What do you think of this transplant? Please give feedback

[Dr. Alan Feller]

I usually don't post in this section, but the patient asked me to do so for him so he can receive feedback he might not otherwise get in the section that clinics usually post in.

 

This patient had multiple old style plug and mini graft surgeries years ago when he had much more of his own hair. As his native hair began to fall away, the plugs and minigrafts become more and more pronounced-a common problem.

 

We undertook to repair this work by implanting along the hairline to blend out the old minigrafts and then focus in the front center area to fill in the where his native hair used to be.

 

Because of the multiple old surgeries it looked like he had a "road map" of tangled scars in the donor area thus limiting the harvest. We were, however, successful in obtaining 2,683 grafts.

 

Visiting with us almost 2 years later he is concerned that the procedure was not that effective. He believes there was growth, but not that much. I thought the results were excellent, paticularly for a repair patient, but of course I am biased, so I offered to put up his pics for the public to see and to offer their opinions.

 

As of our last conversation we discussed implanting about 1500 grafts into the front and top region again to thicken them up. 1,500 grafts is all he has left that can be taken via strip. After than I could probably get another 1500 or more grafts via FUE if he were so inclined.

 

Thank you in advance for your comments.

 

Dr. F

 

 

[Sparky]

Dunno what hes not sure about, he looked weird before and now he looks normal. Nice repair job, cant see any sign of the previous crap wrok at all.

[aaron1234]

An absolute improvement. Sure he is not Antonio Banderas now but he looks a heck of a lot better now. I personally like hairlines that resemble more recession in the temples, but his hairline looks good and natural. If I were him, I would address the front portion of the crown in future procedures with maybe a little more density in the front half.

[danny_m]

wow, what a great repair job! no idea what he is concerned about... his hairline looks great, and echoing aaron, i'd be looking at more denisty around the crown area in a future HT.

 

But he should be over the moon with those results, it is a million miles away from what he had before hand!!

[vincehair]

Wow he complained enough as to make you post it on here.

 

Duh it looks better.

[TC17]

I'm not going to tell anyone how to feel about his hair, but if I were this patient, I would be thrilled.

[Sparse]

Nice repair work: it's a big improvement and a solid overall result - especially given only ~2700 grafts to work with. With another 1500/3000 available to shore things up, he could have an elite, "homerun" result.

[thanatopsis_awry]

Looks really good; he honestly couldn't ask for much more going into things, and with one more session he should really be rounded off nicely. It seems to me like he has lost ground elsewhere, which may be contributing to his attitude -- I went through a similiar feeling briefly when I continued to thin outside of my recipient zone.

[Blake Bloxham]

It is an excellent repair. I'm not entirely sure what the patient's concerns are, but compared to where he was before - fantastic. I'm really not even sure what you would do with 1500 more FUT graphs, let alone 1500 more FUE? Soften the hairline slightly due to the minigrafts (probably not)? More top density? Who knows? It's always disheartening to hear that a patient is not satisfied with their results, and most of the time it is obvious why, but I think this is a great result, considering the circumstances, and hopefully these responses will make the patient believe the same.

[alwayswaiting1]

It is a DRAMATIC difference from where he started.

I'm curious as to how you handle a patient like this. Are you actually offering to do 1500 units for a reduced price or even free? I agree with the future doc, below average results are easily noticed, but this guys results are quite remarkable.

[Mick from Farjo]

Dr Feller,

Your patient needs to look at his pre op pictures again.This is an excellent outcome and he is a very lucky guy.I have seen cases where due to the old scarring etc that the results are not quite as expected.These things happen but this is certainly not the case here.Thanks for posting this case.

 

Mick

[hairthere]

Of course this is great work. i can understand the patient maybe going through "hair greed," but there's no reason to think this surgery was not a success.

[Guest wanthairs]

is this some kind of joke?

 

The results are excellent !

[GettingItRight]

Thank you Dr Feller for taking the time to post my photos for opinions and comments. And thank you to those who took the time to share your opinion.

 

These are my questions/concerns...

 

Here are two photos, the first was taken just prior to surgery that day and the second was taken just two days ago. Two years after my procedure with Dr Feller. I tried to copy the angle, hair style, lighting, ect as closely as possible of the original photo taken the day of the procedure to give a good comparison. As it's hard to compare with different stylings and angles.

 

I don't honestly see all that much of a difference between the two photos, and don't believe there is enough of a real world improvement to 'get out from under the hat'. Is there more hair ? Yes, definitely. Is there enough coverage to be able to go out in the daylight without hiding under a hat ? Not really. Especially with the heavy hairline and nothing behind it. I know this, because when I tried to go out without a hat recently and meet with some people on the street or in the store their eyes went up and their facial expression told the story. Something I believe we all know, all too well. Obviously they weren't impressed. And therein lies my problem.

 

I've seen a lot of great results here on these boards, however I don't think this is one of them. What do you think ? And more importantly, where should I go from here ?

 

 

 

Now, given that I see the difference that 2600 fu's have made, I'm wondering if the 1500 more Dr Feller suggested will even make that much of a difference ? This is really the important question that needs to be answered.

