Bigmac
Administrator
Staff member
Any idea what you’ll you do next? Will it be wait to see if meds make more of an improvement or another HT?
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Uneven/patchy growth after nearly 5 months post-FUE (detailed picture timeline)
L
lightmare
member
Hi BM, I'll be meeting with my surgeon soon to discuss results at the 12 month mark. Then I'll try to figure out a plan from there. I haven't seen much change from 10 to 11 months, but here is how I look at the 11 month mark (after a haircut).
I think I'll likely be getting another HT in the not too distant future - most likely to improve density up front while keeping the current hairline. I'll probably wait several more months to see whether oral minoxidil can improve things some more.
Like you said earlier in the thread more grafts will be needed for a thicker appearance, and I find I'm not fully happy about my density yet (but recognize I am much much better than when I started!). I want to assess the yield to ensure the grafts grew well in all of the areas, and if not, to see if anything like a biopsy would be needed to rule out any scalp issues. Also, I'll be curious to see if my surgeon recommends any other medications during our follow up.
I think I'll likely be getting another HT in the not too distant future - most likely to improve density up front while keeping the current hairline. I'll probably wait several more months to see whether oral minoxidil can improve things some more.
Like you said earlier in the thread more grafts will be needed for a thicker appearance, and I find I'm not fully happy about my density yet (but recognize I am much much better than when I started!). I want to assess the yield to ensure the grafts grew well in all of the areas, and if not, to see if anything like a biopsy would be needed to rule out any scalp issues. Also, I'll be curious to see if my surgeon recommends any other medications during our follow up.
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M
My2021story
member
Who is the surgeon?
Bigmac
Administrator
Staff member
I would give the meds a chance to work before deciding on another HT. They may improve enough that you won`t need another. You can use some fibres while you wait.
Keep the forum informed on how your clinic appointment goes.
Keep the forum informed on how your clinic appointment goes.
L
lightmare
member
So I met with my surgeon for my 12 month appointment! They told me that the surgery was a success given the number of grafts planted, a 9/10 result. Overall they were pleased with the growth and remarked that the right side was indeed thinner than the left, but after looking closely at some pre/post op photos they mentioned that I had more native hair on the denser side, and that they planted some extra grafts there in case I wanted to comb over left to right which was probably the difference maker. It did seem to be the case from the photos we saw.
Like you BM, my surgeon told me that I could wait another 4 months to see the full results of the oral minoxidil upgrade before any more surgeries. They said the finasteride benefit is about 95% apparent by now (12 months of taking finasteride), so the only thing to really wait for is the oral minoxidil. They believe I have another 2500-3000 grafts left before my donor starts to thin out.
My doctor recommended a couple of options:
Like you BM, my surgeon told me that I could wait another 4 months to see the full results of the oral minoxidil upgrade before any more surgeries. They said the finasteride benefit is about 95% apparent by now (12 months of taking finasteride), so the only thing to really wait for is the oral minoxidil. They believe I have another 2500-3000 grafts left before my donor starts to thin out.
My doctor recommended a couple of options:
- A second surgery of ~1500 grafts focusing on the front through the midscalp, and extra density for the thinner areas, mostly leaving the crown alone. They mentioned this would really make the result 'pop' just as much as if not more than the first. Eugenix estimated I could do 3000 with 500 beard grafts, but that was based off photos only as I live in the US.
- Another option is SMP for a density treatment. They believe I have the hair density needed everywhere except the crown for a pleasing visual thickening effect and recommended an SMP clinic they have sent clients to with good results after their HTs. If I wanted some extra grafts in the crown, a couple hundred could help fill it in and boost the SMP effect back there too.
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lightmare
member
Here I am at the 12 month mark. It's been a roller coaster emotionally but I notice a big improvement from where I started.
Here are some photos of me pre and post op, and now. The first set of photos has my hair parted to isolate the problem areas. The second set of photos is how I actually style my hair (assuming the wind doesn't mess it up).
Here are some photos of me pre and post op, and now. The first set of photos has my hair parted to isolate the problem areas. The second set of photos is how I actually style my hair (assuming the wind doesn't mess it up).
Bigmac
Administrator
Staff member
Looking at your pictures I’d say you may have more donor than quoted. I would consult with another clinic before proceeding with another surgery. Your hair looks better styled but it’s just covering up the thin areas with the longer hair.
