Repairs not as effective in growing hair?

[John_in_NC]

Look at this guy from another forum:

http://www.hairlosshelp.com/forums/messageview.cfm?catid=5&threadid=74187

 

He had a horrible HT and went for repair with Dr Feller. On Dr Feller's picture he looks pretty good, but outside he does not. Is it harder for hair to grow during a repair?

 

The next two pictures I think were from hsi first surgery in UK:

 

 

 

 

The rest of the pictures are on the link, I cannot figure out how to add them all.

[Bill - Seemiller]

John,

 

I think repair cases have to be taken case by case.

 

In this example, it appears that a lot of scarring in and around the recipient area could have led to less than optimal growth.

 

From Spex:

 

"BHUK was an extreme repair case performed a while ago in the UK. He brought to the table many variables including a very wide scar and rows of plugs with a great deal of scar tissue in and around the recipient area."

 

And

 

"Remember especially with repair cases some take longer than others and some require more attention and work than others depending on the severity of their personal situation."

 

It also seems that this patient had two types of hair follicles contributing to a less than natural look.

 

From Dr. Feller:

 

"BHUK is a "mosaic" hair wise. This means he has two different types of follicles existing throughout his donor area. One group is the standard hair that he identifies himself with. The other is a much darker, courser, and curlier hair.

I see a patient like this maybe once every 3 years and it is utterly fasinating except for the fact that it works against the patient's goals. The problem was made even worse when his former clinic decided to use minigrafts containing 2-4 grafts on the hairline. By doing this the negative characteristics of the "bad" hair were amplified, and this is readily seen in the before photos.

 

My goal was to cover the entire frontal area with enough density so that the bad hairs could be covered by the good hairs. For the most part it worked, but he still needed some touching up in certain areas which were covered by his second procedure with us. "

 

From what I have read, this patient was made aware of the risks before entering into surgery. Seemingly there is a long term plan in place to help camoflauge the two types of hair.

 

Repair cases are seemingly extremely difficult, especially depending upon the individual cirumstances.

 

Bill

[nobuzz4me]

This is why sometimes its good to fue out those frigging plugs and start over instead of just camoflaging them.

 

Yield may be a little lower and their is a risk of additional scarring but the grafts can be divided and replanted at the correct angles.

 

That is the route I chose being a repair case myself.

 

I will say if you have enough donor hair to dense pack it can be concealed but not all of us have the spare donor.

[John_in_NC]

in all fairness: he may still grow but in the middle I doubt he had any plugs.

 

I also agree that it is more difficult though

[NervousNelly]

I guess that I am not really sure of the question in this particular case. Yes it is harder for the doc as there is poor work that he must conceal and hope that things grow in the scar tissue. Personally I don't see the scar tissue in this case. Why would there be a lot of scar tissue with micros containing 2-4 hairs? I could understand plugs but in this there does not appear to be evidence of scar tissue--usually you see a lighter or whiter skin immediately around the graft. Maybe I am missing something.

[NervousNelly]

Is the first pic a photo post op with Dr. Feller? If yes--the results unfortunately are not good. Yikes. I guess it happens and this is a more difficult case, but I also have seen worse plugs that have been concealed. Can't win them all unfortunately. Bummer. Hopefully something can be done for this poor guy.

[John_in_NC]

Originally posted by NervousNelly:

Is the first pic a photo post op with Dr. Feller? If yes--the results unfortunately are not good. Yikes. I guess it happens and this is a more difficult case, but I also have seen worse plugs that have been concealed. Can't win them all unfortunately. Bummer. Hopefully something can be done for this poor guy.

 

Unless he made a mistake when he posted on that other site. The heading says "After 10 months of growing... in daylight (worst light) indoor lighting is better or with flash. " and the hair is different from the pre-op one. Also it looks like he lost some of his blond native hair in the middle (permanent shock?). I hope he turns OK (meaning much better) since he seems to have suffered a lot already.

[Bill - Seemiller]

John,

 

You are correct in your analysis of the pictures. The picture you posted above is 10 months after his hair transplant with Dr. Feller.

 

Clearly the results are not optimal, but from what I understand this was a pretty nasty repair case. The fact that this patient appears to have two types of hair (as described above) certainly doesn't help matters.

 

His appearance has indeed improved from the original case - but more may be needed to further improve his appearance.

 

This is another example however, about how pictures can be deceiving and why I put so much pressure on clinics sometimes to post pictures that expose a true representation of the work performed!

 

The indoor pictures are taking in different lighting and with his hair combed down. Clearly his indoor pictures look a lot better.

