Westminster Medical Group - Discussion about graft numbers

[dntv]

 

I had my FUE Hair Transplant with Westminster Medical Group in London on the 22nd of February 2023, under the care of Dr. Flaviu Sebastian Deme, who performed the injections and the incisions, while two technicians performed the extraction and implantation of the grafts.

 

I wrote a full seven-page account of my experience here a few days ago, which could be considered unfairly harsh to the clinic, so I have edited my post to focus on the biggest questions only, as a reference for future patients that might have the same doubts.

 

The main issue arose after I went home and was told that the grafts in the donor area don’t seem to match the grafts in the recipient area. This prompted me to count them, which yielded some numbers that didn’t match the numbers claimed by the clinic.

 

Specifically they claimed that they got 1800 grafts from the donor area when I counted 1400, and more strikingly that they performed 1750 incisions in the recipient area, when I could only count 1070.

 

I don’t claim that my counts are 100% accurate, I surely must have miscounted a few grafts here and there, but I don’t believe that I was off by hundreds. You can have a look for yourself if you want, I have provided the photos that I used, with and without the red dots. Some of the red dots are smaller than others because of the annoying Preview software on Mac, but if you zoom in you can see all of them. I have used mainly photos from day 3 for the count, where I had the clearest images and before I had touched the grafts or taken a shower.

 

The main explanation that I could think of was that there was a big graft wastage during the extraction process, due to the potential inexperience of the technicians, speed of the operation, small 0.65mm punches? That I do not know so it is only speculation on my part.

 

Please see the replies to this post for more explanations.

 

My next concern was about the density and distribution of the grafts in the recipient area.

 

I felt from the first day that the density was not great, but what bothered me more is the distribution of the grafts. In their marketing they boast about their natural hairlines, which is one of the things that attracted me to them. They claim that they use fine hairs for the front of the hairline, with a micro irregular design instead of a straight line and gradually getting denser behind the front, but I felt that the frontal hairline was planted with higher density and the temples behind seemed quite sparse, which was even more apparent after the scabs had fallen off, leaving those empty patches that you can see in the photos behind the front line. There might be some shedding in the later photos, but you can see this pattern from the first days, even before the scabs had fallen or I had touched the hairs or taken any showers.

 

People have replied that the results look good and that I am overthinking this, which might be the case, but I just wanted a transparent explanation about these discrepancies, so they can make sense in my head and some impartial opinions about the density and distribution.

 

Please feel free to share your opinion and thanks to everyone that has shared their feedback.

Edited March 22, 2023 by Melvin- Moderator
Member requested edit

[Al - Moderator]

I think you are over thinking it too much. I get it, though. When you see yourself afterwards you think: "OMG! What did I just do?", but you need to just relax and let your body go through the healing. Try not to think about it too much. Spending 5 hours trying to count each graft is probably not the best thing to be doing if it's going to bother you too much afterwards. It doesn't look too bad. I'd understand if you got an obvious botch job, but the only thing I'd really say against the clinic here is I think the hairline grafts should have been angled forward a bit more.

It doesn't look very dense, but it looks OK. I won't fault the clinic for that, though, because with you saying you want the hairline higher and saying you think you are going to lose a lot more hair... well I can understand the Dr not going as dense as he may have. I don't know if he would have given you a higher density or not, but I think I would have made the same call on the density level if I were the Dr based on what I'm reading from your post. Again, I think it looks OK, just not high density... and that may be fine for you. You have to wait it out and see how the growth turns out.

For the midscalp and crown, you don't really have much loss in those areas, so there isn't really much that can be done there yet. It would have been nice to see a few before pictures of you with longer hair, but it looks like you have hair in the crown, but it's miniaturized and maybe looking thin when it's grown out. If that's the case then transplanting there may not be worth it yet. You'd have to wait until you get more loss. It's hard to tell without seeing before pics.

The donor area is very spread out which I like. You won't be able to tell anything was done once it heals. You don't want the donor area confined to one small area that will be obviously thinner.

On the graft count, it sounds like they may charge for a range of grafts rather than actual graft count. I'm not a big fan of that, but it sounds like that may be how they operate based on your post, so I don't want to get into how many grafts you got vs how many you paid for or how many they say they did. It's hard to get an accurate count on your own head anyway.

The amount of donor punches vs the amount of grafts transplanted is something that doesn't get talked about enough. I've mentioned it a couple of times in other posts. You are always going to get more attempts than actual grafts. There's going to be some transection and some grafts that simply don't come out intact when they are pulled out. If the punch size they used was 0.65 then I personally think that's too small. You are going to have a higher rate of non useable grafts/donor attempts with very small punch sizes. Small punches can work well on some people, so I'm not going to say whether that was good or not in your case. I only wanted to point out that there is going to be more punch scars than actual grafts. That's normal. It's not because they are throwing away good grafts. I think (no idea really, just my opinion) that a normal rate is around 5% to 15% of punches that don't yield a good graft. Most of them will grow back because the follicle is still there.

