Jump to content
Wingnut

My Second Hair Transplant Consultations and Questions

Recommended Posts

So for my second hair transplant I've got the following goals in mind :

-No post operative unexpected issues (eg infection) and minimize shock loss in donor area

-Complete my head of hair. I have about 60 cm^2 of crown and roughly 12 cm^2 of hair line to do and touch up and weak areas from my first HT.

-Do any future touchups via FUE. While strip wasn't that painful, it was very annoying for 6 months.

 

I went into the consultations asking for another 4000 grafts.

 

I've spoken to the following Doctors : Dr. DeYarman, Dr. Alexander, Dr. Reed, and Dr. Ross.

 

Dr. DeYarman (http://www.deyarmanmedical.com/) wants to do 50 hairs/cm^2 in the hair line and 40 hairs/cm^2 in the crown. For a total of 3000 grafts. Although my initial closure was sutures and a few staples, all his surgeries now are staple only closures. As I have documented my experiences with DeYarman already, I'll leave this here.

 

Dr. Alexander (http://www.biltmoresurgical.com/) (who didn't see me in person) and I had a long conversation about how to do sterile surgery including his practices and how a lot of doctors do not follow good sterile surgery processes. He was also confident in his ability to achieve 70 grafts/cm^2, (which really is not one of my goals.) While I haven't ruled him out, he is down on the list due to him being in Arizona.

 

Dr. Reed (http://www.ljhr.com/) (although he hasn't seen me in person) feels comfortable with only about 2200 grafts, I have an appointment to see him on October 11 for a consultation. I was really impressed with our initial emails, I emailed him on a Friday night and he emailed me back on Saturday and then we exchanged one more email on Sunday. I am concerned with the three weeks required to get an initial consultation (yes, I realize it is ISHRS conference time).

 

Dr. Ross who I saw yesterday, brought me the most "confusion" so far. I saw his patient advisor first, but he spent a good hour with me during the consultation, I was in consultation for 1.5 hours. Dr. Ross only feels comfortable with inserting 30 grafts/cm^2 in any specific surgery, in other words to achieve 60 grafts/cm^2, he requires two separate surgeries. He specifically said that anything over 30 grafts/cm^2 are wasted and would probably not result in growing hair. His patient advisor doesn't feel that I have achieved any better than 30 grafts/cm^2 in my first surgery (although some should be better than that given the number of grafts I had placed). I even pushed Ross for 40 grafts/cm^2, he said, "I can do it," but it's wasting your hair. He also had a very strong opinion about what I should do for a hair line and what looks fake (regarding temple hair characteristics and my forehead wrinkles). I admire his integrity here.

 

Further, Ross doesn't do a trichophytic closure, only the standard sutured closure, he didn't see any value in the trichophytic closure. When he inspected my scar, he said (while it was good, about 1 - 2 mm), there wasn't a single hair growing in the scar. Dr. Alexander also spoke poorly of the trichophytic closure, stating that it was a waste of hair (as possible donor hair is left to grow through the scar). Ross stated that a widened scar is soley due to donor laxity. Fortunately for me (only 8 months out), I apparently have excellent laxity in the scalp. I have been doing infrequent scalp exercises based on the JoTronic YouTube Video (just FYI, other Doctors reference that video).

 

When I discussed my concerns regarding the donor shock I had in my first surgery (took about 6 months to fill back in). Dr. Ross only feels comfortable with a 1.2cm maximum wide donor area to lessen the impact to the area, I am pretty sure that my first surgery was much wider than that.

 

Dr. Ross feels comfortable only with about 2500 grafts which is 30 grafts/cm^2 over the area he measured to be 84 cm^2. This will probably yield higher density as my crown has some (although minimal) growth after the first HT, but the new hairline will only be 30 grafts/cm^2.

 

Right now, I feel most comfortable with Dr. Ross simply because of his integrity regarding number of grafts, after hearing my concerns about surgical sterility he whipped out a comb from a surgically sealed package (which was totally unnecessary BTW.).

 

Some areas of concern for Dr. Ross: can't find any results pictures or positive long term reviews on any forum for him (anyone out there a patient of his?) and a strange concern, that he doesn't have hair washing facilities in his office. Although he seems to have a modern up to date office (with a 12k patient chair), he has no facilities to wash hair. Fortunately for me, in my previous surgery I insisted the Doctor wash my hair the first time after surgery and thats how I found out I had a recipient infection. Dr. Ross's patient advisor said I could come in for a check up whenever I felt like.

 

 

So this leads to my two questions :

 

1) It seems to me that the trichophytic closure is almost not valuable. The value is in the closure. Anybody have a body of data that contrasts this completely?

 

2) Any comments on only doing 30 grafts/cm^2? What I am looking for is people that feel they got greater than 30 in a single session (and not just in one cm^2).


