How do growth guarantees work, if donor is depleted

[Mike2098]

I am looking into getting a procedure for the crown area, within the next six months. I have narrowed it down to Dr Bicer and Dr Erdogan. I am leaning towards the latter because I want the temples reconstructed as well. Dr Bicer also does temple work, but I have not found many examples of her work, in that area online and was told it is a case by case thing. I am having trouble deciding because of some of the past negative Asmed reviews. I have already undergone a failed procedure before, so can't afford it again, because I have quite a large area to cover. Both clinics offer growth guarantees but if my donor is used up, how will they carry out a repair procedure. I don't know if anyone else has been in this position, so any help would be appreciated.

 

[Britanium]

Unless your choosing the top tier package where Dr Erdogan is actually performing part of the procedure I would choose Dr Bicer.

With a failed procedure already you don’t want a tech only procedure, much better to choose Dr Bicer who is one patient per day and involved fully. 

[Melvin- Admin]

There are no guarantees to surgery. Dr. Bicer has said she does not guarantee any work. Watch my interview with her, she’s one of the most ethical surgeons in Turkey.

https://www.instagram.com/tv/COVwlIcnqSh/?utm_medium=copy_link

[gillenator]

No guarantees that I am aware of.

[Raphael84]

The terminology "growth guarantee" is really quite misleading.

Medicine is not a perfect science and any certificates of guarantee issued by clinics have no real standing as each patient presents their own physiology and there can never be a "guarantee of growth".

Far more genuine and realistic is to understand what your preferred doctor/clinic perceive as acceptable growth, and in the event that growth does not meet this standard (generally a percentage), then they would agree to a "touch up".

In terms of "repair" surgery, this may present quite a different scenario.
Many patients are able to achieve impressive growth when revisiting the same recipient area. It is more common now due to low cost poor quality clinics and "repair" surgery is more in demand than ever and results can be extremely impressive.
Having said that, patients who have had poor to no growth from a previous surgery must attempt to understand why that occurred. If it was due to the poor quality of the previous surgery, then it is important to appreciate that if intending to revisit the same recipient area that is no longer "virgin scalp", this may create additional challenges due to potentially compromised skin and scarring which is now part of the patient´s physiology when beginning "repair" surgery and so depending on the status of the patient, growth may not be "guaranteed" in any way. Poor growth in a subsequent surgery may be due to the "damage" done from previous surgery. This is also in relation to the donor area. If previous surgery was aggressive with a poorly managed extraction pattern, decline may have occurred in the donor area. This may not be overly visible in terms of obvious over harvesting, but if too much demand was put on blood vessels below the scalp in the donor area due to a focused and heavy extraction pattern, follicles that were "untouched" may have been effected due to a compromised blood supply and therefore experienced some kind of miniaturisation.This is unfortunately one of the realities of repair surgery and highlights the importance of selecting the right surgeon first time round.

In virgin cases, poor growth with a quality physician is uncommon, but it can happen.

Crucial factors to consider are -

*The patients health

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

*Hair characteristics (viable candidacy)

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

*Operative day factors

*Choice of surgeon, equipment and techniques

*Patients skin, does the patients characteristics result in extreme popping or bleeding causing complication to surgery

*Correct post op care

*No chemical usage such as dyes or other products, Toppik or fibres post surgery

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, then it is harder to rule out any conditions. In the case of poor growth, one needs to understand why it happened and attempt to rule out any physiological influences such as some of the above.

Edited June 22, 2021 by Raphael84

[Britanium]

This is a post which needs pinning 👌 🙏

[Mike2098]

I guess growth guarantee was not the appropriate term to use in this case, since I know a few clinics that advertise this, mainly hair mills. I guess what I should have said that if a repair procedure would be possible, and I believe that is what some clinics will offer if the transplant does not turn out to what me, as a patient and the doctor expected. The main issue I am having is getting a true estimate for my donor capacity. Before my second procedure I consulted with several doctors, such as Hasson and Wong, and was told a procedure of even 3500 grafts FUT+FUE would be pushing my donor to the limit. After another 4300 grafts, procedure my donor area still looks good, so I was just curious what would happen, if I maxed out my donor for the third and hopefully last procedure, if it ended up failing. I went with a world renowed surgeon for the first procedure and to this day, still have no idea why it failed, so I have to prepare for the worst, just in case.

[Gatsby]

There is no such thing as a growth guarantee regardless of which doctor performs surgery on you. This is one of the biggest misnomers in this industry. No one can predict a person's physiology after under going a hair transplant. What may be considered good growth by one doctor may be considered poor growth by a patient. Growth is such a subjective concept that it can't universally be measured. A better guarantee is that the doctor and his/her team will do everything they can to give you the best growth possible. That however is not a guarantee.