 

 

Should I even bother at all ?

Where should I put them ?

Will I then finally be able to 'get out from under the hat' ?

Will I just have a very expensive ht that I have to keep hidden ?

Will others still notice the heavy hairline with no hair behind it which is an obvious dead giveaway ?

 

 

 

 

Photo taken just prior to procedure - two years ago

 

 

 

 

Photo taken two days ago - Two years after procedure

 

 

 

This is by the way NOT a criticism of Dr. Feller,or his work. I'm just looking to finally resolve this long standing problem. Something I'm sure most here will understand. There are more than enough cheap shots, and attacks on these boards. I'm just hoping for some helpful advice. I will probably be posting on other boards as well to get further advice.

 

 

Thanks in advance for your help...

[Bill - Seemiller]

GettingitRight,

 

Before I offer any feedback, I'm hoping you can clear things up for me.

 

When was the first photo below taken? Obviously, the first photo below shows the appearance of a lot more hair then the second photo (below) you took two days ago.

 

Dr. Feller's Photo

 

 

Your Photo

 

 

Were both photos taken around the same time? Which photo would you consider more accurate?

 

Obviously, one shows the hair combed while another shows it completely messy. But the difference in the appearance of density is astounding when you compare the two.

 

I must admit, this is one of the reasons why I'd really like to see doctors do their best to always compare apples to apples. I understand hairstyles change, but before and after photos should really be similar in lighting conditions, background, hairstyle, hair color, camera flash, and condition (dry verses wet). I know not all of the above are always attainable, but many of them are.

 

Bill

[Coligion]

Dr. Feller's pictures show the forelock and 1/3 zone as fairly thick and dense, while GettingItRight's current photo shows extensive thinning in the same areas. Like Bill mentioned, the hairstyles are not consistent and are likely causing irregularities. If GettingItRight's current photo is an accurate representation of his final result, I too would be disappointed.

[lost my swagger]

take a look at dr fellers pic above(that Bill posted) to me it seems if you simply MESS the hair it will absolutely 'open up' density wise.. all 'gettingitright' has done differently is removed the comb forward style..

 

this is a CLASSIC case of how pictures can mislead and be easily manipulated...

 

i would bet my left testee that if any of us were to see Gettingitright in person we would agree that his density is severely lacking..at best i bet he can do little more than make it look 'Passable' when styled correctly.

 

im so glad that gettingitright posted his pic, AFTER everyone got a chance to say how 'amazing' the result was..because it is not....

 

 

he is right to have concerns, his result is no doubt NOT what he expected, NOT at all what he was hoping for, and NOT what he was told he could expect......

 

 

ps...im not sure a mere 1500 more grafts will get him where he wants to be either... perhaps another doc would be a better choice. IMO a larger session(if possible) is needed if you want acceptable density... all the best 'gettingitright'

[GettingItRight]

Hi Bill,

 

Sorry for all the confusion.

 

The first photo you posted was taken about three weeks ago at Dr Fellers office.

The second photo you posted was taken by me two days ago here at my home.

 

I'd say they both are accurate.

 

The reason my after photo (the second photo you posted) looks as it does is that as I had said, I tried to copy the angle, hair style, lighting, ect as accurately as possible of the original 'before' photo taken by Dr Feller just prior to my procedure two years ago. I thought that would give me the most accurate comparison of before procedure and after procedure for me to judge my results by.

 

However if I combed my hair down (my Moe look) it would look the same as the first photo you posted ( Dr. Feller's Photo).

 

I hope that cleared things up...

[Dr. Alan Feller]

Edit...

 

My original post was way too long so I'm going to shorten it:

 

Styling is everything to a hair transplant. Without it almost no HT will stand.

 

The goal of this repair was not to fill in the central forlock area, but naturalize the hairline, cover the worst group of plugs, and maximize thickness when the hair is styled from left to right.

 

GIR, it looks like your recent "after" photo was taken with the hair wet. You should know that your "before" photo was taken dry. Your "after" photo also shows continued hair loss in the two years since your procedure.

 

From your post I can see that you are most concerned about the middle forelock area. Now that your hairline and more obvious plugs have been blended in you should take your remaining grafts and pack it into this area. But you must understand before hand that it is a VERY scarred up area and that you may have a decreased yield compared to a less damaged scalp. I suspect you will grow well, but it's only fair that you know all the possibilities.

 

Dr. F

[thanatopsis_awry]

I see what Swagger is getting at, truly; but the horror show pic GIR posted looks like it is not just wet, but that there has been a *clear* loss of native hair all over. Even taking into account the effects of styling for better or worse, IMHO, water and continued loss *must* be playing a large role here.

 

This combined with an admitted effort to expose the HT for its flaws (which can be said and done for most any HT) seem to complete the proverbial picture here.

 

It's a picture that should be painted, perhaps, if not to just put it out there that you can make a good HT look quite bad quite easily, and that GIR's situation really isn't atypical.

 

Styling his hair forward and his density seems excellent; this is obviously an illusion, but such is the nature of the beast for most intents and purposes. I would be shocked if GIR couldn't work in some paste or w/e and add some pinache to his doo that would compliment him....