 

Bill

[gazzasgoin2]

From the other site it seems BHUK has just completed a second HT this week that should provide further density in the temples to camouflage.

 

It does seem like he was an extremely difficult case due to the extent of his previous sub par work and his unusual hair characteristics.

 

IMO you have to give credit to any doctor willing to take these more difficult cases on when optimal results will always be more difficult to achieve.

 

Hopefully he will get his desired results from this next pass.

[TheHairLossCure]

Growth in scar tissue, recipient or donor, is not always as predictable as we would like. I think most doctors are upfront about this when confronted with repair cases. It is important to note that, at 10 months, we do not always see the final result. A small percentage of patients will experience significant improvement after the 1 year mark. Let's hope this the case.

[John_in_NC]

Originally posted by Bill - This is another example however, about how pictures can be deceiving and why I put so much pressure on clinics sometimes to post pictures that expose a true representation of the work performed!

 

The indoor pictures are taking in different lighting and with his hair combed down. Clearly his indoor pictures look a lot better.

 

Bill

 

You guys should push for standards in picture taking: what type of lighting, flash /no flash, from how far and what positions. If you take the picture from far enough or in certain lights, people will be mislead and that is not fair to prospective patients. By having standards it's much easier to judge.

[chucky]

in the pre op picture it looks like their is a purpleish colour around the plugs which looks like faded bruising,this may be the damaged skin or may be camera/lighting.Its hard to see scarring from punch holes/slits but if you imagine this.A hole is punched in your skin which causes a break and the body immediately tries to repair this hole thus leaving scar tissue however minute and if you have say 1000 of these in a certain area where holes have been made with no growth there is going to be quite a bit of scar tissue which is very hard to see.

the result looks better with the hair flat and it does look thin when brushed back but there is still maturing to come and bhuk is going under the knife again.

maybe dr feller can explain this better.

i have followed this case and considering the damage done previously i feel the result so far is on track with bhuk expectations.

lets hope the second pass adds more density as he deserves it.

[Bill - Seemiller]

John,

 

You guys should push for standards in picture taking: what type of lighting, flash /no flash, from how far and what positions. If you take the picture from far enough or in certain lights, people will be mislead and that is not fair to prospective patients. By having standards it's much easier to judge.

 

I agree. This issue is HUGE in my opinion and I've been pushing it for some time now.

 

Sometimes I take a lot of heat from members for being TOO critical of pictures but this very thread should show our members why I HAVE to push. I'm concerned about lighting, angles, hair styles, etc. It all adds up and though the INTENT may NOT be to deceive, they simply aren't accurate.

 

I believe in an accurate representation of the pictures and the truth is that there is NOTHING like outside natural lighting that exposes the truth.

 

This is yet another reason why generally speaking that patient posted pictures are still better than when a physician or consultant posts pictures.

 

Bill

[John_in_NC]

Originally posted by Bill - This issue is HUGE in my opinion and I've been pushing it for some time now.

 

 

Keep up the good fight and happy thanksgiving.

[M&M]

Very interesting topic about scars and about photo accuracy. I was taking photos of my 18-month growth and depending on where I took the photos (even when no flash was used), my hair would go from thick to thin in a matter of seconds. Talk about depressing!

[John_in_NC]

Originally posted by M&M:

Very interesting topic about scars and about photo accuracy. I was taking photos of my 18-month growth and depending on where I took the photos (even when no flash was used), my hair would go from thick to thin in a matter of seconds. Talk about depressing!

 

Hi M&M,

there is guy right now on the other forum who has taken some pictures with flash and is flattering himself even though he knows his hair looks crappy. At 11 months he posted horrible looking pictures and was depressed...days later new pictures surfaced and he was happy and glad to be the center of the attention since everyone made belive they didn't see the other ones.

 

at least you're honest with yourself

[chucky]

hi john

which forum and poster is that as i would like to have a look

thanks

[John_in_NC]

One sentence for you Spex: walking conflict of interest.

Me: On no one's payroll.

 

If the patient had not put his pictures we would have thought that this was an amazing transformation--judging by your picture. At least don't try to spin it as such... and don't shift blame when you get caught. I did not take any of these pictures, and I was merely pointing out the night and day difference. Your personal attacks are not called for. This is a forum to discuss, not to praise everything a doctor does. Many things could have gone wrong and maybe no doctor could have gotten a better result, but at least be honest. Instead of attacking me explain the picture discrepancy!

 

BTw., I put "I think" on more than one picture as I was not 100% sure, especially if they pulled one picture out from the other forum, the order they'd appear here and so on.

