Time for a Second Procedure?

[BaldEagle1982]

I've been losing my hair gradually since my mid 20's (about 8 years ago) and 3 years ago got a hair transplant with Dr. John Gillespie. I got approx.1800 grafts.

 

Although I was somewhat happy with the results, ie.) it looks better than it did before and my suture is undetectable, I expected more coverage (but I am told most people do after their first procedure). That, coupled with the fact that I've aged in 3 years and have continued balding, means I am seriously considering a second procedure. I've attached my before and after (3 years after lol) photo.

 

By the time I schedule it and find the money to pay for it, I will have been 4 years since my first procedure. I have the following questions for the forum, if you could answer them for me it would be a tremendous help;

 

1.) Did most of you expect more from your first procedure? And if so, is it because you had somewhat unrealistic expectations of what a first transplant can do?

 

2.) How long is it recommended to wait in between procedures? For me, it will be 4 years. Doctor says that's a perfect window.

 

3.) Can anyone speak about their experiences with Dr. John Gillespie? I found him to be pretty good; but am considering other options, just incase. Is there another highly rated surgeon in Calgary or Western Canada?

 

4.) Typically at a second procedure, how many grafts would someone get?

 

 

Thanks in advance,

[zhairz]

Are you doing anything to stop the progression of your hair loss? I am intending to keep the hair from my first procedure as long as I live, if I fail I will not be going back for a second.

[Louisjams]

So you raise a good question. When is the optimal time for procedure #2. Honestly, anytime beyond 12 months out is probably fair IMHO and at 4 years you should be totally fine.

 

There are a few things you should keep in mind.

 

1) Your 2nd procedure will likely be smaller than your first, often due to scalp tightness and tension.

2) You will likely experience shock loss in the hair transplanted from the first surgery. From everything I have read this hair comes back (fellow posters, correct me if I am wrong) when the hair from transplant surgery #2 comes in, but you will likely look much worse before you look better. This can be very upsetting as you are used to having hair on top.

3) You may not have as good a scar after your 2nd procedure as you did after your 1st procedure, but you will probably still have a good scar overall.

[Al - Moderator]

Your 2nd procedure will likely be smaller than your first, often due to scalp tightness and tension

 

I don't think that applies in this case as he didn't have a large procedure to begin with at only 1800 grafts. His scalp shouldn't be too tight at this point. He also claims that his scar is undetectable, probably partly due the the smallish sized procedure causing less tension, so there shouldn't be too much of a scar to remove in the 2nd procedure, thus allowing the Dr to get more grafts.

[Louisjams]

I don't think that applies in this case as he didn't have a large procedure to begin with at only 1800 grafts. His scalp shouldn't be too tight at this point. He also claims that his scar is undetectable, probably partly due the the smallish sized procedure causing less tension, so there shouldn't be too much of a scar to remove in the 2nd procedure, thus allowing the Dr to get more grafts.

 

It is possible, but in many cases (not all) subsequent procedures tend to be smaller.

[Dr. Glenn Charles]

Dr. Gillespie is a great hair restoration surgeon. He happens to be a really nice gut too. There are so many factors that need to be considered when figuring out how many grafts to extract with each procedure. Many times the actual grafts count is controlled more by donor density, amount of current hair loss and family history of hair loss/ potential future loss more than how many grafts did doctor want to get. So it is really difficult to compare yourself to other patients who have posted on the forums.

[BaldEagle1982]

Hey guys, thanks for your input.

 

FYI - I had some scalp tightness after my procedure but that's been long gone for years now so I have ZERO tightness.

 

Can someone comment or speak to my first question (based on the photos above)?

 

1.) Did most of you expect more from your first procedure? And if so, is it because you had somewhat unrealistic expectations of what a first transplant can do?

 

Also, is noticeable shock loss a guarantee with a second procedure? More notably, I thought the hair from the first procedure will last forever so will it eventually come back?

[BaldEagle1982]

Dr. Gillespie is a great hair restoration surgeon. He happens to be a really nice gut too. There are so many factors that need to be considered when figuring out how many grafts to extract with each procedure. Many times the actual grafts count is controlled more by donor density, amount of current hair loss and family history of hair loss/ potential future loss more than how many grafts did doctor want to get. So it is really difficult to compare yourself to other patients who have posted on the forums.

