Disappointing results

[Truth Seeker]

I've had 3 transplants over the course of 7 years, the last in 2003. Over the last 7 months, my hair loss has accelerated to the point where I have almost nothing but transplanted hair on top. The thinning has started to drop to the sides of the scalp and to the back of the crown. I use Prothik as a concealer, and it is getting more and more difficult to apply this without it being noticeable. I can only style my hair one way, and it's very, very flat. I also have concerns that, when out in sunlight or people standing over me, that this is very noticeable.

 

I had a phone consult with Shapiro and based on photos that I sent, they felt I had one transplant left with about 2500 FUs available. They referred me to Dr. Bernstein in New Jersey because he was closer. What he told me was very distressing. He felt that I had less donor hair available than Shapiro estimated (Though Shapiro told me that Bernstein is more conservative). Also, the donor scars from three previous surgeries are all over the place. None of the surgeons really tried to keep the scarring uniform. The back of the scalp was too tight to do any further surgery.

 

Bernstein's conclusion was to wait a year, prescribed Propecia, and felt that I could only get 600 FUs and do the hairline. Needless to say, this is very disappointing to hear.

 

I needed to vent, but also wanted to hear anyone else's thoughts on this?

[hairworthy]

Originally posted by Truth Seeker:

Bernstein's conclusion was to wait a year, prescribed Propecia

You mean you've never taken finasteride before?

 

Can you post a few pics so we can be in a better position to evaluate your situation? Don't give up, there are many guys out there who once felt like you do now. I like to believe that, whatever your situation is, there is always hope with the right surgeon.

[HK500]

I am also surprised that you were not taking Finasteride.

You have already consulted with very good Docs and it would be interesting for our community to look at your pictures, you'll get a lot of interesting advice.

[PB]

How many grafts did you have in total from the three surgeries and how much area has been covered with transplanted hair? Please show some pictures.

[Truth Seeker]

I was never able to afford Propecia in the past. Bernstein broke it down to 1/4 tablet/day. The first surgery was 368 micros/minis in 1994 with a Dr. Giannato in Boston. In 1999 I had 1100 with Dr. Lauria out in Long Island. In 2003 I had another 1100 with Dr. Pistone, who says he did micros/FUs. Bernstein says that the grafts are good, but he would have positioned them differently.

[nobuzz4me]

Truth,

 

Dr. Bernstien is very conservative. I believe Shapiro or another Doctor could do the job more to your liking.

 

You should really check with Dr. Feller who also does fue. He may be able to work around your scarred donor better than taking another strip and harvest more FU's. Keep in mind though it is more expensive to have FUE.

[NervousNelly]

As always it is challenging to give you advice based on photos and especially only one, but I would have to say that it surprises me that Shapiro says you only have 2500 FU left. There must have been some waste in previous surgeries if there was only 2500 grafts in total. Obviously though he knows what he is talking about and I would trust the surgeons before us online specialists.

 

Definitely check out doc Feller as NoBuzz stated. He might be able to combine the 2 types of surgeries possibly? In any case, you had better do lots of research and get it right this time as it sounds like it is the finality. You definitely need to go with someone capable of a larger session, that is for certain. Good luck.

[Gorpy]

You really need to do an in person consultation. While doctors can provide feedback from photos you provide, there's no substitute for an in person consult. The doctor can really get a good look at you and test your laxity.

[Bill - Seemiller]

Truth Seeker,

 

Welcome to the forums my friend. In all honesty, unless you have a really thin donor area (which doesn't appear to be the case) or terrible laxity (which can only be judged in person), I can't see how you would only have 2500 grafts left if you've only had 2500 grafts. I'm echoing and agreeing with NervousNelly on this. An "in person" consult with a more liberal doctor might be appropriate, especially since you are going for the largest number of grafts possible. As others have said, Dr. Bernstein is a terrific doc, but much more conservative. Please, do NOT let location dictate who you go to. If I were you, I'd continue your consults...and in your consults I'd consider consulting with Dr. Feller, and Hasson and Wong. Dr. Hasson is known for his mega mega sessions...of course, donor laxity and density are what you will need for a large session.

 

Could you show us some more pictures of the top of your head AND the hairline? Based on that picture, I can definiately see that the crown is pretty thin...but I can't see up much further.

 

Bill

[John_in_NC]

whatever a strip doc tells you...add at least another 1000 in FUE (provided you have the $$) Obviously you need to plan it carefully, that is your last resort.

 

Dr Feller is 20 min away from Dr Bernstein's office so go there as well.

