Dr Diep FUE 1356 Grafts on Temples (NW2/3) [2-12-2020]

[Tentpole91]

So the good news is that the hair is definitely growing in, and many of the grafts seem to have taken hold. 

The bad news is that the pattern on the right side remains quite distinctive in harsh light. I remain puzzled as to why Dr. Diep took this approach. While I am hopeful this will diminish with time, I’m starting to think about potential ways to repair this or minimize it in the coming years. Perhaps SMP, but would need to look more into that. 

[Tentpole91]

I've sent photos of current growth to a few other surgeons. The two that have gotten back to me so far (well-regarded by this forum, based in the US, long waiting lists) seemed concerned by the regularity of graft placement on the right side, and recommended further surgery to refine and soften the hairline. At the same time, they both felt that fixing the right side would be relatively simple due to the small area and strong graft growth. Which is great news. 

I've also reached out to Dr. Diep to see what he recommends. I'm 99% sure he will tell me that I need to wait another six months to fully evaluate the success of the transplant. and he's probably right. I remain hopeful that the singles in front will grow in so that there is no detectable "pattern" to the hair on the right side. But as they say, hope for the best and plan for the worst. Hence the decision to seek out second opinions from professionals.  

I do want to emphasize that it isn't all doom and gloom though. While the placement of grafts is frustrating, the grafts themselves are growing in well, and the left side of the transplant is looking pretty damn good right now. It's a total trip to see how much the transplant changes the shape of my face, and to feel hair where there wasn't any before. Attaching photos of both sides to give you all a visual sense of the progress at 5.5 months. Looking at them visually, it's hard to believe that both sides were done by the same doctor. 

[ShadowMoon]

On 7/27/2020 at 9:55 PM, Tentpole91 said:

I've sent photos of current growth to a few other surgeons. The two that have gotten back to me so far (well-regarded by this forum, based in the US, long waiting lists) seemed concerned by the regularity of graft placement on the right side, and recommended further surgery to refine and soften the hairline. At the same time, they both felt that fixing the right side would be relatively simple due to the small area and strong graft growth. Which is great news. 

I've also reached out to Dr. Diep to see what he recommends. I'm 99% sure he will tell me that I need to wait another six months to fully evaluate the success of the transplant. and he's probably right. I remain hopeful that the singles in front will grow in so that there is no detectable "pattern" to the hair on the right side. But as they say, hope for the best and plan for the worst. Hence the decision to seek out second opinions from professionals.  

I do want to emphasize that it isn't all doom and gloom though. While the placement of grafts is frustrating, the grafts themselves are growing in well, and the left side of the transplant is looking pretty damn good right now. It's a total trip to see how much the transplant changes the shape of my face, and to feel hair where there wasn't any before. Attaching photos of both sides to give you all a visual sense of the progress at 5.5 months. Looking at them visually, it's hard to believe that both sides were done by the same doctor. 

Left side looks great, right side is noticeable but could be worse. I wonder why Dr. Diep did his incisions like that. Was very intentional rows.

[jimcraig152]

On 7/27/2020 at 9:55 PM, Tentpole91 said:

Looking at them visually, it's hard to believe that both sides were done by the same doctor. 

I'm in my 11th day post procedure with Dr. Diep. My immediate observations echo what you are saying now. Here is what I wrote on my thread:

On 7/29/2020 at 12:09 AM, jimcraig152 said:

In looking at the receipient site, I could clearly see the differing result of having two separate people of varing skill worked on either side. The right side clearly shows some grape-vinyard like rows that you would see across a hillside winery. Some of that was also visible on the left side, but less so. The woman that worked on the left side was the one that shaved my head. She must have been the senior-most assistant as her work was better. I have no idea which of the women worked on the right side. But the right side was clearly inferior work.

In any case, your yield is looking exellent. But the graft placement pattern leaves has room for improvement. All we can do is wait.

On 8/2/2020 at 2:27 PM, ShadowMoon said:

I wonder why Dr. Diep did his incisions like that. Was very intentional rows.

I do have thoughts on this. But we should probably start another thread on this. I don't want to hijack OP's thread. Page me if you create such a thread.

Edited August 4, 2020 by jimcraig152

[whattheFUE]

If you ever consider a revision in the future, do not go back to this doctor. The hair transplant industry in cali is pretty chop-shop still, even with surgeons that are more recognized.

[Tentpole91]

@jimcraig152 thanks for stopping by and adding your thoughts. I agree that the yield is excellent. I also had two techs working on my head. I remember asking each one how long they had been working for the clinic. The one on my left side had been with the clinic for 6+ years. The one on my right had only been there for 6 months. 

My understanding is that the doctor makes the incisions and the techs implant. But anecdotally, the side that looks way more questionable in my case was also the side that had a much less experienced technician working on it. 

