HIGA's Long Road to Recovery - 2400 Grafts with Dr. Epstein

[Here I Grow Again]

Here's my pics to 1 yr.

 

 

 

[Bill - Seemiller]

HIGA,

 

I think your results look really good. As I stated in your other thread, before and immediately postoperative pictures would help us better evaluate your results. but it appears you had 2400 grafts over a larger bald area which has given you some nice coverage and some hair density. Any plans to go for future work?

 

Bill

[Here I Grow Again]

Thanks Bill,

 

I will see if I can get some immediate post pics from Dr. Epstein and post.

 

Yes I have been contemplating a second pass but want to first enjoy what I just got for a little bit ;-)

[frog]

a really good result?! again am i missing something here...i can not see any difference at all hardly, and why is there only one pre op picture (an unclear side one) and not a top one, front one? why is it purple also?

 

i can not see a 2400 difference at all ..anyone else feel this is a very good result?? is that why there have been no replies, everyone just being polite?

 

the hair looks shaved down pre op and just grown out after , where are the 2400 grafts??? what happened here?

there is clearly not 2400 growth in my opinion.. i think your assessment on many pictures is somewhat misguiding to the viewing public.

 

why is there still so much shockloss after 9 months.. is the permanent?? i thought shockloss occured around the scar and for a few months..not 9 .. is it all back now?

 

 

anyone else think this is "a really good result" for a 2400 grafts?

 

3 + 10 months, where is the 2400 difference?

[Jorge1977]

I have to agree with Frog

[Jfree]

HIGA, Don't take this as a personal critique. The most important thing is how you feel.

 

But with all due respect (to Bill... and even Dr Epstein), I don't see much difference here.

 

Is there more hair from month 3 to month 10? I guess. But it sure doesn't look like 2,400 grafts/5,000-plus new hairs.

 

These photos (3 and 10 months) look like something you'd see in a cheesy propecia ad - some fuzz, but very minimal growth. I don't think I've ever seen such little improvement from month 3 to 10 for this size of a transplant.

 

I would contact Dr Epstein pronto.

[hairthere]

I have to concur, these are not "WOW" results. It looks as if the 2400 were spread out over the entire area which would have provided coverage, but not density. I'm guessing that's what HIGA wanted as he seems pleased. Most Docs probably would have packed those 2400 into the front and then done the vertex/crown in a second surgery. HIGA if you could please supply immediate post-op pics as Bill suggested. Thanks!

[thanatopsis_awry]

The lack of a top-down picture to reference at ~12months may be exagerating the effect, or lackthereof, of improvement (?). After the 7th month mark, at least to me, I found it hard to get a good grasp of things -- and certaintly a *ton* can happen between the 7th month to the 12th.

 

I have to say though that I too was quite "underwhelmed" by the difference -- it just didn't feel at all like 2400 grafts. Like Bill/hairthere mentioned, it looks like the grafts were widely distributed over a vast area; perhaps that, along with no top-down photos and your hair charachteristics are playing a large role in this sentiment.

 

Bottom line, though, is that you are pleased and you know your hair better than any of us ever could.

[Bill - Seemiller]

Frog,

 

This is a patient displaying their results, not a solicitation. Why are you acting as if there is some kind of deception here?

 

I also love how you selected two of the most blurry and least quality pictures to broadcast your point. Weren't you just raving in another post about the important of high quality pictures?

 

But do you honestly think that 2400 grafts placed over a large balding region is going to give someone a "wow" result?

 

I think these are a better comparison.

 

3 Months

 

 

11 Months

 

 

Keep in mind also that we don't have any preoperative pictures to view at this point.

 

Bill

[frog]

oh right, i the one with the agenda ...

 

 

i feel that your assessment of this is as a "really good result" is way off the mark as only confirmed by every other poster here who were prepared to actually be honest. i only chose from the pictures provided as they were an exact match and thought they were a clear example this is not the result you make it out to be.

yes i feel accurate , clear, pictures are vital to assess results i also believe honest opinions are required also...

 

if this patient only grew his hair out from his 3 month situation/pre op situation, the difference would have been very similar regard less of the 2400 grafts?? in my opinion. sorry didn't realise i wasn't allowed an opinion...

 

i will let everyone elses opinion clarify that this is not a really good result even though you think it is. maybe we are all wrong..

[hairthere]

Bill, one question though: if a person puts their results on the Internet for all the world to see aren't they more or less asking for solicitation?

 

At the same time, if I wasn't happy with my results i wouldn't post them, which indicates that HIGA is indeed pleased and we should let it go at that...