 

Thanks Doc, I tend to agree with you RE: Dr. Gillespie - I was very happy with his service and the work he did; just wondering if I should've expected a little less from my first procedure because, as far as results are concerned, I wasn't over the moon. Can you comment?

 

I think he mentioned my density isn't great but not too bad either so we'd be looking at another 1,000 or so grafts with the second procedure.

 

 

Thanks,

[gillenator]

Regardless whether it's the initial or subsequent procedure, with FUHT there must be adequate scalp laxity to accommodate the size of the strip being excised.

 

My first procedure involved roughly 960 grafts, the second was 1200, the third was 2300 and the fourth and last procedure was 2450 grafts...all by FUHT.

 

So my procedures increased in size each time and there was plenty of time between each one.

 

On my last procedure my doctor informed me that it would probably be my last strip and would need to do FUE if I ever wanted to have more work done in the future. That was back in 2006.

[Dr. Glenn Charles]

I do think that many patients expectations going into the first procedure are a little over inflated. Which is understandable. Also if there are any weaker existing hairs in the transplanted area, which there usually is, there will be some shock loss that does take away from the net gain . Keep in mind these hairs would have likely fallen out soon even without having had the hair restoration procedure.

[BaldEagle1982]

I did speak to the doc recently and he reminded me that there was quite a bit of tightness in my sclap at the first procedure so the second one would be tighter. Also, he comfirmed he did 2,200 grafts after the first go around.

 

He recommended for my second procedure I get 1,500 grafts because he doesn't think I can get much more from that donor area. Does this offer a good amount of coverage? Would it be worth it for only 1,500 grafts? ie.) is that amount a noticeable difference?

 

Also, I am quite worried (even though the doc said it shouldn't be) that recovery on the second procedure will be much worse due to tightness. Can anyone comment? How were your second procedures compared to your firsts, in terms of tightness, discomfort, etc?

 

 

Thanks,

[aWidowsPeek]

You need a lot of grafts and i would go FUE if i we're you. You're wasting your time doing another small strip procedure. Anyone that tells you otherwise is a liar.

[Louisjams]

I think if you have had FUT once before and did well there is no reason you could not do a 1500 graft FUT. Remember, you have to do what works best for your individual situation.

[Steeeve]

I think you should exhaust your options with FUT before moving on to FUE, as others have suggeststed. It’s just an opinion, though.

 

I’m all for FUE but since you’ve already had an FUT procedure I think it’s best to try and get as much out of that as you can... It’s not like you should be worried about getting a scar. You’ve already got one and there are scalp laxity excercises you can do to help your head out. Search out “scalp laxity excercises” on YouTube. Search out “Hasson and Wong” on YouTube-they put up a great video on laxity exercises.

 

Again, that’s just my opinion. If FUT isn’t in the cards then it just isn’t but if you can get more bang out of that buck then I say go for it before moving on.

 

This is coming from a guy who’s looking at an eventually very high Norwood level and my thought process is all about planning for the future. I want to get the most hair out of this head so my plan is to utilize everything I can with strip and then moving on to FUE later.

 

Good luck with your decision and happy growing!

[gillenator]

Regardless of the size of the procedure, there must be enough laxity whenever FUHT is being considered...anything short of it can potentially produce a wider than desired strip scar which nobody wants.

 

I agree that scalp laxity exercises are advisable if you must do FUHT but remember, that's no guarantee that you will gain adequate laxity. At least with FUE, laxity is not an issue and no risk of a wide strip scar.

[BaldEagle1982]

Regardless whether it's the initial or subsequent procedure, with FUHT there must be adequate scalp laxity to accommodate the size of the strip being excised.

 

My first procedure involved roughly 960 grafts, the second was 1200, the third was 2300 and the fourth and last procedure was 2450 grafts...all by FUHT.

 

So my procedures increased in size each time and there was plenty of time between each one.

 

On my last procedure my doctor informed me that it would probably be my last strip and would need to do FUE if I ever wanted to have more work done in the future. That was back in 2006.

 

If your first two procedures were so small this didn't worry you? Where did they get the rest of the strips from?

[BaldEagle1982]

I think you should exhaust your options with FUT before moving on to FUE, as others have suggeststed. It’s just an opinion, though.

