Need second Surgery after first not completely successful

[Stevensen]

I had about 1,500 FUT 18 months ago by a surgeon who is recommended on this forum in the NY area. At this point he said that I am not going to see any further improvement and recommended a second FUT of the same number of grafts for another pass through. He said that it happens with patients from time to time and there was nothing I could have done since I did everything right. As he is highly respected here I do not doubt anything he said but I wanted to see what others thought. I would prefer a FUE the second round but he said that given my lower success rate a second FUT would maximize the best outcome. I am disappointed but I guess it is just the genes.

[JDEE0]

Who was the surgeon (I know you say they're recommended, but still)? 

Do you have any better pics of the result as well as pics of you pre-HT situation and some immediately post-op so we can say the implantation pattern, whether enough grafts were placed etc.

It's most likely not 'your genes' at all. It's far more likely to be a result of less than ideal planning on the surgeons part (i.e. in this case they didn't plant densely enough in the hairline), so if they've made you feel as though it's your fault, then I'm not on board with that one bit...

It's hard to tell from that pic, but it looks to me as though there are doubles around the hairline? I could be wrong, but it seems that way. If so, I have to question how good this surgeon actually is. 

You also seem to have some strange colour around the follicles, again, better pics would help as I may well be wrong.

 

Edited November 13, 2021 by JDEE0

[Britanium]

Dr Bloxham ? 🤔

[Stevensen]

Yes, JC71...

JDEE0, I can't find the photos right after post-op but I could look if it really is important. Here are two from about 13 months post-op. So maybe 1,500 was too small given my density to begin with? Thanks. By the way, he said my scar healed very well, which probably doesn't make a difference since the next FUT would cut around it anyway...

Yes, the color is more noticeable on these photos. Maybe inflammation? I did have severe pain in the graft areas the night of surgery.

[JDEE0]

Bloxham is a good doctor, but to answer your question, I wouldn't be able to say if 1500 was enough or not without knowing what size area was covered. 

Maybe you have some sort of scalp condition that has caused poor growth with the redness present. Has Bloxham said anything about it?

[Stevensen]

No, he didn't say anything about it, but I'll ask and report back.

[Britanium]

I’m have been on the forum too long when I recognise work 😂

[Britanium]

But yes be interesting to hear some feedback from Dr Bloxham. 1500 isn’t a vast amount of grafts unless you had very minor recession. If your looking at FUE for your 2nd session then it wouldn’t hurt to consult with some other Drs/Clinics. I don’t personally agree that another FUT is the best option. Especially as the more FUT you have the greater the risk of having a stretched scar. 

[Stevensen]

Thanks, you have a sharp eye! I heard about the risk of a stretched scar but my thinking was that since this (and the next) wasn't such a large procedure it might not be as bad?

[Britanium]

Just now, Stevensen said:

Thanks, you have a sharp eye! I heard about the risk of a stretched scar but my thinking was that since this (and the next) wasn't such a large procedure it might not be as bad?

It all depends on the laxity in that area. How does your scar look now ? Usually Bloxhams FUT scars are pretty amazing and pencil thin. 

[Stevensen]

You would know better than me. How is it?

[Britanium]

Looks pretty good to me. And no doubt not even noticeable having your hair at that length.

Edited November 14, 2021 by JC71

[Stevensen]

Thanks!

[BDK081522]

I actually think Dr. Bloxham pushes patient's toward FUT too much. For a 1500 graft surgery you shouldn't have to have a scar like that. It's actually wider than most of his scars. Since we don't have graft placement photos it's difficult to determine if it was low yield, low density, or improper planning. Also, it makes no sense if he said since the first FUT was "lower success rate" (i.e. poor yield) to suggest another FUT because in his eyes it gives better results than FUE. He still harps on the antiquated take of FUT yields being much higher because the grafts aren't skeletonized as with FUE. The study is out there. With today's FUE techniques the yields are almost identical. So, it doesn't make sense to suggest another FUT when he said the first one didn't grow particularly well. Honestly I would look for a different clinic at this point and go with FUE. You probably only need about 1000 grafts or less to enhance your density and could even fill in your scar if you're so inclined. 

