Hair Transplant 9.5 months (getting nervous)

[Hairguy650]

Hey all here is my 11th month update. First off all after thinking it over I figured there was really no benefit to keeping the doctor anonymous. Someone mentioned above that these posts should be used to guide people through the entire hair transplant process. With that said, and to the surprise of nobody who had guessed, it was indeed Doctor Bloxham. I am going to his office next week for my first in-person checkup that I mentioned above. He and his staff have been incredibly responsive for all the questions I had post surgery and have been helpful in addressing my concerns when they arose. 

So here are my 11 month pictures. So my concerns from the prior month are still around. Fortunately from my last post I think my left side has filled in even if just slightly. The right side is still my major concern as I can't really tell a difference from the prior month:

Also is there a way to change the title of this thread? Would be more helpful to people if I could 

 

 

 

 

Edited May 14, 2021 by Hairguy650

[Mark Wolfer]

What I'm not understanding really is the decision to go FUT for a relatively low number of grafts. Do you have a weak donor area? I get that you're 26 but your hair is pretty thick and full looking from the angles you've shown and I'd have thought you'd do well with FUE in this case. If you're not on fin / duta you should really consider this.

[Hairguy650]

3 minutes ago, Mark Wolfer said:

What I'm not understanding really is the decision to go FUT for a relatively low number of grafts. Do you have a weak donor area? I get that you're 26 but your hair is pretty thick and full looking from the angles you've shown and I'd have thought you'd do well with FUE in this case. If you're not on fin / duta you should really consider this.

It was a mutual decision before the procedure. He showed me a 2000 graft "dense frontal band" result on a patient with similar loss as mine. He also stated that FUT would result in better coverage and would leave a healthier donor area behind in the future if need be. He mentioned my donor area was very thick. I was on fin briefly but got scared off from the sides. I dont think I mentioned this yet but most of my loss occurred from 19-21. At almost 27 I've had no more noticable loss so I figured I'd just keep an eye in it

[stephcurry30]

Definitely an improvement but with 2000 grafts i would of expected a bit more density. 

Who was your surgeon? 

[Hairguy650]

1 hour ago, stephcurry30 said:

Definitely an improvement but with 2000 grafts i would of expected a bit more density. 

Who was your surgeon? 

Dr. Bloxham

[Mycroft]

Dr. Bloxham's clinic definitely emphasizes the FUT first approach. They have the ability to perform FUE but the strip work seems to represent most of their cases. Not a criticism, just an observation.

I have a couple of thoughts. One is that I may have shot for a slightly higher graft count for this area of coverage, more in the neighborhood of 2,500, but your scalp laxity may have been a limiting factor. The other is that you have definitely not gotten anywhere near 2,000 healthy, growing grafts so I hope Dr.  Bloxham is still working with you on getting this straightened out. 

 

[Hairguy650]

2 minutes ago, Mycroft said:

Dr. Bloxham's clinic definitely emphasizes the FUT first approach. They have the ability to perform FUE but the strip work seems to represent most of their cases. Not a criticism, just an observation.

I have a couple of thoughts. One is that I may have shot for a slightly higher graft count for this area of coverage, more in the neighborhood of 2,500, but your scalp laxity may have been a limiting factor. The other is that you have definitely not gotten anywhere near 2,000 healthy, growing grafts so I hope Dr.  Bloxham is still working with you on getting this straightened out. 

 

That's going to be the major conversation I think that is going to happen. I want to ask if he realistically thinks that this will blend in with the native hair based on what he sees here. I'm almost hoping he claims that the despite 18 months being the usual endpoint that my growth is pretty much done so we can at least move on to the next steps. Really don't want to drag this out until the end of the year when its possible I'm done growing. I'm actually off for the summer until my next semester starts in the fall so it would be ideal if he would be willing to do a 2nd surgery then. Like I've mentioned above he has been excellent to work with but I don't seeing him agreeing to be so hasty and performing a 2nd procedure at ~11/12 months. I don't know if this is relevant in regard to the results so far but the procedure itself was pretty rough. I don't remember how long the procedure was but I think it neared 7 hours and I experienced a ton of "popping". Also my tolerance for pain was quite low so they had to keep numbing the area.

