L'Anonyme

Well, no, it doesn't all sound good, but I'm glad your procedure went well. I just wish you'd post some pictures since you seem to turn up in *every* Dr. True thread to reiterate how great the clinic is....

Just so my update doesn't get lost in my other thread, I'm starting this new one as well. It's been a while since I've posted, but on March 19, 2007, approximately 10 months after my first procedure with Dr. True, I went back in to have him do my second procedure, which yielded an additional 1156 FU's (736 1's, 420 2's = 1576 hairs). [My first procedure and all photographs can be found easily by searching "1150 grafts", and I've had a few comments there about the second procedure already from _hairbank_.] The initial 1150 didn't produce the density I was hoping for, and several hundred of them didn't appear to grow at all, so I received 200 grafts this time for free. Needless to say, I was hoping for much greater than about an 80% yield for the first pass, but the central portion of the hairline, and especially the right side, were much sparser than I would've expected after examining photos of the first group of recipient sites. In fact, I would characterize the result on the right side of the hairline as pretty pathetic, and it was very densely packed this time around. The right side of my scar also didn't turn out too well (a subcutaneous stitch came to the surface and I had to remove it myself about a month after the stitch removal proper), but the entire scar was excised and the problematic portion revised during this second pass. I also had 10 or so 2-hair grafts turn up in the frontal hairline, and they needed to be FUE'd out and placed further back where they belonged. All of these problems arose as the first tranplant began to mature, but Dr. True has been very responsive to all of my concerns thus far, so I'm hoping for much better final results that match some of his most impressive work on patients with a similar hair/skin contrast as mine. I'll try to keep everyone updated as things develop.

Just so my update doesn't get lost in my other thread, I'm starting this new one as well. It's been a while since I've posted, but on March 19, 2007, approximately 10 months after my first procedure with Dr. True, I went back in to have him do my second procedure, which yielded an additional 1156 FU's (736 1's, 420 2's = 1576 hairs). [My first procedure and all photographs can be found easily by searching "1150 grafts", and I've had a few comments there about the second procedure already from _hairbank_.] The initial 1150 didn't produce the density I was hoping for, and several hundred of them didn't appear to grow at all, so I received 200 grafts this time for free. Needless to say, I was hoping for much greater than about an 80% yield for the first pass, but the central portion of the hairline, and especially the right side, were much sparser than I would've expected after examining photos of the first group of recipient sites. In fact, I would characterize the result on the right side of the hairline as pretty pathetic, and it was very densely packed this time around. The right side of my scar also didn't turn out too well (a subcutaneous stitch came to the surface and I had to remove it myself about a month after the stitch removal proper), but the entire scar was excised and the problematic portion revised during this second pass. I also had 10 or so 2-hair grafts turn up in the frontal hairline, and they needed to be FUE'd out and placed further back where they belonged. All of these problems arose as the first tranplant began to mature, but Dr. True has been very responsive to all of my concerns thus far, so I'm hoping for much better final results that match some of his most impressive work on patients with a similar hair/skin contrast as mine. I'll try to keep everyone updated as things develop.

I agree with you about 1150 possibly not being enough; I knew this going in and a second procedure was already discussed as a possibility to achieve the results I was looking for. The goal was not to endanger too much native hair in the first pass, but lighting aside, I think the photos show what needs to be shown. And yes, techs placed all of the grafts. In case there was any ambiguity in my wording above, the explanation about the hairs in telogen was offered by Dr. True and is not my own surmise. Again, I can accept it up to a point but there did seem to be an alarming number of 2-hair grafts too far forward. I'm not sure I comprehend the point about techs being able to see the bulb; Dr. True mentioned that the second hairs in telogen could only have been seen through an electron microscope, so if anyone has any further clarification of this issue, please chime up. I know these smaller cases don't attract a lot of attention, but I'd be interested to hear what Pat and some of the other frequent posters here have to say. Thanks for the input, hairbank....

Hey hairbank... As for the closure, Dr. True stated what many surgeons do, that different patients will heal differently, and that whereas a trichophytic closure may benefit 90% of patients, the other 10% might've had less stretching using the previous non-trichophytic method. I can accept this explanation up to a piont, but in my case the 5% of the scar that turned out poorly is most certainly implicated with the subcutaneous stitch(es?) that remained under the skin after I had my sutures removed. They weren't terribly painful and didn't cause a bloody mess ??? la Spock's case, but they did disrupt the fineness of the line when healed and no hair grew through that section. Regarding the poor yield, we didn't really discuss causes but I did bring it up and that's when the offer of free grafts was extended. I certainly wouldn't blame my physiology and am inclined to believe it was a quality control issue, which is disappointing given the small size of the case and the fact that I was the only case on that day (a much larger case on a second patient had been cancelled). At least we're not talking about a huge waste of grafts, but every one that doesn't grow is gone forever. As for the 2-hair grafts, I must've had quite a number of them with one hair in telogen, though ending up with that many in the frontal hairline was certainly not what I was hoping for. That said, they've all been revised, so we'll see how everything grows out. My 8-month and immediately post-op pics should be up now.

