New to the forum, not new to HT!

[hair2stay]

Hi all,

 

First off, I have to say this forum is invaluable. If only this technology existed years ago! Well unfortunately the same can be said about HT technology and practices. I am here to share my story and seek others opinions.

 

I am one of the many who got suckered in to HT at an age too young (24) with the promise of staying ahead of hairloss progression. Fact of the matter is the Dr's should have turned me away. At that age I was to immature to make the proper decision. By the time I hit 30 something all I wanted was the freedom to shave my head and forget about hair entirely. Well, guess what? That ain't an option now thanks to a whole lot of mediocre work and poor judgement on behalf of the 24 yr old sucker I was and the enterprising Dr's who saw dollar bills sprouting from my head.

 

I had (2) surgeries aprox 100 grafts each in '92 - '93 by a Dr Leonard of RI. He is the grand 'ole chap who happily married me to this life long comittment. I then went to Bosley for (2) more surgeries of 250-300 grafts each in '93-'94. Yep, I thought this was the holy grail and I would be fixed! Silly me, suckered by the advertising. In '98 I headed off to NHI after seeing that they were truly changing the HT world. 950 grafts were placed by Dr Bernstein, with the advice that none of the previous grafts should be excised and a return for a 2nd would get her done. I never went back because I thought the results were a great improvement. Yet, I was not really fulfilled and did not think the work lived up to expectations.

 

Fast forward to today. I have created a photo album with the same subject title "New to forum, not new to HT" Take a look at the pic's, they speak for themselves. I have consulted with all the best Dr's in the field now (all coalition dr's) and have received suggestions that run the full course from excising everything and starting over to excising nothing and filling in with dense packing.

 

This is a tough time for me, deciding what to do next and trying to develop faith in the next process. My case is difficult, no doubt, and I am tired of the unknown. Perhaps I should do nothing and wait it out even farther? Propecia and 5% rogaine have curbed the loss, been on both since inception. Now it's time for all of you to chime in. I respect the opinions of the many people here. I have spent many days reading everything that is archived here. I've searched everything under Feller, Shapiro, Hassan & Wong, Epstein, Repairs, Bernstein, etc. So, please don't suggest that I search the board for answers. I want real opinions from real people! Thank you all and I promise to keep the photos coming when I make the next move.

[nobuzz4me]

Hair2stay,

 

Welcome to the forum,

 

I checked out your pics and like you have had 3 hts myself incuding the nasty larger plugs at the ripe old age of 23.

 

Your native hair looks like it is holding up well on top and in the crown and your hair texture looks real good. I actually think you can be fixed easily with the right doctor and right plan.

 

You may want to consider Dr Feller who is experienced in FUE. What he could do is thin out those plugs in the front (via fue removal, not cored out) and re-distribute them in the hairline. You could combine this with additional FU's, taken via strip or fue from your donor.

 

I just had a procedure done 3 months ago to repair and add more fu's. Check out my photos under: Nobuzz4me road to recovery.

 

Good luck, PM me if you like,

[hairbank]

hair2stay-

 

Sorry to hear of your unfortunate experiences at such an early age. How old are you now?

 

I looked at the pic you posted here then at your photo album. My first thought............you've got a pretty good-looking head of hair. If your crown is holding up and the meds seem to be working for you, there's no reason you can select one of the quailty Coalition Surgeons that can achieve your goals.

 

You've definitely "been there, done that" and it sounds like your looking in the right places to refine what you have and add some finishing touches. IMO you really don't need that much work at all .

 

My advice...........select from one of the best, see if your desired goals can be achieved and then go for it. The results for these clinics speak for themselves and you really have a great base from which to start.

 

Hope this helps.

[the B spot]

Hello Hair2stay and welcome!!!

 

I am sorry to hear of your past experiences, although you are not the first to post here about Dr. Leonard.

 

I normally would not come out and "advise" someone to go to a particular Doc, but I think in your case, you need a hairline specialist, period.

 

Each of the Docs you suggested will do a great job, but you need artistry to disguise your current hairline and the ability to feather this into your frontal core.

 

My suggestion is 1300-1600 grafts.

 

The reason for this is two-fold.

 

1. You must gradually increase your density to match up with your existing density behind the first hairline. To do this, your going to need some grafts.

 

2.IF you yield a limited amount of 1 hair grafts for some reason, your EXACTLY the type of patient who will (potentially) justifyably need some sub-follicular division to yield some additional 1 hair grafts.

 

I thought about what nobuzz suggested, and I agree that his suggestion is viable, but I rather like disguising existing pluggy grafts before subjecting the grafts to the traction of fue extraction, dissection and re-implantation again.

 

Of course, the large plugs are a different story, but I see mini-grafts in this case that can easily be disguised.

