5,015 graft extraction, missing grafts? 1700 or 2700 graft FUT, Dr. Blake Bloxham

[bluebird00]

In November 2021, I underwent a hair transplant procedure performed by Dr. Blake Bloxham, for which I paid $14,000 USD for 1700 grafts using the FUT method. Initially, during an email consultation, Dr. Bloxham estimated that the operation would involve between 2300 and 2500 grafts.

Nine months after the operation, I started realizing that my left side was not filling in. I gave it several more months, and now, 27 months later, there's no improvement. It just never filled in like my right side did. Please refer to the images in this thread, labeled ‘A1’. The most recent images are from January, 2024.

Upon sharing my experience online, users pointed out that I had been overcharged for the 1700 grafts implanted, noting that Dr. Bloxham's website lists the cost for a 1700 graft FUT procedure as $10,500. Assuming 1700 grafts were implanted, I should be owed a $3500 refund for the overpayment.

I addressed this billing discrepancy in an email to Dr. Bloxham on February 18, 2024. He responded that after reviewing all documentation related to my case, and having Dr. Feller independently review it as well, they both concluded that my belief of being overcharged or given fewer grafts than reported was incorrect.

Confused by his response, I requested the operating room report and counted the grafts using GIMP. Refer to the preview imaged named A2 attached to this post. I am happy to send the .xcf file as well. However, this forum does not support the .xcf format. If you would like to see the file, please send me a PM and I will provide it.

Before discussing the count, it's worth noting that Dr. Bloxham, post-surgery, informed me that he had implanted 1700 grafts. The .xcf file shows a final count of 1243. This excludes the far left and right sides, which I estimate contain 225 grafts each, reasonably putting my procedure at 1700 grafts implanted, not 2700. I presented this to Dr. Bloxham, who remained firm on 2700 grafts having been implanted.

Upon receiving the operating room report from Dr. Bloxham, I was unable to decipher his handwriting. The report is named A5 and attached to this post.  I have requested a transcription of this report three times. He recently informed me that he is compiling further information to send to me via certified mail, the contents of which I will share in an update to this post.

I remain confused about what happened here. So, I hope you guys can help me understand by answering my questions:

The operation lasted 11 hours. Is this duration normal for a 1700 or 2700 FUT procedure?

Three strips were harvested, with two strips taken after I was initially stapled up, due to an insufficient number of grafts from the first strip. Is this normal? Isn't there a way to plan how large of a strip should be extracted and how many grafts it will yield, to avoid extracting additional strips?

Another doctor performed parts of my surgery. I had my eyes closed throughout most of it, but there were instances where the other doctor was hovering above me as surgery was being performed and I could hear Dr. Bloxham far away from me, definitely out of reach. I don’t recall the other doctor’s name, but he did mention he has his own practice in Florida. I never objected to him operating on me at the time, but I wasn’t happy about it because I paid for surgery to be performed by Dr. Bloxham. I am aware that no doctor can perform a hair transplant on his own. But I also was not aware that this other doctor would perform at least parts of the surgery.

The report documents the strip size as 49.3 sq cm with a follicular unit density of 34 FU/cm², which seems quite large. I don’t know if this is the first strip? All three combined? Based on the dimensions of the strip(s) taken, what should the graft yield have been from a strip of this size? Is the extraction consistent with 1700 or 2700 grafts?

The report mentions a high incidence of popping, which doesn't align with my observations. One of the technicians mentioned a graft popping out, but that was it. The images I shared here show all grafts secured. Do grafts pop out randomly, and could this go unnoticed?

Lastly, is it possible that 2700 grafts were actually implanted? If you agree with my count that only 1700 grafts were implanted, and the operating room report indicates 2700 were extracted, have I lost 1000 grafts somewhere? How could this happen?

EDIT 3/7/2024:
I almost forgot to add... I recall there were 6-8 'follicle fairies' (employees who extracted follicles from my strips), which seems like a high number. Given that the other doctor operating on me appeared to be in training, could some of these staff members have been his trainees? Was my case essentially used for training purposes? Could it be that I lost 1000 grafts due to the inexperienced staff handling the extraction process?

