[Solved by Eugenix] Did Eugenix miss assessing my Retrograde Alopecia

[Eugenix Hair Sciences]

Dear @DeltaV, 

 

Hope you're doing well. Upon reviewing your pre procedure pictures, we have noticed that you have kept your hair very short at the back, which may be contributing to the appearance of thinning in that area. When the hair is trimmed or kept very short, it can give the appearance of alopecia, even when that is not the case. Since the hair on the nape of your neck are retained, it doesn't appear to be retrograde alopecia.

It is important to keep in mind that the naked eye evaluation is more critical in the planning and designing phase of the hair transplant procedure. Microscopic evaluation is done later on, inside the operation theatre to cherry-pick the thick/multi-hair grafts.

It is important to keep in mind that it has only been 4 months since your surgery, and we recommend that you allow your hair to grow out a bit to fully appreciate the results of your hair transplant procedure. Keeping your hair at a slightly longer length will also help to camouflage any thinning or sparse areas in the donor area.

Our post-surgery care team & doctors will continue to monitor your progress and keep in touch with you. Please do not hesitate to reach out to us if you have any further questions or concerns. Do let us know if you want a video consultation with a doctor for addressing any further concerns. 
 

Best regards,
Eugenix Hair Sciences

Edited April 4, 2023 by Eugenix Hair Sciences

[Adam561]

It doesn't appears to be retrograde otherwise the nape hair are the first one usually to go. I think Eugenix does use loupes with 6/8 magnification and are known for donor management. @DeltaV, don't let negativity take over your mind, I am pretty much sure that in the coming 3-4 months you will be a happy man. ovio that 5k+ grafts from the donor will make it sparse, keep it long till you get your full result. 

[DeltaV]

20 minutes ago, Eugenix Hair Sciences said:

Dear @DeltaV, 

 

Hope you're doing well. Upon reviewing your post-procedure pictures, we have noticed that you have kept your hair very short at the back, which may be contributing to the appearance of thinning in that area. When the hair is trimmed or kept very short, it can give the appearance of alopecia, even when that is not the case. Since the hair on the nape of your neck are retained, it doesn't appear to be retrograde alopecia.

It is important to keep in mind that the naked eye evaluation is more critical in the planning and designing phase of the hair transplant procedure. Microscopic evaluation is done later on, inside the operation theatre to cherry-pick the thick/multi-hair grafts.

It is important to keep in mind that it has only been 4 months since your surgery, and we recommend that you allow your hair to grow out a bit to fully appreciate the results of your hair transplant procedure. Keeping your hair at a slightly longer length will also help to camouflage any thinning or sparse areas in the donor area.

Our post-surgery care team & doctors will continue to monitor your progress and keep in touch with you. Please do not hesitate to reach out to us if you have any further questions or concerns. Do let us know if you want a video consultation with a doctor for addressing any further concerns. 
 

Best regards,
Eugenix Hair Sciences

Please schedule a call with Dr Sethi as he is the doctor I selected for the surgery and needs to be held accountable. If Dr Sethi cannot make it then do not bother with any other doctor.

[bigmistake]

3 hours ago, bobs person said:

ore Eugenix, I went to 2 other doctors, who did microscopic examinations of my transplant areas and donor area, and said that it will be a risky surgery as I may be

@DeltaVare you on finasteride ? Can you please name the doctors who rejected you as patient ?

Edited April 4, 2023 by bigmistake

[DeltaV]

28 minutes ago, bigmistake said:

@DeltaVare you on finasteride ? Can you please name the doctors who rejected you as patient ?

Sorry it was @bobs personwho made those comments.

[Eugenix Hair Sciences]

@DeltaV,

We had offered you a video consultation with Dr Pradeep yesterday after which you responded saying that you were not in a rush. Today as well, Ashish from our Post-Surgery Care team is trying to reach you for a video consultation with Dr. Sethi. We're unable to get a response over telephone. 

May we share your pre procedure pics, planning pics and post pictures pics from different angles here, for a better understanding to the community. 

 

Regards, 

Eugenix Hair Sciences 

 

 

[Melvin- Admin]

@DeltaV

I had a closer look, and it appears that the hair wasn’t extracted all the way to your nape. It’s very hard to see given your skin color and punch size. But I’ve outlined up to where the hair was extracted, which is just above the nape. 

 

Based on your photos I think this is okay. Again, it’s hard to judge retrograde alopecia by photos. If you get a fade where the hair is the shortest at the nape and gradually gets longer towards the occipital. It can appear like retrograde alopecia. In reality, it’s just the nape hair appearing thinner because its shorter and the hair is finer. 

I looked at the longer hair pictures you posted, but the angle didn’t really show the nape hair very well. Did you take any other photos at the clinic? Perhaps some different angles would help as well. 
 

EDIT: @DeltaV Please allow the clinic to share additional pictures. 

Edited April 4, 2023 by Melvin- Moderator

[DeltaV]

16 minutes ago, Eugenix Hair Sciences said:

@DeltaV,

We had offered you a video consultation with Dr Pradeep yesterday after which you responded saying that you were not in a rush. Today as well, Ashish from our Post-Surgery Care team is trying to reach you for a video consultation with Dr. Sethi. We're unable to get a response over telephone. 

