FormerFutureKrillin

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2 month update - no photos of the scar this time as all implanted hairs shed a little bit after my last update.

Here are some photos at 1 month post removal. Redness continues to fade and some hairs are growing back (I think there are less grafts still there than it looks in the photos). Some of the ridging/cobblestoning/skin damage from my previous surgery is definitely more evident in certain light conditions - as Dr. Bisanga wisely noted I am in agreement I will probably need some laser resurfacing and/or professional micro needling sessions to help with that, although in normal to bright light the bumpiness is harder to see. Front Scar:

My guess is that it is because in strip you can’t cherry-pick the right number of singles vs multis like FUE, so if your strip had too many 1 hair grafts you would need to combine some of them to make some multis or else it wouldn’t look as good. I’m not a doctor so I don’t really know 100% on either point but I agree intuitively it seems less than ideal from a survivability perspective.

This is confusing the issue - they are saying they often place two, separate, 1-hair grafts into a single channel to “create” a double (or perhaps a 1-hair graft with a 2-hair graft to make a triple etc.). So multiple grafts in one incision, which would mean two 1-hair grafts in a single incision would appear to the software as a single graft with 2 hairs. Thus, the software would be undercounting the total grafts that were extracted. The amount of undercounting would depend on how many grafts were combined this way. This is all the more reason the graft breakdown should be provided asap. The graft breakdown would likely go a long way in clearing this up, which is why it’s so odd it hasn’t been provided. The longer it isn’t provided, the more it seems like Dr. Bloxham just doesn’t have it. For what it’s worth, my graft breakdown from my surgery with Bloxham was also never provided to me, but in fairness, I didn’t ever ask. I would be interested to see if other Bloxham patients on the forum were ever provided with that information.

@bluebird00 the above is where you are off course mathematically. This is by no means a safe assumption as your methodology is not correct. No one has a completely homogenous donor, and you cannot extrapolate your average donor density from a single square centimeter measurement in the thickest part of your donor. It is extremely common for density to drop or vary around the occipital areas (above the ears) without any “visible patchiness”. As an anecdotal example, my donor density is ~30 FU/sq cm lower in certain areas of my donor than it is in the same area in my head that you measured! That is a crazy difference and I have no visible patchiness. It is only detectible by detailed measurements of my donor area at many points. A density difference throughout your donor could either explain or refute the stated graft count. There are plenty of doctors who can give a professional assessment of your donor density at different points. If you insist on taking the measurements yourself, at the very least you need to measure more than just 1 square cm and in more positions to arrive at a “safe” assumption of your average donor density. It will be very hard to do yourself and the more measurements taken the better, as the reality is your donor density likely gradually changes throughout different positions. You absolutely have legitimate questions and concerns that should be answered by the doctor, and in my personal opinion the official response here was not sufficient at all to address your legitimate concerns. There is indeed basic information still missing (e.g., what was your graft breakdown in 1s, 2s, 3s etc). But you are losing legitimacy by claiming strongly that you had over 5,000 grafts extracted based on the faulty assumption above. And just to nip this in the bud, literally no part of me wants to be defending this doctor (just check my post history…), but the point above stands.

Think he agreed an explanation from the doctor would clear this up. As was mentioned earlier, there should be a breakdown of the types of FUs (1s, 2s, 3s, 4s) easily available which would probably help put this to bed - its surprising that information hasn’t been provided to OP.

For what it’s worth, I was able to track down the reddit post you referenced earlier about the techs - that post described my experience to a T (right down to the painful last bit of the procedure). In hindsight, I have come to strongly suspect that the techs that were staffed on my surgery day were rushing to finish my surgery as fast as possible for whatever reason. My surgery was finished extremely quickly for its size (a tech even said as much as they went out the door when I was finished), which I think contributed to some of my issues. I still believe Dr. Bloxham is a good and ethical doctor. But there are more people involved in the surgery than just him, and he’s ultimately responsible for the team. From my research, I agree with the two posts above that my case appears to be an outlier in terms of the result, so I guess weight my opinion accordingly however you want. But in my opinion the mistakes that were made in my case were extremely egregious - mistakes that fly in the face of Bloxham’s own HT philosophy stated on his YouTube channel.

Haven’t put anything on the books yet for next steps, but I’ve heard usually between 8-12 weeks is the minimum spacing for removal sessions. I’m guessing there could be some variance in my case given I already had a lot of scarring on one side of hairline prior to the punches, but we will see. Assuming I need another round of punchouts (would agree that it seems probable, and was definitely prepared for that), I’d prefer to get it done as soon as I can feasibly get it done.

