Mixed Feelings after First HT (FUT)

[elicochin]

28 minutes ago, Dr. William Lindsey said:

I can't tell anyone how bummed this makes me.  Unfortunately privacy laws do not let me discuss things in detail. 

BUT, I'd gotten a concerning email from the patient about an hour ago while on a walk.  I responded with concern and an offer to see the patient this week and that I want both of us to be pleased...and then I get a notification from the forum that rather than discuss this in a private doctor patient manner working toward a good result, that I'm now the subject of scorn.

The patient can certainly publish my email response but I can't go into this further and find this to be a bummer for both of us.  As I can't really respond and expect the sharks to start to feed, I'll simply say that I want every patient to be satisfied and have a 24 year track record of working with patients, who remain cordial and not confrontational, to get results that we're both satisfied with.

Posting a one sided topic is not what I'd call remaining cordial.

 

Dr. Lindsey

Dr Linsey,

Just to be clear, as you can see from my post above, there is no confrontation of any kind here and I have the utmost respect for you and your work. This forum has been a big support throughout my hair restoration journey. This is the place I go for HT related matters so naturally I came here for their opinion. Nothing more nothing less. 

[Aftermath]

1 minute ago, elicochin said:

Dr Linsey,

Just to be clear, as you can see from my post above, there is no confrontation of any kind here and I have the utmost respect for you and your work. This forum has been a big support throughout my hair restoration journey. This is the place I go for HT related matters so naturally I came here for their opinion. Nothing more nothing less. 

I don’t think you’re in the wrong for sharing. The good thing about this forum is it shows the good and the bad. As we are all aware when the best surgeons have problems with certain cases. But it’s just as important to show those results.
 

At the same time I can see the surgeons concerns about being aired out on a public forum, but as a veteran surgeon he be should be aware it’s par for the course and all he can do is stand by his work and sort out any issues 

[Ryan Rap]

@Aftermath I agree. 
 

@elicochin I feel that it’s important to be sharing honest results on the forum like you have done here. 

Now if the results are not honest then that is obviously a different story but everything that you’ve shared seems appropriate to me

[MachoVato]

1 hour ago, elicochin said:

Dr Linsey,

Just to be clear, as you can see from my post above, there is no confrontation of any kind here and I have the utmost respect for you and your work. This forum has been a big support throughout my hair restoration journey. This is the place I go for HT related matters so naturally I came here for their opinion. Nothing more nothing less. 

That's what this community is for... support.

We're not sharks.

[elicochin]

Thank you @qui bono for the detailed reply. Another FUT is certainly an option considering I already signed-up for the scar and Dr. Lindsey had already mentioned about the need for a second surgery. I was hoping that I would get a decent/matured-looking hairline so that I could focus on other areas. It would be a bummer if I had to rework/revisit the entire recipient area.

Edited May 1, 2021 by elicochin

[Gasthoerer]

To be honest, would be a little easier to follow your story if you it would be one thread showing the entire timeline.  Maybe @Melvin-Moderator can combine your threads?

To your result: I am with @qui bono That is a lot of real estate to cover for 3000 grafts. I had the same amount on maybe 1/3 of the area. The scar looks above average IMO, but the growth is average at best. Considering your high NW and poor hair characteristics,  I wonder: What was the discussed goal before surgery? Even with the best outcome this surgery alone would have not been enough. You need (and would have in any case IMO) a large second pass only for the frontal 3rd. And then there is nothing left for crown or thickening the midscalp. 

[elicochin]

@Gasthoerer, thanks for your thoughts. Just to be clear, are you saying that I may not get all the transplanted grafts/hairs growing due to the hair characteristics? what's your thought on cyclical growth? is there a possibility of some of the gaps filled-in a bit later?

[ML488]

Not sure how many multi hair grafts were in the final count, but generally speaking, given the fineness of your hair, this was too large of an area to cover for just 2999 grafts. Really poor planning. Never seen a post op like that where grafts are so far spaced apart. Reciple for disaster.

Edited May 2, 2021 by ML488

[Gatsby]

Dr Lindsey is a well respected surgeon who is excellent in closing up FUT's. Obviously speak with him about what options he puts forward to you regarding your results. As you are now around the 8 month mark it is pretty safe to assume that the pattern of growth has now been established. Now if shaving your head is on your radar or likely to be down the track in your future, then I really would like to caution against further surgery. If you are thinking about SMP then you will need to allow any scar 12 months to heal before having it performed. Scars go on healing for years as they change color after the first year and continue to soften and change. If you were looking at having further surgery then I would look at something like Eugenix who excel in Norwood 6/7 cases. To make up for lost grafts they would augment your surgery utilizing beard grafts to preserve your donor area as much as possible. Both for either future use and/or donor cosmosis.

Whichever way you go, take as much time as possible and do not do anything until at least a year after this FUT surgery. All the best!

[Curious25]

10 hours ago, elicochin said:

July 2019.

OP had orginally stated July 2019 as his surgery date, which I think threw a lot of the early posters towards a more negative tone. The fact that it has only been 10 months post op, isn't as bad as being almost 2 years post op, as was first perceived.

