Cautionary note on precise graft locations (beard example)

[Jk11k]

This is a general warning for those who haven't tried FUE, and want very specific areas filled. I recently had a FUE procedure with about 70 hairs donated from a combination of beard and scalp hair. The purpose was to fill an irregular dime-sized thin patch on my beard under my right jawline. Some facial trauma years ago had damaged the follicles, though there was no obvious scar.

 

The first attempt left about half the desired fill area too empty and I had to go back soon after. But the second attempt still left a remaining third sparse. They mistakenly used too much hair to fill up slightly thin areas I didn't care about. It's also not clear if they got enough usable (non transected) follicles to cover the whole thing, but they claimed so. I assumed it would be obvious where to place the most graphs, but no such luck! I'll try it once again but will wait until the implants mature so I can be sure.

 

Based on my before/after photos, I reached several conclusions.

 

 

1. Make sure you show the surgeon (and "technicians" whom I found out do most of the graft insertion) a clear photo of what you want done. There can be misunderstandings about aesthetics and exact hair placement. It wasn't explained beforehand that the doctor would mainly do the graft extraction step. The two techs had varying levels of competency and it felt like interns were using my small case to get some training.
    
   
2. When the grafts are being inserted there may be enough blood or tumescence in the area to mask what really needs to be filled. I think this is what happened in my case. Coagulated blood spots may have been mistaken for inserted hairs, and when they scabbed over on the first round they got confused again on the second. Since you're not supposed to touch the area, it's easy to assume hair is underneath dark scabbed areas. I wasn't able to see enough detail myself after the first round.
    
   
3. Also, the eyesight (with or without magnifier glasses) of the surgeon should be confirmed as good. I didn't realize they were doing these transplants without extreme closeup vision. You can probably see more with a macro photo than they see through binocular glasses. The locations of graft site holes are critical, since the technicians may just follow where the doctor punched, even if they notice gaps; fear of the doctor's judgement, etc.
    
   
4. I'd let your hair/beard grow long enough for clear contrast. Don't leave it too short for any location vagueness. It looked clear in my macro photos but I didn't realize they'd lack adequate magnification on the chair. 5X lenses were mentioned; is that typical? Or was it a somewhat sloppy operation, I now wonder? They seemed professional enough and the doctor spoke like someone competent, with no red flags online. This wasn't Bosley or one of the other famous outfits. I am keeping details and photos private here.
   

 

 

If you have any hints that the doctor doesn't know exactly what you want filled, or is hastily deciding it for you, show them hi-res photos to confirm the graft sites. They may mean well but this is not a realm where poor communication can be easily forgiven later. It's your money and your hair! They may be too cavalier unless you insist otherwise.

[BUSA]

I got a better idea. go to a top ranked FUE doctor and get it done right the first time vs. rolling the dice with some no name clinic....

[Jk11k]

I got a better idea. go to a top ranked FUE doctor and get it done right the first time vs. rolling the dice with some no name clinic....

 

Your advice may be good in hindsight but there were considerations of timing, distance from a rural area and a cost well under $1k (I'm not rich and don't want to take on credit debt). Others had a minimum of $2k or even $4k. They thought small jobs weren't worth the setup time, which to me seems arrogant vs. a "no name" who's at least willing to do that. This guy was not lacking for credentials according to certifications set up by this industry. I do understand it lacks regulation compared to other specialties, and that's another topic.

 

My main point is about lack of communication, not necessarily ability, plus wildcard technicians who do most of the insertion work. You may not see them until the day of the procedure; is that common?

 

Part of it was also the angle under my jaw, which they said wasn't nearly as easy as scalp work, plus neckline skin with more movement than scalp skin (no skull foundation). If others have had similar work and precision was lacking, please post stories.

[BUSA]

there are about 20 different HT doctors to chose from around the world that I wud trust. if that means u have to save a little longer and wait a little longer then so be it.

 

the problem is most don't have the discipline to do so and roll the dice with someone who isn't a top rated HT doctor and as a result they often regret it. this is because ether just ASSume he or she is good cause ether have a fancy website or their prices are far better then anyone else's. well, most often u get wat u pay for. HT's are no different.

 

were seeing the same think with Dr. maral who has his technicians perform HT's vs himself. no that is not common and if that is how the practice performs HT's then look to another practice. but I'm sure many will have decent results but again its a role of the dice im not willing to make with precious donor hair. if a HT practice screws it up ur screwed!

 

Your advice may be good in hindsight but there were considerations of timing, distance from a rural area and a cost well under $1k (I'm not rich and don't want to take on credit debt). Others had a minimum of $2k or even $4k. They thought small jobs weren't worth the setup time, which to me seems arrogant vs. a "no name" who's at least willing to do that. This guy was not lacking for credentials according to certifications set up by this industry. I do understand it lacks regulation compared to other specialties, and that's another topic.

 

My main point is about lack of communication, not necessarily ability, plus wildcard technicians who do most of the insertion work. You may not see them until the day of the procedure; is that common?

 

Part of it was also the angle under my jaw, which they said wasn't nearly as easy as scalp work, plus neckline skin with more movement than scalp skin (no skull foundation). If others have had similar work and precision was lacking, please post stories.

[Jk11k]

there are about 20 different HT doctors to chose from around the world that I wud trust. if that means u have to save a little longer and wait a little longer then so be it.

 

the problem is most don't have the discipline to do so and roll the dice with someone who isn't a top rated HT doctor and as a result they often regret it. this is because ether just ASSume he or she is good cause ether have a fancy website or their prices are far better then anyone else's. well, most often u get wat u pay for. HT's are no different.

 

were seeing the same think with Dr. maral who has his technicians perform HT's vs himself. no that is not common and if that is how the practice performs HT's then look to another practice. but I'm sure many will have decent results but again its a role of the dice im not willing to make with precious donor hair. if a HT practice screws it up ur screwed!

 

Seriously, only 20 or so competent ones on the planet? How is that figure arrived at? Post a list if you have one.

 

To reiterate, the main problem I had with this one was the placement of the grafts, with 75% ending up in areas I didn't really care about filling. It may have come down to mediocre eyesight and/or tumescence in the area causing confusion.

 

I'd suggest showing all doctors and techs clear photos before the procedure to remove any doubts before starting. Verbal agreements of "yes, I see how you want it" may be misleading. They shouldn't have a problem with a patient deciding the aesthetics in cases like mine. Drawing a scalp or crown line might be a different matter because not everyone understands how it grows naturally. Artistic skill is critical when a purple pen demarcates your future!

Edited November 9, 2014 by Jk11k