----

First Hair Transplant performed by Dr. DeYarman, approximately 4180 grafts on 01/10/2007

Second Hair Transplant performed by Dr. Reed, approximately 2207 grafts on 10/10/2007

Third Hair Transplant performed by Dr. Reed, approximately 1896 grafts on 05/13/2008

 

Total Grafts 8283

Share this post


Link to post
Share on other sites

So for my second hair transplant I've got the following goals in mind :

-No post operative unexpected issues (eg infection) and minimize shock loss in donor area

-Complete my head of hair. I have about 60 cm^2 of crown and roughly 12 cm^2 of hair line to do and touch up and weak areas from my first HT.

-Do any future touchups via FUE. While strip wasn't that painful, it was very annoying for 6 months.

 

I went into the consultations asking for another 4000 grafts.

 

I've spoken to the following Doctors : Dr. DeYarman, Dr. Alexander, Dr. Reed, and Dr. Ross.

 

Dr. DeYarman (http://www.deyarmanmedical.com/) wants to do 50 hairs/cm^2 in the hair line and 40 hairs/cm^2 in the crown. For a total of 3000 grafts. Although my initial closure was sutures and a few staples, all his surgeries now are staple only closures. As I have documented my experiences with DeYarman already, I'll leave this here.

 

Dr. Alexander (http://www.biltmoresurgical.com/) (who didn't see me in person) and I had a long conversation about how to do sterile surgery including his practices and how a lot of doctors do not follow good sterile surgery processes. He was also confident in his ability to achieve 70 grafts/cm^2, (which really is not one of my goals.) While I haven't ruled him out, he is down on the list due to him being in Arizona.

 

Dr. Reed (http://www.ljhr.com/) (although he hasn't seen me in person) feels comfortable with only about 2200 grafts, I have an appointment to see him on October 11 for a consultation. I was really impressed with our initial emails, I emailed him on a Friday night and he emailed me back on Saturday and then we exchanged one more email on Sunday. I am concerned with the three weeks required to get an initial consultation (yes, I realize it is ISHRS conference time).

 

Dr. Ross who I saw yesterday, brought me the most "confusion" so far. I saw his patient advisor first, but he spent a good hour with me during the consultation, I was in consultation for 1.5 hours. Dr. Ross only feels comfortable with inserting 30 grafts/cm^2 in any specific surgery, in other words to achieve 60 grafts/cm^2, he requires two separate surgeries. He specifically said that anything over 30 grafts/cm^2 are wasted and would probably not result in growing hair. His patient advisor doesn't feel that I have achieved any better than 30 grafts/cm^2 in my first surgery (although some should be better than that given the number of grafts I had placed). I even pushed Ross for 40 grafts/cm^2, he said, "I can do it," but it's wasting your hair. He also had a very strong opinion about what I should do for a hair line and what looks fake (regarding temple hair characteristics and my forehead wrinkles). I admire his integrity here.

 

Further, Ross doesn't do a trichophytic closure, only the standard sutured closure, he didn't see any value in the trichophytic closure. When he inspected my scar, he said (while it was good, about 1 - 2 mm), there wasn't a single hair growing in the scar. Dr. Alexander also spoke poorly of the trichophytic closure, stating that it was a waste of hair (as possible donor hair is left to grow through the scar). Ross stated that a widened scar is soley due to donor laxity. Fortunately for me (only 8 months out), I apparently have excellent laxity in the scalp. I have been doing infrequent scalp exercises based on the JoTronic YouTube Video (just FYI, other Doctors reference that video).

 

When I discussed my concerns regarding the donor shock I had in my first surgery (took about 6 months to fill back in). Dr. Ross only feels comfortable with a 1.2cm maximum wide donor area to lessen the impact to the area, I am pretty sure that my first surgery was much wider than that.

 

Dr. Ross feels comfortable only with about 2500 grafts which is 30 grafts/cm^2 over the area he measured to be 84 cm^2. This will probably yield higher density as my crown has some (although minimal) growth after the first HT, but the new hairline will only be 30 grafts/cm^2.

 

Right now, I feel most comfortable with Dr. Ross simply because of his integrity regarding number of grafts, after hearing my concerns about surgical sterility he whipped out a comb from a surgically sealed package (which was totally unnecessary BTW.).

 

Some areas of concern for Dr. Ross: can't find any results pictures or positive long term reviews on any forum for him (anyone out there a patient of his?) and a strange concern, that he doesn't have hair washing facilities in his office. Although he seems to have a modern up to date office (with a 12k patient chair), he has no facilities to wash hair. Fortunately for me, in my previous surgery I insisted the Doctor wash my hair the first time after surgery and thats how I found out I had a recipient infection. Dr. Ross's patient advisor said I could come in for a check up whenever I felt like.

 

 

So this leads to my two questions :

 

1) It seems to me that the trichophytic closure is almost not valuable. The value is in the closure. Anybody have a body of data that contrasts this completely?