 

 

[kiwik]

Doesn't look that bad to be honest! 5 and a half hours doesn't seem too short for only 1750 grafts and two technicians doing the extraction and implantation either. Anyway, the only thing you can do now is wait for the result

[HairFunk]

This was a lengthy read and you're less than 4 weeks post op. The work pretty looks good. You might be working things up in your head / focusing excessively on details to the point of obsessiveness. I'd advise contacting the clinic to discuss all. What have they said about your concerns above? Are you in contact with them??

[HappyMan2021]

OP at this point all you are doing is publicly bashing a clinic you may very well go to again in the future 🤣

I am not seeing any obvious signs of botching (scarring, overharvesting, cobblestone/pitting, too low hairline)

You will have to wait 4-6 months to see if there are any issues with density or direction/angle of the grafts.

As of now there are no identifiable issues. 

Edited March 19, 2023 by HappyMan2021

[Silent123]

Hey man, why not contact the clinic? That was ALOT of negative nit picking about everything possible doh 🤦‍♂️ the work looks very clean. Approaching one month after FUE is waaaay to soon to judge the outcome. Give it time dude 😎

[dntv]

Thank you for the replies. I appreciate the feedback.

I know that part of my account above is probably overthinking and some of my statements a bit unkind in the heat of the moment and I feel bad for that, on top of all the other things. But it is how I honestly felt about everything.

Many interpretations are subjective (personally I find the temple areas behind the frontal hairline to be extremely sparse), but let’s stick to the numbers for now, as I got contacted by the clinic today, so I gave them a chance to explain.

Low count in the donor area (1400 vs. 1800)

They said that my low count in the donor area is because there are some follicular units with 4 or 5 hairs that they split in two in order to get more grafts.

There were no 4s or 5s in the graft counts that they gave me so I asked if the counts were after the splitting or not. They said there are typically about 10% of 4s that are split and then added to the graft count.

I counted about 1400 extraction sites, but let’s say that I was off by 200 and there were 1600. Add 10% that were split in two and we go to 1760, almost the 1800 that they claimed. Not quite there but not terrible. I’m not going to make a fuss over 200 grafts.

Low count in the recipient area (1070 vs. 1750)

This is the more serious one.

They said that my low count in the recipient area is because they do doubling up or packing of the grafts, which means they put two grafts in one incision. So each graft that I was counting was actually two grafts.

That would explain my low count, but then I asked why did you claim that you did 1750 incisions? Shouldn’t that be half?

And they said no, because only 10% are doubled up.

But that contradicts their explanation for my low count.

And on we’ll go in circles, answering but not really answering. Which is why I didn’t want to contact them in the first place. I didn’t expect to get any straight answers.

Anyway, I am sick to the bone thinking about hair so I’m not going to chase this anymore. I seriously can’t.

I might be back in 6 months with some photos as I agreed with them and we’ll see how it looks then.

[Silent123]

Hey man, don’t tie yourself up in knots like this with numbers. You can’t be certain that counting every extraction digitally with a red dot is accurate as you have done for hours and hours. That is not healthy dude. Keep calm and await the result. Try to update the forum monthly with your regrowth photos so we can see how it all pans out. This could be helpful for others who psychologically get caught up in the numbers 😎

[Melvin- Admin]

2 hours ago, dntv said:

Thank you for the replies. I appreciate the feedback.

I know that part of my account above is probably overthinking and some of my statements a bit unkind in the heat of the moment and I feel bad for that, on top of all the other things. But it is how I honestly felt about everything.

Many interpretations are subjective (personally I find the temple areas behind the frontal hairline to be extremely sparse), but let’s stick to the numbers for now, as I got contacted by the clinic today, so I gave them a chance to explain.

Low count in the donor area (1400 vs. 1800)

They said that my low count in the donor area is because there are some follicular units with 4 or 5 hairs that they split in two in order to get more grafts.

There were no 4s or 5s in the graft counts that they gave me so I asked if the counts were after the splitting or not. They said there are typically about 10% of 4s that are split and then added to the graft count.

I counted about 1400 extraction sites, but let’s say that I was off by 200 and there were 1600. Add 10% that were split in two and we go to 1760, almost the 1800 that they claimed. Not quite there but not terrible. I’m not going to make a fuss over 200 grafts.