Edited November 14, 2021 by BDK081522

[Britanium]

4 minutes ago, BDK081522 said:

I actually think Dr. Bloxham pushes patient's toward FUT too much. For a 1500 graft surgery you shouldn't have to have a scar like that. It's actually wider than most of his scars. Since we don't have graft placement photos it's difficult to determine if it was low yield, low density, or improper planning. Also, it makes no sense if he said since the first FUT was "lower success rate" (i.e. poor yield) to suggest another FUT because in his eyes it gives better results than FUE. He still harps on the antiquated take of FUT yields being much higher because the grafts aren't skeletonized as with FUE. The study is out there. With today's FUE techniques the yields are almost identical. So, it doesn't make sense to suggest another FUT when he said the first one didn't grow particularly well. Honestly I would look for a different clinic at this point and go with FUE. You probably only need about 1000 grafts or less to enhance your density and could even fill in your scar if you're so inclined. 

Yup, much as I like Dr Bloxhams work he always veers toward FUT regardless of the grafts needed. And yes the reasoning seems off. And as I mentioned earlier, I would also look at another Dr/Clinic for stage 2. 

[JDEE0]

21 minutes ago, BDK081522 said:

I actually think Dr. Bloxham pushes patient's toward FUT too much. For a 1500 graft surgery you shouldn't have to have a scar like that. It's actually wider than most of his scars. Since we don't have graft placement photos it's difficult to determine if it was low yield, low density, or improper planning. Also, it makes no sense if he said since the first FUT was "lower success rate" (i.e. poor yield) to suggest another FUT because in his eyes it gives better results than FUE. He still harps on the antiquated take of FUT yields being much higher because the grafts aren't skeletonized as with FUE. The study is out there. With today's FUE techniques the yields are almost identical. So, it doesn't make sense to suggest another FUT when he said the first one didn't grow particularly well. Honestly I would look for a different clinic at this point and go with FUE. You probably only need about 1000 grafts or less to enhance your density and could even fill in your scar if you're so inclined. 

Spot on. Whilst I do think Bloxham is a very good doctor, I really, really disagree with his views on FUE. He pretty much outright bashes it by saying that it's inferior and has vastly lower growth rates on average in comparison to FUT.

I've even seen videos of his where patients have come in for round 2 after poor growth with a different clinic and he places the blame on the method rather than the skill of whatever doctor performed it; it almost feels like some sort of anti FUE propaganda campaign and I really don't understand it. As you say, we know for a fact that there is no real difference between the two methods in terms of growth and many of the worlds best clinics don't even perform FUT anymore (not saying this is a good thing per se, just that many of the most respected and reliable doctors only do FUE). 

Whilst I think it is a case where OP can go back to the original clinic for a touch up if he wants to/needs must, I also would most definitely take myself elsewhere and opt for FUE.

Edited November 14, 2021 by JDEE0

[BDK081522]

9 minutes ago, JC71 said:

Yup, much as I like Dr Bloxhams work he always veers toward FUT regardless of the grafts needed. And yes the reasoning seems off. And as I mentioned earlier, I would also look at another Dr/Clinic for stage 2. 

Completely agree! I think he does some very good work but it seems he always suggests FUT. I'm not sure if he's just not had the appropriate FUE training or just truly believes that FUT provides a distinct yield advantage over FUE. Regardless of the reasoning, I think a top surgeon in the year 2021 needs to be a master of both techniques. I'm not bashing FUT as I think it definitely still has it's place in today's industry. It's been proven for higher Norwoods that you can get more lifetime grafts starting with FUT followed by FUE. However, for a first surgery, on a low NW, utilizing only 1500 grafts I believe FUE is the appropiate extraction technique. 

[Mike10]

I have been following Bald truth for a while now. According to them this still happens regularly even with top Doctors for these kind of operations. So it may  not be that unusual to go back for touch up. Not sure whether you agree with that or not

Edited November 14, 2021 by Mike10

[Stevensen]

Thanks Mike and everyone for the insight. Dr. B said that he doesn't think it is a scalp condition because I would have know about it before, but more likely something with the grafts. Below is a photo of the immediate postop.