[Bill - Seemiller]

Spex,

 

John is a well respected member of our community only interested in the truth and does not deserve to be attacked.

 

Thank you for apologizing to him.

 

I happen to agree wholeheartedly with his assessment of the need for an accurate set of photos to be represented. As I've seen a need for it, I've been pushing hard for accurate photos regardless of whether or not it is popular to do so.

 

Whereas I do not believe there is an attempt to deceive on your or Dr. Fellers part, clearly this shows just how important pictures in natural lighting are as they tend to expose the reality of a situation. Clearly the cosmetic appearance of this patient's hair has improved significantly and clearly this is a difficult case. The pictures in natural lighting however, reveal that he is not as far along as the indoor pictures lead our members and guests to believe.

 

Personally, I feel that it is important to hold hair restoration clinics to a higher level of accountability when posting photos and sharing the details. It is clearly critical to the seeking hair transplant patient to understand what he/she is to expect before undergoing hair transplant surgery.

 

Therefore I request that in the future that hair transplant clinics do their absolute best to post photos that best reflect reality with detailed explanations of a given case so that it is fully understood by the seeking hair loss sufferer.

 

Best wishes,

 

Bill

[Perfect Fit]

John - thanks for raising this topic; a thoughtful and well-argued thread and I agree with Bill that some standardisation of pictures would help immensely in making true assessments of results. I guess there is no substitute for meeting former patients in person...

 

Spex - I have met you in person and I have no doubt that you do genuinely try to help guys out in what can be a very cynical business.

[Dr. Alan Feller]

In some cases I believe that a repair case should not be expected to grow as well as a virgin scalp. But such is not the case in ALL repair cases, so let's put that to bed right now.

 

Spex is an excellent example of a repair job. His entire hairline was scarred from his prior surgeries in the UK and his yield might have been expected to be LOWER than a virgin scalp. However, his yield and results were excellent which is even all the more suprising considering he was repaired purely with FUE grafts.

 

Repair patient Spex- All FUE

<A HREF="http://www.fellermedicaldata.com/repair/plugfix/2.jpg%5B/IMG%5D" TARGET=_blank>

 

 

The reason for obvious lower yields in repair cases compared to virgin cases has much more to do with the individual's physiology rather than the simple fact that it was a repair case.

 

Part of the problem may be that many repair patients simply do not have the premium resources left in the donor area that they once had because they were depleted by the HT original doctor. Things like high caliber hair, scalp laxity, and prime locations within the donor area are FINITE and so the repair HT doctor always operates at a distinct disadvantage compared to the original doctor.

 

Another problem hampering the repair surgeon is that he has the double responsibility of not only doing the HT, but undoing the prior work as well. This doesn't always mean removing the prior work, but he does have to figure out how to place the grafts in such a way as to maximize coverage of the old work as well as covering the remaining bald skin. It's a balancing act and it's alot harder than people think. This extra effort can add on 3 hours to an otherwise standard surgery and require more technicians.

 

Here's an excellent example of a paitent I did years ago.

 

Even if the yeild on both virgin and repair scalps were identical, the repair scalp may not look as good because of the presence of the prior bad work. Virgin heads don't have this problem and therefore are at an advantage compared to repair scalps, albiet falsley so.

[Dr. Alan Feller]

With respect to photos, it's actually pretty easy to keep uniformity of angle and light IF the patient comes back each time for photos. In my office I use the same photography lights, no flash, and shoot from about the same distance and angles by habit.

 

But I believe it is way too much to expect uniformity from one clinic to the next.

 

The variations in equipment, physical layout, and the photography equipment alone from clinic to clinic are enough to make significant differences that are unavoidable.

 

Add to this the photo editing variations and upload weight of the digital "final product" and you find that not only is uniformity unlikely, it is impractical across clinics.

 

I see there is some debate or issue concerning Badhair UK's photos, but as he is in England and limited only to the camara and lighting available, there is no way to ensure uniformity with the photos I took in my office 5,000 miles away.

 

The outside photo he presented was at ten months, but his hair had been buzz cut only a week or so before. Add to this that his hair was combed against the grain of the angle of the transplants and of coures there is minimal coverage.

 

Hair transplants are not supposed to be cut. Hair transplant rely exclusively on the layering effect of the hair.

 

When BHUK returned to the office 1 month after that photo was taken, his hair grew out a bit more (I asked him to let it grow) and it continued to mature as expected. When the hair was combed in the proper direction it demonstrated a cosmetically significant result and I took a picture of it and presented it. If he lets his hair grow out even more, then he will look even better. Simple as that.

