Bad Results Vs Good Results

[Rossybop]

From what I gather most HT patients get a relatively good results from surgery while a minortiy get unsatisfying results from surgery.

Of course some "surgeons" produce a lot of bad results while other surgeons produce just some bad results. The best surgeons maybe produce almost no bad results.

As there seems to be more good results than bad results out there, and as it seems that even reputable surgeons get bad reviews, I am wondering why or how is that some patients get terrible results while most patients get good results? Could it be that they get an allergic reaction, they don't respond well to surgery, they were advised against it themselves in the first place etc etc? I'd like to think a lot of surgeons out there could give me a good result however bad reviews discourages me from choosing a surgeon, yet so many "good" surgeons seem to have bad reviews. Why is that some patients get a worse result than others, and are these patients a very small minority?

[BLE123]

This has been on my mind as well when looking at results.

Just recently I saw two cases with the same highly reviewed doctor. As far as I could tell both patients had a similar starting point with regards to loss, similar age, same ethnicity etc. Patient 1 had a legit 10/10 result, one of the best I've ever seen, yet patient 2's result was subpar, not terrible but not good either - a 4/10. I just don't understand why there could have been such a difference in their respective results.

Possible factors to take into account I guess are:

- Donor calibre/quality
- Use of medication (Finasteride/Minoxidil etc)
- Post-op care (following washing instructions, being careful not to damage grafts)
- Overall health of the patient
- Sheer luck/genetics

Honestly it does seem like the last point plays a big part, which is quite off-putting when looking into a possible surgery.

[Rossybop]

Yeah, its a bit baffling isn't it. It almost seems as if there's a 1 in 100 chance you'll get a shit result regardless of who you pick. Bummer isn't it.

[yesplease]

8 hours ago, Rossybop said:

Yeah, its a bit baffling isn't it. It almost seems as if there's a 1 in 100 chance you'll get a shit result regardless of who you pick. Bummer isn't it.

Higher than 1/100, I’d say 

[JohnBob]

I think a good rule of thumb is to judge a surgeon both by their best results AND worst ones. 

I was very excited about a clinic because they have on their social media a lot of spectacular work done but then i saw here a user showing a subpar result and this made me think about cutting that clinic from my prospective list. 

Even if they offer corrective surgery for free, it's not just about money, we're talking about donor area, a very scarce and important resource that is impossible to take back. 

On the other hand, there are doctors like Konior that have a lot of patient reviews here and not a single one turned out bad (as far as I know), and this speaks a lot about the consistency of the doctor IMO.

Edited November 1, 2020 by JohnBob

[Rossybop]

More than 1 in 100 - yikes! Yeah consistency really is important. I think I'll check out Konoir I've never heard of him/her. Thanks!

[Raphael84]

It is a good question and one that everybody who may be considering hair restoration surgery as an option, should be aware of.

If we rule out poor quality surgery for the moment. Whilst poor quality surgery is by far the biggest factor in regards to poor results, let us assume that we are considering highly skilled doctors with years of achieving consistently excellent results.

As @BLE123has previously stated, the first question should be, is the patient a good candidate for surgery. This can be in terms of their donor area,  donor density, follicular groupings, hair calibre etc. One extremely important factor is the level (percentage) of miniaturisation that is present in the patients donor area. If levels are higher than preferred, the risk of poor/non acceptable yield can increase significantly. As can the longevity of the transplanted hair.

Another question in terms of candidacy is, are the patients expectations realistic, are they in line with the surgeons objectives and are they appropriate considering their starting position? 

Any "growth guarantee" offered by a doctor/clinic unfortunately has no worth. This is not to be mistaken with an ethical doctor who will stand by his patient and in the event of non optimal growth, offer a touch up session. This is different to guaranteeing growth. 

Medicine is not a perfect science.

Poor growth with a quality physician is uncommon, but it can happen.

Crucial factors to consider are -

The patients health/underlying skin conditions

• Skin conditions such as dermatitis, psoriasis, scarring, inflammation such as erythroderma, iron dificiency, ongoing chronic illness, lupas, cancer, medication

Hair characteristics

• Donor is very influential such as follicular grouping, donor density, hair calibre, miniaturisation

Operative day factors

• Choice of surgeon, his equipment and techniques
• Patients skin, does the patients characteristics result in extreme popping or bleeding

Correct post op care

• No chemical usage such as dyes or other products, Toppik or fibres
• Following post operative instruction

As you can see, undiagnosed skin conditions can be a cause. Therefore if a patient is not seen prior to the surgery for an in person consultation with their doctor or by a dermatologist, then it is harder to rule out any such conditions.

You may find the following presentation educational in regards to growth and surgery success. Whilst some parts are specific to our clinic, there is much information that is relative to FUE in general  -

 

[alex1985]

I got a FUE transplant 3 weeks ago (had one before 5 years ago, hairline). After shaving my head the surgeon discovered seborrheic dermatitis on my scalp (photos). I was not aware of this skin condition. The surgeon told me it was not a problem, he was gonna to try to avoid the areas as much as possible while extracting. Which he did, but some grafts were taken from those areas. 

 

I just read there is a higher risk of compromised graft survival. Does this apply to me, while there is no dermatitis on recipient area?

 

After reading @Raphael84 post, I am a bit worried...

Edited November 5, 2020 by alex1985

[Raphael84]

@alex1985

Thank you for sharing your photos.

Seborrheic dermatitis is reasonably common to varying degrees. For some patients it can be some light flaking and essentially dandruff, for other patients it can be more aggressive. Oftentimes for patients who arrive at the clinic with longer hair and have not shaved their hair for many years, they are unaware of such things.

As your doctor has explained that it is sebhorreic dermatitis, generally some kind of shampoo would be recommended to treat the area. Something like Nizoral with ketoconazole as its active ingredient can be very effective although many doctors prefer to wait until x amount of weeks post surgery before advising you to begin using such shampoo. 

As you have said that it is not present in your recipient area and from your photos appears to be mainly in your vertex that was untouched in your surgery, your doctor may be okay with you to begin to treat the area. But again your healing and growth is dependent on following your surgeons post operative instructions, so I would definitely recommended asking him/her directly.

[alex1985]

Thank you for your reply @Raphael84. I got ketoconazole 2% prescribed, which I am using now (2-3 times a week).

[Rossybop]

Just seeing this info now guys. I am worried about what effect skin can have on a transplant. I have been diagnosed with sebhorric dermatitis psoriasis before. It comes and goes, right now it is not aggressive, but I want to have a hair transplant in a few weeks! I never have dodgy skin in the donor area, but I have had psoriasis/sebhorric dermatitis on the forehead before and possibly into the scalp. Does this mean I am in trouble for a hair transplant?