washingtondc

Today is 13 days post-op. Yesterday I went back to the office to have the glue in the back wide-scar area removed, and the grafts back there seem to have done fine fortunately. I probably won't fully know how natural that area actually looks until whenever I cut my hair short again; the grafts back there look maybe barely not quite as dense as the native hair, but hopefully that won't matter, and the back is way less important to me than the front. The front is doing its thing, I'm not sure it's really possible to closely monitor the early progress there because it's all mixed in with the previous hairs. From what I could feel in the first days via stubble, it seems like most of the grafts were added to the right side and center, with less on the left. I've been at my office all this week and I'm really hoping sufficient density was added, cause any overhead lighting just cuts right through it to the scalp currently. Recovery from this procedure was far easier than the first one, I didn't have to deal with a suture area bleeding/scabbing at all and there was virtually no facial swelling. Far fewer grafts were added as well which made things easier on the recipient region. I just hope it was enough.

PMed with some questions and info.

Also @Melvin- Moderator (or anyone else who's a mod, not sure if there is anyone else) I haven't seen how to edit the thread title to add a note about the second procedure (Long-hair FUE, 539 grafts, 7/14/22) since it's all going into one thread, but maybe it will let you?

Since a couple of people have asked: No, he didn't really comment on or discuss why the density at the front wound up the way it did after the first procedure. Things are always done very quickly/efficiently in the office and conversation was directed right off the bat towards what was going to be done for this procedure to improve things.

Hi all, thanks for the positivity. My round two procedure was two days ago, and went pretty well. I wanted to update with final pre-op photos before I get into where things are now. These are from the night before the second procedure. That's in bathroom lighting. The initial reason for this second procedure was to repair the gapped portion of scar that was unable to be sutured back together normally after the first (FUT) procedure. That area has been healing over the course of the year and essentially just looks like a widened portion of the scar now, like this: Zoomed out shot for better scale. It's not too big, but still a somewhat significant gap in terms of a spot with no hair growing (to the right edge of this picture): So the idea for this second procedure was to fill this gap area in the back with grafts, and also add density to the front to eliminate the areas from the first procedure that are see-through to the scalp. All of my scalp laxity was used up in the first procedure, so that meant that this one had to be a long-hair FUE. That entails shaving some spots on the back/sides of the head to harvest grafts from, filling the circular portion of the existing scar with grafts, covering those grafts with a special glue to make sure they stay in place, and then using the remaining grafts to address the density in the front. This procedure itself was shorter and easier. I got there at noon, had a lower level of sedation than the previous one, and it took about 4 hours in total. Procedure itself was quite easy and close to painless. Photos of the portion of scalp that had to be shaved to harvest grafts: It's tough to have to shave spots into ~3 years of growth like this, but it's the only way to do this second procedure to touch things up. Many surgeons require the entire head shaved, which is why I went with Dr. Wesley in the first place, because that's not a requirement at his office. The patches are situated in spots that make it so they aren't visible unless the hair is moved around. Shaving that much out definitely reduced the total volume of hair coming off of my head in a not-insignificant way, and it will be probably 2 years or so from now until those portions are