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FUE at Hair Dr Clinic, Leeds (Dr Arshad) – 2500 Grafts – 13-Jan-2021

Bigmac

Bigmac

Administrator
Staff member
It does look like you’ve not had optimal growth. There is still time for more but being realistic it’s a small percentage of patients who see enough growth from this time frame to make them satisfied. You’re most likely going to require another surgery if you want more density so that it blends in to the hair mid scalp.
The large area you had covered was nearly bald. I feel the grafts would have been better utilised concentrating on this area alone and not going into your native hair. The mid scalp and crown looked ok. They should have responded well to meds. Refresh me what regimen you’re on.
I`ve attached a rough image where I would have wanted the grafts placed if I were in your position.
Hopefully, you get some reassurance on the 6th.

A573B5DB-4AC7-443E-BB15-DE35D82EA67E.jpeg
 
H

HT2021

member
Thanks @Bigmac. I'm slowly coming to terms with the fact that a top-up will be required, but it's taking some getting over - I know there's several posters here in the same boat.

I was a bit surprised at the time that the transplant area was so large, but this was explained as essentially future-proofing the transplant for many years to come, so that I wouldn't need another procedure in a few years time once my native hair receded further, while also ensuring density in the frontal section, which sounded ideal to me. Ironically I suppose this approach may have actually made it much more likely that I'll need another procedure pretty soon.

This is probably a difficult question to answer based on photos (and I will see what they say at the check-up), but does that suggest that perhaps the grafts themselves have been fairly successful, and it was just the placement/volume of them that have caused the lack of density?

Regarding my regimen: I'm on finasteride (1mg/day), topical minoxidil (2ml/day), and on the clinic's suggestion I'm using Alpecin caffeine shampoo and taking vitamin D supplements daily.
 
Bigmac

Bigmac

Administrator
Staff member
Re the growth. My personal view is a successful hair transplant is to treat an area with a high enough hair density to create a natural look. There is no need for a second pass to increase hair density between the previous transplanted hair. The density needed depends on the hair characters a lot and hairs per graft. To judge hair density you would need hd pictures and count the placement, it’s not impossible if the picture is good enough. I have counted many donors and graft placement over the years.
Some people will cut out a cm2 on a piece of card, place it on their head and use a hand held scope to magnifier the area which enables them to count the grafts or hair growing. Remember some hairs may be in the resting phase so not totally accurate but very close.

The regimen you’re on should be enough to hold onto your native hair and possibly improve it.
 
F

Follicly_challenged

member
Hi HT2021,

Did you manage to get to the clinic in person on 6th Dec? If so, how did it go?
 
H

HT2021

member
Hi HT2021,

Did you manage to get to the clinic in person on 6th Dec? If so, how did it go?

I did indeed have my check-up, and have since had my top-up procedure on Wednesday 5th January – sorry I’ve been very slow to update this thread.

To summarise the check-up discussion, Dr Arshad agreed that it wasn’t as dense as he'd hoped. He said that it will get a little fuller yet, and could see that there are still some hairs breaking through, but that it wouldn’t be enough for a satisfactory result, and offered me a free top-up procedure to add some extra density.

In terms of reasons for the lack of density, he suggested a few things:
  • First of all, he said that he said that the yield itself was looking pretty reasonable, there just weren’t enough grafts to cover such a big area, and that he thought he probably should have used around 3,000 grafts first time around, rather than 2,500
  • He also mentioned that he had used a 0.7 punch before, which is the reason that the donor area looks so untouched. However, this can come at a cost (you get less tissue, which can make it more prone to drying and trauma), and he said next time he would use a 0.85 or 0.9 punch
  • He also suggested that having had my procedure in January, with the recovery process taking place during a time when I would be sat indoors with radiators on, perhaps that might dry grafts out a little, and perhaps spraying the grafts more frequently than every 2 hours would be a good idea

Here are the results from the 12-month mark, taken the night before the top-up procedure:

_Before (1).jpg
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As for the procedure on January 5th, I don’t want to repeat too much from my first post other than to praise again the wonderful care and support from the team at the clinic, who do everything they can to make the day as comfortable as possible. In the end I had just under 1,000 further grafts put in to the frontal area, which will hopefully deliver the density that I was hoping for.