[Hairguy650]

21 minutes ago, Mycroft said:

Dr. Bloxham's clinic definitely emphasizes the FUT first approach. They have the ability to perform FUE but the strip work seems to represent most of their cases. Not a criticism, just an observation.

I have a couple of thoughts. One is that I may have shot for a slightly higher graft count for this area of coverage, more in the neighborhood of 2,500, but your scalp laxity may have been a limiting factor. The other is that you have definitely not gotten anywhere near 2,000 healthy, growing grafts so I hope Dr.  Bloxham is still working with you on getting this straightened out. 

 

Also just from eyeballing how many grafts do you think made it based on the photos?

[Mycroft]

The popping is possibly a cause for concern and may have contributed to a lower survival rate. If you go for more I'd ask the doctor what he plans to do differently to work around that.

I'm not the best judge of these things but I'd estimate closer to 1,500-1600 grafts. Grain of salt with that, but as I said 2k is also a bit conservative for the area covered considering you had to rebuild most of the front other than the central forelock. I think it's a combination of the two factors, but definitely not an unfixable situation. I'd just make sure to discuss the previous complications and get some assurance that the doctor has a plan for improving the situation on round two.

[asterix0]

Could you ask Dr. Bloxham do to a microscopic evaluation to verify your yield? You were transplanting in slick bald areas so this should be easy enough to do. That way, there will be no ambiguity with the question of if it "should" look like that, or if it is a question of poor yield. 

[Hairguy650]

9 minutes ago, asterix0 said:

Could you ask Dr. Bloxham do to a microscopic evaluation to verify your yield? You were transplanting in slick bald areas so this should be easy enough to do. That way, there will be no ambiguity with the question of if it "should" look like that, or if it is a question of poor yield. 

I suppose it wouldn't hurt to ask. Just from eyeballing it compared to his other ~2000 frontal band results this looks like a poor yield and am hoping there is no debate on that. Biggest hurdle I think will be is if he would be willing to recognize this possibility and repairing it 

[asterix0]

1 hour ago, Hairguy650 said:

I suppose it wouldn't hurt to ask. Just from eyeballing it compared to his other ~2000 frontal band results this looks like a poor yield and am hoping there is no debate on that. Biggest hurdle I think will be is if he would be willing to recognize this possibility and repairing it 

Yes, the yield does not look great, but to get some numerical estimates may be helpful. Recall that it's advertised good FUT yields are 95-98%, which I presume was communicated to you that you could expect to get a similar yield.

Looking at your post operative pictures, it actually appears you had hair transplanted amongst your natural hair though, and not only on slick bald areas? If this is true then you may have experienced shock loss. It is much more tricky to implant around native hairs, as in addition to the trauma to the recipient area, your native (mpb compromised) hairs are not competing for blood flow with the transplanted grafts. Using minoxidil and finasteride can help keep them alive/stronger to overcome this shock. 

[Mycroft]

15 minutes ago, asterix0 said:

Yes, the yield does not look great, but to get some numerical estimates may be helpful. Recall that it's advertised good FUT yields are 95-98%, which I presume was communicated to you that you could expect to get a similar yield.

Looking at your post operative pictures, it actually appears you had hair transplanted amongst your natural hair though, and not only on slick bald areas? If this is true then you may have experienced shock loss. It is much more tricky to implant around native hairs, as in addition to the trauma to the recipient area, your native (mpb compromised) hairs are not competing for blood flow with the transplanted grafts. Using minoxidil and finasteride can help keep them alive/stronger to overcome this shock. 

There's nothing Incorrect about what you've said here, but the spot where he had his native hair (central forelock) doesn't look like it has a density issue. The thin areas that look a bit off are all areas where there was next to no hair present, or at most very tiny miniaturized hairs that were barely visible. I'm not sure I'd really call shock loss a major contributing factor.

