1550 grafts with Dr. Alexander

[fritz68]

I recently (11 days post-op today) had 1550 grafts on my fontal hairline with Dr. Alexander in Arizona. It was essentially a 'redo' of a poor hairline transplant I received from a former coalition doctor. Issues I presented with were (a) poor density of 15-30 grafts per sq cm (b) scar stretched to approx. 0.7mm to 1cm © squint (about 1cm higher on right side) and unnatural hairline.

 

I decided upon Dr. Alexander after (in contrast to first procedure) a thorough review of the coalition doctors who didn't require shaving (don't mind shaving recipient but can't shave donor with scar and not walking round with long back and shaved front). His policy of one patient per day was important for me. Despite flying from Europe, I thought the extra 4-5hrs to Arizona were worth it.

 

The difference between my first and second transplants were night and day.

 

Dr. Alexander was meticulous in his attention to every detail of the process, as were his technicians. He also spent a lot of time revising the scar. I apparently have a highly vascular scalp which Dr. Alexander explained (I think, although I was half out of it) can lead to a more rapid local decline in lidocaine/epinephrine concentrations, necessitating more frequent injections of both. It also sounded like he was cauterizing blood vessels at the back but I might have been imagining it.It was actually quite painful as the scar area became hypersensitive, but I didn't really care if this was the price to pay for a job well done.

 

The first transplant (and not this one) was also performed using a 'stick and place' technique, which I think might be harder for technicians to deal with if the patient is a bleeder, like I am. At least I remember the technicians saying how difficult it was in the first transplant as so many hairs were popping out again.

 

Now it's the waiting game, but even in my naivety I remember being very sceptical after the first transplant as there were so many things that didn't fit. I'm taking nothing for granted but I do know I've gone to a top-notch surgeon this time, so I'm quietly optimistic.

 

At 11 days out there's a densely packed hair line, which I expect will shed anytime soon, so I'll be a very happy man if these hairs decide to come back again. If the scar's improved it will be a home run. Will keep you updated at later dates.

Edited July 10, 2011 by fritz68

[Ahairdown]

Good luck on your new procedure!

 

Did the new doc have any theories on why your donor scar was widened (i.e. no laxity, etc)?

[fritz68]

Thanks!

 

I'm not sure if he specifically said why, but he said he didn't think a tricophytic closure was used (Dr. Alexander uses a 2 layer tricophytic closure).

 

For the record I never performed scalp stretching exercises for the first procedure (surgeon didn't believe in them) and started weight-training 8 days post-op (according the post-op instructions).

 

I've also started weight-training again (just 2 x 45mins per week), I don't believe an increase in blood pressure or 'straining' adjacent neck muscles increases scar tension, but am careful with head movements.

 

The stretching was only on both sides of my head, not on back, suggesting scalp tightness in that area and perhaps poor closure was the cause.

[orlhair1]

Looks good. You should have a nice result. I would be careful with the weight training because it is known to be a cause of stretching the scar. You may want to do a search on here about that. There are a couple of articles on it. I think as long as you are going light for now and avoiding anything that could cause any type of a pulling in the scar area you will be good.

 

Heal well and happy growing!

[fritz68]

Ok, thanks for your advice orlhair1!

[Ahairdown]

Just on the sides... hmm. I can't see how that would be related to weight training either. I usually lift 3-4 times per week (haven't started back up yet). Doc said my closure was really easy with no tension. I created another message thread somewhere with my theory that possibly my weight training before the transplant helped with laxity.

 

What sucks now though is I'll have to give up a lot of my core excercises for a year. Squats, military press, situps, shrugs, rows... all out

 

What does your workout look like at this point? Btw... Arocha told me no weight training until at least two week after, which at that point needs to be very light lifting. Apparently it takes up to a year for the scar to mature.

[orlhair1]

My instructions were similar. I am almost 4 weeks out now. I decided to play it conservative and plan to start some light weights this week. Just did cardio the last couple of weeks. I agree that squats, military presses, sit ups, etc are all out for at least 6 months. But at the end of the day, it should be worth it.

[fritz68]

I believe there are several renowned docs who say weight training is ok 1 week post-op, Shapiro I think, and at least Dr. Alexander's technician said it was ok when she was removing the sutures.

 

I think doctors tend to err on the side of caution which is fine.

 

But there are no studies on this (as far as I know), just empirical and anecdotal evidence.

 

If there was a biologically plausible reason as to why weight-lifting would increase scar tension (and not just blood pressure and 'straining' of neck muscles as I often read) I'd be more inclined to believe it.

 

I do 2 x 45 mins sessions of core exercises, about 12 sets total per workout, with each set lasting 25-35 seconds, so it's about 12 mins total out of 168 hrs per week. I feel more tension on the wound if i simply lie on my bed and put my chin to my chest (for example to watch TV) than lifting weight above my head when it's aligned with my spine.

 

But I think everyone has their own ideas on this so no right answer

[orlhair1]

Agree. Dr. Shapiro told me to go light the second week and after that I would be good to go. He did caution me not to do anything that would pull on the scar for six months. With weights, he said that the main thing is to do the exercises properly so that you hold your head in a position that does not put stress on the scar. He also said that you will feel it if it starts to put tension on it and just stop what ever you are doing if that occurs. So, really just common sense and good form is the key.