It's been a while since I've posted, and I still need to upload some new pics, but on March 19, 2007, approximately 10 months after my first procedure with Dr. True, I went back in to have him do my second procedure, which yielded an additional 1156 FU's (736 1's, 420 2's = 1576 hairs). The initial 1150 didn't produce the density I was hoping for, and several hundred of them didn't appear to grow at all, so I received 200 grafts this time for free. Needless to say, I was hoping for much greater than about an 80% yield for the first pass, but the central portion of the hairline, and especially the right side, were much sparser than I would've expected after examining photos of the first group of recipient sites. In fact, I would characterize the result on the right side of the hairline as pretty pathetic, and it was very densely packed this time around. The right side of my scar also didn't turn out too well (a subcutaneous stitch came to the surface and I had to remove it myself about a month after the stitch removal proper), but the entire scar was excised and the problematic portion revised during this second pass. I also had 10 or so 2-hair grafts turn up in the frontal hairline, and they needed to be FUE'd out and placed further back where they belonged. All of these problems arose as the first tranplant began to mature, but Dr. True has been very responsive to all of my concerns thus far, so I'm hoping for much better final results that match some of his most impressive work on patients with a similar hair/skin contrast as mine. I'll try to keep everyone updated as things develop.

whynot, I had a procedure of 1150 grafts w/ Dr. True about 6 months ago and so far things are coming in nicely. I agree w/ Robert's assessment of Dr. Dorin, and I've actually had more contact with him since he did the balance of my consultation while Dr. True was in surgery and has done all of my follow-up work, both on the phone and during in-office visits. His assessment of my donor was also very conservative, though when Dr. True examined it he estimated about 7000 grafts. It's hard to make sense of such discrepencies sometimes, but I think both doctors tend to underpromise and overdeliver. I'd also say after having studied many doctors and their approaches over the last year that True and Dorin have a slightly more conservative and piecemeal approach to restoration than some of the surgeons who maintain an aggressive presence on boards like this one. Since my loss was rather minimal, I expect to be pleased with this one procedure, and I'll need additonal ones to keep pace with any further loss should it happen. If I had had extensive loss, though, I'm not sure that a True/Dorin multiple surgery approach would be as attractive if I could do it all in one session. Obviously, different patients have different needs; see what Feller and a few other top doctors have to say about your situation.

Just got my official pictures from yesterday's pleasant and very informative 4-month check-up with Dr. Dorin. Apparently, I'm slightly ahead of the growth curve at this point in time. The pictures reveal nicely the proper orientations and directions of the new hairs coming in. Combed the way I actually wear my hair, what's grown has already given me more solidity in the front and a nice shadowing of my eventual hairline, so I look forward to the next few months of progress ....

Tony, Dr. True did some hairline work for me, so I write as someone familiar w/ his clinic, but I don't know about the body hair approach. Did I read you correctly that it would be for the crown only? Did Dr. True show you grown-out results of BH in the crown, and did they look good? I wish he would post examples in this forum so we could all see how your expectations are being set. Best of luck to you if you decide to move forward with it.

Biggest graft count I've seen yet from Dr. True. Surprised by the lack of 3s and 4s, but placement looks dense and excellent. Congratulations on this big step ... !

To expand on the previous entry, I just received this very prompt reply from Dr. Dorin himself: "Technically you are correct. The shape of the donor strip is rectangular in the middle with elliptical (or triangular) ends. Since the tapering length of the triangular ends normally starts 1.5 to 2.0 cm from the end of the rectangular piece, the total square centimeters of donor region removed on you would be about 14.4 square centimeters and not 16.8. Therefore your density of follicles/sq.cm is about 79.9. Please keep in mind that the density of your follicles is not always consistent throughout the entire length of the donor region used. So there will be some variation." So my density isn't as alarming as I'd thought. Thx, B Spot, for reminding us of Dade....

I'm not so much worried about having had a strip procedure as I am about the implication of such a density for future planning. Obviously with a greater distribution of 1s and 2s, the density will be lower. I got about 1.8 hairs/graft, lower than I was expecting, but on a par with what Cooleyfied recently received (6636 hairs divided by 3507 FU). Though his donor density is posted on his thread as b/w 80-100 FU, the math doesn't work out that way; he's got to have lower than that. His thread was helpful to me b/c he posts his donor width within a variable range (1.2 cm -- 1.5 cm), whereas I was only given a single measurement (1.2 cm) by True's office, which I assume was the width of the strip at its greatest. Since the strip is tapered at the ends, and an ellipse rather than a rectangle (and I don't know how to calculate the surface area of this ellipse), the surface area I was working with in my calculation was a bit high. Still means my density is under 80, but not as dire as 68. I'd be at 80 if not a single graft were extracted on either of the one-inch tapering ends. Sound logical? I'll ask True's office about the variability of the width tomorrow....

