Should I go for a touch up to add density?

[Wolfy19]

What to do next?

Dear all,

I had 1450 grafts transplanted in the past and last year I went for another transplant of 1500 grafts. This time while on medication and doing proper research.
The hairline clearly shows a lower density compared to the rest of the head. After having 2950 grafts transplanted in total all on the hairline I am hesitant to go
for another transplant. What is your advice? If I should go for another one to fix this density issue how many more grafts do I need?
Also, is it possible that a hair transplant procedure can hurt native hairs even while you are on medication?

I have added some photos. Thank you!

 

[Norwoody]

Yes, you definitely need to get this fixed.

 

[spring15]

If it's bothering you then yes. I personally think some more density could be added to your hair line

 

[Selb]

I would up the density there yeah.. maybe try microneedling/using min to induce more growth?

 

[Wolf Pack]

That's a failed transplant, sorry to say, yes you have really fine hair but it's clear most of the grafts didn't grow since you had 3k. It should not be see through in all conditions like this, even without the before picture I think it's easy to figure where the surgery was so this is pretty poor one unfortunately. Who did you go to if you don't mind me asking? Sometimes it's due to the Dr/techs but other times your own physiology. Age can play a role but you look young enough, your forehead skin tightness may have limited growth though.

The incisions look natural enough but that is also a poorly designed hairline too for 3k grafts, looks artificial. You have a very high forehead and normally they tend to give arched hairlines with a slightly lower centre point and build the temples, looks way more natural. Best to see another surgeon and try your luck there but be aware of wasting more grafts and potential donor scarring/balding issues too. How many cms is it from the centre of your hairline to between your eyebrows? I made a thread where I collated information on hairline design, maybe look into it so you are better advised.

 

[follicle2001]

I am going to be the outlier here and tell you to wait. It does not look at all like a failed hair transplant to me.

 

[DoctorHouse]

That's a failed transplant, sorry to say, yes you have really fine hair but it's clear most of the grafts didn't grow since you had 3k. It should not be see through in all conditions like this, even without the before picture I think it's easy to figure where the surgery was so this is pretty poor one unfortunately. Who did you go to if you don't mind me asking? Sometimes it's due to the Dr/techs but other times your own physiology. Age can play a role but you look young enough, your forehead skin tightness may have limited growth though.

The incisions look natural enough but that is also a poorly designed hairline too for 3k grafts, looks artificial. You have a very high forehead and normally they tend to give arched hairlines with a slightly lower centre point and build the temples, looks way more natural. Best to see another surgeon and try your luck there but be aware of wasting more grafts and potential donor scarring/balding issues too. How many cms is it from the centre of your hairline to between your eyebrows? I made a thread where I collated information on hairline design, maybe look into it so you are better advised.

I think he should consult with Dr Blake Bloxham as he seems to do well with cases like these. I would be totally devastated if my result look like his.

 

[Wolfy19]

That's a failed transplant, sorry to say, yes you have really fine hair but it's clear most of the grafts didn't grow since you had 3k. It should not be see through in all conditions like this, even without the before picture I think it's easy to figure where the surgery was so this is pretty poor one unfortunately. Who did you go to if you don't mind me asking? Sometimes it's due to the Dr/techs but other times your own physiology. Age can play a role but you look young enough, your forehead skin tightness may have limited growth though.

The incisions look natural enough but that is also a poorly designed hairline too for 3k grafts, looks artificial. You have a very high forehead and normally they tend to give arched hairlines with a slightly lower centre point and build the temples, looks way more natural. Best to see another surgeon and try your luck there but be aware of wasting more grafts and potential donor scarring/balding issues too. How many cms is it from the centre of your hairline to between your eyebrows? I made a thread where I collated information on hairline design, maybe look into it so you are better advised.

Thanks for the reply. I appreciate it. I do want to specify that the first hair transplant was done almost 6 years ago. I was not on medication back then and was too careful after the procedure which led to scabs sitting around for too long after the transplant. Two possible reasons why the first attempt did not really succeed. Also, the native hairs most likely kept thinning out.

Last year I got a transplant after being on medication for more than 2 years which led to a stable situation. So I guess in some way it created a new situation and from then on I got the 1500 graft hair transplant last year. The main reason to get another hair transplant was to lower the hairline just a little and thicken it. I specifically wanted to give that another try and was more confident about a positive outcome since the first time I was not on medication and I learned a couple or two things from my first experience.

Right now, I am thankful for the hair I have and I can style it in a way that the lack of density is not visible but yes I obviously did the procedure so that I could also style it in a way that I would not have to hide the hairline at all. Though the lighting in the photo might emphasize the difference it is clear that it is not a result that I was hoping for and that surely is disappointing.

This time though, the post hair transplant process went exactly the way it should go so I am just really wondering what the problem is. Obviously, I do not know what happened during the actual transplantation procedure but I would assume that the surgeon did what he had to do in the best way possible way. I do notice quite a few thin hairs that seem to not have gain strengtht. All of this together though makes me, at least right now, not really wanting to go for another hair transplant in the near future. Especially if the estimation, no idea about that yet, would be that again 1500 or more grafts would be needed to create a satisfying result.

It is between 6.5cm to 7cm from the hairline to between my eyebrows. The height of the hairline is actually completely fine with me. It looks higher on photos than in the mirror. I do get your point when you talk about the different possible hairline shapes. Again, the hairline itself would be absolutely fine if it just had more density.

