Input Needed- FUE 2521 Grafts 1 year post op results

[wazaam]

I would like to get some objective input in regards to my 2521 FUE procedure at 13 months post op.

 

I personally don't see a big difference in the pre/post op images. I assumed 2521 grafts would have made a much more significant impact specifically to the hairline where they allocated the majority of the grafts?

 

Please review the attached images and provide your feedback.

[Sean]

Wazaam, I am actually trying to figure out what area of the hairline 2521 grafts were placed, the left, the right, or across the entire front? 2521 grafts should definitely provide a substantial change especially if they are allocated to a certain zone? honestly, photos look similar with minimal change? i need to go back and read the photo labels if any to find out which one is pre and post op to get a better understanding of where the grafts were placed.

[wazaam]

The entire front of the hairline and some areas behind had grafts placed.

 

I have labeled all of the images for review. The comparison images show the before on the left and the after on the right.

 

The post op images with my head still buzzed are at 12 days post op and should give a good idea of recipient and donor.

 

I will also post some immediate post ops which will clearly define the recipient areas.

[wazaam]

The entire front of the hairline and some areas behind had grafts placed.

 

I have labeled all of the images for review. The comparison images show the before on the left and the after on the right.

 

The post op images with my head still buzzed are at 12 days post op and should give a good idea of recipient and donor.

 

I will also post some immediate post ops which will clearly define the recipient areas.

[wazaam]

Immediate Post Op Images.

[wazaam]

Here is a side by side comparison top view with my hair combed the same way in both images.

 

The left image is the pre op and the right is one year post op 2521 FUE grafts.

[Gram]

It looks like you had a healthy amount of grafts implanted between native hair. Because you were shaved down, it's difficult to tell if you experienced shock loss. I wonder if you lost a lot of your native and are now left with what was transplanted. Is the caliber of your hair in your hairline and midscalp noticeably different than it was pre op? In your first comparison pic, it looks like it may be.

[wazaam]

The caliber of the hair may be slightly different but to date I haven't noticed much of a difference pre/post op.

[ready4Hair]

Wazaam, I am actually trying to figure out what area of the hairline 2521 grafts were placed, the left, the right, or across the entire front? 2521 grafts should definitely provide a substantial change especially if they are allocated to a certain zone? honestly, photos look similar with minimal change? i need to go back and read the photo labels if any to find out which one is pre and post op to get a better understanding of where the grafts were placed.

 

That is about as damning a critique as one could make without making the slightest judgment; if you can't figure out where TWENTY FIVE HUNDRED grafts were place (left? right? entire front?) and then need to go back and read the labels on the photos to figure out which are pre and post op that should tell us everything we need to know. I agree that the change is not even minimal it is undetectable. I have spent the last few months reviewing various FUE surgeons for my own HT and I can tell you I've seen by now 100s of 2500 FUE cases that either impress me or blow me away with the results and I can't recall one case where I have to wonder which pics are before and which are after.

 

I just went to another FUE site and pulled pics from the first 2500 FUE I could find and this covered more than just hairline. In other words, not a cherry-picked home run just an average 2500 graft result. Not too hard to figure out before or after or notice the grafts in the in-between...

[Gram]

The pic is a bit blurry so i could be seeing things plus I'm posting from my tiny phone screen. My only point is from the looks of the first comparison pic, there is a lot of miniaturization in your before pic while the caliber of your hair in the after looks much thicker. It's possible that you lost most if not all of your miniaturized native hair from shock during your procedure. I'm not sure how you'd be able to asses whether or not this is the case. Regardless I can understand why youre disappointed.

[Swooping]

Was your initial hairline also lowered? Some direct post-op photos would be great.

 

Although pre-op you had a very high density already of your native hairs, albeit thinning. Transplanting a graft into a high density of already native hairs may actually damage the native hairs permanently. Or weaken them more so you lose them. Therefore your overall yield could be very low in that sense. For example you are implanting 3 grafts in the front, but for every 3 grafts you transplant you lose one hair follicle of your existing native hair. Hope that makes sense.

[wazaam]

My hairline was not lowered at all.

 

I have provided immediate post op pictures as well as post op 12 days.

[ready4Hair]

Was your initial hairline also lowered? Some direct post-op photos would be great.

