Confused : 2nd HT FUT planning with Dr. Radha versus FUE with Dr. Tejinder Bhatti

[T20]

Hi all..

somewhat of a long post; so please bear with me

30 years old Indian male, had previous FUT hair transplant at Dr. Radha back in 2012..area transplanted was frontal hairline which had gone totally bald (right & left side). My hair loss as Dr. Radha mentioned was in class IV progressing to V on Norwood scale. Due to scalp laxity issue she was only able to extract ~2200 hair grafts and cover the frontal region and not the crown (which had also started thinning that time). I have been on meds over the past 5 yrs (Finasteride 0.5mg/day mostly regular and Biotin/Saw-Palmetto/multi-vitamin supplements; Rogaine never started).

 

I am planning now on a 2nd HT. If you refer to my album Hair Restoration Social Network ? Community for and by Hair Loss Patients [Note: All the pics are as of today; 5 yrs post 1st HT]; you will be able to make out the transplanted regions on front (right & left sides) from last operation. I deliberately parted/set the native hair aside from the transplanted hair so that the difference in hair density can be made out. I apologize I haven't take pics of the donor area at the back but its in good shape and is not thinned out.

Overall, I have been decently satisfied with the first HT results, the frontal hairline creation and the adequate coverage provided by Dr. Radha for the area which had gone bald. IMHO, she is an excellent FUT surgeon and unlike others is considerate of the fact of the patients requirements and past/present/future hair-loss possibilities and takes care to work out the surgery accordingly.

 

The concerns I have had since the last transplant which I want to address with the 2nd operation are herewith:-

1. The temples/temporal regions (both left & right sections) which were left untouched post 1st HT.

2. The 2nd concern was with the graft density planted in top left & right frontal regions. As of today my native hair in the mid-scalp and behind frontal hairline section is healthy and thick. As long as I comb my hair in such a manner the transplanted hair mixes in well with the native hair from behind, it looks good. But early morning if I get up from bed when my hair is uncombed or when its wet post shower, the demarcation in density between the transplanted and native hair becomes visible instantly. That's why in the album pics I parted my hair in such a way the density of the transplanted hair vis-a-vis the native hair can be made out. The top frontal section (both left & right) graft hair density seems spaced out and doesn't match the density of existing native hair I have behind. Till date, this hasn't become the biggest concern, but am more worried about the future when lets say the mid-scalp native hair I have behind the transplanted hair gets thinned out or shed, this density issue will immediately show up, so really need inputs from the forum members on this.

Having done a lot of research over various HT posts, I have realised this is primarily because since any surgeon worth his salt well-appreciates the fact of future hair loss in the candidate and hence goes by the conservative max density possible/achievable by the grafts yielded (keeping in mind donor area/scalp laxity factors in account) in the 1st operation. The density match-up is more left for a 2nd or 3rd op if the candidate feels so. In my case I already had the problem of yielding less than expected number due to scalp laxity and hence I guess that was the best density which was possible for my case in the 1st operation.

I am in two minds as of today of whether to address this density concern or not in 2nd HT. Yes as I said when the demarcation is noticed this density issue does become instantly visible, hence I do feel at times to get this addressed by filling in additional grafts. On other hand at same time, I think about the potential future hair-loss progression (both how it has been for me over the past and how it could be in future) and hence am equally concerned of being over-aggressive and wasting precious hair grafts right now to fill in density @ front. I am just 30 yrs old today and the crown is already thinning a lot and I can see the progression going towards mid-scalp region which I am scared future down the years will thin/shed out. In that respect I reflect will it be instead rather wise to wait & watch and see how the mid-scalp hair loss progression happens tomorrow (if) and then review the frontal hairline density accordingly in my subsequent hair transplants when I might be addressing mid-scalp/vertex sections. At that time, I will have a better idea/snapshot of how much density to fill in so that it matches the hair behind at that time.

Irrespective, I would definitely like your honest & unbiased inputs for the spaced-out transplanted hair density concern? Is it adequate or too-spaced out from aesthetic purposes? Please accordingly suggest me whether extracting additional precious grafts be ok at this point to fill in more density @ the frontal top right & left regions or should I wait right now for addressing this? If its ok, what is the approx sufficient number of grafts you would suggest based on my pics to resolve the density concern?

