Do Subsequent Procedures Have Delayed Results?

[Time to do something]

I've seen posts here with charts and various articles on the normal amount of time it takes for a hair transplant to surface and mature. However, my understanding is after a second and third procedure the normal surfacing and maturity times are lengthened because subsequent procedures are delayed. Can anyone elaborate on this? How much delayed is a second and third procedure and why? My understanding is on the first procedure hair should begin to surface at month four and mature by month 12 and be completely what one will achieve in 18 months.

[Time to do something]

If subsequent procedures limit blood supply would that mean fewer grafts survive on second and third procedures becuase of less blood supply? My understanding was in order for a graft to survive and be healthy it needed a good blood supply.

[TheEmperor]

I think you are correct. It is not that they take longer to grow, only that less of them grow.

 

Many time what people attribute to "delayed growth" is lower yield. When yield is lower, it takes longer for the growing hair to make a cosmetic difference.

 

I believe hair starts to sprout around month 2, the majority of them have sprouted by months 4-5 (it is at this point that it looks like something is really happening) and then by month 12 they are largely mature.

 

I dont buy into the "delayed growth" rhetoric, and believe it exists to ease patients anxiety and get them closer to the 12 month mark where they are ready for a second procedure. I believe that while 95%+ yield is possible, there is a range of yields from 0-100%. Anything above 75% will look like good yield and be difficult to differentiate from 100% yield. (Unless of course you do a graft site accounting with close up photography.)

[Time to do something]

Wow, this is a revelation. I did not know this bit of information and if this is true it is disturbing that it is never mentioned in consultations. Can a doctor chime in on this? What would cause the blood flow to diminish after a second or third procedure? Do the results become worse and worse with the more procedures one has? Would the third produce even less results than the second? Sprouting by month two seems to be a little earlier than what I've heard. I've also never heard that the majority is sprouted by month four or five.

[Megatron]

I don't know the answer and I too would love to hear what a doctor has to say about this. But, I think we also need to consider that it's easier to make a cosmetic difference in your 1st procedure than in your 2nd. The reason being is that you basically have to double the amount of density in order for the eye to perceive a noticeable improvement. That's harder to do the more hair you have.

 

ps. the more research I do and the more results I see, I'm starting to believe what Emperor said above about growth time being directly related to the final result (ie. the earlier you grow, the better chances you have).

[Bill - Seemiller]

TTDS,

 

I disagree with theEmperor.

 

Delayed growth doesn't necessarily equate to less yield. Scar tissue and limited blood supply can indeed be the cause of both, but not necessarily. Most surgeons take extra precautions so growth yield isn't affected. For instance, keeping the limited blood supply in mind, surgeons typically don't dense pack as many hairs into a single area in previously transplanted areas on the second and third procedures. Some surgeons will also leave a little extra tissue surrounding the follicular units to increase its survival rate.

 

Recent studies suggest that new transplanted hair can continue to grow between 12 and 18 months. This means that hair counts have been higher at 18 months than 12 months, even on the first procedure.

 

Hang in there TTDS. You are still early on in your procedure. While nobody can make any guarantees given that you've had two procedures with less than optimal growth, everything has been done that can be to maximize the chance of success. If you don't get the growth you want this time, I suspect you are one of the rare few where hair transplants just don't take well. But let's hope not.

 

Best wishes,

 

Bill

[TheEmperor]

Originally posted by Megatron:

I don't know the answer and I too would love to hear what a doctor has to say about this. But, I think we also need to consider that it's easier to make a cosmetic difference in your 1st procedure than in your 2nd. The reason being is that you basically have to double the amount of density in order for the eye to perceive a noticeable improvement. That's harder to do the more hair you have.

 

ps. the more research I do and the more results I see, I'm starting to believe what Emperor said above about growth time being directly related to the final result (ie. the earlier you grow, the better chances you have).

 

There is absolutely a correlation between what are considered impressive results and "rapid growth".

 

When half as many hairs are transplanetd, the hair needs to be twice as long to provide as much "coverage".