 

Although pre-op you had a very high density already of your native hairs, albeit thinning. Transplanting a graft into a high density of already native hairs may actually damage the native hairs permanently. Or weaken them more so you lose them. Therefore your overall yield could be very low in that sense. For example you are implanting 3 grafts in the front, but for every 3 grafts you transplant you lose one hair follicle of your existing native hair. Hope that makes sense.

 

Is that a documented fact (lost 1 existing for 3 implants when implanting into high-density area)?

[Swooping]

Is that a documented fact (lost 1 existing for 3 implants when implanting into high-density area)?

 

No, that is just random numbers I pulled off as an example. However the concept is very well possible, I have heard and seen it before. I don't know for 100% though. Perhaps someone can confirm. But as the OP had a high density of thinning native hair implanting grafts into such a high density may cause loss of these already weak hairs. For instance due to the shock they may succumb, but also because of transection made by the incisions. (Or choi pen depending what implantantion method is used)

[ready4Hair]

No, that is just random numbers I pulled off as an example. However the concept is very well possible, I have heard and seen it before. I don't know for 100% though. Perhaps someone can confirm. But as the OP had a high density of thinning native hair implanting grafts into such a high density may cause loss of these already weak hairs. For instance due to the shock they may succumb, but also because of transection made by the incisions. (Or choi pen depending what implantantion method is used)

 

Well I wonder if that was communicated to the patient? In other words 'if we implant 2500 grafts you may lost 800 native hairs in the same area?. In other words, any surgeon actually doing transplantation into existing/diffuse/dense areas should use the utmost precision and caution and not leave anything to chance. I'm not saying the Dr. did or didn't do any of the above but again if you are right about shock-loss and transection risks being so high in these types of cases I hope the Dr. did in fact pay extra special attention to this work. To my eye it does not appear so.

[Whereitgo]

sucks brother. not seeing really any growth on before and after. I just had 2,000 grafts done 3 months ago and only seeing 30 new hairs myself.

 

i feel your pain. hopefully u can get some kind of refund

[Swooping]

Well I wonder if that was communicated to the patient? In other words 'if we implant 2500 grafts you may lost 800 native hairs in the same area?. In other words, any surgeon actually doing transplantation into existing/diffuse/dense areas should use the utmost precision and caution and not leave anything to chance. I'm not saying the Dr. did or didn't do any of the above but again if you are right about shock-loss and transection risks being so high in these types of cases I hope the Dr. did in fact pay extra special attention to this work. To my eye it does not appear so.

 

You raise a good point. Yes something like that should be communicated and I have definitely seen surgeons bringing up this to patients in a situation like OP. Perhaps wazaaam himself can shed some light on this.

[hadenough2014]

I don't see a lot of difference, but that is also not uncommon where grafts are being placed in the midst of a lot of native hairs. Did they discuss with you the possibility of transected native follicles as a result of the procedure?

 

The upside is you have replaced or added to native follicles that were likely to be unproductive in the future, so you won't go through the hairline recession now that you have permanent grafts there.

 

I have seen people with a NW1 or NW2 ask this question before after a HT, so I do not find it surprising that you do not see a big difference when your hair loss was minimal prior to HT.

[zx_toth]

Could you post a picture similar to your pre-op side view with your hair combed off to the side? That picture showed real miniaturization of your hairs and was looking for a similarly styled hair 1 year post op and don't see it. If you could post one like that, that would be quite revealing. Thanks.

[wazaam]

The possibility of potential "shock loss" was in some of the correspondence that the clinic sent.

 

I was under the impression that in the hands of the right surgeon working around native hairs was quite possible.

 

My personal take is that there are two variables at play in my case. The transection rate was extremely high and there may have been a loss of some of the weaker hairs. I would assume that 2500 grafts with proper yield would significantly give a much better appearance than what it has 1 year post op. My hairline was pretty weak to begin with as you can see in the pre op images.

 

It appears that it just about a zero sum net gain which is quite discouraging.

[Sean]

Immediate Post Op Images.

Wazaam, i went back and reviewed your photos. Your post op photos reveal the the grafts were placed in and around your native hair territory till midscalp. The front of hairline seemed to be placed more dense concentrated, however, your hairline does have some sparsity still, loose hairs, which indicate there is some yield issues as well.

