Need advice on hair transplant repair

[keith c]

Hi, might be a long post so thank you inadvance for reading. 

I recently had a hair transplant 16 months ago and currently unhappy with the density and how it looks in the front hairline. 

Im considering a 2nd hair transplant with 'dr. Michalis georgiou' and was wondering if you know off him, and whether hes a good option in being cautious dealing with the donor?

My previous surgery at (sule hair) in turkey has unfortunately left me with pretty bad scarring at the donor area with patchy overharvasted areas. This means its a big challenge for anyone in the future. Dr. Michalis georgiou has mentioned, balanced use of grafts now will make a fade out effect for a more homogeneous look. The idea is that we shall take from the more dense areas. Just not sure if thats actually possible? Opinions on this whole thing would be much appreciated. 

Im also trying to be cautious as i might need further hair transplants in the future as the hair begins to thin as i age. So im wondering is there enough for the repair and for further hairloss if it continues down the road

Fyi; Im 27 years old, been using minoxidil liquid and finasteride daily. 

I have included photos and videos to hopefully paint a better picture of my situation. Thank you for reading. 

 

Best regards, 

Keith 

 

Edited April 23 by keith c
Grammar

[Berba11]

Hey Keith,

You need to tread very carefully and slowly here and not rush into surgery. Your donor does look compromised, so needs to be handled with care. But the key thing here is the approach to the repair of the front. You could simple add a load more grafts to cover up the pluggy hairline and try to mask the sticky-up angles, whilst also improving density. Problem here is, you're going to be using more grafts than you might ideally want to.

You haven't provided any pre-op photos or immediate post-op photos so it's hard to know for sure, but did they lower the hairline? It looks as though they did, and maybe a bit too low. Another repair option you have is to have the hairline removed via FUE over two sessions, and then rebuilt more naturally, softly and more appropriately on a third session. This way the previously implanted 'bad' grafts can be reused further back. This obviously comes with the hassle of a multi-step approach, and tends to cost more, but it may help preserve the donor and will improve the hairline without having to throw too many more grafts into the mix.

[BackFromTheBrink]

My experience of Dr M was great.

He uses a manual punch and is meticulous about his extractions.

The hairline work he performed for me was exactly what I wanted and really improved density.

He was also so detail orientated and changed the surgical plan on seeing me in person to make sure I had a natural result.

As has been said, your donor does look compromised, so it'll be a challenge for any surgeon to extract from it and hide the signs of surgery.

[keith c]

3 hours ago, Berba11 said:

Hey Keith,

You need to tread very carefully and slowly here and not rush into surgery. Your donor does look compromised, so needs to be handled with care. But the key thing here is the approach to the repair of the front. You could simple add a load more grafts to cover up the pluggy hairline and try to mask the sticky-up angles, whilst also improving density. Problem here is, you're going to be using more grafts than you might ideally want to.

You haven't provided any pre-op photos or immediate post-op photos so it's hard to know for sure, but did they lower the hairline? It looks as though they did, and maybe a bit too low. Another repair option you have is to have the hairline removed via FUE over two sessions, and then rebuilt more naturally, softly and more appropriately on a third session. This way the previously implanted 'bad' grafts can be reused further back. This obviously comes with the hassle of a multi-step approach, and tends to cost more, but it may help preserve the donor and will improve the hairline without having to throw too many more grafts into the mix.

That is my big concern aswell. Also, your correct the hairline has been lowered which is something i noticed from the start. I now know how dangerous/risky this is, which is something i wish never happened aswell. Here are some photos that might help l. 

[Berba11]

8 minutes ago, keith c said:

That is my big concern aswell. Also, your correct the hairline has been lowered which is something i noticed from the start. I now know how dangerous/risky this is, which is something i wish never happened aswell. Here are some photos that might help l. 

Thanks for sharing.

So that last picture is interesting. You had a very strong forelock, a hairline height that was naturally very nice and a bit of natural, mature recession. I think you'd have been a great candidate for a much more subtle, conservative surgery to enhance where you'd lost ground. Clearly from your post op photos there's lowered your hairline in the center point by about 2cm's, and gone quite aggressive bring forward the temple corners.

