ideally to not need to be buying and using products for the rest of my life to hide reality... haha. I never needed them before the procedure.

Five months. Not very optimistic, despite the fact that this is my second procedure... There was a small bit of improvement for months 4-5. For my first procedure, there wasn't really any significant change after the 6 month mark, so I think it's likely I really only have about a month of anything much changing left. The grafts that are short stubs are few and far between now, most of the grafts that were added seem to have a decent bit of length. There just aren't very many of them. The front improved minorly, but is still this transparent, and this is in just about ideal lighting: The left side didn't change much. Still the better of the two sides, but not at a density that looks normal a lot of the time: Right side still looks kind of ruler-esque: The main issue at this point is that I still can't put the hair into *any* sort of arrangement that looks natural. No matter how I move it/which direction it goes/what I try to hide, there's always something relatively glaring that jumps out as looking strange. The best I can do is to try to cover the right side, but then the front looks quite weird, like this: There's just not enough hair and I really think, somehow, once again, not enough grafts were added. I don't understand how 500 was viewed as something that would be sufficient. This is the current amount of empty space in the recipient zone: This is how things look when lighting comes from overhead, which is most of the world: People will say "this is only 5 months" but I literally just did this once already, and not much changed after 6 months. Pretty demoralized and would need a miracle at this point. I don't know what to do.

Current space between grafts (camera actually thickens the hair caliber wider than reality in this one; they're thinner):

Lol yeah I'm avoiding looking in the mirror. But it's hard to avoid simple math. This is where I ended up at a year last time: And **far fewer** grafts were added this time. It just feels like it's easy to see what's going to happen again and I don't get why/how so few would be viewed as something that would fix things. I have no doubt things will be improved *some* obviously. I don't know. It's just not a good feeling. I only let it into mind once a month for updates, but the deja vu just feels like it's on the horizon.

4 months. Center: Left: Right: Maybe a tiny bit of improvement on the sides? The photo I took of the right last month was kind of wonky, so hard to tell. I haven't really noticed much change/improvement in the front at all yet; if you compare this photo to my Month 1 photo, they're pretty much the same to my eyes. I can see tiny stubs/short hairs in the mix when I get really close, but they're pretty sparse and aren't making much of a visual difference. Months 4/5/6 are when things grew the most after my first one, so it would be really great if things started doing anything significant asap, lol. @asterix0: He never mentioned the density in terms of grafts/square centimeter as far as I can recall. Before this second procedure I attempted to get an idea of how much density we'd be adding, and was told that the density wouldn't be added uniformly but in varying degrees to make it look the best. He said density would be increased by 50-70% "in areas". So I don't really know what number of grafts per cm I actually need for good visual density, to be honest.

Was able to get the camera to cooperate for a closer-up shot for once so figured I'd let people see. You can see both the current discrepancy in density between the thinned out pre-existing hairline region and the new sparse lower hairline region as well as maybe just a couple new tiny hairs poking through (I really wish there were more, lol... thisisfinehouseonfirecomic.jpg.......) Also before it probably gets mentioned yeah I'm fully aware that I have multiple doubles and even at least one thick triple on the absolute edge of the hairline; I don't know how that happens in a scenario where the clinic is referenced here as world-class, I don't know if I'm being unreasonable by wishing they weren't there (the impression I had gotten here at least was that good clinics didn't do this), I'm not sure if it's even worth trying to repair. Anyway there's a 3-month close-up.

Haha man I sure hope, it's been 15 months now.

3 months. These somehow look worse than last month, lolllll. If you open the ones from September and compare side by side, more empty space in these for sure. Front: Left side: Right side: There are a decent number of tiny stubs at this point, and a few longer new ones. Last time, all the new hairs hair had pushed out by around 6 months I think, because it didn't seem like there was much change after that. Not there yet obviously, but halfway. Months 4-6 is when things grew the most last time, so fingers still crossed as hard as humanly possible haha.

