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

[Al - Moderator]

8 hours ago, bluebird00 said:

I appreciate you addressing my concerns, but I'm still perplexed as to why you questioned my intent. It seemed crude and unnecessary, and I am bewildered by what prompted you to say that. I understand you tried to explain, but it came across as a gut reaction.

 

No no. You misunderstand me. I'm not questioning your intent and it doesn't matter if I or anyone else on this board is. What I'm saying is... to Dr Bloxham it probably comes across that way.... and that's the one that matters because you and he are the ones who have the most knowledge of your surgery, not anyone on this board. As I said earlier you should be asking him for a breakdown of the graft count. You want to know how many single, doubles, triples. That will add up to the total number of grafts done.

 

[chrisu]

any updates?

[bluebird00]

On 3/14/2024 at 5:03 PM, chrisu said:

any updates?

Yes, I will post later tonight. Sorry for the delay. 

[bluebird00]

On 3/14/2024 at 5:03 PM, chrisu said:

any updates?

I have received a document and a couple of pictures from Dr. Bloxham via certified mail, but my post update is not quite ready. I thought I would have more time today. Please look out for an update tomorrow after 6 PM EST

[Chair]

1 minute ago, bluebird00 said:

I have received a document and a couple of pictures from Dr. Bloxham via certified mail, but my post update is not quite ready. I thought I would have more time today. Please look out for an update tomorrow after 6 PM EST

Certified mail? Whats next? A letter from his representation? 

[JoeD]

15 hours ago, bluebird00 said:

I have received a document and a couple of pictures from Dr. Bloxham via certified mail, but my post update is not quite ready. I thought I would have more time today. Please look out for an update tomorrow after 6 PM EST

The doc clearly knows you’re going to publicly post it….

Highly curious, as I’m sure others here are too. 

 

Edited March 17 by JoeD
.

[bluebird00]

For some reason, I am not able to edit my original post..

See the attached letter sent to me by Dr. Bloxham via certified mail, along with a thumb drive containing three images uploaded to this post. In this letter, Dr. Bloxham does not provide any new information and merely echoes his previous reply in this thread, with the remainder of the letter devoted to defending his practice.

No specifics about my surgery are provided. These concerns remain outstanding:

·        Dr. Bloxham has not disclosed the identity of the other doctor who operated on me without my informed consent.

·        Despite repeated requests, Dr. Bloxham has not transcribed his handwriting on the operating room report.

·        Dr. Bloxham has not provided a graft breakdown of my surgery (1’s, 2’s, 3’s, 4’s)

·        Dr. Bloxham has not justified the need for 3 separate strip harvests, especially given his YouTube content explaining that strip harvesting for the required amount of grafts is based on a precise formula. Yet, each harvested strip exposed me to additional surgical risks.

·        Despite the thinness of my results and the large amount of tissue removed, Dr. Bloxham insists that 2700 grafts were extracted and implanted, which contradicts his statement at the time of surgery that it was 1700. My new donor density measurements also suggest more than 2700 grafts were harvested and are unaccounted for..

·        Dr. Bloxham has not explained why my surgery took 11 hours, particularly when his YouTube video titled “How Long Does a Hair Transplant Take” indicates it should only take 4-8 hours.

·        Dr. Bloxham merely hints at the use of multiple grafts in a channel opening but does not confirm this technique was used in my procedure.

·        Dr. Bloxham is my doctor, yet is suggesting answers to the outstanding concerns I have with my surgery performed by him be addressed by another doctor.

Given the criteria for Ethics & Integrity established for recommendation on this forum, I feel a categorical explanation for each of the concerns is warranted from Dr. Bloxham.

[Chair]

9 minutes ago, bluebird00 said:

For some reason, I am not able to edit my original post..

See the attached letter sent to me by Dr. Bloxham via certified mail, along with a thumb drive containing three images uploaded to this post. In this letter, Dr. Bloxham does not provide any new information and merely echoes his previous reply in this thread, with the remainder of the letter devoted to defending his practice.

No specifics about my surgery are provided. These concerns remain outstanding:

·        Dr. Bloxham has not disclosed the identity of the other doctor who operated on me without my informed consent.

·        Despite repeated requests, Dr. Bloxham has not transcribed his handwriting on the operating room report.

