~2200 Graft FUT with Carlos Wesley, NYC, 7/21/21 2nd Surgery 539 grafts, 7/14/22

[John1991]

It's difficult to tell if it's dense enough simply because the existing hair makes it hard to see the graft placement.  Based on the last picture, I think it probably is and you'll likely end up satisfied.  

Edited July 16, 2022 by John1991

[asterix0]

Hoping everything turns out well man, will be checking in here to see your progress!

Did Dr. Wesley give you an explanation why the first transplant density wasn't high enough? It did look like from your initial pictures he just didn't put enough grafts, but I think you got practically full yield from the ones he did put.

Edited July 17, 2022 by asterix0

[washingtondc]

Since a couple of people have asked: No, he didn't really comment on or discuss why the density at the front wound up the way it did after the first procedure. Things are always done very quickly/efficiently in the office and conversation was directed right off the bat towards what was going to be done for this procedure to improve things.

[washingtondc]

Also @Melvin- Moderator (or anyone else who's a mod, not sure if there is anyone else) I haven't seen how to edit the thread title to add a note about the second procedure (Long-hair FUE, 539 grafts, 7/14/22) since it's all going into one thread, but maybe it will let you?

Edited July 18, 2022 by washingtondc

[hairbackpls1]

hey man thanks for keeping us all up to date. I checked in here because i remember we both had our Wesley appt around the same time last year. Glad to hear you got a 2nd procedure as it sounded like you weren't too happy with the first one.

I need to post pics as my 1 year just hit today. I would say i am very happy with the overall result. I definitely look like a new person and have so many more styling options. However I can clearly see where some areas are less dense than others and already know I will be going back for a 2nd procedure to really boost the look. Probably next year though.

Anyway keep us posted on this 2nd procedure - I hope it gives you that density you are looking for. By the way did you have to pay for this 2nd procedure or was some / all of it waived since you had that scar issue?

[washingtondc]

PMed with some questions and info.

[washingtondc]

Today is 13 days post-op. Yesterday I went back to the office to have the glue in the back wide-scar area removed, and the grafts back there seem to have done fine fortunately.

 

I probably won't fully know how natural that area actually looks until whenever I cut my hair short again; the grafts back there look maybe barely not quite as dense as the native hair, but hopefully that won't matter, and the back is way less important to me than the front.

The front is doing its thing, I'm not sure it's really possible to closely monitor the early progress there because it's all mixed in with the previous hairs. From what I could feel in the first days via stubble, it seems like most of the grafts were added to the right side and center, with less on the left. I've been at my office all this week and I'm really hoping sufficient density was added, cause any overhead lighting just cuts right through it to the scalp currently.

Recovery from this procedure was far easier than the first one, I didn't have to deal with a suture area bleeding/scabbing at all and there was virtually no facial swelling. Far fewer grafts were added as well which made things easier on the recipient region. I just hope it was enough.

Edited July 27, 2022 by washingtondc

[BigMike27]

Keep us posted - were all rooting for you. Bet this result is going to be great and can't wait to see your pics as it grows in. 

[washingtondc]

Thanks, I really hope so. I've been out and about a lot more recently which is nice pandemic-wise but also has really thrown into focus the fact that even environments I thought it looked good in actually really are kind of rough.

More photos of what I'm trying to fix, in a room with the lights off on an overcast day, about 6 feet away from the window:

This is actually a case where the camera makes it look better than in person for once, it's a little more glaring in real life. The hairline from that diagonal angle just looks kind of pluggy to me, and the front obviously looks like balding because you can see straight to scalp, even in this low-ish lighting. I'm thinking/hoping that front shot will be fixed once this one grows in (that was kind of the whole point at least...). The right side hairline I'm more worried about. We added grafts behind the hairline (and a lot on that right side) but I don't know enough about this to know if that will actually eliminate the semi-barcode type vibe that's going on on that side (again, it's more blatant seen with eyes). Fingers couldn't be more crossed.

[BigMike27]

I think you're going to have a great result. Looking forward to 3-4 months out and seeing pics.

[Rolo]

Hi again, I am female and have posted before; I am  almost 5-1/2 months post with Dr W, and with same concerns.   I forwarded photos and he said in the 6 month mark would (should?) start filling in with each month thereafter showing more density; I hope so.   I hope doesn't require a second procedure.....

[Rolo]

 I think the second procedure for you will turn out exactly what you expected initially.   Pls keep us posted.......as I have been following this closely.

