Jamind

I have been recommended at least 1600 FUs to fill-in the HT areas by Dr. Pathomvanich's assistant. I also hope to bring the hairline slightly forward and strengthen it, so this figure might rise. Since this recommendation was based only on the photos I have uploaded to this forum, it may not be accurate, but is what I had expected.

Thank you for your response Dr. Charles. As I have previously mentioned to Spex, the most important considerations for me are a doctor's experience, past results and feedback; however, since I believe I would be able to achieve similar results with either Dr. Feller or Dr. Pathomvanich, cost, locality and/or waiting times will most likely be the determining factors. I guess the level at which one judges the success or otherwise of a personal HT would depend on one's expectation prior to the HT. I'm satisfied, and very much appreciated the benefits this HT has given me. However, I don't think I could have been genuinely pleased unless having achieved all I had hoped for in one HT. Given my fine hair, I was evidently unrealistic.

Thanks for the post Irishsailor; I agree with all that you said. Often those men who have great results after a first HT into the frontal areas had a reasonable amount of remaining hair to enhance the effect. In time, without the use of non-medical treatments (the "big three"), those hairs will, of course, cease to exist as a result of MPB. In my case, I had not lost hair anywhere, but the immediate frontal areas, and these were more-or-less completely bald. I tried to be as objective and honest as I could be in my post; I hope this was clear.

Thanks for the response Spex, as quick as ever. I think most of you will see that both lateral zones, and my left temple towards the frontal zone look pretty good, but that my right temple looks thin, an effect which extends into the frontal zone. When held down, the front is evidently thin. I have absolutely no doubt that I would benefit significantly from a second HT. So, as an answer to Spex's question, I am now in the process of considering where and when to have a second HT, to both fill-in the existing hairline, particularly on the right hand side, and bring it slightly further forward from the lateral zones up. Please read my considerations here and post if you can be of any help to me: Recommended Surgeons (for Second Procedure) - Forum By and for Hair Loss Patients

Some of you may have read my recent long overdue update on my HT with Dr. Feller, but if not, please see this post, with photos, here: http://www.hairrestorationnetwork.com/eve/161087-my-experiences-2146-fu-strip-transplant-dr-feller-3.html I think most of you will see that both lateral zones, and my left temple towards the frontal zone look pretty good, but that my right temple looks thin, an effect which extends into the frontal zone. When held down, the front is evidently thin. So, I am now in the process of considering where and when to have a second HT, to both fill-in the existing hairline, particularly on the right hand side, and bring it slightly further forward from the lateral zones up. I may be in Asia during the next six months, so have thus been researching Dr. Damkerng Pathomvanich, who would seem to have some good positive feedback and be experienced with patients from different ethnic backgrounds (i.e., not solely, darker, thicker hair). There are also several recommended surgeons in India (although both non-coalition members), but based on what I have seen and understand, neither has much, if any, experience of working with non-Asian patients, so I would not consider either. If Dr. Damkerng Pathomvanich is my only realistic option in Asia, I would appreciate any feedback any of you can offer me. I haven't dismissed a return to Dr. Alan Feller in New York, but since I may well be in Asia soon, and would prefer to begin experiencing the benefits of a second transplant sooner rather than later, Dr. Damkerng Pathomvanich seems a likely candidate. As a bonus, an HT in Thailand would increase my total HT bill by considerably less than returning to New York.