 

There most certainly ARE clinics out there that use lighting and angles to give a false impression of a good result. The 'ole show a "before" picture of a bald patient with his head down, and then show the "after" picture with his face up is probably the most popular. And while many low clinics use this in there advertising, most don't try that on the internet anymore because members of chat sites like this one will blow them out of the water, and rightly so.

 

Right now, I think Video is probably the best way to negate the angle problem. To an extent also addresses the lighting problem because you can't really use a flash during video. Combing through the hair also gives another dimension of "honesty" that most sup par clinics would never do. Here are a few videos we've put up recently. They are about as honest as you get.

One is of a UK patient I repaired 18 months ago, the other is of a virgin head I did a few years ago:

VIDEO: Repair of "S.A.F" 18 months post op

 

VIDEO: Dense pack of hairline by Dr. Feller

[Dr. Alan Feller]

Bill wrote:

"Clearly the cosmetic appearance of this patient's hair has improved significantly and clearly this is a difficult case. The pictures in natural lighting however, reveal that he is not as far along as the indoor pictures lead our members and guests to believe."

 

Bill, usually we agree, but here you are mistaken.

 

You cannot tell how far along a transplant patient is when his hair has been buzz cut. EVER.

 

He didn't look "not as far along" in the outside photo because the lighting was more "true", but simply because his hair was short. Had that same photo been taken inside it would have made little difference.

 

The only reason the photo I showed of him looked superior to the one he took outside was because I took it over a month LATER and his hair was correspondingly LONGER. Because of this the necessary HT "layering effect" started to kick in and he looked better. If we went outside to take the picture he would have looked the same way, maybe even BETTER.

 

Before coming to us, BHUK had no hope of hiding those plugs.I say plugs and not minigrafts because even though they were small, skin was punched out to put them in. He also had scarring that extended well past the borders of his plugs and he had confluence of scar that made the skin look like a sheet of scar tissue.

 

If we just removed the plugs he would of had strange patches of white skin with hard texture throughout the front of his scalp that would always call attention to itself. Because of this he had to continue forward and cover all the work with more hair. The plan worked and he was happy, that's why he went to the expense and trouble of traveling from England to America for a second time.

[Bill - Seemiller]

Dr. Feller,

 

Thank you for your explanation.

 

You are absolutely correct when you say that hair length and hair style have a lot to do with the cosmetic appearance of a hair transplant result.

 

Clearly a shorter hair cut will seem more sparse when the hair density isn't there than a longer one which utilizes the layering effect. This is true of my hair as well.

 

The outside picture also shows this patient's hair styled back (actually almost straight up) rather than down.

 

This patient's hair however, was not buzzed in the outdoor picture though I don't deny it was shorter and styled differently than in the pictures you took.

 

You can't deny however, that natural lighting has a tendency to expose what indoor lighting does not whether with or without flash. Natural lighting is typically more revealing overall and this combined with hair styling and hair length is why his outdoor picture isn't as flattering.

 

This is not criticism - just a reality. I know that you took quality pictures that expose the truth of the situation in one single environment, but I also know that patient posted pictures are typically more realistic simply because they tend to take pictures in varying angles and lighting environments to see how their hair stands up in all conditions. This in itself shows more of a complete reality.

 

If you take a look at my posted pictures of my third hair transplant, notice that I had the most criticism when I took pictures in natural lighting as opposed to the indoor pictures with or without flash, even though my hair style and length were pretty close to the same.

 

There is no doubt that this patient has improved dramatically and his results look good overall. Now that he has undergone a second hair transplant surgery, I am sure the added density will further improve the appearance of his hair.

 

Best wishes,

 

Bill

[NervousNelly]

Dr. Feller and Bill,

 

Thanks for the interesting discussion. I agree with both of you about this topic. I recently noted on another thread of Bobmans that when his hair was cut short it did appear quite thin. One would never have guessed that at all when his hair is fully grown out.

 

One thing about my own recent HT. Even though I am only just over 3 months, having a little more hair has allowed me to "get away" with a bit longer hair. Prior I started to look dishevelled or somewhat of a Bozo if I let my hair grow out. My point--at 3 months I look much improved not necessarily just because of the growth from the HT, but the little growth from the HT has allowed me to grow out my native hair and everythhing looks fuller. Does that make sense. I believe that it follows along with the point that Dr. Feller was making.

 

It seems like we need to really focus on the right length of hair to make things look most appropriate. Too short and the limited density appears. Too long and things again start to look sparse as the hair falls differently.

 

I have seen some members post results where their hair is too long and in my opinion it has gone past that point where the layering affect worked best.

 

Just my 2 cents. Great topic.