10 Months Update - Dr Bhatti - 3180 grafts in Jun 2013

[eternaldenied]

Hey Guys,

 

Please find attached herewith my 10 months update. I underwent FUE HT surgery with Dr Tejinder Bhatti, India on 20th June 2013.

 

I have booked 8th May 2014 for my second FUE session with Dr Bhatti as I am not happy with what I have for now. I went in for a personal consultation last month and Doctor suggested that we should be able to get 1500-2000 grafts(at max) from the back of the scalp and possibly 300(at max) from the beard shadow area.

 

I am 30 years old. Keeping in mind - the donor density, limited donor area and long term plan , would you please guide me on which area should I get covered to get the maximum result out of my second session ?

 

Option 1. Front Right Scalp which appears pretty thin at this moment.

 

There were grafts planted in this part of scalp in my first session but I believe the right scalp has not grown compared to the left one. See Immediate post op pics below to get an idea on how much area was covered.

 

OR

 

Option 2. Crown/back of the head.

This area was left untouched in my first session for obvious reasons.

 

 

first FUE session - Immediate Pre Op and Post Op Pics.

http://www.hairrestorationnetwork.co...dr-bhatti.html

 

I hear a lot about the shock loss. Would it be dangerous to go for option 1 considering I would be having my second procedure in just 11 months from first session.

 

 

~eternalDenied

[Raj Jayukdht]

I would go for option 1...get as many grafts at the front scalp. You will get shock loss, it doesnt matter when you have your second HT. Can I ask what Dr bhatti has suggested?

[KO]

Consider a different surgeon? While 3.8k grafts was a large area to cover, it should show more density.

 

I think it will look better too if you buzz your hair shorter. Best of luck!

[Blake Bloxham]

Hi Eternal,

 

I think reinforcing the frontal zone - in general - makes the most sense. Have you consulted with any other FUE surgeons to see what they think? Did Dr. Bhatti recommend a plan for the second procedure?

[TakingThePlunge]

I agree with Blake. I like a full frontal zone rather than spreading the grafts thin. Because crowns eat up so many grafts, I like the idea of building up the sides and shrinking the diameter of the balding area, leaving a tinier bald spot.

[Spanker]

Definitely get the frontal zone sured up.

[Mickey85]

I never thought this patient should have been operated on. There is just too much area to cover, he would need a superfluous amount of grafts. If the 2nd procedure is free(i personally think it should be) I would go for beefing up the frontal third, with grafts placed in the mid-section at a lesser density. Having too thick of a frontal third with nothing behind it would look bizarre in my honest opinion.

[eternaldenied]

I never thought this patient should have been operated on. There is just too much area to cover, he would need a superfluous amount of grafts. If the 2nd procedure is free(i personally think it should be) I would go for beefing up the frontal third, with grafts placed in the mid-section at a lesser density. Having too thick of a frontal third with nothing behind it would look bizarre in my honest opinion.

 

Mickey, thanks for your inputs. I believe my pre op pics gives a false picture of a wider bald area because I use to keep bald look earlier. Whatever you see on two sides are my native hair .So its only mid scalp that was bald.

 

Nope the second session is not free. So yes seeing the amount of money I have already spent and will be spending in future. I do think I am stuck.

[eternaldenied]

Hi Eternal,

 

I think reinforcing the frontal zone - in general - makes the most sense. Have you consulted with any other FUE surgeons to see what they think? Did Dr. Bhatti recommend a plan for the second procedure?

 

Hi Blake, thanks for your feedback. I have not consulted any other FUE surgeon in India. Does this site recommend any good FUE surgeon in India? Dr Madhu is more into FUT.

 

Dr bhatti felt it would be better to cover crown/back but when I insisted that I want a fuller frontal look and suggested that we should implant 300 beard grafts in front right scalp and whatever number of grafts we get from scalp we can put that in crown. He agreed to my suggestion.

