Hair Transplant 9.5 months (getting nervous)

[ITA]

6 hours ago, JohnAC71 said:

And we have seen many cases where they will offer “touch ups” and extra work to ensure this. 

@JohnAC71Many, but not all.

[Britanium]

Just now, Egy said:

@JohnAC71Many, but not all.

Certainty not all, but some of the best clinics do. And if it’s Dr Bloxham he definitely would. 

[ITA]

5 hours ago, Hairguy650 said:

Acceptable is subjective and I figure bathroom lighting mirrors closely to how you would look outside on a sunny day. Here are some pictures however in "natural' lighting by sitting post shower next to a window (7.5 months in these photos)

Well, it doesn't look bad here.

[Britanium]

1 minute ago, Egy said:

Well, it doesn't look bad here.

Agreed, i do think all of those 2000 grafts have grown. Just it’s going to be difficult blending with the surrounding density. And as we can see one side isn’t as strong. Still some time to go before it can be addressed. 

[Hairguy650]

8 minutes ago, JohnAC71 said:

Agreed, i do think all of those 2000 grafts have grown. Just it’s going to be difficult blending with the surrounding density. And as we can see one side isn’t as strong. Still some time to go before it can be addressed. 

I imagine if I had to get a 2nd procedure it would have to wait until the 18 month mark. Also forgive the dumb question but is the reason that it will be difficult to blend with the surrounding density because it is not packed in tight enough or it's too immature?

[Britanium]

1 minute ago, Hairguy650 said:

I imagine if I had to get a 2nd procedure it would have to wait until the 18 month mark. Also forgive the dumb question but is the reason that it will be difficult to blend with the surrounding density because it is not packed in tight enough or it's too immature?

Combination of both really. As Melvin mentioned it’s never going to match the native density. You can dense pack it further if it was to end up unsatisfactory to you. It’s all about the illusion of what a hair transplant can achieve. I think yours will need “tweaking” a little at the end of 18 months. It’s actually good considering the area 2000 grafts have covered. I just personally think it could have used a little more. 

[Melvin- Admin]

2 hours ago, Hairguy650 said:

I imagine if I had to get a 2nd procedure it would have to wait until the 18 month mark. Also forgive the dumb question but is the reason that it will be difficult to blend with the surrounding density because it is not packed in tight enough or it's too immature?

It’s probably a bit of both, don’t expect it to be as dense as the native areas with 2,000 grafts. But the hair will mature and grow thicker in diameter up until 18 months. It’s very possible you won’t notice as much by 18 months. That said, if you’re not happy now, keep your surgeon in the loop. Communication is key. 

[Hairguy650]

9 minutes ago, Melvin-Moderator said:

It’s probably a bit of both, don’t expect it to be as dense as the native areas with 2,000 grafts. But the hair will mature and grow thicker in diameter up until 18 months. It’s very possible you won’t notice as much by 18 months. That said, if you’re not happy now, keep your surgeon in the loop. Communication is key. 

Thanks for the response. I'm hoping the maturation phase can help me out here. I've been in constant contact with the doctor and he has been extremely helpful. I'm scheduled to see him in person at the 11 month mark so I'll have an expert opinion on where I stand then. I am a little nervous about bringing up how a 2nd transplant would play out (cost, timing, grafts) but I'll let that happen when it comes

Edited April 6, 2021 by Hairguy650

[pre-screened]

The reality is Bloxham from what I've seen has a conservative approach..........he is working on the basis that every patient ends up a NW5-6......and then asks what would be required to provide coverage for this. Using this he wont go low or too dense unless he's super confident that furture hairloss is probably unlikely. Its conservative and it does ensure nobody is left in a bad place up the road. There is merit in his approach and its admirable..........but for a certain cohort, based on their high expectations, it practically guarantees your back in the chair 18 months later. Looking at the graft placement post-op its pretty clear the grafts up against your original hairline are spaced pretty far apart.

You have good native density...........are you on Fin/minox to halt the loss? Have been on them for a while?.........if not and have no plans to be then Dr.Bloxham was possibly right to go low in the graft count.....thinking you in the future would need another 4000-5000 to cover midscalp & into the crown.

