Fighting infection after 5250 session of FUE+DHI (1 month post)

[FUE_DHI_5250]

Dear all,

4 weeks ago I went on my journey to Istanbul to fight my otherwise unavoidable baldness (the family genes). It turned out... well, it's only a month, but so far I got a big scar right in front of my scalp, and a lot of redness. From my clinic, local Dermatologists, and the Reddit hive mind I got mixed recommendations of what exactly to do about this problem. But some basics first.

Some context about me:

• 26y old, family history of male-pattern hair loss
• Had non-existing temples since ever, got worse over time, hairline receding since I'm 16
• 2y on Fin and Minox, minimum regrowth, but stabilized the loss

 

 

 

 

 

 

 

 

 

 

Here comes the transplant details:

• Decided for IdealOfMed in Istanbul after positive experience with their "consultant"
• Got quoted 3k€ for 3500-4000 grafts in a combined FUE (to fill temples & lower hairline) + DHI (to increase density in front) procedure with PRP
• I went for a no-shave procedure, hoping to cover some of the ugly ducking phase with existing hair. No sure about this decision now.
• Price included housing, transport in Istanbul, a pre- and post-care kit. Added 2x hyperbaric chamber treatments for 300€.
• On transplant day, they ended up transplanting 4250 grafts via FUE + 1000 via DHI, so much bigger than expected
• Overall procedure took 6-7 hours, and was quite hectic with many people involved, entering/leaving the operation room. Hotel-to-hotel I was gone 11 hours in total.

 

The aftermath:

• Initially all looked fine, the scabbing looked fine although very dense & black in some areas
  (see left)
• A few days after the transplant, I fell sick (bacterial infect acc. to blood test); but I'm unsure if this was due to food poisoning, or related to the transplant
• Those areas in particular were very stubborn while scab removal post 10 days
• The clinic recommended me to "just apply more pressure while massaging the scabs off"
• The final "scab" on the front where my scar is now was there until day 15 (see below)
• When it started getting very red & maybe even bleeding (not sure about this), I got concerned and asked for 2nd opinions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The 2nd opinions // what is this?

• While IdealOfMed refused to claim any problem, Reddit (/r/HT) were the first to guide me towards one of two potential side effect routes:
  • Infection is what some claimed
  • Necrosis was the (horror) result others gave (thanks Melvin!)
• The first (online) Dermatologist who only saw pictures of my scalp prescribed me a topical antibiotic cream (FuciCort), saying it is an eczema
• The general practitioner I saw afterwards didn't have any experience with HT, and went with the view of the Dermatologist. He did however point me to other spots on my scalp  that also looked infected.
• So i applied antibiotic cream 2x a day to all these places
• The second Dermatologist I saw wasn't really fond of HT in general and claimed that "this happens when you do this kind of thing", but he also prescribed me oral antibiotics to take (which I already did for 10 days post transplant)
• Finally, the clinic adjusted their assessment and now claims I have an "necrotic ulcer" which can spread

So, at this point it's day 17 post transplant and I started taking oral antibiotics for 10 days. Today marks my 1-month (29 days) post transplant, and am left with a somewhat deep, clearly visible hole on my scalp - not sure if it's a scar yet, but it's clearly from the rest:

 

 

 

 

Some more detail: via Reddit I found another user who was also at IdealForMed a few months earlier for a similar 5k graft transplant and had the same problem: for him he simply kept washing until it feel off and didn't use any treatment. Now, 4 month afterwards he had no growth in this particular area (but weak growth overall).

 

Now I come to you, collected wisdom of the Hair Restoration Network: 

1. What is/was this thing? 
2. Did I beat it, or does the fight start only now?
3. Who's likely at fault here?

Thank you in advance. 
- J

 

Edited March 7, 2022 by FUE_DHI_5250
Formatted pictures for easier readability.

[Gasthoerer]

It is clearly an infection and maybe necrosis (plus infection). 

Necrosis can develop from the infection or the necrosis can develop first by the trauma caused by the slits (especially when they are to deep and or to close) and then followed up by an infection. 

This is a typical risk of a transplant but happens significantly more often at hair mills. It is very likely that there will be no hair growing in this area (there was a case of ASMED in here which was successfully treated with a touch-up procedure). The big questions is the state of the remaining recipient...

 

[JDEE0]

I'm no doctor, but it's not eczema, clearly some sort of infection considering the circumstances (i.e. you've just had your head punctured thousands of times). Whether it was necrotic or not, who knows, I would have hoped the doctors/derms you saw at the time would have been able to tell you that.