Edited April 8, 2014 by eternaldenied

[eternaldenied]

I agree with Blake. I like a full frontal zone rather than spreading the grafts thin. Because crowns eat up so many grafts, I like the idea of building up the sides and shrinking the diameter of the balding area, leaving a tinier bald spot.

 

David, if I understood you correct, what you are suggesting is to get the front zone covered first and then whatever number of grafts is left , use them to shrink the bald crown spot by building up the cirxumference and moving inside the circle.

[Mickey85]

Mickey, thanks for your inputs. I believe my pre op pics gives a false picture of a wider bald area because I use to keep bald look earlier. Whatever you see on two sides are my native hair .So its only mid scalp that was bald.

 

Nope the second session is not free. So yes seeing the amount of money I have already spent and will be spending in future. I do think I am stuck.

 

I was under the assumption that Bhatti stands by his patients. Sounds like I what I was told was fiction....

[eternaldenied]

Definitely get the frontal zone sured up.

 

Spanker, thanks much for the feedback. So, you think I dont need to worry about shockloss because those thin hair on right scalp is anyway dying/good for nothing?

[eternaldenied]

I was under the assumption that Bhatti stands by his patients. Sounds like I what I was told was fiction....

 

So I also believe that Dr bhatti stands by his patients and that is why I did not request him to do the second session for free, neither did I complain regarding anything because I thought if he felt that surgeon error could have been responsible for poor result,he would have offered me free service himself. Since he didnt offer me a free service I believe I am one of those poor responders.

Edited April 7, 2014 by eternaldenied

[saroj33]

So I also believe that Dr bhatti stands by his patients and that is why I did not request him to do the second session for free, neither did I complain regarding anything because I thought if he felt that surgeon error could have been responsible for poor result,he would have offered me free service himself. Since he didnt offer me a free service I believe I am one of those poor responders.

I think you have too much money .. Loan me some money .. )

 

My point is you should ask what you lost .. If you think it is not surgeon's error then why the hell are you going for second surgery .. because it won't grow (according to you).

[AB2000]

For over 3000 grafts you results don't look great after your first hair transplant, and frankly look more like a set of before pics. You posted what you looked like from before the HT and you don't look that much different. Yes there is more coverage now, but a lack of density.

 

Your donor area also looks quite depleted. What Norwood were you before all this began?

 

Two ways to help you going forward. Since you are getting work done by Bhatti and he has BHT experience, tap your beard for hair supply. You'll need it.

 

Also, look into using a hair concealer to touch up the final result. Even though you look less bald now by having coverage up front, it is too spread out to do any good on its own. Some hair fibers should help thicken your hair's appearance.

[eternaldenied]

I would go for option 1...get as many grafts at the front scalp. You will get shock loss, it doesnt matter when you have your second HT. Can I ask what Dr bhatti has suggested?

 

Jay, thanks much for your feedback. So, what you are suggesting is even if I give a gap of say 18 months between the first and second surgery , probabilty and impact Of shock loss would remain the same?

 

Also , do you think those fine thin hairs on the right svalp has the potential to become tetminal hair in few months of time or are those dying anyways in which case I can happily get operated on the same region again.

[Blake Bloxham]

Eternal,

 

Dr. Radha performs FUE, but both her and Dr. Madhu (our two recommended surgeons in India) do seem to focus more on strip. However, a consultation couldn't hurt. What's more, you could always travel for FUE. Remember that spending time and money to travel for a quality procedure usually ends up being more cost effective in the end.

 

Good luck.

[gillenator]

eternal,

 

I got your PM and if you really want my opinion for whatever its worth, I agree a lot with Mickey's comments along with several others.

 

May I politely add that you are destined IMHO for Norwood class 7. You are a diffused thinner and you will have a very challenging time in the coming years ahead of chasing this progressive loss with more and more surgery.

