New HT - staples too high ?

[PD]

Hello all,

 

Finally did it, after a long wait. overall i had a mixed experience, I had two questions for those senior HT guys out there...

 

1. Please look at my photo album - i think my strip went a little too high - if my past history and my genetics was any indication, i may continue to lose hair and within a couple year or 3 the scar from this surgery might be exposed. what do you think ?

 

2. I think I ended up with a traingle shape HT, would have preferred a more curvy base of the triangle to merge with the crown's hair loss, thus making it look like it is part of natural hair loss... i did discuss this idea with my doc but i guess it wasnt possible to do it..

 

overall, it was ok.

Edited June 15, 2010 by PD

[TC17]

The staples might be a little high, but nothing that I would worry too much about.

 

Who was your HT doctor? I think the grafts were placed in far too straight of a line towards the crown and it looks very unnatural to me. Hopefully when it grows in it won't appear that way, but I have never seen a naturally balding man with a pattern like that.

[Maxxy]

PD,

 

Have you put your concerns to Dr. Feller? As you know, Dr. Feller is very experienced. I'm sure the donor is in a acceptable position, it's hard to tell by the one photo you supplied.

 

The straight line in the crown area comes right up to the thinning native hair, maybe the graft numbers feather off towards the crown and once the transplanted grafts grow out it will blend in with the native hair in terms of density and the straight line you are seeing now wont be an issue.

[Sparky]

Well if your on Proscar, you should be ok as far as the staples are concerned. Hairline doesnt look too triangular to me. Will you be having more than one procedure? because you could always add more hair to the temples then.

[qwerty]

At first glance it does look a little high, but take these into consideration:

 

(1) you have lost most of your hair to the point you have the horseshoe look, so it most likely wont go much further if any

 

(2) the doctor alot of times, takes into consideration where you hair is the thickest, so maybe that's where it was deemed to get the most hair

 

(3) if it does go further the scar showing would be minimal - that could easily be touched up with another session

 

The way I see it, the worst case scenario, you can still get a session in there to cover it up in the future, if needed. So long term you can work through it one way or another....

[PD]

qwerty and sparky,

 

unfortunately i am not planning on another HT - this is a great point, i think every HT doc should consider this seriously.

 

maxxy,

No the grafts do not sort of feather off.. they do end abruptly - I wasnt looking for crown area as i dont mind a bald crown. as someone said - "if i dont see it, i am not bothered by it"

 

I think the grafts were placed in far too straight of a line towards the crown and it looks very unnatural to me.

 

TC17,

exactly what i meant by "triangle look" - I was aware of this problem as i had seen an elderly guy's pic on this forum, with the abrupt straight line, who had it done with the same doc. That guy has combed it to his left and it made it even more terrible. i had mentioned this during the intial talk, the doc acknowledged it, but somehow wasnt able to do it. obviously, by the time i saw the top view, it was all over and time to go home.

 

I guess, now that it is over, and i cannot change it, will try to focus on the positive. maybe this will help someone - know the risks, and be better informed.

 

thanks for all your honest opinions !

Edited June 15, 2010 by PD

[Maxxy]

Hey PD,

 

I think you misunderstood me. When I said "graft numbers feather off" I meant maybe less grafts were placed in each zone as the doctor went back, by the time Dr. Feller got to the area where you see the straight line there may only be a few grafts per cm2 matching your native hair in that area. This straight line where the grafts end is obviously now due to the redness, trimmed hair and trauma caused during the surgery. Once the redness fades and the grafts grow the transplanted hair may blend in with your native hair in terms of density and placement.

Edited June 15, 2010 by Maxxy
Typo

[PD]

Hey Maxxy,

 

I think i knew what you meant.. I think the only density diff you will see is between the 1/2 cm band on hairline and the rest - which is a good thing... but what you are suggesting is also possible and probably even better if i had enough grafts. (the goal was to get 3000 but apparently they could only get 2600 which was a surprise to me as the doc told me i had enough density for 3 people.)

 

what i was suggesting is place the grafts strategically, to make it look like i only had loss on the crown.. please see the diagram attached and also shot of my top view. In the diagram, the left is what i was talking about, the right is what i got..

