Depressed with Recent FUT

[aaron602]

I don't talk about "killing myself" over and over again, I have stated that I don't feel alive, and that I feel like im in my 70s.

I have read worse on here before.

hdude46 I have weighed my options with the revision, and I overquoted the 1000 grafts...its about 400-800 grafts

 

like I said I don't want to offend anyon here.

and I can assure you, I will not be complaining here anymore. not one more time. I will be only looking for guidance on my hair.

I have taken peoples advice, and I have applied it before I came to this site.

I want a revision believe me, but im scared of a stretched scar, ok?

I will not talk about my unhappiness anymore. I promise.

[aaron602]

let me make it clear, I would never kill myself, I have no plans, although I suffer from severe depression and it may sound like im feeling "suicidal"

I want to make it clear, im not suicidal

[aaron602]

im seeing a counsler and a physchiatrist, they both know how I feel and would not classify me as suicidal, by any means,

severly depressed though? yes.

that's the last im going to talk about that.

sorry if I gave you guys the wrong idea, Im not trying to be a victim, idk why anyone would want to play that role,

 

in the end you guys are right, your advice is spot on, that I need to treat these disorders first, and that's what im doing

I owuldnt go under the knife until 18 months is up and until I get better as a person.

I will promise you guys that I will try my best.

[hdude46]

My last contribution to this thread. DO THE SCALP EXERCISES AND GET A REVISION.

 

Don't waste 800 grafts on a scar fue. BAD IDEA.

 

That's it. Good luck.

[aaron602]

a couple of things I think need to be noted from me:

 

I have no doubts in my mind that dr keene earned her right to be a coalation doc and earned the right to be known as a doctor of honesty in the field

I enjoyed being in her presence during the initial consultation and during surgery, she listened to everything I had to say and showed compassion for me and was empathetic towards my situation,

I believe she is right when she states that having a hair transplant at my young age is a good idea because of the years that are wasted when living with out hair at this age, she is absolutely correct on this and I was ecstatic that she understood this.

 

But the thing that borught to a state of ,unrest,unhappiness and displeasement with my HT, was the method of transplantation via FUT.

After researching I feel like in the year of 2013 when I had my surgery, it was a well known "opinion" that young men who undergoe HT's for a low number of grafts, should always go for the FUE route, and many other surgeons who practice strictly FUT would agree with this, and this is where I find myself misinformed about the FUT method and I feel like I should have been pushed towards FUE instead of FUT of 1650 grafts.

 

DR keene, is an extremely nice and caring doctor who understands the complications of young male hair loss, I concur with her methodology behind the fact that young men don't get there years back that were wasted due to not fullfillig there lives b/c of hair loss

 

but I feel like FUT is a BIG NO-NO for a 19 year old who only needed 1600 grafts

this is where everything went wrong

I don't want to damage her stellar reputation but I only wanted to point out the facts of FUT vs FUE for young men

[aaron602]

dr keene is a great strip surgeon, but unfortunately for young men , more often than not, strip surgery can be a a failure

[Since21]

I believe she is right when she states that having a hair transplant at my young age is a good idea because of the years that are wasted when living with out hair at this age, she is absolutely correct on this and I was ecstatic that she understood this.

 

If this is correct, I'm sorry, but this is an unevolved person who understands very little about life.

 

dr keene is a great strip surgeon, but unfortunately for young men, more often than not, strip surgery can be a a failure.

 

I don't know what the rate of failure is, but hair transplantation at such a young age is unwise, in my opinion. As has been discussed many times on here, it is a recipe for 'chasing your receding hairline' until you either run out of donor supply or money, leaving you emotionally and financially exhausted.

 

I started losing my hair in my 20s and fretted mightily over it, but thankfully I couldn't afford to do anything about it. If I had been able to, I would have most likely been a lifelong repair case. So those years were spent building my career and family and living life (with intervals of fretting mightily over my hair). When you're older, you're more likely to be in a better position both financially and emotionally to make better informed decisions.

[Mickey85]

I believe she is right when she states that having a hair transplant at my young age is a good idea because of the years that are wasted when living with out hair at this age, she is absolutely correct on this and I was ecstatic that she understood this.