Maybe the Dr can elaborate more on the surgical plan, and what the strategy was/is going to be a second/third pass. All is not lost just yet. 

I would also defend the OP in response to the Dr's post, and don't think he has showed any bad form towards the Dr or clinic - if you read through his posts, he has always remained respectful and actually positive. Bit of a defensive reaction from Dr Lindsey, but I can empathise if he was reading through the thread on his phone whilst walking, as well as receiving emails on the case, he may have felt as though the world was crashing down on him, when in reality it wasn't - it was just the community helping advise one of his patients. 

 

[Gasthoerer]

7 hours ago, qui bono said:

Not to speak for @Gasthoerer directly, ....

There is nothing to add to this explanation👍

[elicochin]

Thank you all for your valuable comments and suggestions; that’s exactly what I was looking for. The timing of my post was just mere realization that emerging from the pandemic lockdown with some kind of hair was not going to work. So far, based on all comments, it is becoming apparently clear that 3000 grafts weren’t enough to cover the area that was targeted. It is also clear that the hairline was not packed enough to get a decent ‘appearance’. Another surgery is needed to address these deficiencies. What’s is not clear to me at this time is whether the best option for the next surgery would be another FUT or FUE. 

[Britanium]

@elicochinAs your going to need to maximise your donor area, and you already have a FUT scar then I would be choosing another FUT going forward. Maybe even a FUT/FUE combo transplant. 

[asterix0]

@elicochin What was the plan prior to surgery? Was it communicated to you that this is the result that you should expect?

I don't think it is anyone's intent here to bring scorn upon the doctor or seek confrontation, rather to just understand what happened in a factual manner, and perhaps offer some advice that could be helpful. 

 

[elicochin]

1 minute ago, asterix0 said:

@elicochin What was the plan prior to surgery? Was it communicated to you that this is the result that you should expect?

I don't think it is anyone's intent here to bring scorn upon the doctor or seek confrontation, rather to just understand what happened in a factual manner, and perhaps offer some advice that could be helpful. 

 

The plan was to address the hairline and frontal scalp. A second surgery was suggested to address the back not including the crown. My understating all along was that I would walk away with a decent amount of frontal hair with a matured and age appropriate hairline based on the previous cases (with thin/fine hair) that was shared as an example. Second surgery in the same area was never an option and I would not have agreed to it in the first place. What worries me right now is that I can still see most of the scalp through the hair and I am unsure how much more density I could achieve in the next 6 months or so. As my son says it's kind of looks 'wispy'. I had a bad feeling about the spacing of the grafts right after the surgery, but I wanted the time factor to play out so I waited. Right now, based on many comments, it's clear to me that I will not be able to have a natural looking frontal hair and it will take a miracle to get a decent coverage.

[Ryan Rap]

You need to make sure you plan carefully and maximize grafts. This most likely would mean going FUT at least once more before going FUE. Also just make sure to give yourself the best chance to improve your situation by going with the best surgeon for your case. I believe H&W would be a solid option given your situation. 

I believe you can still get a more natural looking hairline and decent coverage in your next procedure and we are here to help you out 

[elicochin]

5 minutes ago, qui bono said:

Ive already sent you a PM, but if those were your expectations you should check the density of the hairline yourself. You can cut out a 1cm square hole and then count the grafts like this chap

If its anything under 30 FU per cm you were always going to require a 2nd pass on the hairline and REALLY should have been informed of this prior to surgery. Im disappointed

I will certainly give this a try. Will let you know.

[Helios]

23 minutes ago, elicochin said:

I will certainly give this a try. Will let you know.

You might also consider grafts from your beard if you can go grow one as that will further help to fill things out. 

[SLA]

Looking on the bright side:

You are still only 9 months post operation so things can improve!

Your results, while not ideal are far from bad.

My very amateur guess is 500-1000 more grafts in that area would make a huge difference. Dr. Lindsey did get pretty far back in terms of surface area covered.

Also, you might try some dermmatch and/or fibers to thicken things up. Might be a good to see before moving to a more permanent SMP.

Looking forward to seeing your 12 and 18 month results.

Thanks for keeping us posted as we are here for support!

 

[elicochin]

@SLA I am definitely in agreement with your assessment. Also based on some other comments, I am also coming to a determination that another 1000 grafts can give me a 'decent' coverage that would allow me to go out in public without having to worry about looking 'fake'. Until then, I just need to figure out if I need to go back to my old shaved/trimmed look with the help of some SMP touch-ups. While SMP on the donor scar is an easier decision, SMP touch-ups on other areas is hard to decide because SMP may not be as temporary as advertised, based on some cases I have seen here. 

