Considering a Repair HT after 3800 FUE

[VladRojas]

Hello everyone!

I am happy to have stumbled upon this forum and have the opportunity to connect with others who have gone through similar experiences. Four months ago, I underwent an FUE procedure at the Smile Hair Clinic in Turkey where I received 3800 grafts for my hairline and crown. So far I think my new hairline will look good.
 

However, my donor area was unfortunately damaged during the procedure. Some have said that it wasn't necessarily over-harvested, but rather the extraction was not well-distributed. As a result, there are now obvious extraction marks and patchy areas on the right side and scars in the back. Although my donor area has improved over the past 4 months, it's clear that over-harvesting was a factor.

I am now in search of the best doctor to perform a repair FUE, BHT, or a combination of the two. I regret choosing the clinic that performed my first procedure, so I am looking for a more experienced and skilled doctor this time around. I have considered Dr. Mwamba, but after speaking with two individuals who received repairs from him, they were not fully satisfied. They recommended Dr. Bisanga instead. I've also looked into Dr. Umar, Dr. Lorenzo, and Dr. Cooley. I live in the US but am open to traveling to Europe for the procedure. I have decided to avoid SMP as I am not a fan of tattooed scalp micropigmentation.

I would really appreciate any feedback or recommendations on the best surgeons for this type of procedure. Also, I would like to know what procedures you think would be most effective in fixing my damaged donor area and approximately how many grafts you think I would need. Thank you!

[HappyMan2021]

At 4 months I think its too early to call. For all we know some of the loss in the donor region could be temporary shock loss that will grow back. 

If the donor still looks barren by month 6/7, I think you can draw a more definitive conclusion at that time. 

[VladRojas]

Hi, thanks for that.

i agree, I’ll wait 2 more months, but given the strong signs like scars next to each other, the doctor already told me that that is it shock loss but actually wrong way of extracting grafts.

Also, since these well known doctors are popular, they have availability in the next  3-4 months for a procedure.

so by then I’ll already know the final result. 
 

[HappyMan2021]

Just now, VladRojas said:

Hi, thanks for that.

i agree, I’ll wait 2 more months, but given the strong signs like scars next to each other, the doctor already told me that that is it shock loss but actually wrong way of extracting grafts.

Also, since these well known doctors are popular, they have availability in the next  3-4 months for a procedure.

so by then I’ll already know the final result. 

yea, to clarify, there is no reason you can't be consulting and planning your 2nd surgery right now. But I wouldn't pull the trigger and/or actually proceed with surgery until Month 7 at the earliest. Or at least until you can definitively rule out other causes that may naturally recover.

[VladRojas]

Yeah, definitely this time I want to do much more research, which is why I joined here, I found so much good info.

For example Dr.Mwamba availability is for July. 
 

so in terms to my original question. What doctors do you recommend in the case that my donor was over harvested and I need some repair. 
 

thank you for your responses so far

[HappyMan2021]

Any of the elite repair doctors should be good. Bisanga, Mwamba, Feriduni, and Cooley.

Pretty much any elite doctor, even those that don't market themselves as 'repair docs', has loads of experience doing repairs. So any elite doctor you go with should be good. 

 

[Gatsby]

59 minutes ago, VladRojas said:

Hi, thanks for that.

i agree, I’ll wait 2 more months, but given the strong signs like scars next to each other, the doctor already told me that that is it shock loss but actually wrong way of extracting grafts.

Also, since these well known doctors are popular, they have availability in the next  3-4 months for a procedure.

so by then I’ll already know the final result. 
 

In all honesty I would wait the full twelve months before having surgery again. You want to know exactly what you are working with and you want to give your scalp twelve months to fully recover. 

[Belve]

You cant make any judgment now. 4 months is too early. You have to wait 12 months for full growth. Also donor shock loss happen in many cases which is temporary and comes back after 12 months. So just be patient for the final result before make any plans. I wish you good luck.

