My 1 Year anniversary take a look and lend me your thoughts... (New pics added)

[trooper]

Iv been taking pictures from day 1 to now. My results have not been typical of others with the same norwood scale (NW6) vs the amount of transplants done. So i wanted to get some opinions. Iv received one from a different post and would have to agree that by this time, i should have had much better results. Im an optimistic kinda guy and based on other posts I should continue to grow and thicken for the next 6 months but at this point in time, does anyone think there will be a significant difference from now and 6 months from now? Please visit my blog and comment in this thread with your thoughts. Thanks: Hair Restoration Site for Trooper

[corvettester]

Trooper,

 

At this point, it's not looking good. I'd be really surprised if you had any more growth, though you still have a hope for some maturity. I would have expected double as much growth from 4,000 grafts. I wouldn't be happy with this result, nor would I be optimistic about future growth.

 

Your blog photos aren't very revealing. Could you post some pics of your hair dry, without product, in natural lighting?

 

Also, do you have any sort of dermatological condition that may have contributed to the poor result? Are you on Propecia?

 

 

Corvettester

[HARIRI]

Tsk Tsk. Too Bad for a one year mark. You should be offered a free or discounted repair atleast 50%. The yield isnt that good in my eyes. Im very surprised that its been done by Dr. Feller. But shit happens sometimes, I feel you bro. Try to take clearer pictures without flash and indoor with good lighting and with a dry combed hair. So i can judge better before i become an unfair critic.

[Jotronic]

Forgive me for this but I want to be clear on what is going on here. You had one procedure in 2005 for 2100 grafts, yes? Then a second procedure one year ago for 2000 grafts with Dr. Feller, yes? Who did the first procedure and do you have any pre-op photos before your 2005 procedure?

 

One observation, you don't have enough hair to pull off the gelled or wet look. One of the biggest problems for guys like us that are advanced NW's is that unless you have a mother load of grafts the wet look will only look like the sparse look. You are doing yourself a disservice (cosmetically) by trying to pull this off. As mentioned above you should take photos of your hair dried and styled.

[Blake Bloxham]

Trooper,

 

Like Jo, I'm a bit confused on the timeline. Are the results you're displaying now for the 2,000 graft procedure with Dr. Feller, which occurred after a past procedure (I believe you said another 2,000 graft procedure performed in 2005)?

 

Regardless, while I do believe your hairline looks thicker and more defined, I can understand the desire for more density in the scalp region. It's clear that your restoration was a difficult case from the beginning, but it's disheartening to hear that you didn't achieve what you're looking for.

 

Are you currently using any preventive medications (finasteride/minoxidil)?

 

At this point, do you have any plans for moving forward? Would you like to undergo a second (or third) procedure to increase some of the scalp density? Please feel free to continue this discussion as long as necessary, don't hesitate to ask any further questions, and let me know if you need any assistance researching your "next move."

[Cant decide]

From the front, it looks decent so thats a positive but overall, the density could be better. As others have said, you should stop using gels, etc as there is simply not enough hair. Instead, use good thickening products like Sami fat hair and keep it dry. You will get at least twice the perceived density.

[Cant decide]

Also wanted to say that the "Birds eye" view is always a killer and in my opinion is not a good measure. Unless you are 4 feet tall, most will not see the top of your head. This view can make even the best of transplants look just ok and make decent transplants look sub par.

[alix]

lighting is those pictures is very poor,you need to post better quality pictures in more natural lighting without flash.based on these pictures I'd say poor result.

[trooper]

Trooper,

 

At this point, it's not looking good. I'd be really surprised if you had any more growth, though you still have a hope for some maturity. I would have expected double as much growth from 4,000 grafts. I wouldn't be happy with this result, nor would I be optimistic about future growth.

 

Your blog photos aren't very revealing. Could you post some pics of your hair dry, without product, in natural lighting?

 

Also, do you have any sort of dermatological condition that may have contributed to the poor result? Are you on Propecia?