.....or not, as the case may be! It is now 19 months since my hair transplant (HT) in New York with Dr. Feller, so I have first included a summary of all my thoughts and how the HT has developed since that time. I do have fine hair (individual hair shaft diameter) and this may have worked against me in achieving better results after only one HT. I have never been able to easily style my hair, as it simply doesn't have the thickness (or fullness) to be readily manipulated; it tends to just flop unless a strong hairspray is used. I was thus never going to be one of those guys who has 10 follicular units (FUs) implanted per cm2 (just in case, that is an exaggeration) and soon after appears as a Head & Shoulders model. To that end, I was aware prior to this HT that a second session might be required to alter or thicken the new hairline, some of which would be implanted into areas that were completely bald (viz., the lateral, right temporal and immediate frontal areas). However, since my fine hair was not mentioned to me as being a possible issue with respect to achieving satisfactory cosmetic results by Dr. Feller, I remained hopeful that design and FU placement might be sufficient to create a cosmetic effect of fullness. To a certain extent this has been achieved; in some areas very well, but there are other areas that evidently would have required more FUs to achieve this result. That said, my HT has made a big difference to my life, in that I have been largely freed from hair and hairstyle anxiety; not completely, however. My hair on the left side can be cut relatively normally (i.e., all the same length on top), but on the right side I need a bit more length above the areas that had previously been bald to mask this as my hair falls forward. My hair at the front is normally flicked up in a relatively natural and if possible, messy way, and held with hairspray. My hairstyle has been like this for some time, but where before I had to almost style the hair forward, across and up to cover the bald areas (and it probably looked terrible), it now looks natural. After the HT I experienced no shock-loss, as I mentioned in a previous post, and nor did I see any obvious signs of having dislodged any grafts. Having inspected the placement of FUs at my hairlines from temple to temple, it would appear that I have indeed retained the majority if not all of these grafts. I can thus only assume that the same applies to those behind the foremost grafts. Where I had scarred, there were no obvious scars without at least one hair growing from within. Most of the hairs have thickened and grown, but a few at the front (less than 10) remain shorter and thin. The transplanted hairs although now less unruly feel thicker in places than the hair behind (sc., these are thicker hairs taken from the back of the head), particularly in the lateral zones, but less so at the front where some hairs are still kinked, wavy and generally not straight! Despite now having reached the 19th month post transplant, I remain hopeful that these hairs might thicken a bit more (i.e., become more manageable), although with no significant cosmetic benefit. Now for the photos. Remember, with a HT, the idea is to create an effect of fullness, but not to actually implant the same number of hairs as would naturally exist per cm2 on a full head of hair. Photos can thus be misleading, as the level and direction of light can both enhance or degrade the appearance of a HT; as, indeed, they can a head of hair that is thinning. I have taken numerous photos in low, natural and higher lightening, both close up and from a distance, in an attempt to illustrate this. A further point to note is that I normally wash my hair everyday when I shower in the morning, but had not washed my hair that morning prior to taking these photographs. Since my hair is fine and skin relatively greasy, my hair tends to feel heavy, weighed down and less full each morning prior to washing. This also makes it more difficult to style, as the cosmetic effect of fullness is slightly diminished.

18 month update coming soon. I do have photos from the 6-7 month period as well. Apologies for my absence, I have been living in the middle of nowhere for the past year!

I am due a 6 month update during the next few weeks on both my hair transplant and Revivogen regime. In brief now, however, as you have asked: I am still using Revivogen five times a week, and a generic 2% Ketoconazole shampoo twice a week (e.g., Nizoral). These remain my only hair loss treatments. To date (nearly six months), there has been no discernible change in the appearance of my hair from that whilst taking Finasteride 1.0mg daily, including directly behind the transplant zones and at the crown (where I have a double crown). It is difficult to draw any definitive conclusions yet as to the effectiveness of Revivogen for me. If my hair remains the same for another six months, I will be able to say quite confidently that, based on 8-9 years of experience with all of the above treatments, Revivogen is working for me. My transplant is filling in and looking good, which will afford me a cosmetic line defense if the fall-out begins - This will hopefully be sufficient until something like CB-03-01 (Google it) becomes available.

See my recent hairline results from Dr. Feller here: http://www.hairrestorationnetwork.com/eve/161087-my-experiences-2146-fu-strip-transplant-dr-feller.html#post2267827 I also wrote the following in response to a previous thread and since it is highly relevant to this topic, I have copied & pasted here for ease. I was offered a two day 2000+ FUE procedure at the HS Hair Clinic, Queen Anne St., for 7200 GBP. Previous Post The reason for this post is that I would like to add to my former post that the HS Hair Clinic at which Wayne Rooney had his transplant done is also the one at which I cancelled a prospective procedure after consultation with Spex and before travelling to see Dr. Feller in New York. Incidentally (and not surprisingly), their website is also experiencing unprecedented traffic. I have nothing against the staff, they were very friendly/helpful; however, I wasn't comfortable that there would be much room for negotiation regarding the position and nature of my hairline. The Slovakian doctor didn't seem comfortable (from her own experience) that the hairs would point in the right direction if my greatly receded hairline was significantly lowered. This was the whole point of my transplant and a result that was, fortunately, affored to me by Dr. Feller. Secondly, since I do not know how my hair loss will progress, I might require a substantial number of grafts in the future. FUE, which is the only technique they perform, would not have maximised my donor potential. Wayne Rooney has always worn his hair fairly short and since losing his hair, cropped. A strip scar may thus have been responsible for his decision to opt for the FUE technique at this clinic. Only providing FUE panders to typical consumer culture: "FUE is the latest, most advanced technique and everyone wants it"! It may be a useful adjunct to the strip procedure, but is it really suitable for larger sessions and patients that will require further transplants in the future? All of the above fill me with doubts about the HS Hair Clinic.