Additionally, I noticed the operating room had a window AC unit, which seems unusual for an operating room, and it was not turned on. Dr. Bloxham stated it was cold enough in the room, but this detail strikes me as odd.

I also remember that my extracted follicles were stored in small paper and wax cups containing a whitish liquid. Although I didn't experience any infections, I'm questioning whether this storage method is normal. If it's not, could this have contributed to any graft loss? I'm still trying to understand how only 1700 or fewer grafts were implanted when 2700 or more were extracted. Is it possible that I've incurred a permanent loss of 1000 or more grafts?

EDIT 3/7/2024(2):
Could somebody help confirm the details listed in the report? My understanding is that 2700 grafts were taken from a strip area of 59 cm2, which is the total area of the three strips combined, indicating a native donor density of 45 FU/cm2. However, if only 1700 grafts were actually extracted, this would imply a density of 29 FU/cm2. Neither of these donor densities seems possible, given that the average for most people is around 80 FU/cm2. This discrepancy not only raises questions about the whereabouts of more than 1000 grafts but also suggests that potentially even more grafts are unaccounted for, possibly mishandled. Can anybody shed more light on these numbers?

EDIT 3/10/2024: 
To calculate my donor density, I cut out a 1 cm² box from a white piece of paper, shaved the area below my FUT scar, and took a photograph. My donor density is 85 FU/cm². Refer to my most recent images (D1 (1), (2), (3)). According to the operating room report, a total area of 59 cm² was removed from the back of my head, indicating that approximately 5015 grafts were extracted, based on a calculation of 85 FU/cm² × 59 cm².

The operating room report states that 2700 grafts were implanted. Assuming this is accurate, then have I incurred a permanent loss of 2315 grafts? If only 1700 grafts were implanted, then have I incurred a permanent loss of 3315 grafts? 

Again, this is all assuming the combined strip size indicated in the operating room report is accurate. I want to believe there are errors in the report because, if not, then it seems that I have suffered a serious and permanent loss of the donor area that cannot be replaced.

Dr. Bloxham, could you please help me understand the details of my operating room report, as I have expressed concerns about it above? Additionally, could you explain what occurred during my surgery and identify the other doctor involved in the operation?

 

 

 

Edited March 12 by bluebird00

[jjalay]

Looks more like 1700. What was the name of the other doctor from florida? You should ask who was this other guy that operated on you too.

[Melvin- Admin]

@bluebird00 I sent you a private message. I'm going to contact Dr. Bloxham for his response. There should be a breakdown of grafts totaling the number of transplanted grafts. Sometimes, clinics combine single follicular units into doubles to add density. On the contrary, some clinics split grafts to make more singles. The ladder should not incur a higher cost. 

[bluebird00]

Thank you for your response and the explanation regarding graft density. I must admit, I don't quite understand your explanation and will need to conduct some research on my own. Additionally, I've received your private message inquiring about the date of my surgery, which was November 17, 2021. I had hoped Dr. Bloxham would clarify these issues. However, if he insists that he implanted 2700 grafts, a figure seemingly contested by all observations based on my images, I'm uncertain of the value of his input in this case. Nonetheless, I remain optimistic and look forward to understanding what he is sending me in the mail. It's perplexing though, that he has chosen to send this package via certified mail when he has previously communicated official reports to me via email. If possible, could we please keep this discussion public? Thank you for your consideration.

[Melvin- Admin]

2 minutes ago, bluebird00 said:

Thank you for your response and the explanation regarding graft density. I must admit, I don't quite understand your explanation and will need to conduct some research on my own. Additionally, I've received your private message inquiring about the date of my surgery, which was November 17, 2021. I had hoped Dr. Bloxham would clarify these issues. However, if he insists that he implanted 2700 grafts, a figure seemingly contested by all observations based on my images, I'm uncertain of the value of his input in this case. Nonetheless, I remain optimistic and look forward to understanding what he is sending me in the mail. It's perplexing though, that he has chosen to send this package via certified mail when he has previously communicated official reports to me via email. If possible, could we please keep this discussion public? Thank you for your consideration.

Absolutely, the discussion will remain public. We just need you to authorize him to discuss your case here publicly. This may include sharing some images. Your face will be hidden to preserve your privacy. 

