Regular Member nawoak Posted September 27, 2009 Regular Member Share Posted September 27, 2009 I m a 28 years male. I had already 2 hair transplant operations, total 2500 grafts. The first one was in April 2008: around 1000 grafts. The second operation was in Bangkok in Dec 2008 with Dr. Path: 1500 grafts. When we had the consultation before operation in Decembre he said I needed basically 1300 grafts. I instisted and negociated with him to make it more dense and he accepted that we d put 1500 grafts. This was supposed to cover perfectly the front line and sides areas. I have sent him email with today s fotos and he said that I need another operation with 1000 grafts or more on the same areas. My question is the following: Why he didnt put straight away 2500 grafts instead of 1500 grafts on last Decembre??? so I would not need to come again to finish to fill up the density??? I mean it s not a few 100 grafts that is required, it s about the same number of grafts that we did on last Dec... I d like to have your opinion: - on the work that has been done on the last operation 1500 grafts (comparing fotos before operation and today s fotos) Here are some fotos that will help you to feel the process I went through. I put them in order of date: from february 2008 before the first operation, then November 2008 before the 2nd operation, then the day of the 2nd operation (Dec. 2008), finally Sept 2009 fotos Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 foto Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 f Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 novembre 2008 Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 ft nov 2008 Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 foto nov 2008 Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 foto pre op with doc path Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 pre op with doc path dec 2008 Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 pre op with doc path Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 foto post op dr Path Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 foto post op with doc path Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 foto today Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 today Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 today foto Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 today sept Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 today front Link to comment Share on other sites More sharing options...
Regular Member Ventuoguy Posted September 27, 2009 Regular Member Share Posted September 27, 2009 I think your photos look good. Just my untrained eye. You seem very young also. Best to get on medications and see if that helps. I'd wait it out longer because you will see this transplant mature more fully and also have a chance to see what 'nature' deals you. If you are on your way to developing deep 'widows peaks' down the road in ten years, you definitely will want to conserve your donor hair for down the road. Just my opinion. Link to comment Share on other sites More sharing options...
Senior Member Severn Posted September 27, 2009 Senior Member Share Posted September 27, 2009 From the pics, the front and left side look great. The right side looks thinner but still doesn't look like a transplant. But you are committed now. If you frontal core starts to go you would not want to end up with just the corners filled in. My Hair Loss Web Site - Dr. Ron Shapiro Link to comment Share on other sites More sharing options...
Senior Member Forrest Gump Posted September 27, 2009 Senior Member Share Posted September 27, 2009 From what I could see from the pictures, your hair looks very good. Of course, sometimes pictures can be deceiving. Unless that's the case, the HTs seem to have gone off well. Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 thanks for your reply. I think the work he did was good in a certain way but I have seen many fotos of people quite bold, and with the same amount of grafts done(2500 grafts), they could fill up completely and perfectly a much larger area. So I m wondering if there has been 2500 grafts really transplanted... (as for example he wrote that for the 1500 grafts taken, he took a stripe of 13cm2 and I have between 80 to 90 grafts for 1cm2 on the donor area. When I do my maths: 13cm2*85= around 1100 grafts taken...) I was classified as a Norwood 2 and was supposed to get everything fixed with that 2nd operation. But... Dr. Path said last week, that I would need another 1000 grafts to add density on the same area. According to different doctors to who I send the same photos, my density on the front line and sides seems to be between 25 to 35 grafts per cm2 which is really light for a person with black hair on a white skin. On the consultation day before the operation (last Dec) I required to put at least 50 grafts on the front line though.... I lost confidence in the doctor who took only few minutes to give me the number of grafts needed on the operation day, and who saying 9 months later that finally I would need another 1000 grafts operation. Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted September 27, 2009 Share Posted September 27, 2009 nawoak, I read through your posts and ask that you clarify a few things. Firstly, were both your procedures done with Dr. Pathomvanich or just the second one? Also, did you speak to Dr. Pathomvanich about your concerns? Given the postoperative photo you presented after your second hair transplant of 1500 grafts (with Dr. Pathomvanich), it appears grafts were placed not just in the hairline, but further back to add density. I imagine there were some areas of thinning further back that needed attention. Honestly, you have the result I'd expect for 1500 grafts during your second procedure. I also think that your results look good. I have no reason to believe that Dr. Pathomvanich didn't transplant all 1500 grafts. Perhaps the data you have regarding the length/width of the strip and donor density is incorrect? I'd suggest speaking to Dr. Pathomvanich about your concerns. I can't speak for why he chose to approach your scalp the way he did. However, given your young looking appearance, I imagine he probably didn't want to be too aggressive to save precious donor hair for subsequent procedures if needed. As you are probably aware, all patients are welcome to share their experiences, good or bad on our forum. However, to keep the forum fair and balanced, we give physicians the right to offer their input on specific cases as well. Physicians are at a disadvantage in the beginning due to patient confidentiality laws and member anonymity. Thus, we ask that you give Dr. Pathomvanich your full name, date of surgery, and permission to discuss your case online. I will be contacting Dr. Pathomvanich shortly to notify him of this thread and invite him to offer his input. For more information on how we handle disputes, visit Maintaining a Fair and Safe Enviromnent on our Forum for Patients and Physicians. Best wishes, Bill Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 27, 2009 Author Regular Member Share Posted September 27, 2009 Bill, thank you for your opinion. the 2nd operation only was done by Dr.Path. I already asked him the same questions about my concerns. I m waiting for his reply. I ll let you know as soon as I get it. Link to comment Share on other sites More sharing options...
Senior Member BigBill1234 Posted September 27, 2009 Senior Member Share Posted September 27, 2009 How would you have approached his scalp, Bill? Link to comment Share on other sites More sharing options...
Bill - Seemiller Posted September 28, 2009 Share Posted September 28, 2009 How would you have approached his scalp, Bill? BigBill, I'm not sure I understand your question. Are you asking the hypothetical question of what I would do with his scalp if I was a hair transplant surgeon? All I know at this point is that nawoak looks very young and I'd be extremely reluctant to advise him to get more density in the hairline. Unless the photos aren't accurately representing the result, I think his hair looks good now as it is. In my opinion, he should save the rest of his donor hair for the possibility of future work needed in the event he loses more hair. If he insists in getting more in the hairline, it should be a minimal number of grafts (like 500 to 800) in a few of the thinner looking areas and possibly FUE over strip due to the number of grafts. This of course, is just my opinion and is limited based on the little information I know. Best wishes, Bill Link to comment Share on other sites More sharing options...
Regular Member nawoak Posted September 28, 2009 Author Regular Member Share Posted September 28, 2009 I got Dr. Path reply. Here it is: I looked at the record,the bald area that need to be transplanted measured 48 cm2 .You have 1st session at Yosakarn clinic (cosmetic clinic,not a full time hair).You also were informed about incorrect direction that were transplanted previously.You said you had 1000 grafts for the first session,base on 48 cm2 of the balding area to achieve adequade cosmetic improvement is 50% or 2400 grafts.2400-1000=1400 grafts.Your strip is roughly 13x1 cm2 but not include the tail on both side that will be closed to 15 cm2 Your grafts were break down as 601 single hair grafts,830 two hair grafts,63 three hair grafts a total of 1494 grafts.Remember this is only close to 50% density to achieve cosmetic improvement ,for higher density you need to add more depend on the time of consultation.From my experience for ceribrity always required higher density. Another point is the grafts survival is 90 % on average that need to be put in consideration. Over crowded grafts on subsequent session will result in poor growth from vascular impairment.Too dense the hair line will look like hair piece and future hair loss need to be cosidered. My question is why don't you ask the first clinic to transplant you 2500 grafts in the first place since it's a virgin scalp? I need you to send me the donor scar from my surgery on the right side to compare with the first session. The 1000 grafts in addition base on the calculation is to give you 72% density.It is just the rough estimation.If add on 500 grafts you will get 61% density.If you add on 200 grafts will give you 55 % and your eye can not detect the small changed. hair transplant is the art and science,we work on the living cell it's not the merchandize that you can count exactly.There are many factors involved you need to wait another 3- 4 months to complete one year to see the final result before you decided. Regards, D.Pathomvanich MD Link to comment Share on other sites More sharing options...
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