 

If the hair transplant is lower density, or there is lower yield, it will take longer for the results to materialize and look "good".

 

As far as delayed growth up to 12 months, that just doesnt make sense. Why would a living follicle hang out for 12 months and then start growing? Maybe there will be a small % that do this, but not a majority of grafts.

 

I think all the improvements we see after 6 months are largely the effect of lengthening hair that layers and provides increasingly more coverage.

[Time to do something]

I'm not panicking or suggesting I'm having a problem with hair growth on my third procedure it is far too early to judge that yet. I'm basing that on most of what I've read on here over the years concerning the growth timeline. What I'm reading now disputes that so I'm a bit confused. I'm simply curious about what I've heard concerning that second and third procedures take longer to surface than the first. I was primarily wondering if that is true and if so why? I've never read anywhere except on The Emperor's post that the majority of hair has surfaced by month four and five. I find it odd that no doctor has responded to this post to confirm or deny the statements being made in this post. At no time was I ever told in consultations that second and third procedures produce less due to scar tissue and less blood supply. If that is the case then a fourth procedure would be useless because even fewer grafts would surface.

 

Bill-I believe you've had three procedures. What did you observe with yours as far as the percentage of grafts surfacing with procedure one, two and three and the timeline?

[TheEmperor]

TDS,

I would say 95% of my grafts had surfaced by month 6. The cosmetic advantage did not become apparent until month 9-10.

 

Look at the timeline and understand that the improvements seen post month 6 are virtually all due to lengthening hair and layering.

 

I presume that everyone is similar. You need to give 3-6 months for the hair to grow to have an effect. Consider that 6 months of growth is only 2.5" in length. So it takes at least 6 months AFTER hair has sprouted to provide its optimal cosmetic advantage. Since most guys results are "complete" at month 12, this means 95% of hairs have sprouted by month 6. The majority of sprouting occurs in the 3-4 month time frame, and as early as 2 months.

 

Look at my result with knowledge that virtually no new hairs sprouted after month 6. The improvements were all related to the hair growing longer.

 

I have yet to see a "slow grower" who has a late, excellent result. If the moderators or anyone can provide a link to a patient blog showing this, it would be appreciated and I will reevaluate what I am saying.

 

Slow growth is a euphemism for low density or low yield.

[Time to do something]

I find it odd that no doctor has offered an expert opinion on this subject. No offense all points are taken and considered but I'd really like a professional opinion. Bill could you also please share with us your experience concerning what we are discussing with your second and third procedures.

[Bill - Seemiller]

TTDS,

 

You only just posted this topic and it's a holiday weekend. Also, physician members of this community do not read and respond to every topic. Thus, if you would like the input of a physician, I'd suggest contacting a few of them (including Dr. Shapiro since he was your physician) encouraging them to post on this topic.

 

I've had 4 procedures and noticed the majority of my hair growth between 6 to 12 months. However, the third and fourth procedure did appear to take longer to grow in. I have no reason to believe that I had lower growth yield as a result of the extra delay.

 

I hope this helps.

 

Bill

[Time to do something]

I was just thinking that with 188 people viewing this post that one of them might have been a doctor. Now that the holiday weekend is over I'll give it a couple of days, I'm sure then a doctor will provide his or her professional input. If not I will contact some and post their reply to educate members who may be in the dark on this subject like I am. Thanks for providing the experience you had. What you described matches what my understanding is from all I've read.

[Megatron]

Originally posted by TheEmperor:

I have yet to see a "slow grower" who has a late, excellent result. If the moderators or anyone can provide a link to a patient blog showing this, it would be appreciated and I will reevaluate what I am saying.

 

While I agree with what you're saying, I know that I've seen a slow grower with excellent end results. There's always a few exceptions to the rule. I'll look through the blogs to see if I can find a good example and I'll start with H&W as I suspect there may be some there.

[the B spot]

TDS...I've sent Dr. Ron this thread to get his thoughts...give me a bit and I'll have something for you.

 

Jason

[Time to do something]

Hey Jason,

 

That would be great. I look forward to his response. Also I'd still like to see a pic of your hair. I will be doing the same thing as you with the crown hair piece and I'd like to see how yours blends and what styling options I might have. Thanks!