HOWEVER - if you are on Fin/Minox and its demonstrably stabilized your hairloss for a period of years then a Dr.Hasson for example, IMO, would have done something more like 3,500 - 4,000 FUT into the hairline attempting to more closely match your native (it never will be he can get damn close look at @Aftermath). If your a committed user and succesful responder to Fin/Mox i think Dr.bloxham could have more ambitious here.......but things might change in the next few months and you could be happy and very happy to have a spare 2,000 grafts in your doner and $ in your back pocket....wait till month 15 then decide

Edited April 7, 2021 by pre-screened

[Hairguy650]

16 minutes ago, pre-screened said:

The reality is Bloxham from what I've seen has a conservative approach..........he is working on the basis that every patient ends up a NW5-6......and then asks what would be required to provide coverage for this. Using this he wont go low or too dense unless he's super confident that furture hairloss is probably unlikely. Its conservative and it does ensure nobody is left in a bad place up the road. There is merit in his approach and its admirable..........but for a certain cohort, based on their high expectations, it practically guarantees your back in the chair 18 months later. Looking at the graft placement post-op its pretty clear the grafts up against your original hairline are spaced pretty far apart.

You have good native density...........are you on Fin/minox to halt the loss? Have been on them for a while?.........if not and have no plans to be then Dr.Bloxham was possibly right to go low in the graft count.....thinking you in the future would need another 4000-5000 to cover midscalp & into the crown.

HOWEVER - if you are on Fin/Minox and its demonstrably stabilized your hairloss for a period of years then a Dr.Hasson for example, IMO, would have done something more like 3,500 - 4,000 FUT into the hairline attempting to more closely match your native (it never will be he can get damn close look at @Aftermath). If your a committed user and succesful responder to Fin/Mox i think Dr.bloxham could have more ambitious here.......but things might change in the next few months and you could be happy and very happy to have a spare 2,000 grafts in your doner and $ in your back pocket....wait till month 15 then decide

No fin and minox on and off. I'm 27 and I went straight to a NW3 from ages 19-21. Hairloss stopped and finally at 26 bit the bullet and got a transplant. I told this all to the doctor prior to committing to the procedure. He gave me examples of others my age with similar loss patterns and he suggested 2000 grafts. The examples were dense undetectable transplanted hairlines. I'm going to stick it out and hope time is on my side here. I mentioned earlier that if I'm in the chair a few months from now I'd like to remain with this doctor. If anything I'd hope he would give me a free/heavily discounted procedure to put me at that reasonable place we had discussed prior

[stephcurry30]

39 minutes ago, Hairguy650 said:

No fin and minox on and off. I'm 27 and I went straight to a NW3 from ages 19-21. Hairloss stopped and finally at 26 bit the bullet and got a transplant. I told this all to the doctor prior to committing to the procedure. He gave me examples of others my age with similar loss patterns and he suggested 2000 grafts. The examples were dense undetectable transplanted hairlines. I'm going to stick it out and hope time is on my side here. I mentioned earlier that if I'm in the chair a few months from now I'd like to remain with this doctor. If anything I'd hope he would give me a free/heavily discounted procedure to put me at that reasonable place we had discussed prior

I don't understand why you wouldn't state the name of the surgeon? It will only benefit others that are possibly looking to get future hair transplants from them. 

[Hairguy650]

9 hours ago, stephcurry30 said:

I don't understand why you wouldn't state the name of the surgeon? It will only benefit others that are possibly looking to get future hair transplants from them. 

I mentioned why shortly after my original post. After meeting in person with them for my follow-up I'll disclose who it is and share our future plans going forward 

[pre-screened]

10 hours ago, Hairguy650 said:

No fin and minox on and off. I'm 27 and I went straight to a NW3 from ages 19-21. Hairloss stopped and finally at 26 bit the bullet and got a transplant. 

Ok no fin and 27 years old...........I'm afraid its very unlikely your hairloss has stopped...........your hair loss journey is only starting................Dr.Bloxham was right to be conservative and see if 2,000 grafts might give you the coverage that might make you happy. It still might I can see the hair are immature and wire-y.......i think leave it as I said till 15 months and revist.