Not at 3 months yet but wanted to update with some recent pictures that highlight just what needs to happen for things to look natural. This is side-lit (no overhead lighting) inside of a windowed room that's maybe 20 feet inside of the outer layer of windows (so nowhere near the actual sunlight): It's kind of mind-boggling in a way to me how the first procedure was ever sold as something that was going to be a full result. Even with a bit of stubble starting from the second procedure and no overhead lighting, the hairline looks kind of strange and it's extremely easy to see the line where my previous, thinned hairline originally was. Side-lit again: The front-right portion looks kind of like a pencil-drawn arc or something. In more overhead-lighting, though still at an angle: Just so much empty space. I almost want to joke that if I didn't know better, I must have asked "I want to lower the hairline just a smidge but look equally or more like I'm balding" lol. I know that there's barely anything from the second procedure contributing yet but I just really don't know that the judgement that fewer than 500 grafts would be sufficient to fix this was correct. There's just so far to go/so much to fill... Keeping holding out hope though, for the second time.

Updating for 2 months. No crazy change or anything, as to be expected. When I look super close up in the mirror, I can see the beginnings of some hairs just starting to pop out, but hard to photograph with a phone. Also realizing that how it looks in photos is kinda dependent on how greasy and reflective my noggin is heh, will try to start doing photos at the same time interval after I've showered/without having gone to the gym lol. Front: Left side: Right side: It's still surprising to me how unnatural (comparatively) the right side looks as opposed to the left. In these phone photos here it doesn't seem that big a difference, but in real life, left side looks pretty believable in low/side lighting, but right side looks almost like someone took a pencil and drew a bunch of straight lines, heh. How left looks without overhead lighting: How right looks without overhead lighting: In this second procedure it seemed like way more grafts were added to the right side than the left, so maybe that will help correct things, but I'm not sure. At this stage to my eye it seems like the actual very edge of the hairline itself is contributing to how it looks, and I'm not sure if adding stuff behind that will change that visually. Maybe it will, I'm no expert. Early days for this revision still.

Well, we can probably math this I guess. This was the breakdown of graft numbers: Singles - 31 Doubles - 474 Triples - 34 For 1081 hairs total. From this intra-op photo, I count about 57 spots for grafts that were used to repair the enlarged scar in the back. I'd have to assume that no singles were used back there and it probably made the most sense to use all the triples in the back rather than close to the hairline, so that would mean 34 triples went back there and 23 doubles, for 148 hairs total. This would mean that 482 grafts, and potentially 933 hairs went to adding density to the front region. Think that's enough? Edit: Looking at it more, it might even be like... 3/4ths of the frontal grafts that were used on the right side (left in photos). I definitely want to improve how natural the right looks, but the left needs more density too... Just kind of a shocking disparity.

Looking at those intra-op photos closely for the first time, it's kind of crazy to me just how heavily grafts were added to the right side vs the left. If you drew a line down the middle, I feel like probably more than 2/3 of the grafts were used on the right side of the line (left side from photo's perspective). Hopefully that doesn't result in the left looking strange compared to the right 😅

I realized I hadn't posted the photos I received that were intra-operative: Given these, and the pretty fine caliber size of my hair, do people think this will hopefully resolve the situation? The main thing I'm hoping for is to improve the density so the front looks thicker/non-see-through and also to make the right side look more natural.

This is one month after a second procedure to add density to the first.

Wanted to update as I'm now at over a month. No improvement obviously, maybe a little bit of regression from shock loss; I kind of forgot having to do a second procedure would also mean a second round of that. Normal front: Left side: Right side, very straight-liney/unnatural currently: Front with hair loose, virtually see-through in frontal/above lighting: The apprehension that ~475 grafts still wasn't enough to do what actually needed to be done is definitely there; there's just so much space in those gaps. But there's not much going on at one month aside from shock loss, so wasn't expecting any change here anyway.

Thanks, I really hope so. I've been out and about a lot more recently which is nice pandemic-wise but also has really thrown into focus the fact that even environments I thought it looked good in actually really are kind of rough. More photos of what I'm trying to fix, in a room with the lights off on an overcast day, about 6 feet away from the window: This is actually a case where the camera makes it look better than in person for once, it's a little more glaring in real life. The hairline from that diagonal angle just looks kind of pluggy to me, and the front obviously looks like balding because you can see straight to scalp, even in this low-ish lighting. I'm thinking/hoping that front shot will be fixed once this one grows in (that was kind of the whole point at least...). The right side hairline I'm more worried about. We added grafts behind the hairline (and a lot on that right side) but I don't know enough about this to know if that will actually eliminate the semi-barcode type vibe that's going on on that side (again, it's more blatant seen with eyes). Fingers couldn't be more crossed.