Hair Restoration Procedure Failing....

[seeker2014]

This is my first time positing to this forum so I apologize in advance for the length. Also, I wanted to thank everyone who is already an active member as I have greatly expanded my knowledge of hairloss by looking through the threads before and after my hair transplant procedure.

Just to provide a bit of personal background, I started to lose my hair at the age of 17. As soon as I could, I started taking propecia in combination with rogaine which not only helped retain my remaining hair, but actually significantly increased hair growth in some areas. Granted, when I went off to college, I had to somewhat sport the combover look, but, all in all, my hair loss wasn’t that obvious. This situation continued until my senior year at college when my hairloss accelerated and it was quite obvious (especially in the middle and front) that I was losing my hair. Despite losing some ground in the hair loss battle, I continued to use finasteride and rogaine and eventually things stabilized.

Fast forwarding two years, I finally had saved enough money for a hair transplant. Despite being only 24 years old, I thought I would be a good candidate since my hair loss pattern seemed pretty well established and had not changed that much since my senior year in college. I was also still taking finasteride and rogaine to maintain my remaining hair. I started to do my research and finally decided to meet with a hair transplant surgeon with excellent credentials (actually, someone recommended on this site). After the consultation, I decided to proceed with the hair transplant. I ended up getting 2800 grafts.

After going through the procedure, I patiently waited the year for the transplanted hair to come in fully. During this time, I met with my surgeon nine months after the procedure just to make sure everything was coming in correctly—at the time, he indicated that he was happy with the progress and I could definitely see new hair growth. After the one year mark, I noticed a significant difference and could now grow my hair out to an inch without any obvious balding areas…I was extremely satisfied with the outcome. This was my situation for nearly 4 months until I noticed that my hair started to thin in the areas where I received the transplants. I first told myself that maybe I was being over-sensitive or that a slight shedding was just part of the process, but after 4 months of progressively thinning hair I decided to call up my surgeon and ask him to take a look.

After examining my scalp, he didn’t know why I was losing hair so rapidly from the transplanted areas. Fortunately, the month before seeing him, I went in for a physical to eliminate any medical reason for my thinning hair—everything came back normal. The only thing my surgeon noticed was mild dandruff buildup which he prescribed DHS tar shampoo for, but acknowledged that this was not likely the cause. I have been using the shampoo for the past month without any difference. I forgot to mention that after the surgery, I continued to use finasteride (1.25 mg) and rogaine daily. At this moment, I am basically back to where I was before investing into the procedure and, needless to say, very disappointed with the results. I am going to meet with my surgeon later this month to further discuss my options. That is the reason I am not revealing the name of my surgeon because he will hopefully live up to his word and rectify the situation.

So after that novel (again, apologize for the length) I was curious whether this has ever happened to anyone else before and what did your surgeon do for you? I am just confused why a hair transplant would only work for a year and a half, considering that I continued to use finasteride and rogaine daily. Thanks for your help.

[seeker2014]

Had a request to post a few pics so here they are. The first one shows my hair 15 months post-op when I would say I was near my maximum thickness. The second picture shows my current state (24 months post-op). To be fair, I think the second photo makes it worse than it actually looks as I have blonde hair and it was taken under fluorescent lighting. I would say that it is a bit thicker in the front and right side than what it shows in the photo. But just wanted to post some visual comparisons so everyone could better understand my situation.

[Dutch]

Hello, who was the surgeon? Have you contacted him/her?

 

Photos are very blurry. Do you also have pre op photos?

 

A transplant is not temporary & the hair should stay with you for life.

[seeker2014]

Hey Dutch-

 

Thanks for the response. Sorry about the quality of the photos...I cropped some photos already on my computer so the quality was compromised after expanding them. I'll try to post some additional photos of what my hair looks like today (approximately 24 months post-op). For pre-op photos, I'll try to track some down...they might suffer from the same quality issue since I will have to try and crop them from distance.

 

I have seen my surgeon a couple times after having the procedure completed--once at the nine month mark and then again about a month and half ago. At the nine month mark, he was happy with how things were progressing (and so was I). When I saw him a month and half ago, he commented that he didn't understand why the hair in the transplanted areas was thinning so rapidly. He stated that the only time he has experienced this before is when a patient has an unknown case of "scarring alopecia" which he eliminated as a cause for me. He prescribed some DHS tar shampoo since he did notice some mild dandruff, but remarked it was highly unlikely this was the driver. He told me to use the shampoo for around 2 months to see if things improved (which they haven't). So to make a long story short, he does not know why, especially considering I have continued finasteride/rogaine post-op. I am going back either this month or early next month to discuss my options.

 

I don't mean to be difficult, but I want to keep the name of my surgeon anonymous at this point since I understand the importance of reputation from my own career experiences. I want to provide my surgeon with the ability to fix the situation before I associate his name with a less than satisfactory hair transplant. I can tell you he is someone with high credentials and recommended on several different hair loss forums (including this one).

[seeker2014]

Attached are some pictures of my hair today (again, 24 months post-op). My pre-op condition was extremely similar to what is shown in these two post-op images.

[benidorm1]

That happened To me with my first ht in 1999 looked great for about a year then all transplanted hair fell out: the Norton clinic, ten years later i had a second ht at farjo which was brilliant and no problems since

[JohnGage]

Without clear pictures of your pre/post hair transplant it wouldn't be fair to judge. May be you have lost more native hair since the transplant? Or may be your donor hair was removed outside of the safe zone? Hair follicles in the safe donor area do not have receptors to DHT. Which is a metabolite of the male hormone which when combines to the receptors shuts off the blood supply to the follicle killing it. If safe zone follicles are used as donor, it should last for life.