 

Your crown alone will potentially demand roughly 60% of your available scalp donor and none of us know anything about your available grafts overall much less your donor density. If you pull down the density in the crown, then you can change those percentages. But remember, once you start crown restoration, you have to continue to add to the areas that continue to lose hair and pull downward including the lateral humps on both sides of your scalp. Otherwise there will be an island of hair with a large stripe of missing hair all around the back and sides. Something to seriously consider for the future.

 

So I agree with others that are you best suited to leave your crown alone. Just your frontal and midscalp can consume all of your available scalp donor.

 

You would need to go to BH to attain any sense of "overall" visual coverage because it also appears that your hair caliber is average. Plus you have a wide color to scalp contrast so that adds another challenge to the equation.

 

Honestly? I would have challenged you to think real hard before ever starting on this transplant journey only because your candidacy is not ideal. And then having to resort to unproven BH and the added cost per graft of that?

 

Surely this is not what you wanted to hear but it's an honest opinion. I have dealt with many guys in your situation over the past four decades and cannot even think of one who did not regret getting started when they are headed for the upper advanced classes of hair loss at such a young age. They end up frustrated and broke. That's the truth my friend.

 

HT surgery at this point in time can also advance the rate of MPB so by the time you begin to make some visual gains, more loss occurs and they often wonder why they are not getting ahead.

 

Low dose finasteride may have stabilized your crown and midscalp but that's gone now. So unless your goals are very conservative, and I do mean conservative, you may end up regretting this whole endeavor unless you feel you would be happy with a restored frontal zone and pretty much nothing behind it as you get older.

 

I want to also challenge you to think about opting out for a high end hair system which can potentially provide you with front-to-back coverage and with a level of density that no amount of surgery can attain, considering your donor limitations. None of us want that option but it's a realistic one for individuals like yourself. You can also restore the frontal zone and wear a partial system behind it. That's also a viable option and I know some guys who are doing it and been doing it for years.

 

Well again that's my opinion and just don't want to see anyone end up regretful and broke in the end.

 

You owe it to yourself to do some deep realistic thinking about where you are headed with MPB and your limited resources both in terms of donor and financial.

[gillenator]

I was also very challenged to PM this opinion to you yet something inside me said do a post reply because there are many guys in your situation who do not join these hair loss forums nor do they actively post.

 

Yet I always end up hearing from them "after the fact" and again they are frustrated and broke.

 

So to the guys who may be surfing this thread, I hope this has been helpful information before you pull the trigger so-to-speak...:rolleyes:

[Since21]

HT surgery at this point in time can also advance the rate of MPB so by the time you begin to make some visual gains, more loss occurs and they often wonder why they are not getting ahead.

 

I've never heard of this, gillenator. Can you explain? Thanks.

[gillenator]

I've never heard of this, gillenator. Can you explain? Thanks.

 

This is more common then one might think. Let me first explain that over many years I have observed basically three prominent hair loss "categories" that men with MPB fit in. They are: recessionary, diffused, and recessionary with diffused.

 

Please note that I did not say, "classes". The classes and what the Norwood Scale distinguishes as "patterns" of loss depict defined scales of "recessionary loss" in very defined patterns. But the scale does not depict the various stages of diffused loss and I believe the reason why is because diffused loss can be very tricky to the naked eye.

 

Diffused loss is manifested by the degree of loss to hair shaft diameter (caliber). Recessionary loss can be defined as loss of hair count or mass (density).

 

It is the third category that IMHO is the most at risk for shock and at times permanent shock, and which I believe that Eternal has from his own pics in this thread. Now, as I said, the degree of loss to hair shaft diameter cannot be readily seen by the naked eye. But it can be seen and charted using a high-powered scope and then subsequently downloading the images along with date stamping each image into a file. I offer this service to a few young men free of charge. They are all under the age of 30 and have Norwood class 6 and 7s in their family history, and already are experiencing significant diffusion and/or amounts of hair loss.