I think you would be best off concentrating on the same area again with another 1500 grafts.
Definitely give the oral minoxidil longer to see the benefits. Your crown and mid-section may improve quite a bit. Maybe enough that you wont need a second surgery.
I think you would be best off concentrating on the same area again with another 1500 grafts.
Definitely give the oral minoxidil longer to see the benefits. Your crown and mid-section may improve quite a bit. Maybe enough that you wont need a second surgery.
loui
Valued member
Its definitely a improvement but if I look at before vs 1 year photo, I would say its a below average result still with patches. The area needed more grafts but the growth is not great.
What do you plan on doing forward?
Can you post some photos showing the hairline? With the hair combed back to see the density.
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Bigmac
Administrator
Staff member
If you could add a post-op picture showing your hairline, similar to the above pre-op hairline picture to show how much growth was achieved?
L
lightmare
member
Sure thing, here is what the hairline looks like now.
In terms of what I want to do next, I have reached a point where I think I will wait on a second transplant. The reason being, I want to do it right with a reputable clinic (e.g. Eugenix) that'll give me the results I want at a reasonable price - this is more important now given today's state of the economy. This combination basically requires me to travel abroad (I am in the US), which will take a long time. Furthermore, given real life constraints/responsibilities it might be a while before I am in a good position to take enough downtime away from my family to travel, perform, and recover from another transplant - I was close to pulling the trigger a month ago but some real-life stuff got in the way and that rare window of opportunity closed. The next foreseeable window is likely at least a year, likely more, away.
So, I talked to a couple of reputable SMP practitioners (one from another hair restoration forum that had proven patient-documented results in density treatments) and they both said I'd make a great candidate for an SMP density treatment. This was in addition to my surgeon. Given their feedback, I feel like it might be worth a shot to preserve grafts, and to see whether I can maintain my hair or not on finasteride over the coming years. Depending on how finasteride holds up (or doesnt) it might change how I my second surgery later in the future, if I am satisfied with the SMP results.
However I want some unbiased opinions on this! Do you guys think an SMP density treatment would be reasonable in my situation? I have tried toppik and dermmatch but I have a busy and active/athletic lifestyle - they are messy with sweat, require me to shower more than once a day to keep my routine, and are a bit of a nuisance for my partner and I, hence I only use them on special occasions.
In terms of what I want to do next, I have reached a point where I think I will wait on a second transplant. The reason being, I want to do it right with a reputable clinic (e.g. Eugenix) that'll give me the results I want at a reasonable price - this is more important now given today's state of the economy. This combination basically requires me to travel abroad (I am in the US), which will take a long time. Furthermore, given real life constraints/responsibilities it might be a while before I am in a good position to take enough downtime away from my family to travel, perform, and recover from another transplant - I was close to pulling the trigger a month ago but some real-life stuff got in the way and that rare window of opportunity closed. The next foreseeable window is likely at least a year, likely more, away.
So, I talked to a couple of reputable SMP practitioners (one from another hair restoration forum that had proven patient-documented results in density treatments) and they both said I'd make a great candidate for an SMP density treatment. This was in addition to my surgeon. Given their feedback, I feel like it might be worth a shot to preserve grafts, and to see whether I can maintain my hair or not on finasteride over the coming years. Depending on how finasteride holds up (or doesnt) it might change how I my second surgery later in the future, if I am satisfied with the SMP results.
However I want some unbiased opinions on this! Do you guys think an SMP density treatment would be reasonable in my situation? I have tried toppik and dermmatch but I have a busy and active/athletic lifestyle - they are messy with sweat, require me to shower more than once a day to keep my routine, and are a bit of a nuisance for my partner and I, hence I only use them on special occasions.
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Bigmac
Administrator
Staff member
How are you planning to have your hair styled and cut if you do go for SMP? Your hairline is sparse, are they suggesting adding it along the hairline or slightly further back?
L
lightmare
member
I agree - it is sparse but fortunately I wear my hair down and combed over (like the photo a few posts above), such that only a few rows of hairline might be visible. The bigger thing I am worried about is the scalp area behind the hairline /midscalp visibility after styling. If styled right it’s only a bit visible.
Hence, the plan would be to start the SMP 5 or so rows back and put it all the way into the crown. The goal would be to (in most cases) completely block out the remaining midscalp from the front, and reduce contrast in the crown. Since nobody will be looking closely at the crown I dont see a big issue if there are dots visible there upon close inspection.
