Why did my transplant fail? I don’t get it and it just has been really tough to make sense of.

[Hair-here]

It’s been about 20 months since my hair transplant.  3000 grafts with one of the top frequently recommended docs. Well over $10k spent.
 

And it just didn’t yield well. It’s patchy and just not what I expected at all.  I don’t get it.  I know there’s no guarantees in surgery but it just really sucks to go through all that for such a disappointing result.

My surgery seemed to go smooth.  I didn’t bump my head. I stayed 4 days after just for careful head washes by the staff.  I made it past the initial 14 days and thought my grafts were in for good and the wait began.

i probably am the kind of case where I should have skipped surgery- a NW 6/7 in my 40s who wasn’t on any meds or any hair regimen at all really.  But I was very realistic though with my expectations and went in knowing 3000 grafts would give me back a hairline and some density in my front third only and leave a bald crown.  I just wanted to keep buzzing my hair and the new hair would erase the dreaded horseshoe even if I was still left with a donut.  I thought any new hair would be better- balding is still better than bald, right? Us advanced NWs have a different view of hair. I just wanted to see a hairline again even if a mature pushed back one.

  I gave Finasteride another shot after my surgery, even though my previous attempt 15 years earlier (when I still had a nice head of hair) gave me some mild but unpleasant side effects.

  I just don’t know what went wrong. My doctor had no explanation either but fully agreed it did not turn out well. 
 
  My mind has gone to a number of things but none seem likely:
  Did the large whitehead pimples in the months after surgery hurt my growth?

  My donor isn’t looking so great either. I like to keep it buzzed down and had always planned to do that even after surgery. Probably SMP would have been suggested for my situation but I really wanted some real hair.  I was totally ok to keep looking like your average  balding (but not bald) mature Dad, 

  I just don’t get why it failed. It’s frustrating.  I’ve recently consulted with the top advanced NW docs and plan to give it another shot though. 

  To those who have had poor yields, any idea why?

  My pics show 18 months after surgery and a week after surgery. No pic but before surgery, I was pretty slick bald on top.

  

Edited April 16 by Hair-here

[SXP92]

who did your surgery? 

[Shaheer]

Its still fixable as the doctor kept high forehead. I guess your body is not accepting transplanted grafts. My advise would be just do 1000 grafts more and see if it is accepting why spent another 10k. Let your previous doctor H&W only do it. I know how they design their hairs.

[Hair-here]

7 hours ago, SXP92 said:

who did your surgery? 

I obviously chose not to name the doctor. I honestly just don’t think this was their fault at all and I wouldn’t want to give them any negative press.  They were very responsive throughout the process and even afterwards with suggestions and advice.  And everything looked good when surgery was done.  I think this is just the reality of any surgery, results aren’t guaranteed and everyone’s body reacts differently.

To be fair, the doctor did offer a free  follow up procedure which seemed very generous but I was just unsure that the amount of grafts suggested would be significant enough.

i was planning to just go back to buzzing my head and forget about any more surgery but seeing some of the high NW docs like Pitella, Zarev, and Eugenix I’m now reconsidering.  Even though I keep my hair short and have buzzed/shaved it usually, I have an objectively bad head shape for shaving and really think it would look better with some hair.

My intention with posting was to hopefully hear from some people who had poor yield transplants who went back for another surgery and what their results were. I’m just trying to figure out if it’s worth giving surgery another shot.

Edited April 16 by Hair-here

[bru]

I'm no expert mate but if you were slick bald then I think you did get some growth and another procedure would definitely thicken it up. Good luck and I wouldn't give up if I was you. 

[Hair-here]

1 hour ago, bru said:

I'm no expert mate but if you were slick bald then I think you did get some growth and another procedure would definitely thicken it up. Good luck and I wouldn't give up if I was you. 

I’m not saying there was no growth- for sure I have more hair than before.  Probably my biggest issue is the patchiness.  