 

 

 

Keene was dead wrong in performing surgery on a 19 year old. Sorry. Unless the patient is a burn victim or has scarring from a previous incident, I cannot accept any surgeon performing a hair transplant on anyone that young. It is unethical given that donor supply is limited and hairloss is usually progressive.

Edited April 13, 2014 by Mickey85

[OtherSyde]

After all this discussion, I think most of us are really just waiting for two things in this thread:

 

1. Dr. Keene's input. Where is she? Mods, is anyone in contact with her? If she's super busy, you could even pre-make her an account and simply send her the login/pass information with a link to this thread. She's really getting put through the ringer here by several different people, and I think everyone would like to hear her two cents.

 

2. aaron602 developing and acting on a solid recovery plan. Maybe a scar revision followed by a small FUE procedure (maybe with a little SMP) after a year or so? No more of his young life should be wasted.

[Mickey85]

After all this discussion, I think most of us are really just waiting for two things in this thread:

 

1. Dr. Keene's input. Where is she? Mods, is anyone in contact with her? If she's super busy, you could even pre-make her an account and simply send her the login/pass information with a link to this thread. She's really getting put through the ringer here by several different people, and I think everyone would like to hear her two cents.

 

2. aaron602 developing and acting on a solid recovery plan. Maybe a scar revision followed by a small FUE procedure (maybe with a little SMP) after a year or so? No more of his young life should be wasted.

 

I too am looking forward as to what prompted her to perform a HT on a 19 year old who could very well be prone to future hairloss....

[TakingThePlunge]

Dr. Keene's input. Where is she? Mods, is anyone in contact with her? If she's super busy, you could even pre-make her an account and simply send her the login/pass information with a link to this thread. She's really getting put through the ringer here by several different people, and I think everyone would like to hear her two cents.

 

It was 10pm Friday night in Arizona when I notified Dr. Keene and her rep via email. In my experience, most clinics are monitoring work emails over the weekend. I do not expect to hear from her until Monday.

 

Due to HIPAA, most physicians will not discuss a patient's case publicly without prior written consent. Thus, Aaron will likely need to provide Dr. Keene with this permission.

[aaron602]

i really would rather if this thread be deleted.

I did not want to have this transpire like this

its unfair to dr keene, even if im unhappy

id really like to have this deleted because, I will not be going in to see the doctor to sign a consent for several reasons.

so its unfair to her

so david can we please drop/delete this thread like I wanted before the talk of my doctor was even being seen by anyone?

 

I don't understand, please lets just delete this, I will never mention my experience with her again

im here to get help with a repair nd suppor

Edited April 14, 2014 by aaron602
grammar

[BaldingBogger]

Aaron, i would think you are best off to stop this worrying and flapping about and face these issues head on.

 

Give the clinic the chance to discuss your case. You are clearly not happy with the results.

 

Worst case scenario for you the result was a good one but your expectations with the clinic were not alligned.

 

You may well have a point that your results was sub par. In that case the clinic should explain why. If you delete this thread now it is going to look bad for you and the clinic.

[Mickey85]

Aaron, i would think you are best off to stop this worrying and flapping about and face these issues head on.

 

Give the clinic the chance to discuss your case. You are clearly not happy with the results.

 

Worst case scenario for you the result was a good one but your expectations with the clinic were not alligned.

 

You may well have a point that your results was sub par. In that case the clinic should explain why. If you delete this thread now it is going to look bad for you and the clinic.

 

If the thread does get deleted, we will never hear about why Dr Keene thought it was a good idea to perform a HT on a 19 year old who might lose even more hair later down the track. This is quite paramount and calls into question her ethics. In my opinion anyway.

[Arrie]

If this thread is deleted and the doctor does not at least explain her side (right or wrong), this will always be something that will hurt and question her ethics. An explanation would possibly answer some questions. Aaron we are here for you my friend and don't think that you are at fault for anything, you deserve answers and a solution. Please take care of yourself

[GBU]

People on here really do care about you . I've found my answers here and don't give up .

[LondonHT]

If the thread does get deleted, we will never hear about why Dr Keene thought it was a good idea to perform a HT on a 19 year old who might lose even more hair later down the track. This is quite paramount and calls into question her ethics. In my opinion anyway.