However, one thing that was different compared to last time was that I decided that I would have a small beard transplant procedure as well while I was there, to address the patchiness on my cheeks that has often annoyed me. When researching beard transplants online, I found it pretty hard to find much information (Dr Arshad mentioned that they only get around one beard transplant patient per month, and many of those will avoid posting anything publicly about it because it is that much harder to hide your identity in photos), so I’ll add some details about this here in case it helps anyone.

The grafts in beard transplant procedures can be taken either from the scalp or the neck – mine was taken from the neck (more precisely, the area just under the chin that is generally not visible to other people). The clinic said that Dr Arshad prefers to take the grafts from there because a) those hair characteristics have more in common with the native beard hairs on the face, and b) it doesn’t deplete the donor resources at the back of the head for potential future hair transplants. For beard-to-beard transplants, the clinic charge £5 per graft, and I had around 500 in total across both cheeks.

We did the hair and beard transplants consecutively across the day – starting with the injections and extractions from the head, then from the beard; then all of the channels created on the scalp, then on the cheeks; then the implants into the head and the cheeks were done at pretty much the same time. The day began at 7.45am, and I think we finished at around 5pm. The process is pretty much the same across both hair and beard transplants; and although I had wondered how it would feel having people work on my face and my neck, it actually felt no more strange than the hair transplant process.

The one thing that I hadn’t been prepared for was that the saline injection (which makes the skin on the cheeks taut enough to work on) resulted in my cheeks swelling up massively for the rest of the day. It would have been good to have been warned about this beforehand, because it meant that I had a lot of difficulty talking (my speech was muffled and certain letter sounds just became impossible to say), eating was impossible, and I could only drink through a straw - my partner and I had to head to the nearby Lidl on the way back to get some protein shakes and some straws so that I could have something resembling a meal that evening. Needless to say, this added a lot to the discomfort on the first night, but by the next morning I was basically able to speak, eat and drink as normal, so it was only short-lived. So if anyone is considering a beard transplant – I would definitely suggest you discuss this beforehand, and come prepared!

The recovery from the beard transplant has been similar to the usual process, but with a few differences. It takes a lot of extra care to not allow anything to touch your cheeks as well as your scalp; and as I had some grafts all the up to the side of my mouth, I also had to be extremely careful when brushing my teeth. In terms of washing, it just wasn’t really possible to wash the rest of my face for the first week – I didn’t want to risk getting water onto the grafts, and I wasn’t sure if even using face wipes would be wise, in case the saline sprays caused something from the wipe solution to run into the grafts. So I did feel increasingly grotty as the week went on, and when I was finally able to wash after a week it felt like I was reborn!

In terms of the washing process, the clinic recommended to apply shampoo to the both the scalp grafts and the beard grafts, and leave them for 10-15 minutes before rinsing off with water from a jug. However, the beard area also seems to recover a lot more quickly than the scalp does – the majority of the scabs from my donor area on the chin had gone within 4 or 5 days of the procedure, and as I write this on day 10, almost all of the scabs have now come off from my cheeks. The next stage is familiar – the new hairs should start to shed soon, and then grow back in a few weeks. However, if it wasn't for the residual redness on my cheeks, I think it would be quite hard to tell that I've had a procedure there at all.


Anyway I think that’s enough for now, but please feel free to ask if you have any questions about either procedure, and if I’ve forgotten anything I’ll come back later and add it in!

Finally, here’s some photos from the second hair transplant procedure:

After the procedure

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Day 1

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Day 3

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Day 5

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Day 10

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B

Baldingman23

Valued member
Great informative write up and I’m looking forward to your progress on both the HT top up and the beard transplant. I’m there Tuesday for my top up.
 
Bigmac

Bigmac

Administrator
Staff member
I did indeed have my check-up, and have since had my top-up procedure on Wednesday 5th January – sorry I’ve been very slow to update this thread.

To summarise the check-up discussion, Dr Arshad agreed that it wasn’t as dense as he'd hoped. He said that it will get a little fuller yet, and could see that there are still some hairs breaking through, but that it wouldn’t be enough for a satisfactory result, and offered me a free top-up procedure to add some extra density.