 

I would suggest a consult with Dr. Shapiro, who can show you many repair cases of patients who have the same problem you have.

 

I reiterate, EACH of the docs you suggested will be able to address your concerns, but I think your best served to take advantage of Dr. Shapiro's hairline talents.

 

This is my OPINION.

 

Feel free to ask as many questions as you like as you may get a few differing opinions.

 

Take Care,

J

[Bill - Seemiller]

hair2stay,

 

Welcome to the forums. I'm sorry to see that you went through the mill and back. Sadly, there are many who are in your position. At least with today's technology there are ways to repair this.

 

Firstly, I agree with B Spot...IMO, removing of the old plugs should be a last resort. I think camoflauging it makes a lot more sense and can be pretty "easily" (I use that term loosely) done. In other words, in my time here and other forums, I'VE SEEN WORSE! And I've seen some amazing repair work.

 

I don't typically recommend particular doctors because it seriously should be based on the conclusion of one's research and satisfaction with what they've seen in other patients. So though I know you don't want to hear "research repair work" etc...truly you can only really make this decision on your own by looking at countless photos of repair work and using your discretion.

 

BUT, the above paragraph aside, I agree that a hairline specialist is in order...BUT, people will have varying degrees on what makes a hairline specialist and who that even entails. Personally, I think all of the doctors you mentioned do good work, however, I'd probably peg Hasson & Wong, Shaprio, and Feller among the big names you'd want to check out for sure! My best guess is NONE of those docs will recommend removing the old plugs (I'm curious if I'm right or wrong about that).

 

I hope this helps get you started brother. We certainly feel your pain!

 

Bill

[Bill - Seemiller]

slaphead,

 

I don't want to hijack hair2stay's thread...but have you seen a dermatologist yet? I'm anxiously awaiting to hear about your road to recovery!

 

Bill

[hair2stay]

Thanks for the opinions so far guys, like I said I value them. I know many of you here have seen quite a bit, and in the end although we are individual cases I think one can make a pretty good evaluation based on prior cases.

 

Really that is what I am wanting to hear from the Dr's too. So many, even the best, tend to lean on the "well we can't say for sure, or we don't really know what your results will be" I find this to be BS partly, saving their respective asses if things don't live up to expectations. Come on, these guys have seen hundreds and thousands of cases they can make a damn good assessment of things.

 

My age is 39, and my expectations are clear. I am not concerned with density, a wall of hair, nor do I have hair greed. From day 1 and until day all I am asking for is a natural appearence. Now, I have the same expectations, make it natural and undetectable! Long term I am willing to gamble that the drugs will keep my existing hair, and perhaps newer technologies will come along to improve my chances and future options as well. With that said, I am willing to use up whatever donor supply is necessary to make me "normal" now. Soooo.... to a achieve that goal can we really do it well with 1500+ dense pack grafts and no excision. This is the question I am wrestling with. I believe the excision, and reimplantation process is going to be traumatic and damaging to follicles and skin. The less trauma the better. However one way to get rid of the pluggy look for sure is to get 'em out! This we can be sure of. Grafting 1500+ with no excision does not guarantee that.

 

I am putting all of my faith in the Dr to camouflage to his best ability. Here in lies a bit of unknown. All of my surgeries up to today were done on this same faith, and as you all see my faith was shattered. So can I effectively have faith in Dr Feller or Dr Shapiro or Dr's Hassan & Wong, all who have said no excision is necessary, or do I follow a path suggested by Dr Bernstein in which everything is removed and where I know for sure that the pluginess will be gone? I have seen Feller in person as well as Bernstein, their opinions are 180 degrees polar opposite. Shapiro and Hassan/Wong have only seen photos and both suggest it can be done without excision. Next stop is Shapiro in person...

 

Keep the opinions coming, and God bless you guys!

[Bill - Seemiller]

hair2stay,

 

I'm glad to see i was correct in my assessment...I figured Dr. Feller, Shapiro, and Hasson and Wong would most likely do it witout excision. Personally, with no disrespect intended to Dr. Bernstein...I think his approach is a mistake. Now obviously, I haven't seen it in person...but I have seen worse get repairs by camoflauging. The nice part about camoflauging is that you won't only look natural, but the density will be there too. With excision, you run a huge risk of losing density in addition to scarring. Just my thoughts.

 

Bill

[hair2stay]

My concerns exactly... I know density will be lost, and I know scarring will be a factor, as well as additional hair loss from lost follicles due to transection and trauma. Dr Bernstein has a reputation of being conservative, not quite sure how 3 surgeries (his recommendation) is conservative! Other than the fact that perhaps we save donor hair, and we create a new look that is more suited to my age as I enter my later years???