If you were on Fin and good responder I would have said go for it in terms of 3-4k grafts (recent Japanese long term studies of Fin have demonstrated good efficacy over the long term in terms of halting hairloss) but at 27 and intermittent use of Minox and No fin...........i think Dr.Bloxham took the approach that I mentioned earlier which was to imagine you as a NW5.......and ask what your doner needs might be if you showed future loss in the mid-scalp and into crown

[Al - Moderator]

Looking at all of your pictures it looks to me like a lot of the individual transplanted hairs are still a bit thinner than your native hair, so I think it should mature and thicken up a bit more over the next few months.

 

 

[Hairguy650]

I'm just short of 10 months so just posting a quick update out of the shower. Not much has changed and am still scheduled for an in-person follow up in a month.

 

[Hairguy650]

To be fair those previous pictures were taken in a way that gives full exposure to the transplant alone. The following pictures are how I would like to wear my hair. I've been slicking my hair back since my early 20's however I would have to part it especially towards my weak side because of how receded it is/was. The left side stands well with no native hair coverage needed. I imagine this side will continue to mature and will get to a great spot. The right side is noticeably weaker and I still have to cover with native hair. This is the side I am most nervous about. Definite disparity in density from the left side. The front grew perfectly. There was already native hair their albeit thinning at the time.

 

 

[j1mmy]

Do you remember your hair caliber in microns?

I see what you are talking about. Looks like they might mature a little more, and that will help. Though it is contrasted with the higher density with your native forelock. I think in some cases 2000 grafts could have done the job, though I think to be a homerun here, I would certainly discuss a touch-up with your doctor for a second pass. Depending on what was the original plan of the surgery, and if you handle it well that you are not fully satisfied, he may be willing to offer this to you. 

I would definitely strongly consider all medication options if I were you.  

*edit* and I haven't experienced this personally, but my understanding from seeing other patients is that the "maturing" that happens after 12 months, and closer to 18 months, is often a "softening" of hairs, i.e. that they appear less thick. But for now they seemed thicker from your previous photos, so potentially some improvement to go.

Edited April 15, 2021 by j1mmy

[Curious25]

It looks as though you are lacking in grafts behind the softer single haired frontal line. This helps reinforce the frontal wall, and helps to deflect light from exposing your scalp. You still have time to experience a few more months of maturation, however I would imagine maybe 200 double/multi hair grafts on each side to bring this up to expectation, so not the worst case in the world. If you total 2400 grafts for the original area that needed to be covered, it's a pretty standard graft count, so nothing lost - just a pain its going to require a further surgery, however very rarely does one HT alone do the trick. 

[Hairguy650]

15 minutes ago, j1mmy said:

Do you remember your hair caliber in microns?

I see what you are talking about. Looks like they might mature a little more, and that will help. Though it is contrasted with the higher density with your native forelock. I think in some cases 2000 grafts could have done the job, though I think to be a homerun here, I would certainly discuss a touch-up with your doctor for a second pass. Depending on what was the original plan of the surgery, and if you handle it well that you are not fully satisfied, he may be willing to offer this to you. 

I would definitely strongly consider all medication options if I were you.  

*edit* and I haven't experienced this personally, but my understanding from seeing other patients is that the "maturing" that happens after 12 months, and closer to 18 months, is often a "softening" of hairs, i.e. that they appear less thick. But for now they seemed thicker from your previous photos, so potentially some improvement to go.

I have no idea I will be sure to ask during my follow-up. What is the impact of hair caliber on a final result? Knowing the doctor he will insist on waiting until the 18th month mark until the next steps. Based on his reputation I am hoping if anything he would be willing to touch up the right side free of charge. I'm not too familiar on the nature of touch-ups but from I've gathered many good doctors would be willing to do this.

[Hairguy650]

1 minute ago, Curious25 said:

It looks as though you are lacking in grafts behind the softer single haired frontal line. This helps reinforce the frontal wall, and helps to deflect light from exposing your scalp. You still have time to experience a few more months of maturation, however I would imagine maybe 200 double/multi hair grafts on each side to bring this up to expectation, so not the worst case in the world. If you total 2400 grafts for the original area that needed to be covered, it's a pretty standard graft count, so nothing lost - just a pain its going to require a further surgery, however very rarely does one HT alone do the trick. 

