Repair Surgeons and not feeling like a hot potato game to them. (Miami, FL)

[Babester]

12 months after my HT (1500 grafts, applied to close entries and hairline).

 

I am mortified and disillusioned.

 

I felt that not the total growth of all grafts took place, and that my look was not very natural given the blatant transparency still present in the lowered hairline (which I didn't have problems with before; I only frustrated over my entries; now I have to wear a cap to cover the frontal part).

 

The hair on the sides not only looked scarce and transparent, it grew out kinky and rough, compared to my super smooth, wavy-straightish hair.

 

So I went to Dr Nusbaum, recommended by this site, to ask for an opinion.

 

He basically played hot potato with me. First of all, he found the lowered hairline puzzling. Also the closed off entries. All the hairlines were done in a peculiarly straight manner, he remarked.

 

He said my HT looked like it attempted to create a feminine hairline. Considering I wear long hair and want to sport it long, I did not find this bad.

 

I was mostly frustrated by the transparency and lack of density that I felt was due to not enough growth. The hair on the sides were particularly way too separate to achieve respectable results, and the lateral hairline attempting to close the exits were not close enough to even form a solid hairline.

 

He was preoccupied that, at 20, I wanted to do 2k grafts more to repair and give the lacking density to this hairline and unsuccessful entry closing. What if I needed more hair in the future?

 

I read here that the donor area has 7-8k. With 3.5k, I still have some 4.5-3.5k grafts left.

 

I have not been losing any hair since taking Propecia for over a year, and I'm not concerned with hair loss 10 years into the surgery, considering that treatments will most likely evolve drastically by then.

 

I have abundant hair on my mid and back parts, quite some volume, but I want to even my frontal part out.

 

Since Dr. Nusbaum basically punted on me, I'm pleading with the forum members, doctors, and other experts to help me find a surgeon with a good reputation on repair work for feminine hairlines on men.

[Dr. Glenn Charles]

It sounds to me that you do not necessarily need repair work, but maybe just finishing work. I like to think of it as fine tuning. These procedures are supposed to be approached as if each patients head is unique and in order to restore the hair the doctor should think of it as a piece of art work. Unless the hairline was placed way to low on the forehead, you can certainly have some additional work done in and around the previous work to get you where you want to be. You may even have some grafted hairs that you feel are not in the right direction. By placing more hairs in the proper direction around them helps to weight them down so you can style your hair as you wish. I would say at least 30%-40% of my cases are are either repair or finishing cases. If you have only had one procedure then I am sure you still have a lot of good donor hair remaining.

[Bill - Seemiller]

Babester,

 

It sounds like Dr. Nusbaum is just being cautious. At 20 years old, one previous hair transplant, and several years to come of progressive hair loss, it's important to use donor hair supply wisely.

 

Also, not every patient has the same amount of available donor hair. This needs to be assessed separately along with your hair characteristics, density, present and risk of future hair loss, area of the scalp to be covered.

 

Do go ahead and consult with a few other leading surgeons in the field to garner their input.

 

Best wishes,

 

Bill

[Cam Simmons MD ABHRS]

Hello Babester

 

I understand your frustration but to get good advice you would really need to consult a physician in person or at least to send them photos.

 

Dr. Nusbaum has the advantage that he has seen you and Dr. Charles has the disadvantage that he hasn't.

 

Sometimes the best option is to refine a hair transplant to make it better and sometimes the best option is to not make a bad situation worse.

 

I have not seen you but there are some red flags in your remarks and your reports of Dr. Nusbaum's remarks. You are 20 and had your hairline lowered and your fronto-temporal recessions filled in.

 

Dr. Nusbaum has studied and written about natural female hairlines so if he said that your transplanted hairline had a feminine shape that is very concerning.

 

The extent of future hair loss is very difficult to predict and especially so for young men. My own (conservative) approach is to assume that every 20 year-old man will eventually develop a Norwood 7 pattern and won't take medications for the rest of their life. Of course I do encourage them to use medical treatment but I don't plan hair transplantation as if they will. I also believe that you should plan permanent surgeries based on what can be done now NOT with the hope that someone will get a breakthrough in the future that will rescue bad planning.

 

An appropriate transplanted hairline for someone who has or could have a Norwood 7 pattern is higher and more receded than most 20-year-old's want. They compare themselves to their peers, many of whom still have the same hairline they had as teenagers.

 

There very likely is SOMETHING that can be done to help you, Babester. That may or may not include more hair transplantation. You really need a good long-term plan after a thorough assessment by a dedicated physician and a frank discussion.

 

Best wishes,

[thanatopsis_awry]

Don't feel too disheartened, man; it doesn't sound like you got butchered, and I'd feel pretty confident that you could make a big, satisfying stride in your next procedure. Take your time, research, research some more, don't let location dictate the actual process of your decision-making....keep the forum posted as you go about your consultations (online or live!).