Disappointed and not sure what to do next...

[Pulpedfiction1]

I appreciate the positive comments. Yes, I do realize there are many out there-- on this board, in particular--who are in far worse situations. However, that doesn't make me feel better about where I'm at--I'm unfortunately not one of those people who can just shrug it off and be happy with what I've got. I don't think that makes me a bad person or unreasonably vain. That said, Dr. Beehner did a solid job with a small number of grafts (1700). I would have absolutely returned to him for a second procedure, but was concerned about the conservative approach he was planning to take (another 1700 for a total of 3400...when of my research indicated I'd need to be around 5,000 cumulative grafts to get the coverage I'd like).

 

The only issue I have with what happened at H&W is the fact that they could not come to the conclusion about my insufficient donor supply during my pre-op consult. Yes, I would have been equally crushed--but I would also not be walking around with a nearly completely shaven front and forced to wear a hat for the majority of the next month.

 

What I need to know is how my donor area could have changed so drastically in a mere 15 months. Dr. Beehner's treatment plan originally called for a 2nd HT of 1700 grafts--so he obviously did not feel there were any donor issues before I underwent my first HT. I've been on Finasteride since just before my first HT, and am reasonably certain that it's both slowed down the frontal loss, and improved my crown. I find it highly unlikely that within this time span my sides have naturally thinned to such a degree--although I do now realize that they are not immune to the effects of DHT.

[SADbutTRUE]

I just saw your pics and your back looks good ,its the sides that look weak, overall I think its something that can be improved on, try combing your hair forward in a ceaser style and add some concelear, it will improve how your hair looks right now, the short hair looks good on you and you have a nice shape head. get some consults with some top fue surgens and see what they have to say, good luck and stay positive,

[Pulpedfiction1]

I just saw your pics and your back looks good ,its the sides that look weak, overall I think its something that can be improved on, try combing your hair forward in a ceaser style and add some concelear, it will improve how your hair looks right now, the short hair looks good on you and you have a nice shape head. get some consults with some top fue surgens and see what they have to say, good luck and stay positive,

 

 

I do comb my hair forward. Have tried some Toppik, but it's such a mess and quite the pain to apply. Morever, it doesn't seem to look natural.

 

I've been taking half-measures like these for too long. It seems insane to have to settle when such advanced treatment options are available today. I will most certainly NOT be giving up on surgical options. I have the summer off, and will travel if necessary. I will first consult with Beehner..and am willing to travel to SMG or Dr. Cooley if need be. I'm two hours from New York City, but the rates there are completely insane.

[Blake Bloxham]

Hi Guys,

 

I'm going to send both Dr. Wong and Dr. Beehner an email sharing the details of this thread and asking them both to leave a reply.

[Pulpedfiction1]

Quick update..heading up to Dr. Beehner's office tomorrow.

 

Nervous as can be to get his opinion...but at least I'm doing something about my issue and not just accepting the situation as it stands.

[Spanker]

Quick update..heading up to Dr. Beehner's office tomorrow.

 

Nervous as can be to get his opinion...but at least I'm doing something about my issue and not just accepting the situation as it stands.

 

I advise you to read through this thread again and write down any questions that you have on paper. Not that he would,but he is a busy man, and it is harder for busy people to rush you when you say, "I have written down some questions I need answered and I appreciate your patience."

[Pulpedfiction1]

Agreed 100%. They are quite busy (although genuinely seem to care about their patients, at least in my limited experiences with HT surgeons). Besides, I have the memory of someone twice my age

[TakingThePlunge]

Glad to hear that you'll be seeing Dr. Beehner in person and look forward to hearing how it works out for you. Good luck!

[Dr. Michael Beehner]

I had a wonderful one hour visit with this patient at the end of my work day today and feel very good that I believe his expectations are now a little more realistic and that there is a relationship of trust between us, such that he is going ahead with a second procedure along the lines we planned originally. I am not sure how much donor hair we will be able to harvest, and we left it that he would trust me to take what I thought I could get without compromising him in the way of any undue tension on the closure or marked worsening of the donor density.

I had intended to explain my view of this patient's situation in a note late yesterday, and just ten minutes before I was going to post the note and photos, the patient called in to the office to arrange a visit with me today, so I held off for that reason. The patient and I looked over photos I had taken before his surgery with me, and he realized that he had thin density even then on the sides when the hair was short or lifted up.

 

(The following is the letter I was prepared to send the evening before, which the moderators had asked me to provide in response and which I told the patient I would do.):

I would like to add my viewpoint to this patient's situation and what occurred at our surgery and afterwards. I will try to include with this post three "before" surgery photos, along with three photos from our mini-consultation visit 9 months after the procedure.