 

2) Any comments on only doing 30 grafts/cm^2? What I am looking for is people that feel they got greater than 30 in a single session (and not just in one cm^2).


----

First Hair Transplant performed by Dr. DeYarman, approximately 4180 grafts on 01/10/2007

Second Hair Transplant performed by Dr. Reed, approximately 2207 grafts on 10/10/2007

Third Hair Transplant performed by Dr. Reed, approximately 1896 grafts on 05/13/2008

 

Total Grafts 8283

Share this post


Link to post
Share on other sites

Wingnut,

 

It sounds like you've been doing a lot of homework. That's good...keep it up!

 

1. I personally feel that there is a lot of value in the trichophytic closure but from what I've read and seen, it works better on a "virgin" scalp. Using the trichophytic closure technique, the doctor overlaps one side of the wound over the other so hairs can grow through it. The question is...could more follicular unit grafts be extracted if this closure technique was avoided. Logicly it makes sense since it is taking extra skin laxity to close the wound that could have been used to take a bit more grafts. What is the sacrifice? The scar may be a bit more evident at shorter lengths. Of course, I'd like to hear a doctor's input on this.

 

2. This is obviously an over simplified answer, but IMO, the more density the better. Though a pleasing look can be achieved with lower densities, harsher lighting will reveal the flaws more evidently with lower densities. The difference between 30 FU/cm 2 and 70 FU/cm 2 is an illusion of density verses the real thing.

 

Of course one has to keep in mind the overall area to be covered and the risk of future loss. Some donor should be available in reserve for this case.

 

I hope this helps.

 

Bill

Share this post


Link to post
Share on other sites

Hi Bill,

 

Thanks for the response.

 

Regarding the trichphytic closure, if no hairs grow in the scarline then there is no value to it. AFAIK, the trichophytic closure doesn't yield a thinner scar. Have a lot of people seen hair growing out of their scar?

 

Regarding density, I totally agree. However, my question more related to density put in a single session. I have never heard a Doctor refuse to put more than 30 grafts/cm^2 in a single session, is this common with any other Doctors?

 

Thanks


----

First Hair Transplant performed by Dr. DeYarman, approximately 4180 grafts on 01/10/2007

Second Hair Transplant performed by Dr. Reed, approximately 2207 grafts on 10/10/2007

Third Hair Transplant performed by Dr. Reed, approximately 1896 grafts on 05/13/2008

 

Total Grafts 8283

Share this post


Link to post
Share on other sites

You should be able to place 40-70 fu's cm/2, when appropriate.

 

Dr. Shapiro will do 55-60 fu's cm/2 when the situation calls for it, and only limits patients when supply does not meet demand.

 

To limit a patient to 30, just "because" is not good enough, IMHO

 

Out of your list, my advice is go to Dr. Alexander.

 

Dr. DeYarman had well documented issues here on this site and elsewhere. This is public information, anyone can research this.

 

Dr. Reed is by all accounts fantastic, but I have not seen enough of his work to comment. There have been a couple of happy post-op patients who have posted here.

 

Please do a search on a member named Wrangler for information on Dr.Ross (off the top of my head, I think his experience was less than satisfactory)Things may have changed, but in this case, I think you want to make sure you make the right choice.

 

I would think you would be better off with a doctor with proven, consistent results.

 

Anyway, check out Dr. Keene in Arizona as well.

 

Would be worth a trip.

 

Take Care,

Jason


Go Cubs!

 

6721 transplanted grafts

13,906 hairs

Performed by Dr. Ron Shapiro

 

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

Share this post


Link to post
Share on other sites

Wingnut,

 

I agree with your assessment with the trichophytic scar. If no hair is growing through it, then there is no benefit to it.

 

I can't speak for your situation but there is hair growing through my scar. There are plenty of close up shots of the tricho scar posted on this forum that show evidence of hair pushing through the scar and it really does help camoflauge it.

 

Bill

Share this post


Link to post
Share on other sites

No doubt the T closure provide a superior method of closure regrading scaring..

 

There is a benefit otherwise the top cod would not use it as well as plastic surgeons


JOBI

 

1417 FUT - Dr. True

1476 FUT - Dr. True

2124 FUT - Dr. True

604 FUE - Dr. True

 

 

 

 

 

 

 

My views are based on my personal experiences, research and objective observations. I am not a doctor.

 

Total - 5621 FU's uncut!

Share this post


Link to post
Share on other sites

So the deed is done (again). On 10/10/2007, I had 2207 grafts placed by Dr. William Reed.

 

Highlights:

-Surgery lasted from 7:45am to 7:00pm

-2207 grafts placed total. Approximately 120 grafts (1s and 2s) placed in my temple areas and the remaining placed in the crown.

-I had Dr. Reed and 3 techs working on me.

