Dr. Steven Paul Holt - FUT 1400 grafts (2019)

[halttheholt]

In early 2019, I was a workaholic NW3/4 full time student and full time work. I consulted with a local surgeon Steven Paul Holt of Holt Hair Restoration in Grand Rapids. He initially recommended 1200 grafts FUT. Dr. Holt said that FUT was the gold standard and that 75% of procedures are still FUT. He also said it would work better since I had dark hair. He is board certified by ABHRS and license was in good standing.

Had the procedure in April 2019. Procedure took about 6 hours. They provided lunch. Afterwards they bandaged my head, gave me a surgical cap and had me drive to a pharmacy to pick up prescriptions that they called in.

Every thing seemed to be going smoothly but it was very clear something was off, there were not enough grafts. Dr. Holt told me all I needed was the 1400 and wouldn't go any higher.

Nonetheless, I held on to hope until after 12 months but it dawned on me I was now a repair patient.

In my post op consultations with Dr. Holt, I complained that it looked fake and bad. He told me it looked "patchy" but nobody could tell I had an HT and technically I don't need another one. I kept going on how it's not what I expected and he said " okay, okay you need one. I can do 700 - 1000 more grafts". I was stunned again because this still seemed so low.

Dr. Holt wanted to do another FUT, saying that it'll look better with my dark brown hair and that FUE would look moth eaten. When I complained about the scar, how it was itchy and more sensitive than I expected he countered that "FUE looks like you got shot in the back of the head with a shotgun". For whatever reason he does not like to do manual punch FUE cases greater than 500 grafts and would turn to the ARTAS machine (which is really controversial).

The first 3 photos are pre-op, the next two are immediate post op, and the rest of the photos are from the 12 month follow up.

Please let me know your thoughts. I just wanted to post the outcome here. I've had a second procedure with a different doctor.

Thanks everyone.

 

[Bigmac]

Looking at the pictures I`d say the 1400 grafts were not enough to provide adequate density considering the area covered. I’d have had the hairline higher for the number of grafts. The growth is not that bad, it doesn’t look unnatural, just lacking in density. Maybe 1000 - 1500 grafts if they go over the same area in your second surgery.
The doctor only offering 500 FUE grafts could mean he is not that skilled at extractions. Using the Artas adds some weight to my thinking.
What does your FUT scar look like?
Are you on a hair loss prevention regimen?

 

[halttheholt]

The interesting thing here is when Dr. Holt was sketching the hair line, he asked if I wanted it conservative or more lower? I asked for moderate (big mistake, I should've stayed as conservative as possible) and I don't think I would've agreed to have it this low. The kicker is when I asked for the pre-op photos to see the drawn lines, Dr. Holt's office did not have any on file. They also did not have any immediate post-op photos. So we'll never know what the original plan was. Holt's response to my complaints that it looked bad was another FUT of 700 grafts, which is when I left.

The FUT scar is pretty bad, almost popsicle stick-like. I recently had a repair procedure with Dr. Panine and shaved my head for the first time in my life, being able to see the scar. The attached photos are 1 week out from my second procedure which was an FUE of 2400 grafts.

I'm on finasteride, 1mg.

Thanks.

 

[repairmybadangles]

If it weren't for the FUT scar I don't think this 1st surgery was that bad. The grafts that did grow in did not grow in misangled or anything, and I could be wrong but I personally don't think the lowered-hairline low yield was terrible obvious, and depending how you styled your hair perhaps it was concealed. I think the FUT scar made this from being a disappointing but predictable low-yield 1st pass, into a very unnecessary and needless FUT scar for you.

Obviously still very disappointing and I would probably feel the exact same way, its more of just an FYI that things could have gone so much worse than they did.

Yes, absolutely sub-optimal yield, the quoted graft count was way less than what is needed, and I agree with @Bigmac that Holt likely went with FUT and his graft count not because of best-practice, but because he only recommends what he himself is experienced in. He probably is inexperienced with FUE, but can't obviously admit that to a patient so uses excuses.

But yea, I do agree about the FUT scar. With your latest repair surgery, this all could be water under the bridge and perhaps you could laugh about all this in the end one day, but the FUT scar will remain. The worst part of your surgery with Holt is not the severe graft undercount or the low yield, but this FUT scar you need to deal with.

