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30+ yo gentleman with AGA NW III c/o thin result after a FUT procedure at another facility. He came in for a 2000 FUT procedure and received 256 FU free grafts for a total of 2256 FU. He is about 12 months post-TP. What do you think about this result?

 

 

 

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Employed by Dr. Bernard Arocha. Dr. Arocha is a member of the Coalition of Independent Hair Restoration Physicians.

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To be fair, please show them my results with my hair combed back like in the pre-op pictures dried and a close up of the hair line. The comb overs a bit misleading. Also provide the viewers my density cm2.

 

Show them my donor/scar before and after the procedure. Thanks!

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@Td06 - Are you not happy with your result?


1,792 graft FUE with Dr. James Harris (Denver, Colorado) on April 2-3, 2015

313 graft FUE with Dr. James Harris (Denver, Colorado) on May 3, 2016 to make it perfect!!!

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The pics are not comparable. Vet and combed back hair in the pre op and combed forward dry hair in the after pics is not comparable at all.

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@Td06 - Are you not happy with your result?

 

ModernHair,

 

Unfortunately i am not. My hairline is very see through (i could still see my native one). A little background of my experience.

 

When i first had my consultation with Dr Arocha, he told me a lot stuff i wanted to hear, Checked me out and said i was a good candidate, I had good donor and scalp elasticity, He said my first scar was also good.

 

My goals/expectations for the procedure was to have a great hairline with good density, to be able to cut my hair short and spike it up (not a comb over that i could already do). We agreed that 2000 grafts would be all that i would need to reach my goals and never mentioning that i would need any more prior to the procedure.

 

He showed me examples of his patient results, i told him i would like to have great results like one of the Asian patient i viewed, He said not to worry and that no one can do what he does. He was pretty confident.

 

We talked about fut and fue, he explained both options but he informed me that fue has a higher transection rate compared to fut(fut had a 90% success rate from what i was told). He recommended fut since i already had a thin scar.

 

So i opted to have my procedure done with him instead of the two other Dr i consulted prior.

 

On the day of the procedure we stuck with my existing hairline from the first HT except adding a bit along the temples. Still no mentioning that i would need anymore grafts at this point.

 

The whole procedure was quite painful. i could feel him cutting into my scalp, i had to have them give me additional shots a couple more times.

 

After the procedure was done he came in to examine the work, he said i would need an additional 1000 grafts. Really? is it normal for a Dr to tell you that after the procedure and not anytime before? I wasn't happy.

 

There is more to it but I'll save that for my review. I do understand that some of you will say that my expectation are to high or seem unrealistic but those where my goals and if my expectation were so unrealistic then why didn't Dr Arocha not pass on my case?

 

So far my personal experience with this clinic hasn't been great. I'm sure other may have had better luck but i did not.

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@Td06 - Thanks for the perspective. That really bites. Hard to imagine the doctor finishing up and saying you needed 1,000 more. I'd love to hear what his reasoning was. It's such a science regarding how many transplants are necessary that there's really not much excuse to not know how many transplants are needed prior to surgery and having a set game-plan with the patient. I've never heard of something like that so I'm really curious how it happened.

 

My doctor was within 1% of his estimate (and actually ended up needed a few dozen fewer than initially estimated).

 

I can totally understand your disappointment and agree that the pics are not comparable. I've been careful to document my progress (now at month 6) by making sure my hair is wet each month just like my initial picture, so it's an apples to apples charting.

 

That said, I do think the pictures from your left side show some pretty significant improvement (the right side is much harder to tell) so it's clearly not a total fail (not to downplay your disappointment). Of course, it would be a much fairer comparison if all the pictures were with wet hair and combed back.

 

Not sure why the doctor would post pictures from such an unhappy patient rather than trying to make things right with you. Hopefully, he steps up and makes it right with you.

Edited by ModernHair

1,792 graft FUE with Dr. James Harris (Denver, Colorado) on April 2-3, 2015

313 graft FUE with Dr. James Harris (Denver, Colorado) on May 3, 2016 to make it perfect!!!

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@Td06 - Thanks for the perspective. That really bites. Hard to imagine the doctor finishing up and saying you needed 1,000 more. I'd love to hear what his reasoning was. It's such a science regarding how many transplants are necessary that there's really not much excuse to not know how many transplants are needed prior to surgery and having a set game-plan with the patient. I've never heard of something like that so I'm really curious how it happened.

 

My doctor was within 1% of his estimate (and actually ended up needed a few dozen fewer than initially estimated).

 

I can totally understand your disappointment and agree that the pics are not comparable. I've been careful to document my progress (now at month 6) by making sure my hair is wet each month just like my initial picture, so it's an apples to apples charting.

