Hair transplant disappointing, need your opinion

Hello Dr. Rassman, I need your opinion on my situation. I’m just looking for an informal opinion.

I received a 2900 graft transplant for my nw 3 last year to rebuild my hairline/temples and strengthen my temple points. I went to a prominent surgeon in Europe. I have very thick/coarse hair with a 2.81 hair per graft ratio. My average hair thickness is 61 microns.

My result turned out ok. I got good coverage but was expecting more in terms of density due to my hair characteristics.

I consulted with my surgeon at the end of one year and he noticed that a good portion of multi haired 3,4, and some 5 hair grafts had only 2 hairs and some 3. He thinks my yield is fine (85-90%) however. He suspects there was trauma either during extraction or implantation when using an implanter pen. The first surgery utilized a .9mm manual punch which he says it typically the biggest he uses. His plan is to do a touch up and increase both the punch size to a .95mm and increase the size of the implanter pen. He will also use pre made incisions for the large 5 hair grafts.

I asked if the trauma could be spotted during graft inspection since they are evaluated under magnification. He said no as the trauma is likely on the root sheath and that can’t be seen.

My questions are:

1. Do you think this is a good plan moving forward to achieve better density? I know no surgery is risk free
2. Do you think the trauma explanation regarding the root sheath is feasible?

Thanks for your time

Your doctors sounds like he understands the problem. Small punches can be a problem but with a 61 micron hair thickness, that is an average hair weight, which should not have been a problem. The high hair count per Follicular unit could have produced damage during excision as he suggested. It is good that he is sticking with you and doing what is right to make you happy!  That is a class act.