Edited June 15, 2010 by PD

[TC17]

Like a lot of people on this forum I spend an inordinate amount of time looking at the heads of bald and balding men and yet I have never seen a hair loss pattern like the one that was transplanted on your scalp. Perhaps Dr. Feller can post his rationale for using that pattern, because I think it looks very bad. I'm sorry if that hurts your feelings, but I'm just giving an honest opinion about what I think. I realize you said you didn't want a second surgery, but I can't imagine this one being a stand alone procedure.

[Danielkiwi]

Hi PD

 

I can totally imagine how you feel. I think dr. feller might have targeted 3000 drafts but unfortunately could not get them. did you ask him why he could not get 3000 drafts. This is what makes me scared. I have scheduled my surgery with a top doctor on the basis that i have good donor density and we are targeting 3000 plus grafts. i wonder if there is a test that can be performed during consultation as to how many grafts can be removed. I would certainly not want to perform surgery that could make matters worse as i dont want to be chasing my hair all my life. i am beginning to have second thoughts about my surguery now and thinking about cancelling the same...damn..going bald really sucks..

[Danielkiwi]

Also, since the scar was taken high and PD is saying that he is expecting that area to be bald, then what about the survival chances of the same grafts in the recipient area!!

[TheEmperor]

I think the scar is fine. It is on par with top clinics. If the hair does receded down, the line is vertical so very little of the hair transplanted will shed. That part is ok.

 

The line in the back would cause me concern. I got something similar, but with 4500 grafts the line is back farther. I have a bald "spot" and I concede that if anyone looks at top of my head, this might give it away as a HT. Hopefully the hair planted in#2 will help hide this.

 

I think the docs plant hair with the expectation that you will be back. If they make it perfect, you will probably have less incentive to return.

[Bill - Seemiller]

PD,

 

Congratulations on your recent hair transplant with Dr. Feller. While I understand you have some concerns, I feel that the placement of the scar is within the universal safe zone. I also feel confident that you'll have a nice looking result when it matures.

 

Regarding the placement of the grafts leaving a straight line in the back, have you discussed these concerns with Dr. Feller? Is he under the impression that you are planning on another procedure to target the back? You said you're not planning to have another hair transplant...any reason why not?

 

Given your level of baldness, it would be virtually impossible for 2600 grafts to give you both adequate coverage and density. Since density is typically tapered off gradually further back on the scalp, I suspect that there will be a more natural blend between your transplanted and natural hair than it appears in the surgical pictures. However, in the event you continue to lose more hair, you may decide another procedure is needed. Very often, men with a lot of balding or future hair loss to come require more than one procedure to meet their goals.

 

In the meantime, you have quite some time to wait until you see the final result. Then, you can decide on a next course of action if any.

 

Best wishes,

 

Bill Seemiller

[Megatron]

it's always concerning to me when a patient's valid concerns seem to fall on deaf ears. I really hope you get this sorted out to your satisfaction. everything I've read about Dr. Feller on here gives me the impression he's one of the best.

[Bill - Seemiller]

it's always concerning to me when a patient's valid concerns seem to fall on deaf ears.

 

I'm not sure who you're addressing with this comment, but members of this community (including me) are providing PD with genuine opinions, constructive feedback and encouragement. How exactly do you propose PD's concerns are handled?

 

Frankly, most people wouldn't be happy with only 2600 grafts on such a bald area as it can only accomplish so much. This is why it surprises me to hear that PD isn't planning on considering a second procedure.

 

All that to say, I've sent an email to Dr. Feller so that he can provide PD and our community with his point of view of the procedure and working to meet PD's hair restoration goals.

 

Best wishes,

 

Bill

[Danielkiwi]

i guess the concern here Bill is that why were only 2600 grafts planted when the target was 3000. i think doctors should do a better job in forecasting the grafts....i wonder how hasson and wong consistently get more than 5000 grafts in their procedures..

[Maxxy]

i think doctors should do a better job in forecasting the grafts

 

 

Danielkiwi,

 

Where as I can understand PD's disappointment, 400 grafts isn't a millions miles off the target. Sometimes doctors get it pretty much spot on, sometimes they get more while other times they will fall short. There is many reasons why this may happen and I'm sure Dr. Feller will let us know why this was case with PD.