[Bill - Seemiller]

hair2stay,

 

He's conservative in how many grafts he wants to use in a single session...but not regarding how many surgeries he wants to take to perform the job. In all honesty, I do not see ANY reason why this repair job can't be done in a single session...but that's just me.

 

Bill

[Bill - Seemiller]

slaphead,

 

I don't want to hijack hair2stay's thread...but have you seen a dermatologist yet? I'm anxiously awaiting to hear about your road to recovery!

 

Bill

 

Still waiting

 

Bill

[Gorpy]

Hair2stay,

I have to agree with the others about camouflaging the plugs rather than removing them. One good thing is that they are high enough on your head that you can put a good amount of camouflage in front without lowering your hairline too much.

 

Doctors can do wonders with this type of work now days. Go with a hairline specialist like Shapiro or Keene.

[nobuzz4me]

Originally posted by the B spot:

 

I thought about what nobuzz suggested, and I agree that his suggestion is viable, but I rather like disguising existing pluggy grafts before subjecting the grafts to the traction of fue extraction, dissection and re-implantation again.

 

Of course, the large plugs are a different story, but I see mini-grafts in this case that can easily be disguised.

 

 

 

B-Spot, I have to disagree here with you my brother. Having had plugs and gone thru some repair work myself, I have some first hand experience on this.

 

Let me first say that I totally disagree with Dr. Bernstien's take. Total excision is not needed and would create additional tramua and line scarring when sutured shut.

 

Fue extraction would be best rather than excision to reduce te lets say 9-12 hair plugs down a few hairs each. This alone would break up the pluggy look. It is not intended or neccesary to fue all of the plug hairs out of each individual plug. Adding additional FU's between the rows would finish off the job.

 

 

Hair2stay can clarify this, but I think he got larger plugs not mini-grafts, these look like 3-4mm size which would yield 9-15 hairs, minis tend to be 4-8 hair. This is why camoflage is difficult to hide these stalky looking things. Can they be camoflaged? Maybe. Will they be totally undetectable after camoflaged, maybe. Hair2stay stated he is not concerned about having a dense wall of hair, just a natural look. Thick plugs are dense and they would need alot of dense packing around the rows to match the density of the plugs themselves if the plan were to camoflage alone.

 

Please check out "BadHairUK" photos of Dr. Fellers work, the fued out minis are undetectable and the area heals nicely.

 

Trust me when I say that those who have plugs want to get rid of ANY evidence of large plugs. Camoflage alone cannot guarantee this.

 

Hair2stay, can you clarify the size of you plugs?

[Bill - Seemiller]

Slaphead,

 

Oh whoops! Now I see your post...sorry I missed it the first time. I'm glad you will be seeing a dermatologist. Remember bro...take it in stages. I know you are unhappy with your scars and your results...but let's get your skin condition fixed up first...and then you can start tacking the scars and recipient area through repair work with the top clinics! Please keep us posted bro!

 

Everyone,

 

There are obviously different approaches to hair2stay's situation...and ultimately everyone will have an opinion. Nobuzz...obviously you have experience in this matter, and certainly, in your experience, having some of the plugs removed is what worked for you. But there are other cases out there, where the plugs were not removed, and were camoflauged just fine. So...what is the best route to take? It's difficult to tell really...I still believe that camoflauging in his case is the best way to go for the reasons I stated above. But the decision on which doc to go to is up to him. Hopefully he'll chew on all this information and make the best decision for him.

 

Bill

[hair2stay]

In response to plug size...

 

What appears initially in the photos and upon close inspection is evidence of some rather large size plugs (ie 3-4mm). What in fact we are seeing is a number of things I believe. First off the initial 2 surgeries I had with Dr Leonard in '92-'93 were slit graphs in the frontal hairline. These were definitely the largest size graphs when considering all of the work done. I remember how excited he was to tell me that I was the recipient of such great new technology!!! By the way, when I later met Dr Rassman in '96-'97 he commented that in his opinion this was borderline malpractice. Just thought I'd throw this in to stir the pot a bit!

 

Back to the sizes... So, what we are looking at is some larger slit grafts perhaps 6+ hairs. But in addition to that they are augmented by mini/micro & fu grafts placed in close vicinity. Of course the plan that the Dr's had from Day 1 is to keep going back in filling in gaps. So there are areas where there are some mini/micro & fu grafts tight to the larger slit grafts creating a net result looking like even larger grafts due to the still existing gaps here and there. Really, upon close examination you will see the density vary as you look throughout the frontal area where all of this work has been done. This concerns me, because part of what creates a natural appearence is uniformity in density. Even in thinning hair the density is for the most part uniformly the same throughout the thinning area. This is the beauty of creation!

