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

[Dr. Alan Feller]

My mistake, sorry about that. Didn't realize your face was still showing in some of the photos. I took them down and will repost them after covering your face.

 

Dr. F

[LondonHTseeker]

Hi Dr Feller and everyone else.

 

"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."

 

It seems news to me that Dr Feller thought a third procedure would be necessary and that it was a condition of the surgery. It might be that I have forgotten it was a pre-condition; I don't think so, but it's certainly possible that I have. (Or perhaps Dr Feller might be remembering this part incorrectly. If he has any record of this term being consented to by me I'd be interested to see it. That's not to say I wouldn't have consented to it, I would - cost permitting.) I have therefore absolutely not knowingly omitted crucial information in my write up, in fact all my posts have been completely frank and open. I have absolutely no reason to be disingenuous about my results or lie and nor would I do so. If I thought that further surgery had been a pre-condition that I had failed to fulfill I would of course have said so here, surely nobody reading my posts can doubt that. Where my experience has needed some clarification, i.e. number of ops I've had, I've made the clarification, and anything I felt I got wrong in a previous post I have openly corrected. I have nothing to hide (except my identity, which I'd rather keep between me and the doctor). I also contacted Dr Feller about my case, and he responded by offering a quarter off the price of repeat surgery (with no mention of repeat surgery being a condition of my last surgery), a couple of weeks before my first post here, so I'm not sure why he suggests I didn't. I'm happy to accept this is a simple mistake on Dr Feller's part, like posting my uncensored photographs apparently was.

 

I'm grateful to Dr Feller for agreeing to my request to go low with my hairline. It's no lower than my original hairline was and, since I'm unlikely to lose much more hair in the future, it's safe. I also have a high forehead so I don't think the low hairline looks too much.

 

Although I'm ignorant of HT technicalities, I'm willing to accept the likelihood that my result is largely a result of my personal physiology. Dr Feller is of course right that there are no large holes or gaps among the grafts, they just need more volume.

 

There are things for me to still say in response to the above posts, which I'll do in another post later. I'll just quickly say that I respect and appreciate the open exchange of views here which have retained a civilized tone.

Edited July 15, 2011 by LondonHTseeker

[corvettester]

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.

 

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.

 

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.

 

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.

 

Dr. Feller,

 

I'm a little confused. Could you please clarify a few points.

 

So the first procedure was 1,250 grafts FUT. The second procedure, 17 months later, was only 750 grafts FUT. Why so few grafts for the second procedure?

 

Also, how many more do you think LondonHTseeker will need to get the desired result?

 

Another question is why would LondonHTseeker be advised to come back only 6 months after his second procedure? Isn't that far too early? Would that be enough time for his donor and recipient area to heal?

 

Lastly, how many square centimeters in total was covered with transplanted hair for LondonHTseeker?

 

 

Corvettester

[corvettester]

It seems news to me that Dr Feller thought a third procedure would be necessary and that it was a condition of the surgery. It might be that I have forgotten it was a pre-condition; I don't think so, but it's certainly possible that I have. (Or perhaps Dr Feller might be remembering this part incorrectly. If he has any record of this term being consented to by me I'd be interested to see it. That's not to say I wouldn't have consented to it, I would - cost permitting.) I have therefore absolutely not knowingly omitted crucial information in my write up, in fact all my posts have been completely frank and open. I have absolutely no reason to be disingenuous about my results or lie and nor would I do so. If I thought that further surgery had been a pre-condition that I had failed to fulfill I would of course have said so here, surely nobody reading my posts can doubt that. Where my experience has needed some clarification, i.e. number of ops I've had, I've made the clarification, and anything I felt I got wrong in a previous post I have openly corrected. I have nothing to hide (except my identity, which I'd rather keep between me and the doctor). I also contacted Dr Feller about my case, and he responded by offering a quarter off the price of repeat surgery (with no mention of repeat surgery being a condition of my last surgery), a couple of weeks before my first post here, so I'm not sure why he suggests I didn't. I'm happy to accept this is a simple mistake on Dr Feller's part, like posting my uncensored photographs apparently was.