back to looking relatively close to how they were, but this was my only course of action. Needing a second procedure and having no more scalp laxity left this as the only way forward. It will be slightly strange for a year probably, and then less noticeable to me for the second year, and then gradually back to how it was, hopefully. The whole idea here is improving things for the long term, and I'm totally confident I'll feel it was the right decision a few years down the road. The total number of grafts harvested was 539, overwhelmingly doubles: Singles - 31 Doubles - 474 Triples - 34 That comes out to 1081 total hairs by my math. Dr. Wesley mentioned that the scar gap portion had healed a little better over this past year than he had hoped, meaning it was smaller in size than he was thinking it would be, and would require fewer grafts to repair. I forget offhand how many exactly were needed to repair the scar portion, I think it was 65-85 but will try to get the exact number. This left the remainder (450-475) to be used to address the front density. They were placed primarily in an arch shape in the region where my hairline had been lowered in the initial procedure, just behind the hairline to hopefully fill in that swath of lesser density. It's kind of hard to see the graft placement because they all went into areas of existing hair, but these are photos from the day after the procedure: A plus to having all the grafts placed where there's already hair is that the scabbing/redness is better hidden, but I'll also highlight the fact that the scabbing is really very minimal in general, those photos look pretty amazing to me for being literally the day after the procedure. I'd bet I'll be able to be out in public with absolutely no one the wiser as soon as I hit about 10 days in when I'm able to fully wash all of my hair normally, the scabbing is so minimal and it seems like many of the grafts even have no scab at all. I came home yesterday after my morning-after follow-up to remove bandages and check on things. After my initial procedure last year, my hair had been a little bit tangled and knotted in a few places, and it took some work and some trimming some knots out to fix, which was understandable as my hair is long and can tangle easily. This time, it was far worse. Like, not just knots, somehow so tangled near the bottom that it formed essentially a solid mass. I'm still trying to envision how it even would have happened to the extent that it did, it took hours with multiple people with conditioner/oils/tools/scissors to try to fix it at all, and in the end, most had to be cut off. I'm grateful that it's even possible to do an HT procedure with long hair, but it was a little demoralizing to have to chop off even more hair on top of what was actually necessary. In terms of the density in the front, it's hard to tell as always at this early stage, but it looks far better to me with these added grafts. I definitely don't have the same sense of "This looks significantly less dense than the pre-existing hair behind it" like I did after the first go-round. The stubs are kind of acting like SMP at the moment before they fall out, making the overall scalp seem darker, and I'm quite optimistic that once they grow back and longer they'll be at a density that looks natural and full. I logged in today to see a couple people estimating I'd need 7-800 grafts to correctly fill in the front; in reality I added 450-475, so I'm hoping and trusting there's a reason you guys have whatever job you actually have and aren't experts or HT surgeons and what I have is enough, lol. Final set of pictures from this morning, two days post-op, after my first (very careful) soak/wash: Crazy how little scabbing there is. I'll update this periodically, though since all of the hair is going to be growing in places where there's already hair, I have a feeling the results are going to be a little harder to see on a gradual basis as they would if the hair was growing in unoccupied space. It will probably just get gradually darker/fuller looking, I'd think.

