What do you think of this transplant? Please give feedback

[Bill - Seemiller]

Guys,

 

Let's not make this dicussion about Dr. Feller's ability to produce a natural looking hair transplant with maximum growth yield. Dr. Feller has an excellent reputation and a track record to prove his results are excellent. However, there will always be cases even under the best doctors' care that are less than optimal. Given all the information and photos I've seen of this result, I feel this very well may be one of them.

 

Why some of you are getting angry at Dr. Feller for doing his best to help a patient in need of repair is beyond me. Our responsibility as forum members should be to walk along side GIR and give him the best advice possible - not to point blame at a reputable physician or the hair transplant industry as a whole. GIR made the choice to undergo another hair transplant and Dr. Feller did his best to give him the very best results and reasonable expectations. So what's the problem?

 

If some of you feel that Dr. Feller is being treated differently than an unknown or less than reputable surgeon, well, he is. If a physician proves to do excellent work consistently and is honest and transparent, I feel he/she has earned the right to be respected and supported by this community. Thus, I do feel that unless there is good reason, Dr. Feller ought to be given the benefit of the doubt.

 

Now, onto my opinion of this particular case...

 

In my opinion, the after photos showing GIR's hair combed look terrific. However, when his hair is tossed up like it was in the before photo, I see only slight improvement at best.

 

No ifs, ands, or buts about it, styling can significantly impact the cosmetic appeal of a hair transplant. Quite honestly, I do wish that the initial before and after photos posted by Dr. Feller were consistent regarding hairstyle. Thus, it seems that the primary reason there's a debate on this thread is due to how the photos were initially presented.

 

The question is...what was the percentage of the 2000+ grafts that grew? If less than what's expected (which appears to be the case by the photos), what was the reason?

 

Since GIR is a repair patient, previous scarring may be at least partly responsible for less than optimal growth.

 

Since there isn't (or at least shouldn't be) a question of Dr. Feller's skill and ability, the next step should be GIR and Dr. Feller getting together to collaborate on a plan that will help GIR meet his hair restoration goals.

 

GIR should not be blamed for how he feels about his hair transplant nor should Dr. Feller be accused of performing less than his usual excellent work. Like it or not, things happen and they just have to be worked through.

 

Feel free to continue to offer your input on this thread. But try to keep the gloves on and keep the blows above the belt

 

Best wishes,

 

Bill

[rpachigo]

My concern would be that Dr. F has stated that he has 95% growth of his grafts. I would take that to mean that 100% of his patients have 95% yield or better. This result would not meet that threshold neither would unfortunateHT nor Malloy (although early and not enough photos there) so that means that there must be 57 other patients who did get that kind of yield. For some reason I doubt that - I could be wrong. I have seen an averge yield rate quoted at about 100% for 10 fu/sq. cm., 90% for 20 fu/sq. cm, 80% for 30 - 40 fu/sq. cm and so on. Coalition docs should have higher yield but for some reason I doubt it would be 95%.

[GettingItRight]

Originally posted by Bill - Associate Publisher:

 

Now, onto my opinion of this particular case...

 

In my opinion, the after photos showing GIR's hair combed look terrific. However, when his hair is tossed up like it was in the before photo, I see only slight improvement at best.

 

Best wishes,

Bill

 

 

 

Hi Bill,

 

Thanks for getting back to us with your comments and opinions. I was curious as to what you thought. I agree with you that there is only a slight improvement at best.

 

As to those who called into question why I posted those "horror show pics" "with an admitted effort to expose the HT for its flaws" I respectfully say to you it was not my intention to make Dr Fellers work look bad, but to clearly show the area in question and that the grafts in that area did not grow. The original 'after' photos posted, with my native hair combed forward to cover the area in question were not an accurate representation of what was, or was not there. Those photos were, as has been said, an illusion. This was not a thread about how well a dr can do a comb-over, or create an 'illusion' to disguise the bald area. It was to determine if the grafts that were placed in that area behind the hairline actually grew in. Which I believe they did not. Or at least most didn't. And to determine that, you have to brush the hair away from the area in question to view it. That is just the simple reality of this. And it is very puzzling as to why some here just don't seem to understand that.

 

To those who questioned why I would post those hideous " horror show" photos I pose this question to you...

