Failure in the donor area on the left side

[Melvin- Admin]

Let me tag @Dr. Felipe Pittella for his response.

[Dr. Felipe Pittella]

Dear Community, 

Thank you for tagging me here. 
First and foremost, I’m indeed sorry for not reaching the full expectation of the patient. However, as I told him in our last video call, we are not yet done. I’m willing to work with him to achieve the best result possible for him. Taking into account the patients expectations and claims combined with the real possibilities that can be offered by the FUE technique. So I offered him and I’m offering again, the possibility of a touch-up and further refinement of the areas of concern with no cost. This is not a privilege of this particular case, this is how I would treat any patient who’s expectations haven’t been fully met by my work. Fortunately, this is the first one, in almost a decade. 

As for the strategy, allow me to clarify. The patients forehead was larger than I have estimated in our video call and in the photos submitted for evaluation. Thus, the 4500 grafts I initially estimated was not going to be enough to meet my standards of density and coverage. So, with the patients consent we decided to transplant a higher number of grafts with no additional costs to the patient. The additional grafts were free. The complete details of this strategy with the precise area covered and density applied can be found in the description below in the photos.

 

So, the total area to cover was 170cm². The areas were divided as described below.

 

The density placed in each area and the amount of grafts implanted was:

Front: 50 to 60 (55) grafts/cm² -> 67cm²x55g = 3685 grafts

Temples: 16 grafts/cm² -> 22cm²x16g = 352 grafts

Middle: 10 grafts/cm² -> 39cm²x10g = 390 grafts (***implanted only 250)

Crown: 35 grafts/cm² -> 42cm²x35g = 1470 grafts

TOTAL GRAFTS IMPLANTED: 5758

 

From the upper perspective:

 

From the Crown perspective:

 

Anterior perspective:

 

 

I hope you understand that if i'd transplanted any amount of grafts under the amount I've actually transplanted it would grow out low density areas and the result would be even further from the patients expectations. To be honest I'd like to put a higher density in the crown and temple areas but for that I would need even more grafts... 

In regards of the periauricular area (left and right), if wanted I can also post some photos to show how it was before the extractions (long hair and harsh light). 

 

Anyways, I'd like to reaffirm that I'm willing to try to reach the patients expectations with any further refinements necessary in order to reach the best result possible for him. 

Feel free to ask any question regarding this strategy. 

Edited November 9, 2022 by Dr. Felipe Pittella

[Melvin- Admin]

Dr. Pittella,

Thank you for your detailed response. Yes, please post the photo of that area in harsher lighting, so we can get a better comparison.

[HairEnthusiast101]

This is why I love this community. We are blessed to have the best doctors in the world constantly adding advice and helping patients if need be. It is truly a case by case situation. Plus @Dr. Felipe Pittellais easily at the top of the hair transplant world right now. The donor healing could definitely still improve with time but from a side angle the results of the recipient area look very very good. But I’d expect nothing but the best from Dr. And I truly believe he will make this situation right OP so don’t worry you are 100% in the best hands!

[samz_033]

Dr Pitella's work is among the best I've seen from any surgeon, particularly in Norwood 6 and 7s. He is up there with the best.

[Dr. Felipe Pittella]

On 11/9/2022 at 1:21 AM, Melvin- Moderator said:

please post the photo of that area in harsher lighting, so we can get a better comparison.

Those were taken just before surgery.
Long-hair and harsh lighting: 

 

Photos bellow were taken by the patien 5 months before surgery
(shorter haircut and darker setting)

 

[Melvin- Admin]

The member asked me to post this on the topic from our private conversation. 

@Jairo P 

Would appreciate you posting the resolution here in the community. 

[Jairo P]

Dear Friends, I know this forum for a short time. Thanks for the analysis of the members and to Dr Felipe for explaining the strategy.

In my case, a second densification procedure will be carried out and, if possible, the condition of the sides will be improved.

In my other thread I will post updates of my progress.
Thanks.

[Jairo P]

Em 11/07/2022 às 14:41, Melvin- Moderator disse:

O número de enxertos depende da pessoa e de seus objetivos. Se você estava apenas fazendo a linha do cabelo, então 5.000 parece muito, mas você baixou a linha do cabelo e transplantou para o cabelo e a coroa.