 

Only by comparing the images of hair shafts over periods of time (6 months, 12 months, 18 months, ongoing), can the loss to hair caliber be effectively observed and noted/charted. I collect samples of hair shafts from their donor zones which represents the base point of comparison. Some areas of the scalp diffuse faster than other areas yet it is going on in vast areas in most of the individuals with diffused thinning, especially women losing by diffused loss and noted by the Ludwig Chart which depicts those various diffused patterns. A fair number of women suffering from generalized thinning do not have terminal hair in the occipital zone where most grafts are harvested from. Many of them are short term candidates or not candidates at all.

 

Now, one thing that many diffused thinners experience is that the native hair that directly neighbors a bald surface is almost always more thin and weak in caliber. That's the hair that is most susceptible to "permanent" shock loss. It usually does not grow back after surgery.

 

What happens is that the overall trauma to the scalp from the recipient incisions shocks out that weak diffused native hair. You must be aware of this right?

 

And it's because those individuals that have advanced diffused thinning can potentially be more susceptible to this because a large percent of the scalp that bears native hair that is DHT receptive is already weakened to begin with. I think I'm starting to repeat myself, sorry. My point is that I have seen some cases where the advanced diffused thinner experienced shock loss in the donor region as well. Not real common but it does happen for the reasons that I stated.

 

Over the years I have observed many younger men with this type of thinning pattern at such a young age, experience higher levels of shock loss and some of them permanent loss.

 

This begins a very advanced rate of loss because the loss occurs directly behind where the grafts were placed where the hair shafts are the weakest and most thin. There is a visual gap anywhere between nine and twelve months post-op. So the patient then feels that he must get back into the chair for another procedure to fill in those gaps of loss and "the chase" begins.

 

Yet a subsequent procedure is simply a repeat experience of the first one. More shock, more surgery, and so on, and so on.

 

The equation is: add incision trauma to an already area of diffused weak hair = faster rate of loss than if surgery was not in the equation.

 

Last comment. Even the fluids injected into the scalp can induce the shock loss and it's just one more factor in contributing to the overall level of trauma from the procedure itself.

[1978matt]

Reminded me somewhat of this post:

 

http://www.hairrestorationnetwork.com/eve/172099-you-surgical-candidate-why-why-not.html

[Since21]

Thanks gillenator. I was in fact aware that some of it had to do with 'shock loss' to already miniaturizing existing hair immediately behind the recipient site - hair that was on its way out anyway. Do you think the skill of the surgeon has any impact on minimizing this? And can an experienced surgeon tell by examining a patient's hair if they are currently experiencing or are at risk of experiencing loss to hair shaft diameter?

 

You mention 'the chase,' but that seems to be the case with a lot of notable successes on here. Maybe not the chase part, but getting back into the chair for multiple procedures to achieve desired results. Now I know you're not talking about them - you're referring to the diffuse thinners who end up frustrated and broke, but it seems very few people, diffuse or otherwise, are one and done.*

 

 

*Except for maybe 1978Matt

Edited April 9, 2014 by Since21

[eternaldenied]

eternal,

 

Well again that's my opinion and just don't want to see anyone end up regretful and broke in the end.

 

You owe it to yourself to do some deep realistic thinking about where you are headed with MPB and your limited resources both in terms of donor and financial.

 

Gillenator, Thanks much for posting. I respect your honesty and appreciate that you have highlighted this issue for the benefit of all. Indeed, its heartbreaking but if this is the fact I would have to accept that gracefully.

 

After reading your posts a couple of times. Now, what do I have next in line for me ? I am already on a path that in the best case I should not have taken but now since I am already here and invested good some money to get what I desired. what can I do to be best?

 

 

 

1. 2500 grafts were taken out from my scalp in my first session. Reading your post and Dr Wesley article I believe we should not touch any more than 1500 grafts from the scalp If I decide to have second

FUE

. This would total up to 4000 and that should be end of it.

 

 

 

2. Beard hair - Yes, I must tap that . May be we can get 300-500 from beard shadow area.

 

Aforementioned are the two resources at my disposal.

