SkinUpPinUp

My words feel so trivial and small at a time like this. But, for what it is worth, she is in our hearts and minds and we wish her all the best.

Please also ensure that you and all the people affected by it also look after yourselves.

Considering what has just happened on another thread with another surgeon, I don't want to stoke the fires of mistrust but there's something here that makes me feel...deeply uncomfortable. In essence: alarm bells are ringing.

Firstly, we have what is clearly an underwhelming result with some interesting reactions from Transmed. Just looking back at the thread, I cannot help but see some very curious occurrences

1. The procedure itself - the graft placements themselves look pretty sparse and far apart. But then, we're talking 2,900 grafts for a patient clearly headed towards a Norwood VI. With a relatively small graft count, trying to gain any sort of coverage - even with concealer - on that level of hairloss is unlikely.
   With such a modest graft count over such a large area - how could this have turned out as anything but underwhelming? This either wasn't properly thought out by the surgeon or communicated properly to the patient.
    
   
2. Dr Melike Kaluhci considering it a "success". Again, this makes me think she had a very low density plan in the first place and, by that assertion, this is a success. I just don't think that the patient was properly communicated with as to what the outcome was supposed to be. Also, the claim that there was a 90% yield rate, hence would only refund 10% of the operation cost. Without a proper hair density measurement and comparing it with the graft density measurement in the recipient area - how was this number reached?
    
   
3. The company comes on here to reply, but only after being encouraged by Bill.
    
   
4. In the post from Transmed, they admit that they have "not been successful" on a public forum. This is in direct contradiction to what was said to the patient on a one-to-one basis (see point 2). Why the change of mind?
    
   
5. In the reply, they publish the full face and name of Albion. Ironically, in the very same post they said they value patient privacy! This, in particular, troubles me as I remember a particularly notorious surgeon doing this sort of thing many years ago to unhappy patients who went public.
   

Now, let me just stress that I do not have an agenda and am not here to troll - I am just trying to call things as I see them. I think that this is an excellent forum and we have some incredible coalition surgeons that post regularly here. Even the most abrasive surgeons (and you all know who I am talking about) at the very least have some damn good - and consistent - results to back them up. So politics aside, the coalition has many great surgeons, Dr Melike Kaluhci, however...(deep breath)...I don't believe is one of them.

Albion71, do what you will here with regards to going back for revision. However, with a finite number of strips and donor hair, I would think very, very carefully before committing, no matter how discounted the rate. There are plenty of other great surgeons in the coalition, you may want to consult and getting an honest and off-the-record appraisal with them before making any further moves.

On a pure maths side of things, were you ever told what density to expect (hairs per cm/2)? If so, where are you now?

Anyway, whatever you do, I wish you the best of luck.

Bill - no offence intended here, mate. I do not mean to ruffle feathers or upset stakeholders. However, I think we need to think about this patients' donor supply, bank balance and happiness - this must take precedence over everything else and to advise anything that is not entirely impartial would be doing this man an injustice.

Guys, if we keep squabbling amongst each other and playing HT surgeon Top Trumps, there will be a very valid reason to lock this thread which is completely counter-productive.

If we can keep things on-topic for the sake of the thread, please do. If this thread has now exhausted itself, let it fade out quietly and wish Jessie and Feller all the best in sorting this out.

I'm going to choose my words very carefully here as I don't think things are completely black and white.

Firstly, I think we must accept that Feller, as a HT surgeon is one of the best in world. His temple point work, in particular, has no equal in the industry as far as I am concerned. Also, that Spex is highly-regarded in the community (this and other forums) for his support and advise.

Secondly, we have to also accept that there are motives at play here, no matter how subtle. Feller wants to protect his reputation, Spex is usually supportive of Feller and the HRN forum mods generally want to keep paying clients (coalition surgeons) happy whilst protecting their own good name. I'm not suggesting corruption as it's really not that simple - this forum is an awesome resource, but there are motives at play here that prevent 100% impartiality from all parties.