Here are some photos from Day 11 - scabs are gone from the implanted grafts. Redness is fading gradually from the area of removal. For anyone curious of the cosmetic effect of the removal of 306 grafts on my frontal line, I’ve posted some photos with my hair down below. IMO, no one other than me (or perhaps some people on this forum) would notice a cosmetic difference at this stage. This makes me feel very validated in my decision and my overall feelings about the prior surgery, and is a bit crazy to think about how so many grafts were essentially not accomplishing much cosmetically.

Today is Day 7 - here are some photos: Scar left side: Scar right side:

Thanks for the post and encouragement. I am sorry that you had to be in a similar situation, it certainly was not easy for me to make the decision to go down this path and I’m sure it was the same with you. Hope everything with the 2nd step goes well, and I’m sure it will given you went to Dr. Konior.

Sure - I’m now at Day 5. The redness is already fading and some remaining hairs are sprouting back through. I’ll try to get a pic of the scar grafts soon, for now it is a bit tricky as I have very long hair and don’t want to rip the grafts out or damage them manipulating my hair too much.

The bottom line is that Dr. Bisanga's assessment and strategy resonated with me and I trust him completely given my in person consultation, his previous results and his experience in repairs of this type. My feelings on my previous procedure, my concerns about a future surgery and a summary of my last interaction with Dr. Bloxham (and my feelings on that interaction) are well documented in my previous thread. Sorry if that feels like deflection, but I really don't want this thread to devolve into drama or mulling on the previous surgery. If you have specific questions feel free to PM me. As for FUE vs. FUT, that is just my personal choice having gone through the FUT recovery. At the time of my first surgery, I thought FUT was right for me given I was young in HT terms, had fairly progressed hair loss (nearly total loss in frontal third, crown starting to thin at young age) and one grandfather who was NW 7. However, being unable to lift weights/stay out of the gym took a large toll on my mental and physical health. I avoided weightlifting for nearly 5-6 months (longer than Dr. Bloxham's restriction of 10 days), and my scar still stretched / is very wide. I really did not want to go through that again if I could avoid it. I also felt another FUT carried a high risk of leaving the scar even wider.

Future surgery will be FUE - I am very, very, VERY lucky to have good donor density. This is an extremely fortunate break, as I think it’s fair to say the vast majority of repair patients also have depleted donor adding to the complication of the repair. My donor density means we’ll likely be able to do some temple point work in the repair surgery. Given how wide my scar ended up from one strip (could easily end up wider or stretch from more strips) and my personal recovery process generally, I wanted to avoid another FUT surgery unless my donor would not permit. I wanted the removed grafts placed in the strip scar because it meant less shaving for the surgery and also I would like to be able to go slightly lower on the buzzer. As you see, 306 grafts is not enough to fill the full scar. I may throw some more into it in the full surgery to help conceal it more.

Exactly this. In my case, the only additional complication is that it was evident prior to the removal session that I would likely need laser resurfacing and/or professional microneedling due to ridging/cobblestoning and generally some fairly large areas of scarring on one side of my hairline. I am still crossing my fingers that once this heals up, it may not be all that noticeable - nevertheless, the goal here was certainly to minimize any further visible scarring.

Hi all! As promised, I am back to document the next steps in my HT journey with Dr. Bisanga. This thread is for what I am calling “Stage I” covering the removal of grafts, the first session of which was yesterday. Stage II will be a repair surgery rebuilding the hairline/temple points/frontal third, similar to the strategy for a couple other posters on this forum. The goal of this surgery was to remove as many grafts as possible in the frontal line and high temple areas within the first half centimeter, with particular emphasis on chunky multi-grafts or misangled grafts. Dr. Bisanga was able to remove 306 grafts during this session. I may need an additional removal session(s) depending on how things are looking. All removed grafts were reimplanted in the strip scar. Surgery itself was uneventful and was completed over the course of a 3-4 hours. No real pain during the procedure and any time I started to feel anything the team was very good about responding with more anesthetic. As many users have pointed out, the pre/post (and during) surgery care, communication and attentiveness of the BHR team is world class and really does help reduce the anxiety of the entire process. I hope this thread and my eventual repair can be helpful reference points to others in this situation or considering this situation or more generally for those researching. However, I would really like to keep this thread focused on this surgery (and the go-forward repair), not on the previous surgery - I have a separate thread for my original surgery. Photos below: This side is harder to see (my hair is falling over half of the scar), but the implantation area was similar to the other side.

