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

[washingtondc]

I've been using this forum a ton over the past months to plan out who would work best as a surgeon for my procedure. I wanted to pay it forward and provide updates with my experience with Dr. Wesley, especially because (while he seems to be highly regarded) there don't seem to be a ton of member-created reviews, progress pictures, patient experiences, etc. for him. So I figured I'd add mine.

I'm a 31 year old male who first started noticing my hair thinning probably just about a decade ago. I went on finasteride in 2012, and have been using it on and off since (no real sides, I just did a bad job meeting with my primary care physician to re-up my prescription when it ran out, and as a result, had a few periods of maybe 9 months or so when I wasn't on it. I was off it for a decent amount of 2020, but just got back on again just over two months ago in May '21. I' also used  topical minoxidil and dermapen some in the past year or two, but wasn't terribly consistent with it (probably not enough or for long enough to see results). I'm now approximately a NW 3.

I had an extremely stressful psychological event happen in mid March of this year, and a month or so after, I started noticing an increased amount of hair shedding out in showers. I have very long hair for a guy (pictures below) so the shedding was very obvious, and that's what caused me to get back on Fin asap. Since then (especially since June) my hair has been shedding at an alarming rate (maybe 200 hairs per day), and seems to be shedding from the back and sides of the head rather than just the area affected by MPB. This has led me to believe that I may have telogen effluvium as well. Unfortunately I had already scheduled and put down a $5000 deposit with Dr. Wesley before I realized this was likely the case, but I discussed things with him and he seems assured that if I have TE, it won't result in a worse transplant result.

I did a consult with another surgeon (located in Ft. Lauderdale, FL) previously before finding this forum, but once I saw more reviews and the surgeons that have been vetted by this community, I decided Wesley was likely my man. The main factors in this decision were his excellent reputation on this board, the many, many quality and natural looking results he posts regularly, and (importantly) the fact that he was taught to do hair transplants without shaving the recipient area. I like my hair long; it took me two and half years to get it to this length, so having to shave it would likely be a deal-breaker. I went FUT because I could just shave and remove the strip from the back and the long hair back there will hide the sutures/scar. I did an in-person consult with Dr. Wesley about a month ago and came away impressed; he seems to know his stuff and is very friendly.

I arrived at 10:30 AM this morning having spent the night in NYC the night before (I'm from out of town). When I arrived, we did a brief recap of the plan for the hairline that we had laid out during the initial consult, and made a few very minor tweaks. I was given Valium and Vicodin, changed into scrub-type gear, and then was off to the races. My donor strip was shaved first and then removed, as well as the implantation slits created, which took a few hours. The combination of Valium and Vicodin made me extremely drowsy, and so I was in and out of consciousness for the entirety of the procedure, but I felt just about 0 pain (just the initial pin prick feelings to numb the scalp). When I awoke, I took a bathroom break and then the technicians began implanting the grafts. This took a few hours again, and I again dozed for much of the procedure. Approximately 2200 grafts were implanted; I'm hoping to get the exact number and follicle breakdown tomorrow. When they were finished, I took a quick few immediate post-op photos, and then my head was wrapped in a bandage. I'll be returning tomorrow morning to have the hair areas cleaned and to receive final post-op instructions.

Below are a variety of photos I've taken over the last 3 months to try to get a good sense for the current state of my hair. Some of them are in harsh lighting with the hair clean, some are in complementary lighting with the hair dirty, some wet in harsh lighting, etc. I also tried to include as many angles as I could so I have as many reference points as possible to compare to in the future. I'm definitely going to be continuing on Fin (more rigorously now) and will likely also add oral Minoxidil into my stack as well, assuming it doesn't produce side effects as I introduce it gradually. Really worried about shock loss of the pre-existing hair and hope that's kept to an absolute minimum, because if you lose a 2-inch hair to shock loss, it's not that big a deal; it will regrow and be the same length in just a few months. Losing hair that's my length is way more of a gut punch because it will literally take 2 years or so for it to regain that length, so for that reason I'm hoping to be fortunate and only experience a little.

Thanks to everyone who's shared so many experiences and so much information on this forum; it really helped me to make a decision. I'll be updating this thread fairly regularly (and hopefully wont be obsessively checking myself every day and/or freaking out when I hit the ugly duckling phase).

