My Experience with Dr Richard S. Keller

[chicago2017]

Hi All,

I had my FUT HT with Dr Richard S. Keller 02/10/2017. I am not happy with my result and my surgeon is telling me that my expectations are unrealistic. I have expected better density. I would like to hear your opinion and recommendations. I had 3,125 FU and most of them were 3s.

He posted my results, but none of the post op pictures show crown from the top.

 

Before

 

12 Months

14 months

Edited November 15, 2018 by chicago2017
Reordering pictures

[AnalogFeel]

OP do you have fine hair? If you have fine hair, keep in mind 3000 grafts really isn't much in terms of coverage unfortunately, especially in crown area. I know we harp on surgeon skill a lot around here but hair traits are probably the #1 aspect to getting a good transplant

 

I'm also a little confused because the pics he posted show a significant difference overall, but your pics are much less impressive. Why do you think this is?

[chicago2017]

Hi AnalogFeel,

I think that my tickness is above the average. I had around 2,000 grafts with 3 hairs. None of the post op pictures he posted does not show my crown from the top. I have some improvements, but I have expected better density.

[Panamera13]

The doc seems right; you can't cover your whole head with 3K grafts. You look great from front and your pics will be awesome.

For crown, use toppik. If you could get a FULL head of hair with 3K grafts, there would be no bald person in the world (whole head has around 100K hairs)

Edited November 15, 2018 by Panamera13

[JayLDD]

Imo it could look a bit better than it does for the graft number, but considering your procedure also included the hairline, you cannot expect a full head of hair in the crown and midscalp. There is definitely visible improvement across the entire area also. 

 

You likely would have required over double your graft number and two procedures for full coverage.

[Melvin- Admin]

Can you post pictures of where the grafts were placed? Were they only placed in the crown or spread out? 

If the grafts were spread out, there is no way possible that you would obtain full coverage and density with 3,000 grafts, most don’t achieve full coverage with 6,000 grafts. I look forward to your response and pictures thanks. 

 

[PeloDinero]

Really scary how much a surgeon can manipulate after photos. To be fair, I’ve never been a fan of Keller’s work and have seen few, if any, impressive results from him. 

[Melvin- Admin]

1 hour ago, PeloDinero said:

Really scary how much a surgeon can manipulate after photos. To be fair, I’ve never been a fan of Keller’s work and have seen few, if any, impressive results from him. 

To be fair, this member is posting photos directly under a harsh light. I’ve posted photos of myself showing the differences lighting makes. Also to be fair, we don’t know where the grafts were placed. If he had 3,000 grafts with 1,000 in the crown, there’s no way you could expect jaw dropping results with 3,000 grafts spread over a Norwood 6 area. Before making comments like this, let’s wait to get the facts first.

Fair comparison, is photos under the same lighting. Now if he can post photos of what his hair looked like before under the same lighting, then we would have a fair comparison. Let’s find out where the grafts were placed and how many grafts were placed in each area before accusing a doctor of trying to mislead the public.

I don’t understand what it is with you, I keep telling you how to conduct yourself and you don’t seem to understand. Everyone else on this thread conducted themselves with respect and provided logical responses, based on the little information available.

Your response is to accuse the doctor of manipulating photos, when it’s clear his before photos in the same lighting, as the doctors (after) photos appear better than this members  after photos under harsh lighting. This is why you have to compare photos in the same lighting to fairly judge results. You can’t take a before photo under a lamp and then after photo in a broom closet and vice versa.

 

[Panamera13]

OP - Also post a before/after pic with "Front Pose". Let's see how much of a difference HT made.

[AnalogFeel]

guys keep in mind OP has a very big crown area to cover and a lot of it is very bald 

 

that's a legit pattern 6 bald spot - you can clearly see 6 pattern forming

[chicago2017]

11 hours ago, JeanLDD said:

Imo it could look a bit better than it does for the graft number, but considering your procedure also included the hairline, you cannot expect a full head of hair in the crown and midscalp. There is definitely visible improvement across the entire area also. 

 

You likely would have required over double your graft number and two procedures for full coverage.

Thanks for the feedback. My procedure did not include any hairline work, just the crown and mid scalp. My hairline was not affected by hair loss. 

[chicago2017]

10 hours ago, Melvin-Moderator said:

Can you post pictures of where the grafts were placed? Were they only placed in the crown or spread out? 

If the grafts were spread out, there is no way possible that you would obtain full coverage and density with 3,000 grafts, most don’t achieve full coverage with 6,000 grafts. I look forward to your response and pictures thanks. 

