Need advice for bad TP

[Rambler]

Hi fellow bretherin, I had a transplant of 900 grafts about 10 years ago at NHI with Dr. Andrews. He no longer works there and has moved on to Bosely. Anyway, at first I was stoked just to see the hair grow in etc.. After a year I just stopped looking close at it.

 

Had a girlfriend during the last 8 years, she knew and no bggie. Having being single for almost a year now I have been noticing the women looking strangely at me, and in more intimate situations, really inspecting me. Very humiliating.

 

I finally did look closer with double mirrors etc.. and to my amazement the transplant really looks blotched when looking down on it from an upper angle which I never had without double mirroring. All of the implants are pitted, almost like pluggines but reversed. Standard face level it looks ok more or less.

 

I went back to NHI and consulted with Dr. Pak and then separately with Dr. Rassman. They didn't seem too bothered with the results but did offer me a procedure of 300 grafts at no charge to "camouflage" in front of it, and maybe put a few of those in the affected area as well. They wouldn't admit that this is the cause of a bad procedure, rather attributed it to the way I heal. Baloney!

 

I've read up on this, even through Bernstein/Rassmans papers and found the reasons for this are bad preparation of the folicule ( leaving too much epithelium on the folicule, and/or placing it too deep in the scalp ) Either way, the surgeon should have been more diligent about quality control.

 

I am not convinced it will do the trick, especially with the up-close inspections. Since I have noticed this, I'm extremely self concious and paraniod. I've researched and there is no way to "fix" this. It will be this way forever.

 

Do you guys have any advice for me as how to proceed with this? I don't know what to do. I really don't want to go legal with this, or if I even can, but I have just recently "discovered" this and I'm kinda freaking out here. All this time everyone else could see it but I couldn't.

 

I have attached an image of the result here.

[Rambler]

Hi fellow bretherin, I had a transplant of 900 grafts about 10 years ago at NHI with Dr. Andrews. He no longer works there and has moved on to Bosely. Anyway, at first I was stoked just to see the hair grow in etc.. After a year I just stopped looking close at it.

 

Had a girlfriend during the last 8 years, she knew and no bggie. Having being single for almost a year now I have been noticing the women looking strangely at me, and in more intimate situations, really inspecting me. Very humiliating.

 

I finally did look closer with double mirrors etc.. and to my amazement the transplant really looks blotched when looking down on it from an upper angle which I never had without double mirroring. All of the implants are pitted, almost like pluggines but reversed. Standard face level it looks ok more or less.

 

I went back to NHI and consulted with Dr. Pak and then separately with Dr. Rassman. They didn't seem too bothered with the results but did offer me a procedure of 300 grafts at no charge to "camouflage" in front of it, and maybe put a few of those in the affected area as well. They wouldn't admit that this is the cause of a bad procedure, rather attributed it to the way I heal. Baloney!

 

I've read up on this, even through Bernstein/Rassmans papers and found the reasons for this are bad preparation of the folicule ( leaving too much epithelium on the folicule, and/or placing it too deep in the scalp ) Either way, the surgeon should have been more diligent about quality control.

 

I am not convinced it will do the trick, especially with the up-close inspections. Since I have noticed this, I'm extremely self concious and paraniod. I've researched and there is no way to "fix" this. It will be this way forever.

 

Do you guys have any advice for me as how to proceed with this? I don't know what to do. I really don't want to go legal with this, or if I even can, but I have just recently "discovered" this and I'm kinda freaking out here. All this time everyone else could see it but I couldn't.

 

I have attached an image of the result here.

[its752]

Rambler, It would be a good idea to start with more pictures of your affected area so you can get the very best advice from the other members here, and I can assure you because I've seen and heard of worse repair cases than yours that you should be able to get that covered up very nicely. The blades to make incisions for the grafts today don't leave marks!

[hoose]

rambler,

 

as its753 said, some pictures showing you hair zoomed out will give a better perspective of your situation; also as its said, today, even bad hts can be repaired buy the top docs; also if you are not already, i would get on finasteride to prevent future loss

[Al - Moderator]

Originally posted by Rambler:

I had a transplant of 900 grafts about 10 years ago at NHI with Dr. Andrews. He no longer works there and has moved on to Bosely.

 

Ha ha. I had to laugh when I read that part. I can just picture the job interview.

 

BOSELY: We want experience. We are looking for an experienced butcher.

 

DR ANDREWS: Well I've been hacking patients apart for over 10 years now. Take a look at this picture of patient # 13. See that wide, uneven donor scar that goes out of the safe area. That is typical of my work.

 

BOSELY: Good, good. What about the recipient areas though?

