Doing another HT after a not-so-great result?

[akuma]

If on any event the first HT does not grow in well. And say the patient got 50 units per cm2. If he goes for another HT, how much can that fix anyway?

 

I mean with 50 U / cm2, its not a empty scalp. There are prior follicles still there, so when the new procedure adds new grafts, how much can really be transplanted? The area would already be crowded.

 

Im guessing not much. So the results from repair work isn't that great i assume?

 

Any insight?

[Cartesian]

How long ago ws the HT done ? How many grafts did you obtain ??

[Spanker]

It really depends. If someone had 50 cm2 grow in, that would not be considered a failure. It is really a case by case basis depending on age and donor, etc. If a doc felt comfortable he may put an extra 15 grafts per cm2 just to beef it up a little more. There are so many variables that to answer a question like this you would have to go in a lot more detail.

[Davis91]

If I remember your case, you had some questionable results in the front hairline only? It could have been the single hairs were trimmed too fine for example. There was a similar case from Dr. Feller posted here a few years back. The next time the grafts were trimmed too keep more "fat" and more multi-units were added pretty soon after the new singles in the front of the hairline, and it looked much better.

 

I recall you had a pretty good head of hair to start, so you could always take a crack at beefing up the density a little without necessarily compromising donor supply.

[RCWest]

If 50 fu/cm2 grew, that is pretty dense for a hair transplant.

[Dr. Glenn Charles]

In most cases 50 Fu's / sq cm is enough to give good coverage. I suppose with very dark hair and light skin it may still look thin in certain lighting.

[akuma]

If I remember your case, you had some questionable results in the front hairline only? It could have been the single hairs were trimmed too fine for example. There was a similar case from Dr. Feller posted here a few years back. The next time the grafts were trimmed too keep more "fat" and more multi-units were added pretty soon after the new singles in the front of the hairline, and it looked much better. .

 

Yea just the front. I am not giving up hope yet, it could improve.

 

What do you mean the single hairs were trimmed? you mean the base of the follicle made thinner? slice the base of the follicle off? wouldn't that affect growth though? Please give more info on this.

 

I recall you had a pretty good head of hair to start, so you could always take a crack at beefing up the density a little without necessarily compromising donor supply

 

Yea I am thinking to take another shot at adding up some more density.

 

It really depends. If someone had 50 cm2 grow in, that would not be considered a failure. It is really a case by case basis depending on age and donor, etc. If a doc felt comfortable he may put an extra 15 grafts per cm2 just to beef it up a little more. There are so many variables that to answer a question like this you would have to go in a lot more detail.

 

So only around 15 U / cm2 can be added?

 

 

If 50 fu/cm2 grew, that is pretty dense for a hair transplant.

 

In most cases 50 Fu's / sq cm is enough to give good coverage. I suppose with very dark hair and light skin it may still look thin in certain lighting.

 

They grew, but the actual hair thickness has not reached full thickness (and i dont know if it will or not). Some hairs are wispy. So im curious how much more can a doctor add to a 50 U/cm2 transplant?

 

15 cm2 more?

 

What about blood supply issues? Would adding extra follicles to a 50 U/cm2 zone reduce blood supply ? due to crowding.

[RCWest]

When was your surgery performed? It can thicken for up to 1-1/2 to 2 years in some people. As long as the hairs are visible and growing, they should definitely mature more.

[Davis91]

Not slice the base of the follicle off, but rather sometimes too much "supporting" material around the follicle/shaft is trimmed off compromising the follicle's capacity to grow at all or grow fully. Many HT textbooks show a photo of what an ideal trimmed graft looks like, and you can find more technical discussions about this topic on this website or others.

 

Mosts but not all, failure to grow lies with the technical team behind the transplant, presuming that you followed basic post op instructions. It is possible--though not definite--that a percentage of your frontal hair grafts were trimmed a bit too much (dividing doubles into singles for instance) and this compromised growth. Or, it could be physiological.

 

I would not worry to much in your case. You are already at the upper % of where most of us would dream to be pre-transplant. You got your temple points done well and 50-60% of your frontal added density achieved I would guess. You have plenty of donor left to try another small round to beef it up. I would take some recent photos and stick it up here for additional commentary, and then consider if you want to keep working with the current doc or not.

 

If we are just talking about a 1000 or less added grafts needed/wanted, you might try another elite doc just to feel safer.

