1869 Grafts with Dr. Diep 2/12/19 (33 y/o Caucasian NW3)

[Curious]

Hair follicles grow close together and a portion of the follicles grow under the surface of the skin.  The key to a good FUE is to minimize the trauma and scarring, and to extract a follicle without damaging the adjacent follicle, which is not easy to do.

[JayLDD]

Compare the size of the hairs in the snippets at the bottom to the punch wounds. Also notice the circled areas of punch scars where multiple scars blend into each other. I'd bet a million dollars that there are at least some adjacent hairs that were transected when the punch size is that large.

I'm not saying hes a bad doctor, nor that the result will be bad because you'll very likely get a good recipient result and after 12 months the donor likely will not be cosmetic issue, but Bisanga for example has done a study on this issue of transecting nearby follicles through large punches and its visible through common sense and simply looking at the photos. Its absolutely going to make a larger impact overall than a smaller punch would, its basic laws of reality. If various punch scars are blending into each other and they appear as big as multiple separated follicles,  this is not going to allow the absolute maximum amount of lifetime grafts from the donor. A larger punch may allow simpler means of getting high quality individual grafts, but it will scar and it absolutely can damage separate follicles to those targeted, its visible above if you consider it logically and analyse it visually.

 

 

 

[hairlossPA]

agreed to what JayLDD stated above. it’s not rocket science. if you use a larger punch, you only increase the risk of damaging nearby grafts, nothing more nothing less. Whether it results in actual transaction or damage to other grafts is up to chance and the skill of the surgeon. those circles that JayLDD drew in my opinion are totally unacceptable for a FUE. it really is I’m sorry. If anyone were to view this scenario with a clear head and not being biased based on previous results, it should really be escalated as a valid concern. that picture is only a portion of your head. can’t imagine that over the full donor region. 

 

and again like Jay said.. you may very likely get a great result and the hair in your donor will be fine.. but those punches are careless in my opinion. 

[FUEblonde1985]

I don't disagree with most of what you're saying, except citing "basic laws of reality" as authority. I'd be interested to see what Dr. Bisanga says on this (still looking for it). Again I'm not saying you're wrong - but keep in mind that the photo I took was one day after, where there is maximum inflammation of the tissue surrounding the punch, and a lot of dried blood. I can also tell you right now looking at the punch sites now that there are healthy hairs growing in places where the tissue is still red - this would tend to suggest against drawing anything conclusive just from the visual depiction one day post op.

I think taking a look at this selection (below - he has any entire category of videos looking at donor scar) might be more helpful for making any visual determinations. Now, I probably know a lot less than most of the people posting on this forum, so I have no idea how these videos compare to donor areas where a smaller punch is used. But I think that is a much more valid visual comparison to make than using mine.

 

Edited February 21, 2019 by FUEblonde1985

[FUEblonde1985]

Here are some current photos from the area you focused on that might help shed some light. Again I'm not saying your wrong, and maybe these photos from 9 days after support what you're saying. I'm just not so sure that anything can be said conclusively from the photos alone. I didn't have the benefit of my fiance taking photos so this was the best I could do with the iphone flash behind the head:

 

 

[FUEblonde1985]

Some extras if its helpful to see other parts of the donor. The greasy appearance is from the bacitracin ointment:

[SWdan]

Dr. Diep does mostly FUE, and if you look at his results it doesn't appear that the larger punch size has affected his end results. I haven't seen any permanent shock loss, or excessive scarring on any of his video's. 

[FUEblonde1985]

Day 9: Still a lot of white stuff remains. Seems like its mostly loose, but I'm too afraid to use any more force than indicated by instructions to get it out, so there it will remain. Back of my head is getting itchy, likely from all the flakes that aren't getting out. There seems to be a couple spots on the hairline where there is a "row" of follicles that didn't live on. Not sure if this was just the hairs there all coming out when i got hit in the head on day 5, or if the grafts were lost. Can't tell if donor is looking better because the hair is longer or if the color is getting better.

I'll probably stop posting daily updates since it seems to be a bit OCD, but I figure anyone else that is doing the same process with Diep will find it helpful to see what the day-to-day looks/feels like.

[Baldrick101]

This isn't a criticism of Dr Diep but there is a  big difference between a 0.8mm and 1mm punch size in terms of the volume of material extracted. Even a slight increase in punch diameter makes a huge difference. So a 1mm punch would create a cylindrical hole that is 45% larger than what 0.8mm would, assuming the depth of the punches is identical. The end result in the recipient area may well be the same  but the surrounding follicles in the donor area may suffer more as a result of greater trauma. 