With this in mind, I'll say this:

Jessie - it does indeed look to me like you've experienced some slight miniaturisation behind the transplanted area. This has nothing to do with the work of Feller or his technicians. I don't know the history of MPB in your family, but I would strongly suggest keeping on the finasteride. Hairloss is progressive and highly unpredictable and this is the unfortunate factor that we all have to deal with. Even with meds, it's likely that we'll all need more than one HT over time.

I hope you find a resolution one way or the other, no matter which surgeon to choose.

Dr Feller - I have an enormous amount of respect for your work - I may one day visit you myself, but I'd be careful with being quick to jump to potentially slanderous remarks. Jessie could be naive or genuinely feels he has a case to argue, but your accusations drift uncomfortably into personal territory. Whilst I admire your candour and refusal to use spin and PR tricks, I'd still suggest being careful with emotional patients as this could make things worse. At a time of distress, feeling like you're alone and being attacked by the only people you feel can understand you can be an awful lot to bear, especially for quite a young patient.

And whilst I agree that strip is generally superior to FUE in terms of yield, it would have been overkill on a Norwood 2 patient like this. Christ, you yourself have achieved some incredible results via FUE, so I don't think there's a need to discredit it here.

Bill - despite requests to lock or delete this thread I strongly suggest you do not, despite personal or professional inclinations to do so. Potential patients need to know as much as they can - good or bad - before opting on a surgeon and I think that for this reason, it needs to be allowed to breath and fade away - which it will - in time. The information here can be construed a number of ways and I think we should leave it to the wider community, and potential patients doing research, to decide. I think deleting or locking the thread may indirectly make matters worse.

It's always worth looking into the pharmaceutical company behind your medication, but companies like Cipla, Dr Reddy, Teva and Almus are all legitimate pharmaceutical companies.

Merck created and patented finasteride, own the Proscar and Propecia brands, nothing more. The actual compound itself is now free for anybody to manufacture and should be no less pure or potent if it comes from a different supplier.

Yep, your hair is fine but it's good that you're prepared to take pre-emptive measures to look after your hairline. I think your hairline has just matured slightly and you've become alarmed by the change - this is not the same thing as MPB, so no need to stress.

I don't think minoxidil is in any way appropriate for you at this stage as it is for hairloss and thinning at the top of the head and crown. It's not great for recession and any hair you gain will need to be treated with minoxidil for the rest of your life to retain it.

Finasteride is probably the best option, if any. This will help to ensure that you keep your existing hair without the need to keep slapping on daily solutions. However, since you are still young and your hairloss practically non-existent, it would probably be worth sticking to a low dose (e.g. 0.5mg per day) unless you notice further hair loss.

Considering the great reputation of Feller (if you're prepared for another long haul flight post-op), or the amount of quality surgeons in the EU (Bisanga, Farjo, Devroye, Feriduni), I see no reason to risk your donor supply and money on a Harley Street clinic.

Bear in mind that a lot of Harley Street clinics tend to be governed by cosmetic surgery chains (Transform, Harley Medical, MYA etc), so you're buying into the company - not the surgeon. Christ, I'll be surprised if you'll get to meet or even find out your surgeon before you get on the operating table.

There are one or two respected plastic surgeons at Harley St, but, to the best of my knowledge, not a single hair transplant surgeon who is ISHRS-certified and has a solid reputation.

Sodium Lauryl and Laureth Sulfate - whilst I wouldn't state unequivocally that it is bad for hair, it can be an irritant to the skin - in this case your scalp. There's also ongoing research as to whether they are also potential carcinogens.

There are also other ingredients like parabens, disodium EDTA, and sodium hydroxide that are commonly found in shampoos, conditioners and skin products. All of which can cause issues in some people.

I'm not suggesting that you go out of your way to avoid them if you're not experiencing any ill effects. I, however, have made the decision to look for gentle hair care and skin products as I also suffer from psoriasis. Up to you entirely.