[Hairguy650]

26 minutes ago, asterix0 said:

Yes, the yield does not look great, but to get some numerical estimates may be helpful. Recall that it's advertised good FUT yields are 95-98%, which I presume was communicated to you that you could expect to get a similar yield.

Looking at your post operative pictures, it actually appears you had hair transplanted amongst your natural hair though, and not only on slick bald areas? If this is true then you may have experienced shock loss. It is much more tricky to implant around native hairs, as in addition to the trauma to the recipient area, your native (mpb compromised) hairs are not competing for blood flow with the transplanted grafts. Using minoxidil and finasteride can help keep them alive/stronger to overcome this shock. 

The frontal portion of my head was the only portion with native hairs and is actually the area where the transplant turned out best. Blends in with the native hair beautifully. The bald areas, and especially on the right side are the places where the yield was lowest

[Parasol]

3 hours ago, Mycroft said:

The popping is possibly a cause for concern and may have contributed to a lower survival rate. If you go for more I'd ask the doctor what he plans to do differently to work around that.

I'm not the best judge of these things but I'd estimate closer to 1,500-1600 grafts. Grain of salt with that, but as I said 2k is also a bit conservative for the area covered considering you had to rebuild most of the front other than the central forelock. I think it's a combination of the two factors, but definitely not an unfixable situation. I'd just make sure to discuss the previous complications and get some assurance that the doctor has a plan for improving the situation on round two.

I had a lot of popping during my most recent surgery too. It was non-stop, basically.

I specifically asked my clinic if that would impact the survivability/yield, and was told that it absolutely would not.

I’m only 6 weeks post-op so I can’t comment on how it turned out for me, but I’ll be curious to hear Dr. Bloxham’s opinion on whether this was the reason, and if so, how you guys can overcome it for the next time.

Edited May 15, 2021 by Parasol

[asterix0]

36 minutes ago, Mycroft said:

There's nothing Incorrect about what you've said here, but the spot where he had his native hair (central forelock) doesn't look like it has a density issue. The thin areas that look a bit off are all areas where there was next to no hair present, or at most very tiny miniaturized hairs that were barely visible. I'm not sure I'd really call shock loss a major contributing factor.

You may be right, but it seemed that his forelock was stronger hair thickness and caliber wise, so the chance of shock loss would be less there. 

The post op pictures on the sides of the hairline do seem to show that some rather fine were grafts placed there, and quite spaced apart as well. Perhaps too many singles were used, rather than just in the very front where they are actually  necessary to produce a natural result. 

[asterix0]

36 minutes ago, Hairguy650 said:

The frontal portion of my head was the only portion with native hairs and is actually the area where the transplant turned out best. Blends in with the native hair beautifully. The bald areas, and especially on the right side are the places where the yield was lowest

It is hard to tell because you had quite a lot of native hair in the frontal forelock already. 

Actually looking more closely at your immediate post op pictures, my previous opinion may be completely wrong, your yield might have been pretty good.

I can only say that it "seems" to me in the originally bald areas, the individual single grafts may be of too fine caliber, meaning they are not inherently thick enough to produce the desired aesthetic outcome with the density they were implanted in. 

If you look at other "home run" hairline cases, it is of patients who have inherently thick, robust donor hair, so you can sort of do more with less so to speak, and do not need to implant very densely to obtain the desired result. Of course, you use fine, individual singles for the very front of the hairline to avoid the pluggy look. 

 

[A Fue Good Men]

1 hour ago, Parasol said:

I had a lot of popping during my most recent surgery too. It was non-stop, basically.

I specifically asked my clinic if that would impact the survivability/yield, and was told that it absolutely would not.

I’m only 6 weeks post-op so I can’t comment on how it turned out for me, but I’ll be curious to hear Dr. Bloxham’s opinion on whether this was the reason, and if so, how you guys can overcome it for the next time.

How many procedures have you had in the past?