·        Dr. Bloxham has not provided a graft breakdown of my surgery (1’s, 2’s, 3’s, 4’s)

·        Dr. Bloxham has not justified the need for 3 separate strip harvests, especially given his YouTube content explaining that strip harvesting for the required amount of grafts is based on a precise formula. Yet, each harvested strip exposed me to additional surgical risks.

·        Despite the thinness of my results and the large amount of tissue removed, Dr. Bloxham insists that 2700 grafts were extracted and implanted, which contradicts his statement at the time of surgery that it was 1700. My new donor density measurements also suggest more than 2700 grafts were harvested and are unaccounted for..

·        Dr. Bloxham has not explained why my surgery took 11 hours, particularly when his YouTube video titled “How Long Does a Hair Transplant Take” indicates it should only take 4-8 hours.

·        Dr. Bloxham merely hints at the use of multiple grafts in a channel opening but does not confirm this technique was used in my procedure.

·        Dr. Bloxham is my doctor, yet is suggesting answers to the outstanding concerns I have with my surgery performed by him be addressed by another doctor.

Given the criteria for Ethics & Integrity established for recommendation on this forum, I feel a categorical explanation for each of the concerns is warranted from Dr. Bloxham.

I read your letter and this “round robin” thing they said…. Yeah well that didn’t happen for me. They only used 2 technicians who placed all of my grafts. I’d go into more detail but I really don’t want a letter from their lawyer threatening to sue me for comments online. Let’s just say based on my accounts of my procedure with Blake that I’d never recommend him to my worst nightmare. Oh boy how I love my half inch wide FUT scar. 

[BackFromTheBrink]

I don't think his letter is unreasonable. It does, however, lack specifics on your case and instead talks generally.

The only think I can see that is definitive is that he extracted and implanted 2700 grafts. However, since that is the main concern you have, I'd say he has addressed that.

The implication is that you had less than 2700 incisions since he uses multiple singles in one incision 'almost every day'. Similarly, he presumes there was only one surgery taking place at the time of your surgery.

If I were to guess, it would be that you have not been given specifics about your surgery because he doesn't have them (such as a record of the hair to follicle ratio of the 3 strips). He also may be concerned about you using his words as part of a legal case against him - e.g he could have checked to confirm how many patients were booked on the same day as you, but chose not to do, or not to disclose that for fear of you finding further fault.

While not directly stating it, he also seems to say that there are only 2 senior doctors. Others may be 'shadowing' but would not have interfered with the surgery. It'd be useful to have a definitive statement that only he and Dr. Feller operated on you, but he chose not to take the opportunity to clarify that.

From reading his letter, the only way you'll know for sure is to take him up on his offer of a consultation to ask him the questions you listed above. I don't think that will help you, other than to perhaps set your mind at rest.

You have paid for the surgery, he believes he's delivered what you paid and you were in no way short changed.

While it may not be what your want to hear, nothing is going to change what did or didn't happen in the surgery. You've really just got to decide whether the outcome is worth the cost (monetarily and in donor grafts), the rest is really largely just noise.

Edited March 17 by BackFromTheBrink

[JoeD]

2 hours ago, bluebird00 said:

For some reason, I am not able to edit my original post..

See the attached letter sent to me by Dr. Bloxham via certified mail, along with a thumb drive containing three images uploaded to this post. In this letter, Dr. Bloxham does not provide any new information and merely echoes his previous reply in this thread, with the remainder of the letter devoted to defending his practice.

No specifics about my surgery are provided. These concerns remain outstanding:

·        Dr. Bloxham has not disclosed the identity of the other doctor who operated on me without my informed consent.

·        Despite repeated requests, Dr. Bloxham has not transcribed his handwriting on the operating room report.

·        Dr. Bloxham has not provided a graft breakdown of my surgery (1’s, 2’s, 3’s, 4’s)

·        Dr. Bloxham has not justified the need for 3 separate strip harvests, especially given his YouTube content explaining that strip harvesting for the required amount of grafts is based on a precise formula. Yet, each harvested strip exposed me to additional surgical risks.

·        Despite the thinness of my results and the large amount of tissue removed, Dr. Bloxham insists that 2700 grafts were extracted and implanted, which contradicts his statement at the time of surgery that it was 1700. My new donor density measurements also suggest more than 2700 grafts were harvested and are unaccounted for..

