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The Story of a 3,000 Graft FUE Procedure Failure

Story time! Although I can’t provide photos (by patient request), I’ll do my best to paint the picture…

A man in his early 20’s flew to Los Angeles from Alaska to see me last month. He already had two hair transplant procedures using the follicular unit extraction (FUE) technique — one surgery of 1,000 grafts, and another of 3,000 grafts — by two different doctors (that I won’t name) who each claim expertise in this process. The 1,000 FUE case by the patient’s estimate was about 50% successful, while the 3,000 FUE case had, according to the patient, no growth after a year. The donor area was heavily scarred from the FUE extractions and were easily seen by lifting up the hair. A strip procedure would have produced less scarring than this patient showed now. To compound the problem, those hairs that did grow from the first surgery were placed in a radial direction (like the spokes of a bicycle wheel) and the hair pointed to the sides, not the normal frontal position. So not only was he dealing with a huge failure of growth, but now he had to deal with poor placement for those grafts that did grow! Imagine a person with hair growing out of his head like the spokes of a bike?

This patient most certainly had a low donor density to start. I recommended a strip surgery to harvest the most grafts he can get and with the reduced donor density, I recommended about 1,300 grafts, which is possibly the most I can harvest. Fortunately, his hair loss was only in the first 1 1/2 inches of the hairline and by taking Propecia he might hold the rest of his hair in place, although there is miniaturization behind the frontal 2 inches, suggesting that he might bald further over time. He wanted to look normal, but I could only suggest that I would try to make him look better.

FUE is not a panacea for scars. As I have said here before, the follicular holocaust that is seen in FUE is substantial, even in the hands of those who claim success. This is a buyer beware market. You should always ask to see a number of patients who had the procedure and look carefully at the donor area. Another FUE procedure on this patient will be disastrous (even in my hands), as scarring is clearly a problem.


2009-01-12 16:34:26The Story of a 3,000 Graft FUE Procedure Failure

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Good view of miniaturized hairs by zooming in on a good photo

Note the thick hairs and the many very tiny and thin hairs throughout the viewing field. This is full blown miniaturiation which is best treated with finasteride in hope the miniaturization will reverse. This is more probable in men in their teens or early 2os. Take such a picture on you to see where you stand.


2019-08-09 11:51:41Good view of miniaturized hairs by zooming in on a good photo

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Grafts in recipient area not placed flush with the skin

Some people have complained about cobblestonning or irregularities of the skin in the recipient area after a hair transplant. This is an example of a technique used frequently, where the doctor’s team left the grafts stick out of the skin. When it heals, sometimes the skin edge of the graft heals elevated from the surface of the scalp and this is what many patients complain about. See picture of patient 9 days after a hair transplant and you can see that the grafts are all sticking out of the scalp and it is not cosmetically pleasing. Also for comparison, take a look at one of our patients compared side by side also 9 days after surgery with dense packing of the grafts but as you can see from the photo on the right, the two patients are night and day for comparison. I am showing this because you should demand this type of post operative appearance because you have to be social and can’t look like a freak like the guy on the left.


2020-08-15 08:31:41Grafts in recipient area not placed flush with the skin

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Great results from taking finasteride and minoxidil (photo)

They say than pictures are worth 1000 words, Great results from using finasteride and minoxidil in combination. If he would have been transplanted, the hairline would be lower, halfway between were it is and the highest crease of his furrowed brow which he nicely shows.


2019-03-26 08:17:16Great results from taking finasteride and minoxidil (photo)

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Thinning Hair in 16 Year Old

hi. i’m only 16 and for a year my hairs been thinning and scalp showing. i usually grow it out very long then shave it. now its shaved and once in a while theres mini hairs no more than 5 millimeters long here and there. i was also on a lot of steroids like protopic and hydro-cortisone for my eczema.

You steroids could be responsible for thinning. You need to discuss this with your doctor. There’s not much more I can offer without knowing more of your history and examining your scalp.

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Gynecomastia from Saw Palmetto?

Hi Doctor,

Thanks in advance for reading.

I have a pretty important question that I would love to receive feedback on. I’ve been on rogaine for about 5 to 7 years and I do believe it has helped maintain my hair; but unfortunately, it has not been up to the task of keeping it 100% stable. Due to my thinning, about a year ago, I decided it’s time to consider propecia. I’m in my 30s.

For various reasons (my wife was prego), I decided for about a year on propecia and try natural supplements first and other topicals first. So, I purchased a specific type of shampoo (I’m drawing a blank on the name) and soy isoflavones. I took those for about one or two months and stopped because my sister (who’s had breast cancer) told me excess soy can cause cancer.

At that point, I heard good things about saw palmetto. So, I bought a bottle of saw palmetto. I took this for roughly 3 or 4 months, although I gained some weight and had normal decline in libido (watery semen)… this really did seem to make my hair thicker. I don’t remember the dosage. But, it was purchased at a pharmacy.

At about month 4, I noticed a swelling on one side of my chest. I got it checked out mammogram, and they said it was unilateral gynecomastia. I quickly stopped the saw palmetto usage.

So, it’s now 8 months later and my hair is still thinning. My chest is now improving to the point it’s no longer really noticeable, other sides are reversing too. I’m considering waiting a few more months to see if it returns 100% back to normal completely, and considering propecia again at that point.

Am I crazy for doing so? What would you recommend?

Thanks

It seems you are self-treating and experimenting without a clear focus and understanding of what is going on. I realize saw palmetto is available over the counter, but there is still side effect potential that people tend to ignore.

I am really not in a place to recommend a specific treatment plan for you, as I don’t know enough about your hair loss history and I’m not your doctor. I would recommend you see a doctor for your hair loss issues and discuss your concerns. Together, you can come up with a Master Plan.

Although I have no direct experience with saw palmetto, I would not be surprised that breast enlargement could occur on rare occasions. I must point out that one of the rare side effects of Propecia is gynecomastia and if you switched to that, you may also have the same problem.


2010-09-02 09:10:29Gynecomastia from Saw Palmetto?

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Hair at Age 10, Blonde Hairs on Temples Are Gone Now at Age 20 (Photo)

You need to see an expert doctor like me, who can do a HAIR CHECK test (https://baldingblog.com/haircheck-test-how-it-is-done-video/) on you to determine if you are going to go bald. This is a lot of recession in someone 20 years of age. Who do you take after in your family line? Blondes are the BEST candidates for hair transplants, but at your age, I would be hesitant to recommend it. You should absolutely be on the drug finasteride if you want to keep your hair. I find that blondes are the best hair transplant candidates because of the low contrast between hair and skin color. If hair is important to you, you will look at my comments seriously.


2019-09-12 12:25:49Hair at Age 10, Blonde Hairs on Temples Are Gone Now at Age 20 (Photo)