[Hairguy650]

4 minutes ago, 5BetaReductase said:

How many procedures have you had in the past?

This was my only procedure 

[stephcurry30]

19 hours ago, Parasol said:

I had a lot of popping during my most recent surgery too. It was non-stop, basically.

I specifically asked my clinic if that would impact the survivability/yield, and was told that it absolutely would not.

I’m only 6 weeks post-op so I can’t comment on how it turned out for me, but I’ll be curious to hear Dr. Bloxham’s opinion on whether this was the reason, and if so, how you guys can overcome it for the next time.

Can someone explain to me the "popping" thing that you guys are talking about? 

[Parasol]

19 minutes ago, stephcurry30 said:

Can someone explain to me the "popping" thing that you guys are talking about? 

In my case, after the extractions and incisions, as the grafts were getting placed in the recipient incision sites, the grafts kept “popping” out. This meant in order to secure them, the techs had to put them in multiple times for the grafts to be securely anchored.

Edited May 16, 2021 by Parasol

[Hairguy650]

Just sent Dr. Bloxham my 11 month pictures. Noted that the left and center are coming along nicely albeit sill being immature. Also noted right side still looks immature and I will continue to see some thickening. I'm hoping that time simply may be all that I need and he put me at ease saying would be able to beef it up at the end if need be. Will update after my checkup this Friday 

[aaron1234]

Yes, one side grew in more sparsely, but this is easily fixed with a touch up procedure.  Also, the right side is damp in your pictures which can make it look even thinner.  Otherwise, you have a killer head of hair!  

[Hairguy650]

Just had my 1st in-person checkup with Dr. Bloxham this Friday. We talked about law school and my plans for the summer before we got into it and it was nice to see his interest in his patients lives outside of the procedure. He proceeded to take pictures and comb through the hair and check the scar. Said the scar was coming along nicely. 

 

The frontal band was an interesting conversation. He immediately noted that while the result was a cosmetic improvement, it was not one of the stronger results he encountered. While he couldn't pinpoint why exactly my results were what they were at 11 months, he noted an interesting observation during the procedure that may have impacted the results. When he was making the incisions on my scalp he said that the holes were closing incredibly fast. Not only may this have been a cause for the popping, but also may have limited the maximum thickness the hair was able to achieve. As someone noted above, the yield was actually pretty good. Dr. Bloxham estimated somewhere between 80-85%. However the scalp especially on the right side almost looks like it is composed of substantially single hair grafts because of the phenomenon above. This all was not the exact language he used but this is how I understood what happened. He said at this point we could either wait for the full 18 months to see if some additional thickness of the follicles occurs or we could go in for a 2nd procedure.

 

Due to my schedule I likely wouldn't be able to come in until December and he noted he would be able to fit me in despite his busy schedule. Additionally he offered a very substantial discount on this 2nd procedure which we both agreed was a fair amount. Based on the flexibility he his providing me with timing and the reduced cost, I will be undergoing a 2nd procedure with him likely in mid-December. What I found amazing is that Dr. Bloxham told me that he reviewed my file and deliberated on my case for some time after my concerns arose at 6 months. During the checkup he already had a game plan in place of approximately 1500 grafts (FUT) to fill in the area with different techniques he would use during the procedure to account for my unique case. It really put me at ease to know he was already a step ahead before I even brought up the idea of a 2nd procedure.

 

While the results of my 1st procedure had not met my expectations, there is no doubt in my mind that I am in capable hands. Dr. Bloxham has a reputation as being one of the best and it is a blessing to know that even if you are an outlier case like my own, he will go out of his way to make things right. I'll continue posting pictures here until the next procedure but will be making a new journal come December.

 

 

Edited May 23, 2021 by Hairguy650

[hairlossPA]

glad you guys came to terms. I would be interested in hearing more about the techniques he plans on using the provide a better result this time around.

"During the checkup he already had a game plan in place of approximately 1500 grafts (FUT) to fill in the area with different techniques he would use during the procedure to account for my unique case."