[Melvin- Admin]

I echo what others have already said, 4 months is too early to judge the donor or the recipient.

[A_4_Archan]

11 hours ago, VladRojas said:

Yeah, definitely this time I want to do much more research, which is why I joined here, I found so much good info.

For example Dr.Mwamba availability is for July. 
 

so in terms to my original question. What doctors do you recommend in the case that my donor was over harvested and I need some repair. 
 

thank you for your responses so far

Wait for full 12 months before 2nd surgery ....

R u on medication ?

And if u cn thn plz.post pre op pics so evry1 cn get some idea about condition u wer in before transplant ..

[VladRojas]

I agree with everyone, I am planning to wait 12 months before I do another HT. I had a consultation with Dr. Bisanga, he said that there is a chance of improvement, but it’s obvios that my donor was  over harvested. 
He told me that managing expectation will be key, since I don’t have a virgin scalp anymore. The response to restocking hair is unique and there is no guarantee of growth. Especially because when the grafts were removed, the blood vessels were disrupted so it changes the whole skin condition.

After that explanation, it makes sense why many people who went under a donor area repair  was not successful . Obviously I’m a bit frustrated with regrets of choosing the previous surgeon.  Which is why I’ll try to go with the best possible surgeon to repair my donor. 

What do you guys think of what Dr.Bisanga said?  Bc in that case I’d be afraid to waste more hair that once implanted might not grow.

If anybody here had a repair donor procedure, I’d appreciate if I can hear about his/her experience. 

Also, between Dr.Mwamba and Dr.Bisanga.which one do you guys think is better?

My impression with Dr.Bisanga is that he is more cautious and he requires in person conslultation to make a good assessments. Dr.Mwamba didn’t explain all the risks of no growth and didn’t require an in person visit. This makes me wonder how good Dr.Mwamba is

thoughts ? 

 

[A_4_Archan]

12 minutes ago, VladRojas said:

I agree with everyone, I am planning to wait 12 months before I do another HT. I had a consultation with Dr. Bisanga, he said that there is a chance of improvement, but it’s obvios that my donor was  over harvested. 
He told me that managing expectation will be key, since I don’t have a virgin scalp anymore. The response to restocking hair is unique and there is no guarantee of growth. Especially because when the grafts were removed, the blood vessels were disrupted so it changes the whole skin condition.

After that explanation, it makes sense why many people who went under a donor area repair  was not successful . Obviously I’m a bit frustrated with regrets of choosing the previous surgeon.  Which is why I’ll try to go with the best possible surgeon to repair my donor. 

What do you guys think of what Dr.Bisanga said?  Bc in that case I’d be afraid to waste more hair that once implanted might not grow.

If anybody here had a repair donor procedure, I’d appreciate if I can hear about his/her experience. 

Also, between Dr.Mwamba and Dr.Bisanga.which one do you guys think is better?

My impression with Dr.Bisanga is that he is more cautious and he requires in person conslultation to make a good assessments. Dr.Mwamba didn’t explain all the risks of no growth and didn’t require an in person visit. This makes me wonder how good Dr.Mwamba is

thoughts ? 

 

Thts good tht u r willing to wait till 12 months...thn u will get the clear picture of ur donor as well as the implanted grafts ..both are really good surgeons bt i just have a bit more confidence in dr bisanga....bt u cn choose anyone frm thm and u wont be wrong...

Did he tell u to be on medication ? 

[JL7UTD]

Hi , what did Smile Hair Clinic say about your situation ?

 

[VladRojas]

@ArchanNo he did not, but im on finasteride and minoxidil. So ill continue with that. 
Dr. Lorenzo's office said to me that they dont repair donor areas from work of other clinics. They specialized on the recipient area. I read here that Dr.Lorenzo could be like that. 