 

DR ANDREWS: Here's a picture of patient #34. Look at that pluggy hairline I gave him.

 

BOSELY: Very nice.

 

DR ANDREWS: Yes. And I even had him convinced it was state of the art. I told him all this bull about how double and triple follicular units are the new way to go.

 

BOTH: (laughing)

 

BOSELY: But what about pitting? I want to see some pitting.

 

DR ANDREWS: Ah. Then take a look at these pictures of patients #18 and 24. These guys can't hide those pit scars even in the dark.

 

BOSELY: Excellent! You're hired. When can you start?

[Bill - Seemiller]

Rambler,

 

I'm sorry to hear about your situation.

 

As our members already stated, additional photos would be helpful.

 

However, it sounds like what you are describing is "pitting" which indeed comes as a result of poor quality work. It sounds like the incisions made were not the right size for the grafts. And considering it was 10 years ago, I am guessing minigrafting was used which is an outdated technique.

 

Dr. Rassman is correct however, that camoflauging the area is one means of hair transplant repair. It sounds typical for cases such as yours assuming you don't have old school plugs which may need to be removed if they are extremely obvious.

 

It was nice of both surgeons to offer you a small free session to camoflauge the area. Though I don't know much about Dr. Pak, I deeply respect Dr. Rassman's medical advice and do not believe he would steer you wrong.

 

I hope this helps,

 

Bill

[Rambler]

Thanks for the replies. I think the pic I posted shows pretty clearly what the problem is, but I have uploaded a couple more. This is just one side, but both sides are the same.

 

Pic 1

Pic 2

[JM]

Did you digitally sharpen those pictures for any reason?

 

That might make it look worse.

 

Just askin'.

[thanatopsis_awry]

Looks to me to be a case of "dolls' hair" (aka pitting, I suppose); but, given the options you have, and how great various docs are at repairs, I wouldn't fret too much as I think your problem is very much solvable!

[Rambler]

JM, no I didn't alter these photos in any way except to crop out the specific area. Here are a couple more ( sorry they're a bit large in weight ) that shows it in natural light and from a normal "face view" where it isn't so bad.

 

Natural Light

Normal face view

Normal face view 2

 

I know the pittedness is more pronounced when pulling the hair back or in incandescent lighting .. and up close of course.

 

thanatopsis_awry, You say the problem is "solveable". Ok so maybe a cover up procedure will camouflage it a bit but I will still be stuck with the pitted ones and forever.

 

Maybe a lot of guys are just thrilled to have hair in an area where it wasn't before but I expect better results than this. I will never again be comfortable with a woman up close. I would rather have a balding "normal scalp".

 

Dr. Rassman brought in an employee in my recent consul with absolutely perfect results, and Dr. Pak has had 2 very excellent procedures, and they were done at about the same time I had mine. Seeing these didn't make me feel better, it made me even more pissed off. I paid the same as everyone else and did not get the same results.

[Rambler]

I am convinced that the results I have are due to a poor quality procedure, be it surgeon/assistant error. At this point I do have to accept what is .. is and it can't be undone. However, I do feel like Dr. Rassman owes me a bit more than just a cover up procedure.

 

NHI has told me that Dr. Pak would be the one to do the cover up procedure. All due respect to Dr. Pak, I do not feel comfortable with this.

 

I could use another procedure of 1200 grafts or so behind the area that was done. Do you all think it is fair and ethical to ask that not only does NHI do the offered cover up procedure, but that Dr. Rassman himself perform the surgery? If I were CEO of an industry such as this and had a legitimately unhappy client I would want to take care of the matter personally.

 

I also want to request of Dr. Rassman that he do the second procedure at a fair discount. I would do it for free if it were me but I do not know the business/ethical side of Dr. Rassman. I suppose the end result will tell but from what I have resarched he is a stand up guy.

 

To make my point a little clearer, do you think Dr. Rassman would feel confident if I were an actual patient at an open house and have potential clients looking at my result? I am an actual NHI patient. If I saw me I wouldn't be impressed.

 

What are your opinions on this whole matter?

 

Should I accept the offer of the cover up procedure? Should I insist that Dr. Rassman do it himself? Do you feel that they owe me something for a procedure that I paid plenty for and that is not what I was told it would be, and now needs to be covered up?

 

I am a fair person. That is why I am seeking advice from others before I contact NHI again.

[Janna]

Rambler,

 

You can still get a natural looking hairline. Some or all of the noticable hairs can be punched out, cut down and replanted into another area. We've also used lasers to make course hairs grow to be finer hairs. There are steps you can take to soften up your hairline to make it look natural. You are not stuck with your unsatisfactory ht. Good luck!