I wonder what could have caused this. The examples he showed me at 2000 grafts resulted in perfect coverage hence why we agreed to 2000 grafts. The only thing I can think of rather than pure chance is that perhaps a technician messed up? I had a different technician for each side and there is a noticeable difference between by left and right side 

[j1mmy]

13 minutes ago, Hairguy650 said:

I have no idea I will be sure to ask during my follow-up. What is the impact of hair caliber on a final result? Knowing the doctor he will insist on waiting until the 18th month mark until the next steps. Based on his reputation I am hoping if anything he would be willing to touch up the right side free of charge. I'm not too familiar on the nature of touch-ups but from I've gathered many good doctors would be willing to do this.

 

Hair caliber accounts for coverage. It is the reason hair transplants are an "illusion of density". Moving hairs from the donor area and placing them in the recipient area requires a lot less hairs to be moved than you would otherwise expect simply looking at the recipient area. Hairs in the recipient area during hair loss are often naturally lower caliber, minituarised, and have lost pigment due to this.  
 
"Hair Caliber: Mathematically speaking, hairs with larger shaft diameter provide exponentially more surface area coverage; therefore, patients with thicker-caliber hair can expect to obtain much denser coverage (better aesthetic results) versus patients with thin-caliber hair (when controlled for the number of follicular units transplanted)." 
 
An average hair caliber for caucasians might be .55 microns. If one patient has .45 microns, and another .65 microns, that is a huge difference in how many grafts they would require to achieve coverage. It will almost certainly be one factor your Dr. took into account. But it can add to explaining why you saw results that were "full" with the same number of grafts. This in addition to hair curl vs straight, hair colour vs scalp colour, hairs/graft count.  
 
Do you know the breakdown of your 2000 grafts? 

Edited April 15, 2021 by j1mmy

[Curious25]

10 minutes ago, Hairguy650 said:

I wonder what could have caused this. The examples he showed me at 2000 grafts resulted in perfect coverage hence why we agreed to 2000 grafts. The only thing I can think of rather than pure chance is that perhaps a technician messed up? I had a different technician for each side and there is a noticeable difference between by left and right side 

Could be due to a lower survival yield, or your hair calibre not being comparable to the examples he showed you (however if it was a good doc, he would have factored this into consideration). 

[Hairguy650]

3 minutes ago, j1mmy said:

 

Hair caliber accounts for coverage. It is the reason hair transplants are an "illusion of density". Moving hairs from the donor area and placing them in the recipient area requires a lot less hairs to be moved than you would otherwise expect simply looking at the recipient area. Hairs in the recipient area during hair loss are often naturally lower caliber, minituarised, and have lost pigment due to this.  
 
"Hair Caliber: Mathematically speaking, hairs with larger shaft diameter provide exponentially more surface area coverage; therefore, patients with thicker-caliber hair can expect to obtain much denser coverage (better aesthetic results) versus patients with thin-caliber hair (when controlled for the number of follicular units transplanted)." 
 
An average hair caliber for caucasians might be .55 microns. If one patient has .45 microns, and another .65 microns, that is a huge difference in how many grafts they would require to achieve coverage. It will almost certainly be one factor your Dr. took into account. But it can add to explaining why you saw results that were "full" with the same number of grafts. This in addition to hair curl vs straight, hair colour vs scalp colour, hairs/graft count.  
 
Do you know the breakdown of your 2000 grafts? 

I'm pretty sure he told me on the day of surgery but I didn't note it anywhere. I'll shoot him an email and report back

[j1mmy]

Just now, Hairguy650 said:

I'm pretty sure he told me on the day of surgery but I didn't note it anywhere. I'll shoot him an email and report back

Do it! All useful information in your arsenal of how best to move forward should you want a second pass  

[Hairguy650]

On 4/6/2021 at 12:56 PM, JohnAC71 said:

Please do keep us updated. Be interesting to see if it progresses to a satisfactory level. I can see the weaker side also. Usually they eventually catch up with each other. Fingers crossed 🤞 

Just got done talking to him. Here is his response:

Here is the information I have about graft break down: 

1,204 multis 
796 singles

As far as microns go, this isn't something I typically measure. However, fine hair is typically considered 60 microns and less; "normal" hair is 60 - 80 microns; and "coarse" hair is 80 microns and over. Just based on the appearance of your native/donor hair and the size of my incisions the day of surgery, I would say you are slightly on the coarse side; so my estimate would be around 85 microns or so.