I was reading more about restocking procedures to fix a botched donor area. I didnt know that the response to restocking hair is uncertain and there is no guarantee of growth, given the scar tissue. Which makes me wonder how worthy it is to go through that procedure. Because i wouldn't like to waste more hair on a donor area that is going to reject the transplant. Dr.Mwamba suggested mixing the extraction from the nape & temporal zones with beard hair. So we preserve some scalp hairs. for future procedures. @Tiger2050  @Melvin- Moderator @RTC @Britalian @Gatsby @gillenator   Thoughts?
 

[JL7UTD]

@VladRojasDid you go back to Smile Hair Clinic with your results ? I have had FUE with them and I’m currently at 1 month.

Thanks

Jim

[VladRojas]

@mustang I saw your whole process on getting repaired your donor area. Incredible! What is your experience in terms of success from beard to donor area? Can you take a look at my pictures and give me your opinion?

[gillenator]

On 2/8/2023 at 4:09 PM, VladRojas said:

@ArchanNo he did not, but im on finasteride and minoxidil. So ill continue with that. 
Dr. Lorenzo's office said to me that they dont repair donor areas from work of other clinics. They specialized on the recipient area. I read here that Dr.Lorenzo could be like that. 

I was reading more about restocking procedures to fix a botched donor area. I didnt know that the response to restocking hair is uncertain and there is no guarantee of growth, given the scar tissue. Which makes me wonder how worthy it is to go through that procedure. Because i wouldn't like to waste more hair on a donor area that is going to reject the transplant. Dr.Mwamba suggested mixing the extraction from the nape & temporal zones with beard hair. So we preserve some scalp hairs. for future procedures. @Tiger2050  @Melvin- Moderator @RTC @Britalian @Gatsby @gillenator   Thoughts?
 

Because donor sources are limited, restocking becomes a real challenge to put it in perspective…and yes the yields vary so much for a number of reasons: composition of scar tissue, most of the time BH is used which in itself has unreliable yields.

The best donor source is hair that is very coarse and why I feel beard donor is the only viable for this type of therapy…and just as a side note, this type of procedure is better clinically termed as DRT (Donor Replacement Therapy) coined by one of the most talented repair surgeons in the world who is based in Georgia.

Another approach is known as DST (Donor Shade Therapy) that most clinics miss this concept whereby the grafts are placed between the scars instead of inside them…the hair must grown out to approximately 2 inches and the end result hides the scarring and also produces visual coverage if done correctly and with the right candidate…some donors are too scarred or moth-eaten to experience adequate success with DST procedures.

[mustang]

On 2/8/2023 at 10:39 PM, VladRojas said:

@mustang I saw your whole process on getting repaired your donor area. Incredible! What is your experience in terms of success from beard to donor area? Can you take a look at my pictures and give me your opinion?

My best success rate was from beard to donor, I would say it was roughly the same as scalp hair in terms of survival

If I can rank them based on some patch tests I would say

1. Beard (90%)

2. Leg (75%)

3. Armpit (50%)

It depends on how coarse the hair is as well, some people have very thick chest hair that will yield great results.

One important factor I would consider when I do it again is not leaving the grafts outside the body for more than an hour, thus slits first and then upon extracting implant quickly (they seem to survive less time outside the body than scalp grafts but this is just my perception) and secondly doing PRP and injecting after the slits are created so that they reconnect to blood vessels as soon as possible

Maybe I'll do a patch test with these variables on bold spots and post pictures if you guys are interested so we can assess growth of each method and body part

 

Edited February 10, 2023 by mustang

[gillenator]

The overall yield is usually best with the most coarse hair quality like beard donor because of the scar tissue…and it’s always a good idea to do small test sessions whenever using various sources of BH.

[VladRojas]

Hi @gillenatorand @mustang thank you both for your answers. @gillenator May I ask for the name of the Doctor you mentioned who is an expert in repair procedures (DRT) based in Georgia?

Yes, I also read that the yield of beard hair is great, especially for the donor area where we want to achieve density.