Just got my donor strip measurement from the True/Dorin office this afternoon: 14 cm long by 1.2 cm wide = 16.8 sq. cm. This puts my donor density at 68.45 FU/sq. cm. I know that densities can vary widely over the scalp, but does this sound low? Bernstein's densitometry estimated my donor density at 2.3 hairs per grafts, but with this procedure it came out to about 1.8. Not terrible--perhaps it means I'll need fewer FU/sq. cm transplanted to restore a full look?

Tony, Dr. True, like a number of other doctors in the coalition, doesn't mandate that you shave the recipient area, so you'll want to discuss the approach with him when you meet. I'll think you'll be able to be back at work without having to shave the entire top of your head.

The Phase III trials were called off several years ago, so there are no trials to complete. Glaxo is not seeking an indication for MPB w/ Avodart, so it can only be taken off-label for hair loss.

I second the comment about swelling. After my procedure w/ Dr. True a few months ago, I had absolutely no swelling whatsoever, and I wasn't even as diligent about icing as I could've been. The whole procedure for me was painless start to finish; I'd be hard-pressed to say that I was even in any discomfort post-op. Of course I could feel stitches in the back of my head, but that was about it. I too have found Dr. True to be honest and gracious in all of our discussions, and b/c I was the only procedure scheduled for that day, Dr. Dorin also assisted with the surgery. I hope you'll find a lot has changed in the last 10 years, Tony. Good luck to you and keep us posted on your progress.

What is this doctor's name? He is most definitely a quack and I would RUN if I were you. Stick around here and do some real research. You do NOT transplant into non-thinning areas! You also usually start from the hairline and mid-scalp and work your way backward, conserving precious grafts for the crown should they ever be needed, transplanting the back of the head LAST. Shock loss doesn't occur with one gender any more than the other. That is an absolutely ridiculous statement. You need to find a good transplant doctor, and at a NW1 with 50% loss (i.e., no balding, no cosmetically significant thinning), you sound like you are NOT a candidate for a hair transplant, just someone who is letting anxiousness about the future overwhelm your judgment. The best thing you can do is get on Propecia NOW and plan on taking it indefinitely. Even if your loss isn't noticeable to anyone but you, taking it will help ensure that you lose no more hair. You don't want to start getting transplants that you don't need and that will shock out more hair than you have now....

That's not true, really. The incidence of sexual side effects for users of Propecia in the clinical trials was barely higher than that reported in the placebo group, and for most men sexual side effects resolve even while on the drug, suggesting that for many sexual side effects are a self-fulfilling prophecy. Propecia actually leads to INCREASED libido in about 1 out of 10 men. Don't listen to alarmists who have "heard" things. The data is out there and easily found on the web, so do your homework. This drug is indispensible if you're serious about keeping your hair.

I wouldn't risk it. Get a prescription, buy the real thing, and know what you're getting. It's bad enough wondering if Propecia is working effectively w/o having to second-guess whether you're really taking Propecia at all.

"Reinforcing" is the wrong way to think about it. If you transplant into an area that's thinning but still has enough density, you could shock out permanently what native hair is already there, leaving you worse off after the HT than before.

I don't know where you got the 400 graft figure from, but if you've already got hair in an area, then putting even more there in case you lose that native hair is not the way transplantation works. "Staying ahead of your hairloss" is not a phrase you should be hearing from an ethical doctor, and I doubt one would operate on you given what you're describing. Do you _have_ frontal hairloss? Do you know your possible final Norwood pattern? How old are you? These are all important factors, but what you've described so far doesn't make it sound like you're a candidate.

I agree with Robert. I think you need to wait and not get on a surgical treadmill that has no end in sight. No matter how many more photos or daily posts you make at this point, none of us can give you the kind of assurances about your results that you're looking for. You're clearly obsessed with your hair in a very unhealthy way for someone so young, and the fact that you've lost this much hair already means you have to conserve your donor supply for what could be an even more extensive progression. Maybe psychological counselling might even be an option at this point; you've got to get your mind on something else before you drive yourself crazy....

I've heard it said a number of times that hair loss stabilizes by the mid-30s, but I don't think anyone should bank on that, and the experiences of many, many men certainly contradict that. I think the last person I remember making that comment was Rassman on his baldingblog, though I think he was specifically addressing the question of someone who had already been losing hair for quite some time and may have been near the end of the worst of it. Dr. True's site claims that balding usually progresses aggressively for anywhere from 8 to 14 years and then levels off. Again, I don't know where the evidence for this comes from. I didn't notice hairloss, really, until I was almost 30, so I'm hoping Propecia keeps things stable. The most logical rule of thumb seems to be that if you start losing appreciable amounts of hair in your teens or early 20s then you are probably headed for extensive balding....

BTW, total hair count was 2072 hairs: 353-1 hair; 672-2 hair; 125-3 hair.

Which Doctor A did you have surgery with? Sounds as if you might have diffuse unpatterned alopecia, which only affects 1%-2% of MPB sufferers. If that's the case, you weren't a good candidate for a transplant in the first place, and it's no surprise that your grafts were an utter failure. You shouldn't have been operated on if the donor hair in the back is thinning along with the rest of your hair. It isn't permanent hair at all in that case.