[Tentpole91]

As far as the row-like patterns go, I've emailed Dr. Diep about this and his response didn't acknowledge that the right side looks unnaturally regular & pattern like. He asked me to wait for the year mark before making any judgments. That was kind of frustrating to me because it feels pretty obvious that there's too much regularity, and other doctors wasted no time in pointing that out. 

Hoping that this gets better with time!

[Sam818]

Hopefully it will soften up and improve over time. If it doesn’t it is an easy fix if you go to a more meticulous surgeon. How is your donor area? 

[Tentpole91]

@Sam818 exactly, should be a relatively straightforward fix. Donor is okay-ish. My barber tells me that it gets better every month. 

[jimcraig152]

12 hours ago, Tentpole91 said:

@jimcraig152 thanks for stopping by and adding your thoughts. I agree that the yield is excellent. I also had two techs working on my head. I remember asking each one how long they had been working for the clinic. The one on my left side had been with the clinic for 6+ years. The one on my right had only been there for 6 months. 

My understanding is that the doctor makes the incisions and the techs implant. But anecdotally, the side that looks way more questionable in my case was also the side that had a much less experienced technician working on it. 

If my early results at the 16 day mark are any indication, yield is something we MHTA patients can all rejoice in.

I don't think it is the tech's fault on the right side. Although, that is a strange coincidence. The surgeon makes the inciscion. I think Dr. Diep starts from the left side, then moves right. So as he runs low on donor count, he cuts corners and becomes less artistic and more like a crop-planting machine, leaving more pronounced rows. Then as he goes over the graft estimate as he is making the incisions, he must park himself on the right side and extracts more from that side. Just about all Dr. Diep's patients show asymetry towards the right on the donor side.

One more question. Was your procedure estimate 1356 grafts to begin with? And when you signed the paper, did you allow Dr. Diep to go over by 100, 300, or unlimited grafts?

[Specific-violinist60]

On 8/10/2020 at 12:12 AM, Tentpole91 said:

@Sam818 exactly, should be a relatively straightforward fix. Donor is okay-ish. My barber tells me that it gets better every month. 

Can you please post pictures of your donor area before and after your next haircut? I just had a procedure with Diep and this is by far my biggest concern. My donor seems grossly over harvested. I love wearing my hair short in the back but i’m sad to say those days are probably over

[Tentpole91]

Sure thing. My hair stylist is aware of the transplant and actually cuts the hair shorter on the sides to kind of blend the line. So he makes it not look that bad. 

I'll see if he can do a normal 2 all around and take some photos. I have not gone down to a 1 in the back and do not plan to. 

[LonelyGraft]

On 2/13/2020 at 6:34 PM, ruca2 said:

@Melvin-Moderator I didn't share my results. I had a small FUE from Bosley before finding this site. I then was led to Dr Diep by results posted here and his YouTube channel. From a macro perspective the transplant looks okay and the casual observer wouldn't notice anything out of the ordinary. However, I'm extremely detail oriented (picky and slightly a perfectionist) and can't help but notice major flaws. My donor looked bad. Punches were extremely large, bloody and he left a linear line at the bottom of the extraction zone that almost looked like an FUT scar. I had to have had smp to my donor. Some of his angles in the hairline were too perpendicular and when my hair is shorter it sticks awkwardly up. He did a small section on the temporal side were the hair should have been oriented down and forward. He placed them angled straight back. 

What norwood were u before any surgery?

[BDK081522]

@LonelyGraft At 18 years old I was a 2 with some slight crown loss. I luckily noticed early and got on finasteride. This brought back my crown but the recession up front continued. So at age 37 before any transplants and after being on finasteride for almost 20 years I was a 3. 

[LonelyGraft]

2 hours ago, ruca2 said:

@LonelyGraft At 18 years old I was a 2 with some slight crown loss. I luckily noticed early and got on finasteride. This brought back my crown but the recession up front continued. So at age 37 before any transplants and after being on finasteride for almost 20 years I was a 3. 

That’s a decent run on fin especially since you started losing hair younger. Is it the standard 1mg dose? You had over 5k grafts just for the hairline and temples?

[BDK081522]

@LonelyGraft yea I was taking 1mg Propecia for prob the first 10-15 years. I now take 1.25mg cut from 5mg finasteride.  5507 grafts to be exact. Total rebuild and lowering of hairline, along with temples and temple point reconstruction. Crown shows no signs of loss anymore and midscalp is strong. I am always cognizant that I may recede behind the transplant but I've shown such a strong propensity for the DHT blocking mechanism of finasteride that it is unlikely. And if I do I have much more in the bank for future restorations. 

[LonelyGraft]

5 hours ago, ruca2 said:

@LonelyGraft yea I was taking 1mg Propecia for prob the first 10-15 years. I now take 1.25mg cut from 5mg finasteride.  5507 grafts to be exact. Total rebuild and lowering of hairline, along with temples and temple point reconstruction. Crown shows no signs of loss anymore and midscalp is strong. I am always cognizant that I may recede behind the transplant but I've shown such a strong propensity for the DHT blocking mechanism of finasteride that it is unlikely. And if I do I have much more in the bank for future restorations. 

