They say that like money, you can never have enough hair. And who on this forum would ever object to more hair on top of their head?

Call me greedy, but last week I went in and got 1,631 grafts (3,907 hairs) added to the top of my head. Yes, while others limp by with no hair transplant at all I had the nerve to ask and get even more with the masterful Dr. Ron Shapiro and his staff. So now I’m back in the post op mode with a numb head and a long wait ahead for sprouts.

Graft and Hair Breakdown of my Surgery:

257 one hair grafts – 257 hairs
764 two hair grafts – 1,528 hairs
424 three hair grafts – 1,272 hairs
85 four hair grafts – 340 hairs
101 DFU grafts – 505 hairs
(Double Follicular Units with 4 to 5 hairs per graft)

Total of 1,631 grafts (3,907 hairs)

Dr. Shapiro played it safe to avoid any unnecessary tension on the donor suture by not going more than 1 cm wide. He varied the width, which averaged about 8 cm wide across a combined length of 28.5 cms. Thus he removed about 22.8 cm2 of donor tissue from the sides and back of my head. He also used three internal sutures to reduce tension on the skin level sutures, which were staples. He also did a trichophytic closure to minimize any cosmetically visible scarring.

Going into this most recent surgery I was very happy with my current donor scar, which was hard to find even under close examination. I did donor stretching/massaging exercises two or three times a day for two to three weeks prior to surgery. I started to notice my donor laxity really improving toward the second week. I only wish I had started earlier. Both Dr. Shapiro and I think these exercises increased my scalp laxity considerably.

I highly recommend that any potential patient do these exercises to optimize the amount of donor tissue that can be safely removed in any one session. To see an excellent video presentation on how to do these useful exercises visit our the Scalp Exercises post by Joe Tilman of Hasson and Wong (thanks Joe). To view this post visit http://hair-restoration-info.com/eve/forums/a/tpc/f/346...711060762#3711060762

I expect this most recent session to heal up well, especially given the limited width of the donor removed. It has also been easy to conceal my post recipient grafts since they were placed in and around my existing hair transplants. In fact, two days after surgery I went out dining and drinking with no cap – just some limited amount of Prothik spray.

Background

My first hair transplant was in September of 1996, followed only 6 months later with a second session and then a third session less than a year after that one. It was heady times to go from a balding thirty something to a thickening man.

But years later, despite the use of Propecia, my midscalp and crown areas gave up hair. As they say “hair loss is progressive”. So a couple of years ago I added about 1,000 grafts in my crown area. This surgery was performed in Florida by Dr. Rose. This small surgery healed up great, especially in my donor area. Although this was a small session it did add enough fullness in my crown so that with some limited use of Prothik or Toppik my crown actually looks fairly full.


More recently I found that my hair stylist was thinning my hair on the side a bit to balance with the top. So I decided a more permanent solution would be to have Dr. Ron Shapiro remove some of my donor hair from the sides and transplant it to the top where it was needed.

After looking my photos from a top view with my hair was parted it was apparent that I could benefit from more hair in this central area. I also wanted to thicken up my hairline a bit in the corners and central area. Dr. Shapiro was also able to add some hair to the top of my crown area.

Next week I will get my staples out. That should be interesting. In the past all my donor closures were done with running nylon sutures. This is my first experience with staples.

Over the past week my scalp in the donor area was simply to numb to feel much of any thing. But I expect that as healing accelerates in my donor area in the coming week, and feeling returns, I will find the staples to be irritating. So far I’ve had no need or interest in taking the Vicodan pain pills. Perhaps I will put them to recreational use at a future date 

I don’t expect to experience any shock loss since all my new grafts were added in and around hearty transplanted hairs. Now comes the long wait for spring and all the new sprouts.

Eight Month Update

As of July 21st my last session with Dr. Ron Shapiro was at 8 months post op. My impression at eight months is that the improvement at this point is subtle. In fact, during the past few months I have really not noticed the transplanted hair growing in.

This could be due to the transplanted hair being added in between existing hair. Or it could be that after five surgical sessions my scalp vascularity is compromised so that my new hair growth is suppressed or greatly delayed.

I'm proof indeed that hair loss is "progressive" and can only be treated as it progresses but not "cured". All twenty two year olds who are in a rush to use up their limited donor area to dense pack their receding hairlines should keep this concept in mind.

Remember hair transplants can't restore a full head of hair on people with extensive hair loss - it can only create the "illusion of fullness".

I find that by using Prothik spray or Dermmatch does dramatically increase the look of fullness of my hair transplants. I expect that other cover up products like Toppik etc also provide similar benefits.

I hope my growth is just very delayed at eight months. I'll
keep everyone posted.

11 month update

I think I may have been a "late bloomer". I think it is harder to notice an improvement when hair was transplanted into areas with existing hair. But at 11 months it appears that the growth, while slow and perhaps delayed, does seem to have made a subtle improvement. Some believe that may I will continue to see improvement in the coming weeks.