[Melvin- Admin]

Thanks for your review, Dr. Wesley is one of the best. Can’t wait to see your updates. I have no doubt you’re gonna look great in 12 months 🙌🏼

[Britanium]

What a superb write up. Very detailed. You chose well. Look forward to seeing your subsequent updates ! 🙏

[washingtondc]

So, we unfortunately ran into a little bit of a minor snafu with my procedure. I guess my scalp laxity was tighter in the middle portion of my donor than it was on the sides. So Dr. Wesley reached the middle suturing the strip back up, and the middle portion didn't quite reach back together in the usual way. So he had to use different sutures in that portion and there's a bit of a small gap that he says will likely result in a dime-sized bald spot/potential scar; he's offered to FUE hairs into that region free of charge in 6 months or so.

A little disappointing to know I likely won't wind up with the pencil-thin scar you're supposed to in that region but I pretty much always have long enough hair (and intend to have long enough hair) that it hopefully won't be noticable, but at least he's offered to graft into that area to somewhat repair it. I also have to wear a heandband-shape bandage to allow that area to heal for a few extra days, and may need to have the sutures taken out in a two-step process rather than all on the same day.

Has anyone here ran into this issue in with an FUT where the middle scalp laxity doesn't allow for normal suturing?

[washingtondc]

Adding pictures from 24 hours post-op. I have to wear the headband bandage because the back of my head is still bleeding.

So still really curious about this suture laxity issue. Did I really spend months researching this, narrow things down to a premier hair surgeon in the country that I travelled hours to get to, take things pretty conservatively and still run into an issue that no one on this board has ever seen before? That would definitely be my luck this year so far.

The suture gap tightness is getting quite annoying, I have to be extremely careful when I eat because if I open my jaw too much, it moves/tightens the skin on the scalp, and it seems to pull the gap apart some and cause more bleeding. I've taken to blending my meals in a Cuisinart before eating to try to avoid chewing as much as possible, but I still have to move my jaw some. I can post a picture of the gap if people aren't too squeamish, it's basically just like a wider part of the suture line where there's space between the edges and a little blood.

Has no one run into this before?

Edited July 23, 2021 by washingtondc

[Britanium]

@washingtondcwould you be able to show a pic of the FUT scar ? Thanks 🙏 

[Britanium]

I know it’s not ideal but at least Dr Wesley will do his upmost to rectify it as much as possible. FUE in to the area will definitely help. In a way Im glad it was Dr Wesley as another Dr/Clinic might not have done so well. I have been on the forum  for about a decade and have seen all sorts of FUT scarring. I don’t think yours will end up noticeable. Especially after the FUE is done. 

[washingtondc]

10 minutes ago, JohnAC71 said:

I know it’s not ideal but at least Dr Wesley will do his upmost to rectify it as much as possible. FUE in to the area will definitely help. In a way Im glad it was Dr Wesley as another Dr/Clinic might not have done so well. I have been on the forum  for about a decade and have seen all sorts of FUT scarring. I don’t think yours will end up noticeable. Especially after the FUE is done. 

Okay, thanks; that's reassuring. I hope that's the case. This would all be super easy if it had all just sutured up normally, this just makes it annoying/complicated because I did long-hair so the blood all gets into it and dries and just further complicates cleaning/sleeping/etc. Hopefully the bleeding will stop in a day or two and it will all be smooth sailing from there. Appreciate the input.

[Britanium]

20 minutes ago, washingtondc said:

Okay, thanks; that's reassuring. I hope that's the case. This would all be super easy if it had all just sutured up normally, this just makes it annoying/complicated because I did long-hair so the blood all gets into it and dries and just further complicates cleaning/sleeping/etc. Hopefully the bleeding will stop in a day or two and it will all be smooth sailing from there. Appreciate the input.

I had a horrible stretched scar from my 2 FUT procedures. Years later I had it revised and it’s so much better. I hope that yours will turn out ok. 🙏

[washingtondc]

Suture issue aside, how do the grafts and transplant look to everyone? Density okay? Every time I see intraoperative photos from Wesley I was always impressed because it seemed like somehow a lot of the grafts never even had the initial red ring around them; they're just tiny bristles that blend into the skin. So there are actually a lot more hairs there than there are red spots, which kind of seems to be different from the impression I get of most post-op photos.