 

My take is you didnt need to be operated where dense hairs were so heavily present and preferably around thos areas. There is a very good chance based on the result itself, some dangerous transection occurred destroying either native or tranplanted hairs for the most part. The hairline still is not dense as the post op shows a highergraft placement towards the front, you can tell by the loose hairs in your hairline. Im thinking you wanted some solidifying density up front?

 

It looks like you had a healthy amount of grafts implanted between native hair. Because you were shaved down, it's difficult to tell if you experienced shock loss. I wonder if you lost a lot of your native and are now left with what was transplanted. Is the caliber of your hair in your hairline and midscalp noticeably different than it was pre op? In your first comparison pic, it looks like it may be.

 

I agree he has healthy hairs for most part. I think careless placement led to shockloss and transection which had no indication of recovery a year post op. It is tragic because a little over 2500 grafts were used, this is a lot, with little to show for it in a period of a year. It is unlikely he has lost a reasonable amount of native hairs out due to recession and i do not think it could have impacted his result in such a short amount of time, it would be ludicrous to say this was gradual recession. The caliber of his hair seems better than the photos of the patient readyfor hair posted but his result distinction is not even near this result. I think the procedure failed and it did not amplify density with those 2521 grafts. Not trying to make Wazaam feel bad, but it is good he gets an accurate depiction and critique to save him from further emotional distress. Wazaam, i do recommend whatever clinic did this as i think at the very least, there is an issue, probably more than half your grafts did not yield as a result of placement, at least 70% of your growth seems like it could have been impacted. I am very surprised at your preop pics and post op pics, seeing you had ample native hairs, that the surgeon decided to develop this plan for you. This seems like a high risk move made by a surgeon, working in zones where you had lots of native hairs. I do not even know why such number of grafts were recommended if your hairline wasnt lowerd and you did not have extensive loss. Recipient placement and transection played a big role here, it could have also been extraction. How were your grafts extracted? Was this done in one day? Manual or motorized Fue? Were your grafts left out of body for a long time? You got blond hair, that usually makes things look even better after transplantation, or so ot should.

 

That is about as damning a critique as one could make without making the slightest judgment; if you can't figure out where TWENTY FIVE HUNDRED grafts were place (left? right? entire front?) and then need to go back and read the labels on the photos to figure out which are pre and post op that should tell us everything we need to know. I agree that the change is not even minimal it is undetectable. I have spent the last few months reviewing various FUE surgeons for my own HT and I can tell you I've seen by now 100s of 2500 FUE cases that either impress me or blow me away with the results and I can't recall one case where I have to wonder which pics are before and which are after.

 

I just went to another FUE site and pulled pics from the first 2500 FUE I could find and this covered more than just hairline. In other words, not a cherry-picked home run just an average 2500 graft result. Not too hard to figure out before or after or notice the grafts in the in-between...

 

Ready4hair, like I said, i dont want to sound like im being harsh on Wazaam, but this result really warrants the truth for Wazaam. It is honest critique that saves a person from further anguish. I too have seen those 2500 graft and other results across multiple forums that had distinct changes on a person when the work is localized to a specific region, such as the region here. Here, it is the frontal 1/3 and it is absolutely ridiculous to say there is a noticeable difference with 2500 grafts. I even saw 1000-1500 graft fue frontal results in person, in the frontal 1/3 that had a more distinct change. This, especially with similar hair type. Blond hair color usually can make a more distinct result outcome versus black hair, thats if it is done right.

 

Wazaam, what were your ultimate goals or what exactly did you pay for? Density? Filling in the front hairline and for increased density?

 

At this point, i would also get in touch with the surgeon that extracted those grafts and ask for a remedy? Did you present your concerns yet? If not, they may give provide you with some help? Based on evaluating, the surgeon will probably understand your concern and help you out and try to rectify the situation. It's worth a shot to let them know as soon as you can. You can start to get an idea from feedback so far of the outcome. Definitely looks like more than 70% grafts could have not yielded, as the result is not an indicator of a distinct 2521 graft procedure in the zone shown, and thats being generous. Wish you the best, keep us updated.

[wazaam]

Sean,

In response to some of your questions;

Im thinking you wanted some solidifying density up front?

 

Yes given that I still had a decent amount of native hair I wanted to create a refined hairline and improve the density in the front 1/3. I thought with 2500 grafts placed in the recipient zone that would have been accomplished.

Recipient placement and transection played a big role here, it could have also been extraction. How were your grafts extracted? Was this done in one day? Manual or motorized Fue? Were your grafts left out of body for a long time? You got blond hair, that usually makes things look even better after transplantation, or so ot should.