[washingtondc]

Wanted to update as I'm now at over a month. No improvement obviously, maybe a little bit of regression from shock loss; I kind of forgot having to do a second procedure would also mean a second round of that.

 

Normal front:

Left side:

Right side, very straight-liney/unnatural currently:

Front with hair loose, virtually see-through in frontal/above lighting:

 

The apprehension that ~475 grafts still wasn't enough to do what actually needed to be done is definitely there; there's just so much space in those gaps. But there's not much going on at one month aside from shock loss, so wasn't expecting any change here anyway.

Edited August 24, 2022 by washingtondc

[Ryan Daniel]

The reason you are seeing it very straight and unnatural is because they are implanted with a very strong upwards direction. I'm not sure what month you are in, but you may find yourself requiring a touch up for some extra density

[washingtondc]

49 minutes ago, Ryan Daniel said:

The reason you are seeing it very straight and unnatural is because they are implanted with a very strong upwards direction. I'm not sure what month you are in, but you may find yourself requiring a touch up for some extra density

This is one month after a second procedure to add density to the first.

[washingtondc]

I realized I hadn't posted the photos I received that were intra-operative:

Given these, and the pretty fine caliber size of my hair, do people think this will hopefully resolve the situation? The main thing I'm hoping for is to improve the density so the front looks thicker/non-see-through and also to make the right side look more natural.

Edited August 24, 2022 by washingtondc

[Ryan Daniel]

Excellent, thanks for the update and I apologize for not reading your entire history. I wish you good luck 

[washingtondc]

Looking at those intra-op photos closely for the first time, it's kind of crazy to me just how heavily grafts were added to the right side vs the left. If you drew a line down the middle, I feel like probably more than 2/3 of the grafts were used on the right side of the line (left side from photo's perspective). Hopefully that doesn't result in the left looking strange compared to the right 😅

Edited August 24, 2022 by washingtondc

[Vann]

1 hour ago, washingtondc said:

Wanted to update as I'm now at over a month. No improvement obviously, maybe a little bit of regression from shock loss; I kind of forgot having to do a second procedure would also mean a second round of that.

 

Normal front:

Left side:

Right side, very straight-liney/unnatural currently:

Front with hair loose, virtually see-through in frontal/above lighting:

 

The apprehension that ~475 grafts still wasn't enough to do what actually needed to be done is definitely there; there's just so much space in those gaps. But there's not much going on at one month aside from shock loss, so wasn't expecting any change here anyway.

Only 475 wow… did you have to pay anything for this touch up?  And you’d be surprised how shock loss can make you look worse until it happens.

39 minutes ago, washingtondc said:

I realized I hadn't posted the photos I received that were intra-operative:

Given these, and the pretty fine caliber size of my hair, do people think this will hopefully resolve the situation? The main thing I'm hoping for is to improve the density so the front looks thicker/non-see-through and also to make the right side look more natural.

Additionally, thank you for sharing your photos once more. I think 475 grafts can go a long way but it depends on your graft count. Since you have finer hair I’m sure you would want more triples than singles. But since it’s in the front maybe more doubles? I’m not exactly sure but think of it this way. 
 

475 x 1 = 475 hairs

475 x 2 = 950 hairs

475 x 3 = 1,425 hairs

and so on… 

 

assuming that you have a combination of different grafts in a smaller surface area I think your concern for a future touch up may not be necessary.

overall, I think given your skin contrast, hair color, and hair quality play against each other. This smaller procedure may be the solution. It sucks you can’t fast forward it but I am sure you’ll be where you need to be in no time.

[washingtondc]

43 minutes ago, Vann said:

Only 475 wow… did you have to pay anything for this touch up?  And you’d be surprised how shock loss can make you look worse until it happens.

Additionally, thank you for sharing your photos once more. I think 475 grafts can go a long way but it depends on your graft count. Since you have finer hair I’m sure you would want more triples than singles. But since it’s in the front maybe more doubles? I’m not exactly sure but think of it this way. 
 

475 x 1 = 475 hairs

475 x 2 = 950 hairs

475 x 3 = 1,425 hairs

and so on… 

 

assuming that you have a combination of different grafts in a smaller surface area I think your concern for a future touch up may not be necessary.

overall, I think given your skin contrast, hair color, and hair quality play against each other. This smaller procedure may be the solution. It sucks you can’t fast forward it but I am sure you’ll be where you need to be in no time.