Edited May 2, 2021 by elicochin

[elicochin]

15 hours ago, Gatsby said:

Dr Lindsey is a well respected surgeon who is excellent in closing up FUT's. Obviously speak with him about what options he puts forward to you regarding your results. As you are now around the 8 month mark it is pretty safe to assume that the pattern of growth has now been established. Now if shaving your head is on your radar or likely to be down the track in your future, then I really would like to caution against further surgery. If you are thinking about SMP then you will need to allow any scar 12 months to heal before having it performed. Scars go on healing for years as they change color after the first year and continue to soften and change. If you were looking at having further surgery then I would look at something like Eugenix who excel in Norwood 6/7 cases. To make up for lost grafts they would augment your surgery utilizing beard grafts to preserve your donor area as much as possible. Both for either future use and/or donor cosmosis.

Whichever way you go, take as much time as possible and do not do anything until at least a year after this FUT surgery. All the best!

@Gatsby, as I can see from your profile/postings you have a good understanding and experience with SMP. In my case even if I do another HT down the road to fix the current HT shortcomings, I still need to find a temporary solution to bridge the time-gap so that I can go out without a hat/cap. One of the options I am considering is to go back to my old shaved/trimmed look with the help of some SMP touch-ups. While SMP on the donor scar is an easier decision, SMP touch-ups on other areas is hard to decide because SMP may not be as temporary as advertised, based on some cases I have seen here. I would love to hear your thoughts.

Edited May 2, 2021 by elicochin

[SLA]

43 minutes ago, elicochin said:

@SLA I am definitely in agreement with your assessment. Also based on some other comments, I am also coming to a determination that another 1000 grafts can give me a 'decent' coverage that would allow me to go out in public without having to worry about looking 'fake'. Until then, I just need to figure out if I need to go back to my old shaved/trimmed look with the help of some SMP touch-ups. While SMP on the donor scar is an easier decision, SMP touch-ups on other areas is hard to decide because SMP may not be as temporary as advertised, based on some cases I have seen here. 

For sure...go try a little dermmatch and fibers which might tide you over until this procedure matures fully/another procedure.

Keep us posted!

 

[Gasthoerer]

2 hours ago, SLA said:

My very amateur guess is 500-1000 more grafts in that area would make a huge difference.

Honestly, I tend to disagree. For me 2500+ Grafts are required. Maybe less (1500?) if the focus is really only the frontal 1/3 and midscalp is avoided. Therefore, I recommend to research very carefully, and visit at least 1-2 additional clinics in addition to the discussion with your current clinic. There are not much bullets left. 

Visit clinics which does mega session FUT like H&W and Hattingen.

Visit clinics which excel in BHT. 

Visit clinics who doe FUT/FUE combination...IMO you need to think also about donor homogenization to get a decent result. 

Edited May 2, 2021 by Gasthoerer

[Curious25]

I’m afraid it’s going to take a lot more than 500-1000 grafts to bring this upto a satisfactory result. 
 

IMO you’re looking at least another 1500 in the hairline and frontal 1/3 alone to bulk this area out and create an illusion of fullness. 
 

Like has already been aforementioned, large amount of real estate to be covered, with fine calibre hair is never an easy fight - which is why I think it is important for us to have answers from the Dr about what his strategy was for this case, and why he executed your surgery in this way. 
 

Hopefully you have >2000 grafts available from your beard, and some decent chest donor would also be a great help. If you can squeeze out another 4000 grafts from your scalp donor via both FUT and FUE, combined with some BHT and SMP, I think you’l be in a much better place, and close to obtaining your original goals. 
 

I agree, consult with a variety of surgeons and clinics that are renowned for mega sessions such as H&W and Hattingen - Eugenix, Mwamba, and Bisanga are all great options for using BHT . . And there are a few users who are pretty shit hot for advice when it comes to SMP, more specifically SMP for density, is what you need to focus on. 
 

In regards to your original Dr, it’s worth hearing his two cents, and overall analysis on your case - FWIW I think his response to you on here was pretty out of order as it came across as a post purely focused on self preservation, flipping it on the head as though he was the victim here at the expense of you and other posters trying to ‘scorn’ his reputation - which if you read back through the thread, was absolutely not, and has not been the case. 

I don’t know much about his work, as I’ve never seen a patient posted thread of his on here (not that I’ve looked), the only thing I can recall is a recent video where he advised against restoring temple points, which is an area of surgery I’d fully expect a world class doctor to be capable of doing. 

[Gatsby]

3 hours ago, elicochin said:

@Gatsby, as I can see from your profile/postings you have a good understanding and experience with SMP. In my case even if I do another HT down the road to fix the current HT shortcomings, I still need to find a temporary solution to bridge the time-gap so that I can go out without a hat/cap. One of the options I am considering is to go back to my old shaved/trimmed look with the help of some SMP touch-ups. While SMP on the donor scar is an easier decision, SMP touch-ups on other areas is hard to decide because SMP may not be as temporary as advertised, based on some cases I have seen here. I would love to hear your thoughts.

SMP would not be a good solution for this. Even though it begins to fade over several years it will still stay with you. More importantly you would have to wait at a ‘minimum’ of a year between surgeries for any scar to heal (preferably longer). Scars are unstable in the healing process and SMP in the scar can change color or migrate as the scar heals.