Haha if you were thinking a second procedure was maybe inevitable based off of caliber in pictures, it would have been nice to hear that back when I was initially expressing concern about the density. Honesty/transparency lead to credibility; the opposite, not so much. Just some purely friendly unsolicited advice. Also, I wouldn't fully say I'm not happy. It's an improvement in many ways. It just looks wonky in a lot of situations and to me isn't quite on the level of the appearance of most of the post-op photos I've seen from the office. Regardless, I'm trying to just be positive about the fact that this is possible at all (whether it needs to be done once or twice), and I'm thoroughly optimistic that the second pass is going to leave things great. Edit: I wanted to leave one other thing that I think is worth noting. I think it looks slightly better in person/viewed with eyes than it does in photos. It seems like the camera/software accentuates the gaps in photos beyond how they actually appear to the human eye. If I compare a photo I've just taken to the mirror, what's in the mirror looks better to me. So in truth I'd say it looks slightly better than the photos indicate, just figured that was worth tossing out there.

Thanks. Yes, the way Dr. Wesley initially described it to me, he'll have to shave a number of spots the size of a finger/thumb, and the grafts will come from there. I sent an email a while back asking if he could do a greater number of smaller spots to limit the total impact, and the office responded in a way that made it seem like he was on board with that plan. Since my hair is long, I don't think they'll be visible or anything, but it's obviously going to affect the actual volume of hair and is the sort of thing where the back/sides won't return to a more natural situation compared to everything else until at least like... mid 2024 or 2025 or something. Also, to make sure this one-year result is totally represented, I'll also add some photos soon of what it looks like in lower-light situations. As I mentioned, in low lighting, I am happy with how it looks. There are just a few too many common environments right now where it looks strange. Also contributing right now is the fact that these one-year grafts are at a very awkward length compared to the rest of the hair and stick up crazily all over the place, which obviously time should help with. Edit: In a room with the lights off: Inside of my car, in the bottom level of a parking garage:

Updating again as I'm now beyond 11 months, just a few weeks away from a year. Unfortunately, as I was kind of suspecting, those last photos I had posted at month 6/7 were pretty much it in terms of growth. Here are a few pictures from just now. This is in soft, diffused light coming from above, but not very close, or even directly overhead or anything. Very standard lighting for life. I wish I could say this is what I had fully envisioned for one year haha. It seemed kind of clear immediately following the surgery that the hairline density was going to wind up as sort of a see-through/awkward strip compared to my existing hair. I appreciate the people who didn't just bat away my assessment with "you don't know what you're talking about, wait for a year" and who were actually honest and straight with me. That said, in low light conditions and at night, it looks very good. I'm just not nocturnal haha. My hairline is obviously a little lower than it was, which was the goal; it just looks... strange in a lot of very common environments. The good news is that Dr. Wesley is doing a touch-up procedure to repair the scar from my original donor and to add density to the front. I will have to shave portions of the hair I've been growing for three-plus years to do it (it's a long-hair FUE since all my scalp laxity was used up in the first procedure), which I was really, really hoping to not have to do, but I just don't have any other options at this point. I'm hoping he can at least distribute the shaved patches so they're as numerous and small as possible to minimize the size of bald spots on the back of my head. The procedure is July 14th. I was really hoping to not have to do this whole process of healing and hiding more than once, but maybe I should just be grateful that it's possible at all. Things can't always go the way you'd choose. I'm thoroughly optimistic that this second procedure is going to add density to a good level and result in an appearance that's natural both now and down the road. I have faith in Dr. Wesley and expect that I'll be over the moon this time next year. Im not sure what protocol is, should I just continue this thread for the second procedure? Or should I start a new one? Thanks again to this community for your knowledge and guidance.

I wanted to pop in to update (no photos this time but will post soon). Things have improved marginally since my last photos (mostly maybe I think just due to hairs getting longer and creating increased shadow on the scalp?) but not in a crazy-significant way or anything. In some lighting, I'm incredibly happy with how I look, but in many environments, like being at work or even just in stores or that sort of thing, I realize what things actually look like. I become aware of when a light source is overhead and futilely try to move to somewhere where it's not overhead, haha. I have a follow-up procedure scheduled for July to repair the scarred area in the back and to add a bit of density to the front. I'm optimistic that this second one is going to put things in a place that earns a huge thumbs up.

Glad yours seems to be turning out how you'd hoped.

Hopefully... I'm not made out of donor grafts either though lol, that's a truly finite resource... And I can't do another FUT because this strip was already too wide to heal normally... And I'll be destroyed if shaving my head is a requirement to fix things... To the second question, I hadn't talked with him in months, figuring any response was likely to be "you need to wait for 12 months and things will be great" (or that sort of sentiment, which does often hold true), but when I realized yesterday there was virtually no change from months 6 to 7 that I could see, I did email the office.

Sigh... I'm not made out of money

Yeah, I've had this thought too honestly, good point.

I haven't had the scar area repaired yet, it didn't seem like the best idea to head into NYC during the delta/omicron waves, but now that that's significantly waned, maybe it's time. I just took a walk around the office as there's hardly anyone here today, checking it in lots of spots, and I'm not sure I realized the full extent of just how often it looks like it does in the 6 month pictures. At this point it really gives more a visual impression of "balding" than it did pre-procedure, in maybe half of all environments. I was doing a decent job telling myself that I'm only slightly over halfway through the process, but with virtually no change from month 6 to 7, it's hard to not get concerned some again. Has anyone had months where no growth has happened partway through, followed by significant new hairs sprouting afterward?