 

If you were to go see an ht patient in person, or maybe one of the drs so called showcases to exam his results. Would you stand back five to ten feet from him to only view the drs 'illusion'. Compliment him on his perfectly coiffed hair, and leave satisfied you saw everything you needed to see ??? Or would you get up close, push the comb-over to the side and take a good close look to determine the yield, density and quality of his work. I know what I would do... But I'll wait for your reply(s).

 

As to those 'great results' you see online and in photos. One question you should ask yourself is will this hold up in the real world. It's one thing to sit in your drs office with your hair perfectly combed. It's quit another to be in the real world with wind, sun, rain and general moving about. As for mine it doesn't last more than a few minutes before the hair combed forward to cover the bald area just behind the hairline blows back, falls to the sides or just sticks up. Exposing a heavy hairline with nothing behind it... not very attractive to say the least. So much for those great results. As many have said here, it's an illusion. However illusions don't always stand up to reality. This of course is by no means all the drs fault, but illustrates that you should understand why the patient is dissatisfied first before you dismiss him.

 

To clarify, my sister has been a beautician/hairstylist for over twenty years. I've been through all the hairstyles and hair products. The point of this ht was to fill in behind the hairline, not do a comb forward to cover it up. Which in the real world doesn't work. At least for me. I believe if the grafts in the area behind the hairline had actually grown, my over all look would have been far better and more natural. And with this I would have been satisfied.

[Dr. Alan Feller]

GIR,

Your point is well taken. Especially the part where you look at a hair transplant showcase not just by standing 5 feet away and looking, but by closely inspecting with a comb as well. I insist that be done by all my potential patients who have a chance to look at my prior patients.

 

But your case is WAY different because you were a repair surgery. You had multiple plug/minigraft procedures in the past. Your donor and recipient areas were well depleted and scarred down and your old HTs were so obvious that I remember you used a massive comb over from the side to cover them. You no longer have to do that.

 

Maybe you don't realize that the best of your grafts were used to soften/thicken the hairline and the left side where you part your hair from. The very worst of your grafts-mostly weak single hair FUs were used in the middle top area.

 

The reason we didn't pack everything into that top area is because without a more natural hairline you could never benefit from such a fill in because by coming your hair backward you would have looked very pluggy.

 

As I wrote in a prior post, if you focus the remainder of your grafts into the center you should be able to significantly cover it, but I say again you must be aware that becuase that area is largely scar tissue the yields in that area may be lower than normal.

 

Perhaps I'm missing something or am not propertly articulating my thoughts. I think it's time for another experienced HT physician to jump in and comment on this particular case and GIR's concerns. Would they have done anything differently?

 

Dr. Feller

[Ronald]

This is a juicy thread.

 

Lostmyswagger,

 

 

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

 

Yeah, the whole point of a hair transplant is to mislead people sir, to trick them into thinking that you are less bald than you actually are. Dr. Feller DID style this dudes hair in a way that was meant to deceive people because in doing so he made him appear to have more hair than he actually does which again IS THE POINT OF A HAIR TRANSPLANT. You have to remember that you are moving hair around, not creating new hair.

 

Us baldies have three options to deal with hair loss. I would like to use Thana's weblog as a reference (I hope you don't mind Thana, I know you are a good sport so I am confident it will not be an issue).

1) Go bald, do nothing. Take a look at http://www.hairtransplantnetwo...opyID=1125&WebID=557

 

2) Get baldness treated with meds and hair transplant but do NOT use creative hair styling coupled with helpful hair products. http://www.hairtransplantnetwo...opyID=2051&WebID=557

 

 

3) Get baldness treated with meds and hair transplant and creative hair styling coupled with helpful hair products.

http://www.hairtransplantnetwo...opyID=2050&WebID=557

 

 

GettingItRight,

 

My advice to you is to choose option 3. In Dr. Feller's pics, you hair is creatively styled and it looks great and I think if you try to follow Thana's suggested regime, I suspect you could make it look even better:

http://hair-restoration-info.c...66060861/m/978108134

 

I give this advice to address this quote:

 

As to those 'great results' you see online and in photos. One question you should ask yourself is will this hold up in the real world. It's one thing to sit in your drs office with your hair perfectly combed. It's quit another to be in the real world with wind, sun, rain and general moving about. As for mine it doesn't last more than a few minutes before the hair combed forward to cover the bald area just behind the hairline blows back, falls to the sides or just sticks up. Exposing a heavy hairline with nothing behind it... not very attractive to say the least. So much for those great results. As many have said here, it's an illusion. However illusions don't always stand up to reality.