 

I’m all for FUE but since you’ve already had an FUT procedure I think it’s best to try and get as much out of that as you can... It’s not like you should be worried about getting a scar. You’ve already got one and there are scalp laxity excercises you can do to help your head out. Search out “scalp laxity excercises” on YouTube. Search out “Hasson and Wong” on YouTube-they put up a great video on laxity exercises.

 

Again, that’s just my opinion. If FUT isn’t in the cards then it just isn’t but if you can get more bang out of that buck then I say go for it before moving on.

 

This is coming from a guy who’s looking at an eventually very high Norwood level and my thought process is all about planning for the future. I want to get the most hair out of this head so my plan is to utilize everything I can with strip and then moving on to FUE later.

 

Good luck with your decision and happy growing!

 

Thanks so much for your advice! I totally agree with you - might as well get the most I can out of FUT since I've already done it. Besides, I am told the density is greater if I am doing FUT and I am all about getting the most density.

 

Question: will an additional 150-1700 really make a noticeable difference? Doesn't seem like a lot of grafts. Then again, not sure if I am able to do more. Can someone post what a 1500-1700 graft difference look like?

 

I've attached my photos for reference

[JayLDD]

You will need in the range of 4000-5000 grafts for full coverage.

 

Look into doctors with experience at higher norwoods and large megaessions such as Koray Erdogan for FUE or Hasson + Wong at FUT. Don't waste time with the same doctor who did the last transplant.

[Steeeve]

You will need in the range of 4000-5000 grafts for full coverage.

 

Look into doctors with experience at higher norwoods and large megaessions such as Koray Erdogan for FUE or Hasson + Wong at FUT. Don't waste time with the same doctor who did the last transplant.

 

100% agree with this advice.

[BaldEagle1982]

You will need in the range of 4000-5000 grafts for full coverage.

 

Look into doctors with experience at higher norwoods and large megaessions such as Koray Erdogan for FUE or Hasson + Wong at FUT. Don't waste time with the same doctor who did the last transplant.

 

Please explain why doing another procedure with him would be waste of time?

 

But if the doc that did the last transplant says I can max out at another 1,700 grafts how do you think Hasson + Wong could do it for 4,000 grafts? Am I not stuck my physical limitations?...

[JayLDD]

Please explain why doing another procedure with him would be waste of time?

 

But if the doc that did the last transplant says I can max out at another 1,700 grafts how do you think Hasson + Wong could do it for 4,000 grafts? Am I not stuck my physical limitations?...

 

Probably good to just come out and say it, your current surgeon doesn't know what he's talking about. Your first set of results were not disastrous but they are poor, there's a reason why people are telling you to go elsewhere. There are physical limitations, and there are limitations based on the talent and skill of particular surgeons, of which yours appears to have little.

 

Not every surgeon is equal, there is no standard protocol and particularly in the US and UK the majority of surgeons are behind the times and virtually incompetent. You've made multiple threads about it as if the people here are idiots and don't know what they're talking about, do some of your own research looking at the work and opinions of other surgeons. If you can't handle the truth or this annoys you, then go back to the surgeon who did your first procedure. Enough people have informed you on this at this point.

[Steeeve]

Probably good to just come out and say it, your current surgeon doesn't know what he's talking about.

 

Dr. Gillespie has been a doctor working in hair restoration for over 25 years. Now, I’m not new to this and can completely understand that that alone really doesn’t hold any weight as a lot of doctors who’ve been around for a long time are still using older techniques, maybe even outdated, however I think he’s a fine doctor who gets good results. I’ve never seen, by many others’ standards, an outstanding result but beauty is in the eye of the beholder. I have seen two patients, in person, with my very own eyes who’ve had very good surgeries performed by him. One was an older gentlemen, while his results were not very dense they were extremely natural for his age and the other was a man currently in his thirties who had two surgeries 3 years prior, at the time, and he got full coverage-again not the most dense but it was very very natural. This second guy wanted one more go-round to bulk up on some density-I don’t know the outcome of that.