[hairwaiting]

what can a person do with scarred recipient site, to increase blood supply??

[Maxxy]

what can a person do with scarred recipient site, to increase blood supply??

 

I'd also be interested in ideas to increase the blood supply... would using Minoxidil up until the surgery date help with this?

[hairwaiting]

Originally posted by Maxxy:

what can a person do with scarred recipient site, to increase blood supply??

 

I'd also be interested in ideas to increase the blood supply... would using Minoxidil up until the surgery date help with this?

 

ive read from a few doctors that it might. i regret not doing it...i wonder if its too late, im about 2-3 weeks post op

[Time to do something]

It's been two weeks since I posted this and still no reply from a doctor. Hmmmm? I'll try to get an answer for you guys directly from a doctor and post my findings.

[aaron1234]

I think Emp and Bill both have good points on this topic.

 

My second procedure has come in a lot faster. But my first procedure was also not a very good one. Even so, I was still feeling and seeing new hairs at 8-11 months. They didn't make much of a cosmetic difference in the end, but new growth certainly can happen in the late months.

 

However, the earlier you are seeing new hairs probably increases the likelihood you will be pleased with your procedure.

[Time to do something]

aaron1234, Am I understanding you correctly that your second procedure produced results faster than the second one? That is the opposite of what I've heard generally.

[aaron1234]

Well, my growth started at about the same time for both HT's. However, my second procedure had more grafts and was done by Dr. Paul. So maybe it wasn't necessarily faster, but at least better.

[the B spot]

TDS--I am sorry mate! We've been fairly swamped here recently, which is no excuse for you..just an explanation.

 

I wanted Dr. Ron to be able to put something together as a medical explanation and he will, I know personally it seems that for each successive HT it take just a bit longer to grow in..just as we all know it takes longer for the crown to come in vs the hairline/mid-scalp. It's just one of those things.

 

Some lucky chaps never notice this, others do not achieve full results for 18 months.

 

I promise to get something a bit more substantial..I just do not want to think we are blowing you or this thread off.

 

Talk soon,

Jason

[Time to do something]

TBS,

 

No worries, YOU are doing us a favor answering this and I know how crazy things can get putting you behind. I'm still excited about my procedure with Dr. Ron. Please let him know I'm going to take some pics this weekend which is the five month point and send them to him. Thanks

[Janna]

In all my years at SMG, I have yet to hear subsequent surgeries equate to less growth. I believe the following quote from MEGATRON is spot on.

 

' But, I think we also need to consider that it's easier to make a cosmetic difference in your 1st procedure than in your 2nd. The reason being is that you basically have to double the amount of density in order for the eye to perceive a noticeable improvement. That's harder to do the more hair you have.'

 

There are plenty of patients who achieve less than optimal results with their first procedure. There are varying factors that come into play for a good result whether it's a patient's first, second or third HT surgery. That's why research is important to choose a clinic/doctor who will give you the best chances of obtaining a great result not matter which # procedure you are on.

 

I hear SMG and other clinics' patients worry about growth at 4, 5, 6, 7+ months post op but you can't expect full results until 12 months post op. And there are studies which indicate final results may not be determined until 18 months post op. Typically, we all know at least a year's time need to be given before judging results.

 

As for 'late grower' or 'early/fast grower', these two terms do not matter so much after 12-18 mos post op. Of course the early growers will enjoy more hairs longer period of time but do they get more growth in the end? How you perceive growth ??“ early or delayed depends a lot on patient's expectations. While one patient might be thrilled, another may be disappointed.

Most patients get majority of growth by 9 months post op and then the remaining time is for the hairs to thicken and mature so the change is very subtle. This subtle change will not likely be picked up in pictures but I've heard from many patients who just feel there is another marked change from 9 months to a year.

 

TDS - to address your intial question - there may be delayed growth by a month or two in some patients but it certainly isn't true for everyone. We look forward to seeing your updates. I hope you are experiencing some growth by now. Speak soon.