[Rawkerboi]

Should have buzzed your hair completely cleaning would have been much more easier 

[FUEblonde1985]

Day 12. Still not able to get the recipient area completely clean. Starting to wonder if I am just am not being aggressive enough with the cleaning, or if its a result of having the area completely dry for 3 days post-op. You're right that the long hair isn't helping, but I like that I will still have something to work with since I need to minimize the appearance at the office (I work in a very professional setting and also have daily contact with clients). The spot on the back that seems to look bald appears to just be a weird result of lighting. The top of my head near recipient area is still completely numb. I know that numbness can last months, but still concerning since no changes in sensation since day 1. Can't even feel a needle poke.

[FUEblonde1985]

Had my 2 week follow-up today. It seems that my initial concerns about how the surgery went were unfounded - I was worried about excessive bleeding affecting the surgery and the length of time the surgery took. Turns out, we just got started fairly late in the morning since there was another surgery that was scheduled before mine (FUT I believe). There was no bleeding outside of what was to be expected. The Dr. used a 1 mm punch for my donor area and said that everything is looking good right now but believed I would likely have persistent redness due to my skin tone/type.

Final graft breakdown: 4190 hairs

1 - 318

2 - 881

3 - 502

4 - 166

No new pictures to show since everything looks more or less the same.

[baldlivesmatter]

On 2/13/2019 at 10:21 PM, FUEblonde1985 said:

By the time things were wrapping up, I was asking for the painkillers prescribed to try and get ahead of the pain that I could feel coming on. The painkillers they gave me did not seem to have any effect on me (Tramadol) so my girlfriend and I drove straight to the pharmacy, and wouldn't you know everything was closed by 10pm, and the one 24 hour pharmacy was out of percocet. Most people describe the post-op pain as being relatively minor but I was experiencing the worst head pressure/pain I had ever felt. I ended up quickly glancing through the post-op instructions and seeing something about how ibuprofen can be taken 4 days post-op and in my pain and dizzyness from the valium, believed that meant I could take ibuprofen and took 3 (turns out I wasn't supposed to do that because of the blood thinning effect). While his written instructions, if you actually parse out the language, say that you can take ibuprofen after the 4th day, it is very easy to misread the instructions if you are in a daze from the sedatives and in a lot of pain.  I was mildly annoyed because my girlfriend had been in the waiting room since 4 pm and could have picked up the prescriptions for me as I had asked (but they declined to let her because they said they already had painkillers for me).

 

 

On 2/21/2019 at 2:17 PM, FUEblonde1985 said:

Here are some current photos from the area you focused on that might help shed some light. Again I'm not saying your wrong, and maybe these photos from 9 days after support what you're saying. I'm just not so sure that anything can be said conclusively from the photos alone. I didn't have the benefit of my fiance taking photos so this was the best I could do with the iphone flash behind the head:

Odd timing on the proposal, but congratulations nonetheless! 

[FUEblonde1985]

My last weekend before going back to the office. I think I may be successful in keeping attention off of the back. Bought some light brown dermmatch - I don't think its the best match for the hair color but it seems to be working a bit.

I also got a haircut today and the unfortunate reality is I don't think my barber could really do a whole lot to create a reasonable style that will cover the recipient area. The problem is that they just went too high when they shaved the donor and I don't have enough temple hair to brush forward, and my hair is too light and fine to really provide any real coverage. That in conjunction with the fact the recipient is still very much red - I have no way to conceal it. I can brush my hair forward but you can still definitely see the red outlines of the recipient area if you look for it. So I'll likely just put it out there on day 1 and tell everyone where I was the last three weeks.

Also, there seems to be a bit of irritation (possible pimples) in the recipient area. I don't know if its cause for concern or what. Most of the hairs are still there, but you can see them falling over like limp noodles and many have fallen out already.

 

[nb98]

Can’t you sweep it over?

i did it before I got a haircut 

 

[FUEblonde1985]

1 hour ago, nb98 said:

Can’t you sweep it over?

i did it before I got a haircut 

 

The tech unfortunately buzzed all the way up on the sides so I have no hair behind the temple area to brush forward. I can only brush forward the hair on the crown and it doesn't sufficiently cover the temples.

