Opinions please! Dr Turan second op 3.5k grafts update 5 months

[MaximumMM]

Hi all, 

A bit of an update here, and I'd really welcome opinions, especially on the possibility of addressing my area of concern.

I'm now nearly 5 months out from my second procedure with Dr Turan.

I'm pretty happy with how the first transplant has grown in, and the second one seems to be coming along. It's hard to tell, as it was mostly in the mid scalp and the crown. 

I had 4.4k grafts first time around, and 3.5k this time, including 500 beard as I've mostly exhausted my donor and am coming from a Norwood 6.

The one major caveat is that I have kept my hair very short throughout both procedures. The plan has always been to grow it out after the second procedure has grown in, as per my previous update: https://www.hairrestorationnetwork.com/topic/70857-dr-turan-44k-grafts-7-months-update-and-opinions/#comment-747285. I just prefer it that way. So that does make it a bit harder to judge!

It's still a bit sparse on top, but I hope there should be more to come. 

My main annoyance is the patch at the back which didn't get any grafts. I checked a few times before and during whether I would have enough grafts to get full coverage, and was told definitely yes. I also emphasised that I was willing to sacrifice some density in the front and mid in order not to leave any glaring bald patches. So I was surprised to see that patch completely untouched. I was also surprised that such a large proportion of my grafts (over half) were placed in the mid-scalp. The pre-op plan and graphic agreed stated that all grafts would be going to the crown. So again, I was surprised. I felt my pre-op coverage in the mid-scalp was ok and I could have used more grafts in the crown. Maybe I'm wrong though.

I queried both things, but it was very difficult to get a straight answer afterwards via the clinic. They eventually said that the bald patch was part of the 'donor' area, and that restricted blood flow means the lower crown (the part not touched on me) is 'very rarely' implanted. That's not something I've ever heard before, and it doesn't make immediate sense to me, so I was skeptical. I'm aware that blood flow in the crown is restricted generally, but is it really so much worse in the lower crown that surgeons don't touch it? I'm skeptical, but I'd love to know if anyone else can shed any light on this? 

I do appreciate the Dr has a balance to strike in prioritising the preference of the patient and using their own professional experience and judgement in placing grafts. But like I say, this was all very poorly communicated before and after, so I was disappointed, not to mention I was hoping to walk out with all areas covered to a greater or lesser degree. 

Anyway, I'm hoping that once it grows out I can cover that area. As I say I'm quite positive overall. I'm also weighing up whether to use my remaining 500-750 grafts on that patch, as it bugs me.

Any thoughts on any of it gratefully received! 

I've included pictures of my hair pre second op, post first op (so you can see where the grafts were), post second op, and now.

 

 

 

 

 

Edited September 11 by MaximumMM

[Gramatik]

It looks good so far. Donor looks homogenized too. I think you still have some grafts available in your donor.

[MaximumMM]

43 minutes ago, Gramatik said:

It looks good so far. Donor looks homogenized too. I think you still have some grafts available in your donor.

Thanks! Any view on the untouched area and the possibility of putting grafts there?

Edited September 11 by MaximumMM

[Ccd99]

1 hour ago, MaximumMM said:

Thanks! Any view on the untouched area and the possibility of putting grafts there?

The area below the crown is part of the donor but typically considered an unsafe zone subject to further hair loss. Most NW6/NW7 patients have some thinning in this area. I have it too but it's not as visible as yours. If you grow your hair longer there is a good chance it will be covered to the point it does not bother you - that is the case for me when it is longer (you can see my thread in the signature below to see what I mean).

I suppose some Dr's are not comfortable transplanting here as the area could lose hair further, and you could subject it it permanent shock loss due to trauma etc. Maybe once it's all grown in you can considering doing some SMP in that area to camouflage?

 

[MaximumMM]

20 minutes ago, Ccd99 said:

The area below the crown is part of the donor but typically considered an unsafe zone subject to further hair loss. Most NW6/NW7 patients have some thinning in this area. I have it too but it's not as visible as yours. If you grow your hair longer there is a good chance it will be covered to the point it does not bother you - that is the case for me when it is longer (you can see my thread in the signature below to see what I mean).