[Here I Grow Again]

Hi everyone,

 

Let me just say that I appreciate all your feedback. I did indeed post for feedback good or otherwise. That's why we are all here; It's like peer review.

 

The minimal difference between the early-mid months also perplexed me a little and I honestly can't rule out my poor pic taking skills as a factor. Some pics seem to be better than others and I did play with the settings on the camera throughout (Zoom, Landscape, quality and even lighting) which is why some pics are blurry, etc.

 

This is not to make any excuses at all so again all feedback is greatly appreciated and I am going to send Dr. E an email asking for the immediate post op as I don't currently have one.

 

Nonetheless, when I look at my most recent pics, there is clearly, (at least to me so again feedback welcome) a difference between now and 3 months as pointed out by Bill with pics. I am enclosing an additional pic here which I hope provides a better view.

 

The bottom 2 are pre-op top view and around 3.5 months respectively and the top two are 1 year.

 

PS- While pre-op my barber used to ask me if I wanted him to trim the little hairs straggling in the front and just recently when he was not in and had a cut by someone else they took out the blowdryer and started blow-drying my front. Got a kick out of that- must really be something a little more significant up front now.

[the B spot]

Bill--did you make Dr. E aware of this thread?

 

#1--I think perhaps people are decieved as to the area of coverage vs. the area of need.

 

#2-- 2400 grafts over the large area of coverage is not going to provide any overwhelming results.

 

#3--It is possible that some of the severe post-op issues HIGA had caused some grafts not to grow.

 

#4--It is possible that some of the native hair HIGA retained either fell out or was shocked out due to surgery or post-op issues.

 

#5--it is possible that HIGA is an extremely slow grower and will continue to gain gradually over the next 3-4 months.

 

I think it is fine that people express their displeasure or dissatisfaction with a result. Just make sure you are looking at all possible issues.

 

HIGA-- I don't remember your post-op case-- did you have tight donor, low density, or were you trying to retain native hair? Is that why you and Dr. E opted for 2400 grafts? Are you planning another session?

 

I personally believe that you should cut you hair shorter for now, until he does another session. It will look less thin for now and be less of a hassle.

 

Again, don't get down--- your fine--you were not butchered or robbed and with the 2400 grafts if you add another 2500-3000 your end result will look great!!!!

 

Take Care,

Jason

 

PS-- I am offering my opinion on HIGA without seeing any immediate post-op pics.

[Byehair]

B-Spot

 

You suggest cutting his hair shorter. Isn't the point of a transplant so a person can grow their hair out a bit?

Obviously he enjoyed the blow dryer treatment.

This just doesn't appear to be 2,400 worth of grafts.

I seriously doubt it will be posted as one of Epstein's web highlights.

[Jfree]

I've been following this post with interest as a long time observer/non expert.

 

Several questions...

 

1.) If Epstein weren't a Colation Doc, would Bill have stated this procedure to be "really good?"

 

2) If this procedure were performed by a Bosley or MHR how much negative ranting would we be hearing? The silence has been deafening.

 

3.) If this procedure were performed by ANY Non-Coalition Doc how many posts would be demanding HIGA get a refund?

 

4.) Would any Colalition Doc, including Esptein, ever use these results for the marketing of their services?

 

5.) If all were told this is what you get for 10,000 bucks would anybody EVER get a hair transplant?

 

6.) Does appeasing HIGA (for Epstein's rep?) really serve him any good?

 

7.) Could Epstein use Billero's "really good" comment in defense of a dispute HIGA may have going forward?

[Bill - Seemiller]

Everyone,

 

If you all look at my original post on this thread, I had made the assumption (and I might be wrong) that 2400 grafts were spread out over almost his entire head. It is clear that HIGA has a large area of baldness to cover (as can be seen in his before pictures).

 

If I am incorrect (which will be cleared up by immediately postoperative pictures), then my initial post may have been a little premature.

 

However, for those who are questioning my motives and agenda, obviously you don't know me at all! I have NEVER had a problem calling it like it is regardless of whether it was a Coalition doctor or an obscure unknown doctor. I have always been honest and my intentions have always been to help others. Those who actually know me and have interacted with me on the forum can back this up.

 

Regardless, most of us have lost sight of the fact that this patient is satisfied so far. Remember also that 2400 grafts is not going to produce a "wow" result unless they are densely packed in a small area.

 

Perhaps all of us (including me) should reserve final judgement until we have more surgical details and immediately postoperative photos (which I stated in my initial post would help us be able to better evaluate his results).