·        Dr. Bloxham has not explained why my surgery took 11 hours, particularly when his YouTube video titled “How Long Does a Hair Transplant Take” indicates it should only take 4-8 hours.

·        Dr. Bloxham merely hints at the use of multiple grafts in a channel opening but does not confirm this technique was used in my procedure.

·        Dr. Bloxham is my doctor, yet is suggesting answers to the outstanding concerns I have with my surgery performed by him be addressed by another doctor.

Given the criteria for Ethics & Integrity established for recommendation on this forum, I feel a categorical explanation for each of the concerns is warranted from Dr. Bloxham.

 

 

 

 

 

 

most (not all) has been answered and the OR report has been transcribed in this thread.

- Graft count: while he did not give specific breakdown, he does essentially say that excess singles from the strip were combined to make multi-grafts behind the hairline, in single incisions. If the exact graft breakdown wasn’t listed in OP report and/or recently by doctor, then I’ve got to assume it wasn’t documented.

-Procedure time: strip needed extending on both sides due to the lower density on the sides, as written on the operative report. That plus repeated popping, vasovagal/syncope (passing out), would account for additional hours.  

- exact role and identity of other “shadowing” doctor: this has not been answered and should be  

- seeking outside/2nd professional opinions: at this point, if you don’t believe what he has told you, then I don’t see any other way, but don’t know how helpful that would be. You could take him up on the offer to come in and discuss face to face or call in on phone for your remaining specific questions. He did also offer for you to record that. 
 

At this point you’ve got a “decent” (not outstanding) result and don’t look like you’re significantly balding.  I think it would be best to just move on and stop torturing yourself over this. 

 

Edited March 17 by JoeD

[Chair]

6 minutes ago, BackFromTheBrink said:

I don't think his letter is unreasonable. It does, however, lack specifics on your case and instead talks generally.

The only think I can see that is definitive is that he extracted and implanted 2700 grafts. However, since that is the main concern you have, I'd say he has addressed that.

The implication is that you had less than 2700 incisions since he uses multiple singles in one incision 'almost every day'. Similarly, he presumes there was only one surgery taking place at the time of your surgery.

If I were to guess, it would be that you have not been given specifics about your surgery because he doesn't have them (such as a record of the hair to follicle ratio of the 3 strips). He also may be concerned about you using his words as part of a legal case against him - e.g he could have checked to confirm how many patients were booked on the same day as you, but chose not to do, or not to disclose that for fear of you finding further fault.

While not directly stating it, he also seems to say that there are only 2 senior doctors. Others may be 'shadowing' but would not have interfered with the surgery. It'd be useful to have a definitive statement that only he and Dr. Feller operated on you, but he chose not to take the opportunity to clarify that.

From reading his letter, the only way you'll know for sure is to take him up on his offer of a consultation to ask him the questions you listed above. I don't think that will help you, other than to perhaps set your mind at rest.

You have paid for the surgery, he believes he's delivered what you paid and you were in no way short changed.

While it may not be what your want to hear, nothing is going to change what did or didn't happen in the surgery. You've really just got to decide whether the outcome is worth the cost (monetarily and in donor grafts), the rest is really largely just noise.

Dr feller no longer practices apparently. He’s more of a consultant now. That’s how it was when I paid top dollar back in 2016. Fellers hands never touched my head. I paid “top dollar” and only Blake’s hands touched my head. I remember feller coming in and Blake showing him what he was doing, feller gave some piece of advice or mumbled something then walked out. Feller came in again during the graft placements by the two techs and told them multiple times how to do the graft placement. I’d go into further detail but then I’d be accused of being a liar and threatened with a lawsuit. 

[BackFromTheBrink]

Just now, Chair said:

Dr feller no longer practices apparently. He’s more of a consultant now. That’s how it was when I paid top dollar back in 2016. Fellers hands never touched my head. I paid “top dollar” and only Blake’s hands touched my head. I remember feller coming in and Blake showing him what he was doing, feller gave some piece of advice or mumbled something then walked out. Feller came in again during the graft placements by the two techs and told them multiple times how to do the graft placement. I’d go into further detail but then I’d be accused of being a liar and threatened with a lawsuit. 