[Truth Seeker]

Feeling around the back of my head, I myself feel that the donor area is limited. Shapiro and Bernstein have stated that having three previous transplants, primarily micros and minis, have really reduced the number of available donor hairs. In addition, the planning of these doctors was so poor, just scattering the hairs almost randomly around my head. They never said, "OK, this is what you need to be doing...work the hairline and move back." That didn't happen. Propecia was always recommended, but at the time, it was unaffordable to me. In addition, I was resistant because I try to keep as much toxic, man-made drugs out of my body. That's just the way I am.

 

But, I'm at a point where concealants like ProThink are starting to show their limitations. I really don't want to go the replacement route, considering I've already spent $20,000 over my adult lifetime on hair transplants.

[NervousNelly]

I just wanted to state that considering you have had 3 previous surgeries with older technology you have a very natural look. You are fortunate for that. It could have been a lot worse.

 

Yes, even though it is natural looking, there is very little density. I think that if you want to get more coverage and maintain a natural look, you have no choice but to pursue another HT. I understand that it is expensive and sucks to have to consider spending more money, but your confidence and self esteem will drastically improve. Think of the things in life that we waste our money on that give no value. This will be invaluable for you. Hell, it may even give you enough confidence to increase future earning potential.

 

Please see Dr. Feller in person as he is a top notch surgeon and the most reasonably priced. See what options he has for you.

[Truth Seeker]

Thanks! Those pics are 6 months old. I think the thinning is worse now. I recently moved, and my shower head has very hard water...lots of hair in the drain, like I've never seen before. I know a lot of that is scrubbing out the Pro Thik.

 

I've only been on Propecia for 6 weeks. I don't see anything yet, but I expect that at 6 weeks, I wouldn't.

[NervousNelly]

Worrying certainly isn't going to help as I for one believe that stress is a factor in many different issues.

 

Again, see Dr. Feller and get his opinion. You have to understand that you will never have a lot of density. You are always going to have a somewhat thinner look, but as you age it will be that much more natural looking and you won't have to worry about complete baldness. If you can get 2500 FU it will go a long way in the frontal zone and I think that you will be quite pleased.

 

Also consider sending photos to Dr. Rahal in Ottawa Canada (http://www.rahalhairtransplant.com)as he is very talented at creating illusion of density and when you convert US money he is the most reasonably priced.

[Truth Seeker]

I sent photos to Dr. Rahal. I never heard back from him.

[NervousNelly]

Call his office and try again until successful. You need to explore all viable options at this time.

[the B spot]

I think if Dr. Shapiro feels that you have about 2500 left, then that is most likely a very close estimate.

 

However, given that your strip scars are all of the place, I would suggest doing a couple of 1000 graft FUE sessions.

 

Unless Dr Shapiro feels he can excise a significant amount of scar tissue and still get 2000+ grafts, I simply would not do another strip session.

 

Do a session of 1000 grafts in the frontal core.

Grow it out.

 

Do another session of 1000 grafts.

Decide EXACTLY where you want coverage.

Grow it out.

 

Decide if the 2000 grafts are enough to satisfy you and your needs.

 

From what I see in your pics, you need to be judicious in your placement and density.

 

Given the shape and placement of your hairline, I would suggest starting at about 20-25fu's cm/2 in the hairline and increasing density as you go back in the frontal core.

 

I think you will look great when you are all done.

 

In addition, you may find that by doing FUE you will gain some additional grafts that were not available by strip.

 

Slow and steady is how you should approach this--- resign yourself to a 2-3 year approach to this in order to make sure you get it PERFECT.

 

Take Care,

J

[hairbank]

Truth Seeker-

 

I'm truly sorry to hear about your situation and hope you'll find a solution. It sounds as if you have varying opinions as to your donor hair. Since it's a finite supply and you're running out, I would make the most of it and get several opinions from some of the qualified Docs recommended here. You want to get the most bang for your buck so be sure you know what direction you want to go before you drop it into drive!

 

It may have been mentioned to you, but if not, take Proscar and quarter it instead of buying Propecia, it's much more cost effective. You can get a 4 month supply at your local Wal-mart pharmacy for around $78.

 

Let me know how things go for you,

[Truth Seeker]

Hairbank,

 

Thanks for the input. I'm already on a daily regimen of Propecia, prescribed by Dr. Bernstein. I'm taking 1/4 tab every day. I haven't seen any results, but it's only been 6 weeks. We'll see how it goes.

 

I've been extremely judicious about this. I even went back to Pistone a couple of years ago for another consultation. He recommended only 1,000 more grafts, concentrating on going down the center of the scalp. That's the big issue that I have had. None of the three surgeons ever came up with a game plan. The transplants neverfilled in an area. Pistone ascribed that to continued fall out of my hair, but I believe it has just as much to do with his lack of packing the scalp with any density.

