First of all, let me say that Dr. Brad Limmer and his staff are a highly professional team that make you feel at home and will answer any and all of your questions before, during and after the procedure. I had two procedures done, one was yesterday, Monday, and another one today, Tuesday. As soon as today's procedure was finished, I drove 4 hours from San Antonio to my home in Angleton, just south of Houston, and I feel pretty good. I am a little sore but do not have any pain. Jessica made me feel at home both Monday and Tuesday when I arrived there at 7:30am. Zhuling is an excellent technician who numbed the donor area of my head both days without any pain what so ever. The only time I felt anything was a slight pinch when she initially inserted the needle then proceeded to inject the medicine real slow giving time to deaden the area and I did not feel the rest of the injections she gave me. Dr. Brad then proceeded to remove the donor strip. The only thing I felt was a slight pressure while he sewed up the wound. The young lady who was my cutter was Hoang (I hope I spelled her name correct) and she was very meticulous and did a great job of cutting up the grafts. My planter was Anna and I cannot say enought about this young lady, she is excellent and I felt zero pain as she worked for hours both days. I was given Vicodin to take after the surgery when I got back to my hotel room but I did not need it. I did take a couple of Tylenol and went to bed. I did have some soreness when I got up Tuesday morning but was never in any pain. The procedure today, Tuesday, was an exact copy of Monday. Was there any discomfort? Yes, I did have a little discomfort this morning, I was a little sore and did have a slight swelling as was expected. Was I ever in any pain? No, I was not, and even as I type this, 9:55pm central time, I still feel pretty good and have not taken any Vicodin because I haven't needed it. Would I do this procedure again? Without question, yes. Dr. Brad took pictures before and after my surgery and I agreed to have him post them. I won't be able to wash my hair for the next couple of days, it's driving me nuts having my hair oily with neosporin on my donor area. I am very pleased the way Anna placed my grafts and can hardly wait for the growth to set in.

I highly recommend the Limmer clinic, they are an excellent team, do an outstanding job and really care about the patient, there is a family atmosphere that makes you feel at home. Thanks, John

John,

I'm glad that everything went so well for you. Sounds to me like it was a great experience and now it is just a matter of the waiting game. Please keep us posted as to your progress and I look forward to your pictures. Thanks for sticking around and continueing to post.

NN

Slowlythinning, Congrats! Sounds like a typical experience with a coaltion Doctor.

I'm sure the clinic gave you post op instructions but one of the most important is to keep the donor area clean & scab free. This minimizes scarring & promotes fast healing.

So don't be afraid to use your fingers & gently wash along the suture line.

Look foward to seeing your pics!

Now the waiting game, thats where I'm at...

Happy Growing!

All aboard!!!

Please have a seat sir on the waiting train.. There are plenty of seats in the back of the car...!

Congrats and good luck!!

Thanks guys, my wife put some neosporin on the suture line this morning and that helped to take the itching away. I will be able to lightly shampoo the back of my head tomorrow afternoon and looking forward to that. Can hardly wait for the 7th day so I can shampoo my whole head. I will keep you guys posted on my progress. Happy growing to all and have a good 4th of July. John

SlowlyThinning,

I'm really glad to hear that you had a good experience with Dr. Limmer.

I hope you'll post some details for us. How many grafts did you receive? Do you have a breakdown of hair counts?

I'd really love to see some pictures of the recipient area, and especially the donor area immediately post op. I'm especially interested in seeing the donor area scar pictures where the scar from session 1 meets the scar from session 2. Are you willing to post any pictures?

Hair transplantation is a lot like a roller coaster. You are nervous going into it, experience a lot of ups and downs, but in the end, you are excited, glad you did it, and you might even want to do it again.

I look forward to seeing your progress my friend...you're in for a fun ride!

Falc

I had a total of 3000 grafts done, don't know what the hair count was. Dr. Brad took several pictures of the donor and recipient areas and said he would post the pics right after the holiday. I'll get my wife to take some pics as well and post them. Really had a very good experience and found that hair transplatation is virtually pain free with just a little discomfort and the normal swelling. My wife says I look younger since the slight swelling took away the wrinkles off my forehead....lol...Should of done this long ago. I'll keep you guys posted. Thanks, John

John,

Just wanted to check as I posted the same question for another patient. Did you have EXACTLY 3000 grafts done? The odds of getting an exact number like that, especially which is exactly the same as the projected number is very rare...not impossible, but rare. So I'm just wondering if you got close to 3000 grafts, or EXACTLY 3000 grafts. If you don't know, perhaps send an email to the Limmer clinic to see what they say.

I look forward to seeing your poictures my friend.

Falc

Falceros,
No, don't really know exactly how many grafts I got, went in for 3000 but I will ask the clinic. I do know that I'm very pleased with the procedure and my balding areas were covered very well. Thanks, John

John,

Jessica called me about your question. I am out of the office, but
you had right at or just over 3100 grafts and will get the pictures
of the whole procedure together from pre-op, excision/closure and
final photos together when I get back next week.

I also spoke with Pat today and hopefully he and Jessica have been
able to get the prior photo loop running from my last post July 3rd.
It shows not only several post ops of guys who had similar
procedures, but also a nine photo set documenting exactly what was
done in your operation. We will put yours together and post it next
week.

Specifically regarding your donor excision, you had and average f.u.
density of 84 grafts per square cm. Total excision area was 38 square
cm. Your donor epsilon was 1.2-1.3 cm wide and ran from ear to ear as
will be seen in the photos. The only way to have gotten anymore
grafts would have been to increase the width of the excision or start
splitting follicular units up into a bunch of 1 hair units. The
latter was not only not needed, but increases the risk of graft
transection and truthfully just exaggerates what was done (and does
not move anymore hair).