 

Very good point. Please remember that good hair products are designed to help our hair deal with the real world. Choosing option 3 will help you with your concerns.

[thanatopsis_awry]

Good points, Ronald; and I don't mind the reference at all, especially since I agree with all you said.

 

It's counter-intuitive, but too often I notice guys going through with a surgical hair transplant, yet they don't have the will or desire to properly style their hair.

 

Whether you get a HT or not, you basically need to spend a minute or two styling your hair to really make it look good. It just so happens that with a HT the punishment for not doing so is 1000x worse than if you were non-MPB.

 

HT + styling = really good

 

HT + bad-style = balded/bad

 

Regular Dude + no-style = normal/solid

 

Regular Dude + styling = really(maybe reallyreally) good

 

In my...not-so-limited experience ...on average guys who get surgery to restore their hair actually spend less time (and less resource, i.e. product) tending to it than your run of the mill, non-MPB guy. Unfortunate, but true.

 

Again, a metric -- let alone *the* metric -- for a HT is not how bad you can make it look. The swipes about how bad it is that you need to style your hair well post-HT are so overhyped; you need to do this to have your hair look good HT or no HT. You simply "must" do it post-HT. It nonetheless is a very simple, quick process *if* you've experimented and/or have the wherewithall.

 

Getting a world-class HT can be like buying a lambo, filling it with peanut-oil, and expecting it to purr like a kitten and drive like a dream. Don't do this.

[Dr. Raymond Konior]

GIR

 

A situation like yours is certainly a difficult one, both for the patient and for the treating physician. Having had the opportunity over many years to evaluate and treat countless 'repair' patients such as you, I have to assure you that there is rarely, if ever, an easy, slam-dunk, one step fix for an unsightly old-fashion plug transplant.

 

Repair patients are unique in many ways - the problem at hand is typically a difficult one and the expectations for improvement are high. I wish that there was a simple fix for situations like yours, but the fact of the matter is that the deck is stacked against the average plug repair patient from the moment he walks in the door for a consultation. It is understandable that repair patients want a quick fix, i.e. density and refinement, in a single step. That is what I would want if I were placed in the same position. However, from a physician's perspective, I look at a scalp like yours and the first thing I think about are the limitations of what can be done in a single session.

 

The list of contributing and conflicting factors that has to be considered in someone presenting for plug repair is long. These factors include -

 

The hairline is typically unnatural and harsh ??“ it will need refinement.

 

The old transplant zone is thin and pluggy ??“ it will require additional density.

 

The donor site often shows poor elasticity, compromised density and a complex network of scarring. The ability to extract sufficient grafts for a full repair is often impossible.

 

Circulatory, scarring and other 'X' factors have to be taken into consideration since graft survival may be compromised despite the highest quality surgery on the planet. This is an extremely important factor. Any experienced surgeon recognizes just how unpredictable graft yield can be in an old plug zone and it behooves him or her to educate the patient as to the potential risks associated with too aggressive a grafting strategy.

 

Had you presented to my office I would have stressed not only what I could accomplish, but, perhaps more importantly, what I would not be able to accomplish ??“ that being a full 'fix' of your situation in a single procedure. Your immediate postoperative graft distribution photograph reinforces the notion that many of your grafts were used in the frontal region for softening and refining. The central tuft appears to have been transplanted with a much lower density, which is consistent with a grafting strategy that focuses on refinement and hairline appearance. The contrast of your dark hair and light skin definitely works against you in terms of reinforcing a thin appearance. A secondary focused restoration in that central zone should make a major difference in bringing you where you want to be.

 

I want to reinforce that I sympathize with you and your concerns, just as I would with any other plug repair patient looking for a solution to such a problem. However, I also relate to the difficult situation and the limitations imposed upon the physician by the nature of the problem at hand. The successful management of a case like yours relies on great communication between the doctor and the patient. Was there a failure to communicate that you would need more than a single session to achieve the combined goals of refinement and density? I know there are some bold physicians who would offer a one-step guarantee for a complete repair, but my experience leads me to believe that a single session in a case like yours would have to leave something 'undone' ??“ which in your case is the central density that you seek. I do believe you are in extremely capable hands with Dr. Feller and encourage you to continue your communication with him. You have come a long way and I believe you will find the solution you seek with the plan that has been proposed. Good luck to you.

[rpachigo]

Exellent reply Dr. Konior. I don't believe GIR was counseled completely regarding possibly needing a second procedure.