 

That said, I do think the pictures from your left side show some pretty significant improvement (the right side is much harder to tell) so it's clearly not a total fail (not to downplay your disappointment). Of course, it would be a much fairer comparison if all the pictures were with wet hair and combed back.

 

Not sure why the doctor would post pictures from such an unhappy patient rather than trying to make things right with you. Hopefully, he steps up and makes it right with you.

 

ModernHair,

 

Thanks man, I appreciate the concern.

 

That's what i figured also, When looking at my hair line up close i can defiantly see why i would need more. some areas do look incomplete, esp the front.

 

My main concern now is the scar which he did offer to fix during our follow up. He offered two options, fue or scar revision using a 2 layer closure which would get it back to where i buzz it back to a #3 again like its an easy fix. I asked to see some before/afters examples but he didn't have any for me to view.

 

Unfortunately i don't feel comfortable having more work done with them. As a patient I felt mislead, communication with their clinic has been poor, multiple emails ignored, and my concerns were not properly addressed.

 

Again these are my view and experience with the clinic. They are welcome to post their side.

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Just have to say that it was very classy of Dr. Arocha to post here, even if he's limited in what he can say! I'm impressed! Hope the OP calls to work things out!


1,792 graft FUE with Dr. James Harris (Denver, Colorado) on April 2-3, 2015

313 graft FUE with Dr. James Harris (Denver, Colorado) on May 3, 2016 to make it perfect!!!

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Hello HTN members and Dear Patient TD06,

Wish I could participate, but I am bound by HIPPA . TD06 please call the office, we tried to message but you have not responded. Here is a link to FUT scar improvement through FUE:

 

With all due respect Dr, The only message i got was from Arochainfo(10/9/15) asking for my email address to send photos that I've requested months ago. Shouldn't your clinic already have that on file? Especially after I've sent multiple emails to your office that went ignored.

 

When i asked to see pictures of your scar revision, i specifically asked to see ones with large scars (like the one i have now) using your 2 layer closure and fue, not just one example that you've had floating around for awhile. Its not comparable in my situation. Please post those examples.

 

Again, post my results with my hair combed back/up like in the pre-op pictures dried/wet and a close up of the hairline from the front and sides.

 

Also post before and after pictures of my donor/scar.

 

What was my density cm2 for the procedure?

 

Thank you,

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I was made aware of this particular post by Dr. Arocha who expressed some concern regarding comments made about this particular result. After looking at the pictures, I do happen to agree with what some member said that photos showing the hairline with the hair combed back would be ideal. Thus, I encourage Dr. Arocha to post some of these photos in the interest of transparency.

 

That said, in order to keep this forum balanced and fair to all parties, both patient and physician must be fully able to participate and share their side of the story. Unfortunately, physicians are bound by HIPPA and require their patients permission to share medical information with others. Thus. I ask that TD06 give Dr. Arocha the necessary permission to post and share whatever details he feels is appropriate in this case.

 

TD06, does Dr. Arocha have your permission to participate and share whatever he needs to present his side of the story? Please contact him and let him know so that there is no confusion.

 

I also encourage you to contact Dr. Arocha privately to discuss your concerns and see how you and he might work together to satisfy you and give you the result you want. In my opinion, Dr. Arocha is a stand-up physician, very ethical and does excellent work. I know he stands behind his patients so I encourage you to contact him and work with him.

 

Thanks,

 

Bill

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Td, i actually know the aches and pains of what a see through hairline can do. I know it very well, even after more than 4400 grafts...

 

I totally agree, these forum representations of luscious hair in the front need to be shown combed backwards. If its wet before than show it wet after.

 

I really hate it when some docs even comb your own native hair forward, to add artificial density in a photo to the area where the docs has made incisions. Some do this in photos and it may even confuse the stuff out of the patient thinking something positive is goin on.

 

Anyway, bottom line is it is mentioned you need to give permission for doc to basically give his versions of the stories after he has comminicated with the forum partners. If you are willing to do this, document everything accordingly including any posts made or etc., make sure you keep contant refreshes to note any visual text changes and edits if any.

 

Aside from that, will you be willing to post your situation with wet hair and dry hair side by side slicked back for users to get an idea of the gravity of the concern?

 

Would really like to know the density planted in tecipient zone for hairline and groupings, it may help guage it.

 

Best of luck and j hope you get that resolve.

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TD - I hope you resolve your issue with Dr. Arocha. Hopefully its simply an issue of adding some density to your hairline to hit the mark you want to achieve. I know it could be disappointing, but look at the bright side, at least you weren't butchered in a botched up or bad surgery, etc. If you need another 1k grafts, you could probably easily achieve this thru an FUE procedure as well. Best wishes to you and hope you're able to work out your issues with Dr. Arocha - who from all prior posts here, seems to be very reputable.

