Question about "two-session" surgery treatments?

[Midiman]

Hi,

I'm looking at having roughly 2500 grafts performed by either Shapiro (MN) or Keene (AZ) soon. I've researched H&W and Armani and their megasession options and prices. However, at 46, I'm concerned about shockloss and am wondering if a "dual session" treatment might actually be better for me? Can anyone offer their opinion on these? I know hair density is important but I don't want to overdue it the first time out!

Thanks

 

[Guest]

JonWB,

Well you sure are bringing up a very legitimate concern. How large will the recipient area be? Are you having the grafts implanted front to back or will they be confined to a smaller surface area? What Norwood class are you in at 46 years old and what is your family history for male pattern baldness? Are you on any hairloss meds?

The closer the recipient incisions are to each other, the more potential scalp trauma there is. Some surgeons like Dr. Shapiro utilize custom made blades that accomodate the exact size of the grafts dissected. You also want to ask both doctors which type of incisions they would be employing such as lateral slits.

In addition, the more natural hair there is in the recipient area, the more there is to potentially shock out. And especially so if the natural hair is also diffused and weak. The weakest hair typically does not come back if lost to shockloss.

So yes many patients choose to do their sessions on a smaller scale to minimize the trauma and resulting potential shockloss to their existing hair. I wish you the very best!

 

[Midiman]

Thanks gillenator...

How large will the recipient area be?

Not sure, I believe about 80cm

Are you having the grafts implanted front to back or will they be confined to a smaller surface area?

Mainly to the frontal half

What Norwood class are you in at 46 years old and what is your family history for male pattern baldness?

Class 4, not a lot of family male pattern baldness... my dad had a good deal of hair when he passed away

Are you on any hairloss meds?

Yes, Propecia... full dose until surgery, then probably .5mg afterwards

A date with Dr. Keene opened up so I went ahead and scheduled it. She suggested a 25-30 FU per cm2 transplant and I think I know why... I have a fair amount of natural hair still left on my frontal zone. Maybe she feels anything with more density would cause that hair to fall out quicker due to shock loss? I haven't discussed that with her though... holiday weekend slowed communication a bit. I'd like to transplant more, but maybe this is a better option right now?

Thanks again!

 

[Guest]

You're welcome JonWB. Dr. Keene is a good doctor with good ethics. I would bet anything that she is indeed thinking in terms of minimizing shockloss and also to allow you to get as much use out of the natural hair you still have left. You're in good hands. :wink:

 

[CCS]

Dr. Keene is the best in the US if not the world

You are in very good hands. I had two procedures with her. You will not be able to find the scar on the back of your head 4-5 months after the procedure. I had a 1300 graft procedure and a 1900 graft procedure. The 1300 graft procedure was much more less uncomfortable. The area will be pink for a few months after the procedure, and hairs near the donor strip may go into shock and fall out temporarily, making it look like there is a big scar back there, but you will clearly see the pores and know it is not a scar. In 4-5 months the area will fill back in. Do not tilt your head down for 6 months. You can get away with it a little, but you need to minimize the tension back there to have the smallest scar possible. I don't know of any other doctors who use 19 inch computer monitor screens to view the donor strip, or only take out a little at a time. If you go to bosley or a $3 place you will pay with your scar.

She is right about not going over 30. Not only would there be shock to existing hairs, you could kill donor hairs as well unless they are very fine. Dr. Keene does not adise going in between existing hairs. Neither do I. You can grown all those out. Read my topical dutasteride posts. It will be 6 months before the hairs grow out fully and a year before they reach full thinkness. This is similar to drug regrowth time frames if you respond well. Definitely fill in the empty scalp with 30/cm2, and maybe let her do 12 or 15 in the other areas if you really want, but don't push it on her.

You also should start thinking about what hair line you want. The one she suggests will make you look better than you currently look, but I did not like the one she suggested for me. I drew mine myself and she filled it in where I specified. Had I not done my research, I might not have known what would look best. If you are going to pay all this money and want every edge possible getting women, you need to pick the very best hairline for you, and not just take one that looks better than what you have. If you don't have much donor hair or have a lot of area to fill, your options will be more limited. Doctors are much more skilled at doing mature hairlines because that is what most guys who can afford hair transplants get. For a NW3 like myself trying to be a NW1, the doctors are not quite as skilled. She seemed confident when she drew the line, and maybe she was right, but I'm VERY happy with were I drew it. I just need to lower it a milimeter or two in corners on my next visit.

 

[CCS]

and stay at 1mg/day untill at least a few months after surgery, and use minoxidil starting 1 week after surgery. use it now too, but not 3 weeks before surgery. She'll repeat that to you.

