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FUE transplant 3687 grafts post op journey Dr Arshad


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  • 4 months later...
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Any update? Should be five months now. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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  • 6 months later...
Posted (edited)

Hi both really sorry to have not posted an update until now thanks for your interest, I only just saw your questions. I will post an update for sure, would it also be useful to post updates from 3,6, 9 month photos etc? I would have to dig them out.

11.5 month update is: I went in to see Dr Arshad a couple of weeks ago and we both agreed that it has not achieved the desired result. We have agreed to go for a second procedure on May 20th 2021 (exactly 12 months after the first procedure). Not exactly sure how many grafts will be taken at this stage will depend on how the donor/recipient area looks when shaven.

I will make sure to post a lot more updates this time following the procedure and respond to any questions/comments. Appreciate any questions, comments insights etc :).

Here are some pictures after 11.5 months. I have tried to take a variety of angles/styles. The ones where the hair is longer was pre hair cut a few days ago where the hair is longer and pushed to one side.
D59EC2F1-D295-464E-9583-01B3B628E192.thumb.jpeg.f736bed2f78bf7a80e8ba8ceef2e8979.jpeg

C0AC9F88-B9D6-44B3-926B-AE9C98AE58CD.thumb.jpeg.a68ab193e3964a1de6395fe2f1ec0a48.jpeg129A0692-5DF6-4CD0-8124-A98531B363C7.thumb.jpeg.98056b054c83f67369cb3f6311f115de.jpeg77BE9723-8DFD-43B4-8B16-E9D11559AEAE.thumb.jpeg.aa5491cceac912e4d592cb7b3d5a160d.jpeg309D0AFE-4D63-4F6B-A575-695DA29688C7.thumb.jpeg.28d05216808281a6da13fcdeff6ac374.jpegF37AC4F0-93FA-4C64-B0BE-C5F15B293AC5.thumb.jpeg.229714ac75c54dd2d9a5e965ceb9aefd.jpegFACF5863-ACFD-4035-A8A9-D2717DF0782A.thumb.jpeg.c2661bfd935df46be1a46095180c29f2.jpeg1BE0B93A-764F-4BEE-8DCF-A495D469032C.thumb.jpeg.89689277acde448f95b58566e2150547.jpeg

 

 

 

A8CB85C0-EA49-46C1-BFCC-5BD895353010.jpeg

 

Edited by UKFUE27
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Did Dr. Arshad offer any explanations as to why you didn’t get the desired result? Did he say he didn’t place enough grafts, or that you had poor yield (or if it was poor yield, why that might have happened), etc?

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Posted (edited)

I’m really sorry to hear of your subpar results. 
 

I hate to say it, but not only have you not had much growth, your donor looks like it has been pretty severely over harvested as well. Quite concerning, because whilst sub optimal growth is sometimes an unfortunate outcome with even the best clinics, there should be no excuse for leaving a patients donor like this, especially from a recommended clinic. 
 

Was it the Dr who performed the whole surgery ? 

Edited by Curious25
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Posted (edited)

How short is the hair on your sides in the updated pics? I hope you reach your goals after this second surgery. Are you on finasteride?

Edited by James5150
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Thanks for posting and I'm sorry to hear about your results. I know you've already booked in with Arshad for a second procedure but you might want to consider going to someone else.

This isn't the first time I've seen Arshad with results that have poor yield. We also had an anonymous account a few days ago who complained about poor yield and an overharvested donor. Although there was no proof that this was not a troll, it's starting to seem like this was genuine complaint. 

 

 

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Sorry about your situation. Like others have mentioned, you should absolutely take a step back and reconsider before you go for that second op. Your donor is looking sparse. As it stands if I passed you on the street I wouldn't notice, but if you go for a second op with the same doc and he extracts the same spots again I'd be concerned for your final outcome.

If you're not on Fin, it may be a better option to hop on it and get into a light routine with dermarolling + minoxidil. Give that a go for at least 6 months. If you're not seeing the improvements you want, seek out a HT expert who specializes in beard hair - maybe some place like Eugenix. There's lots of options out there and recommendations on this forum.

Good luck!

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Thanks everyone for all your support and comments.

There are pictures of my donor pre procedure after the head was fully shaved at the top of the thread but can try to find find ones where the hair is longer if that would be useful?

In terms of why the result wasn’t as good as expected, Dr Arshad said it can be a number of reasons but didn’t specifically speculate. He did say it wasn’t due to lack of grafts as over 3600 grafts were used with the objective of 45-50 grafts/cm2.

Dr Arshad did all of the extraction and incision making himself whilst the technicians sorted and implanted the grafts.

I have been using Saw Palmetto, biotin and topical minoxidil for a few years but have not used fin due to potential long term side effects.