 

 

Hi Melvin,

thanks for the feedback. Please see my pictures bellow and let me know your opinion.

 

Before 

Grafts placement

Month 2

Month 3

 

 

 

Edited November 16, 2018 by chicago2017
Adding pictures

[Melvin- Admin]

Honestly,  the results don’t look impressive, but you had the grafts spread across the entire scalp. Unfortunately, with the grafts spread out like that, you were never going to get a dense result. 

The crown itself requires over 3,000 grafts and you would still likely see scalp under harsh lights. This is because hairs lay flat around the whirl, so the hairs don’t cover the scalp as well. 

Think of it like this, a corn 🌽 patch with the corn stalks all standing upwards will cover the ground and dirt from an aerial view. Now, imagine the corn stalks are layed all flat on the ground, this will expose the ground and make the dirt visible. This is why crown density is so hard to achieve.

With that said, you did see improvement and I would say typical for the area covered. You likely had 1,000-1,500 grafts in the crown itself and the rest in the midscalp.

[JayLDD]

8 hours ago, chicago2017 said:

Thanks for the feedback. My procedure did not include any hairline work, just the crown and mid scalp. My hairline was not affected by hair loss. 

"30 year old whose objective was to have a conservative frontal hair restoration,"

 

The presentation from Keller said this so I assumed, seems a little dishonest then.  Imo because your case was difficult from the amount of area to be covered if you wanted full coverage you would have benefited from going to a surgeon that is especially proficient in high norwoods and large graft numbers,  namely Erdogan and Lorenzo for FUE and Hasson/Wong for FUT. 

[PeloDinero]

19 hours ago, Melvin-Moderator said:

To be fair, this member is posting photos directly under a harsh light. I’ve posted photos of myself showing the differences lighting makes. Also to be fair, we don’t know where the grafts were placed. If he had 3,000 grafts with 1,000 in the crown, there’s no way you could expect jaw dropping results with 3,000 grafts spread over a Norwood 6 area. Before making comments like this, let’s wait to get the facts first.

Fair comparison, is photos under the same lighting. Now if he can post photos of what his hair looked like before under the same lighting, then we would have a fair comparison. Let’s find out where the grafts were placed and how many grafts were placed in each area before accusing a doctor of trying to mislead the public.

I don’t understand what it is with you, I keep telling you how to conduct yourself and you don’t seem to understand. Everyone else on this thread conducted themselves with respect and provided logical responses, based on the little information available.

Your response is to accuse the doctor of manipulating photos, when it’s clear his before photos in the same lighting, as the doctors (after) photos appear better than this members  after photos under harsh lighting. This is why you have to compare photos in the same lighting to fairly judge results. You can’t take a before photo under a lamp and then after photo in a broom closet and vice versa.

 

Who said anything about lighting? The issue is that there wasn’t a top-down shot of the crown shown in Keller’s post. It’s known that most top, respected surgeons will show a top-down, especially if the crown was the area addressed! You are sure quick to come to the surgeon’s defense a vast majority of the time. Isn’t this forum supposed to by patients, for patients?

[Panamera13]

This is what the doc says in his post - "30 year old whose objective was to have a conservative frontal hair restoration, thicken mid scalp & to reduce his crown area from a class 6 vertex to a 3/4 class."

So, the question is what's the crown now - NW4 or not as promised?  (It was NW6 earlier). 

 

 

[chicago2017]

8 minutes ago, PeloDinero said:

Who said anything about lighting? The issue is that there wasn’t a top-down shot of the crown shown in Keller’s post. It’s known that most top, respected surgeons will show a top-down, especially if the crown was the area addressed! You are sure quick to come to the surgeon’s defense a vast majority of the time. Isn’t this forum supposed to by patients, for patients?

I am not trying to be unfair. I just think that Dr Keller was not honest with me and is not accept ing fact that my result is below average. I understand that I cannot have density as before but what is point of having result like this. It is better to do not have HT at all. During my consultation he said I will have good results. He did not mention that I will need 2nd surgery. In my opinion my final result is not good. During 4 months post op he said I can expect poster results, during 7 months post op visit that my density will double. None of this happened. You can see that in May I haves aked him to post pictures that show my crown from the top and hair counts. He never did. You can contact him and ask him  to post all his pictures, but I just think that pre op and post op pictures should be the same in the term of what they showing. If three of my pre op photos in his post show crown from the top, I would expect 3 post op that show crown as well. I think that it is fair expectation. 