In his letter he identified 3 roles - supervising doctor (him and Dr Feller), technician (seemingly with some more senior/responsible for providing updates) and observing doctor. He doesn't mention who does what as part of the actual surgical work, so it's open to interpretation.

[Chair]

14 hours ago, BackFromTheBrink said:

In his letter he identified 3 roles - supervising doctor (him and Dr Feller), technician (seemingly with some more senior/responsible for providing updates) and observing doctor. He doesn't mention who does what as part of the actual surgical work, so it's open to interpretation.

I spoke to their person at the desk a few weeks back and was told that feller no longer performs any surgeries. 

Edited March 18 by Chair

[bluebird00]

8 hours ago, BackFromTheBrink said:

I don't think his letter is unreasonable. It does, however, lack specifics on your case and instead talks generally.

The only think I can see that is definitive is that he extracted and implanted 2700 grafts. However, since that is the main concern you have, I'd say he has addressed that.

The implication is that you had less than 2700 incisions since he uses multiple singles in one incision 'almost every day'. Similarly, he presumes there was only one surgery taking place at the time of your surgery.

If I were to guess, it would be that you have not been given specifics about your surgery because he doesn't have them (such as a record of the hair to follicle ratio of the 3 strips). He also may be concerned about you using his words as part of a legal case against him - e.g he could have checked to confirm how many patients were booked on the same day as you, but chose not to do, or not to disclose that for fear of you finding further fault.

While not directly stating it, he also seems to say that there are only 2 senior doctors. Others may be 'shadowing' but would not have interfered with the surgery. It'd be useful to have a definitive statement that only he and Dr. Feller operated on you, but he chose not to take the opportunity to clarify that.

From reading his letter, the only way you'll know for sure is to take him up on his offer of a consultation to ask him the questions you listed above. I don't think that will help you, other than to perhaps set your mind at rest.

You have paid for the surgery, he believes he's delivered what you paid and you were in no way short changed.

While it may not be what your want to hear, nothing is going to change what did or didn't happen in the surgery. You've really just got to decide whether the outcome is worth the cost (monetarily and in donor grafts), the rest is really largely just noise.

8 hours ago, JoeD said:

most (not all) has been answered and the OR report has been transcribed in this thread.

- Graft count: while he did not give specific breakdown, he does essentially say that excess singles from the strip were combined to make multi-grafts behind the hairline, in single incisions. If the exact graft breakdown wasn’t listed in OP report and/or recently by doctor, then I’ve got to assume it wasn’t documented.

-Procedure time: strip needed extending on both sides due to the lower density on the sides, as written on the operative report. That plus repeated popping, vasovagal/syncope (passing out), would account for additional hours.  

- exact role and identity of other “shadowing” doctor: this has not been answered and should be  

- seeking outside/2nd professional opinions: at this point, if you don’t believe what he has told you, then I don’t see any other way, but don’t know how helpful that would be. You could take him up on the offer to come in and discuss face to face or call in on phone for your remaining specific questions. He did also offer for you to record that. 
 

At this point you’ve got a “decent” (not outstanding) result and don’t look like you’re significantly balding.  I think it would be best to just move on and stop torturing yourself over this. 

 

Where is the double packing?

again, where is the double packing?

 

 

 

 

[JoeD]

4 minutes ago, bluebird00 said:

Where is the double packing?

again, where is the double packing?

 

 

 

 

I don’t know how to tell the difference between which is a natural multi-hair graft in one incision vs >1 single hair grafts combined in one incision 

Edited March 17 by JoeD

[shiba1985]

On 3/12/2024 at 3:43 PM, bluebird00 said:

The total area of the 3 strips harvested is between 56 cm² and 61.8 cm². This is derived from the surgery report and transcribed as follows:

 

 

1st strip: 29 cm * (1.6-1.8 cm) = 46.4 cm² - 52.2 cm²
2nd strip: 3 cm * 1.6 cm = 4.8 cm²
3rd strip: 3 cm * 1.6 cm = 4.8 cm²

I have shaved my donor area just below my FUT scar as shown in this picture, which allows me to perform an accurate count of 85 follicular units in a 1 cm x 1 cm square.