[Toad_NW3]

Truth Seeker,

 

Sorry to hear about your expierences and dilemma. I hope everything works out for you. I just want to echo what others have said that you need an in person consultation with either Shapiro or Bernstein. Both are considered top docs.

 

Also, you say you are taking 1/4 pill of propecia a day, but I assume you mean you are taking 1/4 proscar daily to get the same type of dose?

 

Good luck to you. You are among friends.

 

Toad

[Truth Seeker]

Hi Toad,

 

I DIDhave an in person w/Bernstein, and he wrote me the script for Proscar. It's a 5mg pill, quartered. 3 month supply, $20 at CVS.

 

Once the weather breaks around here, I probably will go see Fuller in Great Neck. It's not too far from where I had my second transplant, Eastwood Medical with Lauria. Awful experience, contracted Hep-A up there (not necessarily from him). He also gave me a lousy stock tip on a medical company that cost me a lot of money!

[Pat - Community Publisher]

Truthseeker,

 

I feel for your situation. You have really been through the mill and experienced surgery with two of the worst physicians in the "industry".

 

You have certainly been given some excellent advice by the above posters. I'm familiar with all of your previous surgeons and they are not recommended on this community for many good reasons. Dr. Giannotto is a notorious back slapper who is known among both patients, former employees and doctors for doing very poor and over priced work. Dr. Loria who thank God is now retired is also notorious for talking the FU talk but not delivering. Dr. Pistone's work is probally better but it is still not very refined or dense.

 

You really need an ultra refined session at this point to fill in between the many sparse grafts you have. The doctors you are now consulting with as well as Dr. Feller and Dr. Rahal can pull this off for you.

 

I also strongly recommend that you start doing scalp massage exercises to maximize what can be safely be removed from your donor area.

 

Best wishes, Pat

[Truth Seeker]

Thank you Pat. When I had my first session, with Giannoto, he very much indeed was a "back slapper". That was in 1994, and the only way to really research before the internet were infomercials. Back then, it was Bosley, and a couple of other chains, championing slit grafts, macros & minis, using actors like Dan Haggerty as their spokesmen. Giannoto was affiliated with a group in Boston, and was charging $11/graft while Bosley was charging $33, and doing scalp reductions. This group was also selling replacement systems, of which my salesman was wearing one (Cam Neeley, former Bruins center, was a client). They showed me all the pictures, and this guy, a salesman, was making the determination of what I needed. I never saw Giannato until the day of the surgery.

 

Then there was the internet, and before this website came along, you had all the surgeons putting up their websites, again, showing excellent photos of their work. Lauria was doing grafts at $4-5/graft and marveled at the work he could have done had I seen him before Gianotto. The $6500 I spent on 368 grafts w/Giannoto would have been better spent at his place, according to Lauria, than w/Giannato.

 

Pistone was ultra conservative with my needs from the beginning. He's got a great ad campaign...a billboard on the Philadelphia side of the Walt Whitman Bridge that shows a bald man with spark plugs on his head. But he also does liposuction and face peels. In the Philly area, he's considered the best of the hair transplant surgeons, and known more for that than his cosmetic surgery.

 

The mistakes ultimately fall with me. They were my decisions. Of the three, I'd say I'm happiest with Pistone. Giannoto all but forgot about me and I had to call for follow-up to my care. When I finished with Lauria, my Mom, an LPN, was appalled at the amount of blood and scabbing on the scalp a couple of days after the surgery. Pistone however, there was little bleeding, a nice clean scalp, and the healing process was very good, with monthly follow ups for a year. My Mom, again an LPN, was very impressed with how my scalp healed with him. I wouldn't go back to him, though.

 

It looks like I need to get a passport if I want to get a consult in Ottawa. Oh well. I'm a Phillies fan, and their AAA farm club will be playing there for the season. Two birds w/one stone!

[mike2007]

Hi truthseeker;

Well i also feel for your situation and concern... unfortunately i can not give any better advice that what has been posted here by "veteran" of this site.. however i just wanted to tell you that i wish you the best for your forecoming decision, hoping it will be the best option for you.

As for doctors advices , i don t really understand the concept of saying : you have only 1 HT left...

If a guy A has made 3 HT of 300 grafts each

and a guy B has made 1 HT of 900 grafts. Does it mean that A guy has only one more HT, and B guy can have another 2 ?

What is the mandatory field here ? the donor area ? the number of HT...

I m in the case of A guy ?!:! Thanks for providing info....

[Truth Seeker]

Mike,

 

Shapiro's office feels that the number of transplants plus the type of grafts (micros and minis) affected the elasticity of the donor area, and also reduced the amount of remaining donor hair by 1/3. I don't believe he meant what had already been used, but what the three surgeons left behind.