[GreatPelo]

I'd recommend seeing 1-2 other hair specialists. This will give you a balanced set of opinions. I'm always fearful of going back to the same surgeon who did not deliver a successful procedure the first time. I wouldn't see other doctors with another surgery in mind, just yet. I would go to them for different angles of what happened. You need to know this in order to know which direction to move forward.

 

Best of luck!

[seeker2014]

Thanks for the reply JohnGage. If it was a longer period of time, I would consider the native hair angle. However, I had stabilized my hair loss three years prior to the HT with a combination of finasteride and rogaine (which I continued daily after the HT) so I just find it hard to believe that the transplanted areas would thin so rapidly (within a matter of 5 months after reaching maximum thickness). When I saw my surgeon a month and a half ago, he could not explain why this had happened. I suppose it is possible that my surgeon harvested outside the safe donor area, but all my grafts were extracted from the classic safe zone. I am going back to him within the next two weeks so hopefully I get some answers. I might be able to post a better pre-op picture…currently trying to track one down.

GreatPelo, thanks for the advice. I am going to do at least another six months of research before I do anything. At this point, I might just want to get my FUT scar camouflaged via a small FUE procedure. I have been reviewing some work done by other HT surgeons in order to compile another short list. Even though my surgeon has excellent credentials, I just could not trust him to perform any further procedures….so hoping he will grant me a partial refund that I can then use for the FUE procedure. A la segunda va la vencida! (espero)

Benidorm1, congrats on the second HT working. If you don’t mind me asking, did you ever find out why the first HT didn’t take? And did the first surgeon grant you any sort of refund?

[Spanker]

That sucks. I don't see how it would be on the surgeon if it grew after 15 months and then fell out. I'm not sure why this would happen. I'm really sorry to hear it and you definitely have an extreme case. Did you notice excessive shedding after 15 months?

[hsrp10]

I think it may be one of two things.

Could be a process where your body eventually rejects the new hair and actually attacks the hair follicles, some type of scarring alopecia (though your doc seems to rule that out).

Or you are a weird/poor responder to finasteride where it actually accelerates the overall balding process, this is a low possibility but some do see accelerated loss.

 

I would consult with some of the best hair restoration physicians out there for a second opinion, could always get in contact with Dr. Konior for example to see what he says.

[seeker2014]

Thanks for the reply, Spanker. In retrospect, I would say that after the 15 month peak, I noticed gradual thinning for around 2 months. Granted, the true extent of the loss could have been concealed since I had recovered a significant amount of regrowth from the HT. Then, around the 17 month mark, I noticed/experienced some rapid shedding until around the 19 month mark. I decided to wait 3 months just to see if the hair would fill in after the shedding phase (which it didn't) and this is when I contacted my surgeon for an appointment. It is almost like my hair grafts synchronized for one extremely productive 3 month cycle of growth (from 12 to 15 months) and then just disappeared...I really don't have a explanation.

[seeker2014]

Thanks for the reply, hsrp10. My doc seemed pretty confident it wasn't scarring alopecia and I had appointments with a dermatologist before the hair transplant who didn't mention anything about this condition. I have done some research about scarring alopecia and never really experienced any of the symptoms such as isolated areas of baldness that expand (if anything, I am more of a diffuse thinner on top), red/scaly skin in affected areas, or severe burning/itching. I asked my doc if this was even a possibility and he seemed very confident it wasn't. Additionally, I had my thyroid checked to make sure it wasn't somehow haywire. Typically, thyroid imbalances cause indiscriminate hair loss (still was retaining my sides and back) and medical tests ruled out this possibility.

 

In terms of finasteride, would it only somehow affect transplanted hair? I have been taking finasteride/propecia since I was eighteen. The only time I experienced significant thinning was during college (senior year) when I decided to separate the pills in half and not take it daily (damn limited college finances . Ever since that failed experiment, I have been taking 1.25 mg everyday (for the past 4 years).

[FUE2014]

Very strange, would love to hear the opinions of Future HT Doc or some other docs who contribute here.

[Since21]

My first thought was harvesting outside of the safe zone. Did you have FUT or FUE?

[1978matt]

Where were the grafts placed?

 

For someone with what looks like a NW6 pattern and fine hair, 2800 isn't going to make a great deal of difference. I'm not saying the doctor got it wrong, only that you may have lost ground in the following years.

 

Perhaps your hair loss is too aggressive for Finasteride/minox to be effective long term. I think they are about 90%/80% respectively.

[seeker2014]

Thanks for the reply, Since21. It was a FUT procedure.

Thanks for the reply, 1978matt. The grafts were primarily placed in the front 2/3 of my scalp (focusing on the middle). I see what you are saying with my hairloss pattern mirroring that of a NW6 case. Before I went into this procedure, I realized that later down the road (I was projecting somewhere in my mid-30s) I would probably have to make a decision whether to pursue additional HTs due to finasteride/minox only slowing down the inevitable. Saying that, I just find it hard to believe that my hairloss would progress this much in nine months (from 15 months post-op to 24 months post-op), especially considering I have not deviated from my finasteride (1.25 mg daily)/minox regimen for the past 4 years. Even though the picture I originally posted is not of the best quality, from an overall perspective you can see that (at the 15 month mark) I initially responded pretty well to the HT.

I do appreciate you giving me an honest opinion about my current state. I agree with what you are saying…I plan on not pursuing any other HTs in the future since I am 26 and already expended 2800 grafts. The only thing I am investigating now is a quality FUE surgeon who can camouflage my linear scar so I can buzz my hair down a bit shorter (right now, I can get away with a 4 guard).