FormerFutureKrillin

On 5/20/2024 at 11:07 PM, baldfighter said:

why did you decide to remove grafts from the frontline? From your previous thread I thought you were mainly unhappy with the density behind the hairline, which could be fixed by adding more grafts there?

I don’t want this thread to derail into dwelling on the first surgery, but this is a fair question and I will say I was unhappy with more than just the lack of density behind the hairline and in my opinion the issues could not be solved just by adding more grafts behind the hairline (as much as I wish that were the case!).

In addition to the issues I noted in my 12 month update in my prior surgery thread, I would say the main problems were: (a) the hairline was too low (it was on my forehead brow wrinkle/muscle - take a look at the photo in my first thread with the surgical lines to see this), (b) there were too many multi grafts in the hairline and since the hairline was too low the only option was to remove them and (c) there were misangled grafts that needed to be removed.

Month 3 update. Skin continues to improve in appearance and I think some hairs are finally starting to sprout through in the scar-recipient area.

Next month I will be undergoing a second removal session with Dr. Bisanga. I will provide continued updates in this thread.

Yes please update @FortunatePatient there are a few of us on the same path as you right now and are very interested in seeing how the repair surgery turned out. Thanks!

Any update? Was looking great at 5 months.

10 hours ago, KUPNIK said:

Hi bro is there anyway to privately contact you am thinking of removing some grafts as well in the beard area with Dr Bisanga in future

Sent you a PM

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:

15 minutes ago, asterix0 said:

Interesting, I didn't know that was possible. Why would a surgeon prefer to do that, intuitively it would seem to compromise graft survivability? 

 

 

 

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. 

5 hours ago, asterix0 said:

Well, there can certainly be more than 1 follicle in a graft, that is the whole point of there being single, double, triple follicles in a graft.

We are talking about grafts though, not hair follicles. 

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.

6 hours ago, bluebird00 said:

As I do not have any patchiness in my donor area, we can safely conclude that my donor density is on average 85 FU/cm² throughout.

 

@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.

13 minutes ago, jjalay said:

How do you know that he had mostly singles on the strips and that he combined singles to add density?This sounds like assumptions to defend the doctor to me. This doctor is recommended in this forum and he should explain this situation publicly in this forum as it is demanded for doctors that are recommended here, otherwise there is no point for patients to present their cases here. Also if another doctor started making slits on the patients head to get training on fue this is definitely not ok.

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.

1 hour ago, Cyzkm said:

Which outcomes are you referring to? to me he seems very knowledgeable and responsive so I’m surprised to see complaints. These were the two negative outcomes I found 
 

(Reddit link removed)

 

 

 

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.

1 hour ago, Berba11 said:

Things are healing up nicely. How long do you have to wait before your second round of punch outs? Obviously you'll need to have the ones that have started to poke through punched out as well.

You're dead right about how removing these grafts hasn't had any negative cosmetic impact on the overall appearance. I've made the point before on this forum that simply having enough of a hairline to frame the face is 1000x more important that having a low or aggressive hairline. Often less is more and I think that can be very true with HT's.

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:

11 hours ago, RazersEdge said:

I’ve been lurking this forum for about a year now and I felt obligated to finally post. I wanted to give you some hope OP. I too had an FUT about 18 months ago that I wasn’t satisfied with. I also had a rather wide scar.

I went to Konior for a 2 step repair. He removed maybe a couple hundred unsightly grafts in temples and hair line and placed them into the strip scar. Not only did I not have any evidence of scarring from the extractions, I also had really great growing in the strip scar. In fact it looked like every one of the grafts placed into my FUT scar survived because the camouflage is so much better.  My strip scar wasn’t as long as yours but it was about as wide and I managed to get solid coverage. 

I had my 2nd step operation with Konior about a month ago and we placed another couple hundred into my strip scar. If they survive as well as my first go around then I reckon I’ll be able to cut my hair pretty sure (2-3 guard). 

I’ll be following your case OP. Good luck. 

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.

On 2/21/2024 at 12:57 PM, chrisu said:

Thanks, what influenced your decision to go with another surgeon this time? Did Bloxham say anything about your results and doing another surgery with him?

14 hours ago, chrisu said:

following up, OP can you message me. In similar situation as you and considering FUE

Thanks

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. 

3 hours ago, chrisu said:

Hey thanks for posting your updates. Curious why are you taking the implants out and putting them back in the original strip scar area? For your second procedure do you plant to go with FUT or FUE?

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.

13 hours ago, Berba11 said:

Depends. The forehead tends to heal a bit differently to the donor area, and usually if the extractions are precise and there aren't too many extractions too close together, they often heal without any visible scarring.

Extracting these grafts can be complex if the directions of the implanted grafts are all over the place, because the surgeon is having to guess the angle needed to punch graft to graft. Also some people just mark up and scar more easily than others, so some patient to patient variation is expected. The best hairline removal work seems to leave very little to no visible scarring at all though. Hopefully that's the case for the OP!

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.

10 hours ago, Sunset Dune said:

I don’t see the problem your result looks decent and there’s definitely a cosmetic improvement compared to pre-op (entire front was nearly receded).

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.

On 11/27/2023 at 7:36 AM, JoeD said:

Any updates? Hope it worked out well for you. 

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?

2 hours ago, cloudyhaze said:

Yea I agree with the higher density behind hairline after seeing the results of some ppl on here too. 
 

Are you planning on checking in with Bloxham in office now that it's been 12 months? What are you thinking for next steps in terms of potentially getting a second procedure in general?

1 hour ago, stephcurry30 said:

I agree with the majority of your posts. The 3 big issues here are the widow's peak (which just looks completely unnatural and something I would be upset about), the left corner/temple looks like no grafts were implanted there, and the lack of density behind the hairline. I would touch base with the Dr/clinic and see his response and see if you can get a free small repair/improvement

35 minutes ago, asterix0 said:

@FormerFutureKrillin For that number of grafts only in the front I would have expected a better result as well, and all of your points are well stated. I don't think you are being unreasonable at all.

Now, it is a dilemma whether to go back to where you were dissatisfied with your result, I personally would look to other doctors who excel in hairline work, and I would also go for FUE instead of FUT in your case. 

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.