 

I'm grateful to Dr Feller for agreeing to my request to go low with my hairline. It's no lower than my original hairline was and, since I'm unlikely to lose much more hair in the future, it's safe. I also have a high forehead so I don't think the low hairline looks too much.

 

Although I'm ignorant of HT technicalities, I'm willing to accept the likelihood that my result is largely a result of my personal physiology. Dr Feller is of course right that there are no large holes or gaps among the grafts, they just need more volume.

 

LondonHTseeker,

 

I don't doubt you at all, nor do I believe anyone else does. You're new to the forums and as you now see we try to be very thorough in our analyses and critiques of patient results. It's only natural that, as a newbie, your posts were a little ambiguous. Thanks for clearing them up though... give yourself a month on the forums and you'll be just as pedantic as the rest of us!

 

 

A few more observations and questions regarding your case...

 

 

The fact that you waited so long before considering a third HT only supports your claim that you were completely unaware of the necessity of such. Clearly, there must have been some sort of miscommunication between you and Dr. Feller. This is not unheard of.

 

Also, judging from Dr. Feller's response, it doesn't appear that there is anything physiologically amiss with you. If I understand him correctly, he's saying that it's not a matter of physiology with you, but rather a matter of area versus density. Therefore, I wouldn't worry that your case is hopeless or that you're "one of the unlucky few" as you titled this thread. Apparently, you just need a third pass and you'll be golden.

 

Have you gotten a second opinion in person of the result of your first two HTs? I always recommend consulting with multiple doctors before committing to getting an HT and consulting with multiple doctors for an opinion of the result afterwards.

 

Do you know how many square centimeters were covered in your first two HTs? I really couldn't tell from the pics Dr. Feller posted, but it looked like more from the pics you posted. I'm guesstimating that it's approximately 65 cm2?

 

How do you feel about the 25% discount for your third procedure? Do you consider that to be a "very healthy/substantial" discount?

 

 

Corvettester

[bonkerstonker]

IMO this is a completely disastrous Ht and I'd be well upset about how it panned out. However I feel that dr and patient are both to blame, firstly londons requests clearly weren't going to work well and fair play to dr feller for pointing it out to him but I'm sorry to say I feel you should have refused to do it how he wanted it or convinced him away from the aggressive attitude that you knew was going to leave him looking sparse. I know you'll say he was gonna come back and fill the gaps in but it's just a completely wrong way to do it as the patient will feel like he's constantly under construction which will cause attention and leave his mind to play tricks. Dr Feller i still love your work and don't feel this has turned out how it did from the execution of your work it's simply bad because of how it was done over such a big space.

[orlhair1]

I agree that if the patient is doing something that the doctor advises against or which will by necessity require a second procedure for a decent outcome, that communication should be very clear to the patient and probably confirmed in writing to avoid misunderstandings like this if the doctor decides to go forward with it.

[Dr. Alan Feller]

LondonHT,

It's not unusual for patients to forget what was planned and agreed upon prior to surgery, especially if it was 4-5 years ago. I certainly wouldn't remember, which is why I make and keep detailed notes during each patient's visit. You are welcome to a copy of your chart along with the entry of Sept 15 that annotes that you were returning for another pass. If you email me a fax number I will forward it to you today.

 

Also, if you look at the preop picture for your second surgery you will see the temple point areas I referred to marked in blue ink. That was the area we were going to fill in addition to the second pass.

 

Bonker,

I disagree with you. Planning two passes is more the norm than the exception. Because his proposed hairline wasn't too aggressive I agreed to do it. And had he returned as planned his results would now be applauded. LondonHT showed his willingness to follow through with his procedures by coming from England two times. I had no reason to doubt he'd come for his third. If I did, I might have refused, but he was clearly motivated and capable of finishing.