May we share your pre procedure pics, planning pics and post pictures pics from different angles here, for a better understanding to the community. 

 

Regards, 

Eugenix Hair Sciences 

 

 

Go ahead

[DeltaV]

23 minutes ago, Eugenix Hair Sciences said:

@DeltaV,

We had offered you a video consultation with Dr Pradeep yesterday after which you responded saying that you were not in a rush. Today as well, Ashish from our Post-Surgery Care team is trying to reach you for a video consultation with Dr. Sethi. We're unable to get a response over telephone. 

May we share your pre procedure pics, planning pics and post pictures pics from different angles here, for a better understanding to the community. 

 

Regards, 

Eugenix Hair Sciences 

 

 

This is not correct please. You said that Dr. Sethi will be back tomorrow and allow some time to check availability and update you. I replied saying take your time as im in no rush. You never scheduled anything until I messaged here today.

[DeltaV]

So folks, I had a video call with Dr. Sethi where he explained me with pictures that there is no chance of me having retrograde alopecia. Luckily, they had some more pictures from different angles. A good 40 mins was spent by Dr. Sethi reviewing my pictures and videos on the big screen. Also, Dr. Sethi explained that microscopic evaluation of the nape donor area would have given false positive.

I only told Dr. Sethi that I wished that we had all this detailed conversation during my designing stage. He told me that just trust Eugenix to get it right. 

I have allowed Eugenix to post my pictures and provide their side of the story for the community and then we can close this topic. Thanks to Eugenix and everyone.

[Bb111]

Hey @DeltaV I'm glad you got to speak to Dr. Sethi and your concerns were addressed. I hope you are feeling a little better.

 

My experience through their process is that they eyeball the donor in the design phase and move on to the surgery unless their are concerns and the donor needs a closer look preoperatively. In the surgical phase they use high power loupes to look at the donor and perform the extractions. If  the donor looks better or worse under the high power loupes they may talk to you and alter the plan. This is actually what happened to @Bandit90 if my memory serves me well. They looked at his donor under the high power loupes and realized it was much better than the  test. They spoke to him, altered the plan ,and well the rest is history. 

 

Now we can debate if this is the best order of events to examine the donor.  However from my own experience they definitely perform a detailed look at the donor with microscopic magnification with high power loupes. It just happens later then you think. 

 

Also if it helps you you can look at my thread. I had extractions done in a similar pattern as you and actually had grafts taken from the nape. You can see where I am now at 8 months. I believe @Melvin- Moderator also had nape hair used.

 

Anyway looking forward to your updates and hoping you get the results you are looking for.

 

Edited April 4, 2023 by Bb111

[Eugenix Hair Sciences]

Private Video transcript of Dr Pradeep’s explanation: 

 

Dear @DeltaV, 

We hope that the video consultation was helpful to you. Here is the summary of the consultation for you and the community. 

 

Pic A: Side view (Left postero lateral), before marking and before trimming
———-

This is the hairline area - the character of the hair from the neck side or front/ temple area is that the hair is:
a) lightest,
b) thinnest and
c) The slowest in growth.

They characterise the soft landing to the nape or the frontal hairline. If you keep this hair short, it will look light and when we use flash while taking pictures, it will look further light. When you have short hair (whether on the nape or mid occipital area), it cannot obstruct the light and hence looks sparse. This is a “false sparse” and one can get confused by seeing only one angle. But when you go through the other angles, you can see no retrograde thinning. And these are the soft hair that can be used for creating the softness of the hairline or the temple.

Now coming to the next picture.

Pic B: Same View (After extraction)
———-

Here you can see that these hairs are not utilised at all, and just above that, they have thicker hair, which we are sure will grow in the hairline or the temple area that will give the soft landing, the graded landing to the hairline and the temple. So, a lot of hair are not taken from this area. It is randomly taken. Most of thick hair has been taken from the denser area where he has, the better-quality hair.

Now, we will be making a comparison, with pics just before the extraction stage (with marked) and after the extraction.

Pic B: Same view (Marked area: trimmed) and after extraction.
————

So here in the planning picture, you can see that we have trimmed up to here, and between these two lines, we had planned to take the hair which will be used for creating the softer hair on the temple and hairline. So below this line, you can see a vast area of hair that was not trimmed. This hair mentioned above was not utilised.
Coming to the immediate post-surgery picture, you can see that this vast area has not been used for extraction. The random extraction above it, consisting of single follicles, is used under a microscope for the hairline.

Therefore, as you can see, there is no retrograde thinning. We have many examples to show genuine cases of retrograde androgenetic alopecia. We have the expertise to determine what is retrograde alopecia and what is not and which hair we need to pick to put in, which goes behind the hairline. There was no error made in the procedure for this patient. The judgment and execution have been per the medical expertise earned over the last 12 (24 experience years together) years by Dr Arika and me.

We understand that the "ugly duckling" phase is alarming for many patients, and we are committed to standing by them. All the High-Definition pictures of the pre-planning, planning and post-operative procedures are on record. We still reiterate that everything has been done in the proper order. Just be patient. We will be with you through this ugly duckling phase and stand by you.