Will have to check out your thread.

 

[Wolfy19]

I think he should consult with Dr Blake Bloxham as he seems to do well with cases like these. I would be totally devastated if my result look like his.

I have seen several videos that showed really good results done by them indeed. They seem to specialize on repair work.

 

[Wolfy19]

I am going to be the outlier here and tell you to wait. It does not look at all like a failed hair transplant to me.

I appreciate the response. I also do not want to rush into making any decisions. I am curious though as to why you do not consider it a failed hair transplant?

 

[trialAcc]

I appreciate the response. I also do not want to rush into making any decisions. I am curious though as to why you do not consider it a failed hair transplant?

I wouldn't listen to him and instead consult some of the best surgeons because you probably only have 1 more shot at this. Granted you showed us a less forgiving angle and light, but 3k grafts in the hands of one of the top doctors would look like the photo below.

Also, regardless of medication your grafts would not have disappeared that quickly even if you had an FUE. I doubt many of your original 1500 grew.

 

[Wolf Pack]

Thanks for the reply. I appreciate it. I do want to specify that the first hair transplant was done almost 6 years ago. I was not on medication back then and was too careful after the procedure which led to scabs sitting around for too long after the transplant. Two possible reasons why the first attempt did not really succeed. Also, the native hairs most likely kept thinning out.

Last year I got a transplant after being on medication for more than 2 years which led to a stable situation. So I guess in some way it created a new situation and from then on I got the 1500 graft hair transplant last year. The main reason to get another hair transplant was to lower the hairline just a little and thicken it. I specifically wanted to give that another try and was more confident about a positive outcome since the first time I was not on medication and I learned a couple or two things from my first experience.

Right now, I am thankful for the hair I have and I can style it in a way that the lack of density is not visible but yes I obviously did the procedure so that I could also style it in a way that I would not have to hide the hairline at all. Though the lighting in the photo might emphasize the difference it is clear that it is not a result that I was hoping for and that surely is disappointing.

This time though, the post hair transplant process went exactly the way it should go so I am just really wondering what the problem is. Obviously, I do not know what happened during the actual transplantation procedure but I would assume that the surgeon did what he had to do in the best way possible way. I do notice quite a few thin hairs that seem to not have gain strengtht. All of this together though makes me, at least right now, not really wanting to go for another hair transplant in the near future. Especially if the estimation, no idea about that yet, would be that again 1500 or more grafts would be needed to create a satisfying result.

It is between 6.5cm to 7cm from the hairline to between my eyebrows. The height of the hairline is actually completely fine with me. It looks higher on photos than in the mirror. I do get your point when you talk about the different possible hairline shapes. Again, the hairline itself would be absolutely fine if it just had more density.

Will have to check out your thread.

So your forehead size is normal enough for you but the reason it looks large is because it is protruded in shape and also no temple peaks at all. That said, I don't think the size is a problem (like you wrote too), but density. The hairline shape is off and doesn't complement you. I'll link a few good transplants with a big forehead and fine hair, which is what a top surgeon should aim for you with you. You can see some of Beesanga's and Rahal's work and a few random ones I've linked in with a quick search. I had barely 2000 grafts and while I have thick hair which would be like 4k grafts on someone with fine hair, yours is still below par for thin hair calibre. Medication shouldn't impact the implant area as such, rather preserve the native hair behind it, the grafts didn't grow, simple as that. That said the medications will help you preserve all your hair everywhere long term.

Did you go to the same Dr twice? Also you didn't name him unless I missed something (reading quickly), fair enough. Try to look for someone who specalises in such repair work and also bear in mind will you have adequate donor in future. Because the area you need working on your hairline is another 2k grafts as it's still large which means 5k grafts just in your hairline...so imagine you get hair loss behind and your donor capacity is limited. Also will you be okay with FUT in the future etc. You don't want to end up with a balding crown and midscalp with a pluggy type of hairline. So I think you need to ask the guy the right questions. Sometimes it's best to leave things as they are, maybe go for something conservative and say to him to only deal with the first 1cm of the hairline - this will drastically reduce the grafts you need and you can slick it over the thinner area behind it and preserve grafts. Ideally you need a central peak area to your hairline but I think he may just put a slight widow's peak to make it look natural as you have bigger problems. Also you need to determine if the failure is something to do with your scalp fibrosis/blood supply/underlying health problems.

Just realised I can't attach images...just google fine hair and high foreheads and you'll get a good idea. Very natural below.

 

[global]

You'll never get the same density from a transplant as your natural hair and combing it back will only accentuate that. Also doing it in two goes (and now possibly a third) is never going to be as good as doing it properly the first time as implanting between existing hairs is more difficult and growth from second surgeries into the same area tends not to be as good due to the scarring caused by the previous procedure.

Having said that if they only implanted in your hairline as you say then for 2950 grafts it isn't a good result. 3000 grafts should be enough to give good coverage over nearly the entire front third of the head. Are you certain they really implanted that number? Not implanting the number of grafts you actually pay for is rife in the hair transplant industry.

You could go for a third procedure if it bothers you but now you also have to think about your donor supply because it isn't unlimited and you'll now be using even more of it up on just the hairline when you might need that hair in the future to cover further back if your loss continues. You look young in your photos so this is a real possibility.

If you do decide to go for the third procedure don't go cheap, go for someone proven, otherwise you could just end up in the same boat again.