Points to Consider before Second HT Procedure ?

[eternaldenied]

Guys,

 

Do you think it will be a good idea to put together questions to ask your doctor/points to consider before going for a second HT procedure ?

 

I believe we have many people on this forum who have had multiple surgeries. It will be good to hear /learn from them on things they wished they knew before going for their second HT.

 

By the end of this process, if this thread contains a lot of valuable information, may be moderators can make this a sticky one.

 

Bring it on. Thanks much.

 

 

~eternalDenied.

My case: http://www.hairrestorationnetwork.com/eve/174361-contemplating-second-hair-transplant-session.html

[eternaldenied]

No one with any inputs?

[RopainNogain]

I think this is an extremely important topic. Many who have had one transplant go into a second with a relaxed attitude. They might think to themselves that everything will be the same as the first procedure because I know what to expect. Could be the case, but with a 2nd procedure comes new risks.

Risk of stretched scar and tighter scalp because of 2nd strip taken during FUT.

My main concern would be about transection of healthy follicles that are in a natural shedding phase. A hair would not be visible by the doctor during the creation of the recipient sites.

Growth times can be lengthier for a 2nd procedure

Also, depending on the type of procedure (adding density to an area or construction an entirely new area), new expectations need to be addressed. Adding density to an area will not be as noticeable or as drastic of a result as constructing a bare area.

[Shampoo]

I believe we have many people on this forum who have had multiple surgeries. It will be good to hear /learn from them on things they wished they knew before going for their second HT.

 

Will the same doctor be performing your 2nd surgery?

 

The reason I ask is it seems Dr. Carlos Wesley in New York spoke of a study that showed when patients have multiple surgeries if they do not use the same surgeon again they are more likely to have post-op nerve pain.

 

Of course I am sure Dr. Wesley would agree that a patient should not stay with the same doctor if he had a terrible result or poor chemistry/problems with the first doctor.

[abcd0000]

Yes, please! I am considering doing a second FUE and my main questions are:

 

1. How to avoid transection in the crown area? Is it a big issue?

 

2. Can I lower my hairline a bit? I asked for the highest possible hairline and now I realized that I should have listened to the doctor...

[hsrp10]

For a second HT, go with a doctor who places the grafts himself and shave your head as short as possible in the recipient area to lower risks of shockloss.

Also choose a doctor who has a low or very low rate of shockloss complaints from patients.

 

Try to avoid starting/stopping any meds prior to the surgery and for several months post-op.

And make sure to give enough time in between surgeries, especially if working in the same area of the scalp.

[eternaldenied]

Will the same doctor be performing your 2nd surgery?

 

The reason I ask is it seems Dr. Carlos Wesley in New York spoke of a study that showed when patients have multiple surgeries if they do not use the same surgeon again they are more likely to have post-op nerve pain.

 

Of course I am sure Dr. Wesley would agree that a patient should not stay with the same doctor if he had a terrible result or poor chemistry/problems with the first doctor.

 

Ah, this is interesting to know. Yes, I am going to get operated by the same Doctor i.e Dr Bhatti, India.

[eternaldenied]

For a second HT, go with a doctor who places the grafts himself and shave your head as short as possible in the recipient area to lower risks of shockloss.

Also choose a doctor who has a low or very low rate of shockloss complaints from patients.

 

Try to avoid starting/stopping any meds prior to the surgery and for several months post-op.

And make sure to give enough time in between surgeries, especially if working in the same area of the scalp.

 

hsrp,

 

thanks much for your inputs.

 

Meds

I had been using Rogaine 5% once at night from past 3-4 months but I have now stopped the same because I read it in Dr Bernstein webpage that one should stop rogaine 15 days prior to the surgery for better scalp laxity.

 

enough time

- I will be in my 11 month for second FUE. Is that a point of concern ? many asked me to wait a little longer (15 months) but I have some personal commitments due to which I need to get away with full head of hair asap.

Edited April 5, 2014 by eternaldenied

[TakingThePlunge]

Assuming a patient had a good experience with his first physician and is planning to use the same doctor. then I would recommend following that surgeon's advice regarding the appropriate interval between surgeries, scalp laxity, transection risks, etc. Personally, I like the idea of waiting at least one full year between surgeries.

 

Remember, shock loss is typically temporary. It's only the weak, miniaturized hairs that were on their way out that may not regrow. Transection, on the other hand, is the act of killing healthy hair follicles by cutting into them when making recipient sites. There is always a risk of transection when placing grafts around existing hairs.

 

Scalp laxity is another concern but many have had success using scalp stretching exercises. Lots of guys have multiple strip surgeries with no problems.

[Dr. William Lindsey]

Good thread and you guys hit on most of the highlights.

 

Also...I see lots of people who could benefit from 2 cases (class 4s and above). And I try to show folks examples in the office of cases we've done with scalp/hair/ethnicity/age SIMILAR to the prospective patient.

 

In particular for a class 4 or 5 I have several examples. Here is a brief synopsis of our discussion:

 

Assuming you get a decent result from the first case and really frame your face I belive your "happiness index" from spending that 12k or so will be pretty high. Now do you want or need a second case? That is the question.

