1150 Grafts/Dr. True/5.25.06

[L'Anonyme]

Some background: 34 years old, started Propecia 2+ years ago, began receding in the front at age 28-29. Diagnosed as 3V, possible 5/5A. FUT 1150 grafts to the hairline at attempted density of 40-50 FU/sq. cm. depending on what native hair was left. Painless surgery, no swelling, redness and 80% of scabbing gone from recipient area within a week, redness from donor area virtually imperceptible at 3 weeks. So far the experience has gone as well as I could expect and I've been very impressed with the True/Dorin clinic, pending final results of course....

Edited March 16, 2011 by L'Anonyme

[L'Anonyme]

Sorry if this should have gone in the patient gallery section. In any event, I thought it would be useful to have another Dr. True thread w/ photos, ???  la Bill, who's done an excellent job of documenting his progress photographically....

[hoose]

IMO, I don't think you really even needed a HT. It looks like to me that you have a mature hairline. Most people don't even have that density and hairline after a HT. I think you should of just stayed on Propecia and waited until you lost more hair/reeceded more.

[L'Anonyme]

I certainly understand that argument and weighed it very carefully, though what had been my mature hairline had been slowly fraying and moving upward for the last 5 years. I'm certainly staying on Propecia, and since my hairloss hasn't been precipitous so far, I hope that will slow down any further loss, especially as things proceed backward from the hairline region. The native densities left in the transplanted zone were well under 5%.

[pushing 40]

To me, he is a perfect transplant candidate. Why: he's 36 so loss pattern and veracity is pretty much easily defined; very young looking face from what I can tell; simply has a higher mature hairline and wants it back where he had it done; not trying to cover huge amounts of bare skull with thin sparse hair. What could be more perfect than that? I think the problem is that much more balder men want to say "why'd you do that? hell I'd die to have what you had BEFORE the transplant". People tend to think if you're not really really bald or balding, you shouldn't do it. I think its the opposite.

[L'Anonyme]

pushing40, interesting comments. i'd say no one is probably more conservative and cautious about undertaking such an irreversible surgical procedure as this than me. this forum was invaluable to me during a long research process, and one of the reasons i wanted to document my case publicly was because there were very few examples here of people who hadn't lost too much hair but were old enough to consider getting a procedure. i thought it might be instructive to show what could be done for someone with my degree of hair loss who wasn't too young, rash, or badly informed to seriously consider going forward with a transplant. interesting that you could tell from my pics that i have a young-looking face, too...lol.

[hoose]

You guys do have some valid points. Your hair loss has stabilized for the most part at mid-30's, especially if you are on Propecia.

[L'Anonyme]

Originally posted by L'Anonyme:

One month photos posted.

[L'Anonyme]

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

[HairHope]

I love the fact that he doesn't shave the recipient area, thus you look back to normal in a few weeks.

 

Best of luck

[Guest]

dhoose75, can you clarify what you said that hair loss has stabilized for the most part at the mid-30s? Do you mean for L'Anonyme or most men in general? Thanks

[L'Anonyme]

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....

[L'Anonyme]

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?

[JakeVig]

68cm2 is low density. Normal density varies between 80-100cm2. You're still in the lucky group of not having to deplete your donor supply.

[the B spot]

I would double check that L, sounds a little to low, to be honest. Perhaps low enough that you should not have had a strip session. As they say in Dade County, "Demand a recount!"

[L'Anonyme]

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....

[L'Anonyme]

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....

[the B spot]

Good For You L!!!!!!!! I thought that number seemed a tad low for a surgeon with the rep of Dorin/True to procede with a strip and not offer FUE instead. Now you can plan accordingly should you go in for another HT. I am glad that you shared that information with us, and sent many of us looking up the definition of ellipse =)

[brucewayne]

L'Anonyme, looking forward to checking back and seeing the results in the months to come. Will you be posting them here or in the patient gallery section?

[L'Anonyme]

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 ....

[L'Anonyme]

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.

[hairbank]

Nice hearing from you, L'Anonyme-

 

Sorry to hear your experience was less than satisfactory but glad to hear that Dr. True is trying to take care of the situation. Can you post any pics of your final outcome before HT #2 along with some post-op pics?

 

I'm interested in what Dr. True said about your poor yields and scar issue? He is recommend on in our Coalition Surgeons on this site.

[L'Anonyme]

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.

[hairbank]

Thanks L'-

 

Had a chance to review your pics. I wish the lighting were a little better but i could still see that the results were definitely subpar. I also followed whatyou were saying about the central and right side having lack of growth while the left side seems to have fared better. 1150 Grafts might not have been enough to give you the coverage you needed in the hairline but the growth was inconsistent, at best.

 

I'm not sure what I think of the 2-hair grafts being in the telogen phase...............even if they were, the bulb should have been visible when the grafts were being trimmed so it may have just been poor work by the tech who placed the grafts. Did a tech place all of your grafts?

 

I'll be anxious to hear reponses from Pat as well as other posters regarding your situation but I do believe it really needs researched further as to why you had these kinds of results. We're very quick to refer our Coalition Surgeons to those opting for an HT........all the more reason accountability is so important.

[L'Anonyme]

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....