[washingtondc]

On 7/23/2021 at 5:29 PM, washingtondc said:

Suture issue aside, how do the grafts and transplant look to everyone? Density okay? Every time I see intraoperative photos from Wesley I was always impressed because it seemed like somehow a lot of the grafts never even had the initial red ring around them; they're just tiny bristles that blend into the skin. So there are actually a lot more hairs there than there are red spots, which kind of seems to be different from the impression I get of most post-op photos.

Warning, gross/dried blood pictures in next post.

[washingtondc]

So I'm now 6 days post-op, and starting to take a closer look at the actual grafts and placement and density, and going through the traditional rite of passage of being slightly apprehensive. Hopefully I'm way off here. Initial picture for frame of reference:

Then a zoomed in crop:

 

Then a zoomed in comparison where I've highlighted 8 of my thinned out existing hairs in green and 8 of what I can see to be transplanted hairs in blue:

 

Obviously, the density of my thinned existing hair appears far greater than what it looks like the density of the transplant zone is? Like, unless there are grafts that have been transplanted that have literally 0 stubble sticking through (none of my grafts have fallen out or started shedding yet), this is a pretty big difference? Further, since a decent number of grafts have been transplanted into that area where I have existing hair now (pending whatever is permanently shocked out) the density there is only going to increase, just furthering the disparity? Hopefully I'm way off or missing something here; I'm not sure how I'm not going to wind up with a distinct and unnatural looking line a couple centimeters wide at the edge of my forehead...

I'm well aware that a transplant will never achieve initial/natural density; but the entire reason I did a transplant was because my existing hairline had thinned far below natural density (far beyond 50% thinner) already, so the density there is already extremely thinned out/see-through. I can't really imagine what this frontal region is going to look like unless I'm misunderstanding something; can anyone here explain or have you seen this turn out alright?

Thanks very much. I doubt I'm the first to scrutinize the difference in density, but it just seems like a large difference to me.

Edited July 27, 2021 by washingtondc

[pre-screened]

Quick take on this - is you want a feathered look.......less dense at the hairline gradually moving back into thicker 'wall' of hair behind

What your describing above is exactly how a natural hairline would look.........you want the density disparity.....you want the existing hairs behind your new hairline to be beefed up with way more grafts such that your hair INCREASES in perceived density as it moves back into the mid-scalp.

I would also say that at the Day 5 it is very possible some of the grafts implanted have shed their hair shaft leaving only the root behind under the skin where you cant see it. Predicting what your final result will be from photos taken in your bathroom mirror is, as any prior HT patient will tell you, a fruitless and pointless exercise. Its frankly a waste of your time.......dont waste the next few months looking in the mirror for hours & looking at photos on your phone............everything is baked in the cake right now.......you'll see your final results in the next 12 - 18 months. You picked IMO one of the best surgeons in the world and used an appropriate amount of grafts for the area. My expectation for you is a killer natural result

My suggestion in terms of monitoring - is pick a day each month where you stand in the same place and take a few pics in the same light (& of course share your pics here)......and do your best to forget about it for the rest of the time

[washingtondc]

5 minutes ago, pre-screened said:

Quick take on this - is you want a feathered look.......less dense at the hairline gradually moving back into thicker 'wall' of hair behind

What your describing above is exactly how a natural hairline would look.........you want the density disparity.....you want the existing hairs behind your new hairline to be beefed up with way more grafts such that your hair INCREASES in perceived density as it moves back into the mid-scalp.

I would also say that at the Day 5 it is very possible some of the grafts implanted have shed their hair shaft leaving only the root behind under the skin where you cant see it. Predicting what your final result will be from photos taken in your bathroom mirror is, as any prior HT patient will tell you, a fruitless and pointless exercise. Its frankly a waste of your time.......dont waste the next few months looking in the mirror for hours & looking at photos on your phone............everything is baked in the cake right now.......you'll see your final results in the next 12 - 18 months. You picked IMO one of the best surgeons in the world and used an appropriate amount of grafts for the area. My expectation for you is a killer natural result

My suggestion in terms of monitoring - is pick a day each month where you stand in the same place and take a few pics in the same light (& of course share your pics here)......and do your best to forget about it for the rest of the time

Thanks; that's helpful. Comparing it to pictures from Day 1/2 I don't see any missing grafts, but entirely possible. 

My nature is to be kind of analytical/scientific so I always wind up scrutinizing this sort of thing. I know from being on here that it's truly a waiting game and I'm going to have to change a bit for this process and be less focused. I wanted to make sure it didn't look like a big issue to any/all of you who have been seeing this process for years, because I'm still quite new compared to a lot of the veterans on this site. Thanks for your perspective.