I suppose some Dr's are not comfortable transplanting here as the area could lose hair further, and you could subject it it permanent shock loss due to trauma etc. Maybe once it's all grown in you can considering doing some SMP in that area to camouflage?

 

Thanks for the response. Yeah I figure maybe once it's grown out it may be ok. And SMP is a good option. I actually already have SMP on the top. 

I don't quite understand why the fear of further loss in that area would stop a Dr implanting there though? 

 

Surely that's applicable to all areas of the scalp? So long as the hair being implanted is from a safe, DHT low zone, it shouldn't really make a difference as far as I can see. Maybe I'm missing something though.

My understanding is that safe and unsafe zones relate more to extraction rather than implantation?

Edited September 11 by MaximumMM

[MaximumMM]

Any other opinions, especially on whether it makes sense to get a further transplant, and whether anyone can tell how many grafts I might have left, would be really appreciated!

[Matthias]

The number of grafts you have left depends on the skill of the surgeon (e. g. Zarev is very good in donor management). I see great potential left given that you have a buzzcut.

[MaximumMM]

44 minutes ago, Matthias said:

The number of grafts you have left depends on the skill of the surgeon (e. g. Zarev is very good in donor management). I see great potential left given that you have a buzzcut.

Thanks. Do you mean great potential for further growth, given that I have a buzzcut?

[Matthias]

30 minutes ago, MaximumMM said:

Thanks. Do you mean great potential for further growth, given that I have a buzzcut?

I think with the right surgeon you can harvest a couple more grafts from your donor which still gives a healthy appearance with a buzzcut. Also naturally, you will have more FUT grafts left than FUE grafts.

[MaximumMM]

53 minutes ago, Matthias said:

I think with the right surgeon you can harvest a couple more grafts from your donor which still gives a healthy appearance with a buzzcut. Also naturally, you will have more FUT grafts left than FUE grafts.

Right. I'm not necessarily intending to keep it as a buzzcut, I've been doing that as an interim measure. I'm intending to grow it longer and see how I feel about it. Hopefully it should look fuller once longer.

[Al - Moderator]

It could be that the SMP you had was making it hard for them to determine how bad that crown area was where they didn't transplant anything. With your hair growing out it is much more obvious, but with the SMP it looked OK (See below). Did you say you were on meds? I don't remember. Some Drs would rather not transplant in that lower crown area if you've started on meds because that is usually where you will get the best regrowth from meds, so they tend to hope the meds work in that area, so they can concentrate on filling in other areas. Eugenix has that philosophy, but it's been a hit or miss from what I've seen. Sometimes it works out and sometimes it doesn't. The good news is you can always add a few grafts into the area.

 

Looks OK with a shaved head and SMP, but much more noticeable once the hair around it grows.

 

 

[MaximumMM]

33 minutes ago, Al - Moderator said:

It could be that the SMP you had was making it hard for them to determine how bad that crown area was where they didn't transplant anything. With your hair growing out it is much more obvious, but with the SMP it looked OK (See below). Did you say you were on meds? I don't remember. Some Drs would rather not transplant in that lower crown area if you've started on meds because that is usually where you will get the best regrowth from meds, so they tend to hope the meds work in that area, so they can concentrate on filling in other areas. Eugenix has that philosophy, but it's been a hit or miss from what I've seen. Sometimes it works out and sometimes it doesn't. The good news is you can always add a few grafts into the area.

 

Looks OK with a shaved head and SMP, but much more noticeable once the hair around it grows.

 

 

Thanks. I think it's highly unlikely they didn't notice there wasn't hair there. It's pretty apparent even with shaved hair from the picture. Maybe the meds reason, but they didn't cite that, just that 'it's very rarely done and difficult to implant there.

Sounds like you think that's not necessarily the case?

I hope it will be less visible with longer hair falling over it.

[romeo_gent]

Nothing much to offer, but may I say that your hair looks good and will only get better once you have your growth from the second ops. I do feel what you experience is more of a planning and communications gap that Doctor could have done it better. All the best!!