 

There are patients who come from abroad who request procedures that go out of bounds but I have no problem refusing to perform them and have done so on several occassions. LondonHT's plan was not out of bounds.

[bonkerstonker]

I see your point and I know you are a caring doctor but from my own view which is of a patient I personally would hate to be in a situation where I was left with a area looking extremely dodgy and fake while I was waiting for more work. like I said before it causes far too much attraction from others that will sadden the patient which is the complete opposite reason for having a Ht in the first place.

 

If londons plan wasn't out of bounds I'm wondering how did he end up with a transplant that is so far out of bounds it can not be seen.

 

Obviously all this above is on the assumption that Dr Feller did say london would need a 3rd Ht. London seems a pretty honest guy to me and he implys otherwise so who knows.

Edited July 15, 2011 by bonkerstonker

[Dr. Alan Feller]

Bonker,

There is always more than one way to skin a cat. For 99.99% of my patients I pack as much as can be packed into a relatively small area in one procedure. I believe this produces the most signficant cosmetic impact, and it worked well for his first procedure which was a very conservative lowering of the hairline. But if a knowledgable and educated veteran patient wants to deviate from that plan it is his perogative and there is nothing wrong with it UNLESS they don't finish what was planned.

 

I know LondonHT just forgot the plan, who wouldn't after 4-5 years? Even a thousand grafts placed between his current grafts will make for an impressive after picture.

[bonkerstonker]

This case is a tough one with it being over 4 years but all in all London I think your next Ht will make things a million times better and I respect you Dr Feller for talking this through publicly and not dodging it.

[TC17]

Dr. Feller, approximately how much surface area was covered, and was the density uniform throughout the entire area?

[Dr. Alan Feller]

Appreciate it Bonker. I always tell it like it is even if it doesn't win me any popularity contests or sets off the luny fringe. I assure you and everyone: I know exactly what I do when I do it and why. And through the diligent use of digital photos and documentation I can demonstrate that each step and decision I make in planning and performing a procedure is calculated and logical given all the variables available. No physician would have acted differently than I did with this patient and there is absoltuely no issue here. LondonHT just has to finish his plan and move on. The fact that he willingly or unwillingly took a 4 year hiatus is of no consequence.

 

TC,

I don't have a clue as to the surface area covered in terms of measurement, but it is larger and lower area than my average patient (look through my hundreds of posts and pictures...ever see me do a hairline quite like this one?). And yes, the distribution was even throughout except for the posterior most part where I overran the old grafted hairline area from his first procedure to thicken that area up. Mostly one hair FUs and thin 2 hair FUs used throughout.

 

If he had the hair caliber of say an Uncle Jessie or even a Spex he would be far closer to finished even without a second pass. But even with their hair a second pass would have been strongly recommended if not required. Each person has their own unique physiology which is why no HT procedure is "one size fits all".

Edited July 15, 2011 by Dr. Alan Feller

[Bill - Seemiller]

I appreciate everyone's involvement in this topic, especially LondonHTSeeker's and Dr. Feller's. There certainly may have been some miscommunication as to the long term game plan. But hopefully now, both London and Dr. Feller can work together to help this patient get the results he ultimately wants and deserves.

 

I believe in addition to me in my first post on this topic, it was Aaron who suggested that someone post immediately post-op photos. Dr. Feller, do you have them? If so, I encourage you to post them from both procedures so we can see the placement of the grafts. This would certainly help in evaluating the results in conjunction with the photos we've already seen of the results grown out.

 

There is no doubt that LondonHTSeeker's results are thin and can't stand alone. However, I too agree that another larger procedure could provide him with the results he wants and deserves.

 

Dr. Feller, Corvettester asked some good questions in a previous post that I think would be helfpul if you answer. I've quoted them below for your convenience and input.

 

"So the first procedure was 1,250 grafts FUT. The second procedure, 17 months later, was only 750 grafts FUT. Why so few grafts for the second procedure?

 

Also, how many more do you think LondonHTseeker will need to get the desired result?