Again, I'm not a doctor, but I would think considering it's a whole month post op now and the infection has clearly subsided that you are out of the woods and you don't have to worry about it spreading or worsening anymore. Although the grafts in that spot might never grow, who knows. 

You went to a cheap hair mill, so they are likely at fault for having (what I can imagine are) sub standard hygiene practices which led to an infection, but this sort of thing does happen with any clinic from time to time, so it's impossible to tell for sure. 

Also, you haven't had 5250 grafts, that is a lie, probably 3000 max, but I think closer to 2500.

[Melvin- Admin]

Have you consulted with any doctors? Let me tag @DrTBarghouthi

[Gasthoerer]

On 3/6/2022 at 7:51 PM, JDEE0 said:

Also, you haven't had 5250 grafts, that is a lie, probably 3000 max, but I think closer to 2500.

If this is true (and you might be right) this would be good news actually. 

[FUE_DHI_5250]

On 3/6/2022 at 7:46 PM, Gasthoerer said:

It is clearly an infection and maybe necrosis (plus infection). 

This is a typical risk of a transplant but happens significantly more often at hair mills. It is very likely that there will be no hair growing in this area (there was a case of ASMED in here which was successfully treated with a touch-up procedure). The big questions is the state of the remaining recipient...

 

Yes, I think so as well, but I'm wondering what my best case of action would be, now after 10 days of oral antibiotics and 14 days of antibiotic cream? My clinic simply says "continue to use Fucidin", but these treatments shouldn't be for this long. The next time I'm meeting a (proper) dermatologist is in 11 days from now.

Remaining recipient looks fine I would say (although bald, quite a bit of shedding, and red), and the other "black spots" are completely gone after the treatment. Only this "valley" up front left...

[FUE_DHI_5250]

On 3/6/2022 at 7:51 PM, JDEE0 said:

Also, you haven't had 5250 grafts, that is a lie, probably 3000 max, but I think closer to 2500.

To be honest, I think the no-shave really covers quite a lot of it. My donor area looked really heavily harvested, compared to the 3-4k areas I've seen I would argue that they (at least took) quite a bit more. Try comparing the total area covered with my profile pic / second picture in the post:

Edited March 7, 2022 by FUE_DHI_5250

[JDEE0]

Well, to be clear, I was basing that on the recipient area - there's no way that's nearly 5500 grafts when looking at the size of the area and the density implanted (which looks fine, my point is that it looks fairly standard in terms of density and for said area it would need to be unusually densely packed to make it the claimed number imo). I can see around about 3000 grafts.

As @Gasthoerersays, this would be a good thing as it means you have way more donor in the tank. Only potential problem is that they could have taken 5000+ but not implanted them all due to high transection rates etc, hopefully not, do you have any clear pics of the donor to get a better idea?

[DrTBarghouthi]

13 hours ago, Melvin- Moderator said:

Have you consulted with any doctors? Let me tag @DrTBarghouthi

Thanks for tagging. It is hard to tell exactly, but seeing the immediate photos after surgery, I do feel that some areas were dusky. This refers probably to some level of ischaemia/ necrosis. This resulted in delayed scabbing and slower healing in these spots and then final healing by secondary intention (scarring). You can have hair put in those areas later if no growth occurs in it though. The redness could simply be related to your skin type having delayed healing after all the trauma. Remember 5000 is a huge number for this area. 

[FUE_DHI_5250]

5 hours ago, DrTBarghouthi said:

This resulted in delayed scabbing and slower healing in these spots and then final healing by secondary intention (scarring).

Thanks Doc! Any specific care I can give it (the scar) to heal better? Should I continue using antibiotic cream?

 

5 hours ago, DrTBarghouthi said:

Remember 5000 is a huge number for this area. 

Yes, I am aware, but I never asked (agreed) for a procedure this large. The estimate was 3500-4000, during hairline design they didn't communicate something else to me, and only afterwards told me the transplanted number.

[Gatsby]

I would also look at contacting @Doron Harati who also had a bad transplant in Turkey (and nearly died might I add) and has since had a successful repair. Not only that he has had a second surgery and is looking great! All the best!

[DrTBarghouthi]

8 hours ago, FUE_DHI_5250 said:

Thanks Doc! Any specific care I can give it (the scar) to heal better? Should I continue using antibiotic cream?

 

 

Yes, I am aware, but I never asked (agreed) for a procedure this large. The estimate was 3500-4000, during hairline design they didn't communicate something else to me, and only afterwards told me the transplanted number.

Yes continue the antibiotic for a bit To protect the weaker skin initially. 

[Melvin- Admin]

1 hour ago, DrTBarghouthi said:

Yes continue the antibiotic for a bit To protect the weaker skin initially. 