Low count in the recipient area (1070 vs. 1750)

This is the more serious one.

They said that my low count in the recipient area is because they do doubling up or packing of the grafts, which means they put two grafts in one incision. So each graft that I was counting was actually two grafts.

That would explain my low count, but then I asked why did you claim that you did 1750 incisions? Shouldn’t that be half?

And they said no, because only 10% are doubled up.

But that contradicts their explanation for my low count.

And on we’ll go in circles, answering but not really answering. Which is why I didn’t want to contact them in the first place. I didn’t expect to get any straight answers.

Anyway, I am sick to the bone thinking about hair so I’m not going to chase this anymore. I seriously can’t.

I might be back in 6 months with some photos as I agreed with them and we’ll see how it looks then.

Seems like you’ve been spending too much time on Reddit. It sounds like you didn’t have a lot of density in the donor area. Surgeons often times double up single grafts into one site to add density.

Let’s say you had 1700 grafts with mostly singles. Instead of creating 1,700 sites with low density, the surgeon might opt to create 1000 sites with singles combined so its denser. 

Now, splitting grafts is something different. If they extracted 1,400 grafts, they should only charge you for 1,400. If they split the grafts you shouldn’t have to pay extra. That’s the only issue I could see, but 200 grafts wouldn’t make a huge difference. 

All in all, I understand you’re starting to second guess a lot of things. It’s likely buyers remorse. It’s very possible that you end up very happy with your results, and all of this will be insignificant if that’s the case.  Keep track of your progress here. We can’t cast judgement good or bad at this stage. 

[Gatsby]

This is an unproductive way to get through the ugly duckling phase and at only 4 weeks you haven't even begun it! It's like working out at the gym for four weeks and trying to count every rep you performed to see why your muscles are not huge. A hair transplant also takes time and patience. Communication with your surgeon is key. Try and take the focus off the hair if you can for a while. All the best.

[HairFunk]

I see this a lot on here with guys panicking about what they have done after their procedure and lashing out. You may not have been ready to undergo the process and recovery phase despite thinking you were. 'Buyers remorse' is a good way of explaining it as Melvin mentioned above. How old are you? How long have you been thinking about surgery for? The work looks good and the hairline higher and natural. I think you might just well be pleasantly surprised with the outcome. Hang in there is all I can say and keep us all updated. 

[Davies]

On 3/21/2023 at 2:08 AM, dntv said:

Thank you for the replies. I appreciate the feedback.

I know that part of my account above is probably overthinking and some of my statements a bit unkind in the heat of the moment and I feel bad for that, on top of all the other things. But it is how I honestly felt about everything.

Many interpretations are subjective (personally I find the temple areas behind the frontal hairline to be extremely sparse), but let’s stick to the numbers for now, as I got contacted by the clinic today, so I gave them a chance to explain.

Low count in the donor area (1400 vs. 1800)

They said that my low count in the donor area is because there are some follicular units with 4 or 5 hairs that they split in two in order to get more grafts.

There were no 4s or 5s in the graft counts that they gave me so I asked if the counts were after the splitting or not. They said there are typically about 10% of 4s that are split and then added to the graft count.

I counted about 1400 extraction sites, but let’s say that I was off by 200 and there were 1600. Add 10% that were split in two and we go to 1760, almost the 1800 that they claimed. Not quite there but not terrible. I’m not going to make a fuss over 200 grafts.

Low count in the recipient area (1070 vs. 1750)

This is the more serious one.

They said that my low count in the recipient area is because they do doubling up or packing of the grafts, which means they put two grafts in one incision. So each graft that I was counting was actually two grafts.

That would explain my low count, but then I asked why did you claim that you did 1750 incisions? Shouldn’t that be half?

And they said no, because only 10% are doubled up.

But that contradicts their explanation for my low count.

And on we’ll go in circles, answering but not really answering. Which is why I didn’t want to contact them in the first place. I didn’t expect to get any straight answers.

Anyway, I am sick to the bone thinking about hair so I’m not going to chase this anymore. I seriously can’t.

I might be back in 6 months with some photos as I agreed with them and we’ll see how it looks then.

Hi, interesting reading your account about the numbers. Do you have any update on how this progressed in the end? I had a consultation with Doctor Deme recently and quite liked his straight forward approach. I'd be interested to see how this turns out for you. Thank you 

[Davies]

Any updates ?

[Silent123]

Hey man, usually when they don't come back, it means they've likely got the result and moved on in life. Happens often here. This post was very over-analytical though 🤣

[jaypee2502]

I would love to know how this turned out in the end... 

 

Am thinking of going to Dr Sebastian myself. 