Had it been thin but consistent I would have just looked thinning and balding maybe more normally.  But the patchiness is what makes it look much worse.

[bru]

I meant to say decent enough growth it wasn't a complete fail. I'm not sure how your donor is but I wouldn't lose hope. Maybe go with the topical finasteride and minoxidil combo I had some good growth of that.  And then whatever grafts you could get. Your not expecting a full head of hair but enough to make you happy. Wish u all the best. 

[Youth_Again]

looks like H&W to me

[SXP92]

No doubt there is some variation of results patient to patient, but hard to know what to attribute this to. Did the doctor do the extractions and incisions him or herself? or did an assistant/ technician do that part? It's weird to see such low yield in the hands of a skilled and experience operator. Especially when it's being placed into normal tissue. Not like this is being put into some thick FUT scar with low vascularity

I would definitely seek second opinions on your situation. Which region are you located in? maybe the forum can give you some recommendations on other people you can consult with

Definitely wouldn't take your doc up on an offer for a free second procedure. I know you have some faith left in your doc but you need to be singularly focused on who can get you the best cosmetic result from this point forward. Seek those who are expert in repair cases

Edited April 16 by SXP92

[Hair-here]

Yes I didn’t plan to take up my old doctor on his repair offer. I was really just looking to cut my losses and go back to buzzing it, but then I saw some results from the big 3 high NW doctors and changed my mind.

I don’t know them as repair docs but they sure seem to be good at advanced NWs like me.  I’m willing to travel as far as needed.  My only concern was whether there’s any way to know if there’s any indicator how second surgeries turn out after a poor yield on the first surgery.  I don’t see cases like those posted much, especially for advanced NWs like me.  In my mind though, even worst case another poor yield would still be a step better than where I am now and best case, the doc works his usual magic with a tough case.

[gaz9318054]

Have you talked to a medical doctor? It may be wise to get checked out for any sorts of medical conditions that affect growth before going in for another transplant.

[asterix0]

It looks like Hasson and Wong from the shape of the hairline, and the grid like pattern.

Nevertheless, they have in recent times had numerous unsatisfied patients post here. It does seem like quality has been slipping there, I think doctor involvement has been minimal from what I remember reading. 

[Hair-here]

36 minutes ago, gaz9318054 said:

Have you talked to a medical doctor? It may be wise to get checked out for any sorts of medical conditions that affect growth before going in for another transplant.

I would be open to a doctor visit but what exactly are they looking or testing for? I’ve been to a dermatologist and he didn’t notice anything atypical about my hair or scalp that would explain poor growth. But also a dermatologist might not have a lot of experience with hair transplants. 

Edited April 16 by Hair-here

[gaz9318054]

6 minutes ago, Hair-here said:

I would be open to a doctor visit but what exactly are they looking or testing for? I’ve been to a dermatologist and he didn’t notice anything atypical about my hair or scalp that would explain poor growth. But also a dermatologist might not have a lot of experience with hair transplants. 

Not sure.  I just don't see any reason why you wouldn't have far better growth with your previous procedure. It's uniformly poor, as opposed to being patchy or anything. This suggests to me that there might be a more fundamental issue impacting growth, but I'm certainly no doctor.

If it were me, I'd ask my primary care physician about it and follow their advice, including running any tests or ordering bloodwork as they see fit. Get as much information as you can, you know? Good call on speaking with a dermatologist, by the way. Perhaps get a second opinion from another dermatologist who knows more about hair and hair transplants.

Edited April 16 by gaz9318054

[Eli_Avdikian]

Do you have a before picture ?

[Hair-here]

4 minutes ago, Eli_Avdikian said:

Do you have a before picture ?

Sure, here it is- I had a few random hairs still hanging on but basically solidly bald.