[bluebird00]

I will authorize Dr. Bloxham to discuss my case publicly, provided that my face is blurred and my personal information, such as my name, date of birth, and address, is not disclosed. Thank you for agreeing to keep this discussion public. I am eager to learn more about the details of my operation.

[bluebird00]

jjalay,

I believe it was Dr. Powell, though I'm not entirely sure. I hope Dr. Bloxham can answer that question here.

[Britanium]

3 strips taken on one procedure 😳 no that's far from usual. 

The 11 hours would usually indicate more than 1700 grafts for a FUT, but considering there was multiple strips taken and extra time needed then it's very difficult to ascertain how much time was taken for each step of the procedure. 

I agree that it's possible to get a very good idea of the grafts implanted via GIMP, but it's not going to be 100% accurate. Another Dr would perhaps also be able to say how many grafts might have been implanted. I'm unsure, but will say I definitely don't think it's 2700 from what I can see. 

 

Edited March 7 by Britanium

[jjalay]

22 minutes ago, bluebird00 said:

jjalay,

I believe it was Dr. Powell, though I'm not entirely sure. I hope Dr. Bloxham can answer that question here.

Never heard of this doctor but i wouldnt be happy either if another doctor contradictory to what was agreed operated on me.

[Berba11]

18 minutes ago, Britanium said:

3 strips taken on one procedure 😳 no that's far from usual. 

The 11 hours would usually indicate more than 1700 grafts for a FUT, but considering there was multiple strips taken and extra time needed then it's very difficult to accatain how much time was taken for each step of the procedure. 

I agree that it's possible to get a very good idea of the grafts implanted via GIMP, but it's not going to be 100% accurate. Another Dr would perhaps also be able to say how many grafts might have been implanted. I'm unsure, but will say I definitely don't think it's 2700 from what I can see. 

 

The OP also mentioned possible ‘popping’, which may mean he was oozing a fair bit during surgery and in order to negate popping, they had to work a little more slowly and allow the oozing to subside. That, plus the multiple strips (which is very odd indeed), could certainly account for a longer, slower surgery. 

[Britanium]

Just now, Berba11 said:

The OP also mentioned possible ‘popping’, which may mean he was oozing a fair bit during surgery and in order to negate popping, they had to work a little more slowly and allow the oozing to subside. That, plus the multiple strips (which is very odd indeed), could certainly account for a longer, slower surgery. 

Yeah I saw that too, it's very clear this was far from a straightforward ht, lots of things to consider here. 

Dr Bloxham hasn't posted here in years, let's see a public response to each of the very valid points the OP has raised. 

[Melvin- Admin]

45 minutes ago, bluebird00 said:

I will authorize Dr. Bloxham to discuss my case publicly, provided that my face is blurred and my personal information, such as my name, date of birth, and address, is not disclosed. Thank you for agreeing to keep this discussion public. I am eager to learn more about the details of my operation.

Yes, no identifying information will be shared here publicly.

[JoeD]

7 minutes ago, Britanium said:

Yeah I saw that too, it's very clear this was far from a straightforward ht, lots of things to consider here. 

Dr Bloxham hasn't posted here in years, let's see a public response to each of the very valid points the OP has raised. 

Would be very interested for Dr. Bloxham to respond.

 In that note posted I could decipher a few things that would prob account for a much longer case than typical

- for the extra 2 strip areas, says poor laxity, extraction density lower than (can’t read last word)

- bleeding 4-5/5

- difficulty closing 5/5, thin floppy skin and constant pre-syncope/vaso vagal

- medium to high degrees of leaking during site creation, graft placement and popping  

 - grafts: ~2700

 

[Berba11]

22 minutes ago, JoeD said:

Would be very interested for Dr. Bloxham to respond.

 In that note posted I could decipher a few things that would prob account for a much longer case than typical

- for the extra 2 strip areas, says poor laxity, extraction density lower than (can’t read last word)

- bleeding 4-5/5

- difficulty closing 5/5, thin floppy skin and constant pre-syncope/vaso vagal

- medium to high degrees of leaking during site creation, graft placement and popping  

 - grafts: ~2700

 

How on earth you’ve managed to decipher that handwriting I’ll never know. I can’t even make half of it out *after* you’ve transcribed it! Good work!