[pre-screened]

Yep everything is as expected in your case - not a single thing I can see that points to anything out of the ordinary or unusual.....rather the opposite I see top class work from a top class surgeon. Yes the slight opening of FUT wound in the back is not ideal but it looks no more than an inch or so........the wound either side of it looks absolutely stellar already you'll have tiny tiny linear scare.

The natural constituency of the hair transplant patient is to be somewhat obsessive/anyatlical/OCD......its these very traits that get people focused on their hair loss and then ultimately give them the drive to go to the doctor and then get into the chair.

Its hard to 'let go' when your scrutinizing led you to pull the trigger on the operation but the way I handled it is that ultimately you went and did something about the issue bugging you but now you need to park the scrutinizing as it plays no positive role moving forward. It had its uses in getting you to address the problem all it will do now is increase stress/anxiety which is a minor net negative for your future result. The best scientific approach for the benefit of your result is to forget about it and go for walk every-time you wanna spend an hour analyzing zoomed in photos  

Edited July 27, 2021 by pre-screened

[Melvin- Admin]

This might help

 

[washingtondc]

19 hours ago, pre-screened said:

Quick take on this - is you want a feathered look.......less dense at the hairline gradually moving back into thicker 'wall' of hair behind

What your describing above is exactly how a natural hairline would look.........you want the density disparity.....you want the existing hairs behind your new hairline to be beefed up with way more grafts such that your hair INCREASES in perceived density as it moves back into the mid-scalp.

Was thinking about this a bit more and got a little confused reconciling it with what I thought I knew. Just for the sake of learning and discussion: I thought the conventional wisdom with HT was that you were supposed to fill the hairline as densely as possible (as that's the front and what everyone sees) and then you can decrease in density as you move back, as further back becomes less and less visible.

What you're describing here is the inverse of that, the hairline being more sparse and then a denser "wall of hair" starting behind it. 

That's why we see people like Hasson and Wong really dense-packing the hairline, making that the densest part of the scalp, and then lesser farther back. Is that not kind of the opposite of what we're describing here, with the front few centimeters being less dense than the hair directly behind it?

Thanks, just always trying to understand/learn and it seems I may be misunderstanding something.

Edited July 28, 2021 by washingtondc

[Melvin- Admin]

2 hours ago, washingtondc said:

Was thinking about this a bit more and got a little confused reconciling it with what I thought I knew. Just for the sake of learning and discussion: I thought the conventional wisdom with HT was that you were supposed to fill the hairline as densely as possible (as that's the front and what everyone sees) and then you can decrease in density as you move back, as further back becomes less and less visible.

What you're describing here is the inverse of that, the hairline being more sparse and then a denser "wall of hair" starting behind it. 

That's why we see people like Hasson and Wong really dense-packing the hairline, making that the densest part of the scalp, and then lesser farther back. Is that not kind of the opposite of what we're describing here, with the front few centimeters being less dense than the hair directly behind it?

Thanks, just always trying to understand/learn and it seems I may be misunderstanding something.

There are two schools of thought. Dense-packing and then moving back for additional coverage, or covering more area with less density and adding density with subsequent procedures. Check out this thread and article 

 

[TheManeMan]

Your hair line design looks great. Really looking forward to seeing how you progress.

[pre-screened]

On 7/28/2021 at 9:50 AM, washingtondc said:

Was thinking about this a bit more and got a little confused reconciling it with what I thought I knew. Just for the sake of learning and discussion: I thought the conventional wisdom with HT was that you were supposed to fill the hairline as densely as possible (as that's the front and what everyone sees) and then you can decrease in density as you move back, as further back becomes less and less visible.

What you're describing here is the inverse of that, the hairline being more sparse and then a denser "wall of hair" starting behind it. 

That's why we see people like Hasson and Wong really dense-packing the hairline, making that the densest part of the scalp, and then lesser farther back. Is that not kind of the opposite of what we're describing here, with the front few centimeters being less dense than the hair directly behind it?

Thanks, just always trying to understand/learn and it seems I may be misunderstanding something.

The feathered look I'm speaking about is as follows. For the purposes of this lets presume the doctor has put a uniform 50 FU per/cm.