Such a pleasure to have you on the board 👏🏼

[DrTBarghouthi]

2 minutes ago, Melvin- Moderator said:

Such a pleasure to have you on the board 👏🏼

🙏🏻🙏🏻🙏🏻🙏🏻

[Doron Harati]

I was botched terribly by Arenamed clinic in Turkey on my 1st HT, was overharvested with 5000 grafts in 1 day surgery with medical malpractice, thankfully I was saved by the paramedics in ambulance and escorted in a wheelchair, luckliy a year after I had a repair by Dr. Maras at HDC clinic which I am very happy with the result.

I don't bring my case as a reference for @FUE_DHI_5250, but from my experience as a coordinator of HDC clinic, it's very rare the clinic approve a candidate for 5000 grafts session, it happens but very few have such a strong donor that the doctor can verify for minimum trauma to the donor with good preservation result, those sessions take around 2-3 surgery days.

I agree completely with @DrTBarghouthi for 5000 grafts are huge amount to cover your area.

I posted a thread with a paitent that had necrosis from his 1st procedure due for making the slits too deep.

You still have a lot of time to heal and recover from the procedure.

[kirkland]

3 hours ago, Melvin- Moderator said:

Such a pleasure to have you on the board 👏🏼

I second that. Thanks @DrTBarghouthi

[kirkland]

Just like having a doctor provide insight on this board, it's also great to have insight from @Doron Harati

It must be scary as f**k to go through what @FUE_DHI_5250is experiencing. To have someone share their own personal and similar experiences, and to know that there can be a remedy to it, must be comforting. Good luck, OP.

[shiba1985]

4 hours ago, Doron Harati said:

I was botched terribly by Arenamed clinic in Turkey on my 1st HT, was overharvested with 5000 grafts in 1 day surgery with medical malpractice, thankfully I was saved by the paramedics in ambulance and escorted in a wheelchair, luckliy a year after I had a repair by Dr. Maras at HDC clinic which I am very happy with the result.

I don't bring my case as a reference for @FUE_DHI_5250, but from my experience as a coordinator of HDC clinic, it's very rare the clinic approve a candidate for 5000 grafts session, it happens but very few have such a strong donor that the doctor can verify for minimum trauma to the donor with good preservation result, those sessions take around 2-3 surgery days.

I agree completely with @DrTBarghouthi for 5000 grafts are huge amount to cover your area.

I posted a thread with a paitent that had necrosis from his 1st procedure due for making the slits too deep.

You still have a lot of time to heal and recover from the procedure.

OMG man. this is horrible. I am glad you are ok in the end. 

[splitting hairs]

Hi,

It looks like you had necrosis.  Dr Lorenzo has presented on this and how it should be managed.  

 

Edited March 10, 2022 by splitting hairs

[kirkland]

18 minutes ago, splitting hairs said:

Hi,

It looks like you had a haematoma and necrosis.  Dr Lorenzo has presented on this and how it should be managed.  

 

Great post - thanks for sharing. I feel like anyone doing research for a HT should watch this. Would probably cause some people to reconsider the surgery altogether but could show what can happen if you don't make a good decision for the clinic you choose.

[Melvin- Admin]

34 minutes ago, splitting hairs said:

Hi,

It looks like you had necrosis.  Dr Lorenzo has presented on this and how it should be managed.  

 

Wow what a fantastic video, very informative. 

[nycshearling]

I had a very similar situation happen but not severe and the doctor has been helpful in addressing. I have no hair in the affected area and hope to have a second transplant to cover it up (less than 300 grafts)

[kirkland]

19 hours ago, nycshearling said:

I had a very similar situation happen but not severe and the doctor has been helpful in addressing. I have no hair in the affected area and hope to have a second transplant to cover it up (less than 300 grafts)

Hope everything works out for you.

[rhuanstts]

Hi @FUE_DHI_5250 how are your results going? I contacted IdealofMeD because all the good reviews on TrustPilot, Google, Reddit, etc. Your case is the first bad one i've seen about them. After some months, how is your transplant evolution going?

[John1991]

25 minutes ago, rhuanstts said:

Hi @FUE_DHI_5250 how are your results going? I contacted IdealofMeD because all the good reviews on TrustPilot, Google, Reddit, etc. Your case is the first bad one i've seen about them. After some months, how is your transplant evolution going?

Don't go to a second rate country to get a medical surgery performed.  Your health and your appearance are too important (obviously the latter is because you're getting a hair transplant) to not get the best possible care.  Regardless of where you go the best case scenario is you have several months of an altered social life/weird appearance, so do yourself a favor and give yourself the best chance to be satisfied after that 4-6 month down period.

Edited August 4, 2022 by John1991