Sorry for the delay, these are the pictures from the 7 month mark... Again, this is with fairly standard front lighting that's a bit above eye level. I'd be lying if I said I wasn't feeling a little apprehensive at this point. There doesn't really seem to be much discernable difference between this and the previous month's photos... Is anyone ever done growing at the 6 month mark? Things definitely need to thicken up a lot more to not look strange in a lot of environments...

@Rolo @Melvin- Moderator @JC71 Hi all, sorry for the delay, been busy and preoccupied with things. I took pictures at the 6 month mark but hadn't posted them yet. In short: Things are still progressing, but definitely not close to where they need to be yet. In extremely dim lighting and the dark, the recipient area looks pretty natural. As we all know though, life has lighting haha, and there's still a lot of progress needed in environments with light. This is front-lit with relatively soft lighting: Obviously still a very significant/apparent difference in the recipient zone compared to my pre-existing, already thinned hair. The left side (this is mirrored) is beginning to approach a consistency that could be believable, but isn't there yet. The right side looks stranger and more sparse, easy to see the defined line between previous hairline and the recipient zone. Adding a shot of the current recipient zone density, significant empty space at this 6 month mark. Here's a shot laying in bed with dim lamp lighting. Above is sitting in normal lighting at my desk at work. And finally, sitting at home on my couch in my living room. As mentioned, when it's dark, it looks believable... but people don't live their lives in the dark haha. It's funny, in most lighting right now I actually look *more* like I'm balding than I did before the procedure (in a way). Pre-procedure my hairline was obviously higher, but the hair at the hairline was less thin than the recipient zone is now. Currently, with the recipient zone so sparse, it gives a visual sense of "balding"/"thinning" more immediately than before. I'm doing my absolute best to try to keep positive about this and remind myself that though 6 months is an important milestone, there is hopefully still a long way to go. I'm no expert but I would think the hairline area needs to close to double in density to look more natural in most lighting. I'm not sure I'm going to get there. I sure hope so. Again, this is only 6 months so I have to keep waiting for full results, as I'm well aware.

Here's where things are in standard overhead lighting found in an office/home/etc. at this point:

Five months. Continued growth. In super-low light situations, I can almost envision what it will look like aesthetically when complete. Still a long way to go density-wise obviously, but getting better little by little.

One third of the way there. Four months. Recipient hairs are getting a little longer and more numerous. Obviously nowhere close to the density they'd need to be to look natural, but that's why this takes time I guess. I feel like shock loss in the recipient zone has continued to this point; portions of pre-existing hair definitely seem more transparent, but again, this is just the four month mark.

Thanks for the responses you guys, I appreciate it.

At what point on the timeline is shock loss usually complete?

One quarter of the way there, three months. Still not much going on really, as expected. A couple grafts that have hung around are getting longer.

One sixth of the way there. This is just about two months post-op. Some of the grafts that haven't shed yet are starting to get a little bit of length, it would be cool if those wound up not falling out and starting over, but who knows I guess. Still a tiny bit of redness, hoping that finishes fading sometime soon.

So it seems like the redness is actually now starting to increase rather than go away? First picture from less than a week ago, second picture from last night (taken at same time/skin condition, it's also actually more red than the camera indicates): Is that normal? Not sure I've read about redness reversing and starting to increase for people before. The clinic mentioned I might see an ingrown hair or two at this stage but I don't remember anything about general skin redness regressing. Edit: Also, damn, just realizing that it looks like that frontmost middle portion of existing hair may have been hit significantly in the 4 days between with shock loss... Wondering about the redness increase though.

Actually @UnbaldEagle... out of curiosity, I see you had a transplant some months ago. Did you use stemoxydine religiously during the growth period to this point?