 

The procedure was a two day session. The first day to the grafts were extracted by the Artas robot roughly 1100-1200 grafts. The second day the grafts were extracted by a tech using a motorized punch. Again there was roughly another 1100-1300 grafts extracted on day 2. I have not sure exactly how long the grafts were kept out of the body as I wasn't keeping track. As the procedure was split up into two days I can't imagine they were out of the body too long.

I assumed with my hair/skin contrast the results would be more apparent. The caliber of my hair was described by average/fine. My hair does have a slight wave to it appears a little better than what it is and helps with coverage.

 

Wazaam, what were your ultimate goals or what exactly did you pay for? Density? Filling in the front hairline and for increased density?

 

At this point, i would also get in touch with the surgeon that extracted those grafts and ask for a remedy? Did you present your concerns yet? If not, they may give provide you with some help? Based on evaluating, the surgeon will probably understand your concern and help you out and try to rectify the situation. It's worth a shot to let them know as soon as you can. You can start to get an idea from feedback so far of the outcome. Definitely looks like more than 70% grafts could have not yielded, as the result is not an indicator of a distinct 2521 graft procedure in the zone shown, and thats being generous

 

My goals as I stated previously were to fill in the frontal third and refine the hairline. The temple areas had receded quite a bit and needed to be addressed. There was some slight improvement there from the grafts that did yield. The hairline goals were to add density and refine.

 

I have had a 6 month and 12 month consultation with the patient rep at the clinic. I expressed my concerns during both of those consultations. During my last consultation I expressed that I thought the overall result was quite poor. I even pointed out that the yield on the right side was so poor that I could still see some scalp. The patient rep stated they stood behind there work. I was offered a touch up of 200-300 grafts. I am not sure what 200-300 grafts what even do at this point? If we have already tried 2500 with little cosmetic impact it is my opinion that doing a touch up wouldn't do much for my case. If we throw in the fact that I still have native hair in these areas I may just be compounding the problem at this point?

 

I have asked the patient rep both via phone consult and email to have the surgeon review my results and let me know his thoughts as I had some concerns. I have not heard from my surgeon at all since the procedure took place.

 

I am not sure exactly the percentage that yielded but I would say it was a fairly low amount. There appears to be a lot of transection in my case on top of some of the native hair being lost or damaged.

 

My goal when I created this thread was to get some objective feedback on my results. I obviously am not happy with the results but I wanted to make sure it wasn't me as I know cosmetic surgery and it's results are subjective.

 

In looking towards the future I am not sure if it is in my best interest to pursue a repair or second procedure at this time as there is a lot of native hair to work around? Any feed back on this would be appreciated.

[GreatPelo]

There is absolutely NO WAY a patient with your amount of hair should've been recommended 2500+ grafts. Way too much! When transplanting new grafts, they have to have a certain amount of space from others to ensure they receive enough blood to survive. By transplanting too close, can not only cause new graft to receive too little blood, but can also cause damage to native follicles in the area.

 

I will bet who ever performed this procedure was not a specialist....and even allowed techs to do all or most of the surgery, including harvesting and site creation. Was the doctor very involved? Are they a specialist or do hair restoration as one more of their numerous services?

[wazaam]

I will bet who ever performed this procedure was not a specialist....and even allowed techs to do all or most of the surgery, including harvesting and site creation. Was the doctor very involved? Are they a specialist or do hair restoration as one more of their numerous services?

 

The surgeon and clinic who peformed my procedure is a reputable hair clinic. I researched for over 3 years before choosing the surgeon. I am not sure if the FUE protocol is very consistent. I would certainly consider them a specialist as there is a lot of published work by the clinic.

 

In terms of the surgeons involvement;

Artas robot extracted grafts day 1

Tech extracted grafts Day 2 using a motorized punch

Surgeon did the incisions and site creation

Rotating techs cut the grafts and implanted

Multiple procedures were taking place

[GreatPelo]

Artas tends to have a higher transection rate than motorized manual.

Why is a tech extracting and not a licensed doctor?

 

Whether they are reputable or not....2500 was way over what you needed. You didn't have room for so much...so I'm sure you had a high rate of shock or even damage to native hair. Many factors involved here.....end result = not a satisfied patient, unfortunately.