I have had consultations with Dr. Umar and Dr. Mwamba. They both suggested that I would need around 1500 to 1750 grafts to make it look decent in my donor area. They suggested extracting hair from virgin areas on the scalp (Nape and Temples) and also from the beard, stating that this repair procedure would help a lot to make it less obvious that my donor was overharvested. They both said that SMP would give the final touch to make it look great. However, I am not a big fan of SMP because I do not want ink in my body. Therefore, I am trying to seek other resources before resorting to SMP.

Dr. Bisanga said that he would not perform any procedure and that only SMP would help. I felt a bit annoyed by his response, given that I saw he has helped worse cases than mine. What do you think of this? It makes me wonder if Dr. Mwamba and Dr. Umar are not truly honest. However, it makes no sense because they are top surgeons.

My realistic expectation for the repair procedure is to minimize the evidence that I had a procedure done on my donor area. As long as it looks better than it does right now, I would be happy.

Any feedback would be greatly appreciated. @Archan @Melvin- Moderator @Tiger2050

Thank you

[Gatsby]

@VladRojas my advice would be to wait the full twelve months because your scalp and hair growth in the donor will improve and yo want to know exactly what you are working with. As repair patient myself from previous bad hair transplants and scars from correcting them I have to agree with the advice that you've been given. SMP and donor farming will improve your results tremendously once you get to twelve months. For FUE scars SMP is a great tool to have. Farming hair back into areas will make the area more vascular also (though I don't see any major scarring). Don't make a rushed decision but I am sharing this from own personal experience over the past 38 years. I wish you all the best.

 

[Mr Sinister]

hi @VladRojas, responding from the other thread 🙂

so definitely wait at least 12 months before doing anything. i did smp 7 months post surgery to my donor and wish i hadn't because it didn't give the desired outcome. in my experience smp only works well if you keep the hair really short as above or you have enough density in your hair so that the naked eye can't really see the individual dots as it is mostly covered by hair. in my case, i was very thin in the donor and adding smp. you could easily see the dots through the hair when it grew longer. the eye can easily detect a difference between 3D (hair) and 2D (smp). a few of my friends spotted it easily.

donor restoration is the only way you'll get some fullness back in the area, but it won't be perfect. then maybe look at smp to add some density if you require.

i had a small donor restocking from bisanga. 1,000 grafts. mostly beard and some chest grafts. it's not perfect. go in with low expectations. mustangs result is superb and a rare case. so don't go into it thinking you're going to get 90% success rate from beard into scarred donor. he's a rare case, and one i envy hahah. i think bisanga is maybe saying no to you because he's probably seeing so many cases and would rather focus on new surgeries rather than repairs. just my thoughts. plus, i think mwamba is the better of the 2 with repairs. his strategy to homogenize the area is a good one.

it looks like you'll need anything from 1,000 - 2,000 grafts. bare in mind you will still lose hair on top in the future so you want to save some grafts for future surgeries. that's why i went in with a small repair. i've saved some beard, chest and scalp donor for future surgeries on top. i'll still need 3,000+ grafts which i barely have left now in all donor areas. 

ALSO... are you on any meds? try and exhaust all non surgical avenues to maintain what you have. unfortunately for me fin gives me extreme side effects and i'm still waiting to see results after years of minoxidil with micro needling 😒  i've done prp, used all the shampoos and tried all the herbal supplements. at best i've only ever slowed my hair loss. but everyone is different, so make sure you try all these routes to maintain existing hair.

final advice is to give it time. not just for your hair to heal, but for your mind to heal. it's tough to go through, but i am in a much more secure and comfortable place now mentality wise just because I've accepted what i have. i know it's never going to be perfect.

good luck x

[VladRojas]

Hi @Gatsbyand @Mr Sinister , I really appreciate both of your responses. Yes, I agree with both of you that I should wait until the 12-month mark before doing anything. This will allow enough time for me to heal and get used to my new look. Although I am happy with how my recipient area is progressing, it still feels a bit strange to see hair where it was once bald.