 

I am sure Dr Keene would be delighted if this thread was deleted.

Fully agree with your opinion Mickey.

[Hairtechnician]

The difficult thing about patient blogs is that protecting the privacy and anonymity of those who post can obscure or obstruct the knowledge of clinical nuances that contribute importantly to medical decision making. Likewise, the anonymity of those who respond, can cloud or camouflage a clinical bias which may not be based on scientific knowledge or expertise. In hair restoration, as all disciplines, expertise and training in the medical specialty are important. A doctor/surgeon must insure that all aspects of the medical history and hair loss history are part of the decision making process. It does not serve a worried patients interest to criticize their surgeons decisions, without being aware of all information—and can in fact unnecessarily increase or even cause a patients anxiety. Bloggers who request information, in my opinion, are best served when other patients share their experience of how to deal or improve a particular problem. This online environment should be a supportive one, and help guide fellow patients through a temporary anxiousness or to ask their doctor the appropriate questions if they need to. I have had patients share that experience from this website, and appreciate it.

 

In my over 20 years of performing follicular unit transplantation , I have operated on a handful of patients under the age of 21, and only a small fraction of my overall patient population are under the age of 25. A decision to proceed with surgery at a young age must include a thorough understanding of the progressive nature of hair loss from androgenetic alopecia (AGA or male pattern baldness)—but if in my clinical judgment, after weighing the pros and cons, I think it will benefit a patients life and livelihood I have on occasion, been willing to do so. It is more customary for me to prescribe medication to stabilize a patients pattern. However, when I know the medication is not likely to achieve a goal that I think is reasonable, then surgery may be the best approach. Without violating the privacy of the patient which prompted my response, I would like to share the stories of a couple other patients who did not blog but were very young when they had surgery—their experiences changed my perspective. In the first 5 years of my career in hair restoration, I adhered strictly to the “rule” that no patient under the age of 25 should have surgery, as they won’t be able to predict their future pattern. During that time finasteride was not yet available, but furthermore, even with the benefits of medication these drugs cannot typically restore hairline areas that have receded….and can be the source of significant anxiety to many young men.

 

Several years into my career, I was approached by a mother about her 20 year old son, who refused to attend family functions, refused to be included in family photos, and refused to be seen without a baseball hat because he had lost a considerable amount of frontal hair and had no distinguishable hair line. He sat in my office with his mother as she shared their story, but when I asked him if he felt the hair loss was interfering with his life, he looked down at his hands and stated firmly that this was all his mothers idea, he was fine with his hair loss. I explained to his mother how I could not recommend surgery to anyone who did not wish to have it, and the patient indicated he would be fine to proceed if it would make her happy. I felt ambivalent, by her report his hair loss was causing extreme self consciousness—by his, he was not at all disturbed by it. I spent a great deal of time explaining the benefits of medication therapy to stop future hair loss and suggested if he was not bothered by his hair loss there was no real rush to proceed with surgery at his young age—that in fact he would benefit from knowing if the medication might strengthen some of the thinning areas. I did express concern that something was causing his unwillingness to attend social functions, but the patient was adamant it was not his hair. A few months later he came back in for a follow up appointment; I was surprised to see him on my schedule as I did not expect him back for a year. When we spoke he felt his hair loss had stabilized, he was no longer shedding, and reported to me that he still wasn’t bothered by it. I told him I thought it was fine to continue on medication and he could always consider surgery at a later date if he ever changed his mind. Peculiarly, I received a call from his mother about 20 minutes after he left the office—she was calling to schedule a date for his surgery. I shared with her that her son stated he was fine with how he looked—and she stated he was the one who called and asked her to schedule. I felt perplexed, but assumed that despite his revelations to the contrary, she knew it was affecting him and he was willing to let her help him—even if he did not wish to admit it to me. I do my best to make patients feel comfortable, but when a parent comes to my office with their child, I know they have their child’s best interests at heart and are looking for me to help. A year after his surgery, his mother shared how his life had changed. He had become very social, he no longer wore a hat, he attended family functions again, had a girlfriend, and had experienced great success in his work which involved sales. When I saw him in my office, he looked me in the eyes, not at his hands…and though by then he was only 21 years old… I knew we had made the right decision. Although it has been some years since I have seen him, I did see him for several years after his surgery and we did eventually do a second procedure to strengthen his density and fill in for a little bit of additional hair loss—though the medication seemed to be holding him quite well. Furthermore, the permanent hairs in the front, allowed him to cover areas behind it which were slightly thinner.

