18 months post op, and looking for suggestions.

[Ryan Daj]

Hi guys,

 

As I promised, I am going to put some pics of my post-op 18 months from a FUT 1,000 grafts.

 

I'm happy with the hairline, very good job, but the density is a little disheartening. Perhaps part of the problem is that my hair is very thick around the area, and a second surgery is almost necessary from what I've read to get the kind of density I'm after.

 

Any suggestions about who to go to? or what could fix this? Also, my hair right now is very short, a number 2, and it's wet... I did this to get good pics (also sorry about the one on the right, I couldn't get the camera to focus)

 

Thanks everybody,

Ryan

Edited March 15, 2011 by Ryan Daj

[youngsuccess]

Honestly, based on this particular pair of pictures, I can't detect any hairline issues, density-related or otherwise. Maybe try taking a couple more shots that more accurately expose the perceived problems. It's always better to use non-flash photos like you did, but the downside is that unless you remain perfectly still under strong lighting conditions, there is usually some degree of blurriness, as seen in the second cropped picture.

 

The upper temporal region on your left side appears a bit thinner, but considering how short your hair is cut, it doesn't look that inconsistent with the rest. Hard to tell because it's wet and a little blurry, too. How does it look grown out? One direct shot of the entire hairline might help. Looks very natural to me, and you may not want to compromise that with another procedure yet. How's your scar detectability at that length?

[Mp96]

I think the works looks pretty good.

 

 

By the way, good choice in doctor. I actually think it's a good idea to have a female surgeon.

[Ryan Daj]

Thanks, as I write this I am currently trying to take some pics that show what I'm talking about. I'll try to post them really soon!

[Ryan Daj]

Here's a photo of the back, I tried without flash. So it's a tiny bit grainy, but it is in the bathroom, with 4 giant lightbulbs, so this is how it looks even in an area with a lot of light. The scar doesn't bother me at all.

[Ryan Daj]

Here is a picture of the right side, I'm not 100% sure what's going on though, my hair is not red. Something is up with the color.

 

Anyways, you can sort of tell what I'm talking about. There is significantly less density there than the rest of my head. Especially in one or two spots, where there is like a streak of hairlessness.

 

Also, when it's longer, its more irritating, because there are so few hairs there, you can't do anything with them.

[Ryan Daj]

Anyways, I probably should not expect too much. I'm using my blackberry's camera function for these pics. Sorry, hope you can kind of get the gist of what I'm saying though.

[youngsuccess]

I think I can see what you're referring to, but post-op pictures would definitely help. You currently have an aesthetically pleasing and natural-looking contour to your hairline, with proper, subtle recession toward the temporal angles.

 

It definitely doesn't look like you've achieved uniform, native-like density, but creating a nice widow's peak and decent central hair that tapers off towards the sides was a sound approach I think, as opposed to transplanting a solid, straight wall of hair that's evenly dense throughout. If you continue to lose hair but keep a closely-cropped hairstyle, I think you can maintain a more natural appearance this way, without a completely symmetrical and overly loaded front. Is it more the hairline or area behind it that bothers you?

 

The good news is that you've only used 1000 grafts so far, and your scar looks very good. I'd discuss your goals with Dr. Keene. In addition, you might want to look into FUE options if you're interested in only increasing the density in target areas. Looks very good to me, though.

[Bill - Seemiller]

Ryan,

 

I can only echo what some of our members are saying. While your hair density in the front is a little thinner than I'm sure it was in your hair glory years, it's very natural looking and refined. That said, it would help if you provided before and surgical photos so we have something to compare it to.

 

1000 is simply not a lot of grafts and since hair loss is progressive, you may have lost and continue to lose more natural hair. Thus, if you're not on both Propecia and/or Rogaine to try to prevent future loss, I'd strongly recommend considering them.

 

As to what to do next, is there a reason you don't want to go back to Dr. Keene? In my opinion, she's top notch and if you stick with her, I'm sure she'll help you meet your hair restoration goals.

 

Best wishes,

 

Bill

[Ryan Daj]

It's the area behind that bothers me. I see what you're saying. I've been on finasteride for two years now, and haven't seen any hair loss.

 

I heard from my dermatologist that my premature hairloss could have been caused by accutane, which I took when I was 17. So, I'm fairly certain I shouldn't have any more hairloss for a decade or so...

 

I also assume you meant pre-op picture? Well, I am going to try to find one, and post it in the next post

[Ryan Daj]

Oh about Dr. Keene, the reason I didn't want to go back was because I don't want to get another gash scar on the back of my head. And according to her website she specializes in FUT. Any suggestions?

[Bill - Seemiller]

Ryan,

 

With each subsequent FUT hair transplant procedure, the previous scar is harvested and replaced with a new one. You won't have more than one scar. That said, your scar according to the photos looks well concealed by your short hair.