[Dr. Alan Feller]

Thank you Dr. Konior for joinng in this discussion to help GIR. I'm sure he will apreciate the comments a great deal and it's nice to know that a colleague is prepared to come forward and discuss honestly the limitations that repair patients can present. We can only try our best.

 

Rpachigo,

Obviously you are unaware that I councel all my patients throughly regarding their particular situations, this goes double for repair patients. I do not appreciate you misinforming the viewing purblic.

 

GIR,

My door is always open to you as it is my absolute peasure to continue trying to help repair you. I hope Dr. Konior's post helped to clarify at least some of the variables that go into fixing old transplant work. If you are interested in focusing on that middle area now to the exclusion of any other area then I am happy to go forward with the plan we came up with during your last visit.

 

I think this thread has run it's course and this will be my last post.

 

Thank you for the comments.

 

Dr. Feller

[Bill - Seemiller]

I too appreciate Dr. Konior's input on this thread. I think from a technical point of view, it's loaded with information about the variables that might impact what can realistically be achieved in repair patients.

 

As Dr. Konior said, the key is trust and continual communication between the physician and the patient and to work through hurdles as they arise.

 

GIR, I do encourage you to take Dr. Feller up on his offer and to utilize his open door policy. I've personally found him to be very fair and accomodating of all his patients.

 

Best wishes,

 

Bill

[GettingItRight]

Thana and Ronald,

 

I do hope you will take into account that what sounds good in theory and works for some, does not in fact work for all. As to styling and product, I couldn't be in better hands. Dr Feller is as we all know, a skilled, dedicated and experienced world class surgeon, and as I already stated my sister along with her staff has over twenty years experience as a beautician/hairstylist. However when illusion clashes with reality, we all fall to different sides of the fence. The amount of product I would need would be counter-intuitive. As I've learned you must use product judiciously at best or run the risk of drawing attention to the area in question.

 

Thana eluded to this himself when he referred to naturalness and undetectability.

 

"The three tenants throughout research: density (the illusion and actual increase), naturalness (both undetectability of product *and* boosting the naturalness of the HT itself) "

 

That said... if I were able to properly fill in the area behind my hairline I believe I would be in a much better position. I would prefer to look as an older naturally thinning man, if need be, than an over-processed guy trying 'way too hard' to conceal his balding with a comb-over. Which I'm told by the women I've spoken to is all to obvious.

 

Understand, the opinions I've expressed here and throughout this thread were derived mostly from feedback I received from friends and family. Mostly females.

[GettingItRight]

Dr Konior,

 

Thank you for your excellent contribution to our discussion. And for your very insightful and helpful comments.

 

As to placement, in my untrained opinion I thought it might have been best if the bulk of the grafts were placed in the area behind the hairline.

 

Be that as it may, here I stand and I hope to move forward rather than belabor the past. And for that I do need to determine the following...

 

How well will further grafts placed in the 'scared' area in question grow ? And what percentage of growth can I expect ? This is of course paramount to making my decision.

 

And will the 1500+ grafts I have available be enough to make a noticeable cosmetic difference ? Or, in the end will I have a 'somewhat denser' area but still be relegated to having to do a comb-over ? Realistically then, I would have to wonder what would be the point ?

 

Lastly, and perhaps most important. Are repair patients who are sans 'strip' donor hair, still candidates for further work via FUE ? Whereas adding an addition 1000+ to the equation would obviously make or break the end result.

[GettingItRight]

Dr Feller,

 

Yes, actually I found Dr. Konior's post very helpful. I do hope you can clarify something for me. As I mentioned in the Drs post, how well do you anticipate the grafts placed in the previously mentioned 'scared' area will grow ? And what percentage of those grafts do you expect to grow ?

 

Will the 1500+ available grafts that are left make enough of a cosmetic difference to alleviate the need of any further comb-overs ?

 

And after one is depleted of 'strip donor' what would be the possibility of further work if necessary via FUE ? Or perhaps even better a combination Strip/FUE session consisting of the remaining 1500 strip plus an additional 1-2k in FUE alleviating the need for any further work.

 

Thank you...

[M1A1]

GIR,

 

I have read this series of posts over and over... And With that said, at least from your posts, you are handling your situation with calmness and logic-quite frankly, it's impressive. Your points and questions are logical and seem very well though out...

