Am I one of the unlucky few? 4 years post strip with Dr Feller

[LondonHTseeker]

Am I one of the unlucky few who don't grow very well, or is this a normal result for 2000 grafts into the hairline at the front? Opinions are appreciated.

 

http://www.hairrestorationnetwork.com/LondonHTseeker/albums/768

[orlhair1]

Do you have any before photos? Were all of the grafts placed in the hairline? It does look thin to me, but without more info it is difficult to tell. As you know dr. Feller is highly regarded and I would recommend discussing your concerns directly with him.

[LondonHTseeker]

I don't actually have any before photos unfortunately. Yes the grafts were all placed at the front, basically where it looks thin. Behind that I have thick hair. I'm discussing it with Dr Feller at the moment, just wondering what peoples' opinions are here. Thanks for the reply.

Edited July 14, 2011 by LondonHTseeker

[YouOnlyLiveOnce]

I'd say that looks very thin for 2k grafts. Good luck with with finding a resolution

[NEWHAIRPLEASE]

Before photos would certainly help, maybe you can contact Dr Fellers office and see if they have any? It also has been 4 years? Might be a case of losing more native hair.

[LondonHTseeker]

Thanks for the further messages. I definitely haven't lost any more native hair. What is now the area of thin hair at the front was completely bald before the strip surgery, I had no inbetween or thinning areas of hair and the balding hasn't progressed since. My hairline quickly receded at the front in my early to mid twenties then stopped without going further in land so to speak!

Edited July 14, 2011 by LondonHTseeker

[Bill - Seemiller]

LondonHTSeeker,

 

While I agree that your hair looks quite thin in the front, I'd be curious to see what your hair looked like before surgery and one year afterwards. Seeing photos 4 years later without anything to compare it too unfortunately, doesn't showcase much.

 

The question here is whether or not you've had less than optimal growth or whether or not your natural hair thinned out leaving you with a much thinner look. So I have a couple of questions/suggestions.

 

1. Please post photos showing your hair before surgery and 1 year afterwards

 

2. When did you start having concerns about your hair transplant? Posting your first set of concerns 4 years after surgery seems to indicate to me that you only became dissatisfied recently, which could indicate that you initially had good results, but became unhappy as your natural hair thinned out over time.

 

3. Where were all the grafts placed? Were they all placed in the frontal third or were some spaced out into the central region of your scalp. If you have any pictures showing your scalp immediately post op, I enourage you to post them.

 

4. Have you expressed your concerns to Dr. Feller, either after your results grew in after a year or recently?

 

Unfortunately, we don't have enough information to determine what may have happened here. So I encourage you to provide some additional pictures and information and also, I encourage you to contact Dr. Feller to see how he can help you meet your goals moving forward.

 

Ultimately, I wish you all the best in getting the thicker, fuller head of hair you're looking to achieve.

 

Best wishes,

 

Bill

[LondonHTseeker]

Hi Bill

 

In response to your questions:

 

1. I don't have photos of my hair before surgery, I guess I could ask Dr Feller for them. I also didn't take any photos at one year post op, I was trying to forget about it and let the whole result come through. I've been coping with the thin hair at the front by having it a bit longer behind and brushing the hair forward and to the side.

 

2. My concerns have constantly been there but I was trying to forget about it really because I haven't had the money for a revision, so I pushed it to the back of my mind. It hasn't been a case of me being happy and then not being. I definitely haven't lost any more native hair since the operation.

 

3. All the grafts were at the front. I have thick hair behind that (including the middle of my head) and that area hasn't thinned at all. Only Dr Feller has pics of my scalp post op.

 

4. I mentioned my concerns briefly to Spex a few years ago but failed to follow up with photos. It's really only at this point (last few weeks) that I've been trying to get it sorted out, strange as it may seem.

Edited July 14, 2011 by LondonHTseeker

[eddiemunster]

that's an unacceptable result IMO, and I'm sure Dr. Feller and his team would agree. They should, at a minimum, offer you a complimentary session to provide the intended result.

[corvettester]

2. My concerns have constantly been there but I was trying to forget about it really because I haven't had the money for a revision, so I pushed it to the back of my mind. It hasn't been a case of me being happy and then not being. I definitely haven't lost any more native hair since the operation.

 

3. All the grafts were at the front. I have thick hair behind that (including the middle of my head) and that area hasn't thinned at all. Only Dr Feller has pics of my scalp post op.

 

 

London HT Seeker,

 

Sorry to see your poor result from Dr. Feller. This is an unacceptable result. For the amount of time and money you must have spent on this, you deserve much better. In my opinion, you should definitely be expecting a lot more growth / coverage with 2,000 grafts.

 

It's only surprising that you waited so long to voice your concerns... 4 years, geeze! At least nobody will accuse you of being impatient!