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In your first pre op shaved donor photo, it does appear there are already sparse areas in your donor region - I can’t see any FUE scars, however had you already had a procedure prior to this ? 
 

If not, did the Dr mention anything about your donor, IE it being low on density or showing signs of miniaturisation  ? 

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@Curious25 I had not had previous surgery no. I think that in the pre op pics it could be lighting coupled with it being fully shaven I’ve always had very thick hair on the back/sides and Dr Arshad commented on how good my donor area was before and during the first procedure.

I’ll upload some further images of my current donor area to see what everyone thinks as to whether another procedure is possible. Again all help is greatly appreciated!

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I’m certainly no expert, but the donor does appear to be showing signs of over harvesting.

I’m sure someone such as @Melvin-Moderator or one of the more experienced members can give feedback here and would be well placed to do so.

(I was also told that my donor was good and now have concerns that it’s looking a little over harvested and showing no signs of improvement)

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Hi @UKFUE27

Thank you for updating us. I do agree the results could be denser. Now, I don’t see anything wrong with the donor. My donor looks pretty similar. Given the number of grafts, it looks normal. Of course, we all scar differently. Please pm me your name and date of surgery, I’d like to reach out to Dr. Arshad so he can respond to your case.

From my many conversations with Dr. Arshad, he’s very ethical and I’m sure he will make it right. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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thanks for the advice and offer Melvin however the purpose of this update wasn’t to question the clinic publicly. The idea was to gain helpful insight and support from the community with the possible second procedure/post procedure which I’m glad that I have!

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10 hours ago, UKFUE27 said:

thanks for the advice and offer Melvin however the purpose of this update wasn’t to question the clinic publicly. The idea was to gain helpful insight and support from the community with the possible second procedure/post procedure which I’m glad that I have!

Well, it’s not fair to post publicly without allowing the surgeon to respond to your concerns and the communities concerns publicly. After all, there is no surgeon who gets it right every time, but how they respond and stand by their patients is what separates the good from the bad. 

I cannot in good faith host a one-way discussion, and keep the topic public unless you allow the surgeon to respond to your concerns and some of our members concerns publicly. So I do hope you change your mind. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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@Melvin-Moderator I think @UKFUE27 was fair in his update and certainly did not come across in anyway like he was trying to publicly out the surgeon.

He was asked for an update and gave an honest update- and detailed that despite the surgery not going as planned did note that the Dr was working with him to resolve, so a fair post I feel and he has offered to document the repair/ 2nd procedure, which again, I think is very fair and transparent for all to see.

In respect of the donor, there are a number of members who have commented that they feel it looks over harvested but you don’t think so. I would be really keen to get your insight here as I think it certainly looks more noticeable in the donor than one would expect from a top surgeon.

Would you expect this to improve given he is 11 months now?

(Please don’t take my post as being negative, I am just keen to get your view as you have stacks of experience and have consulted with many to Dr’s)

This forum has been a great help to me over the years so always keen to learn from members and gain insight.

Thanks

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@Classygentleman

I agree @UKFUE27 was fair and of course we want our members and community to speak openly and freely. But we also expect surgeons to respond publicly, or at least be given the chance. 

I don’t expect it to look drastically different, by 11 months you more or less know the results. Of course, it will improve some, but probably not to his satisfaction. 

I want to make it clear we are here to host an open forum where members and physicians can speak openly. This is why our forum is popular. So again, there’s nothing wrong with having the doctor respond to his concerns, if anything it would be helpful for others to see how the clinic responds to cases that don’t go as planned.

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I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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3 minutes ago, Melvin-Moderator said:

@Classygentleman

I agree @UKFUE27 was fair and of course we want our members and community to speak openly and freely. But we also expect surgeons to respond publicly, or at least be given the chance. 

I don’t expect it to look drastically different, by 11 months you more or less know the results. Of course, it will improve some, but probably not to his satisfaction. 

I want to make it clear we are here to host an open forum where members and physicians can speak openly. This is why our forum is popular. So again, there’s nothing wrong with having the doctor respond to his concerns, if anything it would be helpful for others to see how the clinic responds to cases that don’t go as planned.

@Melvin-Moderator I completely agree- would be great to see the Dr response as to help everyone see how the issue is addressed and rectified.

Hopefully @UKFUE27will be in agreement so it can help others.

In relation to the donor, what in your opinion constitutes over harvesting?

I was always of the opinion that this was when you are able to see clear patches of scalp and the donor is visibly less full in certain areas, although maybe my expectations were too high?
I Only mention this as a number of results posted here show little to no sign of surgery in the donor area.

 

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Hi all, 

Please see below comment from Dr Arshad. 

