Intro and some questions

[ratt57]

I joined this site some time ago and have logged on pretty frequently to get info re: hair loss/transplants, and it would also come up in Google searches quite a bit as well. About sixteen days ago I finally went ahead and had the procedure. I was pretty high on the Norwood scale (between a 6 and a 7), and did a lot of research before settling on John Diep in Los Gatos, California as a doctor. He seemed very genuine, honest with what to expect, and experienced upon meeting him, and I even went as far as to check out references with Dr. William Rassman in Los Angeles, who he apparently worked with. Rassman e-mailed me back almost immediately with a very good recommendation, so I went ahead and chose him.

 

The experience was long and I'm hoping, going to be successful. I was in surgery for about 12 hours and received approximately 4190 grafts before walking out of there at 8:00 and checking into a hotel down the street for the night. The staff and Dr. Diep were great, very concerned that I wasn't in any pain, and incredibly patient (I work in the medical field, but can't imagine being a surgery tech. placing grafts into tiny holes in someone's head all day like that. I was really amazed at how they took such a tedious job in stride). I have to also confess I tend to videotape a lot of experiences in my life, and they allowed me to tape the removal of the strip as well s the suturing up of the lesion (Dr. Diep was very cool about it, but thought it was "a little wierd." He's right). I'll tell you that after watching the procedure a few days later, I had no idea what was going on behind my back and it was pretty amazing... I couldn't believe the amount of blood and the fact that the Lidocaine injections alone kept me from feeling anything. It's a pretty amazing procedure.

 

The hair has all pretty much fallen out now, and started about 10 days after the procedure (that's normal, isn't it?). The scar actually blew me away when I got a look at it later. At first I I couldn't see it from the side and thought my hair was covering it up, but after looking at it with two mirrors three or four days later and and reaizing I'd been walking around in public and had no idea what it looked like to others, I was pretty mortified. It's still slightly scabbed over and red, and I'm wearing a baseball cap to cover it up. I'm returning to work tomorrow and not looking forward to the barrage of questions from co-workers and patients as to why I'm wearing a cap throughout the day. I'm hoping by another two weeks my hair will have grown over the scars enough so I can dispense with it. I still have some soreness and slight redness around the scalp due to the amount of grafts I received, but it's subsiding daily.

 

My question is this: I looked great when I walked out of there after the surgery and for several days after. However, I'm reading that densely-packed FUT grafts often have a high "death rate." Has anyone on the site ever experienced this after having that many grafts placed at one time? I've spoken with two of the surgical techs who worked on me and have worked with Dr. Diep for quite awhile now. They're very familiar with shock loss, but are both telling me that they've never seen one patient who hasn't responded to the procedure in a positive way. They said losing some percentage of the grafts always happens, but the majority remain.

 

Anyway, any feedback you guys might be able to give me would be very appreciated. The wait is definitely anxiety-provoking. I'm also wondering... does the scarred area shrink as time goes by, because I think that's going to be my next concern. I've been wearing my hair short for so long now due to being a "chrome dome" that I'd like to be able to keep it maybe a little longer, but not much. I'm also checking out FUE procedures and am feeling like they have a ways to go, not only in success rates, but price per graft re: fixing up the scarred site. I'm also curious that if a scar shrinks approximately how many grafts it would require to cover it up, but I'm sure that differs with every individual.

 

In any case, I'm assuming it's normal to be anxious that the shock loss will result in no hair coming back at all... if it is, I'm definitely there already. Dr. Diep has informed me it will take 3-4 months to see any growth, and right now that feels like a couple of years. At this point, we're looking at the end of the year at least.

 

One more topic I've never really seen addressed here: I knew this wasn't a procedure I would obviously not be able to keep secret for too long, so told a few co-workers about it before I went on vacation. I immediately started being "judged" re: why I would want to spend $$ to do this, as well as the usual "You look fine just the way you are." This was something I wanted to do for me after many years of being bald, and am not sure just what to say to people if they start giving me disapproving comments (and the scars will only add on to it). Has anyone else dealt with this?

 

Hey, thanks for any advice, suggestions, etc....

[Blake Bloxham]

Ratt,

 

Right now, this all seems pretty normal to me. I wanted to address a few of your concerns:

 

1. I wouldn't make any judgment about the scar at the moment. Frankly, it's going to take some time for everything to normalize, and I really wouldn't evaluate the quality of the scar until fully reviewing the results at the 12 month mark.

 

2. It takes at least 3 months to star seeing new growth, but keep in mind that it takes 12 months for results to mature 100%.