[hairlossPA]

donor looks sparse. what are your thoughts on it?

[FUEblonde1985]

17 minutes ago, hairlossPA said:

donor looks sparse. what are your thoughts on it?

Which part?

[hairlossPA]

maybe it’s just the lighting toward the top of your crown 

[Legend007]

I was worried about the same thing.. it was very important for me to be able to cover up the hairtransplant after surgery .. that’s why I grew my hair long for almost a year .. n when they had to shave to the donor n sides I had a lot of hair to cover up things .. as the tech was shaving my hair .. doctor hasson told his tech to leave the front of my sides alone .. so I can have something to work with in hiding my transplant .. n it’s been great .. I haven’t really experienced the ugly duckling phase, had enough hair to cover up things. 

[Melvin- Admin]

16 hours ago, FUEblonde1985 said:

My last weekend before going back to the office. I think I may be successful in keeping attention off of the back. Bought some light brown dermmatch - I don't think its the best match for the hair color but it seems to be working a bit.

I also got a haircut today and the unfortunate reality is I don't think my barber could really do a whole lot to create a reasonable style that will cover the recipient area. The problem is that they just went too high when they shaved the donor and I don't have enough temple hair to brush forward, and my hair is too light and fine to really provide any real coverage. That in conjunction with the fact the recipient is still very much red - I have no way to conceal it. I can brush my hair forward but you can still definitely see the red outlines of the recipient area if you look for it. So I'll likely just put it out there on day 1 and tell everyone where I was the last three weeks.

Also, there seems to be a bit of irritation (possible pimples) in the recipient area. I don't know if its cause for concern or what. Most of the hairs are still there, but you can see them falling over like limp noodles and many have fallen out already.

 

Can you wear a fringe haircut? Like peaky blinders I mean it's high and tight on the sides and your hair is definitely long enough to wear down.

[FUEblonde1985]

It’s just not long enough on the sides.  I can’t cover both the hairline and temple area.

[FUEblonde1985]

3 hours ago, Legend007 said:

I was worried about the same thing.. it was very important for me to be able to cover up the hairtransplant after surgery .. that’s why I grew my hair long for almost a year .. n when they had to shave to the donor n sides I had a lot of hair to cover up things .. as the tech was shaving my hair .. doctor hasson told his tech to leave the front of my sides alone .. so I can have something to work with in hiding my transplant .. n it’s been great .. I haven’t really experienced the ugly duckling phase, had enough hair to cover up things. 

I think the unfortunate reality is Diep wanting to extract so high up necessitated shaving so high. I would have preferred him going further into the left side of the donor instead of going up.

[FUEblonde1985]

4 hours ago, hairlossPA said:

maybe it’s just the lighting toward the top of your crown 

I don't have any concerns at this point. The lighting is probably what you are seeing. You can definitely still see the redness from donor extractions when the light angles are right. But right now it would appear that the red undertone rather than any meaningful density loss is the cause of visibility in the donor area.

[FUEblonde1985]

Day 25:

The week at the office was pretty uneventful. Everyone was surprised by my haircut since its a lot shorter but I don't think it occurred to anyone that I had a HT. One of the judge's did not even recognize me when I came into his court. The donor area wasn't really noticeable with the use of dermmatch- but my recipient area is still fairly red and you could plainly see it if you were looking at my head. With the way I was styling my hair though, (and the fact that you couldn't really see that my hairline was receding before) - it likely just looks like a redness near my hairline that could be caused by ?? who knows. I told a couple people and they were very interested in the process. I'm sure everyone else can see the redness but no one seemed to really overly invested in figuring out what the redness was.

The top of my head and recipient is still fairly numb but I can slowly feel sensation returning. Will probably take a few months at this rate. Many of the recipient hairs have shedded, a lot remain, a few seem to continue growing. Was using bacitracin for a few days on the recipient to address some of the pimples/redness as advised by the Dr. Redness remains in the donor area but it is becoming increasingly less visible as the hair around it grows.

I *feel* like there is a noticeable loss in density in the donor and from certain angles it looks a bit worrisome, but it seems fairly comparable to other donor areas I've seen with the same skin type around the same time. I'm guessing there is some mild shock loss - but I can't tell if the visibility is due to continued redness or due to shock loss or overharvesting.

Comparison photos are from day 1/3

 

Edited March 9, 2019 by FUEblonde1985