 

The main reason however for going for the 2nd HT is obviously the thinned crown section. It had already started thinning when I went for 1st HT & has progressively thinned a lot more. The frontal mid-scalp looks good & has held up thankfully. As you can see, there are a bunch/lot of miniaturised native hairs still in the crown section and its's not gone totally bald yet. I understand the crown is a black-hole of donor hairs and many surgeons advise to save precious grafts for other regions and get crown covered later. Also I understand that even though I get it covered now the region would most probably expand further which I would have to later address in a future HT, hence I have decided clearly am not looking for any super-packed density for the crown. Since the region is not totally bald yet, hence right now the conservative number of grafts I am looking for covering the thinning crown section is around 800-1000 max. This number I feel would be adequate enough to give it a sufficient coverage alongside the already existing native miniaturised hairs [hoping they don't shock-loss fall off permanently] to give it a fuller look. The main high concern I have in covering the crown is the permanent shock-loss post HT which might happen for the weak miniaturising native hairs I have in the crown section. Also I am equally a lot more concerned about potential shock-loss to the adjacent hairs in the mid-scalp region which are healthy as of today. I am really skeptic that they don't suffer a shock loss (temporary or permanent) and the HT becomes a trigger of their thinning out.

Please let me know if my graft estimate would be good enough or I might need potentially more for the as of today thinning crown section ? Also (forgive for my understanding of the HT process), will the doctor keep the native miniaturised hairs intact in their place or will he/she be plucking them out and instead replacing with new grafts from the back donor area?

Also give me a honest input/feedback whether and what would be the potential side-effects of getting the crown section addressed. Can the shock-loss be alleviated somehow ?.. Will post-operation being on regular medications (Finasteride) help reduce the chances of shock-loss?

 

Overall apart from above, the major query I had was:-

FUT vs FUE? This has become a major dilemma for me ever since I started researching for the 2nd HT. I have gone through suitable amount of literature and the forum posts/feedback of FUE vs FUT debate.

 

Overall my case (already having a previous FUT with a scar) falls in quite similar to this below helpful feedback I read on one of the forum posts (quoting it here):

"For an advanced NW with no intention of wearing their hair buzzed super tight or shaved completely, strip surgery is recommended and then FUE. Some people have average of both and are generally benefited from getting FUT to max out with what their laxity allows, and then moving into FUE/BHT to extract what they were unable to extract prior. Your laxity be be the key to what is best for you in your next procedure if you are considering FUT again and it makes sense as you already have a donor scar to loosen your scalp for a couple of months to prepare for surgery. If you work hard on the scalp laxity exercises then you should get a respectable number of grafts as the donor density still looks decent. But generally speaking, if the scalp doesn't have enough laxity for a strip procedure, it will/should be avoided."

Even one of the FAQ on Dr.Bhatti website says:

"Doctor, I already have had one FUT procedure done. My previous doctor has examined me and said I can go for another FUT procedure. But I am exploring FUE this time. - Reply: Since you have already got an FUT done, I will suggest you again go for an FUT procedure since the prime advantages of going for an FUE is now lost. You now have a linear scar. Once the FUT procedure is done and when the scalp due to resulting tightness will not allow another you can contact me for an FUE procedure. This will be optimal utilisation of the scalp donor given that you already have a linear scar."

Personally I have never shaved my hair to buzzed-cut or completely shaved nor am fond of one and immaterial of it I already have one scar from previous HT operation so the major benefit of 1st time FUE is already diminished for me. If I opt for FUT, Dr. Radha had already advised me last time of scalp-laxity exercises if I happen to come in again in future. On the other hand I have been impressed with the advancement of FUE over the past yrs and can see how almost everyone young chooses FUE over FUT now and how in hands of a good surgeon the yield results can rival that of FUT.

 

The queries I had regarding FUE vs FUT are:-

As mentioned above I am not looking for a mega-session for 2nd HT operation. At max 800-1000 for crown and approx at max 100-200 to fill in the temples and if I decide on it another (not sure of exact number ??..) for adding more density to frontal top. This adds up to 1200+ minm grafts. Does this number of grafts warrant one more FUT/strip surgery or a FUE would be ideal for such a case. If FUE is ok, having a FUE now will it hamper/rule out any potential FUT operations totally if need be in future ? If not, what precautions will a FUE surgeon need to absolutely take to ensure this doesn't happen?

If instead I choose FUT, will it result in a new 2nd scar or will the previous scar from 1st FUT itself be revised ? (An idea of having 2 separate scars at the back does look scary bad ). There are posts where I read people who have had mixed opinions after having had previous more than one FUT sessions and are looking forward to correcting the FUT scare in their next FUE operation.

 

My opinion of Dr.Bhatti & Dr. Radha is they are best & highly qualified in their individual techniques and will take-care/ensure to minimise the negativities of each technique as much possible.

Coming to the individual doctor feedback I have gone through:

My unbiased view of going for FUE with Tejinder Bhatti:

As far I have researched I have found Dr. Bhatti's pre-op and post-op consultations and patient reach-out and feedback/followup extremely meticulous and top-notch. Even though the results have been overall a mixed bag (going by the forum results) with the major concern in majority of unsatisfied cases being the lack of density, I really appreciate the fact the the doctor himself or the forum representatives here have ensured the patient doesn't feel alone and they are with him to suggest the next corrective action.

My unbiased view of going for FUT with Dr. Radha:

Off-late some of the recent reviews I have read on hairrestortationnetwork.com about the FUT HT operations have been on negative side. Some of the patient results have been underwhelming and the one common feedback is the lack of thorough communication between the client and the clinic/doctor especially post-operation. This is something being an ex-patient I have also faced. Even though am satisfied with the results of the previous HT, I would like a better thorough communication. Still my view of Dr. Radha hasn't changed in terms of her work-output primarily because the negative results have been more of exceptions rather than the norm and my personal experience feedback of her is that she is utmost honest/transparent of the possibilities.

 

I have already reached out to Dr. Radha for a consultation. Will do the same for Dr. Bhatti based on the FUE possibility for me feedback I receive to this post.

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Overall, guys will really appreciate if you can go through my album profile and the above post and help me in my queries with your unbiased/honest feedback & suggestions. Please help me with my FUT vs FUE 2nd HT dilemma. If instead any other doctor/clinic you would like to advise me to look into please do let know?

Also please let me know what's the approx number of grafts for each concerned section you think I might need ?

[MayiraP0chu]

Tedious read! Lol!

 

I don't know where to begin. There s been a plethora of questions thrown around sporadically. Il try and be organised and answer as many I can.

 

1. I see a daylight between the transplanted hair and the native hair. From your accounts, I take it sparse density was given because of your scalp laxity limitations. It easily needs about a 1000 grafts to bring about a decent transition between the transplanted and the native hair.

 

2. Your crown might suffice with much lesser grafts than you estimate. An acquaintance of mine (Forum Member) got his crown work done last month with Dr. Radha. She estimated 200 grafts in his PreOp consult for a little smaller crown than yours. We both were shocked. She, in his words, said, "I have a trade secret that helps me achieve the crown illusion with much lesser grafts than my peers". I don't recall how many grafts he actually ended up getting. He did an FUE with her btw. Had a 1000 grafts put in for density in the front as well to strengthen his first transplant he got from her 2 years ago. 500 grafts should do well on your crown if we were to accept her claim.

 

3. You need to go on Fin BEFORE the surgery than after. If you are in no hurry, 6 months of Fin would be very good. If you are impatient, give it 2-3 months. I do not think you are in any danger of serious shock loss and permanent damage to your existing hair.

 

4. You are looking for a couple of hundreds in the temple. Roughly, it should all add up to 1700+/- grafts. That makes the Strip procedure worthwhile again.

 

5. As Dr. Bhatti's website says, you have lost the prime advantage of not having a linear scar by going the Strip route in your first attempt. I don't see why you should opt an FUE unless you can't handle the downtime a strip procedure brings along. And, you will have only one scar. Your previous scar will be replaced with the new one.

 

6. And lastly, you have hit the nail in the head in your assessments of the doctors. I endorse you word by word on that. Dr. Bhatti's is one of the most thorough website I have seen in the industry, with a wealth of information right down to dollar rates. His patient relations is excellent with his two reps here doing some commendable job. And as for Dr. Radha, she is lackadaisical when it comes to that part of the business, but, she more than makes it up with a good pair of hands and a solid skill set.

 

I won't tell you which procedure or which doctor to choose. But, I will tell you this. It is time for a top up. Go for it mate. Enjoy your 30s!

Edited October 21, 2017 by MayiraP0chu

[T20]

Hi MayiraPochu,

Thanks for the encouraging words... matter of fact I in my research timeframe I went through your entire dossier of Dr.Radha's surgery which indeed convinced me of getting a consult from her irrespective of some of the unsatisfied results around.

Great write-up buddy and yes Happy Growing !.. Looking forward to your results & follow-up !!!

 

Some replies/follow-up qns to your response:

1) "It easily needs about a 1000 grafts to bring about a decent transition between the transplanted and the native hair."

I agree to the number .. around 800-1000 of them would give enough decent coverage for the density issue. But the main concern is will I be over-zealous right now to have this covered by addnl grafts or should I use it wisely later in future. From whatever I read in forum posts the average number of scalp donor hair a person has varies around ~5500 (not counting body hairs) [correct me if this number is misleading/incorrect]. I have already used up 2200 and extra minm 700 needed for (temples+crown) going by your figures.. which means I would have ~2600 lumpsump left in the bank. If I use up 1000 now for frontal density that just leaves me with 1600 for any potential mid-scalp/further crown loss in future. That's the part which scares me Anyways for this am leaving upto to Dr.Radha's & Dr Bhatti's feedback based on their acumen.

2) "500 grafts should do well on your crown if we were to accept her claim"

I would be pleasantly surprised if Dr. Radha quotes something similar for me too (yet to get a reply )

Will it be possible for you to share your acquaintance's member-id. I can PM him individually to get an idea of his operation & feedback. Will definitely help a lot. Also if you din't mind asking why he opted for FUE next-time around as opposed to 1st time FUT? Was scalp-laxity an issue or just he din't want to redo FUT.

How was the feedback for Dr.Radha' FUE surgery?.. this would be the 1st time I am reading a post about her FUE opn... also was the recipient area on frontal shaved off even if the case was to increase density only in that area?

Also (forgive for my naive understanding of the HT process), will the doctor keep the native miniaturised hairs in the crown section intact in their place or will he/she be plucking them out and instead replacing with new grafts from the back donor area ?

 

Also, I wasn't able to PM you. It opened a tab but nowhere to writeup msg. Am I missing something?

Edited October 22, 2017 by T20

[MayiraP0chu]

Hi MayiraPochu,

Thanks for the encouraging words... matter of fact I in my research timeframe I went through your entire dossier of Dr.Radha's surgery which indeed convinced me of getting a consult from her irrespective of some of the unsatisfied results around.

Great write-up buddy and yes Happy Growing !.. Looking forward to your results & follow-up !!!

 

Thank you! Good my thread was of some assistance.

 

I have already used up 2200 and extra minm 700 needed for (temples+crown) going by your figures..

 

200 for the temples was your figure from your opening post. I merely used it to get a rough total to show you that Strip procedure is not off the table. You soon enough should get reasonably accurate figures from the doctors. You can chew on it then.

 

From whatever I read in forum posts the average number of scalp donor hair a person has varies around ~5500 (not counting body hairs) [correct me if this number is misleading/incorrect].

 

First of all, grafts are harvested, not hairs. A graft can have from 1 to 4 hairs in them. 2 hairs/mm2 is generally considered as average. Unless one is on the high ends of Norwood, he should be able to get 5000-7000 grafts easily. There are people who have 10000 plus grafts going as high as 12000. On an average, I would say on a healthy donor, it shd be possible to extract 8000-9000 grafts (16000-18000 hairs) while maintaining the cosmetic appeal of the backside of the head. Now, there are a lot of factors like donor density, scalp laxity, Norwood scale, age, racial background that determines the number that can be got. So, I would say you have enough left in the bank for future procedures. But, Il leave that to you to make a judicious decision.

 

Will it be possible for you to share your acquaintance's member-id. I can PM him individually to get an idea of his operation & feedback. Will definitely help a lot. Also if you din't mind asking why he opted for FUE next-time around as opposed to 1st time FUT? Was scalp-laxity an issue or just he din't want to redo FUT.

Also (forgive for my naive understanding of the*HT*process), will the doctor keep the native miniaturised hairs in the crown section intact in their place or will he/she be plucking them out and instead replacing with new grafts from the back donor area ?

 

I am not sure if he would appreciate me giving out his information. Sorry! He opted for an FUE, as he was going in for just 1000-1200 grafts and the downtime from the Strip surgery wasn’t worth for it. He sorta called it a gamble himself. Neither was FUE his first choice of procedure nor was the doctor known for her FUE skill. He has no laxity limitations. The guy was completely shaved for the operation. Don’t know if she also operates with the hair on.

 

And about PMing, you wouldn’t be having the privileges yet as you are new. You should get it in a while. Try opening a thread and alerting the Mods. I can try PMing Bill. But, he generally is overloaded with messages. I am yet to get a reply myself, for a request I had put in a while back.

Edited October 22, 2017 by MayiraP0chu

[Shera]

Hi T20,

 

You are 30 years old heading for a possible Norwood 5. You had an FUT of 2200 grafts to rebuild your previously balding hairline.

 

To summarise, you want your temporal regions reinforced, you want your balding crown filled and you would like to address the issue of density in your previously implanted hairline.

 

"The main high concern I have in covering the crown is the permanent shock-loss post HT which might happen for the weak miniaturising native hairs I have in the crown section."

 

If these hairs are on the way out anyway then the trauma of surgery in this area might speed things up.....shockloss. You are on Fin so it looks like these hairs can't really be helped much more and a year down the line the end product of surgery will possibly look the same, shockloss or no shockloss. About 1000 grafts in this area seems appropriate, there is the option for you to compliment this area with beard/chest grafts to keep your scalp donor banked for future hairloss.

 

You are already on Fin so you are doing your best to minimise the risk of shockloss to adjacent grafts. Dr Bhatti will not dense pack this area so that will further reduce the trauma to existing native grafts.

 

No Doctor in their right mind will remove healthy grafts from your recipient areas.

 

I think the decision to go with FUT or FUE lies solely with you. I personally feel that either surgery will give you the same look. Without being an expert in FUT I would probably look at the scar you have now and see how it looks. Do you want to risk it looking worse? If it looks bad now, is there a chance you can revise this with another FUT (kill two birds....)? If you feel you are heading for more surgeries further down the line, does it make sense to max out with FUT first?

 

For FUE, depending on your donor area of course (pics would be useful) I would advise you to have 1000 grafts in the crown, 1200 in your hairline (which I feel will be adequate to add the density to ensure your hairline is uniform with your mid scalp) and maybe 300 grafts to reinforce your temple areas.

 

That's 2500 grafts in total of which you have the option of taking approximately 500 of them from your beard/chest area.

Edited October 24, 2017 by Shera

[AllAboutHair]

For your case, I think both FUE and FUT options look totally fine.

 

1) Can you handle another strip surgery? Some people are little scared to go for multiple FUTs just like

me.

 

2) Do you think FUT will give as much of grafts you need? FUE is more controlled approach and we can plan on how much we want to get, but in FUT, you may not get all grafts you need (In your case, you may need less number of grafts so FUT may work)

 

3) Cost. FUE is going to cost >> FUT. Some people may not afford for FUE.

 

Based on all the above factors and suggestions from others, you can choose one you are more comfortable with.

 

If you ask me, if I am in your shoes, I would go for FUE.

 

Thanks