Também parece que você teve alta densidade em uma área completamente sem cabelo. É muito diferente do transplante entre os cabelos, você precisa de muito mais enxertos para criar densidade em uma zona calva.

 

Quanto ao seu doador, essa zona parecia fina antes de você fazer um transplante de cabelo. Mesmo aqui com o cabelo mais comprido, dá para ver que é fino.

Agora, combine isso com cirurgia e parecerá mais fino. No entanto, uma foto anterior foi tirada com cabelos mais longos e em um ambiente muito mais escuro. A foto do depois com o cabelo curto de frente para a luz. Aposto que você deixa o cabelo crescer e tirasse uma foto com uma iluminação semelhante, não ficaria muito diferente. Já que a foto anterior foi tirada na clínica. Acho que o melhor a fazer é voltar à clínica e comparar maçãs com maçãs. Dr. Pittella é ético e um dos melhores, tenho certeza que ele quer te fazer feliz. 
 

Iluminação escura/cabelo brilhante Cabelo curto/iluminação

 

Em 11/07/2022 às 14:41, Melvin- Moderator disse:

O número de enxertos depende da pessoa e de seus objetivos. Se você estava apenas fazendo a linha do cabelo, então 5.000 parece muito, mas você baixou a linha do cabelo e transplantou para o cabelo e a coroa.

Também parece que você teve alta densidade em uma área completamente sem cabelo. É muito diferente do transplante entre os cabelos, você precisa de muito mais enxertos para criar densidade em uma zona calva.

 

Quanto ao seu doador, essa zona parecia fina antes de você fazer um transplante de cabelo. Mesmo aqui com o cabelo mais comprido, dá para ver que é fino.

Agora, combine isso com cirurgia e parecerá mais fino. No entanto, uma foto anterior foi tirada com cabelos mais longos e em um ambiente muito mais escuro. A foto do depois com o cabelo curto de frente para a luz. Aposto que você deixa o cabelo crescer e tirasse uma foto com uma iluminação semelhante, não ficaria muito diferente. Já que a foto anterior foi tirada na clínica. Acho que o melhor a fazer é voltar à clínica e comparar maçãs com maçãs. Dr. Pittella é ético e um dos melhores, tenho certeza que ele quer te fazer feliz. 
 

Iluminação escura/cabelo brilhante Cabelo curto/iluminação

 

 

Edited November 12, 2022 by Jairo P
foto

[Melvin- Admin]

7 minutes ago, Jairo P said:

 

Interesting topic, photos should be compared under equal conditions, friend  compared shaved head vs big hair, but it should be big hair vs big hair.

Yes! Exactly. Refreshing to see a patient understand this, it’s very important to compare apples to apples.

[A Fue Good Men]

@Jairo P @Dr. Felipe Pittella

just curious, how will the donor zones be corrected? Where will the grafts come from? Is there an estimate for how many grafts to repair the donor?

[Gatsby]

@Dr. Felipe Pittella you have just given me another reason why I think you are one of the best surgeons on the planet (especially for Norwood7 cases). 👍

[Hairy future]

On 13/11/2022 at 02:36, 5BetaReductase said:

@Jairo P @Dr. Felipe Pittella

apenas curioso, como as zonas doadoras serão corrigidas? De onde virão os enxertos? Existe uma estimativa de quantos enxertos para reparar o doador?

In fact, the patient already had rarefaction in some points on the sides, but only near the ears and temporal recesses, in which case it is important to make a personalized plan before the surgery.

 

   It is possible to see in the current photos (with light) that the flaws have become larger and are all over the lateral area. Need to get a cut with a good barber to minimize.

 

In the evolution that the patient presented in another topic (3 to 5 months) we observed the difference in density between the lateral donor zone and the donor zone of the posterior part (neck).

 

It looks like there were a lot of follicles implanted, but maybe the growth rate in the crown was not very good, as we can see in the 11 month evolution.

 

 

Friends, follicles removed from the donor area with points of failure, are they resistant to transplant?

[alopeciaphobia]

The response in here is great, although I have to say that I'm concerned that with the whiteboard picture the Dr. has leaked serious personal information of the patient (age, surname and what medications he uses). The patient registered on this forum without his full surname, so clearly he prefers not to be fully identified.

Thats not right.

 

Edited June 8, 2023 by alopeciaphobia