A few points: 1. I have chosen relatively favorable pictures throughout my posts in an effort of fairness given HTs are, after all, an illusion of density. However, I could easily take pictures to illustrate problems. Or, I could just style my hair the opposite way and you would be able to see how weak and unnatural the other side looks (which is a problem generally). 2. If you don’t see the problem with the scar, then I don’t know what to say. Maybe I am unlucky and scar poorly, that is possible. I absolutely have to have my hair scissor cut, I can’t use a buzzer. 3. There are additional big problems not evident by the photos. Those will be very clear next month. Overall sure. I can’t argue that it does look ‘better’ when styled exactly the same way as pre-op. But that is part of the problem - I can’t style it any other way without dumping a can of toppik in my frontal third. And even then, I can only style it carefully in one particular direction to hide the weak side, and the multi-grafts in my hairline still stand out. I’m not confident at all in styling it up and still feel very anxious on windy days. This is all just my personal view and if you would be happy with this, great - but I am not, and I don’t think I’m being unreasonable.

Not much has changed in terms of the overall result or my feelings about it. The scar has stayed about the same as well (~7mm almost all the way around, on one side it thins out fairly well towards the very end near the temple). I will have a more fulsome update next month, which will document my next steps. I have decided to move forward with Dr. Bisanga. Unfortunately my HT journey is going to be much longer than it probably should have been, but I believe I am making the correct decision for my case.

@MikeJohnDaDon how’s it going?

Thanks, all. At my 7.5 month check in, Dr. Bloxham was very optimistic on the overall result at the time and thought the left side would catch up, and said he wanted me to wait until 15 months (instead of 12) before scheduling the second check-in and before he would make a final assessment/discuss next steps in detail. This seemed a little off to me at the time, but I decided it was better to trust but verify so to say. Unfortunately, it did not sit better with me as time went on. As for my personal next steps, I am scheduled to see Dr. Bisanga for an in-person consultation in a few months. This may seem odd for someone who just underwent an FUT, and I don’t want to get too deep into my rationale here beyond what has already been discussed (could probably be it’s own thread), but in short, at this time I believe Dr. Bisanga’s method and philosophy are well-suited/the best for my current case - will obviously have to wait and see what he thinks, though. Will be sure to keep you all updated once my path forward is more clear.

@cloudyhaze I would not worry about the hairline design yet - firstly I don’t find your hairline design quite as sharp, secondly on some patients it can work very well just from viewing many results online and thirdly I would give it time to mature because it is impossible yet to say how it will look grown out (same reason I waited so long to make the assessment). Yes; I know from Dr. B’s videos that his philosophy is to go lower density behind the hairline due to blood flow concerns. I guess my only point is that other doctors have demonstrated it can be done with more density successfully and also the strategy works best if you have a high number of 3-4 multi grafts or thick hair. If you have a bunch of 1-2s, not sure it’s a great strategy but then again maybe that’s just luck of the donor. Re: Multis on hairline - highly, highly doubt this was intentional on Bloxhams part. Can’t imagine intentionally placing dark multi grafts in close proximity (with one directly on the hairline) in such a prominent spot given everything he says about hairline design. It’s just an unusual number of them close to the hairline in a prominent spot. There a 1-2 other multis along my hairline elsewhere (that to me is totally fine/bound to happen), but you can’t pick them up because they are very soft looking. Perhaps these will soften with time as well.