I agree with the above. There will be more maturing but not enough grafts were transplanted or they were spread out too thinly resulting in a less dense appearance, especially when comparing it to the native hair behind.


In terms of reasons for the lack of density, he suggested a few things:
  • First of all, he said that he said that the yield itself was looking pretty reasonable, there just weren’t enough grafts to cover such a big area, and that he thought he probably should have used around 3,000 grafts first time around, rather than 2,500

I believe this is the case, the area was large with grafts extending towards the crown which would have been better utilised in the frontal third In my opinion.

  • He also mentioned that he had used a 0.7 punch before, which is the reason that the donor area looks so untouched. However, this can come at a cost (you get less tissue, which can make it more prone to drying and trauma), and he said next time he would use a 0.85 or 0.9 punch

I think this requires more explanation. Using a smaller punch will require more skill to extract undamaged grafts. The smaller the punch, the more chance of transection (slicing/damaging grafts). Grafts extracted and handled correctly should survive provided they`ve not been damaged when scoring (punching) and extracting them.
Using a larger punch makes it easier and safer for grafts to be extracted without damage.
Drying out. The grafts should be stored in a solution that prevents drying out. When planting the grafts, regular spraying will eliminate drying out. Punch size should have no bearing on this. Grafts should be kept moist at all times

  • He also suggested that having had my procedure in January, with the recovery process taking place during a time when I would be sat indoors with radiators on, perhaps that might dry grafts out a little, and perhaps spraying the grafts more frequently than every 2 hours would be a good idea

I’ve not heard of this. More information would be required to establish if heat from radiators would have an effect on graft survival.



The growth does look decent. It’s just thin as mentioned above. You do have fue scarring but it’s not visible with your hair at this length and I doubt you will be shaving your head to the bone.

As for the procedure on January 5th, I don’t want to repeat too much from my first post other than to praise again the wonderful care and support from the team at the clinic, who do everything they can to make the day as comfortable as possible. In the end I had just under 1,000 further grafts put in to the frontal area, which will hopefully deliver the density that I was hoping for.

However, one thing that was different compared to last time was that I decided that I would have a small beard transplant procedure as well while I was there, to address the patchiness on my cheeks that has often annoyed me. When researching beard transplants online, I found it pretty hard to find much information (Dr Arshad mentioned that they only get around one beard transplant patient per month, and many of those will avoid posting anything publicly about it because it is that much harder to hide your identity in photos), so I’ll add some details about this here in case it helps anyone.

The extra 1000 grafts will hopefully add the density required to give a homogenous illusion that blends in with your native hair. You look to have healed quite quickly which is good.
It would be great to see some pictures of your beard to beard transplant.
Thanks for a well documented post.
Here's to wishing you a great result from this second procedure.
All the best.
Bm.
 
H

HT2021

member
Thanks so much as always for your perspective and input, @Bigmac.

Hopefully the extra 1000 grafts (on top of the previous 2500) will make the difference.

I should probably just clarify when Dr Arshad discussed the possibility of radiators causing grafts to dry out, that was really more speculation/ a suggestion on his part among others when discussing my 12-month result, rather than something he was stating as a fact. In any case, I probably over-compensated this time around, spraying my grafts every 30 minutes or so to make sure that they stayed moist!

I'll try and add some beard photos in a later post in case they're helpful to anyone. In the meantime, I'll add some hair photos from the last couple of weeks. I'm now at day 25, and well into the shedding stage again.

I had hoped that, because the transplant area was smaller this time around, the shedding wouldn't extend all the way to my crown like it did last time. But no luck! Hopefully the regrowth period will look less uneven this time around given I have more native hair now, so when the new hairs start to grow through, they'll do so in denser areas rather than bald ones. But we'll cross that bridge when we come to it!