 

Now if you are a 50ish year old guy like me...I hypothesize that there is a 25% chance you'll actually show up for a second case. Why? Because your satisfaction per dollar spent and per ouch incurred will be fairly low. All the people you interact with will see you with hair. Only you and perhaps your buddies will notice your bald crown. And when people don't belive me I tell them to go to the mall down the street, sit and watch guys there age walk toward them. And see if they notice that bald crown some have or is it really "no big deal" for most guys. I've got several cases like this to show prospective patients.

 

Now what if you're 25 and a class 4 or 5. That is an entirely different deal. Most of those guys are telling me they are being teezed, or its impacting their confidence or social life and they are ready for part one. And they are pretty happy with the results, but not as happy as the older guys...why? Because they still feel balder than their peers. The rest of their friends have crowns with hair and they worry about impressions on girls their age (in these guy's minds((who knows what is actually going on in the real female brain on this or many topics))). For these guys the "happiness index" of a second case is high and I'd guess 70% will get a second case.

 

Its the happily married 35 year old that is the hardest to predict. They may be fine with aging into a bald crown or they may want a second case.

 

Lastly what if you are class 6 or 7, like 2 guys I saw yesterday. The 40 year old I belive will be ok with 2 cases and still a bald crown. The 25 year old will likely look significantly younger with hair framing his face and covering much of his scalp in front of the crown, but he's likely out of hair...no chance of covering the remaining crown to any successful degree. Will he be happy that he did 2 cases and still has a bald crown? I believe inherent head shape will make the call. If a young guy has the option of shaving his head and he looks good with a shaved head, perhaps he ought to try that before committing to surgery (for guys who are class 6 and 7s as we're discussing). That way he knows what his real options are...shaved or 2 cases and a bald crown. If however the fellow has a head shape that is not amenable to shaving down....then HT is a reasonable choice, even 2 cases and a bald crown for a young guy.

 

These are all things that ought to be discussed at the initial consultation. Unfortunately in the quest to worship the almighty dollar, some doctors don't bring these issues up, and in the quest to desparately get some hair, some patients will jump at any affordable short term solution without evaluating the long term consequences.

 

Again good thread.

 

Dr. Lindsey McLean VA

[Cant decide]

Good thread and you guys hit on most of the highlights.

 

Also...I see lots of people who could benefit from 2 cases (class 4s and above). And I try to show folks examples in the office of cases we've done with scalp/hair/ethnicity/age SIMILAR to the prospective patient.

 

In particular for a class 4 or 5 I have several examples. Here is a brief synopsis of our discussion:

 

Assuming you get a decent result from the first case and really frame your face I belive your "happiness index" from spending that 12k or so will be pretty high. Now do you want or need a second case? That is the question.

 

Now if you are a 50ish year old guy like me...I hypothesize that there is a 25% chance you'll actually show up for a second case. Why? Because your satisfaction per dollar spent and per ouch incurred will be fairly low. All the people you interact with will see you with hair. Only you and perhaps your buddies will notice your bald crown. And when people don't belive me I tell them to go to the mall down the street, sit and watch guys there age walk toward them. And see if they notice that bald crown some have or is it really "no big deal" for most guys. I've got several cases like this to show prospective patients.

 

Now what if you're 25 and a class 4 or 5. That is an entirely different deal. Most of those guys are telling me they are being teezed, or its impacting their confidence or social life and they are ready for part one. And they are pretty happy with the results, but not as happy as the older guys...why? Because they still feel balder than their peers. The rest of their friends have crowns with hair and they worry about impressions on girls their age (in these guy's minds((who knows what is actually going on in the real female brain on this or many topics))). For these guys the "happiness index" of a second case is high and I'd guess 70% will get a second case.

 

Its the happily married 35 year old that is the hardest to predict. They may be fine with aging into a bald crown or they may want a second case.

 

Lastly what if you are class 6 or 7, like 2 guys I saw yesterday. The 40 year old I belive will be ok with 2 cases and still a bald crown. The 25 year old will likely look significantly younger with hair framing his face and covering much of his scalp in front of the crown, but he's likely out of hair...no chance of covering the remaining crown to any successful degree. Will he be happy that he did 2 cases and still has a bald crown? I believe inherent head shape will make the call. If a young guy has the option of shaving his head and he looks good with a shaved head, perhaps he ought to try that before committing to surgery (for guys who are class 6 and 7s as we're discussing). That way he knows what his real options are...shaved or 2 cases and a bald crown. If however the fellow has a head shape that is not amenable to shaving down....then HT is a reasonable choice, even 2 cases and a bald crown for a young guy.

 

These are all things that ought to be discussed at the initial consultation. Unfortunately in the quest to worship the almighty dollar, some doctors don't bring these issues up, and in the quest to desparately get some hair, some patients will jump at any affordable short term solution without evaluating the long term consequences.

 

Again good thread.

 

Dr. Lindsey McLean VA

 

I agree with all of this Dr but there are quite a few NW 6 that can also have the crown addressed as well. They don't have to live with a bald crown after two ops. Granted, the coverage will not be very dense in the crown but it does not have to be dense provided they have the donor.