I used GIMP, a professional-level photo editor, to perform this count. As I do not have any patchiness in my donor area, we can safely conclude that my donor density is on average 85 FU/cm² throughout.

Using simple math, the number of follicular units that were harvested can be easily determined. If there are 85 follicular units per square centimeter, and the total area of the 3 strips harvested is between 56 cm² and 61.8 cm², then the math works out as below: 56 cm² * 85 FU/cm² = 4760 follicular units on the low end, and 61.8 cm² * 85 FU/cm² = 5253 follicular units on the high end.

Please let me know if that does not make sense to you. None of the information above is derived from anonymous forum users; it is derived from the surgery report and meticulously counted from the photographic evidence I captured of my donor area using GIMP.

 

Strip density varies drastically as one goes from occipital to temporal area. You cannot calculate the density at the thickest part of the scalp and assume the entire strip has the same density. It drops significantly. 
 

[jjalay]

1 hour ago, shiba1985 said:

Strip density varies drastically as one goes from occipital to temporal area. You cannot calculate the density at the thickest part of the scalp and assume the entire strip has the same density. It drops significantly. 
 

Three strips to harvest this small amount of grafts according to the doctor? Something doesnt fit here.

[chrisu]

OP can you book a consultation with another surgeon to help expedite this and get another opinion?

[chrisu]

OP I looked over your pics again and it seems like you had more density in the middle beforehand? Not sure if its the new implanted hairs that make it appear like that?

[BackFromTheBrink]

3 hours ago, jjalay said:

Three strips to harvest this small amount of grafts according to the doctor? Something doesnt fit here.

It's not really three strips though, its one strip lengthened twice to get the number of grafts needed.

Looking at it the other way, the OP claims 1700 grafts. What FUT strip of that length would contain as few as that, and why go back for two more areas if you're planning to short change the patient by that amount?

To me it looks like the OP has 3 options - go back to the surgery and speak to him as he suggested or go and see another surgeon for a second opinion, or wait. The area covered would be very sparse with only 1700 grafts, so it'll be obvious if he has in fact had 2700.

[Al - Moderator]

It sounds like some people are confused about the 3 strips. I don't have any direct knowledge of the surgery, but here is what it sounds like happened. Dr Bloxham didn't get enough grafts from the original strip he created. Either the density wasn't as high as he thought (density can vary a lot. It's not the same all over) or he may not have been able to cut the strip as wide as he wanted due to low laxity/scalp tightness. It could have been some of both. I any event, what happened was he didn't get as many grafts as he needed, so he went back and extended the strip on both sides. See the picture below to understand. The green line is the first, original strip taken. To get more grafts, he extended both ends further towards the front. The red lines are the 2 additional strips taken which simply made the original strip longer. So there is only 1 FUT strip, but taken out in 3 sections.

 

 

[asterix0]

Can anyone help me understand, with the pictures OP provided, using software to count the grafts since they were transplanted on bare scalp, how we cannot get the accurate number of grafts from that?

Why speculate on strip width and all these things instead of just counting the grafts?

[asterix0]

A graft is clearly identifiable, it doesn't matter if it's a single, double, or triple, all we have is a binary classification of graft or no graft. If we are talking about hairs then that is a different story. 

[HatMaster]

Personally I think his response is straightforward and reasonable. The only piece that seems “off” to me is that they don’t have a precise graft count with classifications. At least for FUE I think this is almost always noted and made available to the patient. 
 

I agree with other comments that if you want to dive deeper into specific questions about your surgery, you’ll need to sit down with your surgeon (maybe a video call would work if it’s too inconvenient to visit physically?) and/or consult with another doctor. 
 

Since your doctor stands by his claims, it’s unlikely you’ll get a refund unless another doctor examines you and directly refutes what he’s saying. Even then, you’d probably have to involve the legal system. So, to be honest, I think you’d be best off moving on. 
 

For what it’s worth, I think your result looks great. 

[BackFromTheBrink]

16 hours ago, asterix0 said:

Can anyone help me understand, with the pictures OP provided, using software to count the grafts since they were transplanted on bare scalp, how we cannot get the accurate number of grafts from that?

Why speculate on strip width and all these things instead of just counting the grafts?

Because they implanted more than one extracted follicle in some of the incisions.