Well in the first 1cm of of the front of your hair are going to be just 1 hair grafts......gradually moving back to 2 hair and 3 hair grafts..........this is what I mean by feathered and less dense/coverage moving back to thicker coverage. By defintion 50 FU per cm of 1 hair grafts (50 x 1 hair grafts = 50 hairs total) , is less than dense than 50 FU's of 2 hairs (50 x 3 = 150 hairs).....so density increases as you move back from the hairline even though the units per cm might be the same. Its coverage game.....numbers of follicular units, by number of hairs in units by how thick the hair = perceived denisty/coverage.

In this way the feathered natural look is created.

Look around you - even look at your previous hairline.............a natural hairline in a mature man will have slightly less density/coverage at the very front.........this is of course how we men recede over time......miniaturization of the hairs at the front moving slowly backward.

The process of hairloss and then hairtransplant can play tricks on the brain..........I'm sure previously the natural hairline that you eventually completely lost........spent many years and many centimetres with pretty low density........back then the glass was half full because you still had hair there and didn't care that much...........now the glass is half empty just given your journey.

Look around at some of your friends, not the 1% with killer 19 year old hair.........the normal dudes you considered to be pretty lucky with their hair......think about where you perceive their hairline to be in terms of the framing of their face etc. I think you might be surprised if you look closely how many hairlines you've never examined before are optically maintained by very very few follicular units / hairs. So few in fact that a HT surgeon would be asked to do touch up if delivered that front hairline density. The framing of the face with a new hairline is 90% of the magic of the hairline hairtransplant......the human eye naturally drifts up without a break point...........even a few hairs sitting out front and 7 inches from centre of your eyes can go a long way to moving someones perception of you from bald to not bald from bad hair to normal hair.

[washingtondc]

You raise some good points.

On 7/30/2021 at 2:26 AM, pre-screened said:

The process of hairloss and then hairtransplant can play tricks on the brain..........I'm sure previously the natural hairline that you eventually completely lost........spent many years and many centimetres with pretty low density

You're right, it did spend a lot of time with very low density; so low that it was significantly below 50% of original and became essentially entirely see-through. And that level of density? The green highlights in my image. That was my pre-existing hairline, which has maybe twice the density of the entire band of transplanted hair that will be my new hairline. So that's why I'm trying to figure out how the new hairline will possibly look natural or have any sort of density that's not going to be essentially non-existent; the thickness/caliber of my hair is very fine and if I had to guess, that transplanted area looks like it's maybe like... 20-25% of the original native density. It looks like it's going to be this weird, thin band of overwhelmingly empty space.

Especially now having seen hairbackpls1's graft location and density for the hairline from the exact same surgeon just a few days later, it's making me wonder.

Edited August 4, 2021 by washingtondc

[washingtondc]

Anyone know of any examples where the density looked that low with very fine caliber hair and it ended up looking alright any time the person was outside?

Sorry, just second-guessing myself now...

Edited July 30, 2021 by washingtondc

[giegnosiganoe]

The very tip of the hairline will always have lower density - this is where you sprinkle in grafts in a semi-random fashion to create a natural look. If you group the hairs ~1cm higher up, you can see the density is higher.

[washingtondc]

3 hours ago, giegnosiganoe said:

The very tip of the hairline will always have lower density - this is where you sprinkle in grafts in a semi-random fashion to create a natural look. If you group the hairs ~1cm higher up, you can see the density is higher.

Sure but like... only a tiny bit.

I placed a green circle and a blue circle of the same size at random spots in the pre-existing see-through hairline and in the even thinner transplant portion. Is this really not a pretty big problem?

 

 

Edited July 30, 2021 by washingtondc

[pre-screened]

No because I can assure you by now some/alot of the hairs have shed the shaft without you even noticing leaving only the root under the skin......not every future hair is going to be represented now by a little stub.

Your engaged in fruitless exercise of examination.......trust the process.....trust the doctor you choose.....you think Dr.Weselsey somehow forgot how to do hairtransplants just on the day you were in with him.

Ive said it before but will say it again - you went to a great doctor....that was all you needed to do......staring at zoomed in photos wont change a thing now (& to suspect the worst is a waste of your time). Your results are now baked in the cake.....you'll see them fully in 12-18 months.

Suggest if your FUD is out of control and dominating your thinking....you should scedule a meeting with Dr.Wesley and write down all your question. He also I'm sure has high def inter-operative and post-operative photos.....ask for those and you'll have a closer representation of what grafts were implanted where and by how much.