 

Another question is why would LondonHTseeker be advised to come back only 6 months after his second procedure? Isn't that far too early? Would that be enough time for his donor and recipient area to heal?"

Ultimately, everyone here wants the same thing for LondonHTSeeker, including Dr. Feller and Spex - which is to see this patient meet his hair restoration goals. Thus, everyone is on the same side here. Thus, let's all encourage a continued collaboration between the educated patients and dedicated physicians in the field in order to help hair loss sufferers restore their hair. After all, this is what it's all about.

 

Best wishes,

 

Bill

[bonkerstonker]

Amen to that bill we're all hear to help each other against the plight of hairloss!

[The count Of Baldecristo]

I just want to say that it was so wrong to show the guys face on the internet! I am sure the transplant business is all about anonymity and only few people go full monty i dont understand how this mistake was made!

[LondonHTseeker]

It's kind of confusing now knowing who to reply to. I should mention that the initial price for a revision quoted by Dr Feller and mentioned by me earlier in this thread has been significantly reduced, which I appreciate. It's really just about me getting the money together now because I'm confident in Dr Feller being able to sort it out, what he has said makes sense.

 

It's funny seeing the photos of me before my HT's, I had lost quite a lot at the front there - more than my brother has...but at least I'm taller than him! So far as the lunatic fringe goes, as Dr Feller mentioned at one point, I'm looking forward to not having to tame my lunatic fringe with gel every day, if I can fix another surgery!

Edited July 15, 2011 by LondonHTseeker

[LondonHTseeker]

 

Dr. Feller, Corvettester asked some good questions in a previous post that I think would be helfpul if you answer. I've quoted them below for your convenience and input.

 

"So the first procedure was 1,250 grafts FUT. The second procedure, 17 months later, was only 750 grafts FUT. Why so few grafts for the second procedure?

 

 

 

Bill

 

Hi Bill, the second was 2000 grafts.

[Dr. Alan Feller]

LondonHT,

I'm glad everything is coming together now.

 

I want to make it clear to the viewers that I authorized Spex to offer you a big discount before your first post went up. I have a great appreciation for repeat patients and take care of my guys, especially when they travel as far as you do. I just don't advertise it online.

 

Continue to work with Spex to set up your date for your return. We'll document it throughly and post the photos on the site.

 

All the best.

 

This will be my last post on this thread .

[cwatte]

The count of Baldecristo + 1... If LondonHT hadn't signed the waver to publish his photos he should be flat out pissed.

[LondonHTseeker]

Don't think there's any point in that. If I discovered the photos had been saved by someone and leaked elsewhere I wouldn't be happy, but I think that's unlikely.

 

By the way, at the start of this thread I only mentioned the 2000 grafts of my second HT because I couldn't remember how much had been used in my first HT.

[corvettester]

TC,

I don't have a clue as to the surface area covered in terms of measurement, but it is larger and lower area than my average patient (look through my hundreds of posts and pictures...ever see me do a hairline quite like this one?). And yes, the distribution was even throughout except for the posterior most part where I overran the old grafted hairline area from his first procedure to thicken that area up. Mostly one hair FUs and thin 2 hair FUs used throughout.

 

 

I find this statement rather troubling...

 

I have had five in person consultations. At each consultation, each doctor measured my head and gave me an estimate of surface area to be covered in squared centimeters. They ranged from 40-50 cm2, with the average being 45cm2. Not only that, but most of them noted it in my patient profile package. In fact, I still have a few of them and, of course, I have the one from Dr. Dorin.

 

What I don't understand is why this information is not part of the patients chart. I always thought that it was standard operating procedure in the HT industry. I mean, a patient needs to know this sort of information so as to be able to calculate the number of FUs /cm2, etc... In my opinion, this information is just as important as number of grafts planted and hair count!

 

I don't think this is asking too much. I'd like the community's opinion on this one.

 

 

Corvettester

Edited July 16, 2011 by corvettester
Grammar. Clarity.