 

In the next few days I'll post some pics doing pretty much exactly what GIR has done -- spray out my hair so as to destroy all surgical illusion/artistry of density, make my hair damp, and snap some photos. It will look horrible, trust me, and you'd wonder how I ever leave my apartment without a burka.

[TC17]

gettingitright,

 

Can you provide us a little bit of background on you, please? I'd like to know how old you are, when you started losing your hair, family history of hair loss, how many surgeries you've had and any other information that could help shed better light on your case.

[lost my swagger]

couple things..

 

1... dr feller, i LOVE when you say STYLING IS EVERYTHING WITH A HAIR TRANSPLANT....... you are correct, sad that not everyone undergoing these procedures today is made aware of this fact.

 

2.... i do NOT think GIR has said that his 'after' is with WET hair... so speculating seems pointless...

 

3. thana-- givin your wording about GIRs "horror" pic that he posted i take it you feel as though GIR set out to provide the WORST possible photo of his situation to illustrate his case... while there is maybe some validity to that im curious how GIRs pic is ANY different to the pre op pictures that dr feller took.. or any other HT doc for that matter... they ALL(some go way to far) take pre op pics with the hair looking its absolute worst, would you not agree?? i see feller all the time parting hair certain ways or pinning up hair to reveal the the 'problem' areas with his patients pre op pics...... all GIR has done is the same thing with his post op.. he has kept it consistant..and GIRs "problem areas" show very little improvment UNLESS combed in ONE particular style... it makes no difference to me if GIR has lost native hair or not(which really cant be determined anyway), this was not a successful transplant...GIR is confined to the ONE style that can make his hair look decent... and the wind better not be blowing or he looses that look aswell...

[thanatopsis_awry]

He can part his hair to the side, he can push his hair forward; he just can't spray out his recipient zone in every direction. Can he style his hair by pushing up the front? I dunno; I'd encourage GIR to find out and see if he has yet another styling option.

 

I just don't buy that GIR is confined to one gimp hairstyle. It's already been shown he has at least two and his density looks excellent.

 

Why would GIR, or anybody, want the metric for determining the success of their HT to be when it is displayed in the most unattractive -- and unlikely -- manner?

 

The question, which I'm not sure GIR has anwered, is if he could style his hair combed forward or to the side pre-op and attain the density he now has post-op....?

 

Dr. Feller can comment specifically on his own pre-op pic protocol, but I agree that I always, unequivocally prefer clinics to show pre-ops that show the hair in not just the most "exposed" state but a more natural state. I have seen Dr. Feller take post-ops, though, that isolate the "exposed" area shown pre-op to illustrate the growth that has occurred. I think GIR should just mimic this by parting his hair in the middle, while it is dry.

 

Whether or not GIR can style his hair to make it look bad shouldn't be the true metric for whether this is a success; whether GIR could style his hair with the perceived density he *now* has *before* his HT is.

 

I would also appreciate a follow-up as to whether he feels he has lost native hair and whether he has water in his hair. Both elements influence a perception of a HT's success, so they are both totally valid to take into account.

 

Does it suck that you now have *these* variables in play that dictate just how good your HT will seem? Ya, but it is what it is.

[Dr. Alan Feller]

LMS,

Thana wrote exactly what I would have written.

 

A hair transplant is not to be measured by the very worst that it can be presented. All transplants are to give the Illusion of thickness, coverage and naturalness. This goes DOUBLE for repair cases like this one.

 

Let me be perfectly clear, the GOAL of this surgery was NOT to fill in the forelock area, but rather to maximize the donor area that remained to make his hair look as thick and natural as possible when styled. I'm proud of these results, and I think the photos speak for themselves.

 

If the future goal is to fill in the forelock area alone, which it is because I've talked with GIR personally, then I would focus the remaining of his donor area in the forelock, instead of spreading it out over the entire frontal area.

 

But there is a CATCH. If you look at his before and intra op photos you can see all the scarring throughout the forelock area. This MAY reduce his overall yield compared to a virgin scalp.

 

If it were me, I'd hit that area as hard as I could now that the worst of his plugs are now blended in and he can now style his hair without a massive combover.

 

Furthermore, LMS, there are HUGE improvments in GIR's after photo. Look at the hairline. Instead of a thin line of "dots", it's now a band of quite natural looking hair. That's thanks to about 1000 single hair graft packed into his hairline. Also, look at the clump of plugs just behind the left side (patient's left) of the hairline. See how in the after pic it is thicker and more natural. I weighted his HT to the front hairline and (patient's) left side because that's where he regularly parts his hair. That's where the very best of his grafts went. The remaining weak and single hair grafts went into the forelock area to build a base and give the new hair (and old plug/minigraft hair) something to comb into.

 

Everything I do in my clinic is carefully considered and weighed and I have no problem sharing it with the patient or the public at large. And it's my pleasure to share it here with you.

 

Thank you one and all for your comments and making this thread intersting and educational.

 

Dr. Feller

[hairthere]

Did you guys happen to notice the amount of recipient area scarring this patient had? all things considered, this is a great result dr. f. you guys are talking about styling options? before ht this guy had none.