 

I have notified Dr. Epstein of this post via email so that he may be able to end any confusion.

 

Bill

[Jeffrey Epstein MD, FACS]

Thanks Bill for notifying me as to what is going on with my patient's posted results.

In all fairness, there are several points that need to be made so that a more balanced perspective can be obtained. I prefer not to be compared to some of the large chains, for I have spent almost 15 years refining my techniques and providing my patients with the very best work possible.

When I first consulted with this patient by email, I informed him that the goal would be to transplant a minimum of 2200 to 2400 grafts, but that the goal would be to try to obtain as many as 3200 grafts if possible, given: his relatively light scalp that would contrast significantly with his very dark and wiry hairs; his relatively young age and the high likelihood that his remaining vellus scalp hairs in the area of the transplant are at high risk of soon falling out; and that my experience was that individuals with his presenting characteristics simply do not achieve significant results with procedures of 2200 to 2400 grafts- that the resultls would be quite natural appearing despite the challenges of working with such coarse hair, but that I would do everything I could to give him the very best results, and that he likely would benefit from a second procedure.

 

Obviously my patient heard quite well what I advised him about, and therefore he is NOT DISAPPOINTED for I was honest. In fact, I am happy with his results, which obviously are not my "poster" results, but not every patient can have incredible results. In fact, I have had the patient speak with at least one other prospective patient from his area, so I am not trying to "hide" anything.

In the procedure, I was able to obtain 2411 grafts, for a total of 3743 hairs. This was because of the relatively low donor density and the tightness of his donor area- and of course I wanted to minimize donor site scarring so did not try to obtain too wide of a donor strip- he obviously wears his hair somewhat short. The procedure went quite well, but he had over 8 weeks of prolonged erythema/redness and irritation in the recipient area which was successfully treated with two courses of antibiotics.

 

 

So, what is going on? Hopefully there will be at least a bit moroe growth to come. In any case, I anticipate, and have relayed these thoughts to my patient, that he will be able to have a second procedure that will make a nice improvement in his density. I really like this patient, have a wonderful rapport with him, and look forward to giving him the very best possible results.

 

Jeffrey Epstein, MD, FACS

Miami and NYC

www.foundhair.com

[the B spot]

Edit posted the same time as Dr. E.

 

 

Jason

[wylie]

Actually, I think the patient looks great, the transformation was seamless, the results look perfectly natural.

 

And thats whats important. If he wishes for more density he will get that with another session, in the meantime, he has considerably more hair after 2400 grafts and sounds as if he is quite pleased with these results.

[Gorpy]

This is not a bad or unexpected result considering the hair characteristics that Dr. Epstein describes. This patient only received 3743 hairs from his 2400 grafts. That's way below average. The average 2400 graft patient would receive around 5200 hairs at a 2.2 hair per graft. His 3700 hair procedure is the equivalent of a 1700 graft procedure for an average patient.

 

Considering that he covered an area somewhat equivalent to my first procedure (I think), that's about what I would expect. I had 300 more grafts, but 2000 more hairs moved - and mine was still somewhat thin!

 

Never underestimate how much hair it takes to get a significant result.

 

Gorp

[Here I Grow Again]

Ok folks, I'd like to chime in here as the patient in order to share some background info that will hopefully clear several things up so give me room for what I have to say:

 

First, as I mentioned in my previous post I welcome all feedback and please believe me when I say I am in no way discrediting anyone's opinion posted here. There have been very good points made.

 

I DO NOT believe Bill is here but to provide honest feedback and opinion period, and respectfully disagree with anyone who thinks otherwise. I am not here to defend anyone at all but I think that's a bum wrap undeserved so I wanted to mention that.

 

With that said, I can't help but wonder if we are looking at all the pics on the album? I am in no way trying to be funny but I feel like the biggest improvements were in the 11-12 months and thought those pics reflected a bigger change but it looks like folks are making final judgements on the 10 month pics. Just want to make sure since I've posted additional pics in my last post that show current state, and am thinking not everyone saw those.

 

If we are all indeed looking at the same pics then ok.

 

Anyway let me back up and start from the beginning for the sake of disclosure and clarity.