 

If you want to go the FUE route due to fear of additional scarring, you will indeed have to select another surgeon since last time I checked, Dr. Keene did not perform FUE. Physicians recommended by this community that have shown a good number of impressive examples of their FUE work and results include Dr. Feller, Dr. Devroye, Dr. Feriduni, and more recently True and Dorin. Dr. Shapiro is also doing FUE however, I don't recall seeing any grown out results yet (someone correct me if I'm wrong). This may be a good place to start if you are considering FUE.

 

Best wishes,

 

Bill

[Ryan Daj]

Wow i just learned a lot from that post. Thank you so much for that reply! Somehow it made me feel better and sorry i let some frustration out in the last post. Thanks for being such a good guy and great group of guys.

 

Like i said i was not aware that they harvested over the old scar i was upset after seeing some horror photos of guys with tons of scars on the back of their head.

 

Best

Ryan

[Mp96]

Originally posted by Bill - Managing Publisher:

Ryan,

 

With each subsequent FUT hair transplant procedure, the previous scar is harvested and replaced with a new one. You won't have more than one scar. That said, your scar according to the photos looks well concealed by your short hair.

 

If you want to go the FUE route due to fear of additional scarring, you will indeed have to select another surgeon since last time I checked, Dr. Keene did not perform FUE. Physicians recommended by this community that have shown a good number of impressive examples of their FUE work and results include Dr. Feller, Dr. Devroye, Dr. Feriduni, and more recently True and Dorin. Dr. Shapiro is also doing FUE however, I don't recall seeing any grown out results yet (someone correct me if I'm wrong). This may be a good place to start if you are considering FUE.

 

Best wishes,

 

Bill

 

 

 

So Bill, your saying that the patients first scar incision is used again during further procedures? I think this would make sense so the patient doesn't have a number of lines in the back of their head.

 

I am just courious because i have had a consultation with a doc who is recommended by this community and they wanted to use a new area of my head for a new strip to balance out my hairline from my previous surgery even though I requested to use my old scar.

 

Can u elaborate more on this?

 

 

Thanks in advance!!

[Bill - Seemiller]

Mp96,

 

Your interpretation of what I said is correct. It's standard practice to harvest a new strip in the same location so that the old scar is contained within. One scar is typically easier to conceal than two scars.

 

Rarely, a surgeon may discuss the possibility of taking a new strip creating a second scar if they feel removing the old one is too risky or if they feel they can get more hair. Physicians should always go over the reasons with their patients, especially for any approach that deviates from the norm. I trust your surgeon went over his/her reasons with you. If you'd like to discuss this, feel free to either create a new topic or email me privately. I don't want to hijack Ryan Daj's thread with a new topic of discussion.

 

Best wishes,

 

Bill

[Ryan Daj]

If you make a new post please put a link to it!

[Hairtechnician]

Just to verify, yes, Dr. Keene would take the donor strip from the same area as she did before, so there would not be an additional incisional scar. Unfortunately, there is no scarless procedure, though it is minimized with the double layer and trichophytic closure that Dr. Keene uses.

 

When grafts are removed through FUE, the small .75 - 1 mm holes that are left in the area where they are removed are left open to fill in, usually with scar tissue. So while the scars are usually very small, just as they are with the strip technique, there is still no scarless procedure. FUE tends to leave more of a moth eaten appearance when it scars, where as with the strip procedure, it is a fine linear line, and hair can actually grow out through the incision with the trichophytic closure. There are other disadvantages to FUE, such as not getting as many grafts from the area due to damage to the follicles.

 

We have patients with the strip technique and trichophytic closure where we can't find any evidence that the donor was removed. The same people who scar from the strip technique are more likely to scar from the FUE technique, but refining the FUE scars would be more difficult than refining a strip excision scar.

 

Remember that in order for you to make a comparison of how your hair looked before to how it looks now, it is important not to cut it as short as possible--the shorter the cut, the more likely it is to look thin. Even men with no hair loss can appear to have thin hair when it is buzzed.

 

Also, if you thin as you get older, and we do the same density as your youthful hair was, it will limit the donor supply for the future. I know Dr. Keene also put you on Finasteride to maintain the hair you have, but there is still a risk. So you need to weigh your options carefully. Your current result looks very natural and completely undectable as a hair transplant. Right now you have plenty of donor for the future. And your normal hair style is not a buzz cut. It would be nice to see what it looks like grown out to the length you normally wear your hair.

 

I think your results look great Ryan, but if you have concerns, please call us to schedule a follow up with Dr. Keene.

[Julius]

I like your buzzed look, but it looks a little thin in the transplanted region. If I was you I would get another strip procedure to fill it in, as you already have the scar. Cheers