 

 

Corvettester

 

 

Geez... I'm pretty bummed right now, however, as you requested, Below are some pics of my hair dry in different lighting using a different camera. The appearance of these pictures here vs the ones i provided in my blog arent far matched. I cant go outside cause its raining. I don't have any dermatological conditions nor am i on propecia. I don't take any medication either.

By the look at the amount of hits on this post and only 1 reply... Its obvious that my results are not positive. I'm real sorry everyone as im hoping my results do no deter you from getting a Transplant. There are many cases with positive ones just that i may be the exception. Thanks a lot for your input. If any new results form, ill let you guys know.

 

 

[trooper]

Forgive me for this but I want to be clear on what is going on here. You had one procedure in 2005 for 2100 grafts, yes? Then a second procedure one year ago for 2000 grafts with Dr. Feller, yes? Who did the first procedure and do you have any pre-op photos before your 2005 procedure?

 

I think it was ~2004 iv done the procedure with Dr. Feller in the amount of 2100 grafts. Last year iv done the same procedure with him in the amount of ~2000 grafts. So between then and now, this pictures above are the end result. Most of the pictures are from me coming out of the shower and shortly allowing it to dry is where you see the others. No gels or anything. Clearly, these results are not typical of someone who had 4000+ grafts but i cant blame Dr. Feller as the results may be due to my own hair not taking for whatever unknown reasons. He has had way to many positive results for me to blame him hence the problem lies with me.

Im sooo down right now you cant imagine. Ill pull back up for sure but just cant think of that right now as im not even sure which option i have.

[Gin0rm0usF0rehead]

Definitely do not use gel anymore.

[TakingThePlunge]

trooper,

 

I'm very sorry to hear the your results have not met your expectations. Have you discussed your results with Dr. Feller? If you have not, I highly encourage you to do so.

 

I see in your blog that you acknowledged experiencing progressive hair loss after your first hair transplant. Those initial 2000 grafts would not have gone far given your degree of hair loss. However, this second procedure probably should have resulted in more density.

 

I'm sure Dr. Feller counseled you regarding realistic expectation. What were the goals of this second procedure and were you told that subsequent hair transplants may be in order?

 

Best of luck!

[TC17]

The most recent photos that you posted with your hair dry look MUCH better. Is there a reason why you're not taking Propecia? With your relatively young age, aggressive hair loss, and the fact that you've already undergone surgery (thus removing the option to buzz your head), it would seem as though Propecia would be a necessity. The other good news is that while you might not have had great results, you've "only" used 4,000 grafts. Assuming you have average laxity and density, you should easily have another 2,000-4,000 grafts from strip alone left. What did Dr. Feller say regarding your donor?

[corvettester]

By the look at the amount of hits on this post and only 1 reply... Its obvious that my results are not positive. I'm real sorry everyone as im hoping my results do no deter you from getting a Transplant. There are many cases with positive ones just that i may be the exception...

 

Trooper,

 

You shouldn't be apologizing for anything, this is what the HTN is here for. If there were only great results posted, it wouldn't have any credibility. You're actually doing a great service to the community by posting your poor results. Potential patients need to know the risks and pitfalls.

 

I'm sorry to see that it hasn’t worked out for you, especially since you seem like such an optimistic, nice guy—you deserve a nice head of hair. However, it's good that you're taking such a positive approach to the matter. Provided you still have donor hair availability, there is still hope for you.

 

 

Corvettester

[hairthere]

Trooper, I know how discouraging this whole process can be: you've had two procedures and are still not happy with your hair. The reality is you will never have the same head of hair you once did and the HTs will only give the appearance of a full head of hair. However, that is contingent on a combo of factors such as: number of grafts used, donor quality, and styling.

 

Now, 4k grafts sounds like a lot, but it really is not on someone with a high NW#. Your donor quality looks to be fine, is that accurate? You also appear to have some diffuse thinning in your donor--did Dr. Feller comment on this? Other posters have already commented on styling (not using gels, etc.).

 

I would say go back to Dr. Feller for another consultation and see how he feels about your result. I think your grafts probably all grew, it's just going to take a lot more to get the effect your looking for. Best of luck.

