The Elusive X Factor

[voxman]

The 'topics that rarely get discussed' thread had me thinking. Tell me if this sounds familiar.

 

Patient 'A' and patient 'B' - both 30 years old, both with NW3 diffuse MPB, and both with medium caliber hair. Both go to 'Recommended Doctor Z' for a 3000 FUT (or FUE) HT.

 

Both effuse enthusiastically about the procedure, the Doctor, the Staff, and the aftercare. Both follow the post op instruction to a Tee. All is good!

 

In Three Months, 'A' starts to pop and sprout on schedule and 'B' is getting a few pimples and a few hairs. 'A' gets a round of cheers and 'B' gets counseled that it is 'early'.

 

At Six Months, 'A' looks good and is on his way to 'success', while 'B' is already in doubt that his HT will succeed.

 

At Month 12, it is evident that 'A" got a great result, is happy and is gold plating his combs. 'B' on the other hand, shows 30% growth, spotty results and is being counseled to look into a 2nd Procedure.

 

What happened? What warning signs can we post about expectations and results? How do we handle the failures and how do we really define success?

[KO]

^On that point, another issue is the timeline. Growth typically starts 12-16 weeks post HT, but when a patient doesn't see growth, they get s lot of comments like"oh this is too early etc..."

[harryforreal]

In contrast, how often are people told wait a few more months before passing judgement?

 

I waited a total of 18 months before I passed my final judgement: surgical success, aesthetic failure.

[Dolph1969]

You pay your money, you take your chance. No guarantees. If you've been with a reputable surgeon, it hopefully turns out ok..

 

The X factor result is totally subjective. The recipient may be over the moon, others indifferent to the result.

[Dr Blake Bloxham]

Interesting thread.

 

I think the "X factor" can be viewed in two different ways:

 

1) an unknown factor with a patient's physiology that simply makes them a poor responder to hair transplantation

 

2) an unknown factor that is outside the patient's physiology and more related to the aspects surrounding surgery.

 

I've read articles where some doctors think patients in category 1 may have some sort of overactive immune response to the transplanted follicles. The body basically views them as "wrong" and subsequently rejects/attacks them. Frankly, I'm not convinced. While there is a basis for certain types of immune-mediated alopecia, I've never really seen any convincing evidence of this happening or being discovered after a transplant.

 

But there are also other aspects of a patient's physiology to consider. Things like hair caliber, color, compromised vascularity to the scalp in patients with certain conditions, overloading grafts and overwhelming the blood supply in certain areas (search "Diamond of Death" in YouTube if you'd like a more detailed explanation about this -- or if you just miss hearing me and Dr. Feller!), and scarring from past surgical procedures can always play a role as well. Hopefully these are all discussed thoroughly with patients beforehand and everyone goes into the situation with a good plan and good expectations.

 

The second category is interesting as well:

 

Obviously there are things that can be done during surgery to contribute to an "X" factor. Graft handling, the size of the slits, out of body time, and the surgical plan all contribute. And I will say that there is an absolute unknown for FUE. I won't turn this into another one of "those" threads, but I will simply state that some patient's follicles simply don't like FUE as much as others. Drs. Rassman and Bernstein wrote a fascinating paper about some of what can contribute to this (google "FOX test" if you'd care to read it). But there are absolutely some follicles that either cannot handle the additional stress and strain of FUE extraction (even if they look good while they're being extracted) or the properties of the surrounding skin aren't conducive to FUE or don't like to let go of the follicular units.

 

But FUT isn't immune to the "X factor" either. So I don't want to make it seem as such. It removes some variables associated with FUE, but you can still have surgical mishaps if a staff isn't highly trained to dissect and place FUT grafts.

 

I've discussed the growth timelines before. And I do think they are wildly variable. And I do think the internet can create some additional stress for those who are on track or slightly behind, because we often see people put up awesome 6 month results online. And why wouldn't they? They're excited and want to share. But it's going to stress you out if you're only around the 40-50% mark like you should be at 6 months. And I've been guilty of putting up these "fast grower" results too!

