gillenator

The grafts go dormant for roughly three months before the enter a new growth phase so they are probably just beginning to sprout...

I can certainly understand the confusion. A couple of things... First, curly hair can indeed be more difficult to extract without transection because it is challenging to know the exact direction of the curly hair shafts in the underlying dermis layer of scalp. And the more acute the curls are, the more difficult it can be. In addition, transection is transection. Permanent damage to the graft. It is not really the damage to the root as much as the damage to the follicle which the root is attached to. If the clinic decides that a graft is not intact enough to place in the recipient site, than that's still a graft wasted anyway you look at it. This is why selecting a FUE surgeon who has demonstrated skill in the end result with FUE, and especially inclusive of a high yield (regrowth), is imperative. And for those individuals like yourself who have curly hair, need to require examples of that surgeons past work of other patients who have curly hair characteristics. Because if the FUE surgeon being considered does not have the proven results with curly hair individuals, the potential transection rate can be out of this world...:confused: Best wishes to you in your journey of finding the right FUE surgeon...

Some docs want to take a separate strip in order to harvest as many FUs in that strip specimen versus taking out the former scar with the secondary strip harvest. And removing the first scar does not guarantee that the secondary strip scar will come out more favorable. There can be a number of reasons for why a scar comes out wider than expected. It can be anything from surgeon skill including closure method, to lack of laxity, to the individual's physiology including how they heal especially in the event of a raised scar. Yet whenever a scar does not have a favorable outcome, the individual definitely wants to get a number of opinions/recommendations from other surgeons before any subsequent procedure. Because it may come down to only doing FUE in future procedures.

I remember more than a decade ago almost all surgeons/clinics would require their patients to start a pre-op anti-biotic before their procedure, and continue on approximately three days post-op. Then it seemed that it was no longer viewed as necessary. Some docs may feel that because the scalp is so enriched with blood flow, along with better sterilization, less invasive methods, etc., that using a pre-op anti-biotic was no longer necessary. In addition, some feel that if it does occur, most cases can be successfully treated post-op and rarely will impact the end result. Even though infections are rare, it's a debatable subject. IMHO, the patient should at least be counseled and offered the option of using a pre-op anti-biotic.

Probably the main sign to look for is that there is a combination of the various signs and symptoms that you mentioned. It's when there is an aggregate of bumps that have tenderness with inflammation and redness with white tips that can also ooze liquid. When there are post-op pimples, they are hit and miss, not lots of them and confined to patchy areas where there is corresponding inflammation, etc. Make any sense? Of course if you are suspect of folliculitis, "contact your surgeon as soon as possible".

Yep, no doubt that is a lost graft and that is exactly what it looks like when a graft comes out post-op. A trickle of blood that is unquestionably oozing from the recipient site. Generally speaking, the grafts are pretty secure after 3 days post-op. But let's say the individual does not clot properly, could there be a lost graft past 3 days? Sure. Or if there are issues of slower healing, etc. Good thing you did not lose more than one...

Thanks for the kind words guys... I have to say that in four decades of following this field, that I have never heard of anyone having an adverse result in their HT procedure due to being a smoker. But like I previously hinted, smoking in general terms is far more detrimental to one's overall health and life. The silent but sure killer...