[chicago2017]

11 hours ago, Melvin-Moderator said:

Honestly,  the results don’t look impressive, but you had the grafts spread across the entire scalp. Unfortunately, with the grafts spread out like that, you were never going to get a dense result. 

The crown itself requires over 3,000 grafts and you would still likely see scalp under harsh lights. This is because hairs lay flat around the whirl, so the hairs don’t cover the scalp as well. 

Think of it like this, a corn 🌽 patch with the corn stalks all standing upwards will cover the ground and dirt from an aerial view. Now, imagine the corn stalks are layed all flat on the ground, this will expose the ground and make the dirt visible. This is why crown density is so hard to achieve.

With that said, you did see improvement and I would say typical for the area covered. You likely had 1,000-1,500 grafts in the crown itself and the rest in the midscalp.

 

Please see my post above. You can ask Dr Keller to post his feedback as well. Thanks.

Edited November 16, 2018 by chicago2017

[JayLDD]

4 minutes ago, chicago2017 said:

I am not trying to be unfair. I just think that Dr Keller was not honest with me and is not accept ing fact that my result is below average. I understand that I cannot have density as before but what is point of having result like this. It is better to do not have HT at all. During my consultation he said I will have good results. He did not mention that I will need 2nd surgery. In my opinion my final result is not good. During 4 months post op he said I can expect poster results, during 7 months post op visit that my density will double. None of this happened. You can see that in May I haves aked him to post pictures that show my crown from the top and hair counts. He never did. You can contact him and ask him  to post all his pictures, but I just think that pre op and post op pictures should be the same in the term of what they showing. If three of my pre op photos in his post show crown from the top, I would expect 3 post op that show crown as well. I think that it is fair expectation. 

From the results I have seen I don't think Keller is equipped or experienced in dealing with high norwoods like yourself that desire full coverage. You would have strongly benefited from the select small group of mega-session surgeons like those I mentioned above that could achieve a fullish coverage in a single procedure, if you were to have a second procedure I would recommend you research them. Also Hattingen clinic is another to look at.

[PeloDinero]

Showing a top-down pre-op and none in the post-op is egregiously trying to manipulate the results, lighting aside. 

[Melvin- Admin]

1 hour ago, PeloDinero said:

Who said anything about lighting? The issue is that there wasn’t a top-down shot of the crown shown in Keller’s post. It’s known that most top, respected surgeons will show a top-down, especially if the crown was the area addressed! You are sure quick to come to the surgeon’s defense a vast majority of the time. Isn’t this forum supposed to by patients, for patients?

I am quick to ask for facts first and not make assumptions. This forum is for patients by patient, but that doesn’t mean it’s a free for all on surgeons. Without facts, we can’t just go around making accusations, which you tend to do without any facts. 

Now that the facts are clear, I will agree that the photos presented are incomplete and the doctor should present a photo of the crown since it was transplanted. However, the physician clearly transplanted in to the midscalp stopping at the hairline, which he showed. Could a better presentation be done? Sure, but previous to the patients post, we didn’t know if the hairline was done as well. 

This forum has to maintain balance, when something is wrong call it out, if and when we have all of the facts. Now that there have been two issues that we know are clearly wrong we can address them. However, previous to this information, we didn’t know if the hairline was transplanted or just the crown or if the entire scalp was transplanted. Rather than get the facts you’re first reaction is to throw accusations. If you see Jean, got the facts first then he called out what he saw wrong. Do you see the difference in the approach? 

[Melvin- Admin]

55 minutes ago, chicago2017 said:

Please see my post above. You can ask Dr Keller to post his feedback as well. Thanks.

I will respond to the thread, because if the front wasn’t transplanted the thread should be changed, I will also ask him to post a photo of the crown. My response is the same however, I think the results are pretty much standard for spreading 3,000 grafts over a large area. In my opinion, the 3,000 grafts would have been better suited for just one area. However, the doctor may have been thinking that it would look unnatural having a hairline and crown in tact with the midscalp thinning. If that was his thought it’s understandable since this isn’t seen in nature.

Obviously, the biggest issue I see is that this was not explained to you prior. You should’ve been told you require upwards to 6,000 grafts if you want the crown and midscalp to match the front. Remember the crown is a large area and around the same size cm2 wise as the front and midscalp. Also, because of how the hair angles are placed it requires more grafts to achieve visual density, for the reasons I provided previously.