Because of his relatively young age (early 30's) and the fact that I felt quite certain that someday he would have a much larger than usual horseshoe-shaped bald area on top, I used somewhat of a modified "frontal forelock" pattern. By this I mean, I tried to create in the marked off zone (seen in the top-down view in the "before" photo) just behind the hairline an increased density of grafts by using DFU's and TFU's. The large area behind and to the sides of this denser front-central zone I refer to as the "wraparound zone," and in this area we scattered 800 FU's sparsely throughout it to begin some light coverage and create a gradient away from the denser forelock region. 620 FU's were used to create the frontal hairline. The rear crown/vertex was not transplanted. We used dissolvable (Chromic catgut) suture to close his donor area, which I do rarely for those who say that getting the sutures removed would be difficult for them to do. I don't think doing so had anything to do with any problems post-op.

When measuring the donor area density of hairs before his first surgery, I sampled three 5mm x 5mm squares under magnification and counted 19, 19, and 18 respectively in these views, which averages out to around 75 FU/cm2, which is below average for most males. I did not measure the density of the side areas and in hind site wish that I had. As we do for the majority of our patients, he was given a choice of having the "combination" approach with both FU's and DFU/TFU's (total of 1700 grafts) or an all-FU approach with 2500 FU's. It turns out he received the equivalence of around 2200 FU's with our combination approach that day. His FU's were 30% 1-hairs, 60% 2-hairs, and 10% 3 hairs. I would also like to point out that my operative report showed there was "no tension" in closing the donor wound edges. Usually, when donor area shocking occurs, it is almost always related to excessive tension on the wound closure, which was not the case here.

The photos I am attaching show three before surgery and three taken 9 months later at our Newburgh, NY office in follow-up. The close-up view of the left side with the comb holding the hair up was taken at that 9 month time point also. When I saw him at that follow-up visit, I noted that the rear scar was very thin, as was the right side. On the left side there was perhaps some mild donor thinning limited to an area around 10mm in width. I took a photo of the area with a comb lifting the hairs above it. I thought his hair growth on top was what I expected to see at 9 months. That consultation took place in early January of this year (the surgery was in April of 2012). About 2 months later, we exchanged lengthy e-mails, in which the patient stated his hope that there would eventually be no "see-through" areas on his scalp, and he once again stated that the "shock loss" areas on both the right and left donor areas above the ears were slow to get better. The patient mentioned a patient that we posted on the HTN who had a very full result, and I pointed out in my reply that this patient had much coarser hair and his donor density was much greater. I responded by again going over the plan to increase the density at the next visit in the areas we transplanted the first time and also encouraged him to do scalp stretching exercises before the next procedure.

So that's a recounting of what went on between the patient and I prior to this evening's meeting. I think the biggest factor present here in all this is that somehow we failed to communicate on what the reasonable expectations for him were. He may have had a vision in his head of virtually no baldness or thinning being present when all of his transplanting was finished, which is unrealistic, given his young age and already fairly large area of hair thinning and loss. I had a vision of framing his face so that, after 2-3 procedures, you couldn't see through the hair in front, but that there would be still moderate thinning of density behind that area due to the limitations of donor density and supply.

 

I am grateful that the communication lines and bond of trust were opened up and carried us all through this. Our philosophy is to stick with each one of our patients until they are happy, no matter what that takes. People sometimes ask me if we give any sort of "guarantee," and I simply reply with the above statement and our 24 year record of holding good on that promise.

 

(The 2nd, 4th, 5th, and 6th photos are "after" photos". The other three are "before" ones)

 

Mike Beehner, M.D.

Saratoga Springs, NY

[Pulpedfiction1]

Just to add to Dr. Beehner's quite thorough post...

 

The pre-op photos helped to not only realize the progress I've made, but also shed light on the fact that I had indeed been thinning on the sides all along. In fact, when viewing the pre-op and post-op (9 months) photos of my left side, it almost looked thinner in the pre-op.

 

Dr. Beehner spent well over an hour with me, and addressed all of my concerns in a very straightforward manner. I strongly feel that he has my best interests in mind.

 

Thank you all for your input. I feel leaps and bounds more optimistic than I did last week.

[SADbutTRUE]

thanks for responding doc, pulpedfiction good luck with your second procedure with the doc, , from looking at your pre op photos big improvement,

[Pulpedfiction1]

Quick update....

 

Had my 2nd HT with Dr. Beehner today. It went quite well.

 

Totals were 1552 grafts and 3707 hairs:

1207 FU's (1-3 hairs each), 201 Multi-FU's (4-5 hairs each), and 144 FUE's

 

We decided to avoid my especially thin left-side, and do some FUE in a nice, thick area about an inch above the donor scar.

).

Obviously, I'm very relieved to get this done (what a July it's been!) Dr Beeher and his staff were nothing short of great.

 

I'll put up a picture tomorrow after my hair wash.

[agenteye]

Woohooooo Pulped! That's awesome buddy, congrats. Can't wait to see the start of number two......

[Fue123]

Yea I have to say that in looking at your pre ops I think doc did a stellar job for you. I think this was perhaps a case of unrealistic expectations. You've gone for virtually a NW5 to having excellent coverage.

[Will88]

Just joined this board and this is the first thread I've read. I must say I'm confused. Why would someone who's hair is so important to them put themselves through all of this when you could just get hair replacement and look exactly how you want for the rest of your life?