 

If I were you I'd do one of three things:

 

1. Demand a refund... Good luck with that.

 

2. If you still feel comfortable letting Dr. Feller work on you, insist that he do a repair procedure free of charge... Good luck with that one too.

 

3. Go somewhere else for a repair job... Probably your best option. If you're in the UK, I'd suggest taking a short trip to Brussles to see Dr. Bisanga. From what I've seen, he does excellent repair work.

 

 

Corvettester

[alix]

sorry but this is very poor result for 2000 grafts placed in the hairline,even if the hairline area was completely bald.a repair is required.

[NEWHAIRPLEASE]

Good post and explanation spex

[orlhair1]

Well stated Spex. When one makes the decision to have a HT they have to realize that there are a lot of factors that go into the outcome, which you have set out well. While everyone wants "wow" results, those results are not the norm. I know when I was consulting, I asked about the need for more than one procedure, and while I hope I don't need one, everyone was very open, that sometimes more than one is needed. Optimal outcomes are more likely with top surgeons such as Dr. Feller, but as you say this is surgery and there are no sure things. People are way too quick to blame the doctors without knowing all of the facts. I sure hope this thread does not turn into one of those. That is why my first response was for him to consult and work with Dr. Feller. I understand why he is concerned, but that should not morph into a blame the doctor thread in my humble opinion.

Edited July 15, 2011 by orlhair1
Spelling error

[Ahairdown]

How many grafts were used in the 1st procedure? Hope you get some resolution because yeah, it looks way too see through.

[corvettester]

This may well be a classic case that the actual HT was a success and yielded higher than you think but your hair calibre is not favourable and it's just a case you need more density given the surface area covered and in actal fact it's not a failure just more is needed. Similar to "corvettesters" results maybe. He is seeking further surgery as not yet reached his goal.

 

Yield however if in actual fact is low is not necessarily the fault of the doctors.People often require more work based on personal variables, goal, physiology, hair characteristics, previous surgery etc etc - Its very common. Again see corvettesters result for example.

 

Spex makes a good point: perhaps you just need more density (a lot more) and it's not technically a failure after all. How many cm2 did you have covered? From the photos, it looks about the same as mine.

 

With my case, however, I knew from the very beginning that I would need two procedures. My doctor made it very clear to me: first, establish the hairline and fill in the temples; second, add density as needed. I chose the conservative route, some choose a more aggressive approach—to each his own.

 

What about you, LondonHTseeker, did you expect to need two or three procedures to get your desired result?

 

Again, I think Spex had a good idea to compare your hair characteristics and goals to mine... however, not your results. After all, we seem to have very similar hair characteristics (Anglo-Saxon, fine, dirty blonde). I too had hair transplanted onto a completely bald surface, almost as much as you. I had 1,700 grafts FUT over approximately 45-50 cm2 in October of 2010. Perhaps my case can shed some light on yours.

 

Unfortunately, I experienced less than optimal growth in the immediate center of my hairline in an area about 2-3 inches in length. Also, my right temple point has had almost no growth (please be sure to view my hair loss blog). Although, personally I feel like I got a much better result than LondonHTseeker did, even with my problem areas.

 

 

There are no guarantees however of 100% success so yield can be lower than initially expected. It's surgery after all and this is why patients sign a disclaimer prior to surgery testifying to understanding this facts surrounding surgery. If you feel another surgeon should have done better then that's your opinion, however we see patients from ALL clinics who are unsatisfied and feel they need more work and didnt get what they paid for originally. It's not necessarily the previous docs fault, just the nature of surgery p - its not an exact science after all. These docs do not offer their patients free surgery to return to them i can assure you...

 

Fortunately for me, when I expressed my concerns with my doctor, neither he nor his patient advisors waved the disclaimer in my face and told me that I should have known better—quite the contrary actually! He told me that he supported me unconditionally and that he would make it right no matter what.

 

So what's important here is that your doctor is standing behind you. My doctor offered me a second procedure free of charge. In fact, he also offered to add as many grafts as I felt necessary for density, free of charge, so that I wouldn't have to come back for a third procedure.

 

 

We have tried to work with you privately throughout and this was your second session with Dr Feller as you returned satisfied after the first one and wanted more and wanted to lower the hairline quite aggressively i believe given your specific request.

 

I'm confused on this point: did LondonHTseeker have one or two procedures with Dr. Feller? If so, how many grafts were in the first one and how many in the second? In his initial post, he suggests that he had only one procedure of 2,000 grafts FUT. Am I missing something?

 

If he only had one procedure, then it's still an unacceptable result. However, if he had two procedures, then it really isn't looking good!

 

 

I appreciate you mean no disrespect posting here towards Dr Feller in this manner or trying to create some form of leverage however you are bringing his name into question yet he has had not had any opportunity to examine your results for himself in person to actually assess the outcome and give you his opinion which is unfortunate as this topic now isnt painting him in a favourable light, yet he has done nothing wrong and even without seeing you offered you a very healthy/substantial discount already and as you know we are trying to work with you privately.