 

3. The density of your procedure does not sound inappropriate. Yes, in certain instances, grafts can be packed "too densely" and this can diminish the yield, but it's not overly common and doesn't sound like the case here.

 

4. Shock loss can take anywhere from 3-5 months to fully resolve, so you have a little bit of time.

 

For now, I think you should take a deep breath and try to relax a bit. It seems like you did your research, and it's far too early to make any judgments or decisions.

[ratt57]

Hey, thanks for the reassurance, Blake. It's a long wait, and I'm doing my best to relax. (Also, are you seriously training to be an HT doc?) I just have one more concern, however, and can't seem to find an answer anywhere... my doc told me he recommended using propecia and minoxidil after the transplant, and gave me an Rx for propecia, which I promptly filled and have been taking. I also happened to have a box of Kirkland minoxidil in the cupboard, which I also began using the next day. I stopped 4-5 days later, as have used minoxidil extensively in the past and had virtually no results; I'm continuing on the finasteride. The problerm here is my doc didn't say WHEN to start using the minoxidil... and everything I'm reading on the web is recommending NOT using it for at least 2-10 days due to possible alcohol/propylene glycol complications with the grafts. I didn't wait, as my doctor didn't tell me to. Have you heard of this happening before, and were there complications (for instance, no growth)? I spoke with one of the surgical techs last week who informed me the doc should have told me to wait 3-4 days before taking it, but that she doubted it was a concern. She didn't sound that convinced, however. My last concern, I promise, lol...

[Raphael84]

Ratt, You will be fine. Just try and relax a little. Just think of the positives that your procedure will bring. Dont worry about the Minoxidil. Wait out the recommended 10-14 day post HT days before beginning to apply. Have faith that your on your way to a great result!

[Blake Bloxham]

Hi Ratt,

 

Yes, I am currently in medical school.

 

Also, it's probably best to wait 10-12 days before starting the minoxidil. The reason why is because by 10 days, the grafts are fully anchored and you can't really dislodge them or cause any immediate damage. However, I highly doubt using it for a few days before stopping caused any damage.

 

Also, remember that both those drugs can be associated with an initial "shedding phase" for the first 3-4 months, so don't be alarmed if you hair seems especially thin up until the 4 month point (which works regardless because you'll start seeing regrowth from the meds and hair transplant at this point in time).

 

Additionally, feel free to ask as many questions as you need!

[ratt57]

You guys have been great... appreciate the advice, Raphael and Blake. Sorry to come off like such a worry wart, but spent a lot of $$$ on this procedure, don't want to screw it up, lol. Blake, I'm a nurse... as I said, I videotaped my procedure, pretty amazing (and kinda grisly) to watch. The incredible thing I realized was just how much tissue is able to stretch; my doc cut a pretty wide strip out, was surprised how easily he was able to suture it closed again. Almost put it on YouTube! :-)

[cowl]

I am not an expert, so please take these answers with a grain of salt.

 

'Shock loss' does not apply to you. It sounds like you've already lost most of the hair you're going to lose off the top of your head. Shock loss is accelerated hair loss for men who are still balding for hair that is already genetically predisposed to fall out. (My interpretation from "Hair Loss & Replacement for Dummies", Rassman). Furthermore, shock loss does not apply to transplanted hair. Don't worry your hair will grow!

 

Yes it is expected for the transplanted hair to fall out after 10 days.

 

The minoxidil will not affect the hairs in any way.

 

You should not have any noticeable death rate for densely packed FUT. If you only did 4000 grafts to cover a full head, that is not super dense, it seems to me. Sounds like you're trawling the internet for bad news.

 

Your scar will likely be very fine and not noticeable, despite the fact that it is pretty gruesome now. You will not need to correct it. You will not need FUE. You will likely be satisfied with the outcome and not want another procedure.

 

(One mistake I made, however, on the first HT: don't use too much bacitracin. After a few days, wounds should be kept clean and dry for the most part, though you can apply it sparingly. But you're a health professional so you know that.)

 

I understand your mortification of the big red line in your head. From my first HT I had staples which made it look like a huge zipper. Frankenstein. Fortunately, I work from home so I didn't have to hide it and no one saw it. But yes, everyone should have a hand mirror after the surgery.

 

For now, you can ask your doctor if you can use a make-up concealer to hide the redness. This would be like a skin-colored lip stick.