 

A second case I will share is similar in nature, except that there was no parent involved. A 22 year old young man came to me to ask me to fill in his hair line. We discussed the risks of advancing hair loss, which might be stabilized with medication—but there was no certain way to know that until more time had passed. So he began medication therapy, and a year later when I saw him his pattern had stabilized. He asked if I would do surgery, and I said we needed to wait for another year to be sure he was stable—this happened the next year, too. At the “magic” age of 25 we operated and filled in his hair line—and when I saw him back several months later he looked younger than when we first met. He was thrilled, glad to be getting carded again…and while I was happy for him, I thought about the 3 years I had refused to operate on him…with the wisdom of hind sight, I knew he hadn’t benefitted from that lost time—his pattern was stable on medication and from experience, I could have predicted that after about 6 months. And even if it wasn’t completely stable, he was intelligent and educated on the subject of progressive hair loss. Knowing what the risks were—that he might some day need another surgery, he could have, and should have been allowed to make that decision—age was not the issue, since the risk of additional hair loss was still present when we operated at age 25. In fact, for men of all ages, the risk of needing to ‘chase a hair line” is present in virtually every patient we operate on who has a minimal pattern of hair loss! In order to avoid that, should we then require that all patients progress to a Class V-VI pattern before proceeding with surgery? I don’t think that is reasonable. I am pleased to say that I am aware of the happier lives of many young men, who have their confidence restored by what I do. Nevertheless, do I encourage all young men to proceed with surgery? I would never suggest it unless he had been seen and evaluated by an experienced follicular unit transplant surgeon. Because of experience and knowledge I do have the ability to know whether a patient is likely to have progressive hair loss, and whether they are likely to benefit substantially both emotionally and cosmetically. Even in cases of Body Dysmorphic Disorder, according to studies and personal directives from psychiatrists I have spoken to when faced with this issue, some patients will be cured or substantially benefitted—but not all, and a multi disciplinary approach may be necessary.

 

In the case of this blogger, I know this patient does not wish to discuss his personal issues online, and I respect that. I have attempted to contact him and will continue to do so. I am unhappy that he has concerns about his scar—and once it has fully healed and we have dealt with it, I am confident it will not be an issue for him. At this point he is only 8 months post surgery and I would advise against massaging the donor area until he has been evaluated again as that can result in stretching of scar tissue if it is not fully remodeled because skin heals at different rates. I was very pleased with his evolving cosmetic appearance when we met a few weeks ago, and he seemed to be also.

 

When dealing with young patients I do have concerns about the use of donor harvesting with the technique of follicular unit extraction, which in the case of 1500 grafts would have required a distribution of extraction sites between 100-150 square centimeters of his donor area. If a young man goes on to progress with falling lateral fringes or posterior hair line upward recession, these sites will be exposed (as happened in the ‘bad old days’ of punch graft harvesting using larger grafts) and the grafts will be lost. The entire development of the strip harvesting procedure was to take advantage of the concentrated harvesting of donor hairs from the zone of hair most likely to be permanent, and most likely to stand the test of time when transplanted. I further find this to be an advantage when we are trying to use as little donor hair as possible in order to achieve our goals—and with all the current, reliable hair counts on graft survival for both robotic and hand held FUE machines showing a lower survival with FUE vs strip harvesting with microscopic dissection (~70% vs >95%) there is less wasted donor hair from a potentially dwindling resource. Using simple math, I would have had to harvest over 2000 FUE grafts for 1500 to survive. I don’t think offering FUE donor harvesting for young patients offers substantial advantages over strip harvesting—and worry that with time we will have a whole group of young men with exposed scars in the future from over zealous use of that technique. That said, I do offer both forms of donor harvesting, and caution patients to consider that the appearance of a transplant is based on the experience of what occurs where the hairs are grafted (transplanted)—as most patients are not adversely impacted cosmetically by either form of donor harvesting unless they plan to wear their hair very short. If an educated patient opts for FUE, I will perform that method of donor harvesting at their request. It is my position that all competent hair restoration surgeons should know how to perform both techniques and allow patients to make an informed choice.