 

[Midiman]

Well thanks for the advice and comments. Less than 10 days now...

Jon

 

[Midiman]

Hi guys... Finished the surgery with Dr. Keene last week and everything went great! A couple of questions please...

At 7 days (using lots of saline), I don't seem to be forming any scabs. Do these ALWAYS form or with this density level (25-30), might I avoid them all together?
Also, my suture removal needs to be done this week. Do I have to contact a specialized physician for this or can my regular doctor snip them out?

Thanks!

 

[CCS]

anyone can snip them out. what is cheaper, travelling to dr keen to do it for free, or paying another Doctor to do it. I could be wrong, though. just ask her. she is not making extra money by removing them, but might want to see what it looks like.

as for the saline, that is normal. i forgot to mention that in my previus posts. the scabs in back will start to fall off, and you can help the loose ones carefully, but don't force any. if you feel anything wet, you know you forced a good one. picking scabs is bad. the more you keep your nose up these next few months, the less tension on your sutures, and the smaller the scar, not that i know from experience since all of mine have been small except the one bosley gave me.

get off your pain meds if you have not already. you might feel as much discomfort as a head ache, but it is good to feel a little pain back there so you know when you are putting tension on it.

 

[Guest]

Technically speaking, those formations at the very tip of the grafts are in fact dried up tissue above the scalp line. There can be a liitle dried blood there but really, it's dried up tissue that we call crusts. So the saline is really facilitating the healing process and in the next several days, those tiny crusts should start coming off. As CCS pointed out, don't force them off. Usually after 10 or 12 days or so post-op, you can start gently rubbing them off your scalp when you shampoo and they should rinse right out.

Glad to hear all went well!

 

[Midiman]

Great!... thanks for the explanation. I can see what you're talking about now. I guess I expected larger scabs. My local doctor will remove the suture on Wednesday. Never having had a major surgery, I wasn't sure who'd be qualified to do it. Can't wait for that! I've also started some MSM supplements just to help things along.

Thanks for the help... and gillenator, the post comment

 

[Guest]

You're welcome JonWB and just think, the growth will be coming soon! :hairy:

Removal of sutures is a cake walk. I have done many of them over the years and I don't charge anyone anything for it either. That way they can keep their anominity.

I simply wet the area by spraying saline and let it set for 10 minutes. That softens the tissue and thread. Then I use a small sterile scizzors to snip the knots and begin to pull the thread through using small forceps working from one side to the other. I can remove the entire thread in one piece that way. Then I wipe the area well with alchohol prep pads and you're good to go.

Wetting the area before removal and waiting for several minutes really helps eliminate the sting when they come out! :wink:

 

[Guest]

JWB, forgot to ask you, any swelling in the forehead? Are you using ice?

 

[Midiman]

JWB, forgot to ask you, any swelling in the forehead? Are you using ice?

No swelling at all... I took the prescribed steroid for three days after the procedure and have kept my head elevated for the past seven nights of sleep. I had some tightness at the back of my head at first and iced that for a while but now I hardly feel it. The suture seems very flat against my head now.

BTW, my doctor is charging the minimal office fee... $50. Not bad considering the way I'm gonna feel afterwards!

Jon

 

[CCS]

wow,

I had swelling down to my eyes. no steroids. and myscabs in the suture area made it not flat. it is pretty flat now, but I can feel a tiney ridge that went away in 5 months last time. my surgeon did not use the saline. It hurt a bit, like getting a shot, but was OK. the surgeon did not use a thread, but a single fillament that felt like solid plastic. i read that is the best for preventing scaring, though the saline sounds like a good idea. of course the patient can soak his head before getting there if he wants. no need for the doctor to do it.

 

[Midiman]

Damn, sorry about your swelling CCS! Not sure it made a difference but Dr. Keene used a tri-closure suture. And yes, I plan on bringing my own saline tomorrow!

 

[Guest]

Thread is just a loosely used term like suture. From a technical standpoint, you are absolutely correct and I'm sure you are also aware of staples that are sometimes used to prevent stretching.

 

[CCS]

i did go to Dr Keene. Twice. I selled every time I had a transplant, though it was a bit less with her than with bosley, and much less when i had my second procedure with her, which was only 1300 grafts. when did she give you the steroids? i just got pain meds. she told me that swelling can't be prevented and is part of the natural healing process, but that ice and sleeping on an incline help a lot.

 

[Midiman]

The steroid (prednisone) was part of my meds. Only six... two a day. Maybe she only recently started including those? I asked my wife if she noticed any swelling to my face after the procedure and she said 'no'. I guess I was lucky. Got the suture out this morning... aah relief!!!