 

So now when considering tight packing 1500+, will the Dr's attempt to match the density that we are seeing within these larger appearing grafts? I would think that that would be the only way to essentially make the old work not noticeable to the naked eye. Is this really a realistic expectation? Compunding the challenge, behind the hairline where you see large areas of hairloss, the skin is scarred and there is vascularization. Dr Feller confirmed my hunch, that there were grafts placed there that did not take previously. He felt as though the incisions were to large in previous surgeries, and the only way to get hair to grow there will be with the most finite incisions possible.

 

Another thing I should share, where the photos don't reveal, is ridging. The entire frontal area, to touch, is raised with definite ridging evident. In the right light your eye can pick it up too. Prior to the 950 fu's with Dr Bernstein in '98 I had cobblestoning as well. His surgery definitely reduced that, but the ridging remains. I think 1500+ grafts will contribute to the ridging, yes or no? Excision would alleviate ridging, perhaps, at the expense of scarring?

 

Comments...

[Gorpy]

I think 1500+ grafts will contribute to the ridging, yes or no? Excision would alleviate ridging, perhaps, at the expense of scarring?

 

I don't think grafts placed by one of the top doctors would contribute to existing ridging. I think the new grafts would not only camouflage the larger grafts, but also the ridging.

[the B spot]

Buzz--- I would have agreed with you 100% had I felt the size of the grafts were actual "plugs", but even with the hair grown out, it is only at the very base of the hairline, right above the scalp level where it is most noticeable.

 

You are right, most of the larger plug grafts need to be excised almost every time.

 

Now we have the ridging issues as well.

 

I think transplanting in this area using many 1 hair grafts and using 2-3 hair grafts behind the hairline will disguise the poor work 100%.

 

It will be interesting to see how this plays out and which plan of attack hair2stay chooses.

 

Later Guys,

J

[nobuzz4me]

B,

Yea, it is a interesting case, particularly with scar damage in these areas. I think he has very good quality hair and it appears to be thick. Sometimes this makes the plugs stand out even more because they are dense.

 

Just so I am clear, I did not say all large plugs need total removal. The fue punch out would only thin the existing plug by 1-3 hairs -not remove entirely.

 

Large graft removal in which someone is trying to completetly reverse a HT is not undetectable. This is not necessary for Hair2stay but I think Bernstien suggested it as an option even though he did a prior procedure on him

 

 

How many patients have ever gone for HT then years later went for a reversal with the same Doctor?? That would have to be a first!

 

 

Checkout BadHairUK's case. I think Feller did a great job on his repair and he fued out some small plugs.

 

Peace,

[hair2stay]

Glad I'm not the only to find Dr Bernstein's recommendation strange, knowing that he was the last one to work on my head. Specifically, I asked him if we should remove the pluggy stuff back in '98 and at that time he said no. I asked him why the contradicting prognosis now? His reply was that "his thinking has changed" and he believed that complete removal was the best option for me now. He commented further on the advancements surgically in the past years have resulted in a complete rethinking of how to handle cases like this. Also with the amount of time elapsed since '98 he said he has seen long term results of similar cases, and insisted that this was what he believes what would be best for me. Nonetheless, this was all very hard for me to swallow. He also went on to strongly recommend that I get 2nd opinions, stating that nobody else will make the same recommendation as him because he has more experience with excision and reimplantation, and does more of these surgeries than any other doctor... Not sure if this validates his opinion???

 

My intentions are not to slam Dr Bernstein, I am just trying to categorically place his opinion amongst others and determine it's value. Again I value what everyone on this board has to say. Even though you all aren't Dr's, I consider you all peers who have real world experience. Comments welcome...

 

And yes, good quality hair, thickness, dark hair on white skin these are all attributes that make the pluggy stuff stand out more... This is an additional challenge my case presents.

 

h2

[Bill - Seemiller]

He also went on to strongly recommend that I get 2nd opinions, stating that nobody else will make the same recommendation as him because he has the more experience with excision and reimplantaion, and does more of these surgeries than any other doctor...

 

Honestly, personally, I'd be dissatisfied with Dr. Bernstein's answer here. I'm glad he recommended that you get a second (and really I'd take it as far as a third) opinion. But why would he already know that his peer physicians wouldn't recommend the same as he, and then attempt to discredit their response by stating he has more experience than any other doctor.

 

I suppose his statement might be true...maybe he does have more experience with excision and reimplantation than most, because most doctors do that only as a last resort, whereas he may make that common practice.

 

I don't have the answers, but I know anytime a doctor self promotes himself without evidence that his methods are indeed superior, a red flag goes up in my mind.

 

Certainly there are cases where excision is necessary, but I do not personally believe that this is true every time.

 

I further add that my opinion is NOT based on gut...it's based on seeing a number of successful repair jobs where old work was camoflauged with FU grafting successfully.

 

Bill