logo, You certainly bring up some valid questions and concerns that many guys are faced with as to whether to go with FUHT or FUE. And while I agree with some of the comments in the quote provided, FUE has come a long way with more doctors engaging with it and increasing both their talent and proficiency. Not sure when those comments were made regarding large sessions being difficult to perform, because that certainly is no longer true with those FUE surgeons who have increased their skill level including the size of each session. Albeit it true that some individuals have a more "mushy" scalp texture, the instrumentation has come a long way and more patients are viable FUE candidates than say, 10 years ago. The negative forces of compression, traction, etc., in the extraction process are becoming more manageable than they were a decade ago. But here's the deal. Whether we are discussing the merits of either method, the bottom line end result is largely dependent on the skill of each individual surgeon within his/her realm of competence. In other words, could the lack of growth from your prior FUE procedure be more related to a higher rate of transection than your physiology? So it's always possible that your last FUE procedure may have had a completely different end result with a surgeon who has a demonstrated high skill for manual FUE compared to someone with much less experience and proven skill. The same can be said for FUHT. There are in fact several FUE surgeons who have never performed FUHT and claim that they never will. So you certainly would never consider them for FUHT. Also be careful about using beard grafts as a stand alone donor source because there definitely are visual compatibility issues, growth cycle indifferences, and small graft sizes since an extremely high percent of BH FUs are single hair bearing grafts. So it would take many more BH grafts to provide the same level of visual coverage compared to multiple hair bearing grafts that only come from scalp donor. Beard hair works the best when it is mixed with scalp donor at a lower mix ratio. And I would also be careful using beard grafts on the hairline because of the visual incompatibility issues that I just mentioned. Beard hair is better suited for scar repair and in lower visual impact zones like the mid-scalp and crown IMHO. Lastly, we as lay folks could never give one another objective advice as to whether or not you are a better candidate for FUE or FUHT. That requires an in person examination and the competence of a licensed physician. Wish you the best in your situation along with the decisions in your journey...

With FUHT, the donor area where the strip is excised is indeed closed with sutures, staples, etc., immediately after the strip is taken and before the grafts are inserted. Possibly the doctor was telling you that the techs do all of the graft placement and after they are all placed, the procedure is pretty much completed. Still, what I don't like is that it is always possible that the patient may need more anesthesia before the procedure is finished and only a licensed physician should be administering anesthesia. That's the law in the land. In addition, what happens if the patient's vitals start failing? Then what? Although it is extremely rare but it can happen. Also, the surgeon should be inspecting what he/she expects. In other words, a responsible and ethical doctor would want to be routinely observing what his techs are doing and making sure each graft is placed properly both in depth and angles. A responsible doctor would look the entire scalp over before releasing the patient and also doing an exit interview which includes advice and addressing any post-op questions involving taking pain meds, etc. Could the doctor have a golf game he is trying to make later in the day? I just don't have a good feeling about this at all...:rolleyes:

Is your question more specifically addressing whether or not the inhalation of tobacco smoke is an issue? If so, just know that nicotine can still be delivered into the bloodstream as one's saliva can deliver nicotine to the stomach where it is absorbed into the bloodstream. The nicotine can then potentially cause restriction to the blood vessels that deliver blood throughout the body including the scalp. This can reduce the amount of oxygen to the grafts. Is it a big deal? IMHO, I don't believe so. I had 4 separate HT procedures and smoked cigarettes both pre-op and post-op and had no problems with my results. I have since quit smoking altogether including cigar smoking as I developed terminal stage lung cancer back in 2009 and yet survived it. I lost my right lung and the unfortunate thing was I had to almost lose my life to get serious about quitting and not smoking at all. My health is much better since I quit... Obviously I do not condone any form of smoking...

Your grafts should be fine. Your epidermis which is the outer layer of scalp was symptomatic and very doubtful that your grafts were impacted because they are imbedded in the inner dermis layer of scalp tissue where the blood supply exists. It is amazing how many chemicals and alcohol based ingredients are added to various shampoo products. Many of these alcohol additives can cause itching, redness, and even inflammation. Glad to see that you found a good alternative shampoo product...

First of all, you have a diffused thinning pattern and because of that, you run a higher risk of shock loss. So if it were me, I would never have that many grafts done. Remember, with FUE you can always add more grafts as you lose more of your native hair as time passes. And at your young age, you will lose more hair because MPB is indeed progressive. Not sure if you are on any effective hair loss meds. If not, you run even a higher risk of future loss. It is your scalp and your hair loss. Be more assertive and if your doctor is not willing to accommodate your concerns, I would find a new surgeon who will. Best wishes to you in your journey...

The suction can also potentially remove some of the blood within the graft tissue which can also cause the grafts to perish...:confused: IMHO the proper approach is to make sure the size and type of recipient incisions being made accommodate the peripheral size of the grafts being placed into the recipient sites.