[Mickey85]

Simply informing the patient of the potential risks of a hair transplant at a young age does not relinquish you of your ethical and moral obligations. I find your reasoning unacceptable. If the individual has serious image problems, that has to be sorted out through therapy, not a hair transplant. Being very image conscious and young means that a failed procedure or stretched scar would ve more devastating effects compared to someone who is older and has had life experiences. You are basically passing on the onus onto the patient which i do not agree with at all. Any patient can have a distorted perspective ESPECIALLY younger individuals. They think they won't care how they look when they get older but we all know that is not always true. When I was 19 i couldn't even decide what i wanted for breakfast, yet you gave this patient a hair transplant knowing of the potential future risks and knowing that the patient most likely would not decline surgery. If someone is in a consultation they generally have a desire for a ht. Did you expect this 19 year old to decline surgery after you informed him of the risks? You should have turned him away, the onus was on you. No one is saying a patient has to be a norwood 5 for you to operate, we are saying it is unethical to operate on someone as young as 19 because surgery is a serious decision and 19 year olds tend to make choices rather carelessly.

Edited April 15, 2014 by Mickey85

[BaldingBogger]

I have to agree with the above. 19 years of age is far too young for a myriad of reasons. The main 2 being the future escalation of the loss. My hair at 19 & 27 was incomparable with the loss suffered. Being Norwood 1 at 19 with massively thick area which all of a sudden around my mid 20's starting falling out. With finasteride and minoxidil i might add.

 

The 2nd main reason being the patients mental maturity and life experience in decision making. There is no way a 19 year old can make these key decisions which will impact the rest of their life. i.e Having an FUT scar and not having the ability to buzz hair short in the future in the event that the result is sub par.

 

Also the implication of going the FUT route instead of FUE due to overhavesting concerns is lame in my opinion. No ethical clinic will over harvest FUE over a certain threshold to leave signs of obvious scarring in the future. This same logic would apply to FUT overharvesting in which the patient would look a hell of a lot worse overharvested on FUT then he would post FUE still having the option to totally shave off hair.

 

This patient was far too young in my opinion and not in the right mental state for a procedure.

[GBU]

I think that Dr. Keene cares about her patients and looked at all sides of the issue before performing the surgery . It is clear that this patient and the technique used were a mistake in hindsight . I'm not sure what to think of ethics or thought processes in this case . My heart goes out to this patient .

[TakingThePlunge]

Guys,

 

We truly do feel for Aaron. It's clear that he is unhappy and we've given him the opportunity to share his experience and seek a resolution through our community. However, he has not only made it clear that he does not wish to continue this discussion, he has also requested that it be deleted and, to date, has not provided Dr. Keene with the necessary permission she needs to discuss his case in detail publicly.

 

Given that none of us are privy to the events that transpired between Dr. Keene, her patient and his family that led to the decision to proceed with surgery, it's unfair to criticize and malign the physician.

 

Unfortunately, without Aaron's consent, this thread simply cannot develop into a productive and transparent discussion. Thus, we have decided the best course of action at this time is to lock it. If Aaron should change his mind and wish to allow Dr. Keene to discuss the details of his case publicly, we'll be happy to reopen it.

 

Aaron, if you'd like assistance in providing Dr. Keene with the necessary permission, you can email me at service@hairtransplantnetwork.com. If I don't hear from you in two days, I'm going to archive this topic. However, it can be restored at any time in the future should you change your mind.

 

Again, I want nothing but the best for this young man. Best of luck Aaron, no matter what you decide to do.

[TakingThePlunge]

As of today, Dr. Keene has still not been given the permission she needs to discuss Aaron's case publicly. Thus, we will be archiving this thread. However, before doing so, Dr. Keene has requested that we post her final response.

 

Again, we wish Aaron all the best. Should he decide to contact Dr. Keene and provide the necessary permission, we will reactive the discussion.