[akuma]

Not slice the base of the follicle off, but rather sometimes too much "supporting" material around the follicle/shaft is trimmed off compromising the follicle's capacity to grow at all or grow fully. Many HT textbooks show a photo of what an ideal trimmed graft looks like, and you can find more technical discussions about this topic on this website or others.

 

 

 

why would the doctor trim the around the follicle if they know it would affect its growth? to make space for the 2 -3 hair grafts doesn't seem to be a good enough reason.

 

upon close inspection i do notice that the 2-3 hairs have matured. But the single hairs at the front of the hairline are still thin and curly.

 

 

Mosts but not all, failure to grow lies with the technical team behind the transplant, presuming that you followed basic post op instructions. It is possible--though not definite--that a percentage of your frontal hair grafts were trimmed a bit too much (dividing doubles into singles for instance) and this compromised growth. Or, it could be physiological.

 

 

 

I did post op instructions to the dot. What do you mean physiological?

 

I would take some recent photos and stick it up here for additional commentary, and then consider if you want to keep working with the current doc or not.

 

I've added new pictures to my other thread. I'd like to get more comments on it.

[Davis91]

I can't recall your hair count. It may have been the case that the doctor needed to cut some one hair grafts out of two or three hair grafts for your hairline. Also, single hair grafts, whether they are "made" or naturally occurring, are the most susceptible to trauma according to some sources, including handling trauma by techs.

 

By physiological it could be the "x" factor unknown--for some reason the singles may have had their growth stunted for no particular reason or fault of anyone--i.e. a physiological reason that will not be determined.

[akuma]

I can't recall your hair count. It may have been the case that the doctor needed to cut some one hair grafts out of two or three hair grafts for your hairline. Also, single hair grafts, whether they are "made" or naturally occurring, are the most susceptible to trauma according to some sources, including handling trauma by techs.

 

By physiological it could be the "x" factor unknown--for some reason the singles may have had their growth stunted for no particular reason or fault of anyone--i.e. a physiological reason that will not be determined.

 

but isn't the whole point of follicular unit extraction is to preserve the units how they are? And hence not to split the 2-3 hairs units into 1 hair units.

 

Even if the singles are required for the frontal hairline, splitting the units is bound to affect the hair growth. So why would doctors risk that?

[strypp]

I can't recall your hair count. It may have been the case that the doctor needed to cut some one hair grafts out of two or three hair grafts for your hairline. Also, single hair grafts, whether they are "made" or naturally occurring, are the most susceptible to trauma according to some sources, including handling trauma by techs.

 

By physiological it could be the "x" factor unknown--for some reason the singles may have had their growth stunted for no particular reason or fault of anyone--i.e. a physiological reason that will not be determined.

 

davis91:

great responses

thanks!

 

it is reported by some that FUE has a lower survival rate (yield) than the strip method

 

not to worry

i bet any of the top docs who specialize in hairlines would add to what you have

 

consult with rahal

i hear he does hairlines pretty good

[akuma]

davis91:

great responses

thanks!

 

it is reported by some that FUE has a lower survival rate (yield) than the strip method

 

not to worry

i bet any of the top docs who specialize in hairlines would add to what you have

 

consult with rahal

i hear he does hairlines pretty good

 

I got FUT done though. Not FUE.

[strypp]

oh...

 

well, it seems like either the 50cm2 density that the doctor inserted did not totally survive,

 

the grafts inserted into the existing hair damaged the existing hair follicles

and/or set them into their non-growth period,

 

or

 

50 grafts/cm2 density was not enough given your hair characteristics to not give the see through scalp look

 

don't fret

this is fixable

consult with some docs

 

realize sometimes this happens and may not be due to the doctor you have chosen

[Janna]

Hi Akuma,

 

I don't know your story and did not notice any pics to view but if I understand your original question you are asking how much more can be added on top of 50/cm2?

 

You mention that you currently have 50/cm2 but are you basing this on your ht physician telling you or were you able to get your density measured with a hair counting device? I agree with Dr. Charles that generally 50 per cm2 would give good density so if you feel you need more, your density may not be at 50/cm2. However, if you indeed have 50/cm2 and you need a little refinement to achieve a denser look, another 10 to 15gr per cm2 could be added in the hairline without compromising the blood supply. It's less risky to add to the density in another procedure rather than try to dense pack too much in one procedure. This is when you risk the blood supply.