I have been taking Propecia for over eight years. But I think I may begin using Rogaine 5% to see if I can improve the hair quality and thickness in my crown area. Frankly, I should have started using Rogaine post op to speed my regrowth.

Best wishes, Pat

Fantastic! I can see you snuck another one in when no one was looking, you sly devil! Where do you keep coming up with more donor hair? Are you not telling us something, maybe like a lab in your basement where you carry out you hair cloning experiments. I am sure you can't wait until spring time to show off your new locks. Best of Luck and a speedy recovery, I am sure all members on this forum wish you the same!

Wow....Pat the Publisher back in the chair again. I had no idea that you were planning on getting another surgery. Truthfully, you didn't need it, but I understand the desire...it's called HAIR GREED, which of course, we all have. And you are right...we can NEVER have too much hair. I think this additional 1600 grafts will help give you a bit more density. I think at this point, with as much hair as you already have on your head, it's good that you went for a smaller surgery, especially to minimize donor scarring. It makes me wonder if 3 years or so from now I'll consider having one more "smaller" surgery to see about getting my scar revised (only if I need it, which it's too early to tell at this point), and to get a few more grafts to add to the illusion of density. Looks like a good strategy.

I couldn't tell by your post...but did any of these 1600 grafts make it into your crown? Or did you just focus on the top 2/3 of your head?

Either way...happy growing!

Falc

That looks great Pat. Were the DFU's placed in a specific area like the central core or were they spread around all over behind the hairline?

Congrats Pat!!!! I know you and I share the same opinion of Ron, so I will just say congrats on yet another successful operation.

Do you feel any sexier? LOL!

Congrats Again!!!!!!
J

Thanks for the congratulations guys. It's fun to be a patient again.

The grafts, including the DFUs were really concentrated in that central landing strip on the top of my head (ok, so I exagerate), wth some fus in the hairline. I got a dusting of grafts at the top of the crown, which should help give me more crown coverage.

As for feeling sexier - I hope not. I wouldn't want to attract the wrong kind of attention and have all my staples torn out in violent act of passion :-) Ooch.

Congrats pat!! I have a question for you, were you at all worried about shockloss. When you have procedures how dense can you go without getting into permenent shockloss?

Congrats pat!! I have a question for you, were you at all worried about shockloss. When you have procedures how dense can you go without getting into permenent shockloss?

Troy, I'm not really concerned about shock since the grafts were added in and around strong hair transplanted hair that has no minaturization. In addition, the session is not densely packed and Dr. Shapiro did use minimally invasive incisions. In the past, when he went back in between my transplanted hair I had no shock loss.

Also Dr. Shapiro uses high powered loops and takes plenty of time to assure that he goes around existing hairs so their follicles are not transected. This is just one of the many reasons why a truly excellent surgery takes time and can't be rushed.

As for permanent shock fall out this really only seems to occur with hair follicles that were producing minaturized follicles and were on their way to the grave yard in any case. But I do think Propecia and even Rogaine can strengthen such at risk hair and give them a greater resiliance to being shocked.

Most shock loss is temporary from what I've noted over the years.

Best wishes, Pat

Congratulations Pat.

Heal well and grow well. By having another HT you increase the credibility of this field in general.
Grow fast!

Dr. Feller

Sweet as PAT!! Well done indeed! Hair is like money - you always want more!

If not already get on MSM ;-)

Grow well brother!

Pat,

Congratulations to you on your HT from Doc Shapiro! Like the others, I had no idea you were contemplating another one................you sly dog!!!!

Hey........one quick question for you (maybe for Doc Shapiro)?? What would you estimate your density per cm2 to have been before going under the knife again? We have threads going back and forth on "to shave or not to shave", however, I have often wondered what the most "dense packing" Shapiro or others could perform without shaving down while at the same time offering reasonable assurance of no follicle transsection.

Any thoughts? Anyone have any thoughts on this?

At any rate, it looks like it went great and you should be healed up and growing in no time at all. I've always been very impressed by Dr. Shapiro's work.............................who knows, maybe I'll end up there in time for a touch up or some density??

Happy growin' to you!

Pat, congratulations, you snuck in under the radar and surprised us. You really did not look like you needed more but then again, why not go for all you can get! Thanks for all you do and wish you a great recovery.

A few questions:

How much donor hair do you have left for any future work?

I noticed you did not get buzzed, was this your preference or does Dr. Shapiro usually work around the exsisting hair?

Of the coalition Dr's, which ones buzz the recipient area and which ones will allow you to keep some length of exsisting hair? Some posts I have read suggest that buzzing makes for a better job since the grafts can be placed easier and maybe better directionally. I figure it makes it easier for the doc but if you want some coverage post HT why not keep some hair if the doc can work around it? I personally would not want to be buzzed. (note my name!)

Are you planning on more work or are you going to surprise us again? LOL!

The vast majority of physicians in the Coalition do not require or even request that patients cut their hair short. However, doing so would make it easier for them.