 

JeanLDD is giving you some good advice, baldeagle. To say that the doctor doesn’t know what he’s talking about is a bit of a stretch, as he’s been a doctor longer than Jean has been alive but I completely agree that you need to get out and get some more consultations under your belt. Dr. Gillespie gave you his opinion based on already having his hands on your head so there must’ve been a reason but when you’re given ANY diagnosis you should reach out to others in the same medical field for a second, third, even fourth opinion. THAT is just my opinion. Take it with a grain of salt. Again, I do wish you all the best and good luck with your decision.

[BaldEagle1982]

Probably good to just come out and say it, your current surgeon doesn't know what he's talking about. Your first set of results were not disastrous but they are poor, there's a reason why people are telling you to go elsewhere. There are physical limitations, and there are limitations based on the talent and skill of particular surgeons, of which yours appears to have little.

 

Not every surgeon is equal, there is no standard protocol and particularly in the US and UK the majority of surgeons are behind the times and virtually incompetent. You've made multiple threads about it as if the people here are idiots and don't know what they're talking about, do some of your own research looking at the work and opinions of other surgeons. If you can't handle the truth or this annoys you, then go back to the surgeon who did your first procedure. Enough people have informed you on this at this point.

 

Probably good for me to come out and say this; YOU don't know what you're talking about. I appreciate the feedback but how can you comment on my doc (Dr. Gillespie) without knowing who he is or the kind of work he does? You're obviously a troll who likes the sound of your own voice. Did you consider perhaps that it's been 6 YEARS since I've done my first procedure and have continued to bald since then? Doesn't really reflect the results from the first procedure, does it? Additionally, did you keep in mind that the doctor I went to offered a conservative approach, as I was in my early thirties and knew I would continue balding? No, you just started critiquing my doctors "skill" because he didn't do 5,000 grafts on me the first time. Way to go, keyboard warrior!

 

The only valid tidbit of info in your little rant was that I should seek the opinions of other doctors and I will - I have an appointment with Hasson & Wong in 3 weeks and will see what they have to say. Thanks for that.

 

Lastly, you seem irritated with my posts. May I offer some advice to you: if you don't like my posts don't read them

[BaldEagle1982]

Dr. Gillespie has been a doctor working in hair restoration for over 25 years. Now, I’m not new to this and can completely understand that that alone really doesn’t hold any weight as a lot of doctors who’ve been around for a long time are still using older techniques, maybe even outdated, however I think he’s a fine doctor who gets good results. I’ve never seen, by many others’ standards, an outstanding result but beauty is in the eye of the beholder. I have seen two patients, in person, with my very own eyes who’ve had very good surgeries performed by him. One was an older gentlemen, while his results were not very dense they were extremely natural for his age and the other was a man currently in his thirties who had two surgeries 3 years prior, at the time, and he got full coverage-again not the most dense but it was very very natural. This second guy wanted one more go-round to bulk up on some density-I don’t know the outcome of that.

 

JeanLDD is giving you some good advice, baldeagle. To say that the doctor doesn’t know what he’s talking about is a bit of a stretch, as he’s been a doctor longer than Jean has been alive but I completely agree that you need to get out and get some more consultations under your belt. Dr. Gillespie gave you his opinion based on already having his hands on your head so there must’ve been a reason but when you’re given ANY diagnosis you should reach out to others in the same medical field for a second, third, even fourth opinion. THAT is just my opinion. Take it with a grain of salt. Again, I do wish you all the best and good luck with your decision.

 

Thanks Steeeve, I as well had seen a couple of people in person who had their transplants done by Dr. Gillespie and they looked really good. They looked so good that it helped me in deciding to get a transplant done by Dr. G.

 

As I understand it, his approach is fairly conservative because if you're younger (as I was when I did the procedure) he doesn't want to go too crazy as you'll continue to bald. He initially suggested I do 2,000 grafts and I think I ended up getting 2,400 the first go around.

 

Just spoke with him earlier and he said for this second procedure, we could push it to 2,000 but doesn't want to go much beyond that because my scalp is quite tight and my donor area is average at best.

 

Appreciate the input, it's always good to hear other people like the work of the doctor you're considering.

[JayLDD]

Hmm, well since you're an asshole and came here with your mind made up maybe I'll try some reverse psychology so you piss more money down the toilet on shitty results.

 

DON'T go to Dr. G, his results on you were terrible! You don't want more bad results do you? Go with a good doctor like Hasson or Wong! Avoid Dr. G he doesn't know what he's talking about!