 

If a patient had an average donor density of 100 grafts per cm2 and had say a 30 cm long strip was removed there may be variations in the density along the strip which prevents the doctors from getting his estimate spot on. For example - even 3 grafts less per cm2 on a 30 cm long strip is a short fall of 90 grafts.

[Danielkiwi]

Hi Maxxy

 

I understand where you are coming from. This is what makes this surgery so unpredictable. There is still a lot of issues that remain unanswered in this world of hair transplantation even in the best of hands. Dr. Feller has one of the best reputations and i dont think PD could have done a better job in selecting the doctor. I wish there was a mechanism whereby the doctor could do a trail run and determine how many grafts are possible before the patient can decide to go for it. In this case the patient was told that the donor area was as good as three people and he got only 2600 grafts.

 

I have a question for PD. I think even 3000 grafts would have been less in your case. When the doctor told you that your donor area was that good, did you look into the possibility of having a mega session of 4500+..or did you have financial or other reasons not to do so.

 

Guys, please do all the research as possible and meet as many doctors as possible. Please dont rush in to it. I have already scheduled my surgery and would most defiinitely cancel it if my questions remain unanswered even if my deposit gets forfeited.

[Megatron]

I'm not sure who you're addressing with this comment, but members of this community (including me) are providing PD with genuine opinions, constructive feedback and encouragement. How exactly do you propose PD's concerns are handled?

 

 

chill Bill

 

I think the answers provided by this forum have been outstanding. I was referring to Dr. Feller and/or his staff. PD said he expressed concern about the # of grafts and the recipient pattern in his consultation. Yet, his concern was not heard/addressed and he still is unsure why.

 

as I said earlier, everything I've read about Dr. Feller has been excellent so I too am scratching my head on this one.

[TC17]

I'm not defending Dr. Feller with this post, but the truth is that we really don't know what was discussed between patient and physician. I believe that if the PD raised concerns about certain aspects of the surgery, then Dr. Feller would have done everything within his power to ensure that those concerns be a non issue.

 

That being said, I too have seen a few examples of Dr. Feller's work men where the line between transplanted hair and bald scalp is just too abrupt. I think it looks terribly unnatural and necessitates that the patient return in order to have a natural result. I believe that any surgery, however small, should be a stand alone procedure. I realize that to some people the pattern used on PD would represent a standalone surgery, but it clearly doesn't seem as though PD views it that way. And really, that's all that matters. The success or failure of this, or any surgery for that matter, depends upon the satisfaction of the patient. It's really going to come down to personal preference. I wouldn't be happy with the pattern used, but that doesn't mean that I'm right and others are wrong.

 

I think when it grows out you will look something like NW6 guy, or maybe even this patient.

http://hair-restoration-info.com/eve/forums?a=tpc&f=3521087683&m=653105724&r=653105724#653105724

 

I realize that the patient I linked to is far balder than PD, but the bald spot resembles a large goose egg, and isn't shaped like anything I've ever seen in nature. I am only referring to the very regular shape of the bald crown. To me, it looked more natural in the crown before Dr. Feller placed any grafts there.

[PD]

OK guys, its gotten pretty heated...

 

I somehow get a feeling that my post appeared negative - it was not meant to be... the purpose of my thread is to express my honest opinion and get some honest responses from the experienced guys, I have nothing against Dr. Feller and as a matter of fact, I still think he is a good surgeon.

 

Regarding the # of grafts, I don't think its that easy to estimate the density on someone's donor area just by visual examination... and I have no issues with this, if I have less density, so be it... what can I do ? or can anyone do ?

 

Another question about why didn't i go with larger HT - I was/am scared of the width of the scar, numbness, besides I didnt believe filling up all my head with grafts was necessary, I dont want to look perfect, covering the frontal third is more than enough for me - the risk vs. reward graph isn't linear in my opinion, risk increases way too higher than the difference you are going to see on a person's looks... some might disagree with this, but I really believe this. besides who knows when my numbness is going to return if I go crazy with 4k grafts ?

 

It took me so many years to take the plunge for having one HT, as you can see since when i am registered, I didn't think I ever thought of a second one nor am I thinking of it now.