Edited by home1212

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The new photos help. I think the patient's issue is that while he had receded, he had a pretty good wall of hair behind the recession and was expecting the transplant to get in that ballpark, which of course no transplant will. The hairline is a BIT seethrough and could be a little denser, but I think this is in line with reasonable expectations. I had to adjust to lower density in my hairline after my first transplant, too. If the patient's loss is stabilized, he can always charge up the density a little bit without burning too many grafts.

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agreed, I would consider that a nice result - but its the patient's expectations that need to be satisfied or brought in line with reality - as I always remind people, any HT is simply an "illusion" of density..

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I personally don't have a problem combing my hair to the side to block light. My HT is not at 100 percent density nor did I expect it to be. Although is does seem to be a natural transition.

 

It is really important to get a true idea of what the patient expects prior to surgery. This doesn't look like a failed surgery to me but more of a miscommunication.

 

I've never been a fan of the term "illusion of density" and I have said many times, because I just look at it as it is what it is. You have so much hair to move and you want X amount of coverage. You and the doc have to decide how much of of your donor to put on the bald. If you get good yield and natural placement the rest is based on your caliber, curl, color, etc.

 

You should know about what density you are implanting in, know what your native hair density is, and have a good guess of what you should end up at. I.e. my native is 70 fu cm2 and I transplanted at 40 fu cm2 so under strong like my transplant could look 43 percent less dense than my native. Under normal lighting it will look much closers because it only takes 50 percent density to look close to normal.

 

I guess you can look at it however you want as long as it's in a realistic way.


I am an online representative for Dr. Raymond Konior who is an elite member of the Coalition of Independent Hair Restoration Physicians.

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I am not a medical professional and my opinions should not be taken as medical advice.

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We at Arocha Hair Restoration do not simply like our patients, we love them! And because of this, I am only replying as asked of me, somewhat reluctantly because I always prefer to keep things confidential.

 

This patient’s outcome is what it is- a very nice improvement of a very thin hairline after a prior surgery elsewhere. I regret that we missed the mark for this patient’s goals. His lofty goal to wear his hair short and spike it up only became apparent after the donor harvest. I automatically increased the recommended estimate number of grafts from 500-1000 depending on hair caliber to increase the likelihood for those patients wanting to be able to spike. The technique employs FU family pairing in strategic areas in the forelock and in the define zone. However, I want the whole HTN community to know that I personally offered to work with him to do a second procedure to further enhance his hairline density instead of spending the time answering his questions online. Furthermore, I told him that he would need an additional 1000 grafts, only because he kept turning around while I was making sites to show me on his smartphone the jpegs of a patient on my website who had very coarse hair about 110 microns. The patient’s hair is medium/fine caliber.

 

The other factor operant was the increased bleeding, this makes it a big challenge to dense pack, since I was literally racing against his heartbeat. Also during surgery, as the hair became very wet, the advancing thinning throughout his frontal half became apparent. Hence, the 2000 FU where employed to anchor the hair line into the thinning fringes as well as enhance his thin hairline. To have employed the grafts only in the hairline would have created a thicker hairline with subsequent erosion of the humps. That would soon require further transplantation to anchor the new hairline or the hairline would become free floating. That is, an anterior persistent fringe would have been created as the thinning continues behind that hairline. The insinuation that we perform surgery on him without anesthesia, is just not very likely. I instruct all patients to frequently give us feed back if they feel any discomfort at all. We teach them a pain scale so we can gauge the order of magnitude of the pain. We have a wide array of short and longer acting local anesthetics so discomfort is not necessary. It is true however, that patients that bleed alot, also metabolize their anesthesia faster and will need more frequent blocking.

 

The allegation that we have been unresponsive is not quite accurate. No one has ignored any of his emails, as a matter of fact we agreed to see him on a Sunday at our Dallas office, because he could not take time off work during the week. But that is not all, we had to drive from our Houston office to see him in Dallas, that is 260 miles each way. Not exactly unresponsive or lacking caring. Sorry about this long post. Many thanks to all the supportive posters, especially those that tried to help the patient to see that his result is not bad, instead it is good. He should be primed for building the strong hair line that he so desires so much. I have no regrets, but one: wish I could have had the opportunity to finish my hair artwork masterpiece!

 

Sincerely,

 

Bernard Arocha, MD, Diplomate of ABHRS, Fellow ISHRS

Edited by Dr. Bernard Arocha

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Very interesting to see both sides of the story. I personally think it's a great result, just shows you that lofty expectations could really hinder Doctors reputations on this website.

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Glad Dr. Arocha chimed in. I think one of the most difficult aspects of practicing in this area has to be keeping patient expectations under control. People get strangely emotional about their hair, and I know that sometimes try as doctors might, they can't simply tell patients that they're not going to have thick, luxurious hair even after a transplant.

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