 

Your irrational fear is that six months from now you will have a bald head and nothing but a huge scar to show for it. LOL. You better show pics in 6 months! Don't worry about the haters. They're just jealous.

 

Finally, I'm not sure why you don't want to discuss this with your doctor. But you can. Like you said, you paid a lot of money. If you don't trust him, that's another story.

[PupDaddy]

Like cowl said, there is a difference between shock loss, on the one hand, and the shedding of the hairs from the transplanted grafts, on the other. Shock loss refers to the temporary loss of native hair (non-transplanted hair) around the donor strip or native hair near to or amongst transplanted grafts, caused by the trauma of taking the donor strip or making recipient sites. Some ht patients experience some shock loss of native hair, others don't. What you seem to be describing is the standard shedding of the hairs from the transplanted grafts. This is normal and expected. Most or all of the hairs in the transplanted grafts will shed (fall out) within the first couple of weeks following the transplant. Not to worry. Grafts typically shed their growing hairs soon after being transplanted and the follicles then enter a dormant stage lasting several months. Then the new growth cycle kicks in and all those hairs that fell out of the transplanted grafts are replaced with new hair that starts sprouting and popping through the surface of your scalp. The hairs produced during this first post-transplant growth cycle can be somewhat wiry, thin, and/or course, but again, not to worry. The hair will mature and its quality will improve and return to normal (as it was when formerly located in the donor area) as it passes through additional growth cycles. That is why everyone says it can take 12-18 months to fully assess a hair transplant.

 

So try to relax, and here's wishing you great growth and success.

[ratt57]

Sounds like I definitely had mixed signals re: what "shock loss" was. Don't think I'm experiencing any of it so far, looks like I have some hair loss below the donor area, but have a feeling that's pretty common. Still waiting for enough hair growth over the scar... it's been three weeks, and it's hardly grown over the side scars at all.

 

 

I DID speak this morning with my doctor (or at least with one of his techs) and set up a phone consultation with him for Wednesday. She relayed the info re: the minoxidil to him and he relayed back to her that, yes, I "may have done some major damage and should have waited a month." He never told me this, just said, "You need to think about getting on Rogaine and propecia," and handed me a prescription for finasteride, which I promptly filled. The tech is now telling me all I can do is wait a year to see what happens. This is incredible; am wondering now if the minoxidil caused me to shed the hairs within two weeks (I'm reading that a large majority of patients are losing theirs one-two months after transplant). I didn't notice that I lost any grafts,(just one that I could see, when I scratched the back of my head and it bled a little; I could actually see the graft at the end of the follicle) but the shedding seemed to happen very suddenly. Have a phone consultation set up with my doc on Wednesday, but I have a feeling there's really nothing he can say except "Just wait." Wht the hell did I possibly do? Is there any recourse I can take if it doesn't grow? I would imagine it's impossible to prove that the minoxidil caused/didn't cause it if there's no growth. I really wish he would have told me about the waiting process. I may have blown $12,000 of savings and lost a huge strip of hair on the back of my head for nothing. Am reading some docs on the web that are telling their patients to resume Rogaine up to 48 hours after surgery, so maybe it's not an issue; but the majority of them are cautioning to wait two weeks to a month... f***...

 

Cowl: just wanted to say your e-mail definitely calmed me down... hope your predictions are right. According to my doc, it's not looking so good.

[cowl]

I'm sorry to hear that. Again I'm no expert but my understanding of minoxidil is that it would only affect hair that had a genetic predisposition to fall out and would have no effect on your back hair, or hair transplanted from your back. I think you are probably fine, but please let us know what the doc says.

 

There would be no reason to use minoxidil on transplanted hair.

[ratt57]

Hey Cowl: my understanding from doing a lot of reading on the web is that during the first 3-4 days the iimplanted grafts are extremely delicate, and apparently the alcohol/propylene glycol in the minoxidil can cause them to dry out and die. Again, I wish something a little more specific had been said about this before I left the clinic; I have a great doc, and after 12 hours of surgery, we were all pretty worn out, so he probably was just preoccupied. At this point, I'd say it's a long waiting game... :-)

 

Still finding several docs on the web who are recommending starting minoxidil 48-72 hours after surgery, so maybe my mistake wasn't that destructive. At this point, only time will tell.

 

Anyway, again, thanks for the support.

[cowl]

I see your point about minoxidil. Yes the 'inactive' ingredients could affect the hair. However, just as the newly transplanted hair is very delicate, it is also very resilient at the same time. I think it's unlikely that you caused any damage. In my unprofessional opinion, the fact that the hair shed normally is a good sign. I suspect you are a "worst case scenario" type thinker, and that is not helpful in this situation.

