AA1989

Compare a hair from your head to a hair from your beard. If you are like me and most people, they will be fundamentally different in coarseness, calibre, curl, length, etc. Clinics need to be judicious in their use. Imagine beard hair visible in your hairline. If you check many of the top HT clinics, they refuse to use beard or body hair for scalp transplants. As you have beard hair on your scalp, can you feel/see the difference?

Yes you're right, it allows the HT on the front and midscalp to have fully evolved. Given you knew that why didn't you wait a few more months and get a complete assessment?

You haven't seen it but have you requested the clinic provide you with a copy?

If two parties that have entered into a commercial agreement cannot find a resolution, then the OP has the right to seek legal advice. I make no judgement on the success or otherwise of their case, but in a democracy I respect their right to make that choice.

What does the OP want? I asked the question earlier I have not received an answer. Indeed, the broader question is what would satisfy the OP and allow them to move on? Ultimately, if the OP can not come to a resolution with the clinic, then he has the option of legal redress, I assume based on misselling/malpractice. I'm sure the clinic would robustly contest this.

@AJ_HTYou were clearly extremely knowledgeable going into your repair after such a bad previous experience. For the benefit of members can you show us examples from your research, of what you expected with 2500 grafts? (given a similar start point).

@Melvin- Moderator can you address this very serious allegation with the clinic and report your finding to the community. I know you take a very dim view of NDA's in the HT industry. It would be a worrying development for a recommended clinic to try and manipulate feedback/reviews.

The OP should reflect on how realistic their expectations were. Having been told you were a Norwood 5, you are asking if 2000-2500 grafts are enough to cover not only your frontal and mid-scalp but also your crown. Those 3 areas amount to approximately 200cm2 on a NW5. The math tells you 2500/200 is 12.5 grafts/cm2. The 'illusion of density' only really starts at 40+ grafts/cm2. This may sound like a criticism, but as someone who has experienced a previous poor HT, consulted multiple doctors, you should have known the basics of density and coverage.

I'm prepared to give the clinic the benefit of the doubt on re-establishing a new hairline, given it was a repair job. The repair is not to lower the hairline. Rather it is by-product of creating a new natural hairline. A poor hairline from a previous procedure often has multiples, mis-angled grafts, incorrect design.

@AJ_HT At the heart of your complaint, you believe the clinic miscalculated the number of grafts required to provide the density you expected. The clinic contends they harvested the maximum number of grafts they could without overharvesting an already depleted donor. It seems the clinic was being ethical in not wanting to leave you with a destroyed donor. We see on the forum many instances of a badly depleted donor - its tragic. As clinics often get paid by the graft, there is a financial incentive to over harvest. Two questions: Why would the clinic choose to make less money unless they felt there was a high risk of damaging your donor? Why would the clinic use beard grafts unless they felt there was a high risk of damaging your donor?

I hope this is a just a misunderstanding. A Non-disclosure agreement very serious allegation. Their use is considered unethical within the community. Melvin wrote a very good article on this very subject. https://www.regrowhair.com/would-you-go-to-a-hair-transplant-surgeon-that-makes-you-sign-an-nda/

Pretty much rocking a faux hawk at only 3.5 months - great progress

The clinic did use beard grafts (see OP's 1st post) This does lend weight to the clinics position that the donor area was depleted. Why else would they use beard grafts?

@AJ_HT Can you clarify, do you want another free touch-up as Melvin suggested? If so, why have you not responded/returned to the clinic? This position seems at odds. If you are not looking for any additional free work, What do you feel the clinic could have done differently? What would be a satisfactory outcome to this thread? @AJ_HT I want to say it takes a lot of courage to present your case and listen to feedback. While you are unhappy with the results, you have made progress. If you have additional donor capacity, you have options for the future.

Again, for the benefit of clarity, are the documents that require a signature emailed in advance of attending/booking a procedure? This is important for transparency. It seems like the patient was presented with a document he wasn't prepared to sign.

It would be helpful if the clinic could provide their high quality pre/post surgery photos to help members and the patient understand how they arrived at their diagnosis of a compromised donor.

I must agree with this. This would absolve a clinic of any responsibility regardless of the standard of their work. Are patients made aware they are required to sign this document in advance of arriving at the clinic for their procedure?

There seems to be a fundamental difference of opinion/misunderstand. Can we see photos see photos of the donor pre and post surgery?

I think the possible issues are:- The initial 2500 was spread over a large surface area. This was never going to meet your density expectation. Without intervention, you look to be heading for a high Norwood 5+. The clinic was banking on a good response to finasteride to compensate for the lack of density. You should have been advised to get on Fin a year before surgery and then assess your requirements. It doesn't look like you are one of the lucky high responders. What is the distance from the centre hairline to glabella? Your original surgery may have simply been two low and flat, which makes any repair more challenging and demanding of grafts.

Revisiting this case, I think it is worth bearing in mind that the OP was a high Norwood with only light patches of diffuse hair. The cases where frontal third is transplanted are often supported by a robust forelock, which strongly contributes to the wow factor. Although the OP says he is now on fin, there is a strong possibility that the small amount of hair in the front third may have been lost in the 8 months between transplant and presentation of the newer photos. If those hairs were already on their way out then the HT may have even hastened the process. Let bear in mind the OP was a high Norwood. With the second transplant filling out the top and crown, the OP will have full long term coverage, albeit with modest density. Factor in a potential 3rd touch-up procedure to the hairline, and the OP will have a result beyond his best expectations. @TGR46Really looking forward to seeing the evolution of your 2nd procedure and props for presenting such honest, high-quality photos.

This is a much better read on graft survival rate factors. https://injertocapilar.com/sp_faq/factors-influencing-graft-survival/

The hair transplant industry is big business and all in not what it seems. No need to search their whole website. The 'we have a survival rate of 99%' follows just after telling us the industry standard is 60-70% in the same article/sales spiel. Clearly it's the usual rubbish. They are low-balling the 'industry standard (according them)' so they can set the reader up for the sales pitch

Aren't you being a little selective with your quotes? Just below that on their sales spiel they say:- <yawn>

Lots of positives from the latest batch of photos All options open regarding hair style, the buzz cut looks good. Donor has healed well with minimal scarring. Good growth in the recipient area. The hairline suits you - good choice Temple points look good. Still only 3 months in! How does the donor look in person? You mention the growth in the temple points. Are you finding the transplanted hairs are blending in well or doing their own thing?

We should have pretty much the final results now. The clinic photos were taken at the 8 month mark (1st Dec), although @TGR46 is now at the 11 month mark. It would be interesting to see if the case has improved. Regarding intervention to improve the density. This can come down to how satisfied the patient is with their result. The OP has expressed a high level of satisfaction. The old adage 'if it ain't broke don't fix it' comes to mind. I would have requested additional grafts to fill the spaces to reach/exceed the original required 3600+ grafts. The logic is, if the Dr says you need 3600+ grafts and, for example, only 2700 grow, then by definition, the result is sub-par.