I also had a consult with Dr. Dorin. He was nice and polite and I did not feel rushed whatsoever with him. (Dr. B didn't rush me either to be fair.) Dorin said that I should see a dermatologist first because the same growth problem I had this time might happen again and he would not want me to be disappointed. I may have to use a topical steroid in the weeks before FUE. He thinks a 1,200 FUE is enough to fill in the area and 400 for the scar. But he said that he does not recommend doing the scar at the same time because he would have to shave the back as well as the sides and I would look pretty barren. Later I could do a smaller FUE for the scar that will not be noticeable will long hair.

Do you think that is a better option? Obviously, two procedures will cost way more but if the success is better I would do it that way.

I will now add that in my experience Dr. B is kind and is rare in his direct relationship corresponding with patients, and I am sure he intends the best for them. Which makes it hard to say that Dr. Dorin said the scar was not good at all. He said it is placed at a strange angle and the scar is twice as thick as it should be for such a small procedure and that is one reason why he does not do trichophytic closures for his patients (which have included his own father) but straight sewing. The problem with trichophytic is that if the hairs do not grow through the skin it looks twice as bad as it would normally be, according to him.

With my hair he said there will be singles in the front edges but afterwards a mix of doubles and triples because it would look too stalk-like with all singles. When I asked him about PRP (he did not suggest it first, a good sign), he said that it will help the growth/healing rate of the hairs but in the long run will not make any difference unless you do it every year. He would give me it half off with the procedure. If money is not a concern, would it be worth it?

Last, when I asked about applying the consult fee ($175) to the surgery, I was told that I will be given instead some free liposomal ATP. I read that there is some benefit to ATP spray but is it overkill to have both it and the PRP? Some part of me feels that the spray is not worth so much money but I will use it if it could help. I tried searching the forum for this but it is me or the search doesn't work that great?

Edited November 21, 2021 by Stevensen

[Otar Norwood]

Do you have any pictures of your entire scalp before and after and with different lighting? Very hard to see the forest from the trees based on what you've posted.

[Stevensen]

Unfortunately I don't because this is the only one he took that he said was good. But I would guess that the ones on the lower half are likely the transplanted ones.

Edited November 22, 2021 by Stevensen

[mcr7777]

It looks like you have bumps and redness around the transplanted hairs in this photo. Is that the case?   

Do you have itching/burning/tingling sensations?  

[mcr7777]

I have been reading more about what the 2nd HT doctor mentioned to you about seeing a dermatologist. 

 

It clearly looks like there is inflammation around the transplanted grafts.  The 2nd doctor was absolutely correct saying you should see a dermatologist before another HT.  I'd strongly recommend finding a doctor that specialises in hair conditions e.g. autoimmune alopecia.  HT doctors often can't diagnose more unusual autoimmune alopecias like LPP, FFA and Alopecia Areata....you need to find a hair specialist derm - not a general one.

 

The last thing you want to do is have the same thing happen again after a 2nd HT.  It could potentially make things worse. 

You need to find out the reason for the sub-par result - and more importantly understand what those red marks are around the hairs and establish it's not an autoimmune condition.    I  was diagnosed with LPP (lichen planopiaris) after my first HT - and nearly went ahead with a 2nd.  But thankfully now and getting treatment for the condition - which is autoimmune and different than MBP treatments.

 

[Stevensen]

Thanks for the advice, no sensations at all in the transplant region. I will see a dermatologist and share the findings.

Does anyone know if the ATP spray is necessary if going with the PRP?

[JDEE0]

To be honest, PRP in general isn't going to do much to help, period. 

Also, just read some of your other replies in the thread and wanted to say that Dr. Bloxham shouldn't be telling you that you don't have any scalp conditions (namely, different forms of scarring alopecia) because, as he reasons, he or you would've known about it before. There are many cases (and I can point you to a few if you like) online of people who went to good docs and had poor growth at the end. Once they had a biopsy, they were found to have LLP or something similar. Neither they or their HT docs had any idea up until that result came in.

Often times it is asymptomatic and is pretty much impossible for the HT to pick it up prior to surgery as there are no signs. I'm not saying you have something wrong, just pointing out that he shouldn't be saying that to you, and that it is indeed a real (but unlikely) possibility. Just thought it important to point out as I wouldn't be happy if I was you and went for round 2, had lacklustre growth again, went for a biopsy and it turned out the Dr. was wrong and I did have some autoimmune scalp issue.