[corvettester]

Trooper,

 

 

I hate to sound harsh, but your result is less than optimal, to say the least. In some of the pics, your hairline looks downright pluggy. However, it seems like you can minimize it via styling options with your remaining hair.

 

I have to disagree with TC17 that the pics look “MUCH better.” In my opinion, they look worse because they’re more realistic than the others. The one without flash (see below) is particularly troublesome considering that that is how most people will see you.

 

Your hairline is about as ill-defined as it gets. I would definitely consult with some coalition doctors on a repair job. If you could just get your hairline repaired, it would minimize a lot of the sparseness and the see-through element in the back and mid-scalp because most people see you at eye-level, from directly in front or the side.

 

As for the rest, I don’t know what to tell you. It doesn’t look anywhere near 4,000 grafts to me, unless you were one of those rare cases that I’ve recently heard about where the transplanted hair miniaturizes… I doubt it though.

 

If I were you, and I had more donor hair available, I’d go for yet another pass, but not with Feller: he already had his chance—twice! I don’t care how good his results are with other patients, that has no bearing on your case. I’d ask for a refund.

 

The simple fact that some of your transplanted hair has managed to take hold, yet most of it hasn’t, inclines me to believe that this is NOT an unfortunate case of physiological limitations.

 

Lastly, if I were you, I'd seriously consult with a physician about starting Propecia. It seems like you could benefit from it considering that you stated that you continue to lose hair.

 

Sorry to sound so dim… I just want to give it to you straight.

 

 

Corvettester

 

p.s. As far as your new photos go, I'm going to assume that you didn't set the year in your camera correctly because the timestamp states that they're from today's date, but in the year 2009.

 

 

Edited May 21, 2011 by corvettester
Photo Formatting Issues.

[alix]

Trooper,

the best thing you can do is to book an appointment with your doctor and visit him in person so he can assess your results in person.you have spend all that money and been through all that waiting,etc so even if you are living far away from his clinic it's worth visiting him.

good luck.

[trooper]

Trooper,

 

You shouldn't be apologizing for anything, this is what the HTN is here for.

 

Corvettester

 

I really feel that i should. Look at all the negative comments ("it looks pluggy, poor results, get your money back, etc..") Wouldn't that make you think twice about getting a TP? Perhaps I am getting people worried that have already had a TP and are thinking "what if i turn out like him". Doesn't make it any easier for those people. If i deter even one person for increasing there quality of life by deciding to not do a transplant, based on this post, then that in itself is my fault.

Its questionable whether i should have posted the way i did as opposed to saying "How many grafts would i need to fill this out" or "Would a transplant be able to give me density", etc... I should not have marked this as a 1 year anniversary. Non the less, the damage is done and i am sorry for those looking into getting one. Please, please, please do not let my results stop you. I am one of the rare isolated cases which did not take well and will still promote HT surgery as an alternative to hair loss.

That being said.... I have made an appointment with Feller to discuss my situation. I can only hope i get some form of good news. Heaven knows i need it right now. The thing that bothers me is for the fact i did 2 surgeries totaling ~4000 grafts. If i get another one, whats to say it will be successful? I know the saying 3rd times the charm but do i roll on that and take the chance with the possibility of making matters worse? I cant look back anymore by shaving my head and i certainly cant walk out without a hat so in essence, my only option is to move forward with a 3rd transplant and hope for the best. I was told i still have donor hair for another TP.

I want to thank you all for your honesty and help thus far. Despite the fact i wasn't hoping for these kinds of responses, i certainly appreciate hearing the truth as harsh as they are. I have been given lots of suggestions and will act on them. If anyone else would like to add any further information, then please feel free to do so. I can handle the criticism for the fact that i can only look forward in a positive manner to get this issue resolved/straightened out.

[mahhong]

Trooper,

 

Have you managed to speak to Dr. Feller yet, as Spex suggested? Your results do unfortunately look sub-par but the truth is very likely that no one is to "blame", so don't be so hard on yourself.

