A few questions

[AZ1anonymous]

Hello everyone.

 

I recently passed my one year mark of surgery with Dr. Meshkin. I did 2,000 grafts back in November 2008 and to be honest, my hair is still balding. It looks better than what it used to be like last year, but I just want to know when is it a good time to go for my 2nd procedure. My crown is basically almost bald and I am losing hair in front as well... I'll attach a couple photos to show you as well. These photos are currently what my hair looks like right now after 1 year of surgery.

 

The thing is, I am 23 years old, and I still am not sure how much more my hair will shed, but I really want to keep my hair especially at this age.

 

Should I also go for more grafts this time? Maybe 3 or 4 thousand?

 

Your input is very appreciated. Thanks in advance.

[AZ1anonymous]

Also, here's another photo. And like I said, this is 1 year after my 2,000 graft surgery... So things are...incomplete.

[aaron1234]

To be honest, I don't think you were a great candidate for a procedure in the first place. You have significant balding for a 23 year old. We def could use better quality pics, with more angles. Are you on propecia (finasteride)? You need a hell of lot more than another 2,000 grafts but you are so young that I don't know if it'd be safe to do so. Could we see some before & after pics of the transplanted area?

[Leeson]

Yea, I agree with aaron, you need to stabilize the loss first. Propecia or dutasteride (since it's so aggressive), see what a qualified dr. thinks and not some dr. that just has MD on his wall, if you know what I mean. Hopefully it will halt and maybe grow some back, then re-evaluate at 6 months to 9.

[thanatopsis_awry]

I hope you've already been on propecia(?) Have you lost a ton of native hair since your HT? You look to have thinned into a pretty clear NW5+ pattern.

 

IMO, I would look to carpet bomb the area; hope you can still squeeze out a big # in your 2nd procedure, and try to fill in what you can as best as you can. Combine this with nanogen if you still have persisting thinness that you want to ameloriate.

 

Some pre-ops and post-ops before you lost a massive amount of native hair would be good to see, too, to make a more accurate assessment.

[Bill - Seemiller]

At 23 years of age and signs of advanced hair loss to come, I'm surprised to hear you've already had a hair transplant. Did you and Dr. Meshkin strategize and agree on a long term hair restoration plan?

 

I'd strongly suggest considering getting on the "Big 3", which include FDA approved non-surgical treatments Propecia and Rogaine and scientifically backed Nizoral 2% ketconazole shampoo. Nizoral 2% should be used only 2 or 3 times a week and can be alternated with any shampoo you'd like. You may want to consider other shampoos to alternate with such as Revita, Crinagen, or Tricomin.

 

In my opinon, before even considering another hair transplant, try the non-surgical I suggested above for at least a year. Be sure to research and speak to a physician about potential side effects also.

 

Best wishes,

 

Bill

[AZ1anonymous]

Ouch... So that just ruined my day. I'm pretty sure most of you know what I am going through...but thanks for being honest, I appreciate it.

 

Also, yes, I have been using Propecia and Rogain Foam for the past 8 months or so.

 

As requested, here are more pics. Sorry the quality isn't great, but hopefully it should do.

 

Here's a week before my surgery last year in November.

 

 

 

 

And these two are from today, yes, I am well aware that they look even worst...

 

 

 

 

I am very nervous right now because I don't want to go through my 20's or even 30's without hair. I spent around $5,000 for the transplant and from the looks of it no real results have come out.

[aaron1234]

Well, you do have a hairline but there isn't much behind it. And you can't bank that the hair behind your hairline is going to last much longer with or without the meds. Just stay on the meds, even if it seems like it isn't causing any regrowth. Because the Fin and Minox is probably the only reason why you have hair behind your hairline anyways. I'm still quite shocked you had a transplant that young. Either way, start consulting with COALITION docs (i.e. Shapiro Medical Group, Hasson and Wong, Feller, etc.) via email or in person if you can. Just be prepared to spend more than 5K if you end up going for round two.

[thanatopsis_awry]

I'm a bit confused, but I could just be extremely surprised by some of this new information.

 

Your pre-ops and post-ops look almost identical from the looks I'm taking. You got 2000 grafts? Where were the grafts allocated? If they were spread across your entire scalp, and you lost most of your native hair, this would make sense, but I wouldn't think you'd get 2k spread across that large and thinned of an area(?)

 

I'm assuming Dr. Meshkin discussed the fact that a 2nd procedure would be essentially a given, and "required" almost immediately, given your loss and that you only received 2000 grafts(?)

 

I'm very surprised you weren't on propecia *prior* to your hair transplant over the backdrop of all this.

 

I would do the following:

 

Consult with Dr. Meshkin, and/or a Coalition doctor (e.g. the ones Aaron mentioned), and figure out what your yield was. It seems to me like it may very well have been compromised, though I'm not sure; which is why I'd reccomend getting some keen eyes to go over your case and evaluate this further.