 

Do you think 300 beard grafts + 500 scalp grafts would do any good to front to mind scalp that looks bald as of now.

 

Rest 1000 may be used to reduce the diameter of balding area at crown/back ?

 

I guess have accepted that I can never flaunt the full head of hair. What I am trying to find out here is best utilization of limited resources at my disposal ?

 

Should I go for second FUE ? I think I have to go because I have already spent a good amount of money on first and If I don't go for a second one. I guess money already spent will be down the drain ?

[gillenator]

eternal,

 

Your reply is one of the most mature and respectful comments that I have read in four decades. I mean that as honestly and sincerely as I can express it.

 

A couple of things. First, 1,000 grafts in the crown will not make any visual gain for you. IMHO, it's a complete waste of grafts. I highly recommend that you dismiss having any surgery in the crown. It's just too large of a surface area to make any visual impact with your grade of hair. Plus, it's going to recede into an even larger area of baldness. You don't want any visual island of hair, trust me on that. I have seen it before.

 

If you do decide to go forward, all of your future grafts should IMHO be confined to the frontal zone and a very light density transition in the midscalp, and I do mean very light density transition. The more dense your frontal is, the less natural it's going to look. Don't forget that. And keep your hairline very high as you are going to require future donor to fill in the gaps on your sides (lateral humps) as they progress to a Norwood 7 level.

 

The reason you need a transition zone behind the frontal zone is to keep the frontal core from appearing like a separate island of hair. That's very critical in gaining as natural appearance.

 

Remember, you're still very young and as much as I hate to inform you, there will be more loss in the future both by diffused loss and recessionary loss.

 

Yes IMHO, your beard grafts are the salvation of your case "if" you get good yield from them. Whatever you do, "don't" commit to a large beard graft session. Start with a test session to see how you respond. There is an ongoing discussion, sometimes heated, that beard donor is still part of the head and should not be recognized that it is BH.

 

Don't buy into that balarney! Beard hair is BH without question. Only grafts taken from the scalp is considered viable and there are still very few beard graft cases that are clinically documented. What concerns me is that over the past year, beard hair became one of the hot topics in the hair loss forums. Lots of guys claimed they were having it done. Maybe they did, but my question is, "Where are the results?" ...:rolleyes:

 

Now, I am not stating that beard hair is a fluke but I am very careful to draw any conclusions about anything until I see documented clinical results that are consistent across the board before I can believe in it. This is why you have to approach beard hair just like it was BH because IMHO, it is.

 

You are one to also consider chest BH because it does show promising results in "some" patients. Again the dilemma is there are not enough cases to base an opinion on. In addition, if you do go to the body because you lack scalp donor, be sure you choose a surgeon who has multiple cases of BH that they have done and can prove them to you. Don't just take their word for it. Also, one of the other risks of chest hair is that it sometimes grows back in with a kinky texture and not visually compatible with scalp hair.

 

BH for sure has different patterns of growth cycling in contrast to scalp follicles. Many times BH grafts remain in the resting phase for up to 2-3 years before they re-emerge above the surface. Beard grafts do not have these random cycle intervals from my clinical observations. That's why I am becoming more of a believer in beard donor than below the neck, and into other regions of the body.

 

I know that you are not taking low dose finasteride without even asking you right? I know this is a personal elective decision so no need to pursue that.

 

Lastly, don't make any decisions about surgery right now. Take a good year off from this and give yourself a break. You may very well have a different viewpoint in moving forward with more surgery. You have lived this long so what is another year or so going to make? I don't mean to downplay your feelings but I sense you are rushing yourself into another surgery and you never want your emotions to guide you. Use wisdom and think in terms of your limitations more than what your goals are. Think in terms of what can be realistically achieved, not necessarily what you want.

 

Taking time off will also allow you to reconsider your goals. Plus you can save more $...

 

Hope this makes some sense to you my good friend.

Edited April 11, 2014 by gillenator