Unless you cant afford it? (pretty cheap though if you order in bulk from overseas).

 

Do you at least use Caboki/Topik microfibre to thicken up?

[NoTakeBacks]

Yea I have to say that in looking at your pre ops I think doc did a stellar job for you. I think this was perhaps a case of unrealistic expectations. You've gone for virtually a NW5 to having excellent coverage.

 

Agreed. For only 1700 grafts that is some pretty good coverage considering the area and degree of baldness. Personally, from where you came from, I think you look respectable Pulpedfiction. With that said I'm happy you and the Doc worked things out and went through a second procedure to add some density.

 

Just joined this board and this is the first thread I've read. I must say I'm confused. Why would someone who's hair is so important to them put themselves through all of this when you could just get hair replacement and look exactly how you want for the rest of your life?

Unless you cant afford it? (pretty cheap though if you order in bulk from overseas).

 

Do you at least use Caboki/Topik microfibre to thicken up?

 

Not to speak for Pulpedfiction, but he did state that non-permanent solutions weren't his bag, and that he did try Toppik. So with that said, I doubt if one were not keen on applying concealer everyday, one would not want to be handcuffed to periodically purchasing a "hair replacement system" and having to get one applied for the rest of their life. At least I wouldn't.

 

I would rather spend a few uncomfortable hours, and then months of anxiety/babying of lil' follicles, to end up with my own hair. Hair that will grow and change with me. Hair that is not foreign or synthetic. Certainly not hair that's glued to my head. Even though both are a means to the same end, I would not only feel like a sham, but also squicked out that there's some inanimate netted object glued to my head...

[TakingThePlunge]

Pulped,

 

Congratulations! I couldn't be happier for you.

 

I wish you the best of luck and hope you'll continue to update us on your progress.

[greatjob]

Just joined this board and this is the first thread I've read. I must say I'm confused. Why would someone who's hair is so important to them put themselves through all of this when you could just get hair replacement and look exactly how you want for the rest of your life?

Unless you cant afford it? (pretty cheap though if you order in bulk from overseas).

 

Do you at least use Caboki/Topik microfibre to thicken up?

I would shave my head before ever getting a hair piece. Too much hassle, and to me it's like you're living a lie. I would be completely paranoid, I know when I used concealers that is exactly how I felt and it was a nightmare.

[Shampoo]

I just saw your pics and your back looks good ,its the sides that look weak

 

I am not sure if I've ever seen what appears to be diffuse thinning on the sides like that. Diffuse thining on top I've seen, but on the sides?

Can anyone else chime in on this particular situation?

[Pulpedfiction1]

I'd never consider a solution that was even remotely detectable by the general public.

 

I can only imagine something as simple as perhaps going to the park and playing frisbee with my dog, yet having the speed of the wind at the forefront of my mind. No thanks! I can't even imagine what intimacy must be like with a hair piece. While I do realize that some others have no alternative.....having to worry about about it falling off is just not something that I'm willing to go through. One has to draw the line somewhere. It was between either getting a HT or shaving it all off and becoming a workout nut.

 

Toppik isn't for me....far too messy and time consuming to apply. Doesn't look particularly natural, either.

 

The results from my first HT were quite natural. Best of all, the results were very subtle. Not even the teenagers that I work with on a daily basis could tell that I had anything done.

 

There's no doubt that a HT is expensive, and I'm far from wealthy. However, there really is no price that one can place on their self-image. I've chosen to invest in myself rather than the stock market (and I doubt that I've missed out on the next Microsoft or Apple anyway!). Money well spent, thus far...if for no other reason than I feel optimistic about a situation that was really dragging me down.

 

 

 

 

 

 

Just joined this board and this is the first thread I've read. I must say I'm confused. Why would someone who's hair is so important to them put themselves through all of this when you could just get hair replacement and look exactly how you want for the rest of your life?

Unless you cant afford it? (pretty cheap though if you order in bulk from overseas).

 

Do you at least use Caboki/Topik microfibre to thicken up?

[Pulpedfiction1]

Here's a few quick pictures that I just snapped, showing the recipient area, donor (note the FUE area above the strip scar), and the one side that was part of the strip.

 

Hair length was about half an inch. About how long should it take to get the back presentable? I'm looking around at some other job openings...so while I can hide away in a hat for the next couple of weeks, it's of paramount importance that I look decent enough for a job interview within 2 weeks or so. I'll take MSM to hopefully make my hair grow a bit faster, and am considering ordering some Dermmatch.

[Pulpedfiction1]

Definitely having more post op tightness in the donor than my first procedure. Would this be attributed to the FUE?

[Fue123]

If this is your second procedure you've already lost a strip of skin. That means more tightness and I'm sure the additional swelling from the fue doesn't help either.

 

Best of luck

[Pulpedfiction1]

Makes sense. Thank you! Any thoughts on my post-op photos, guys?

[Raymond2013]

Good luck looks good to me!