I was disappointed that Dr. Bisanga rejected me as a patient without even seeing me in person, but it's okay. Mr. Sinister's point makes sense that Dr. Bisanga may prefer regular FUE/FUT procedures over repair procedures. While I was initially against SMP, I like the approach of doing some donor farming, beard, and SMP. I started using topical finasteride and minoxidil right after the procedure. I had used finasteride many years ago but stopped due to side effects. Instead, I used a laser hat for years, which I think helped. However, I am now considering going back to oral finasteride.

My only concern with the repair procedure is related to Dr. Bisanga's assistant's comment in an email and what I've read about it. He said, "When grafts are taken from one focused area, overharvesting suggests that also blood vessels have been disrupted, and scarring will have occurred in the skin tissue, even if not visible, meaning the scalp's response will be unique, and there is no guarantee of growth." This worries me because if we put beard grafts or scalp hair in these scarred areas, the chances of growth are not high, and I might lose those grafts in trying to repair those areas. When these grafts could have been used for a future hair transplant in the top area. What are your thoughts or knowledge on this?

Mr. Sinister, i thought your repair was done by Dr.Mwamba. Also, You did it on the right side, right?
Gatsby, who did your repair procedure?

Thank you again for your responses. 

[Mr Sinister]

“When grafts are taken from one focused area, overharvesting suggests that also blood vessels have been disrupted, and scarring will have occurred in the skin tissue, even if not visible, meaning the scalp's response will be unique, and there is no guarantee of growth“

Bisanga told me the same and I completely agree. That’s why I only did a small job. It’s a tough decision only you can make. Risk losing donor with no guarantees or save some for the future. We took 800 beard and 200 chest. I think I had approximately 50% success overall. They also had to remove 2 cysts they found in my donor due to the bad work of my first surgery. So they are completely accurate about damage and scarring as a result of poor donor care.

I had mostly the right side behind the ear repaired. 

[mustang]

2 hours ago, VladRojas said:

Hi @Gatsbyand @Mr Sinister , I really appreciate both of your responses. Yes, I agree with both of you that I should wait until the 12-month mark before doing anything. This will allow enough time for me to heal and get used to my new look. Although I am happy with how my recipient area is progressing, it still feels a bit strange to see hair where it was once bald.

I was disappointed that Dr. Bisanga rejected me as a patient without even seeing me in person, but it's okay. Mr. Sinister's point makes sense that Dr. Bisanga may prefer regular FUE/FUT procedures over repair procedures. While I was initially against SMP, I like the approach of doing some donor farming, beard, and SMP. I started using topical finasteride and minoxidil right after the procedure. I had used finasteride many years ago but stopped due to side effects. Instead, I used a laser hat for years, which I think helped. However, I am now considering going back to oral finasteride.

My only concern with the repair procedure is related to Dr. Bisanga's assistant's comment in an email and what I've read about it. He said, "When grafts are taken from one focused area, overharvesting suggests that also blood vessels have been disrupted, and scarring will have occurred in the skin tissue, even if not visible, meaning the scalp's response will be unique, and there is no guarantee of growth." This worries me because if we put beard grafts or scalp hair in these scarred areas, the chances of growth are not high, and I might lose those grafts in trying to repair those areas. When these grafts could have been used for a future hair transplant in the top area. What are your thoughts or knowledge on this?

Mr. Sinister, i thought your repair was done by Dr.Mwamba. Also, You did it on the right side, right?
Gatsby, who did your repair procedure?

Thank you again for your responses. 

Do a patch test of 50-100 grafts on a specific part of your scar and assess growth at 6 months. This is what I did.

You do not need to wait 12 months to have it repaired. 6 months is more than enough.

Also, consider grafting at very low density on a first pass (this has to be a 2 step surgery) to create new blood vessels and bring irrigation back to the area, then, after 6-8 months, you can do a second pass at higher density and it have a much better chance of survival.

Make sure to have PRP after slit creation on both surgeries to maximize survival.