[Al - Moderator]

Did you get any infections in the grafts shortly after the HT  in the areas where there is poor growth? 
if you go for another try I would do a small session of no more than 1000 grafts spread out over the entire area so there’s no dense packing of any. This way you can be sure the grafts get blood supply. If that’s successful after a year then you can go back and do another small one to fill in any areas that still need some filling in. 

[Hair-here]

I did get a bunch of decent sized whitehead type pimples in the first few months, nothing full on infected looking, but for sure some of these were in/near areas that look weak.

[SXP92]

I think your running assumption in this case has to be that the poor growth is related to poor technique by the operator. Nobody will ever know for 100% sure, but that's how I would approach it. Look for a good repair surgeon and as others have suggested, think about doing a "test" case of a smaller number of grafts first. Look for someone who's focused on getting as close to 100% survivability as possible. There are some surgeons out there that are very meticulous and don't do a large number of grafts per day. That's the kind of surgeon you need. I think the focus should really be just homogenizing things and filling in obvious gaps so it has a more "even" look

[Gatsby]

Three thousand grafts unfortunately would be more appropriate for a Norwood 3. I like the conservative hair line design which does frame the face. You could consider a second pass with another surgeon. If so I would recommend a scalp biopsy just to rule out any health conditions with the scalp.

[ITA]

12 hours ago, Hair-here said:

Sarei disponibile a una visita dal medico, ma cosa stanno cercando o testando esattamente? Sono stata da un dermatologo e non ha notato nulla di atipico nei miei capelli o nel cuoio capelluto che possa spiegare la scarsa crescita. Ma anche un dermatologo potrebbe non avere molta esperienza con i trapianti di capelli. 

Many dermatologists have no experience in the hair field and even trichologists often cannot understand if there are autoimmune diseases that can cause a hair transplant to fail. Before undergoing another hair transplant, you should see multiple dermatologists and trichologists, order complete blood tests, and also have a biopsy of your scalp. How do you feel it? Do you see it red or feel burning/tingling?

[mr_peanutbutter]

13 hours ago, Hair-here said:

Sure, here it is- I had a few random hairs still hanging on but basically solidly bald.

dr zarev or dr pittella would use 10k grafts and more on such an area

 

you used 3k

[Hair-here]

Yes I realize 3K grafts was never going to do the full job at all. However when I first got consults, that was the maximum grafts any of them quoted me. I got consults from 5 of the top docs recommended on this site (though not any of the 3 top advanced NW guys).

So 3k was the most I was quoted and with lowered and realistic expectations I went with it.  I actually think I would have been reasonably satisfied if the grafts grew.  Again I was just looking for some hairline definition since I was going to keep buzzing it down. I probably still would have gone back for a second procedure at some point but most of those docs didn’t have high hopes for my donor as a NW 6/7.

It was only now that I have gotten quotes from advanced NW docs that I am being told they can harvest up to 10k grafts from a weak donor and beard.  And so that has given me new hope that I can get some real coverage.

[Hair-here]

2 hours ago, ITA said:

Many dermatologists have no experience in the hair field and even trichologists often cannot understand if there are autoimmune diseases that can cause a hair transplant to fail. Before undergoing another hair transplant, you should see multiple dermatologists and trichologists, order complete blood tests, and also have a biopsy of your scalp. How do you feel it? Do you see it red or feel burning/tingling?

My scalp seems pretty normal. I get a bump here and there from time to time but nothing frequent or bad.  And I can keep an eye on it since I still buzz it weekly at 0 guard.

i will look into a scalp biopsy and second opinions.

[Bucky O Hair]

My guess is that your grafts were probably transected upon extraction, or they stayed outside your body too long before being implanted again.

Did they mention anything unique about your case?
Were your follicles larger than normal?  Did you experience more than usual bleeding?

Good call on not accepting a free procedure from the same clinic.  

They may have had a new technician working on your head who didn't have the expertise...or maybe your follicles were more challenging to remove, but they didn't adjust or adapt for your case.

If you have the money, I'd definitely look into Zarev or Munib.