[dntv]

On 7/9/2023 at 9:32 PM, Davies said:

Hi, interesting reading your account about the numbers. Do you have any update on how this progressed in the end? I had a consultation with Doctor Deme recently and quite liked his straight forward approach. I'd be interested to see how this turns out for you. Thank you 

Hi Davies, sorry for the late reply. I have this account linked to a mailbox that I'm not monitoring.

I've attached photos from the 6 month mark. It turned out as I expected it to when I made this post. The density is not great, but it's not terrible. As for the distribution, the sparser patch on my left side that I pointed out in the original photos is still there, but I'm parting my hair towards my left to cover it. So if you see my right side in the photos being a bit sparse, my left side is even worse if I parted it the other way.

Anyways, I'm not entirely unhappy, it's still better than before and it could have been worse, but it could also have been better. If I had to do it again, I would choose more carefully. And yes, of course I'm moving on with my life, what else will I do? 😄

[Al - Moderator]

I agree it doesn't look great, but doesn't look horrible either. Another session to add some density and maybe lower the hairline just a touch would really help.

 

[Melvin- Admin]

It’s a mediocre result. Hairline is a bit sparse. Have you considered getting a touch up with a proven surgeon?

[jaypee2502]

Maybe your original concerns were correct, but does it take 12 months plus to see the full result? 

 

I must say this has put me off looking at this clinic. 

 

Have you got in touch with them? 

[dntv]

It might get a bit better after 1+ year, but I'm not expecting a big improvement. I mean it's obvious from the original photos that the implants are quite sparse. Hair is not gonna magically sprout from nowhere.

I'm not considering a touch up at the moment. I've been growing it for 8 months now and really don't feel like going back to shave my head and have another surgery.

I have been considering topical finasteride to improve the overall situation a bit, but I'm quite reluctant to mess with my hormones for the sake of my hair. I've been on the fence about this for years.

[DavidSheer]

On 10/17/2023 at 4:29 PM, Melvin- Admin said:

It’s a mediocre result. Hairline is a bit sparse. Have you considered getting a touch up with a proven surgeon?

I always thought 6 month was too early to have touch up. Isn't 6 months like halfway mark only? seem too early to advise have another surgery without waiting for full result 

[Davies]

On 10/16/2023 at 9:32 AM, dntv said:

Hi Davies, sorry for the late reply. I have this account linked to a mailbox that I'm not monitoring.

I've attached photos from the 6 month mark. It turned out as I expected it to when I made this post. The density is not great, but it's not terrible. As for the distribution, the sparser patch on my left side that I pointed out in the original photos is still there, but I'm parting my hair towards my left to cover it. So if you see my right side in the photos being a bit sparse, my left side is even worse if I parted it the other way.

Anyways, I'm not entirely unhappy, it's still better than before and it could have been worse, but it could also have been better. If I had to do it again, I would choose more carefully. And yes, of course I'm moving on with my life, what else will I do? 😄

Thanks for coming back dntv and with such detailed photos at 6 months after your hair transplant. The hairline shape looks quite nice, though the result does look a little sparse at this stage. Though as you had the procedure 6 months ago I’m assuming this isn’t the final result yet? You look to have short hairs still poking through on the photos interestingly and some hairs look really wispy…. Could you please keep me updated as you approach the 12 month mark next year so I can see your final result once it’s all fully grown? Thanks I’d appreciate that as this is a big decision for me 😊 

[Davies]

7 hours ago, DavidSheer said:

I always thought 6 month was too early to have touch up. Isn't 6 months like halfway mark only? seem too early to advise have another surgery without waiting for full result 

Yes, from doing thorough research at 6 months post op the hair implants are about half way into the growth cycle. Then at 12 months it has fully grown out, though takes up to 18 months then to fully mature as the hair texture changes and thickens. Google ‘hair transplant regrowth chart’ good reading 👍
 

 

[HairFunk]

On 10/17/2023 at 4:29 PM, Melvin- Admin said:

It’s a mediocre result. Hairline is a bit sparse. Have you considered getting a touch up with a proven surgeon?

A bit premature at 6 months Melvin to suggest having a top up? He's at 50% of the way through the regrowth juncture only!

OP - Hang in there and keep us updated as you head towards 12 months once the final growth is observed. 

[Melvin- Admin]

5 minutes ago, HairFunk said:

A bit premature at 6 months Melvin to suggest having a top up? He's at 50% of the way through the regrowth juncture only!

OP - Hang in there and keep us updated as you head towards 12 months once the final growth is observed. 

You’re right. My mistake! I thought this was 12 months. I didn’t read the timeframe correctly. There’s definitely a chance that things will improve.