 

Feller is a good guy and he will want to look after you. If you explain the situation to him I'm sure there's something that can be done and the first step is really to go back to him, as your doctor, and get a frank assessment and range of options forward. As others have said, you should almost definitely have donor left for a further transplant if that seems the best way forward, so there are options on the table.

 

Regarding medication, which you say you are not on, my honest assessment would be that medication would be unlikely to make much of a difference looking at the severity of your loss. It couldn't hurt I guess, but I don't think propecia would have much to work on if you did start it.

 

Anyway, an appointment with Dr. Feller is the only real step to take next. It's clear the results are not particularly good for 4,000 grafts, but you do have options left and you don't need to feel too down about things. Speak to Feller and hopefully you can arrange a plan to go forward quickly.

[NEWHAIRPLEASE]

Trooper

I think you have an excellent attitude about this whole situation. As Dr Konior once told me " positive things happen to good people " and you sound like an excellent person who deserves something good! I think that will happen and I think Dr Feller will make it happen! Good luck

[Dr. Raymond Konior]

I agree with Jotronic and others who stress that wet and gelled hair will augment your thinning appearance. Wet hair binds individual hair shafts, thereby producing a much greater see-through effect. You have a very harsh contrast situation with dark hair and very light skin. Keeping your hair dry will produce a more diffuse distribution of the individual hair shafts to help provide better scalp camouflage. I believe TC17 is correct in saying you look much better with dry hair and in his suggesting Propecia as an additional component to your overall treatment plan. You have an aggressive balding pattern that certainly could benefit from stabilization therapy.

Hairthere is spot on with his comment regarding 4000 grafts – it sounds like a lot, but there are multiple variables that influence how that number is affecting your final appearance. It is very clear from the graft distribution that is shown on your postoperative photo that gradients of density were used to optimize your result. A much higher graft density was used along your actual frontal hairline to maximize the aesthetics of your frontal appearance. The bulk of your transplant zone was grafted at a much lower density – perhaps 10-15 grafts per square centimeter. This is why you look so much better from the frontal view than from the top down view with wet hair. Additionally, we know nothing about the hair counts that you had available for the procedure, i.e. are you an individual with a preponderance of one and two hair grafts, or did you have a large number of 3 hair grafts available. Also, what is the status of your donor area with respect to miniaturization? You show a side-view photo in your postoperative collection that clearly reveals a see-through effect in your temporal region. While your hair is wet in that photo, it is also long enough to have provided better coverage of your scalp. What is the reason for this see-through effect – an intrinsically low baseline hair density, reduced hair shaft caliber or the coexistence of miniaturization in your donor site? Any progressive miniaturization within the donor area will compromise transplant density as the years roll on. Corvettester has stated his doubt about the process of transplant miniaturization, but the fact is that it does exist. Transplanted hair will maintain the genetic code of its previous neighbors in the donor site. Donor site graying and donor site miniaturization will be realized years later in the recipient site if the genetic code happens to be programmed that way. I observe donor site miniaturization quite frequently during consultation examinations and can attest to the fact that this process does occur. I also do not understand where the comment about a pluggy hairline came from. It seems clear that your frontal hairline is loaded with single hair grafts and I can not identify any plugginess whatsoever. I am curious as to which photo or photos are being referenced with that statement.

Trooper, you really need to visit Dr. Feller for a follow-up examination. I have great respect for the doctor-patient relationship and would be extraordinarily discouraged if I did not have the opportunity to personally discuss a situation like yours with a patient of mine. I believe you and the rest of the community will gain a greater depth of knowledge regarding your situation by scheduling an appointment with your surgeon.

 

Good luck.

[corvettester]

Corvettester has stated his doubt about the process of transplant miniaturization, but the fact is that it does exist. Transplanted hair will maintain the genetic code of its previous neighbors in the donor site. Donor site graying and donor site miniaturization will be realized years later in the recipient site if the genetic code happens to be programmed that way. I observe donor site miniaturization quite frequently during consultation examinations and can attest to the fact that this process does occur.