 

Altogether, I think the X factor will remain elusive (great way to describe it, Vox)! I'm not 100% sold on there being one identifiable physiological factor that would make a transplant fail. I do agree that there are immune-mediated alopecias, and this could happen if a transplant was performed on one of these patients. But usually these present differently that MPB and patients would know what they had before ever booking a procedure. However, there are some aspects that make some patients better candidates than others.

 

And there can be surgical issues that relate to less than ideal growth. And I think Dolph's statement really sums up the best thing patients can do here.

 

Good discussion!

[garethbale]

Is there any real way to determine if a HT will be successful?

 

I've been told I am a good candidate for surgery however one thing that puts me off going ahead with it is that fear of an unsuccessful outcome, or an outcome that may be successful but a result which I am unsatisfied with.

[hsrp10]

Individual physiology

 

The same physiology that causes me to suffer from chronic scalp eczema also for some reason makes me a fast grower post HT around 8-9 weeks and also an amazing responder to Fin (though Fin kills my sleep).

 

All of us have a unique physiology. I mentioned before in another post, in some cases it may be a good idea to do a test procedure of a few 100 grafts to see if HT will actual work before wasting all of your donor if you have health or age etc. risk factors.

[voxman]

You pay your money, you take your chance. No guarantees. If you've been with a reputable surgeon, it hopefully turns out ok..

 

 

 

Major truth there, Dolph1969, but to gamble with ones future physical fate on 'hoping it turns out okay' makes me wonder what the hell were we thinking? :eek:

[MrGio-WHTCClinic]

The 'topics that rarely get discussed' thread had me thinking. Tell me if this sounds familiar.

 

Patient 'A' and patient 'B' - both 30 years old, both with NW3 diffuse MPB, and both with medium caliber hair. Both go to 'Recommended Doctor Z' for a 3000 FUT (or FUE) HT.

 

Both effuse enthusiastically about the procedure, the Doctor, the Staff, and the aftercare. Both follow the post op instruction to a Tee. All is good!

 

In Three Months, 'A' starts to pop and sprout on schedule and 'B' is getting a few pimples and a few hairs. 'A' gets a round of cheers and 'B' gets counseled that it is 'early'.

 

At Six Months, 'A' looks good and is on his way to 'success', while 'B' is already in doubt that his HT will succeed.

 

At Month 12, it is evident that 'A" got a great result, is happy and is gold plating his combs. 'B' on the other hand, shows 30% growth, spotty results and is being counseled to look into a 2nd Procedure.

 

What happened? What warning signs can we post about expectations and results? How do we handle the failures and how do we really define success?

 

 

There may be additional hair loss occurring. What density was recorded on the patients' recipients prior to surgery? And are both cases taking meds, and what specifically are their medical histories and goals?

[dcaldwell]

I believed for a very long time that there was no hair loss treatment out there that would actually regrow hair. I have never even considered any sort of surgery or hair transplant until a little over a year ago. I just thought that all the procedures were a scam and really didn't give any noticeable results.

To make a long-story short, I saw that the 2nd hair transplant my dad had (different transplant than the first) actually worked. I wasn't immediately convinced and did a lot of research on the procedure before going to see a doctor.

Even after going through with the procedure, there was a huge part of me that didn't expect any results. I've gotten my hopes up in the past about the latest shampoo for hair loss or certain oils you can put on your scalp to help it magically start growing; only to feel completely defeated after no results. I think that the best thing you can do is start out by accepting the truth - that you're losing your hair. The next thing is to keep a really good attitude throughout the procedure and especially throughout the entire recovery/regrowth process. Don't expect the exact same results as someone else. We are all very similar; however, extremely different - especially when it comes to the healing process. Feeling upset about your procedure turning out different than another procedure is sort of like getting mad at someone who eats just as much as you do, except you're gaining a lot of weight while they are not. Every body reacts and recovers differently. You really just have to keep a positive mind.