[bonkerstonker]

I don't see any point of making a issue about the photos having londons face on them it was clearly a mistake nobody is perfect and it was taken down sharply also London him self isnt too bothered as he has handled him self like he has done constantly on this forum as a true gent.

 

London the main thing here is and Like I told you on the other thread Feller is a stand up guy and although you both have a defence and side to your argument he is looking after you.

 

Corv with respect to measuring recipient areas I've never really been bothered with that myself and couldn't care less as I am a diffuse thinner so it's just a matter of filling gaps for me but I think for someone with completely bald areas like your self and others it would be paramount information. I don't think I've seen londons pre op pictures but if he was virtually bald there he should have had the area measured.

Edited July 15, 2011 by bonkerstonker

[corvettester]

Hi Bill, the second was 2000 grafts.

 

So the first procedure was 1,250 grafts FUT.

The second procedure was 2,000 grafts FUT.

Total grafts placed in the hairline and temples comes to 3,250 grafts FUT.

 

 

This whole time I thought that we were looking at a 2,000 graft result. In actuality, we've been looking at the final result of 3,250 grafts spread over two procedures, a couple years post-op. I had initially thought that it looked quite thin for a 2,000 graft procedure, but now I think it looks incredibly thin!

 

As Spex mentioned, LondonHTseeker and I have a lot of similarities. One of the similarities is the approximate area of coverage. What I can't seem to make sense of is his result compared to mine.

 

Just like LHTS, I only had work in my hairline, temples and temple points, not my frontal third. Based on the photos that he and Dr. Feller posted, it appears to my eyes that he only had a relatively few more squared centimeters of coverage than I did... perhaps 10-15cm2 more, if that.

 

I only had 1,700 grafts FUT, and my hair is even finer than his... so why do I have so much more coverage? I apologize if I sound like I'm bragging about my result over yours, LHTS. I don't mean it that way, I simply want to use myself as a point of reference.

 

 

I mean, if you do the math: 1,700 grafts / 45cm2 = 37 FU/cm2 is what I ended up with. However, if you calculate LHTS' stats: 3,250 grafts / 60cm2 = 54 FU/cm2. Please correct me if my math is wrong. I can only estimate the area covered on LHTS based on the photos that Feller posted and the photos LHTS posted as well. He really doesn't appear to have that much more area coverage than I did.

 

However, even if we decided to be overly generous and assume that LHTS had 75 cm2 covered, then that would still put him at 43 FU/cm2, which is still more than me, yet he has significantly less density than I do.

 

He should have much more coverage. His hair should look much more denser. He's pushing anywhere from 45-55 FU/cm2 while I'm at a mere 37 Fu/cm2 and I'm only 9 months post-op! Thus, why the huge disparity in appearance?

 

To me, this is even more troubling. I mean, how many more grafts do you think you're going to need, bro? Based on your photos, I'd guess approximately 2,000-2,500 more? That would put you well over 5,000 grafts in your hairline and temples only... we're not even talking about the frontal third either!

 

That's a lot grafts!

 

I'd really like to hear the community's thoughts on this one. Is this common or advisable? Or is this just a case of a patient getting exactly what he wants? I only ask because I have been advised to never go over 4,000 for the hairline and temples.

 

This truly is an interesting case!

 

 

Corvettester

Edited July 17, 2011 by corvettester
Clarity. Grammar. Spelling. Structure.

[corvettester]

Don't think there's any point in that. If I discovered the photos had been saved by someone and leaked elsewhere I wouldn't be happy, but I think that's unlikely.

 

Actually, I did save your photos. I assumed that you had authorized their publication. I have since deleted them though out of respect to your privacy and anonymity. My apologies.

 

 

Corvettester

[Ahairdown]

Corvette... glad you are part of this community - you do a good job of 'keeping things real'...

 

Also, I disagree with the comparisons between you and the OP's density. Your's is already more dense at only 8 months, and has just started the maturation phase. OP is years out from his procedure.