 

Given you've been on propecia, you've committed to the HT process, and you're still extremely concerned with getting hair where you now don't, I would give serious consideration to my first thought of "carpet bombing" your recipient zone, which is basically the same as you had pre-op.

 

Keep us posted, and I would 100% get in touch with Dr. Meshkin ASAP.

[EpilepticSceptic]

Dude,

 

Did you have a strip or FUE ?

 

If it was FUE, get down on your knees and thank God that you can still shave your head to a #2. Forget about HTs, shave it down, and move on with your life and just accept that some (with your kind of loss at your age) are meant to be bald. With this kind of loss at 23 you WILL end up a NW 7, probably by age 27-30. I know this because I have seen many dudes who had full heads of hair at age 20 progress to NW 6/7 in 5 or 6 years time. They used to make fun of my NW 3 pattern that had fully developed by age 23, and has stayed the same for 17 years now. MPB is indeed a funny beast with a sick sense of humor!

I just don't think you will ever be a good HT cantidate, so I PRAY that your 1st one was FUE ???

[thanatopsis_awry]

labrat,

 

At the risk of theorizing on what MPB may and may not be for certain people, I really don't see why the OP "will"/must become a NW7, let alone speculating that it will happen in a given age range.

 

You yourself testify to the sheer unpredictability that MPB can have when left unchecked, thus looking at the OP and proceeding with an unwavering faith that he *will* be a NW7 doesn't align.

 

He is on fin, which is *huge*, and seems to be responding fine to it. The most critical areas of a response to fin are not having incurring serious side-effects, and the drug itself responding in halting the spread of DHT and expanding your NW zone. Granted, he should have been on this prior to his HT, in my opinion, and I have other concerns.

 

Re: FUE, I'd be beyond shocked if this was FUE, but Dre can clarify for sure. But I'm 99.9% sure it's FUT.

[AZ1anonymous]

Aaron, thanks for the input.

 

Thanatopsis, yes, the grafts were spread across the scalp and he Dr. Meshkin did say that I would have to return for round two. He didn't really do much to the crown area as much as the other areas. Here, check this out... This was taken a couple hours after surgey...

 

 

 

 

Originally posted by labrat69:

Dude,

 

Did you have a strip or FUE ?

 

If it was FUE, get down on your knees and thank God that you can still shave your head to a #2. Forget about HTs, shave it down, and move on with your life and just accept that some (with your kind of loss at your age) are meant to be bald. With this kind of loss at 23 you WILL end up a NW 7, probably by age 27-30. I know this because I have seen many dudes who had full heads of hair at age 20 progress to NW 6/7 in 5 or 6 years time. They used to make fun of my NW 3 pattern that had fully developed by age 23, and has stayed the same for 17 years now. MPB is indeed a funny beast with a sick sense of humor!

I just don't think you will ever be a good HT cantidate, so I PRAY that your 1st one was FUE ???

 

Yes, I do believe it was FUE. I can do a #2 on the back and the scar doesn't even show. I am not 100% sure what a strip is to be honest. I have to also say, shaving my head is not something I want to do. I know some people here will recommend that, but I am not for that, at least not yet.

 

 

I would also like to show you one more picture.... This was about 3 months after surgery.... So you can see after surgery my hair got worst. Right after that picture I started using propecia and rogain again...

 

 

 

 

Also, ONE very important question as well... Does dandruff affect hair loss? Lately I've been having a lot of it. Can that possibly be a cause? Does it affect stabilizing my hair loss?

[thanatopsis_awry]

Hmmm, this is a bit peculiar -- maybe Dr. Meshkin can say for sure if you got FUE or strip...?

 

I didn't even know Dr. Meshkin did FUE, and certainly not for a session size of 2000 grafts. I'm truly shocked by this development. But perhps that is why only 2000 grafts were harvested(?)

 

The immediate post-ops look a bit off to me, too. I'm a bit puzzled all-around about this, to be honest.

 

Dre, in addition to consulting with Dr. Meshkin ASAP, along with some Coalition clinics (e.g. the ones Aaron mentioned, etc.), I would find out 100% if you received FUT/strip, or FUE.

 

This will greatly influence your decision-making process going forward. You also really need to find out if your yield was compromised or not.

 

Before you proceed with any major surgical decisions, I would find out 100% on both these issues.

[Leeson]

The grafts looked spread out and not densely packed. this doesn't looked refined. IMHO

[HaiRisWhere]

Thats a horrible transplant.Hard to believe Dr Meshkin has done it.After seeing your post-op pic I am not surprised that u got such a result.2000 grafts being spread out in such a large area!!..shocking!!

[aaron1234]

Dre,

 

The post-op photo is quite disturbing. I also can't believe you don't know the difference between a strip and fue. That is something that should have been explained to you by your surgeon. Did you have sutures or staples in the back of your head for a couple weeks after the surgery? If so, then you had Follicular Unit Transplantation via strip. But it is certainly not refined.