 

There are many ways in which the grafts can be damaged during a ht procedure. The ht team definately has to take proper care when harvesting the donor, slivering, cutting and planting to maximize yield.

[akuma]

thanks for the responses guys.

 

 

 

Hi Akuma,

 

I don't know your story and did not notice any pics to view but if I understand your original question you are asking how much more can be added on top of 50/cm2?

 

You mention that you currently have 50/cm2 but are you basing this on your ht physician telling you or were you able to get your density measured with a hair counting device? I agree with Dr. Charles that generally 50 per cm2 would give good density so if you feel you need more, your density may not be at 50/cm2. However, if you indeed have 50/cm2 and you need a little refinement to achieve a denser look, another 10 to 15gr per cm2 could be added in the hairline without compromising the blood supply. It's less risky to add to the density in another procedure rather than try to dense pack too much in one procedure. This is when you risk the blood supply.

 

There are many ways in which the grafts can be damaged during a ht procedure. The ht team definately has to take proper care when harvesting the donor, slivering, cutting and planting to maximize yield.

 

Hi Janna,

 

Here is my whole journey.

 

http://www.hairrestorationnetwork.com/eve/165098-doctor-damkerng-pathomvanich-transplanted-scalp-area-growing-slower-than-temples-6.html

 

I was told my doctor that I have 'nearly' 50U per cm2. But I doubt it is 50. Please look at my case on that link above and provide feedback.

[Janna]

Hi Akuna,

 

Thanks for the link. I was able to see your pics and follow your progress for the most part today.

 

The thing that struck me is that the frontal scalp area that was addressed seems greater than 15cm2. I think if you add more grafts within and behind the hairline, you'll achieve the density you're hoping for. Do you have a date set for your next procedure?

[gillenator]

akuma,

 

I also took a peek at your pics from the link you provided. It appears that you had your frontal hairline lowered by 1 to 1 1/2 cm?

 

You have a great visual volume of exisiting hair in the frontal zone however with the wide contrast of dark hair on a fairer complexion, there is much more light reflecting in the commencement of your hairline. Dr. Charles added his insight and wisdom in this area thank you. You may want to add single hair FUs in that region but be careful to not over compact that area or it will not look natural. Proper angulation of the recipient sites created for those single hair grafts are critical. Are you familiar with the "stick and place" method in that area of the hairline?

 

The commencement of any hairline should be done with singles as most natural hairlines occur. There needs to be a slightly lower FU count with some slight visual space them because again, that's how natural hairlines commence. Feel free to ask Dr. Charles about this. I encourage you to look at mature hairlines on others who do not have hairloss and you will see what I am referring to. Look especially at men with wider color contrasts as yours.

 

As far as the yield from your prior FUHT procedure, you are getting closer to the 1 1/2 year mark post-op so you should not be seeing any more new growth from your last procedure. I did take note that you have above average hair caliber which is outstanding for achieving visual coverage.

 

In addition, with FUE, the surgeon can still extract single bearing FUs in the donor area for the hairline. It's when the surgeon is re-building a new hairline or lowering the hairline (like in your case) that they may need to dissect some multiple hair bearing FUs into singles so that they have enough.

 

This is true with strip as well. The strip specimen may not provide enough natural occurring single FUs so the team may have to dissect some of the multiple hair FUs to have enough singles for the new hairline. Highly experienced techs who are competent know how to microscopically dissect and trim the grafts into singles without transecting them. Transection can and does happen depending again on the staff and the equipment employed. Believe it or not, some clinics still dissect the strip without using scopes.

 

Other than that, IMHO your frontal zone looks fine and best wishes to you my friend. :cool:

[akuma]

Hi Akuna,

 

Thanks for the link. I was able to see your pics and follow your progress for the most part today.

 

The thing that struck me is that the frontal scalp area that was addressed seems greater than 15cm2. I think if you add more grafts within and behind the hairline, you'll achieve the density you're hoping for. Do you have a date set for your next procedure?

 

I haven't set a date for the procedure yet. I dont know what to do at the moment.

[akuma]

akuma,

 

I also took a peek at your pics from the link you provided. It appears that you had your frontal hairline lowered by 1 to 1 1/2 cm?

 

You have a great visual volume of exisiting hair in the frontal zone however with the wide contrast of dark hair on a fairer complexion, there is much more light reflecting in the commencement of your hairline. Dr. Charles added his insight and wisdom in this area thank you. You may want to add single hair FUs in that region but be careful to not over compact that area or it will not look natural. Proper angulation of the recipient sites created for those single hair grafts are critical. Are you familiar with the "stick and place" method in that area of the hairline?