 

From Dr. Keene:

 

I assume by the anonymous, online public pontification about ethics in a case where clinical details are unknown to the last two responders, they are not medical professionals, and have no expertise to judge mine or to tell me what my responsibility or advice to any patient should be. I support that lay people have a right to express their opinions, but I note these responders have ignored and attempted to invalidate the opinion of my patient who stated he had made a correct decision for himself. Asserting that he had no right to make this decision himself, (that I should have dissuaded him) seems both insensitive and arrogant. However, when responders are allowed anonymity, and a patient’s best interest does not seem their goal, it begs the question of motive.

 

Nevertheless, I will comment on what I believe are inaccurate assumptions expressed in this blog. Self image isn’t less important at age 19, it may be more so—or at least equally so. There are reasons not to proceed with surgery at age 19, often we are dealing with the early stages of thinning, and surgery could accelerate hair loss. In these cases, which are the majority, I always recommend watchful waiting and medical therapy. Fortunately, most 19 year olds are not affected with AGA at such a young age, but when they are, every patient is entitled to be fully educated about his options, and proceed accordingly. In my experience, few young people can afford cosmetic surgery, and are usually assisted in their decision making by the wisdom of a parent. Presumably this overcomes the reported objection to allowing a young person to make his own decisions—though I will address this assertion momentarily. Nearly all young patients I have seen over the years where the option of surgery has been provided, have parents who are professionals (including medical doctors) and usually do not make this decision alone, simply as a matter of economics. My job is never to persuade a patient to proceed with surgery—at any age—but merely to explain the options they have, both medical and surgical, including the consequences of future hair loss if it occurs. Each circumstance and patient is different, and each has a right to their valid concerns and approach to every challenge, including hair loss.

 

For better or worse, the psychological literature is full of data to support that society and individuals make judgments based on the way a person looks, and this can affect the way a person is treated, whether they are 19 or 90. So it is not just self image we are speaking about, it is the way others view and treat us, too. While counseling can help a self conscious patient accept their hair loss, preventing and treating hair loss is an alternate or adjunctive approach. The more or less ubiquitous acceptance that hair loss due to chemotherapy is emotionally traumatic independent of the associated illness-- raises the question as to why anyone would think young men in particular or any man or woman who loses their hair has no right to be similarly upset, regardless of the cause. Losing hair can impact how we look to ourselves, and to others. Nevertheless, I also accept that some people look great with no hair, and for them shaving the hair off is not only acceptable, but promotes their positive self image. But this approach is not for everyone, either!

 

Returning to the subject of young men and the risk of allowing them to make decisions about treatment of hair loss can be put into perspective if we look at other decisions we allow of 19 year olds. As a society we accept that 19 year olds can make life and death decisions in defending our country through military service. We allow them to decide for themselves whether to be involved with sports, whether it be kick boxing, football or skiing—all of which can have damaging, long term effects on the body. We also allow them to decide for themselves whether they should consume cigarettes or alcohol….or get tattoos or piercings—again, all of these decisions can have long term consequences. Is it reasonable to suggest that making an informed decision about hair loss treatments is out of the question?

 

There are a variety of medical and psychological issues that can make it more or less beneficial to proceed with hair restoration surgery—at any age. I stand behind my decision to help my patient in this case even though he is now concerned with a donor scar. To say more about this case, I would need the patients consent—and he has indicated he prefers to maintain his privacy, which I understand and support. He reached out for support in regard to a donor incision scar, it would have been nice for him to get information from those who have had similar experience and found a successful remedy. Although the blog seemed to get off focus from his concern and actual questions, I will address this further in my office and hopefully provide the assurance he was seeking.

 

I also stand by my comments on the selection of a donor harvesting technique. A donor area and specifically numbers of follicular units are finite. Large sessions of FUE are being performed on patients young and old, who in some cases are drawn in by marketing sponsored by wealthy businesses with big marketing budgets—budgets that may pay for online bloggers to promote a donor harvesting procedure that is not yet fully studied. I am troubled by any technique that reduces graft survival and has the potential for diffuse scarring which may impact the ability for successful surgery in the future if needed. This is particularly true for young people. However, every patient is entitled to their own opinion, and I listen carefully to each of them when they are in my office. If I am confident they have been fully educated and understand the long term risks and benefits of their decisions, they have a right to make them.