 

Your surgeon should be held accountable for (1) performing a transplant on such a young patient who was not on propecia for over a year, (2) poor distribution and planting of grafts, and (3) not educating you in the surgery you were about to undergo.

 

On a side note, it is expected that doctors up for recommendation would be on their best behavior when Pat observes a surgery. It's a shame when they don't perform each surgery as if they were being reevaluated.

[AZ1anonymous]

I see... So can it be that I didn't get enough grafts or it was spread

apart too much? From everything. Also, what exactly does the term "carpet bombing" mean? Would it be just allocating grafts very close together in one

area of the scalp?

 

And lastly before I head to

work, what's your thought on dandruff? Can it screw with the stabilizing of hair growth?

 

All of your comments are very appreciated. This is helping a

lot. Thanks once more.

[EpilepticSceptic]

Brother,

 

Man, I'm still praying that he did FUE on you!! You didn't answer the question yet: did you have staples/sutures on the back of your head ? Did he slice a strip out in the back ? Or did he use a punch tool to extract grafts one by one ?

 

That last pic you posted reveals what I have seen all too often in NW6/7 cases. I have known a number of guys who had full heads of Brad Pitt hair until age 25, and then by 30 they were full blown NW6/7. And the pattern they had developed exactly like yours: from the crown forward, leaving that small rim of hair at the hairline to succumb last to the wrath of DHT. The bottom line is that if you already had 2000 grafts and this is still what you look like, you may only have 4000 left to harvest. That's maybe 6000-7000 individual hairs when the "average" human scalp has 100,000. If you do the math it just doesn't look very promising.

I'm sorry if I sound negative or harsh brother, but I'd just like to help you from making a poor decision. Hair means everything now at 23, but TRUST ME in a few short years the emotional trauma will subside some. BUT, if you become a repair patient from ill advised HT surgery the trauma will be 1000 fold and NEVER subside for the rest of your life!!!! PLEASE be careful and do not rush into anything from here! Get only the absolute best top doc (Hasson, Shapiro, Feller) to evaluate your head and give you the straight dope. And lastly, I still PRAY that your 1st HT was FUE!!!!!

[rpachigo]

If you don't know the difference between FUT and FUE, then that's a problem right there. The doctor should have explained that to you.

[Bill - Seemiller]

dre3kla,

 

I have some concerns about your case and would like to garner Dr. Meshkin's input on your specific situation in order to help you the best way possible.

 

Please respond to my private message with your full name and date of the procedure which will then give Dr. Meshkin the ability to respond to this thread with his medical input. He may require you to give him further permission to discuss your case openly. Of course, your personal identity will be kept confidential and will only be used to identify yourself to Dr. Meshkin so he can properly respond.

 

Thanks,

 

Bill

[Dr. Michael Meshkin]

Thank you Bill for making me aware of this thread, and allowing me to properly respond. Even though this patient did not identify himself to us and we were not aware of his concerns, We took the liberty to go over all the patient charts and photos that we performed surgery on last November and were able to identify him from the pre-op pictures. Just to make this clear, I do not perform surgery on clients less that 22 years old unless the patient and his family insist that there is a severe pshychological impact on the patient, and in addition if the patient agrees to stay on medical treatment such as propecia and rogaine. In such a case, then I may consider the surgery and this was the case with this patient who came in with his mother. After extensive consultation with this client and his mother and having them both sign the consent forms to make sure they understand the consequences caused by performing surgery in an early age, I made an exception. I repeatedly made sure that he understood the need to stay on propecia and rogaine, if he wanted me to perform the surgery. Therefore we prescribed propecia and recommended rogaine from the beginning. Also I made it clear to him that since we are spreading the grafts into a large area, he needs to return for another procedure. The patient came in November 2008, he had 1800g done to fill in the frontal hairline, mid frontal, and some in the crown area. We did 250 1's, 350 2's to build the frontal hairline and temples and the rest 3's for density in the midscalp and crown area. He came in after 10 months for follow up in September. I am going to present pre-op pictures and also post-op pictures that we took in September. As you can see, the post-op pictures that I have posted does not represent what he has shown in his post-op pictures. I'm suprised because when I saw him in September he was happy with the progress. As you can see from the before and after photos only after 10 months for only 1800 grafts he looked good in September of 2009. It is a surprise to me to see the post op pictures that he has posted and I am wondering if he has done something that caused his hairloss since September when I saw him. We will try to contact him for a follow up evaluation so I can truly identify the problem and take care of his concerns. If he continues without a reasonable merit to make false accusations to damage my reputation, then I have his consent to release his photos and I will be forced to show his full face photos and identity him

if necessary, so you can judge for yourselves of the true results. And if those who are quick to judge want, I can use his pre and post ups in my January post under results posted by leading hair restoration clinics.

[Dr. Michael Meshkin]

Post-op frontal picture

[Dr. Michael Meshkin]

post-op frontal

[Dr. Michael Meshkin]

pre-op frontal top

[Dr. Michael Meshkin]

post-op frontal top