Is there a reason Dr. Panine didn't address the FUT scar? I feel like one of the more elite repair surgeons could have addressed the hairline and this FUT scar at the same time. Probably would have cost alot more $ though.

shaved my head for the first time in my life, being able to see the scar.

I do concede that I would be super frustrated and concerned with an unnatural but hidden result. But since in everday life you wear your hair normally and the FUT scar is hidden, you have that going for you. By all means you are completely reasonable and justified in having an additional surgery to conceal it further. I'm just saying if the ladies and your friends and family have no clue its there when your hair is normal length, it may not be as bad 'in real life' as it is in your mind.

 

[Bigmac]

Nice to hear you’ve been able to secure a second surgery to add density to your hairline. Have you thinned out more since the first surgery? 2400 is a lot of grafts to add density to your current hairline.
Donor scar could be improved with grafts placed into it. Is this something you are considering at some point?
Could you add some pictures showing the placement from this second surgery?

 

[Dazzster26]

Hi Friend ,

Have to agree that was a lot of area to cover for that amount of grafts , your donor is precious so please take your time for your next surgery , get some consultations done with other Clinics Surgeons for comparison , just looking at your pictures I would say another 2400 Grafts is a lot but that is just my opinion . Your still in the driving seat you still have donor use it wisely as you may need it further down the track , as Big Mac stated grafts can be put in the scar and their is always SMP .

 

[halttheholt]

@repairmybadangles That's the consensus of the four reputable doctors that I consulted with, that the transplants were not terrible but at best mediocre. I did style my hair to conceal it as best as I could but I was condemned to a "forward" combover. I wish I would've just had Dr. Holt fill in the sides and not do anything with the front.

The best part is in my follow ups, Dr. holt would squint and talk about how small the scar is and it is MASSIVE by modern strip method standards. I can google and see scars that are like sliver.

Dr. Panine's office recommended addressing the scar separately and also reasoned that FUE was the better choice for my second procedure because of scalp laxity and that the new scar might be just as big due to excess stretching. They recommended the hairline repair and potential scar repair being done on separate occasions.

And this brings up Dr. Holt's reaction to me complaining that it didn't look good, saying that "technically" I didn't "need" another transplant. But as I kept going on about how you could see through to my old hairline, he said "okay, okay, you need one" and... recommended a second FUT of a whopping 700 - 1000 grafts. I was so revolted, I told him I wanted to do FUE because FUT actually kind of hurts and I still have residual pain in the scar. He again repeated his spiel that FUT would look better and FUE would look "moth eaten", that I'd have to shave my head, something to the like of "no pain, no gain" and that it would look like I got shot in the back of the head by a shotgun.

In all likelihood I won't do anything in the near future about the scar. I typical always wear my hair 3 - 6 inchers and I'll likely never shave my head like this again unless I get another FUE. It's just another scar I have to remind of something stupid I've done. Have many of those.

 

[halttheholt]

Nice to hear you’ve been able to secure a second surgery to add density to your hairline. Have you thinned out more since the first surgery? 2400 is a lot of grafts to add density to your current hairline.
Donor scar could be improved with grafts placed into it. Is this something you are considering at some point?
Could you add some pictures showing the placement from this second surgery?

I'm not sure, I feel like I am but photos of my head do not show much of a change.

No, to me that seems counterintuitive, putting hairs into the "wrong side" of the head. In all honestly, I've never really kept my hair short. In highschool, my nick name was "mop top". So losing my mop wasn't the greatest experience and I'll keep the mop as long as I can (but only if it looks good). Usually, if my barbers use clippers on the sides it's a number 7 or 8 (1 inch) and I don't think I've ever had my shorter than #5 (1/2 inch) in my life and I mean ever (I'm 31 years old).

Okay, here's pictures (FYI when I said I recently had the FUE with Panine, I mean it, it was 2 weeks ago haha).

I'll start a journey thread on this forum.

 

[Dazzster26]

Thanks for coming back to us , really looking forward to seeing your 2nd surgery updates all the very best