 

Dr.Konior,

 

Yes, I understand that miniaturization of donor hair does exist (I assume you’re referring to Senile Alopecia experienced by younger men). I do not doubt that it exists at all. I meant that I doubted that that was the case with Tropper. Until now, I thought that it was very rare, but you mentioned that you see it quite frequently.

 

In fact, I had never hear about it until just this week in regard to another disappointed patient who goes by the username Mitch Johnson. Dr. Shapiro and Dr. Feller both commented on Senile Alopecia and its adverse effects. However, they both emphasized that it is very rare.

 

For this reason, I said that I doubted that this was the case with Tropper. I mean, what are the chances that the first time most of us ever even hear about senile alopecia, we have two separate cases of it in the same week here on the HTN?

 

So yes, it could be Senile Alopecia… I’d just be very surprised if it were!

 

 

I also do not understand where the comment about a pluggy hairline came from. It seems clear that your frontal hairline is loaded with single hair grafts and I can not identify any plugginess whatsoever. I am curious as to which photo or photos are being referenced with that statement.

 

The photos that I was referring to that I think looked pluggy are #04.jpg, #06.jpg, #09.jpg, and #10.jpg. Hopefully, it looks better in person?

 

Yes, it’s clear that the hairline was loaded up with singles; however, I still think it looks pluggy and unnatural. I don’t think sugarcoating it serves any useful purpose.

 

 

Corvettester

Edited May 21, 2011 by corvettester
Style, Grammar and Spelling.

[Dr. Raymond Konior]

Corvettester -

Your points are well taken. We all make judgments on this site based on photos, and I am certainly not a fan of most photo presentations. Once again, it would be very beneficial for trooper to follow-up with Dr. Feller so that hopefully we could evaluate high quality preop and postop photos with comparable lighting, positioning, and styling. I also appreciate your comments about the rash of patients with recipient site thinning and the possible implication of miniaturization as to the cause. However, debate here is relatively subjective in nature since all of the pertinent details that are contributing to this case are not available. I would be very interested in having Dr. Feller perform a microscopic examination of trooper’s scalp so as to quantitate the extent of miniaturization throughout the area where the harvest was performed. Only with this objective evidence can we move forward with educating ourselves and the hair loss community. Thanks for your comments and contribution to this discussion.

[orlhair1]

The discussion about transplanted hairs thinning is really scary. It is making me have serious second thoughts about proceeding with my scheduled hair transplant. From the discussions it does appear that it might be more than a rare condition?? I am already apprehensive like anyone would be, but then to think that 3 or 4 years down the road my transplanted hairs could be thinning out makes me not want to go forward.

[TC17]

Donor thinning is NOT rare. I've been screaming that from the mountain top for years on this forum, and yet few people have acknowledged it as a reality. I'm glad that this issue is finally gaining some traction and being discussed.

 

I do my fair share of people watching and it's my opinion that roughly 40% of the men I see who are balding in a NW5+ pattern and who are over the age of 60, have a thinning donor area. One is certainly free to call BS on my estimate of 40%, and that's fine. But donor thinning does occur, and according to Dr. Konior, he sees it "quite frequently." (for the record, my dad just recently started to thin in his donor region on the sides of his head. he's about 60, and this just started within the past 2-3 years, so I'm acutely aware of this possibility)

 

Assuming we all agree that donor site thinning is not that rare, and really, I don't think that's even a question anymore, ask yourself then how is it that a doctor can accurately ascertain the number of grafts that a patient has available to transplant? Scalp laxity and hair density are certainly ways to do so, but that assumes that the number of grafts remains constant throughout the patient's life. I beileve that's a faulty assumption. But, if we assume that the total number of grafts remains, and it's simply the hair that shrinks in the donor area, well then the graft estimate may be accurate, but who the hell cares? 1,000 grafts of strong, solid, thick diameter hair is better than a 10,000 grafts containing wispy, thin, cosmetically insignificant hair. My point is that it's of no consequence whether the hair simply thins while the graft count remains the same, or if it is the graft count being diminished in the donor area. It doesn't matter because the effect is the same - the patient's transplanted hair will thin, and his donor may show a scar.