[thanatopsis_awry]

Rambler,

 

First, I agree with you 100% that just having hair where there wasn't hair before is *not* acceptable.

 

I'm not an expert on the details of repair and what exactly can be done to you specifically; though, "camo"ing it is one route for sure. However, I've seen some amazing cases of repair, and while I agree your work is poor, my feeling is that in the right hands it can be dealt with, and worked on to produce a result that won't cause you panic every time you are close w/ a woman.

 

Now, you've been offered a free ~300 graft session to help camo the work; did Rassman, or any other doctor, give you counsel on what else can be done? Including work that you would have to pay for...?

[Rambler]

thanatopsis_awry,

 

I have done very much research on this and it appears that there is no way to actually repair the damage done. Dr. Rassman and Dr. Pak both have told me personally the same. No dermatologic procedure, laser treatment etc.. will repair it.

 

I have not actually consulted with any other doctors. A lot of people would never return to a place where such bad results were obtained, however I am confident that it was not the technology, nor the company per say, rather the competence or quality control of the actual surgeon that is the cause. I think I have successfully nailed the cause of this. Say a person said, NHI does bad transplants, so this person then goes to Bosely because heh, they must be better. Well, Dr. Andrews is now at Bosely so what's the difference? I do know that I would never use Dr. Andrews again for obvious reasons.

 

I do have confidence in Dr. Rassman as a surgeon. I wish that I would have paid the extra for him in the first place. I'm just asking what you all think is fair before I approach him once more with my request of what I expect to be the fair and ethical way to proceed with me.

 

I think my requests are the fair and ethical thing to do. Like I said, I have to accept that what is done is done and I have to move on towards the best possible outcome.

[Bill - Seemiller]

Rambler,

 

Your additional pictures (especially the one in natural lighting) conveys your situation more clearly. Thanks for posting them. In addition to the pitting, it seems like there are some multi-haired grafts in the hairline which is contributing to the "pluggy" look. Whereas this is not a good situation, I have seen much worse than this get repaired.

 

The pitting cannot be corrected, but they can be camoflauged with follicular unit grafts. Placing single haired follicular unit grafts in front of, in between, and around the multi-haired grafts will also create a softer more natural looking hairline.

 

Additionally, as Janna suggested, some physians may choose to excise the existing grafts and redistribute them as smaller grafts. A physician will have to evaluate you to determine the best course of action.

 

Please make sure however, that you thoroughly understand your goals and whether or not they can be achieved with repair surgery.

 

Best wishes,

 

Bill

[Rambler]

Thanks Bill,

 

I wouldn't feel comfortable with removing existing grafts as I believe they would leave behind scarring, possibly worse than the pitting.

 

I do wonder what you think of my proposed request to Dr. Rassman I posted above.

[Rambler]

dhoose75,

 

Thnkas for the suggestion about the finasteride. My hair loss is fairly minimal, just minr thinning on the top sides and receding hairline. I just can't bring myself to be a slave to drugs. Propecia etc.. are not for me.

 

Interestingly though, Dr. Pak suggested I try a product called Toppik. It's a granular fiber powder sprinkled in the hair to beef it up. I don't like these kinds of maintenance products but decided to give it a try.

 

The result was that the powder got inside of the pits making them stand out even more. Horrible.

[Bill - Seemiller]

Rambler,

 

I think considering that you are a previous patient of NHI that Dr. Rassman will work with you and take care of you. As far as what kind of financial deal/discount he will give you, I can't tell you.

 

Did he tell you how many grafts were needed in order to successfully camoflauge the previous work? This may help you determine the costs.

 

If I am correct, he has already offered 300 grafts free which at his rate is about a $2400 value.

 

He is a great surgeon but typically charges a good bit more than other elite hair transplant surgeons.

 

Bill

[Rambler]

Bill,

 

My first consul was with Dr. Pak. He is the one that offered 300 grafts. I then consulted with Dr. Rassman separately. I discussed the additionl procedure I wanted and later in the consul he stated he would put 500 grafts total in the area to be covered up.

 

This leads me to believe it will take 500 to do the job effectively as in addition to the transition area there also needs to be some one hair grafts placed in the affected area as well. By Dr. Paks estimation of 300, and the additional procedure done at the same time, I would actually be paying for the extra 200. Hardly sounds fair.

 

Dr. Rassmans fees are actually a bit more than you quoted. He charges $10 per graft so at 300 that would be $3000. Dr. Paks rate is $6 and on standby it is $5 a graft. Dr. Rassman doesn't have a standby rate, it is always $10. Both have concessions for larger sessions.