The key is to wait until the recipient area has completely healed and also a good idea to remove the crusts first. Some have experienced quicker regrowth, others have not. The idea is that applying minoxidil to the recipient area post-op will help "jump start" the regrowth of the grafts. IMHO, it really does not make any significant difference. Congrats on your procedure...

That is an abnormal reaction especially if you have been using the shampoo all along. IMHO, it is not too long to leave the shampoo on your scalp for 15 minutes duration as long as you diluted it with water and just poured the mixture over the recipient area. But even so, at 13 days post-op, you should be ale to start removing the crusts as long as the recipient area ids completely healed. You may want to consider using a shampoo product that is rich with aloe vera and stay away from shampoos that are chemical based like the product you are currently using. If you read the additives on the bottle, you will see what I mean.

I totally agree and hope you are able to find the right clinic whether in the US or elsewhere. It is clearly an issue of lack of intelligence and proper protocol.

Yes, just to clarify, for most individuals the new growth just begins to break through the surface of the scalp at 3-4 months post-op. Obviously there are some exceptions for early bloomers as well as late bloomers. But the whole premise behind this is that a high percent of transplanted follicles go into the dormant stage for an average of three months and then enter the growth phase.

Generally speaking, doctors prescribe anti-biotics for infections, not for inflammation so that in itself tells you something. Glad to hear that you are having improvement...

We do know that hair that is resistant to DHT or what we refer to as terminal hair in the donor regions of the scalp tend to have optimal color (pigmentation) as well as optimal caliber (hair shaft diameter). When terminal hair is transplanted into a thinning or diffused area, the transplanted hair can potentially be more noticeable because it is mixed into weaker and thinner hair shafts in the recipient area. The color contrast can be more noticeable as well because diffused hair can also loose some pigmentation causing further visual contrast. When some of the hair that is growing through any strip scar is misaligned, then yes it can grow in more dense at various points in the scar. This sometimes happens with the try-closure method, and hard to say how much of that misalignment is from a lack of experience and/or skill. From what I have observed, each case can be dramatically different in the final outcome. Some guys prefer to have FUE added later into a linear scar rather than having a try-closure for those reasons. And they would only need to add FUE if the scar does not come out as thin as they wanted and also many of them desire a much shorter hair style.

More time will definitely help to see how much of this is shock related. One of the most challenging aspects of this is that we never know how things will develop over time as we get older. One of the best gauges to determine the level of permanency of our donor zones is to take a look at the older men in our families who have MPB. Do their donor zones appear dense and strong? Any of them showing thinning of that area?

Sounds like your definitely ahead of what most individuals experience...

Talk with your doc about using a topical cream steroid which can help reduce the lingering redness as well as reduce the inflammatory sensations. You hair looks great Tony...

Just when you think you've seen just about everything...:rolleyes: I agree with Matt that it's a combination of all of the factors stated. In addition, the density in the regrowth "at the scar" and on either side can vary and cause a more pronounced visual differential where the hair is most dense. It's hard to tell from photos how much of it is angulation, and how much of it is the variance in density. You may also have some slight shock on either side of the scar and I think when some of that hair grows back in, it will help reduce the visual contrast. Definitely a good idea to wear the length longer, at least two inches or more...

Most of those hairline grafts should be single hair FUs and hopefully a smaller punch size would be used to extract the ones you want re-implanted. Whenever former grafts are being extracted and re-located, the yield can go down because of the trauma placed on the extracted grafts. The manual skill required in the removal of the former grafts is critical to say the least. So you may want to start with a smaller session to see how the regrowth is and how the extraction sites in your hairline heal and appear post-op. The crown is usually a high demand area as far as MPB goes and can require a large percent of one's available donor. This is why we are seeing more guys using beard grafts for the crown.

The clinics and/or doctors who use an anti-biotic as a consistent part of their protocol normally start their patients several days before the procedure. Then it is continued for up to approximately three days post-op. In your case, the infection occurred several days after and sounds like folliculitis? Antibiotics are not used as much anymore in HT surgery like they were years ago. I think the reason for this is because infections are very rare and if they do develop post-op, most are treatable. Hope everything clears up for you in the near future and your doctor is probably giving you some advice and treating your infection until it is gone.