 

I do respect everyone's opinion, in fact, very appreciative of the honesty here. And for the record, I am really not dissatisfied or anything, just a little worried, nervous and that's all ;-)

 

Again, thanks guys for all your honest posts !

[Danielkiwi]

Hi PD

 

Thanks for clarifying your goals. We all sincerely hope that you achieve what you have in mind. You have taken a brave decision which i am still struggling with and god will listen to you.

 

All the best

[Dr. Alan Feller]

This entire thread is much ado about nothing. Seems like some posters answered all the questions and concerns already, but I am happy to clarify:

1. He received 2,600 grafts because that’s all his donor area could give in a single session. Wouldn’t have mattered who did the surgery. Asian scalps tend to have below average donor density so I wasn’t shocked that he landed at this number. As in all my consults I state I will attempt to get as much as possible, in this case I was shooting for 3,000 grafts, but it simply wasn’t possible even though I excised his donor from ear to ear. He was refunded the difference in money prior to leaving the office. It doesn’t happen often that I come in under my own expected number, but it does happen and will undoubtedly happen again at sometime in the future-such is the reality of surgery.

2. The location of the incision is exactly right. Not too high, not too low. The location of the occipital protuberance is what dictates the level of the incision, along with the thickest area of donor. Pretty simple.

3. The back line of the transplant is also exactly right. It is not “too straight” or unnatural at all. To begin, the back line consists solely of single hair FUs that are spread out at a relatively low density and will therefore appear amorphic when finally grown in. In other words, there will be no defined “line” visible. Second, while PD may have liked me to round it off more, this would have been prohibitive since he only had 2600 grafts to utilize. It would have taken a minimum of 1,000 extra grafts to produce the geometry he discussed in this thread, a number he just didn’t have after filling the front. Third, his hair is shaved in the post op photos. He actually has some native hair in that area which would have blended even the worst transplant.

4. The height of the hairline is proper and appropriate given the available donor area and the size and shape of the head. Anyone who reads these forums and looks at the photos can see that the hairline placement falls right into the average area for patients with his physiological characteristics.

PD, I understand post op worrying. It’s similar to the phenomenon of “buyer’s remorse” and it can cause an incredible amount of stress and anxiety. Some people suffer from this more than others, but it is quite normal. I can assure you that your procedure was performed to the most optimal level and there were absolutely NO technical mistakes or issues as described in the points I made above. So relax and give the scalp time to heal and grow.

Dr. Feller

Feller Medical, PC

Great Neck, NY

[Danielkiwi]

I think your response is really nice Dr. Feller and you did the best you could within your limitations. It is interesting that you bought out the Asian patient topic. I am Asian too and your reponse has me worried and causing me to think if i should really embark on this journey or not. If i am understanding you correctly, are you saying that since our densities are not that great, mega sessions of 3500+ grafts will not be possible? If that is the case, then is it really worth it to embark on this journey? Also, since you were aware of this fact, what made you to suggest PD that his density was as good as 3 people. Is there something you noticed that allowed you to make this statement. I am not trying to undermine you or anything but simply trying to understand whether all this willl be worth it for me. I certainly dont want a half head of hair and a scar to worry about..I am sure you must be very busy but i would really appreciate your response on this

[Dr. Alan Feller]

I did not say he had enough hair for three people. I don't know where he got that from. Furthermore, PD and I did discuss a second procedure prior to the first procedure which might be utilized to lower the hairline, or push toward the crown, or a bit of both.

 

I never tell a patient that one surgery is all that would be needed especially in someone with his level of hairloss.

 

Just because PD had a below average donor area doesn't mean you do. I've had Asians with 3500 extratable donor grafts with no sweat. But as a rule, Asian hair is thicker and therefore tends to have lower numbers of follicles. Inversely, Nordic hair is thinner and therefore tends to have higher numbers.

 

So don't be afraid to have a procedure, more hair is usually far better than less hair. Most top docs are pretty good at guestimating the number of grafts before hand and if you get 3100 grafts instead of 3500 grafts you will still most likely enjoy a signfiicant cosmetic improvement. Remember, you can always do a second surgery if the donor area permits.