 

You use the words "$2400 value". True, the value of the cover up does have a per unit price, but considering the nature of the procedure, a repair of previous bad work, I don't think a monetary value can be factored in here. The cost of the repair is insignificant to me and I do not consider it a value at any per unit price.

 

I am asking you guys as to what you think about my proposed request to NHI ( below ) I think it is fair but wonder what all and any of your opinions are ...

 

 

NHI has told me that Dr. Pak would be the one to do the cover up procedure. All due respect to Dr. Pak, I do not feel comfortable with this.

 

I could use another procedure of 1200 grafts or so behind the area that was done. Do you all think it is fair and ethical to ask that not only does NHI do the offered cover up procedure, but that Dr. Rassman himself perform the surgery? If I were CEO of an industry such as this and had a legitimately unhappy client I would want to take care of the matter personally.

 

I also want to request of Dr. Rassman that he do the second procedure at a fair discount. I would do it for free if it were me but I do not know the business/ethical side of Dr. Rassman. I suppose the end result will tell but from what I have resarched he is a stand up guy.

[thanatopsis_awry]

I don't think the proposal you've outlined is unreasonable; but it's totally subjective to say for sure, of course, and at the end of the day it will be you determining whether their offer is "respectable" enough to take them up on it. It wouldn't surprise me if Rassman and Co. work out something with you along those lines. How discounted the secondary procedure is and who performs what seem like the negotiable terms.

 

I'm curious, when you had your botched procedure, was Rassman still in charge at the time? Also, what is Dr. Pak's standing at NHI?

[Rambler]

Thanks, I agree with you completely.

 

Yes, Dr. Rassman was in charge at the time I had my transplant and was as well doing procedures in the Los Angeles office. I actually consuled with him then as well prior ( and regarding ) to my first surgery. That is when he assigned Dr. Andrews to me for my procedure.

 

Well, There are now only 2 surgeons at NHI in Los Angeles. Dr. Rassman and Dr. Pak. Dr. Pak has been there for about 9 years. He is also Associate Medical Director as Dr. Rassman is the Medical Director.

 

This lends me to believe that Dr. Rassman has a lot of faith in him. Still, I would prefer that Dr. Rassman do anything I do from here on out.

[Bill - Seemiller]

Ramber,

 

Just as an FYI, Dr. Rassman had promised to offer a discounted rate for members of the Hair Transplant Network forum community based on certain criteria.

 

Quoted from his doctor profile

 

"Due to his world renown reputation and high demand for his services, Dr. Rassman fees are higher than those of his NHI associate Dr. Jae Pak, M.D. However, Dr. Rassman is willing to reduce his normal surgical fee of $10 per graft down to $6 per graft for those who are willing to do surgery in his Los Angeles office on a "Standby" basis and be called less than ten days prior to surgery.

 

For those who would like to schedule surgery with him more than ten days in advance he is willing to reduce his fee down to $8 per graft for surgery in his Los Angeles office. After 2,000 grafts all additional grafts will be charged at half rate. Travel reimbursement credits up to 5% of fees paid will still apply. "

 

This is why I said "$2400" value. Be sure to refer to the "Coalition Special".

 

I also do not feel that asking him for a "reasonable" discount is out of the question. I put "reasonable" in quotes because everyone has a different idea as to what that means. In my opinion, it doesn't hurt to ask even that he perform it himself free of charge since he was the overseeing physician in charge of the procedure.

 

However, in my opinion, be sure to price shop with other elite physicians.

 

Even if you end up with an extensive discount, other physicians equally as talented charge much less such as $4-$5 per graft and still have an amazing reputation for producing consistent superior results.

 

Bill

[Rambler]

Bill,

 

Thanks for correcting me about Dr. Rassmans special rate. I wasn't aware of that.

 

Thanks for your opinion as well. I will definitely do some more research and reading on other doctors. Considering having a small cover up procedure, I was thinking it best to cover it all in a single procedure and do the additional (1200 graft ) at the same time. Less stress on the scalp and donor area etc.. but will have to consider everything else as well.

 

Thanks again, to all who have posted.

 

Rambler

[socalguy]

Go get a consult from Dr Siporin in West Los Angeles. He did my HT in December and I am very happy with the work he did. I had plugs that were very noticeable from Bosley and Peterson and he worked in and around them to soften them up and make it look more natural. The Doctor has also had a few HT's so he knows what you are going through.

[Rambler]

Is Dr. Siporin considered one of the elites on this forum?

 

I will read through the forum, but who is considered to be of the elites these days in So. California?