Maybe I'm old school but going into skin head mode for four months is just not for me. I love how the existing hair covers up the new hair transplants. I was out on the town with no one the wiser two days post op. With a buzz cut I'd probally be hiding in my basement watching Robert Dinero in Taxi Driver.

I think this latest session will appease my hair greed for a few more years. I do think that I will have the option of doing more in the future if wanted/needed. I think its wise to leave some donor in reserve in the donor bank.

Hairbank, we really didn't do any measurements of my density. Dr. Shapiro focused on taking as much donor tissue as he could safely get and we got what we got. But my guess is that my donor density may have been some what below average at just under 80 FUs per cm2. With the 101 double follicular unit (DFUs) that I got Dr. Shapiro estimated my total FU equivalent to be 1,737.

Since I'm actually about 80% gray (Yes, probally due to the crazy hair restoration world) I color my hair. But the follicles beneath the skin are much harder for the techs to see, even when using the microscopes. So most clinics try to cut the grafts a bit bigger when the patients hair follicles are white so as to minimize graft transection. For that reason and to create an optimal amount of density I think Dr. Shapiro used a limited amount of DFUs.

All the best, Pat

Thanks Pat, with me its not old school its just old! At 47 and pasty white, if I buzzed it, I would start recieving get well cards in the mail!

Good that you have some troops in reserve!

quote:

Originally posted by Pat - Publisher of this Community:
Hairbank, we really didn't do any measurements of my density. Dr. Shapiro focused on taking as much donor tissue as he could safely get and we got what we got. But my guess is that my donor density may have been some what below average at just under 80 FUs per cm2. With the 101 double follicular unit (DFUs) that I got Dr. Shapiro estimated my total FU equivalent to be 1,737.
All the best, Pat

Pat............I mean what do you estimate your density to be in the "recipient" area, not donor. I agree with you....I'd have opted NOT to shave down. I'm just wondering what the MAX density is that can be achieved in the RECIPIENT area assuming you don't shave down? Any ideas??

Thanks,

quote:

Pat............I mean what do you estimate your density to be in the "recipient" area, not donor. I agree with you....I'd have opted NOT to shave down. I'm just wondering what the MAX density is that can be achieved in the RECIPIENT area assuming you don't shave down? Any ideas??

Hairbank, I wouldn't even venture to guess a number on what various physicians are capable of dense packing without shaving the area. I think that the more existing hair a patient has the area being grafted the more careful a surgeon needs to be to avoid inducing shock fall out - by either transecting existing follicles or creating too many incisions in a given area and generating too much trauma to the vascular.

In general the smaller and more superficial the incisions the more the surgeon can get away with dense packing an area. My impression is that shaving the recipient area makes the process easier by improving visualization. But it does not increase or decrease the amount of hairs that can be dense packed into a given area.

All the best, Pat

Congrats Pat your hair already looked darn good from Dr.Shapiro's work already....so one can only imagine what another 1,600+grafts (3,907 hairs) will do for you, looking good Pat + thanks for all your help along the way.

Nice going Pat and best wishes for rapid healing and regrowth. I am also looking for more density in my next, and I hope final, HT. When I recently consulted with Dr. DeYarman he told me he would prefer me to shave my recipient area to achieve the UR dense packing I am looking for. I think I understand better his reasons from reading the previous comments, nevertheless, I would have a very hard time shaving since I would be contemplating about 4 months of acceptable regrowth before looking normal again and since the whole point of the HT is to look as if nothing happened ....... IMHO, the shaving gives the surgeons a nice safety net to limit transsection and better visibility to better align the axis of the punch holes that will receive the new FU's, it's also a big time saver for them. If think a dedicated MD will take the extra time and effort to work around the fully grown hair already in place so the patient does not have to shave. Thanks to this forum and Pat's dedication we are constantly pushing the envelope and many Dr's. are updating and improving their techniques to keep up with more knowledgeable and more demanding patients.

Congratulations Pat and best wishes for speedy growth. Your suggestion, in a private message, last year at this time to get repairs done on old plugs and get a transplant was one of the best decisions I have ever made. It is truly the gift that keeps giving.My procedure was completed on January 12, 2006. I had plugs removed and a total of 2382 graphs or 5,478 hairs transplanted. The repair is impossible to detect. In October, I visited Dr. Bernstein to arrange for a second procedure in January, 2007 and he was not anxious to do the surgery. He wants me to wait since he feels there should be more growth taking place and that will give him a better idea of how to place the new graphs. Since my visit I am already seeing more improvement or as he stated a maturation process will take place. Although I am pleased with the results, I appear to be a slow grower. Seeing how you were able to hide the HT with your existing hair is great (now that I have some hair to hide the new HT under). Like many folks on this forum I have taken care of my body and the one thing I could not do anything about was my hair. Slowly reversing baldness is a kick in the ass. Also, having a doctor turn down a quick $7,000 to $10,000 because he felt I should wait (while frustrating) is refreshing and obviously the right thing to do. Thanks for the advice and the great forum.