 

So here begs the question, as Dr Feller is a well repsected surgeon with consistently proven AND SOMETIMES AMAZING RESULTS, what is the likely hood of him performing another transplant on you while achieving a high growth rate? From my observation, now after reading your most recent post, and as the first procedure did not achieve generaly acceptable growth, it seems a very risky proposition... According to Dr. Feller, you only have about 3500 FU'S left in your donor area-max. This time GIR, yield failure would be catastrophic to your situation and more importantly, your quality of life...

 

As you noted, Dr Konior, another highly respected doctor gave you some great insight and more importantly, seemed sincere in his right up to you.

 

In the end GIR, as you well know, this is not just another procedure, it's your life... Not to mention the amount of time, energy, and money you invested in this process...

 

Gir, I know you would travel the world to find the best repair doctor. Is there a repair doctor out there who thinks out of the box and who has achieved a high growth rate of success regardles of scarring...Or is this even possible? In my opinion, this is the area where you need to begin...

 

"The truth is easy to recognize, however, at times hard to act on."

[Dr. Alan Feller]

GIR,

I don't know the percentage of possible growth in scarred area NOBODY can accurately predict that.

 

Yes, 1500 grafts will make a signficant cosmetic difference IF it grows well and IF it's all packed into what used to be your forelock area (and fringes).

 

The use of a combover is subjective so I can't answer that. As of now, you do not need to combover native hair from the left temple as you used to when I first met you. That is, the transplants now stand on their own WHEN STYLED of course.

 

The classic use of FUE are on patients who are "stripped" out. Mixing a strip and FUE in your case probably would not make any difference. Getting another 1000 or 1500 after your last strip via FUE is VERY possible, but again, nobody can know until they try.

 

I sincerely hope that helps you GIR.

 

M1A1,

Thank you for the kind comments on this and other threads.

 

GIR may have lost faith in me, and that's ok...but that's not going to make the odds of his next surgery any better. No doctor is going to come on to this thread and state that growth would have been better in their hands, because there isn't a single doctor out there who hasn't faced these same circimstances and produced equivalent results.

 

In fact I've had this very discussion with the following doctors at one point or another over the past few years and all of them have experienced the same exact situation and results:

Dr. Ron Shapiro

Dr. Victor Hasson

Dr. Jerry Wong

Dr. Scott Alexander

Dr. Steve Gabel

Dr. Ed Griffin

Dr. Tom Law

Dr. John Cole

Dr. Paul Rose

Dr. Bob Bernstein

Dr. Bill Rassman

Dr. H. Rahal

Dr. William Lindsey

Dr. Ray Konior

Dr. David Seager (RIP)

and many more.

 

But with that said, I don't think the issue here was poor growth. I know the focus keeps going to the former forelock area, but that was not the focus of the surgery. It simply couldn't be in the first round because what would be the point of using the best hairs in the forelock area when the front area looked so pluggy? NOW the focus can be put on the forelock area... and should be.

 

Ok, now I'm REALLY signing off this thread. GIR, if you have any more questions by all means come on down to the office.

 

Dr. Feller

[Bill - Seemiller]

GIR,

 

Quite honestly, choosing another surgeon isn't going to change the probability of getting better growth the next time around. Nobody really wants to hear this, but being a repair patient with previous scarring does add an extra layer of complication. While some repair patients experience excellent growth, others don't.

 

I do think the best thing to do at this point is take Dr. Feller up on his offer to evaluate you in person and discuss your options.

 

Best wishes,

 

Bill

[GettingItRight]

M1A1,

 

Thank you for your very kind words. Yes it is a life changing decision. And since there is a lot at stake, I certainly will tread lightly.

 

Good luck to you...

[GettingItRight]

Dr Feller,

 

Although you signed off from this thread, I feel compelled to respond to something you said.

I have not lost faith in you at all, quit the contrary. And I'm very sorry if my posts implied as such.

 

To quote myself from a previous post... "Dr Feller is as we all know, a skilled, dedicated and experienced world class surgeon"

 

I do though frankly believe the results were not what I was hoping for, however I never believed you were at fault. Let's be honest about this, I am not qualified to make that judgment. Especially considering all the variables involved. I suppose that's why I'm here ? Hoping to find some answers.

 

I'll see you at your office...

 

GIR

[GettingItRight]

Thanks for your advice Bill.... yes I agree.

 

GIR

[rpachigo]

The one variable to change would be choice of surgeon going forward. If you didn't grow then, I believe you could safely assume your scarring has precluded growth.