[JoeD]

Just now, Berba11 said:

How on earth you’ve managed to decipher that handwriting I’ll never know. I can’t even make half of it out *after* you’ve transcribed it! Good work!

Pharmacist….. who’s handwriting do you think I have to deal with all the time and be extremely accurate?

[Berba11]

3 minutes ago, JoeD said:

Pharmacist….. who’s handwriting do you think I have to deal with all the time and be extremely accurate?

I did wonder if you were a doctor yourself, so that now makes sense!

[Britanium]

5 minutes ago, JoeD said:

Pharmacist….. who’s handwriting do you think I have to deal with all the time and be extremely accurate?

I'm a nurse so used to seeing Dr's scribbling but was struggling 🤣😁 

[Steeeve]

@bluebird00 During my first strip procedure in 2019 my initial graft count was low so the doctor went back and pulled another strip, however, he was able to pull it from where had already pulled the existing strip just an hour or so prior. It was just connected to what had already been taken out so I ended up with one scar.

Am I understanding this that you have 3 separate scars from the one procedure?

Edited March 7 by Steeeve

[Chair]

Sorry you had to go through this. There are so many better doctors out there than Bloxham. I’m not surprised you had graft failure. I know someone else who went to him and didn’t have grafts take. I myself am looking for someone to revise the work he did on me. I paid for their “expertise” and at this point I wished I flew to Türkiye and saved a ton and would have received better results. 

[AB2000]

As an aside, those are fairly good post-op progress photos, in terms of the detail shown.

[Al - Moderator]

2 hours ago, Chair said:

Sorry you had to go through this. There are so many better doctors out there than Bloxham. I’m not surprised you had graft failure. I know someone else who went to him and didn’t have grafts take. I myself am looking for someone to revise the work he did on me. I paid for their “expertise” and at this point I wished I flew to Türkiye and saved a ton and would have received better results. 

 

I'm not seeing an issue with the growth in the case posted here. The end result looks pretty good to me.  There certainly could be a discrepancy on the amount of grafts received and the price charged and I did email Dr Bloxham about this case to get his response, but it doesn't appear to me that there is a graft failure as you put it.

 

[Steeeve]

2 hours ago, Chair said:

Sorry you had to go through this. There are so many better doctors out there than Bloxham. I’m not surprised you had graft failure. I know someone else who went to him and didn’t have grafts take. I myself am looking for someone to revise the work he did on me. I paid for their “expertise” and at this point I wished I flew to Türkiye and saved a ton and would have received better results. 

Every doctor has cases where the growth can be lackluster. I'm sorry if you had a bad experience with him.

That's not the case here, though. Maybe I missed it but I didn't see anywhere that OP was unhappy with the overall growth. As @Al - formerly BeHappy said, there is a discrepancy in what was extracted/placed and paid for.

Pictures don't always tell the full story but from what was posted I think the result looks really nice. 

[chrisu]

4 hours ago, Chair said:

Sorry you had to go through this. There are so many better doctors out there than Bloxham. I’m not surprised you had graft failure. I know someone else who went to him and didn’t have grafts take. I myself am looking for someone to revise the work he did on me. I paid for their “expertise” and at this point I wished I flew to Türkiye and saved a ton and would have received better results. 

can you share your experience? feel free to PM me

[bluebird00]

Steeeve, 

I'm not sure how to reply directly to you on this forum. I believe I have only one long scar because Dr. Bloxham extracted from both the left and right sides of my initial extraction site. In some of these images, you can see how the scar extends past my ear on both sides. The scar isn't noticeable since I always have long hair. However, I'm unsure how it would look if I had short hair.

[Chair]

7 minutes ago, bluebird00 said:

Steeeve, 

I'm not sure how to reply directly to you on this forum. I believe I have only one long scar because Dr. Bloxham extracted from both the left and right sides of my initial extraction site. In some of these images, you can see how the scar extends past my ear on both sides. The scar isn't noticeable since I always have long hair. However, I'm unsure how it would look if I had short hair.

Probably like mine…. A long scar from ear to ear.