[NEWHAIRPLEASE]

Looks good. You should have a nice result. I would be careful with the weight training because it is known to be a cause of stretching the scar. You may want to do a search on here about that. There are a couple of articles on it. I think as long as you are going light for now and avoiding anything that could cause any type of a pulling in the scar area you will be good.

 

Heal well and happy growing!

 

Agree with this statement!

[RCWest]

Would this former Coalition Doctors last name happen to start with an E? Just curious.

 

You are lucky to have a nice head of hair to begin with. Dr. Alexander is an excellent surgeon and I don't think you need to worry this time;)

[fritz68]

thanks RC, yes, I'm relatively lucky with starting point. That's correct re, doc.

[TakingThePlunge]

fritz68,

 

Congratulations on your hair transplant with Dr. Alexander! You deserve an award for braving our summer weather here in Arizona!

 

As expected, your work looks meticulous and refined. I wish you the best and I hope you'll continue to update us on your progress.

[fritz68]

Thank you David, much appreciated!

 

WIsh I could say I did brave the Arizona heat but the limits of my bravery consisted of 100m walks to Trader Joe's.

 

Amazing dust storm though, didn't even need Toppik for 2 days after.

[fritz68]

Here's a 2 week post op pic, it's taken with mobile camera so not great detail, but I'm delighted to say that I was able to return to work on Monday, and even meet girlfriend on Saturday, without anyone noticing (and my girlfriend is observant).

 

The last time I had this done the area was red, raised and pitted (and very noticeable) for almost 2 months.....this time it already looks just like it did pre-op with the exception of grafts that haven't shed yet. Brilliant.

[NEWHAIRPLEASE]

Nice!

[fritz68]

Now at 13 weeks/3 months after 2nd hairline procedure. I've often read that transplanted hair is less susceptible to shock loss, but there was definitely shock loss of transplanted hair from 1st transplant. From about 1 month to now my hair has therefore looked worse than pre-transplant, a thin 2cm zone with a thick hairline behind. Not a good look.

 

However, new hair started coming in at around 10 weeks and it's already starting to take shape, so am optimistic that it will be very solid in a few months. The pic is taking with a mobile phone, I think it looks better in reality, there's actually a small widow's peak taking shape that isn't apparent in the pic.

[wildflowerwildflower]

Thanks for the pics and update Fritz. Looks awesome already!

 

I'm in the final stages of choosing between Dr. Alexander and Hasson/Wong for my 1st HT. I'm extremely nervous even trying to make the final decision. I was going to post a thread asking for advice on this decision -- but you seem to be very pleased with Dr. Alexander, do you have any advice about my decision? Thanks!

[orlhair1]

Thanks for the pics and update Fritz. Looks awesome already!

 

I'm in the final stages of choosing between Dr. Alexander and Hasson/Wong for my 1st HT. I'm extremely nervous even trying to make the final decision. I was going to post a thread asking for advice on this decision -- but you seem to be very pleased with Dr. Alexander, do you have any advice about my decision? Thanks!

 

 

Two great choices between Dr. Alexander and Hassan & Wong. You won't go wrong with whatever choice you make.

[hairthere]

That looks pretty darned good fritz. Dr. Alexander's hairlines are incredible imo.

[fritz68]

Thanks for the pics and update Fritz. Looks awesome already!

 

I'm in the final stages of choosing between Dr. Alexander and Hasson/Wong for my 1st HT. I'm extremely nervous even trying to make the final decision. I was going to post a thread asking for advice on this decision -- but you seem to be very pleased with Dr. Alexander, do you have any advice about my decision? Thanks!

 

Thanks for feedback.

 

Re. Hasson/Wong or Alexander, I'd agree 100% with orlhair1, I don't think you can go wrong with either. My mistake was going to a very poor surgeon for my first transplant who was meticulous only in his attention to the cash, nothing else. The difference between Alexander and the first surgeon was black and white in every respect and I'm sure this would have been the case with Hasson/Wong.

[fritz68]

That looks pretty darned good fritz. Dr. Alexander's hairlines are incredible imo.

 

Thanks a lot hairthere. It's just really starting to take shape but I agree, Alexander does excellent hairlines.

[fritz68]

Am delighted to report things are really moving fast this time (in marked contrast to my last HT), am only 15 weeks out and my hairline looks pretty solid already.

 

I'm really amazed at how much difference a solid hairline makes to my overall appearance, I've noticed that I'm dressing much sharper now as my confidence in how I look has improved (had confidence in who I was, but less in how I looked and tended to dress down).

 

What's apparent is that although there's lots of growth ahead, there are no clear patches of scalp. In retrospect I should have had a 2nd HT about 7-8 months post op from the first as although the hairs mature and the overall look improves, the gaps never disappear.

 

Here's 15 weeks post-op in profile, you can see where the slight widow's peak is and where Dr. Alexander drew it on the first set of pics.

 

Scar---still some shock loss but at the moment it's much more discreet than the scar from the first procedure.

[fritz68]

A little over 4 months...as you can see there's still some gaps there but optimistic it will fill in. This is with minoxidil in morning and again this evening, pic with no flash under strip lighting, think it looks better in reality. Am able to wear hair up off my face, happy with things so far. I need to more hairs to pop through, maturation of the existing hairs won't do it. But plenty of time so no stress.

 

I remember my hair always looked thin and flyaway at the front so it was worst the first day after a shampoo since I was a teenager (20+ years ago). Now I can wash every morning and it looks solid. Fantastic.

[osidekid]

Looks great! Best of luck. Can't wait to see the end result.