[A Fue Good Men]

@Mike2098- please do yourself a favor and try not to jump into surgery too soon. The one piece of advice I would like to give is 1. go to a clinic that focuses on one patient per day and 2. has a doctor at least involved in most of the procedure including at minimum punching out the grafts. Stay away from clinics that are technician heavy meaning doing a large portion of work like extractions and also ones that are juggling multiple patients per day. 

 

when a doctor/clinic is juggling multiple patients a day there is a chance there will be insufficient planning among other issues. You don’t want to be a repair patient, it sucks.

 

it sounds like you’re looking at doctors in turkey. If you’re set on turkey there are really only a handful of doctors that should even be considered. Research wisely. Good luck

[Mike2098]

I won't rush into any procedure, made that mistake the first time. I just wanted to plan ahead, so the earliest I will undergo a transplant is January 2022. I have a 50/50 success rate when it comes to HTs, so I am going to take thing slow. While budget is not an issue, I did pay over 20k for my first procedure which ended up failing and leaving me in a bad situation, which is why I chose Turkey for my second procedure and likely will for the third as well. While I am happy with the results, I would like the type of results someone like Erdogan has produced with countless patients, so only then will I be truly satisfied. I know its risky, because of some of the past results I have seen. I would have preferred Hasson and Wong, truth be told, but like I mentioned they did not think my donor was suitable for even a second procedure

[Melvin- Admin]

On 6/22/2021 at 5:23 PM, Mike2098 said:

I guess growth guarantee was not the appropriate term to use in this case, since I know a few clinics that advertise this, mainly hair mills. I guess what I should have said that if a repair procedure would be possible, and I believe that is what some clinics will offer if the transplant does not turn out to what me, as a patient and the doctor expected. The main issue I am having is getting a true estimate for my donor capacity. Before my second procedure I consulted with several doctors, such as Hasson and Wong, and was told a procedure of even 3500 grafts FUT+FUE would be pushing my donor to the limit. After another 4300 grafts, procedure my donor area still looks good, so I was just curious what would happen, if I maxed out my donor for the third and hopefully last procedure, if it ended up failing. I went with a world renowed surgeon for the first procedure and to this day, still have no idea why it failed, so I have to prepare for the worst, just in case.

Have you gotten a biopsy. There was a case here recently where the patient had LPP. I would suggest you get a scalp biopsy to rule out any underlying conditions.

[Mike2098]

4 hours ago, Melvin- Moderator said:

Have you gotten a biopsy. There was a case here recently where the patient had LPP. I would suggest you get a scalp biopsy to rule out any underlying conditions.

I went to quite a few doctors and none of them suggested a biopsy, they thought it was a surgical error. I ended up asking for it myself and was told there was evidence of frontal fivrosing alopecia and genetic hair loss. Anyway they wrote that the results were inconclusive, so it just left me and the doctor confused. We did another biopsy and this time it just said inconclusive without the additional comments. Unfortunately I have had issues with the medical system here, my brother who is 18 was told he had arthritis because the doctor analysing it did a poor job. Similarly my sinus issues were left undiagbosed for the same reason of misreading xrays and was only diagnosed by going to my dentist, so I do have issues trusting what the doctors are telling me. My hair has grown after the second procedure, so hopefully things will turn out okay.

[Melvin- Admin]

35 minutes ago, Mike2098 said:

I went to quite a few doctors and none of them suggested a biopsy, they thought it was a surgical error. I ended up asking for it myself and was told there was evidence of frontal fivrosing alopecia and genetic hair loss. Anyway they wrote that the results were inconclusive, so it just left me and the doctor confused. We did another biopsy and this time it just said inconclusive without the additional comments. Unfortunately I have had issues with the medical system here, my brother who is 18 was told he had arthritis because the doctor analysing it did a poor job. Similarly my sinus issues were left undiagbosed for the same reason of misreading xrays and was only diagnosed by going to my dentist, so I do have issues trusting what the doctors are telling me. My hair has grown after the second procedure, so hopefully things will turn out okay.

Are you able to travel? Sounds like you may have an underlying condition maybe scarring alopecia or something, best to make sure before getting more surgery.

[Mike2098]

2 hours ago, Melvin- Moderator said:

Are you able to travel? Sounds like you may have an underlying condition maybe scarring alopecia or something, best to make sure before getting more surgery.