Hi all. Hard to believe it’s now been 12 months. For this update, I’ve decided to go more in depth on my thoughts overall now that it is probably the final result. I’ve tried to wait until 12 months to comment on a lot of this up until now, to be as fair as possible Overall thoughts: It is a clear improvement from pre-op and I think in most conditions looks natural I think (I hope you all agree) that the temple closure looks fairly natural and the angles look good. Lack of growth on the left side. I’m sure this is no surprise to anyone who has followed this thread. While the left side has improved slightly over the last few months, it is clear it is going to fall short (as was fairly clear at 7.5 months, as well). Still unclear what the ultimate cause is, but I have to believe the facts that (a) I had pain on that side of my head during the last 30-45min of the procedure, (b) heavier bleeding on that side and (c) heavy crusting/scabbing on the exact spots that are weakest are all either related or at least all part of the problem. Lack of growth (or lack of implanted grafts) behind the hairline. Haven’t talked about this one as much because it’s harder to see with the hair worn down (which is how I’ve worn it most of the time since surgery), but similar to a couple other Bloxham patients, the area just behind my hairline is very weak. I don’t think this was a lack of growth of implanted grafts, but rather just not enough grafts implanted in the area. This was made worse by the lack of growth along the left temple. Hairline design. I’ve held my tongue on this so far as I wanted to wait until 12 months, but I’m a little disappointed in aspects of the hairline design. Mainly, very sharp angles/macro-irregularities were used, particularly at the front of the hairline leading almost to a defined point. I’ve never had a widows peak nor did I ask for one, and one of the reasons I went to Bloxham is that he tends to do more rounded hairlines almost to a fault. If you look at the pre-op lines, we agreed on a rounded hairline with micro-irregularities. While I fully understand the ultimate hairline is not going to be exactly as drawn, mine appears to have ended up very differently in a way that is atypical. I think it doesn’t look quite right and my old hairline did not have such sharp angles. I think it also works against creating an illusion of density due to my rounded/sloped head shape (the sharp angles allow light through the hair from the sides, which frustratingly actually means the front-facing view looks weaker density-wise than my side profile). It’s unfortunate and I don’t know why this approach was taken. As a side note, there are also multiple closely spaced, prominent multi-grafts right at the front of my hairline right at the center of my forehead. This is a clear mistake and not one I would have expected given the clinic reputation. Overall, given my hair type I would have generally expected my hairline to be a little softer. Scar. The scar is about the same as last update. I think it is wider than I would have expected based on how I typically scar. It’s also unfortunately wide enough on the side of my donor that is lower natural density that I have to keep my hair at a longer length all around to cover it. Haven’t tested it, but I’m doubtful I could go down to a 4 or 5 on the buzzer. I have seen some wiry hairs coming through it recently, so perhaps there is still some shock loss resolving. Overall, I’d say I’m about a 5.5/10 on the result - it’s better than pre-op, but I’m not overly thrilled. Lukewarm is probably the best word. This is particularly the case given how many grafts were used. I am open to any feedback. Thank you. Pictures in all light conditions below: Down, no product, slightly dirty Pulled back, no product, slightly dirty sharp angles: Wet Styled no concealer, indoor Styled no concealer, indoor more favorable lighting styled no concealer, outdoor Scar

Thanks all for the feedback. It’s really good to hear that others think it looks good/natural. I also want to make it clear that I do not deny this is a definite improvement from pre-op, and am well aware that HTs are just an illusion of density. I don’t mean to come off too harsh, BUT: - I guess I expected more (whether that’s right or wrong) from nearly 4,000 grafts, recognizing a good number went to my temples. I would definitely be more satisfied if I could style it “up” without having to rely on so much hair fibers. -As Im sure anyone would be, I’m a little worried that I haven’t been offered any sort of possible explanation. Everything is my conjecture at this point. I’m having a hard time thinking about going back for another procedure without having something plausible offered - otherwise I just think “how will I know this won’t happen again if nothing is done differently?”. It is leaving me questioning “what if” constantly and trying to pinpoint the issue. -I am not as convinced this will be a simple touch up. Everywhere a graft was implanted but didn’t grow there is now scar tissue. Given the high implantation density of the frontal area I’m concerned about this. -I’m certainly not going to rush into anything, but I’m leaning toward getting a second procedure on the frontal third (regardless of whether I go back or somewhere else). I haven’t yet been able to put hair loss behind me so to speak, although im in a better place than before. When I started this journey, I told myself I wanted to go all in, and especially take care of the frontal third by as young an age as I can (that’s the part that really bothers me). - There are some minor things about the hairline design that bother me, nothing anyone else would notice though. I will try to get a pic of the scar soon although it looks about the same.

It’s just the lighting of the photo, it’s not still red (see below). No autoimmune issues. I think it is far more likely to be connected with the heavy scabbing/crusting I had post op that resulted in extremely raw skin when the scabs came off. I think the lack of growth along the frontal band in those spots plus a lower density behind the hairline is what is giving the current appearance. Dr. Bloxham said he had no reason to believe the left side should not grow/catch up at my check in, especially based on the left side. I also think the hair that is growing on the left side is normal/healthy. If there were underlying issues I don’t think that would be the case.