Day 12

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Day 15

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Day 19

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Day 24

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I think this requires more explanation. Using a smaller punch will require more skill to extract undamaged grafts. The smaller the punch, the more chance of transection (slicing/damaging grafts). Grafts extracted and handled correctly should survive provided they`ve not been damaged when scoring (punching) and extracting them.
Using a larger punch makes it easier and safer for grafts to be extracted without damage.
Drying out. The grafts should be stored in a solution that prevents drying out. When planting the grafts, regular spraying will eliminate drying out. Punch size should have no bearing on this. Grafts should be kept moist at all times

Hi Bigmac,

I agree this does require more explanation.

It is an over simplistic assumption that the "larger the punch makes it easier and safer for grafts to be extracted without damage".

Perhaps it may be useful to refer to a study published by Dr Rob True (from NYC) in 2018 which grades grafts according to a Graft Quality Index (GQI). Note that grade 1 grafts are follicles with perifollicular tissue throughout and non-follicular (fat) tissue below. It is only logical to accept and as alluded to in the article that the size of the internal diameter of a punch, the type of punch and mechanics of how the punch dissects the follicle from surrounding tissue all have an impact on the amount of perifollicular tissue and non-follicular (fat) tissue excised with the follicle.

I accept that the GQI is a relatively novel concept but as we are constantly striving to improve the yield of surgery for our patients, we are hoping to introduce this and provide all patients with a GQI score as a form of quality control in relationship to surgery outcomes. We are currently working with our microscope engineers so that we can capture images/measurements of this and provide them to patients following their surgery moving forward. I have attached the study by Dr True for those interested. If anyone wants more info about this I am happy to discuss (please drop me a DM).

Regards
Sommiya
 

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Bigmac

Bigmac

Administrator
Staff member
Hi Somiya.

In the past FUE technique used to be discussed in detail with many articles helping people understand the technique. Punch size is very important with pros and cons to smaller or larger. Of course, inner diameter is vital to encompass the intact FU. Too large a punch can create larger unnecessary scarring (not always the case) and even transect adjacent FU, too small a punch may not accommodate splay. It takes a greater skill to be able to safely remove a 3-4 hair unit with average hair characteristics using a 0.75mm punch or under. Clinics do switch punch sizes during surgery to overcome any difficulties such as high transection rates.

Then there is the decision to use a blunt or sharp tip. Or whether to punch and remove or punch and twist when entering the skin.

The exit point of the hair shaft from the skin when punching is not necessarily the direction of the hair follicle under the skin. If not understood this will impact the transection and graft survival. Hair characteristics again need to be understood, curly, straight hair etc.

Not all skin types and hair characteristics make for the best FUE candidate. While an FUE may be possible it may be determined by the size of the procedure and the potential for obvious scarring or increased transection. As a result, some cases may be better to not start rather than begin and not successfully complete.
 
Bigmac

Bigmac

Administrator
Staff member
Thanks so much as always for your perspective and input, @Bigmac.

Hopefully the extra 1000 grafts (on top of the previous 2500) will make the difference.

I should probably just clarify when Dr Arshad discussed the possibility of radiators causing grafts to dry out, that was really more speculation/ a suggestion on his part among others when discussing my 12-month result, rather than something he was stating as a fact. In any case, I probably over-compensated this time around, spraying my grafts every 30 minutes or so to make sure that they stayed moist!

I'll try and add some beard photos in a later post in case they're helpful to anyone. In the meantime, I'll add some hair photos from the last couple of weeks. I'm now at day 25, and well into the shedding stage again.

I had hoped that, because the transplant area was smaller this time around, the shedding wouldn't extend all the way to my crown like it did last time. But no luck! Hopefully the regrowth period will look less uneven this time around given I have more native hair now, so when the new hairs start to grow through, they'll do so in denser areas rather than bald ones. But we'll cross that bridge when we come to it!

Hi HT2021.

Your healing looks to be right on track. The crown shed may be from the numbing agent used as that happens sometimes. It will recover.
The spraying is mainly for your scalp, it helps with the healing As seen in your post ops. Radiator heat should not have any impact on graft survival unless it’s so hot in the room you`re sweating excessively which may cause issues. I’ll not dwell on this though.
I do see quite a bit of scarring in the occipital area from the 0.7 punch. There’s a good chance you’re prone to scarring. Keeping your hair at a certain length will cover these.
It would be great if you start a separate thread to document your beard transplant. A member was asking just the other day.
All the best for great growth and the result you want.
 