Before committing to any further surgery, you might want to follow a repair case that @Tommy1991underwent today with Dr Feriduni (and also @Davyfor example). This will give you some other ideas about how to proceed. Ultimately what's done is done and rushing to try and fix things might make things worse. So definitely take you time and consult with several doctors who do a lot of repair work: Feriduni, Bisanga, Muresanu are all worth reaching out to.

[keith c]

1 hour ago, BackFromTheBrink said:

My experience of Dr M was great.

He uses a manual punch and is meticulous about his extractions.

The hairline work he performed for me was exactly what I wanted and really improved density.

He was also so detail orientated and changed the surgical plan on seeing me in person to make sure I had a natural result.

As has been said, your donor does look compromised, so it'll be a challenge for any surgeon to extract from it and hide the signs of surgery.

I appreciate the reply, i honestly wish i could turn back time. The stress and worries i now have is so much more. The talks i have with him on email is super informative and he certainly understands my situation. Highlighting to me he can make the donor more homogenous. I belive he can fix my hairline but like most of you all said the donor area is not looking great and will only conpromise it more

[BackFromTheBrink]

31 minutes ago, keith c said:

I appreciate the reply, i honestly wish i could turn back time. The stress and worries i now have is so much more. The talks i have with him on email is super informative and he certainly understands my situation. Highlighting to me he can make the donor more homogenous. I belive he can fix my hairline but like most of you all said the donor area is not looking great and will only conpromise it more

That's a good point - a homogenised donor area can trick the eye into making sparse areas look thicker. So while there will be less hairs in the donor area, it won't necessarily look worse/more compromised.

What's clear is that you need a very careful approach from here in on, there really is no margin for error.

Edited April 23 by BackFromTheBrink

[keith c]

11 hours ago, BackFromTheBrink said:

That's a good point - a homogenised donor area can trick the eye into making sparse areas look thicker. So while there will be less hairs in the donor area, it won't necessarily look worse/more compromised.

What's clear is that you need a very careful approach from here in on, there really is no margin for error.

I know for sure. I honestly do feel though the sparse areas are too thin to look presentable. It generally does look alot worse in person. Not sure, but i feel a hair system could be the way foward at this point 

Edited April 24 by keith c

[BackFromTheBrink]

35 minutes ago, keith c said:

I know for sure. I honestly do feel though the sparse areas are too thin to look presentable. It generally does look alot worse in person. Not sure, but i feel a hair system could be the way foward at this point 

I guess the options from here are:

- another procedure for donor homogeneity and density of the hairline. This may still need the very short donor cut you are currently using

- donor restocking (possibly using beard/body hair)

- SMP

- A hair system, though that won't help your donor 

[keith c]

Here is a video i made for some of my consultations. The donor sometimes can seem and look fine at times, so im not sure what the donor actually looks like. It seems to change depending on the area im at. So, im not sure if its just harsh lighting, i know its overhavasted but dont know truely how bad 

[Gatsby]

@keith c I would be very careful about jumping out of the pan and into the fire right now. Even though you are on finasteride and minoxidil, at 27, you don't know how your MPB over the lifespan will move. If you know your history in your family of MPB this will be a helpful guide but not a rule. Do you feel that medication has stabilized your hair loss? If so for how long? You have do have options but I would be looking at least invasive first. SMP is something that you could research into giving your donor more of an illusion of density as a possibility. You could look at having some of the hairline grafts punched out and re-implanted in areas that would benefit you most by them like @Tommy1991 has done. The other thing is that I would be having consultations with a lot of other surgeons to get their input on what the best options moving forward would be. Finally, have you only had the one previous hair transplant? All the best and remember you can always have surgery 'tomorrow.' The last thing you want is to be in a rush.

[Tommy1991]

1 hour ago, keith c said:

Here is a video i made for some of my consultations. The donor sometimes can seem and look fine at times, so im not sure what the donor actually looks like. It seems to change depending on the area im at. So, im not sure if its just harsh lighting, i know its overhavasted but dont know truely how bad 

In order to know if your donor is truly comprised or the level of extraction that could still be achieved you need to be examined under magnification. Hairs per sq cm in your donor needs to be determined. 

Anyway, your hairline needs to taken back, it’s not suiting your face whatsoever and as you get older it will be more noticeable at a glance. No irregularies whatsoever. 
 

It not a complete disaster but you need to think of the future, in terms of hairloss but also in terms of an appropriate hairline design with age.