Regards

The Hair Dr Clinic 

___________________________________________________________

Dear forum readers, 

Melvin has kindly brought this thread to my attention and invited me to leave a comment. I have waited until now to do so as I wanted the patients prior consent. 


I can confirm this is my patient who underwent surgery with me in late May 2020. I think there are several issues here that might be worth elaborating on. 

Growth of transplanted grafts 

In relation to transplanted hair growth I completely agreed with the patient that the overall outcome is not what I would expect from the high standards we set ourselves.  It is very disappointing for me personally to see that the outcome of surgery has not achieved the desired impact and importantly that the patient is not satisfied with the outcome. Despite following strict surgical protocols this is unfortunately a risk of surgery with any clinic/surgeon. The result is not guaranteed. However, it is important for us that the situation is addressed and action is taken by my clinic to try and improve the situation for the patient. Given this, after reviewing the result at 11.5 months (prior to this thread being updated) I did without reservation offer the patient a top up procedure, free of charge. I understand there is the inconvenience of undergoing a further FUE procedure, however, by waiving the fee we aim to make a gesture of good faith that we stand by all patients that we operate on. 

In relation to the pictures the patient has posted on this thread, when I saw the result in person at 11.5 months post op it did not look as ‘sparse’ as some of the pictures (especially when the hair is parted). It is well recognised that hair transplant is the illusion of creating density and if one is able to grow and style their hair to cover the scalp then that is success, in my opinion. No hair transplant can achieve and re-establish native (non DHT affected) hair density. Having said that as mentioned I agree the overall yield is not what I would have liked to have achieved and the reasons for this can be multifactorial including but not limited to unknown biological/physiological factors. In my hands, I have a top up rate of 3 to 5%. I feel this is acceptable, I am open and transparent about this. I council patients about this prior to surgery and it is written clearly in my pre-operative consent form which every patient signs before proceeding. 

Donor zone management 

Donor area management is an imperative aspect of this surgery. I take particular care to try and plan in case of future hair loss or if top up procedures are required in cases such as this. With this patient, I actually advised him not to proceed with the hair transplant given his expectations, family history of hair loss, donor zone characteristics and reluctance to take finasteride. However, I did not refuse him treatment as he signed to say he understood what I explained to him and accepted all the potential outcomes. He was keen to have a fuller frontal forelock in this phase in his life and accepts that later in life with more hair loss he may need to shave his head or look at other non-surgical options. 


There have been attempts to quantify the donor capacity and to calculate the extent the donor area can be maximised without it looking over harvested. In my experience, they are of very limited use in practice. The essence of hair transplant is moving hair from a region that is relatively DHT resistant to an area where there is hair thinning or loss. The hair follicles excised in the donor zone of course do not grow back, so in particularly larger hair transplant sessions I would advise all patients if the hair is cropped short in the donor zone they will MOST LIKELY HAVE EVIDENCE OF SCARRING AND THE APPEARANCE WILL BE LESS DENSE. 

When the hair is grown out in the donor zone it looks more uniform and any evidence of surgery is more likely to be concealed, but this is only after the donor zone hair reaches a certain length. There are many examples on this very platform where patients have been to experienced surgeons for large sessions and in the donor zone (when the hair is cropped shorter) the graft excision points are clearly visible – Melvin is a classic example of this from having previously seen his donor area. 

I understand that some people are strongly averse to their donor zone looking any different at all after hair transplant (even when the hair is cropped short) and to those people my advice is DO NOT HAVE A HAIR TRANSPLANT or at the very least keep the number of grafts transplanted to an absolute minimum. This in my opinion even applies to patients with above average donor density as the overall appearance of the donor zone does not always correlate with quantification methods especially when the donor zone is trimmed short. Factors such as hair to skin colour contrast, hair calibre/character, the angle of hair take-off from the scalp and the manner in which the donor hair is trimmed (scissors cut with layering Vs bad buzz cut) can all influence the appearance of the donor zone. 

Sometimes the issue is confounded when I have patients that undergo large mega sessions and are actually able to crop their hair very short in the donor zone (or even shave it into a ‘fade’) without noticeable evidence of surgery – but this is an exception NOT the norm. Everyone’s healing and scarring physiology is of course different. Whenever the dermis is breached there will be scarring and subdermal changes caused by the healing/repair process. 

Plan going forward 

I have advised this patient that I feel a top up procedure can achieve his goals and that he would need to wear his hair longer in the donor zone, I also informed him that SMP in the donor zone is possibly an option if he wants to crop the hair in the future. I hope he takes up this offer as I am keen to see him with a good result that is more reflective of the work that we consistently produce. 

Kindest regards
Dr Arshad 
12/05/21

____________________________________________________
 

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