 

Some notes:

-My first hair transplant yielded significant shock loss in the donor area. I showed Dr. Reed the pictures of me post-op approximately March 2007. He commented that they looked like the train tracks of the sutures being pulled too tight. Time will tell how the shock loss in the donor area will be from this surgery, but a comparison made between my first closure and this one by non-medical observers is "a day and night difference." This leads to the second note.

 

-Dr. Reed's conservative estimate on consultation was 2700 grafts (again I went into all the consultations trying to get 4000 grafts). However, upon "getting in there," Dr. Reed discovered a 5mm scar in the areas where the back of my head leads to the side of my head, which significantly cut into the number of achievable grafts. I can post pictures if anyone wants to see.

 

My donor area was covered with a pressure bandage for the first night and my head was covered with a bandana, both placed by the Doctor's office. I was instructed not to remove either (which I didn't).

 

I went back yesterday for a shampoo and check up at the Doctor's request. One of the techs also "reset" 3 of my grafts.

 

I just washed my hair myself today and I was instructed to do so twice a day from here on out.

 

I am also going to see him on Monday for a checkup (at my request), he is willing to see me everyday (if I want). I will also be returning on Wednesday for suture removal.

 

I slept on a pillow last night and saw no blood from the donor area leaked onto my pillow, which was a bit of a surprise. My first hair transplant I oozed for 4 days in the donor area.

 

I am feeling good now, I am getting to the end of my Hydrocodone and now onto the 2 Advils every 4 hours. I will save the remaining Hyrdocodone's for falling asleep. No swelling as of yet. I am also on Prednisone and Cephalexin. I was also given furosemide (for swelling, which I have not taken) and Alprazolam for sleeping (I took one on the first night).

 

My experience at Dr. Reeds was great. He seems very straight laced, but him, his staff, and I joked practically the whole day. I was given two (could be three) shots of Versed to make the day go faster. Side note: Text messaging while in surgery and on versed is a very bad idea, when I got home that night and checked out what I actually had sent through the day I was pretty shocked.

 

Obviously, I will reserve my judgements till about 6 months, but things are going pretty well right now. I'll post comparison pictures of my donor area in December to compare the shock loss in the donor area from my first and second hair transplants.


----

First Hair Transplant performed by Dr. DeYarman, approximately 4180 grafts on 01/10/2007

Second Hair Transplant performed by Dr. Reed, approximately 2207 grafts on 10/10/2007

Third Hair Transplant performed by Dr. Reed, approximately 1896 grafts on 05/13/2008

 

Total Grafts 8283

Share this post


Link to post
Share on other sites

Wingnut,

 

Congrats on your surgery, sounds like you are excited about the extra care for the donor. I think all HT candidates should take heed with your case. Bleeding for several days in the donor may indicate a bad closure. This of course, would lead to the wider scar. I am sure things are all good now. What closure was used - Staples or sutures??


NoBuzz

 

 

 

Share this post


Link to post
Share on other sites

Hi NoBuzz,

 

This was a suture closure, many of the doctors I spoke to said that a suture closure gives them better control over how the skin edges lie on top of each and therefore a better result.

 

I'm day 4 now, haven't seen a drop of blood past the pressure bandage removed 12 hours post-op and haven't taken the Hydrocone in 24 hours. I am still stiff and a little sore. I'm going in for a checkup tomorrow and suture removal on Wednesday.

 

I'm pretty excited to see the density in the crown although I know I seeing a lot of "scab density" in the mirror. However, the hair is also only 1/16" long, so it might just look like this. icon_smile.gif

 

I'm also pretty excited about the temple work as well, even how small it is, it does make a huge difference.

 

Sad to say, I'm already thinking of HT#3 for next October. Damn you hair greed, damn you to hell........ icon_wink.gif


----

First Hair Transplant performed by Dr. DeYarman, approximately 4180 grafts on 01/10/2007

Second Hair Transplant performed by Dr. Reed, approximately 2207 grafts on 10/10/2007

Third Hair Transplant performed by Dr. Reed, approximately 1896 grafts on 05/13/2008

 

Total Grafts 8283

Share this post


Link to post
Share on other sites

Great to hear that things went well. In a matter of a few months you will start to see some pretty dramatic changes given the refined work that Dr. Reed is known for. Keep us posted on things and if you can post pics that would be cool.

 

NN


NN

 

Dr.Cole,1989. ??graftcount

Dr. Ron Shapiro. Aug., 2007

Total graft count 2862

Total hairs 5495

1hairs--916

2hairs--1349

3hairs--507

4hairs--90

 

 

Share this post


Link to post
Share on other sites

Congrats on choosing Dr Reed Wingnut. I got 1900 from him back in July 06' and don't regret my decision. In fact, I was in his office the day before you got your surgery and we discussed the possibility of round 2.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×