I rarely feel graft spitting is necessary, except in cases that just
don't have enough natural 1 hair grafts to complete the hairline or
in patients (such as Asians) whose hair shaft diameter and color
require more 1 hair grafts to than normal to soften the hairline.
Graft splitting for the sake of graft splitting exaggerates what was
truly done and could be used as a way to inflate graft numbers and
cost to the patient.

In prior posts I have discussed why I tend to stay around this width
of excision. If I had gone wider, you would have been in more pain,
felt more tightness and increased the risk of a wider scar. In fact
one of the other guys that you ate lunch with was there for
correction of an excessively wide scar from a procedure he had done
by another physician. I will be happy to post those photos as well,
to help people understand why I approach my donor excisions the way I
done. I do not want my patients to have that kind of result.

For those who count specific numbers it might seem a little
frustrating. But when planning my excision I always factor in
basically an extra square cm of donor harvest (above and beyond what
is planned or being paid for), this ensures that patients are
getting not only what they have paid for, but typically 5-10% more
for free. I would rather spend my time, staffs time and patients
time cutting and planting hair. It is the philosophy of delivering
more than promised or paid for.

Brad Limmer, MD

Thank you Dr. Brad for your imput, concern and honesty. I feel that I had a very pleasant experience with my first HT and will do it again in the future if need be. Your staff was wonderful, very professional and made me feel right at home. I will stay in touch and let you all know how I am progressing along. Many thanks, John Saldivar

Thanks for the detailed account of things doc. We look forward to seeing the photos.

NN

Dr. Limmer,

Thanks for your post.

I also look forward to seeing the pictures. I'm very interested in seeing pictures of the donor area where the two scars from subsequent days meet.

Falc

Dr Limmer,

Based upon what you've said, am I correct in assuming that you don't charge additional for grafts that are implanted during the procedure that exceed the estimated graft count?

When you do split grafts for whatever reason, is it also correct to assume that this does not inflate the overall graft count provided?

While I can understand your desire to limit the width of the donor strip, I personally don't agree with the presumption that this causes more pain [I've had 2 procedures with different widths & the difference in pain was not noticeable----pain is pain], nor do I agree with the risk of a wider scar if the closure is performed correctly.

Thanks for your response, as it's always an education to understand the doc's thinking.

Are the 25 cent words like "epsilon" also free?

Rhodeman

I just looked back at the email I had Jessica send and there is no "epsilon" in there. The word was excision. How it changed, unless Jessica was not able to just insert it into the thread, I don't know.

Extra grafts are placed at no additonal charge and never thrown away. I have been amazed by stories over the years by patients who towards the end of the day are notified by the MD they have left over grafts, above what was set out to do. The patients were given the opportunity to pay more or have them thrown away. This is not the practice of our office and never will be. For one, donor hair is a limited resource and to ever think of discarding it is appalling. Second, it is not the patient's fault a physcian took a little extra and he should not be put in a awkward situation of having to choose to pay extra or see his grafts discarded. It is sad to me to ever hear stories like that. It reminds me of a bait and switch approach to medicine.

There is also no additional cost if I feel the need to split grafts. This would be unjustifiable cost inflation. These few patients cannot help it that they don't naturally grow enough single hair grafts.

Regarding the final question. Pain is pain, and different people preceive it to varying degrees. It cannot be predicted prior to surgery regarding to what degree each individual patient is going to preceive their post op discomfort.

However, there is absolutely no doubt that the tighter the closure the more likely the pain. I have done this too much not to know. Your particular case might have been different. A good example of this is the area above the mastiod process (that hard boney area just behind the ear). Routinely this is the tightest area of a donor closure, even though the excision width is no greater. It is also the area that patients first notice discomfort or complain of pain. It is also the area I remind patient to expect a little more discomfort in the first few days post op. So the wider the excision, the more likey the post op pain.

Finally, I doubt you will find any good Plastic Surgeon, Dermatologist, ENT or Hair transplant surgeon who would dispute that the wider the excision and increase in tension of closure will routinely increase the risk of a wider scar.

While each case is different, no physician can predict that a patient with a wide, tight excision will not have pain and a wide scar. After years of practice, myself and many other well quailfied transplant surgeons have seen it all. Please understand that when working with patients, we have to keep these factors in mind. There are exceptions where wide excisons and tight closures heal nicely with limited pain, but that is more the exception than rule.

Thanks for your comments and I will be happy to answer any questions. BTW, is there a spell check option somewhere when posting.

Brad Limmer, MD

Dr. Limmer,

Thanks for your post. Excellent response.

I'd also like to see an answer to this question:

"When you do split grafts for whatever reason, is it also correct to assume that this does not inflate the overall graft count provided?"

Your conclusion is a logical one regarding pain, however, I'm not sure it's 100% true. But then again...what is? There are always exceptions...

Of course, I can only speak in terms of personal experience...

But I actually experienced the MOST pain from my first surgery of 1600 grafts. The least amount of pain was experienced during my last surgery of 3700 grafts with Dr. Hasson.

Now, I've seen 3 different doctors, which means, 3 different (or at least variations thereof) closure techniques, and other assorted variables.

One could also argue that I became more and more used to the pain over time and by the third surgery, I was used to coping with it knowing exactly what to expect.

Interesting discussion...

Falc