Not yet, but I will be getting the second dose of the vaccine soon and was thinking of going to Hasson and Wong, since I live quite close to Vancouver. I saw Dr Gillespie since I live in Alberta, but he did not think scalp issue were the cause and prescribed me propecia when I last went to him. I was not taking it then, and my hair loss was quite aggressive, although it stopped once I started taking it two yrs ago

[gentel_man83]

On 6/23/2021 at 1:18 AM, Raphael84 said:

*No chemical usage such as dyes or other products, Toppik or fibres post surgery

I though all fibers products are safe and not damaging hair follicles or the scalp in any how!

@Raphael84can you explain please?

[ITA]

14 minutes ago, gentel_man83 said:

On 6/23/2021 at 12:18 AM, Raphael84 said:

*No chemical usage such as dyes or other products, Toppik or fibres post surgery

I though all fibers products are safe and not damaging hair follicles or the scalp in any how!

@Raphael84can you explain please?

I think he was referring to the use of the products, hissed after the transplant, that is, when the scalp is still in the healing phase.

[Raphael84]

All doctors will have their own post surgery protocols and instructions that can differ somewhat from other clinics. 
As patients we invest so much of ourselves into hair restoration surgery in terms of the emotional side and of course the time investment in consulting with doctors and researching and educating ourselves. The financial aspect is also a significant factor in the process for each of us.
With this in mind, the importance of presenting the most optimal environmental factors that allow a healthy scalp pre surgery, and the best opportunity to heal and recover post surgery, as well as a clean and healthy scalp post surgery can be influential.

All users have a different idea of what an appropriate amount of fibres may be. The very nature of fibres is that with more hair loss, more fibres must be applied. This isn't ideal especially post surgery as individuals may be attempting to conceal redness or larger areas of scalp and therefore as a result, apply more fibres than preferred. 
I dont suggest that fibres harm hair follicles, but they do neither present the healthiest scalp environment post surgery with so much at stake after a transplant.

I have seen on numerous occasions patients present themselves for consultation be it pre or post surgery, and despite having washed their hair and scalp, fibres are still present meaning that in such cases, they are likely constantly present to some degree. They stick to the scalp as opposed to hair follicles as they should. This is obviously not optimal and can negatively impact the scalp and therefore potentially influence growth.

Edited June 25, 2021 by Raphael84

[SLA]

On 6/22/2021 at 6:18 PM, Raphael84 said:

In virgin cases, poor growth with a quality physician is uncommon, but it can happen.

Hi @Raphael84- You mention here that poor growth is uncommon on a virgin scalp with a quality doctor.

Is there a percentage estimate you feel comfortable sharing? I have seen some doctors say that 95-98% of HTs are 'successful'.

Curious to know your thoughts on this.

Thanks!

 

[Melvin- Admin]

14 hours ago, Mike2098 said:

Not yet, but I will be getting the second dose of the vaccine soon and was thinking of going to Hasson and Wong, since I live quite close to Vancouver. I saw Dr Gillespie since I live in Alberta, but he did not think scalp issue were the cause and prescribed me propecia when I last went to him. I was not taking it then, and my hair loss was quite aggressive, although it stopped once I started taking it two yrs ago

Definitely visit Hasson and Wong, you may want to reach out to Dr. Nakatsui who’s also in Canada, believe he’s a dermatologist but I could be wrong.

[Raphael84]

2 hours ago, SLA said:

Hi @Raphael84- You mention here that poor growth is uncommon on a virgin scalp with a quality doctor.

Is there a percentage estimate you feel comfortable sharing? I have seen some doctors say that 95-98% of HTs are 'successful'.

Curious to know your thoughts on this.

Thanks!

Great question and I think the most important point to highlight is that you asked regarding quality doctors. It is very important that it is understood that not all FUE is performed to the same standard and this hugely influences the percentage of successful results. 

I would suggest that with very elite physicians, that is an accurate range.

There are many elements to a successful surgery. 

To begin with we need to ascertain, what does successful mean for each individual case.
What may achieve satisfaction in one patient may not be possible for another, and so therefore it is important that a thorough consultation is performed to be able to provide both the doctor and patient with the necessary data to be able to understand what may or may not be possible, and if surgery is even feasible. 

If a thorough consultation is not sufficiently performed, then naturally the chance of potentially unsuccessful surgery will increase as surgery may be performed on patients with high levels of miniaturisation for example that may not be good candidates.
 
Without thorough education provided by the clinic regarding each individual case and ensuring realistic expectations are understood, then a great result could be achieved which may not satisfy the patient, as his/her objectives were not in line with that of the clinics and what could realistically be achieved.

Providing all of the above are met, then I would suggest that rates of success are very impressive with the elite.

Your choice in doctor will be the biggest influence on the success of your result.