How many more grafts did your lady surgeon say you have left?

[GE90]

...

 

 

Edited August 24, 2020 by GE90

[Noodles123]

YESS...... This is EXACTLY what I have written about.    Diep's implantation style results in straight rows like if you were looking down a cornfield.   You end up with this sparse, see through effect because the grafts are not staggered.   When they are staggered you reduce the amount of space between the grafts and creates a fuller, more dense look.  This has been my NUMBER ONE complaint from my transplant with Diep (almost 7 years ago).   I can't for the life of me understand why in 7 years, he has not done a single thing to change this technique that looks unnatural up close and results in a less dense looking result.    

And as others have mentioned, his extraction patterns leave a lot to be desired because he does not spread the grafts out.  Rather he extracts them all from a localized area, which results in a visible patch of thinness.  This is exactly what I experienced.   And apparently, he has not changed this approach either.   

It's clear that he does this for the sake of efficiency, but it is inexcusable to be cutting corners when you are charging at the very top end for FUE.    

I've made mention of this in the past, but always felt ignored or dismissed, but glad this is now being aired.

Edited August 18, 2020 by Noodles123

[MrAr]

@Noodles123100% agree

[asterix0]

Not only is the grid-like pattern apparent, he also took grafts that look a bit too thick compared to the front part of your hairline.

I personally would not be happy with this result, considering you had excellent hair before even getting surgery. 

[Tentpole91]

@asterix0 When I emailed Dr. Diep with the above photos, he responded saying that he thought the area "looked fine" and scheduled a skype call in mid-October for further discussion (he bumped it up once Melvin reached out to him). I've discussed the results with three other well-regarded surgeons, and each of them identified serious issues with the placement pattern. There were also further flags around the angle of implantation and the types of grafts used. 

I do need to wait until the 12 month mark to make a final assessment, but one of the clinics I've talked to is already willing to schedule surgery for early next year based on what I've sent over. They feel that the issues are structural, and unlikely to be mitigated by a latent line of fine singles growing in. 

The main things I've learned in talking to other surgeons over the last few weeks:

• While density and hairline shape were originally the main things I cared about, placement technique and angle are also extremely important, and the second two are arguably more important in some ways
• Dr. Diep implanted my hairs straight up, which severely restricts styling options. Straight up is easy to style hair back, but it's harder to style to either side. If the angle was implanted closer to a 45 degree angle (like a natural hair), it would be easier to style. This is actually much harder to fix than pluggy/unnatural grafts, because you can't change the direction of a hair without pulling it back out (thereby burning grafts). This has been flagged as something that is unlikely to be fixed. 
• The placement technique (ie graft interlocking) is just as important as the density that you want to achieve. Again, some doctors are good at this, and some aren't.

Overall, I'm getting the sense that Dr. Diep is good at designing hairlines and getting density. But the finer details that justify $8-10/graft prices -- such as interlocking, appropriate angles, using fine singles in the front, and having a more uniform extraction pattern on the donor, are pretty much all missing from my transplant.

I reserve the right to delete all of this later if I decide that I'm being too harsh. But want to make sure others are able to learn from my journey.

 

Edited August 18, 2020 by Tentpole91

[asterix0]

I think documenting your experience is extremely valuable to prospective patients and hopefully you decide to leave it, but I understand it's a personal decision. I certainly wish more patients documented to the level of detail that you have provided. Such level of detail is something clinics are for some reason hesitant to reveal. 

The wait until 12 months is an unfair cop-out in my opinion, and dismissive of legitimate patient concerns for a traumatic and worrisome experience. 

 

 

[BDK081522]

2 hours ago, LonelyGraft said:

How many more grafts did your lady surgeon say you have left?

Dr Konior mentioned that I have at least 3000 grafts that could be extracted by FUE. I currently wear my hair short on the sides. 0.5 guard at the nape faded up to a 1, then 2 guard. I'm sure if I needed to I could get more grafts via FUT and wear it longer on the sides. Hopefully it never has to come to that though. 

[jimcraig152]

3 hours ago, Tentpole91 said:

I reserve the right to delete all of this later if I decide that I'm being too harsh. But want to make sure others are able to learn from my journey.

I can't wait until I am further along with this process (now on my 4th week post procedure by Dr. Diep), not just to see the results, but to give my disseration and final review. Each time I post something in my thread, I end up deleting 3/4ths of what I wrote before I hit the post button. I take out all the subjective comments (or as many as I can) because I want to be as objective as possible until the final results are in.

I won't delete anything in my thread along the way though. If it ends up being criticism, so be it. I've said in my thread, it is not the criticism that matters. What matters is what one does with it.