 

I have to disagree with the assumption that by bringing one's case to the forum a patient is somehow brining their doctor's name into question. This is what the forums are for: the successes and the failures. Every doctor has cases that are home runs, some that are less than optimal, and perhaps a few outright failures as well. The HTN is a place that we can view and critique all such results for the betterment of the community. No honest doctor should feel threatened by this.

 

Nobody suggested that Dr. Feller has done anything "wrong" so please let's be sure to differentiate between honest analysis of a patient's results versus questioning a doctor's credibility and integrity.

 

In fact, I recently asked my doctor how he felt about me posting my honest experience online and he made it very clear to me that I was well within my right and that he welcomed it. At no point did he become defensive and suggest that I should feel guilty or that I was somehow defaming him or disingenuously seeking leverage.

 

 

 

Many patients can get downhearted from ALL clinics when after HT surgery and we have seen a trend of late of various patients from a range of clinics who are unsatisfied due to more grafts being required and come online disappointed posting which in turn often just turns genuine concerns into opportunities for aliases and rival clinics to bash credible docs.

 

No need to be paranoid, Spex. I just went back and read all the comments for a second time. They were mostly from long-time posters with high post counts. I didn't notice any questionable aliases or member accounts, nor did I see any "bashing" of any docs...

 

Thus, there is really no need to be defensive at all, Spex. I think LondonHTseeker is simply giving an honest account of his experience. Let's wish him the best.

 

 

Corvettester

Edited July 15, 2011 by corvettester
Grammar. Spelling. Clarity. Had to rearrange a few sentences.

[Ahairdown]

Good points Corv!

 

Spex, I'm no HT expert by any means - but expecting to see someone in person that lives overseas isn't reasonable IMO. The pictures clearly show a poor result.

 

That being said, it was nice of the doc to offer up a steep discount for the additional procedure.

[Dr. Alan Feller]

Usually I make hairlines higher and tighter and utilize a great number of grafts to do so as I did in the case of this patient who received over 2,500 in a single sitting.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To be able to produce a hairline as in the patient above in a SINGLE SITTING of sufficient thickness one must use an extremely high number of grafts packed in tightly. As you will read that was not the plan for LondonHT. However, after his second pass the difference should be enormous and satisfying.

 

 

LondonHT, good to see you participating on the forum.

I read your posts and believe you and Spex have been talking. Allow me to review your case for your benefit and that of the forum. I have included plenty of photos below. I think you will find you are right on track:

 

LondonHT came in for his first transplant in 2005 to lower his hairline. Procedure was performed using 1,250 grafts and all went well.

 

LondonHT was happy with results and returned 17 months later for more surgery. (See photos of results of first procedure).

 

My advice prior to the second surgery was to go between grafts from first surgery and lower hairline the same amount as the first surgery which was about 3/4 of an inch. LondonHT understood my concerns but wanted a more aggressive hairline which we proceeded to draw on his forehead (see photo). I told him what he wanted was fine in terms of hairline height, but that he would not be sufficiently thick due to thin caliber hair and overall available grafts. He said he completely understood this but would "rather have a thin lower hairline than a thick higher one", and that he would come back in 6 months to fill it in to achieve the density I recommended.

 

He also wanted to do his temples as well, but I advised him there wouldn't be enough grafts for such an ambitious plan on the second procedure. So we agreed to do the aggressive surgery now and then for him return in 6 months for a fill in and temple work. This is a perfectly reasonable plan, but unfortunately LondonHT never returned.

 

The results posted here after 4 years is exactly what I would expect for a procedure of 2,000 grafts placed over an area that large. Especially if it's a totally bald area like the forehead. Every quality HT doctor would agree with this assessment. Had he come back as planned for "round two" into that area (his third surgery) we would be celebrating his results.

 

Area vs. Density is a well known issue in HT surgery. As most know, I usually prefer to do smaller areas with denser packs. However, in this case, LondonHT opted for a larger area of coverage with lower density which I agreed to perform but with the proviso that he return quickly for a second "fill in" round.

 

To understand this situation better, just compare another patient of mine, Uncle Jessie, to London HT. I put their before pictures side by side and you can see that LondonHT has almost twice the area to fill compared to Uncle Jessie. However, they both received the exact same number of grafts: 2,000 . Uncle Jessie looks finished by one year of growth, but LondonHT looks predictably unfinished by about half. Makes sense doesn't it? Twice the area, half the density.

 

So the solution is simple: complete the plan by doing one more procedure to fill in; and now after five years I believe LondonHT is arranging that with Spex. My understanding is that money may be a bit of an issue and I've asked spex to offer him the same discount I offer any patient of mine who may need it.