There plenty of options if you're prepared to go out of your way. In the UK, for example, there is a brand called Dr Organics that avoid any harsh chemicals including parabens and SLS.

You can cross Farjo off your list completely - the Farjo clinic does not perform FUE.

Hi Aza,

I think it would be easier for everyone to judge graft count if you had slightly longer hair. If you do indeed have diffuse thinning on the top of the head, it is hidden by the fact that your hair is shaved down.

If you post some pictures of longer hair we can make a better assessment because, at this stage, you're looking like a Norwood 2/3 - which is why Bisanga may be reluctant to operate.

Also, bear in mind that H&W only do strip surgery. A scar on the back of the head for a N2/3 is overkill and you may regret it later.

Whilst geography shouldn't be an issue when choosing a surgeon, you have three very, very good surgeons in your country. Bisanga is great with FUE and Devroye and Feriduni both very good with FUT.

So yeah, no real reason to travel when you have some of the best surgeons on your very doorstep!

I would also agree with getting it done rather than waiting. If you have the capital and your hairline is bugging you, I'd just get it over and done with. The fact that it takes 12-18 months to get a final result means that the longer you wait, the more time it'll take for you to stop worrying about going out on windy days!

Whilst it's a given that general exercise and heavy lifting should be avoided post-op for about 2 weeks, I was wondering the same thing applies to meditative exercise like yoga or tai chi at home.

Considering there is no straining, exertion or heavy lifting involved, just peaceful and slow movements and stretching, would the same thing apply?

Just curious on what can be done to pass the time and keep yourself active while you are hiding from the world after surgery.

Any thoughts or experiences?

It may just be coincidence, it may not be, but since I started using Nizoral 1% about three months ago I've suffered from intermittent itching on my scalp.

I've looked at everything from shampoos or hair washing frequency but, considering I now only wash my hair once a day and with a non-SLS and non-paraben shampoo, and that I don't use minoxidil on my scalp, the only thing left that could possibly be causing it is the Nizoral.

Or headlice. But the missus checked my scalp for that and I'm fine.

So...has anyone else experienced this? I'm very tempted to pass on the Nizoral completely if this is a permanent side effect.

Looking good, mate. The journey begins here. It will be interesting to see how this progresses as it's certainly looking promising so far.

Also: massive hands.

Judging by the silence by both Trooper and Dr Feller on this, I'm guessing that they're in the process of sorting this out now.

Naturally, continued silence from both parties may look a bit suspect to the conspiracy watchers on the forum, so fingers-crossed we should get an update soon. This could even be educational to others dealing with less than optimal results that may need revision.

Let's wish them both the best of luck in getting this sorted out.

James, I can see where you're coming from here even if some people disagree.

My hairline is kind of similar to this and I'm having HT later this year - the difference is that I'm past the age of thirty. I'm also trying to address the combo of mild recession and a naturally large forehead.

What makes this difficult to judge is that your pictures hide the eyebrows, it's sometime hard to judge how high or recessed (frontally or temporally) without seeing the hairline in the context of your eyebrows or the rest of your face. It's also difficult to judge something like graft count when you've not specified where exactly you want your hairline to be restored to.

If you're thinking of Bisanga, have a chat with Stephen and perhaps he can give you a better idea of what can be achieved and whether it is wise to do so. However, bear in mind that most HT surgeons in the EU charge around ?5 per graft and surgeons there will rarely perform anything under 1,000 grafts as it is not cost effective when they're only seeing one patient a day. This is a lot of money, especially for someone at your age, so it should give you plenty to think about.

If you really want to retain your hair, there is no real way around it.

The only thing I can suggest is that you experiment with small doses of it and work up from there - you don't have to start with the full 1mg per day straight away, you can work up slowly. With this in mind, if you start having side effects that you're not happy with, you can cut back the dosage a bit or quite entirely if that's really what you think is the right decision.

I really don't think it's a case of first pill and BANG! NO ERECTION EVER AGAIN!