Well, we can probably math this I guess. This was the breakdown of graft numbers:

Singles - 31

Doubles - 474

Triples - 34

For 1081 hairs total.

From this intra-op photo, I count about 57 spots for grafts that were used to repair the enlarged scar in the back.

I'd have to assume that no singles were used back there and it probably made the most sense to use all the triples in the back rather than close to the hairline, so that would mean 34 triples went back there and 23 doubles, for 148 hairs total. This would mean that 482 grafts, and potentially 933 hairs went to adding density to the front region.

Think that's enough?

Edit: Looking at it more, it might even be like... 3/4ths of the frontal grafts that were used on the right side (left in photos). I definitely want to improve how natural the right looks, but the left needs more density too... Just kind of a shocking disparity.

Edited August 24, 2022 by washingtondc

[John1991]

I don't see much of an issue with the graft angles personally.  I think the issue with the first procedure was just a pure lack of density - as you rightly recognized from the start.  You weren't crazy and you weren't wrong - though perhaps you responded less well than would be ideal, it's understandable very soon post-op how frustrating it would be to know that the transplant wasn't going to "work" even if every graft grew.  I think it'd easier to see how this touch up will turn out if your head was shaved in the front, but being able to tell means nothing - how it looks in the final analysis is everything.  Bottom line, you had roughly 2700 grafts placed in pretty much exclusively the frontal hairline, you have a chance for success here - that's pretty on par with most good results.  Lets take the negative view and say you have finer hair than most.   OK, well 2700 grafts is actually more than most frontal hairline restoration results require, so that could certainly account for the finer hair caliber.  

Edited August 25, 2022 by John1991

[Melvin- Admin]

I have gone ahead and updated your title. I do believe you needed the second procedure for added density. Now, it's back to the waiting game.

[washingtondc]

Updating for 2 months.

No crazy change or anything, as to be expected. When I look super close up in the mirror, I can see the beginnings of some hairs just starting to pop out, but hard to photograph with a phone. Also realizing that how it looks in photos is kinda dependent on how greasy and reflective my noggin is heh, will try to start doing photos at the same time interval after I've showered/without having gone to the gym lol.

Front:

Left side:

Right side:

It's still surprising to me how unnatural (comparatively) the right side looks as opposed to the left. In these phone photos here it doesn't seem that big a difference, but in real life, left side looks pretty believable in low/side lighting, but right side looks almost like someone took a pencil and drew a bunch of straight lines, heh.

How left looks without overhead lighting:

How right looks without overhead lighting:

In this second procedure it seemed like way more grafts were added to the right side than the left, so maybe that will help correct things, but I'm not sure. At this stage to my eye it seems like the actual very edge of the hairline itself is contributing to how it looks, and I'm not sure if adding stuff behind that will change that visually. Maybe it will, I'm no expert. Early days for this revision still.

Edited September 20, 2022 by washingtondc

[Vann]

It’s coming up. Slowly but surely. 
 

i do agree photos make things look completely different. But that’s also because things like you said lighting, hair/skin texture, and all other things considered take into play.

 

also the thing you mentioned about how it looks different in person than on photos (left vs right sides) really is subjective because you’re looking at yourself forward. I thought the same thing when I do it but I have a mirror that can reflect straight instead of inverse and it definitely plays tricks on your eyes. For now I recommend you just keep note of how it looks and let time pass to see how it progresses. 

Thanks for the update looking forward to your month 3. 

[washingtondc]

Not at 3 months yet but wanted to update with some recent pictures that highlight just what needs to happen for things to look natural.

This is side-lit (no overhead lighting) inside of a windowed room that's maybe 20 feet inside of the outer layer of windows (so nowhere near the actual sunlight):

It's kind of mind-boggling in a way to me how the first procedure was ever sold as something that was going to be a full result. Even with a bit of stubble starting from the second procedure and no overhead lighting, the hairline looks kind of strange and it's extremely easy to see the line where my previous, thinned hairline originally was.

Side-lit again:

The front-right portion looks kind of like a pencil-drawn arc or something.

In more overhead-lighting, though still at an angle:

Just so much empty space. I almost want to joke that if I didn't know better, I must have asked "I want to lower the hairline just a smidge but look equally or more like I'm balding" lol.

I know that there's barely anything from the second procedure contributing yet but I just really don't know that the judgement that fewer than 500 grafts would be sufficient to fix this was correct. There's just so far to go/so much to fill...

Keeping holding out hope though, for the second time.