 

LondonHT's transplant was definitely not a failure. If you look at the last photo, LondonHT took an excellent close up of the recipient area. The distribution of grafts is uniform over the entire field. No large empty spots or skin disruptions denoting scar tissue or ingrown hairs. This was a perfect success. If you look for a few moments at the picture you will that he has primarily one hair follicular units growing, why? Because tha's how his hair existed in the donor area. I would NEVER place multihair grafts that low on the forhead, thus the predicatble need for a second round.

 

I have no doubt that even at the 6 month mark after his final procedure his results will be excellent and celebrated.

 

Dr. Feller

Edited July 22, 2011 by Dr. Alan Feller

[Dr. Alan Feller]

continued photos:

Edited July 15, 2011 by Dr. Alan Feller

[Dr. Alan Feller]

continued photos

Edited July 15, 2011 by Dr. Alan Feller

[orlhair1]

I should add that none of LondonHT's posts are critical of Dr. Feller and I think he has been professional in seeking opinions. I just think the thread took a wrong turn. At the end of the day I would like to see LondonHT get the results that he desires (and I agree that the results that he has are not what anyone would be satisfied with) and I hope he can work things out to his satisfaction. It sounds like Dr. Feller had a plan for him based on what he wanted done and he is one procedure away from achieving what he wants.

Edited July 15, 2011 by orlhair1

[Cant decide]

I don't know, I still think he should have expected more density for 2000 grafts even in an area that large. How many hairs were moved? If he had a ton of ones then maybe but otherwise, not. Dr Feller is a stand up guy who knows his stuff and he certainly knows better than me but from where I am sitting, it's just too thin for that many grafts.

 

The other thing is that I don't think this patients wish of such an aggressive hairline should have been granted. What was the justification?

[Dr. Alan Feller]

In my practice I give patients a say in the execution of their own procedures. If they go way beyond the bounds of accepted practice I will deny their request, but in this case LondonHT's request to double the area and half the density was not out of bounds. Indeed this method is still practiced by MOST doctors around the world today. Very few do dense packing into small areas as I and a few other clinics customarily do.

 

The plan was for LondonHT to return in 6 months time to perform a fill in procedure. This was a condition of my agreeing to perform the procedure. Unfortunately LondonHT never returned to have the job finished.

 

What you viewers have to understand and accept is that not every patient is the same and not every procedure is the same. Some of the comments on this thread, and many others, demonstrate a complete lack of understanding of HT surgery and its intricacies. My personal belief is that some of it is fabricated to serve personal agendas, but most of it I believe is due to blind wishful thinking and unrealistic expectations.

 

To say this case was a failure or a result beneath expectaion is to demonstrate a woeful lack of understanding of hair transplantation because I knew with 100% certainty how this procedure would look when grown, that's why a second pass was agreed to 6 months later. What I didn't expect was that my patient would not return but post his results four years later as if we never discussed the obligatory second pass.

 

This case is not unlike many thousands that came before it. LondonHT simply needs to do a second pass that was discussed and agreed upon before the first pass for the simple reason that his hair characteristics were not ideal.

 

Most of his grafts are single hair grafts. Such was the case for his first successful surgery and then again for the second. This is rare, but it does happen. Obviously fewer hairs per graft means fewer overall hairs per pass. Just take a close look at the close up picture. It tells the entire story.

 

All he has to do is finish what was planned and he can enjoy his new hair.

 

I don't know why my own patient decided to come onto this website before contacting me and simply asking me what I thought. It is certainly his right to do so, but it's wrong to omit crucial information in the initial write up. I don't think LondonHT made these omissions maliciously as he is just not that type of person if memory serves.

 

Now that I've included a massive amount of important information the record should now be straight.

[aaron1234]

What would be helpful for forum members in cases like these are immediate post-op pics. Seeing where and how the grafts were placed would be cool.

[Dr. Alan Feller]

Aaron,

You are dead on right about that.

 

I'd like to use your case to illustrate the points I'm trying to make here about MOST patients needing to do multiple passes especially if the area is rather large, low on the hairline, or if prior poor work needs to covered or repaired.

 

Your first surgery left you with a rather unnatural look, but despite this you did achieve some density. So you went for a second pass with the obviously more capable Dr. Paul Shapiro. Your results were excellent, but there was still a thin look to the result one year later. A major improvement to be sure in both density and naturalness, but obvious thinness. Why? Poor planning? Poor execution? No, I doubt it. My guess is just physiology in terms of growth yield and hair caliber. Probably the latter.

 

So you wisely opted to have a third pass. This is NORMAL in many patients with average hair characteristics, but even more so for those patients who share LondonHTs particular physiology.

[LondonHTseeker]

Can a mod delete Dr Feller's photos please? I don't want my face on the internet regarding this, trying to retain some anonymity. I'll post more in response to the above later.