Just be sensible with it, be cautious, be safe and see how things go. For what it's worth, I've been using it for a year and my little guy is still alive and well.

I suppose reviewing the work done each month is more workable than a surgeon. The only problem is that rating a surgeon's results also risks offending the patient who has had work done.

The main problem with an award for HT surgeons is that most people on here that have had HTs will only have had them with one or two good surgeons. A person who has had an op with Feller can only really talk about his experiences with that surgeon, how can he or she really have an unbiased and subjective opinion about William Lindsay or Ron Shapiro, for example?

Still, we could do a forum Metacritic of each surgeons work!

That was a joke, by the way.

Cipla is also a legit source (Cipla - Global Presence) as are companies like Almus.

You're buying finasteride for the effect of the core chemical compound, not the brand name or manufacturer. Provided they're both legit manufacturers, there should be no difference whatsoever.

Whilst I've yet to go through the whole shedding and regrowth process myself, I am aware that - at six months - this is typical of the progress usually seen at this stage. This is also in no way a indication of the final result.

The only way is up from here, mate. Just enjoy life, try not to obsess, be patient and before you know it, you'll have a great result. Remember: the more you obsess over it, the longer it'll seem. Chin up, my friend.

SkinUpPinUp, Hope you got everything ok and are doing well.

 

Yep, everything came through within two days and am working on the fine art of pill cutting now.

Just sent you a PM. Good luck in your search.

Re: BAAPS. It's a shame that despite it being a good idea in practice - especially when you consider how many bad surgeons there are in the UK, it hardly equates to a full-on regulatory body and, unfortunately, is not a 100% guarantee that the surgeon will do a great job. With this in mind, I can understand why you'd want to give the UK a wide berth when it comes to further elective surgery.

I'm not sure if this helps but I know that Dr Bisanga (at the BHR Clinic in Belgium) has lots of practice in facial procedures (beard and eyebrow hair transplants). He's not a HRN coalition member, but he is very well respected here regardless.

The problem with the Farjo clinic is that, to the best of my knowledge, they only perform strip (FUT) surgery. This may be overkill when only a minor number of grafts will be needed to cover scarring.

Can I ask which UK surgeon performed your facelift? Was he BAAPS-registered?

So again, I've got those questions? Do you think arnica montana and magnesium are okay?

Also, should it really be a big deal taking 2mg of Fin per day for two weeks? I mean, it's not long term or anything...

Arnica is particularly popular among people who want to reduce their bruising post-surgery. Whilst HT might not incur bruising in the traditional sense, there will be discoloration of the scalp in the recipient area. Will it work? Possibly, and it's something I'll be considering myself when I have HT in June.

Magnesium - beyond including it in a multi-vitamin regime...no idea.

I personally wouldn't be playing with my fin dose as part of my recovery regime. Experimentation with vitamins, herbal and homeopathic supps is one thing; hormone-altering compounds with known side affects is another.

If you're desperate to alter the dose, you could always cut 5mg pills into quarters (so you get 1.25mg instead of 1mg) to give you a little bit of a increase. But yeah, doubling the dose of fin is not something I'd recommend myself. I'm no doctor, but - like whisky - I treat finasteride with restraint and respect to get the best out of it.

Two questions:

1. Why green tea over white tea? White tea has more antioxidants and tastes much nicer (or less awful!).

2. Are you also considering something like Bio-Oil (commonly used to improve the appearance of scars, stretch marks and dry skin) to rub into the recipient area after a couple of weeks to keep the area moisturised and help reduce discoloration?

Blimey, that's a lot of supps! Just remember to eat food though as well, yeah?

If you're itching for something else to add, I know of many who swear by bromelain to help with swelling and inflammation. Whereas ibuprofen is generally discouraged due its blood-thinning actions, bromelain should be fine. Something to consider to pre-empt the day two+ post-op swelling perhaps.

Best of luck, by the way. You certainly have a thoroughly gameplan set out, so more power to you.