 

When I first consulted with Dr. E, we spoke about my hair loss history, family history of hair loss, hair characteristics prior to loss, etc. I also consulted in person prior to the procedure. Now his feedback to me was that due to my relatively young age (will be 40 in January) and degree of hair loss (and it was significant- I believe class 5/6) hair characteristics, skin color and scalp laxity, which all play a role, I would most probably not be able to obtain a full head of hair. We also discussed expectations of the first procedure and future procedures. What Dr. E stated above in his post is 100% accurate. The reason why I chose Dr. E (And I consulted with other members) is because of what I thought was an honest and accurate assessment along with achievable goals. In addition to our discussion I specifically asked to see/speak with past clients with similar hair loss and characteristics as I so that I may assess what my results would look like. I met with a past client in person and spoke to others. Their results were very good and I believe in line with what I could achieve. I disagree that Dr. E would not post such results on his site as I believe if you take a look, there are samples of several degrees of success on there already. This is also another reason why I chose Dr. E because he shares a spectrum of results and not just every stellar outcome only. I believe he sets a realistic expectation.

 

Now let me say that if I was unhappy with my results I would not hesitate to pick up the phone, call Dr. E and voice my concerns and post my pics stating so (but I don't think anyone is really saying I am unhappy so I just mention this in passing.)

 

Anyway, if everyone has indeed viewed my most recent pics and feels that the results are less than favorable I have to humbly respect that opinion and without a doubt that is why we are all here.

 

Ok, so folks I received 2400 graphs approx my first time around. I've read in this forum many times that this amount on someone with my degree of loss will not produce Ricky Martin. Fortunately, we made sure that that was not my expectation and I believe that again most folks in my situation get multiple procedures (2-3) in order to get close to that Ricky or Don Johnson look.This is my first pass after all.

 

So based on what I've seen over the past year and a half on this site I believe the level of density on the first pass is not going to produce what we would all like except for a lucky few, so I don't think it is realistic to expect that now and I don't. Gotta stick with your plans long term.

[Glock08]

HIGA:

Gorpy summed it up pretty well..as usual (nice to see you back Gorp). My Ht didn't start to thicken until the 11-12 months..so you really can't determine results yet. Didn't notice in your post..Are you taking Propecia or using Rogaine?

 

It appears that you have a solid plan of action with a Dr. that is determined to follow the results through to your satisfaction.

 

Wish you the best.

Glock08

[balody]

higa,im glad you have both feet on the ground,you obviously knew when talking to dr e there were limitations to what your hair characteristics could achieve on the first pass.like you i had 2400 on my first session and my hair is course and wirey,so i knew not to expect ricky martin 12months later.

again its all to do with expectations,if clincs only put up pictures of ricky martin like transformations,this is what the less educated are bound to expect.no two people are the same and the sooner people realise this the better.

having said this i think we are well to early to be judging your outcome.alot changes between 12 and 18 months and you wont neccesarily notice these untill you compare photos.good luck

[Bill - Seemiller]

Dr. Epstein,

 

Thank you for offering your professional medical input on this thread. Your and HIGA's last post certainly helped clarify the anticipated result. This leads me back to my original thoughts that this is a good result for the number of grafts transplanted (especially given the hair characteristics you have now described).

 

Many seeking hair transplant patients are always looking for the night verses day single hair transplant session. Whereas these "wow" results are impressive to see, they are not always practical and realistic. Typically these results are seen with a much greater amount of follicular unit grafts and the best hair characteristics.

 

Had Dr. Epstein densely packed these 2400 grafts into only the hair line area, I could understand why people would be questioning the result. But spreading out these grafts over a much larger area (it appears at least half way), is going to to alter the appearance of hair density.

 

HIGA had a very high level of balding (almost a level 6) where even the few native hairs left (especially in the front) were severely miniaturized.

 

In my opinion, with his degree of balding, HIGA's result is expected given the number of grafts (and the number of hairs) he has received. He is a work in progress and can go back if he wants more density and coverage.

 

Dr. Epstein and HIGA, thank you for clarifying this situation.

 

HIGA or Dr. Epstein, if either of you have any immediately postoperative pictures, this will bring some further clarification I am sure.

 

Thanks,

 

Bill

[NervousNelly]

I'm late to add to this thread as when I first saw it, I was waiting for the facts before making comment. Unless I missed it, I still don't believe that there was an estimate of the recipient area cm2.

 

Gorpy summed things up very well. I also believe that there is still going to be some growth to come as at 9 months he was still having shockloss in donor area. This would be another indicator that he is a slow grower.

 

Expectations and satisfaction of results is a totally subjective thing. In this case Higa sounds like he was well versed and informed in his decision. It is unfortunate for the low hair count, but nonetheless, the patient is happy with his personal results and that ofcourse is the bottom line.