H

HT2021

member
Hi HT2021.

Your healing looks to be right on track. The crown shed may be from the numbing agent used as that happens sometimes. It will recover.
The spraying is mainly for your scalp, it helps with the healing As seen in your post ops. Radiator heat should not have any impact on graft survival unless it’s so hot in the room you`re sweating excessively which may cause issues. I’ll not dwell on this though.
I do see quite a bit of scarring in the occipital area from the 0.7 punch. There’s a good chance you’re prone to scarring. Keeping your hair at a certain length will cover these.
It would be great if you start a separate thread to document your beard transplant. A member was asking just the other day.
All the best for great growth and the result you want.
Thanks again for all the support and wisdom!

I've started a new thread for the beard transplant now and have let that member know - fingers crossed it helps.
 
H

HT2021

member
Thought it was probably time to update this thread - these photos are from Day 71 after my second (top-up) procedure.

I think I'm now pretty much back to my appearance before the second procedure, which is a relief - last year I was having to wear baseball caps for about 5-6 months before I looked presentable, so it's nice to already be at that stage after about 2 1/2 months!

Not too much to report just yet - I'm on the verge of needing a small haircut again, and I can feel a bunch of new stubbly hairs popping through, but otherwise it's just a waiting game from here.


I have created a separate thread for my beard transplant here, for anyone who may be interested. I will keep this thread to updates about my hair transplant.



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B

Baldingman23

Valued member
Looking good @HT202!! I’m 2 weeks behind you and it is a good feeling when you can feel small hairs coming through
 
Kevboy

Kevboy

Valued member
The back and sides of your head looks untouched. After this grows in you will look great.
 
H

HT2021

member
As it's now 6 months since my top-up hair transplant procedure (and beard transplant procedure), I thought it was time to update this thread.

It's certainly looking thicker now compared to before, with much more coverage and fewer gaps than before. There are still visible gaps between hairs when viewed from the front, but other than that it seems to be developing nicely, and a huge improvement compared to before the two procedures!

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Just for comparison, here are some pictures from before the transplant, and from 12 months after my first procedure.

Before:

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Left 2.jpg
Right 2.jpg


12 months post first transplant:
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loui

loui

Valued member
As it's now 6 months since my top-up hair transplant procedure (and beard transplant procedure), I thought it was time to update this thread.

It's certainly looking thicker now compared to before, with much more coverage and fewer gaps than before. There are still visible gaps between hairs when viewed from the front, but other than that it seems to be developing nicely, and a huge improvement compared to before the two procedures!

View attachment 33923 View attachment 33917 View attachment 33918 View attachment 33919 View attachment 33920 View attachment 33922View attachment 33921 View attachment 33916 View attachment 33913 View attachment 33914 View attachment 33915

Just for comparison, here are some pictures from before the transplant, and from 12 months after my first procedure.

Before:

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12 months post first transplant:
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Looks like it has thickened up alot with these additional 1000 grafts, and there is still time for more. :)

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B

Baldingman23

Valued member
The top up has made a big difference and like Loui said there is still more to come over the next 6 months!!!
 
H

HT2021

member
I had a haircut a few weeks ago (at the 10 month mark) - the barber styled it a little so I thought I'd take some photos, since I'm still hopeless at styling it myself! A decade or so of styling my hair to hide my receding hairline rather than actually making it look good means I still don't really know what I'm doing now I have more hair to play with :rolleyes:

As you can see the top-up has made a huge difference compared to 12 months ago, and my beard is also a lot more defined. Now that my beard is less patchy, I can grow it a little longer without worrying about exposing the patches, which I think makes a big difference.

It's interesting seeing people's reactions, especially given I've recently seen a lot of people for the first time since before the pandemic (and before my procedures). A lot of people have said something about how I've grown my hair longer, but nobody seems to quite be able to put their finger on what exactly has changed!


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Baldingman23

Valued member
The style suits you well and the top up has made big difference. It’s always funny when people know there is something difference with your hair but can’t put their finger on it. I always think that’s a sign of a good HT
 
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