 

The commencement of any hairline should be done with singles as most natural hairlines occur. There needs to be a slightly lower FU count with some slight visual space them because again, that's how natural hairlines commence. Feel free to ask Dr. Charles about this. I encourage you to look at mature hairlines on others who do not have hairloss and you will see what I am referring to. Look especially at men with wider color contrasts as yours.

 

As far as the yield from your prior FUHT procedure, you are getting closer to the 1 1/2 year mark post-op so you should not be seeing any more new growth from your last procedure. I did take note that you have above average hair caliber which is outstanding for achieving visual coverage.

 

In addition, with FUE, the surgeon can still extract single bearing FUs in the donor area for the hairline. It's when the surgeon is re-building a new hairline or lowering the hairline (like in your case) that they may need to dissect some multiple hair bearing FUs into singles so that they have enough.

 

This is true with strip as well. The strip specimen may not provide enough natural occurring single FUs so the team may have to dissect some of the multiple hair FUs to have enough singles for the new hairline. Highly experienced techs who are competent know how to microscopically dissect and trim the grafts into singles without transecting them. Transection can and does happen depending again on the staff and the equipment employed. Believe it or not, some clinics still dissect the strip without using scopes.

 

Other than that, IMHO your frontal zone looks fine and best wishes to you my friend. :cool:

 

 

Yes i only lowered 0.5 cm to 1 cm.

 

What is the "stick and place" hairline thing?

 

Someone in this forum mentioned that the "follicle" stripping of the hairs for the hairline could be what caused the problem. I thought the whole point of HT was to leave the follicular units the way they are? Stripping double hairs into singles, wouldn't that guarantee bad growth?

[Janna]

I haven't set a date for the procedure yet. I dont know what to do at the moment.

 

Have you discussed the next step with Dr. Path? It sounds like he's willing to get you to where you want to be. I think that the density in the hairline is a bit thin and by adding more grafts to thicken will make a huge difference.

 

You certainly won't be guaranteed bad growth simply from dissecting multi-hair grafts into singles or double hair grafts. In fact, it's done routinely. You just have to be careful in the dissection process using microscopes. When creating new hairlines, you typically need more single hair grafts than what occurs naturally in a strip procedure. Thus, you have to dissect some of the follicular untits of 2, 3, or 4 hair grafts to single hair grafts.

.

[gillenator]

akuma,

 

Got your PM and I presume you want my opinion on your last post on this thread. First off, as I eluded to in my previous post, transection can occur if the grafts are dissected "without" careful microscopic dissection under a microscope. If transection does occur, that's when regrowth and yield are compromised.

 

So I agree with Janna's comments 100%. In fact, she was involved in and supervised the tech team who dissected my last strip.

 

And since more hairline work was done, yes they needed to create more single hair grafts from my strip. They even showed me samples of my grafts before they placed them back into my scalp. This is called microscopic dissection and preparation of grafts. Remember, whenever substantial hairline work is required, there may not be enough single hair bearing FUs exisitng in the donor strip specimen. This is where more singles need to be created from other multi-hair bearing FUs.

 

That leads to your second question. "Stick and place" is a method of creating tiny micro incisions using custom made sized blades that are hardly invasive at all and leave no visible scarring. These tiny recipient incisions were created to accomodate the smaller single hair grafts that were "cut to size" and then placed into my hairline as soon as the surgeon Dr. Shapiro created the incisions, one at a time.

 

There are other benefits of "stick and place" as well. This method allows for the immediate placement of the grafts and less time out of their blood supply. The implication is less effects of ischemia reprofusion (decay of grafts) and improved chances of survival, meaning improved overall yield. Each single hair graft looks like my natural native hair growing out of my hairline. Obviously the surgeon must be skilled at creating perfectly angulated recipient sites with micro-incisions using these custom blades.

 

Ask your doctor about it as Janna suggested. When handled by competent skilled techs, the grafts can potentially be carefully microscopically dissected without transection and they grow just fine. I am a living testimonial of it.

 

And while on the subject of techs, may I say one last comment? My hats off to the hard working, skilled, professional techs who work very hard day in and day out on many of us hairloss sufferers. They are an integral part of the equation which has freed many of us to get on with our lives!

 

Best wishes to you Akuma! :cool: