HT Expectations vs. Reality | 2,600 Graft HT | Dr. Bloxham | Feller & Bloxham

[Dr Blake Bloxham]

From time to time, we see a disconnect between hair transplant "expectations" and the "reality" of modern hair transplant surgery. Most of the time online, it seems like patient expectations were outside or above the -- excellent -- reality of hair transplant surgery.

 

However, sometimes in practice, I actually see the opposite; an instance where a patient actually had lower expectations and accepted a less than satisfactory outcome because they thought this was the reality of modern hair transplantation. And I think it is just as important to discuss this because it helps patients understand what they can expect in general.

 

When expectations match reality, patients tend to be happy and achieve good cosmetic outcomes. What's more, by knowing what they should expect from a transplant, otherwise unsuspecting patients reading this thread will hopefully avoid being taken advantage of.

 

The case today is a patient with advanced hair loss -- essentially a NW VI -- who underwent an FUT procedure in India. The doctor recommended doing a 2,600 graft "mega session" to rebuild a "dense pack" frontal band and do some fill behind to create a smooth transition in the mid-scalp. The patient liked the plan and moved forward.

 

Here's how he looked 12 months after that procedure:

 

 

 

 

As members of this forum know, this result is not an accurate representation of the reality of a modern mega session with dense packing.

 

But when the patient presented for the consultation, he was under the impression that this type of result was the norm. I informed him that his expectations did not match the reality of what hair transplant surgery can offer. And I recommended proving this to him by essentially doing precisely what the first clinic claimed: a 2,600 graft mega session with a dense packed frontal band and a strategic mid-scalp fill that transitioned into his open crown.

 

Here's how he looked 12 months after the surgery at our clinic:

 

 

 

 

Now I believe this is a realistic representation of what a modern hair transplant mega session with dense packing via FUT should look like. And while the final result may have benefited slightly from the existing grafts (which, for whatever reason, did not amount of what 2,600 grafts should look like), I still think this is about right. Always keep in mind that results will vary, but this is something I would feel comfortable showing to the average patient to help create realistic expectations.

 

I'm happy to report that this patient is very pleased with where he is at now. I recently did 1 more FUT (this is when the "after" pictures were taken) to fill a little more in the posterior mid-scalp and anterior crown (which is what the patient actually thought he wanted to do originally before understanding how much thicker the front could look). He's likely stripped out now and will probably return in the future for some FUE to finish up.

 

Hope this presentation is helpful to those researching HTs and wondering what they can expect.

 

Here are some comparison shots:

 

 

 

 

 

 

Dr. Blake Bloxham

Feller & Bloxham Medical, PC

[hitherehair]

how does one spend thousands of dollars on something and not know what to expect? I guess typing in google "feller and bloxham before and after" was beyond him.

[Hassler]

how does one spend thousands of dollars on something and not know what to expect? I guess typing in google "feller and bloxham before and after" was beyond him.

 

I think the problem is that we are all different. You can't actually look at anybody else's before and after picture and say, "I will get that result"....because we all have different patterns and extent of hair loss, our hair characteristics are all different, our faces are all different, and results vary due to other factors like growth rate etc. What makes it worse is that the more research you do the more you can get stuck in an "analysis paralysis" looking at so many good/bad/excellent/indifferent results.....you end up having no idea what you might end up with.

 

This was the biggest problem for me when contemplating a HT. If I'm contemplating buying a BMW I can look at exactly what I'm buying and try it out, so I know exactly what I'm getting before I commit. With a hair transplant your buying "hope" i.e. hope that the final result will meet with your aspirations. The concept of buying hope leaves the door open for the less than ethical doctors to crank the hope up in order to seal the deal.

 

I actually put off having a hair transplant for many years because I believed my expectations were higher than what was achievable. Having such high expectations is definitely a problem if they can't be met, but I was lucky, my pattern of loss and a great clinic/surgeon meant they weren't just met, they were exceeded.

[jjsrader]

He has weak hair characteristics (typical of Indians) so he needs way more total grafts lifetime for significant cosmetic results.

 

As long as he understands this and has the budget - no worries.

 

He'll never have a wow result 'cause I can tell his native hair isn't even that great compared to many men and he'll be a Norwood 7 without transplants and I am willing to bet he is not on Dut or Fin nor is taking high % minox either to stabilize for a number of years.

 

I'm in the same boat w/wimpy 'native' hair.

 

Bloxham is good (I had a 2250 FUT w/Feller in '04) and tends to represent himself well - though w/a bit of his own agenda.

 

We all tend to do that though. Nice post.

[hitherehair]

never understood the native hair argument. Isn't a transplant only as good as the surgeons ability to dense pack regardless of the native hair?

[Gasthoerer]

Density, is just one of many Point for a successfull transplant.

And density is also very dependent on hair characteristics, e. g. hair Diameter and not only how many FU / cm2 are packed.

[Dr Blake Bloxham]

how does one spend thousands of dollars on something and not know what to expect? I guess typing in google "feller and bloxham before and after" was beyond him.

 

Fair question. Unfortunately many patients don't find out about resources like this forum or high quality video presentations on YouTube until after they actually "take the plunge." I think a lot of people may start their "research" off with an initial consultation and become hooked in and just go for the surgery. But, as members here know, research in all forms is key.

[jjsrader]

Ya think? ; )

[Dr Blake Bloxham]

I think the problem is that we are all different. You can't actually look at anybody else's before and after picture and say, "I will get that result"....because we all have different patterns and extent of hair loss, our hair characteristics are all different, our faces are all different, and results vary due to other factors like growth rate etc. What makes it worse is that the more research you do the more you can get stuck in an "analysis paralysis" looking at so many good/bad/excellent/indifferent results.....you end up having no idea what you might end up with.

 

This was the biggest problem for me when contemplating a HT. If I'm contemplating buying a BMW I can look at exactly what I'm buying and try it out, so I know exactly what I'm getting before I commit. With a hair transplant your buying "hope" i.e. hope that the final result will meet with your aspirations. The concept of buying hope leaves the door open for the less than ethical doctors to crank the hope up in order to seal the deal.

 

I actually put off having a hair transplant for many years because I believed my expectations were higher than what was achievable. Having such high expectations is definitely a problem if they can't be met, but I was lucky, my pattern of loss and a great clinic/surgeon meant they weren't just met, they were exceeded.

 

Very nice assessment. Thank you for sharing. I think this will help researching patients in the future.

[Dr Blake Bloxham]

He has weak hair characteristics (typical of Indians) so he needs way more total grafts lifetime for significant cosmetic results.

 

As long as he understands this and has the budget - no worries.

 

He'll never have a wow result 'cause I can tell his native hair isn't even that great compared to many men and he'll be a Norwood 7 without transplants and I am willing to bet he is not on Dut or Fin nor is taking high % minox either to stabilize for a number of years.

 

I'm in the same boat w/wimpy 'native' hair.

 

Bloxham is good (I had a 2250 FUT w/Feller in '04) and tends to represent himself well - though w/a bit of his own agenda.

 

We all tend to do that though. Nice post.

 

Good analysis. And thank you for the kind words.

[Spanker]

He has weak hair characteristics (typical of Indians) so he needs way more total grafts lifetime for significant cosmetic results.

 

As long as he understands this and has the budget - no worries.

 

He'll never have a wow result 'cause I can tell his native hair isn't even that great compared to many men and he'll be a Norwood 7 without transplants and I am willing to bet he is not on Dut or Fin nor is taking high % minox either to stabilize for a number of years.

 

I'm in the same boat w/wimpy 'native' hair.

 

Bloxham is good (I had a 2250 FUT w/Feller in '04) and tends to represent himself well - though w/a bit of his own agenda.

 

We all tend to do that though. Nice post.

How can you tell anything about his donor characteristics with these pics?

[Dr Blake Bloxham]

never understood the native hair argument. Isn't a transplant only as good as the surgeons ability to dense pack regardless of the native hair?

 

Native hair can play a role depending on how prevalent it is before the procedure and how well the doctor is able to worth with/through it.

 

The key with native hair, in my opinion, is to not count on it or create a design that depends upon it in the future. This is because androgenic alopecia is progressive by definition and it is not likely to be there in the future. If you carefully work through it safely (trim it up so you can closely follow the angles, use high magnification, pump the tissue up with some fluid, use very small blades, etc) and create a plan that doesn't need the native hair to be successful, you will should end up with a good result whether or not the native hair sticks around. Maybe it will be very slightly thicker with it, but the transplants will stand on their own and look natural regardless of what happens with the native hair.

 

Thanks for commenting.

[harryforreal]

You definitely helped this man, Dr. Bloxham. Good job. And, yes, sometimes the sales pitch can be quite enticing when first consulting, such as a reduced "sale" price per graft for the next two weeks.

[jjsrader]

How can you tell anything about his donor characteristics with these pics?

 

Um, 'cause I am psychic, of course!

 

Ha! I've spent lots of time oversees and have many friends that are of Indian/Asian descent.

 

Also, I've got advanced 'hairdar.'

 

; )

[Dr Blake Bloxham]

Indian hair type is a definite "catch 22" in my book.

 

Altogether, patients of Indian-descent are good hair transplant candidates. And this is good news because hair loss, from how it has been explained to me, is a very big aspect of their culture. Because of this, I do surgery on at least one Indian patient per week -- with good results.

 

I say the hair type is a catch 22 for the following reasons:

 

It is true that Indian hair, for the most part, does seem to be somewhat "silky" and the follicles -- though large -- can be fragile -- as jj described above. What's more their donor density tends to be lower on average. I also tend to see a lot of Indian patients with advanced NW patterns. This means a big area to cover with less than ideal donor characteristics.

 

Having said that, the plus side to Indian characteristics is:

 

Excellent hair-to-skin contrast ratio. The tanner skin tones with dark hair tends to give excellent coverage. So despite typical lower number procedures and somewhat challenging follicles to work with, patients of Indian descent make excellent FUT candidates.