[Bill - Seemiller]

@chicago2017 and all,

While I can appreciate that you are unhappy with your results, we have yet to see any real good photos showing your crown and mid scalp.   I do agree with you that Dr. Keller should have posted more photos of the midsection from the top down angle and to your crown since that’s where the grafts were transplanted.   However, I suggest that you take some realistic photos under natural lighting rather than extremely harsh lighting which always makes it results look worse than it is. 

Honestly, the crown and midsection according to the photos I’ve seen do look improved and given your level of baldness, I’m not surprised that you don’t have more density. In my opinion, you have got an a great start with 3000 grafts and if you want to get another procedure, you can obtain more density. 

While I reserve my final comments until I see more accurate photos of your crown and midsection after surgery, I am inclined to agree that your expectations may have been too high. The reality is, with your level of boldness, there’s no way that 3000 graphs will give you the kind of density that you want. I have had to undergo 4 hair transplant procedures in order to get the results I have and I still have thinning areas in the crown.   Some people may be unhappy with the results I have if their expectations were to achieve a full, thick head of hair like the high school glory days. But I’m very happy with my results and most people don’t even know I’ve ever experienced any thinning hair. 

However, I’m confident in the way my hair looks now so I will even show people my crown my putting my head down and people saying, oh yeah I guess it’s a little thinner there but it still looks good.   Considering I would be completely bald without my hair transplants, I am very happy with my results. But I also had to be realistic with what could be achieved on a Norwood five A with 9600 grafts.  

The reality is, it would take 22,000+ grafts (50,000 hairs)  all over the top of a completely bald scalp in order to achieve for density. And this is not realistic because we don’t have that many available grafts in our donor area.   It would take approximately 11,000 grafts to achieve  The “illusion of density” which means it will appear thick under normal lighting but under harsh lighting, it will still appear thinner.   

So I think you can imagine that only 3000 grafts placed in a large area of baldness such as the crown which is considered a black hole for grafts and the midsection which is a very large area  simply will not achieve the kind of density and coverage you want in a single procedure. 

You or others might wonder why other positions might have had what looks like better results with the same number of graphs and a similar balding area. I’ll people also have to understand that hair caliber, shaft diameter, thickness,  Color, hair to scalp color contrast ratio,  placement of the grafts, area of the scalp where they are transplanted, etc. all play a vital role in achieving this illusion of density.  

So if you take this post seriously and really analyze and evaluate what you have versus what can be achieved, I think you’ll see that they are pretty much in line. 

Now personally, I think doctors should do a better job explaining this to patients and even let their patients now that they will likely require more than a single procedure to meet their goals if they want a thicker looking head of hair.   However, part of the purpose of this community is to help educate patients so they can do their research before they undergo surgery. 

I wish I could’ve personally explained all this to you before you underwent surgery and maybe would have a different outlook today on your results. Maybe would’ve prepared like me knowing that you would’ve had to go for more than one procedure to meet your goals. 

So like I said, I’d still like to see better photos not under harsh lighting as I explained above about the illusion of density, harsh lighting will impact what the result looks like and its  simply not a fair comparison. That said, I’m still inclined to agree that your expectations may have been too high  which is why you’re not happy with what you have right now. 

At the end of the day, whether you are happy or not, to achieve more thickness and density, you will require another procedure. This should have been explain to from the beginning. Hopefully it was. 

Best wishes,

Bill

[matt3480]

On 11/15/2018 at 8:18 AM, chicago2017 said:

Hi AnalogFeel,

I think that my tickness is above the average. I had around 2,000 grafts with 3 hairs. None of the post op pictures he posted does not show my crown from the top. I have some improvements, but I have expected better density.

Results are definitely lacking. Konior is half hour away from Keller....I will never understand you guys who pass that opportunity up (especially if you have had surgery in the last couple years because there are tons great Konior threads since way before then). 

Edited November 22, 2018 by matt3480

[chicago2017]

5 hours ago, matt3480 said:

Results are definitely lacking. Konior is half hour away from Keller....I will never understand you guys who pass that opportunity up (especially if you have had surgery in the last couple years because there are tons great Konior threads since way before then). 

I had online consultation with Konior but wait time was too long even for in person consultation and I decided to do not wait. My mistake. I am considering him for repair since I definitely need another surgery.  

I have picked Dr Keller because he was recommended on this site and his pictures looked promising. I am not saying that he is not great surgeon and that many people are not happy with him, but in my case the results are not good and he is not standing behind his work. All the time he was trying to tell me that this is good result and my expectations are unrealistic. During consultation he quoted that I will need 3000-3200 grafts and during 1 year post op that I need more. 

Edited November 22, 2018 by chicago2017
Adding