Hence, the plan would be to start the SMP 5 or so rows back and put it all the way into the crown. The goal would be to (in most cases) completely block out the remaining midscalp from the front, and reduce contrast in the crown. Since nobody will be looking closely at the crown I dont see a big issue if there are dots visible there upon close inspection.
M
My2021story
member
Who was the Dr, you ignored the question?!
B
Bobbins
member
Your posting history is interesting.
It seems you’ve only ever posted on Hair Dr threads?
M
My2021story
member
Yet here I am posting on a thread with no mention of that Dr?
Bigmac
Administrator
Staff member
Patients of a particular doctor quite often only comment on threads relating to that doctor.
As you can see, My2021story is a patient of Dr Arshad. His thread is here if you wish to engage in conservation My2021story
Let’s not derail this patients thread.
@My2021story The clinic was Advanced Hair Restoration. Not sure on which US location or doctor.
L
lightmare
member
Thanks Bigmac. Yes, the clinic was Advanced Hair Restoration and the surgeon was Dr. Tania Pauls in the Colorado office. To refresh the thread, only 2500 grafts were used, so the reason it looks thin now is because it is a small graft count over a large area.
Since I was not on finasteride before the surgery (I am now), Dr. Pauls' thought process was to split up a big (4000+ grafts) surgery into two to see whether meds could thicken up some areas. This might change how many grafts would be needed for a good result the second time around.
It makes sense and it appears I got a decent yield, and I will definitely need more help thickening my hair now, especially the midscalp. Hence I hope to get some advice on the feasibility of SMP to help densify the results, and really hope to focus on answering that question to see if that is a viable option for me at this point.
Since I was not on finasteride before the surgery (I am now), Dr. Pauls' thought process was to split up a big (4000+ grafts) surgery into two to see whether meds could thicken up some areas. This might change how many grafts would be needed for a good result the second time around.
It makes sense and it appears I got a decent yield, and I will definitely need more help thickening my hair now, especially the midscalp. Hence I hope to get some advice on the feasibility of SMP to help densify the results, and really hope to focus on answering that question to see if that is a viable option for me at this point.
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loui
Valued member
I would be hesitant to go back to this clinic, did she offer another surgery for free?
As I see it your result looks to be about 1500 grafts that grew, with a bald spot not growing at all. Thats a 60% growth rate, usually a great Dr have some 90+% growth rate.
I would probably get a scalp biopsy if I were you, to check if there's any issues there before proceeding with another surgery.
You have a foundation now which is good going forward, I don't want to sound negative but I don't agree with the Drs evaluation of the success rate.
L
lightmare
member
Hi louii, I was thinking about a biopsy too. I did see several dermatologists in my area that all said my scalp looked fine, and when I asked about a biopsy they told me they did not know where to take samples from as the scalp looked clean with healthy (but miniaturized) follicles growing and no signs of scarring alopecias. Said that taking a biopsy would be a shot in the dark as there were no other clues of scarring or any other alopecia.
So I was Triple diagnosed as MPB. But at the same time I look back at my 5 month pictures which did seem to have *some* hair in that bald spot and wonder if that was just how the hair parted in those shots or not…and scarring alopecia can be hard to catch.
Anyway, that is another seed of doubt in the back of my head, and another reason why SMP to help conceal more might help. If it is really scarring alopecia, the SMP would fade in localized regions where the scarring was, and we can treat them prior to another HT.
So I was Triple diagnosed as MPB. But at the same time I look back at my 5 month pictures which did seem to have *some* hair in that bald spot and wonder if that was just how the hair parted in those shots or not…and scarring alopecia can be hard to catch.
Anyway, that is another seed of doubt in the back of my head, and another reason why SMP to help conceal more might help. If it is really scarring alopecia, the SMP would fade in localized regions where the scarring was, and we can treat them prior to another HT.
loui
Valued member
Alright I understand. I have tried to help a friend get a biopsy and I found it to be quite difficult to find a Dermatologist who does it in my country. They seem to mostly check on the hair and scalp, which from my reading experience can be difficult to spot any underlying condition so I don't get it why they do not do biopsy more often.
I think its good to take your time and think through what to do next and feel 100% before going through with anything from now on is a good approach.
I am going through removal of badly placed grafts and badly angled grafts at the moment myself and its draining as you think daily on what to do with it and how to become happy with the situation and move on.