 

Please let us know what they say. Regardless of what happens you are doing everyone a service by reporting your experience here.

[ratt57]

I suspect - actually, I know, lol -that you're right about that last statement, especially when it comes to having to wait for long periods of time (had a rare form of lung cancer four years ago, and beat it after chemo and radiation and have been in remission since January, 2009. I'm learning the internet is one of the worst places to do research... everything I read about my cancer type at that time said I would be dead within six months to a year. Didn't happen, obviously). To be fair, I also spoke with a doctor in Atlanta today, who recommends his patients starting on minoxidil 48 hours after the procedure. He said he wouldn't recommend 24 hours, but it probably didn't do any harm. All I can do is wait at this point, and see what happens. The earliest I can expect to start to see any growth would be by the end of the year (3 months); in any case, cowl, thanks again for your positive vibes...

[hair70]

You will be ok Ratt.

 

You picked one of the best if not the best hair transplant surgery team around.

 

Dr Diep is the man!

 

There is soo much different advice online as to post op care I don't think anyone really knows what to do.

 

What is important is that you picked Dr Diep who lives, eats, and breaths hair.

 

He loves what he does and takes pride in his work w/o fancy advertising, etc and his results speak for themselves.

 

What other doctor gives you his direct line to call anytime?

 

Hang in there!

[ratt57]

Thanks, Hair70, sounds like you've had past experience with Dr. Diep too. He seemed like a really cool guy to me, too, and definitely knew what he was doing (only I wish he'd been more specific about the minoxidil); unfortunately, he also doesn't know the answer to this and is just telling me to wait. Also, he never gave ME his direct line... :confused:

 

Something strange, and I noticed it beginning last week, but thought I was imagining things: it's only been five weeks since the procedure, and not only me, but friends I went to dinner last night are seeing hair growth, particularly in the upper front of my head. Tiny dark brown hairs. I always had a few "spiky" type hairs up there, but they were a lighter color. The grafts shed two weeks after the surgery - and everything I'm reading is insisting that due to the time limit of the dormant stage, hairs won't begin growing for at least 3-4 months. I'm seeing a substantial amount on the top of my head than it seemed like I had before, and on closer inspection, even tiner ones below those that haven't grown out yet (and might not. lol). It's not dense, but it's definitely there. I've been using propecia and have continued the minoxidil, since it seemed like I was out of the danger time zone at this point. Is it possible those two meds could be "speeding up" the dormant stage and the transplant did work, or is that not physically possible and am I imagining there to be new hair where it's just the regular fuzz? Close-up, it's harder to see, but if I stand back from the mirror, I can definitely see what looks like 100% more. I also developed a pimple on the top of my scalp, which I've never had before, and it's clearly an ingrown hair. Very weird. May contact Dr. Diep tomorrow and if he's going to be there make the drive to Los Gatos if he can examine me for a couple of minutes, although I'm not sure he can tell the difference between transplanted hairs and my very sparse former ones. Anybody else have something like this happen this soon, or have heard of it? If this IS the beginning of the new growth I hope it continues... it was pretty thick when I left the doc's office the night I had it done, would be awesome to see that again.

Edited October 14, 2012 by ratt57
misspellings and a bad smilie!

[hair70]

that is really neat you see some new hairs whether newly transplanted ones growing or existing hairs that were on their way out kinda revived by propecia, etc.

 

it probably is a bit early for transplanted hairs to grow yet but you and i know the quick results dr DIEP usually achieves.

 

i am not a transplant surgeon but i think when follicles are traumatized by poor extraction methods / poor extraction angles / improper size of extractors used / improper depth of extraction / etc, you get slow and poor growth of transplants and hence the varying results people are getting. . .

 

dr DIEP does all his extractions with his special tools and meticulous nature which i believe makes a huge difference. . .you will see results quicker.

 

the "ten" page post op instructions have the office number if you have any questions during regular business hours and also the evening number if there are questions during non office hours which i believe is his direct number.

 

congrats on being over one month out.

[ratt57]

Hey, Hair70, you sound like you're doing a commercial for my doc! How do you know so much about his techniques, are you a former patient?

 

I've also thought the bit of early growth I'm seeing could be from the propecia and minoxidil, but I'm also reading those drugs take at least 3-4 months to show any progress, just like HT. I'm probably imagining it because I'm impatient, but the wierd thing is other people are noticing it too.