Frustrating Post-Op Experience...

[seeker2014]

I posted on this forum awhile back under the thread “Hair Restoration Procedure Failing”. I meant to post earlier than this, but, recently, I have been extremely busy as I am working and completing my MBA at the same time. Just to provide everyone with a brief synopsis of my case, I went through a HT about 2 years ago. When I went in for my 9 month review, the doctor was very happy with the progress (and so was I). At the 12 month mark, I experienced peak growth. However, starting at the 15-16 month mark, I experienced significant shedding only in the area I had received the transplants. During this time, I had not my changed daily routine of Rogaine (5% solution) and finasteride (1.25 mg). At the 19 month mark, the thinning was extremely noticeable so I proceeded to contact my doctor for an appointment.

 

During this first meeting, he noticed some mild dandruff and recommended a DHS shampoo to clear it up. However, he pointed out he did not believe this was the cause of my problem. I used the shampoo for 3 months with no improvement. At this meeting, I asked him if I had any signs of skin disorders like alopecia scarring. He assured me the only thing he noticed was the mild dandruff and requested I contact him for another follow-up appointment.

 

At the second meeting (which was about a week ago), I explained that my situation was still the same and well below what I expected for 2800 grafts. He conceded the results were definitely less than satisfactory, but then proceeded to point out my scalp looked “red and inflamed” and instructed me to see a dermatologist for a possible scalp biopsy. As he explained, there was nothing wrong with the procedure, but something had changed with my scalp conditions post-op. To be completely honest, I feel like he is making me jump through hoops so he can avoid responsibility for a procedure that ultimately failed. Some family members looked at my scalp and remarked that it did not look red or inflamed nor have I ever noticed these conditions.

 

I am going to see a dermatologist so my scalp can be examined just so I have more evidence to back my case. But, honestly, I don’t think I will proceed with the scalp biopsy as my insurance won’t cover it (the procedure costs $300-$500)…a dermatologist should be able to identify anything seriously wrong by examining the surface of my scalp. I was just wondering if anyone else has gone through an experience like this before and could provide me with some guidance. Next time I go in will be my last and I am going to request some type of refund.

 

The doctor who did my procedure is recommended on this forum so has all the qualifications of a type rated surgeon. I would not like to reveal his name at this time since we are still in the negotiation process. Thanks for your help!

[hairweare]

If your result was satisfactory to both you and the surgeon at 9 months, I would think that any subsequent hair loss especially in the recipient area where presumably your native hair was most susceptible to either progressive MPB alopecia or shock loss, should not be considered the fault of the surgeon.

[seeker2014]

Thanks, hairweare, for the response. In terms of shock loss, it is my understanding that it typically happens almost directly after a procedure is completed. With the preliminary research I have done, there seems to be several causes for shock loss including the doctor using too large of an instrument in relation to the size of the graft, the doctor transplanting hairs that are already in the process of miniaturization, or a patient’s scalp is thin increasing the risk of damage to arterial vessels. I have no idea if any of these apply to me and I guess there is no way to prove it. However, I don’t understand why shock loss would set in 12 months after the procedure…I am not saying it is impossible, but I just have never read case where shock loss happened so long after a procedure was completed.

 

In terms of progressive MPB, I just think it is too large of a coincidence that all my native hair would start falling out right after my hair reached its maximum thickness. I don’t think I included this in my original post, but prior to having the procedure I had been on finasteride consistently for 3 years with my hair loss remaining about the same. So I don’t understand why all of a sudden my MPB would just kick into overdrive, despite being on meds, returning my hair to basically its pre-op state within 4 months.

 

It just does not make sense to me that a procedure that is classified as permanent would only last for 3 months followed by significant hair loss. Again, I want to thank you for responding to my post and in no way am I trying to attack you (I hope my post did not come off that way)…I am just trying to rationalize why things happened as they did. Again, my doctor could not really explain what happened so it is quite frustrating at the moment.

[hairweare]

Please clarify if the hairs that you lost were native or transplanted. I can tell you from personal experience that I had a full head of hair at the hairline and frontal region 15 years after my HTs at age 40 and then suddenly 15 years later despite being on finasteride, I lost all my native hair and some DHT sensitive grafted ones as well within a span of 2 years! In March I had 1800 FUE grafts and will be getting a second procedure in November for another 1500 grafts the result of which will hopefully get me back to where I was a couple of years ago after I thought my hair loss had stabilized.

 

With MPB, stabilization is only a hope and hair loss will likely be progressive occurring in fits and spurts throughout your life. If you are lucky drugs may slow it down or give a longer period of reprieve but ultimately we all fighting a never ending battle that at best we can fight to a draw.

[seeker2014]

Thanks for sharing your experience…it helps me understand my situation a bit better. From your experience, how can you distinguish between a grafted and native hair? I can tell you that I experienced the greatest losses in the transplanted area (approximately the front 2/3 of my scalp) with some crown recession. I noticed when I was going through this shedding stage, the hair shafts that fell out appeared thicker and longer than what I had observed before the procedure. My doctor remarked that he had never seen a case where someone had lost so much hair from a transplanted area in such a short interval of time. He was also confused since the grafts were removed from the classic safe zone (I had a FUT procedure done) and should have been DHT resistant. How was your doctor able to determine that some of your grafts were DHT sensitive?...did he run some sort of test? I think the only other procedure I would have done moving forward is a small FUE procedure to camouflage my scar so I can cut down my hair shorter. However, I don’t want to go through another procedure if the grafts prove to be DHT sensitive. I hope your procedure from March is working out well!

[KO]

I wonder if the shedded hairs aren't permanently gone.....hair shedding due to dermatitis is different. You should definitely see a dermatologist though.

[hairweare]

I am not so certain that all follicles in the "safe zone" are or will always remain DHT insensitive but your case may be different and only the doctor that is most familiar with your specific situation can accurately assess why your HT did not meet your expectations.

[seeker2014]

 

Hey KO:

 

Thanks for the response. I am definitely going to see a dermatologist just to cover all bases. My dandruff before being prescribed the DHS shampoo was not serious compared to other cases I have seen (my hair surgeon described it as "mild"). When I was on the DHS shampoo for three months, it took away the little dandruff I had, but with no improvement in hair growth. That would be great if my condition was just temporary, but I don’t think that is the situation.