I have read a number of posts about shock-loss recently. To the best of my knowledge, however, I experienced no (or at most, minimal) shock-loss in my transplant area. This might be due to the nature of my frontal recession, such that most of the transplanted hairs were implanted in front of my old hairline. That said, I did have a significant number of hairs in front of my former dense hairline and some diffuse thinning of the hairline, particularly on the left side; both of these areas were involved in the procedure as if completely bald. These hairs must thus have remained in place and, although shaved for the procedure, continued to grow afterwards, as at four months post-procedure they are now 1.5 inches in length.

Thanks Meaina, Glad you found my post informative - This is what this forum is for: sharing in a constructive manner. I will add updates as and when appropriate. Good luck.

Thanks dude - Appreciate the comment.

Stop being modest Spex: Or you could, of course, buy Spex's guide: Maximum Hair Minimum Loss. After consultation with Spex and the various information he made available to me, and further research of my own, I cancelled my transplant as planned and rebooked with Dr. Feller in New York: My experiences - 2146 FU (Strip) Transplant with Dr. Feller Bear in mind that Spex has had ten (10) transplants himself and has been helping guys such as yourself for many years.

I am not recommending that you take Dutasteride, just advising what I did. I took it every day initially, but then reduced it to once a week. I did not take Finasteride on the "off" days. If you are determined to take Dutasteride, but see no obvious benefit after an extended period of taking it, go back to taking Finasteride (only).

I have written about my experience with Finasteride and Dutasteride here: My Experience and Unwanted Finasteride (and scroll down) Dutasteride almost immediately made my hair feel thicker (to the touch), but did not significantly alter my hairline. I had largely passed the point of no return in the frontal and temporal areas. One capsual of Dutasteride a week would probably be enough since it is metabolised in the body so slowly (much more so than Finasteride). In my opinion, taking both together is unnecessary. Be aware that whilst there are studies of men having a deficiency of 5-Alpha Reductase Type II that show this has no adverse or abnormal effects, there are none to show the long term effects of inhibiting both Types I and II. Finasteride inhibits only Type II, whereas Dutasteride inhibits both, and in many men is unnecessary.

I can now say that after four months since my surgery, the back of my head actually feels like my own again. For those who have not had strip surgery, you might not be aware that the nerve endings on the back of the head take at least three months to regenerate after the trauma of the surgery. My use of the word trauma is intended to reflect the medical procedure and not my personal experience, which was akin to visiting the dentist. If you're terrified of the dentist, ignore this comment! I still have some residual numbness, but the area is largely resensitised to touch. My donor scar is also fading, but is still clearly visible. In the two attached photos my index finger is indicative of the narrow width of the scar. The second photo also shows that in places the scar has already completely faded. Some shorter hairs are also visible; I believe these must have gone into shock after surgery and are slowly growing back in and around the scar area. It might be worth my noting that I had the staples removed after twelve days (ten days was recommended to me by Dr. Feller) by a nurse at my local UK GP surgery. I took the staple removal tool given to me by Dr. Feller, which the nurse gladly used as she only had one other (sanitised) tool left. I had had a shower shortly before this, so my skin (and scabs) was hydrated, supple and clean. I also took some Ibuprofen as the area was still pretty sore.* Each staple removal (23 in total) was thus nothing more than a slight prick and quite therapeutic. See Spex's guide for a video guide of staple removal: Staple Removal | Spex uk hair transplant veteran * Don't take Ibuprofen immediately after surgery as this thins the blood and could increase bleeding. I was given Hydrocodone (Vicodin), which had the unfortunate (and indicated) side effect of making me feeling extremely nauseous; particularly when I stupidly took a pill on an empty stomach during the night after surgery!

Sorry, the shampoos I was recommending are not anti-DHT; as I mentioned before, such shampoos do not stay on the scalp LONG enough for them to have any significant affect on the levels of scalp DHT. I wouldn't waste your money. If you want to use something topical, such as topical Spironolactone or Revivogen Scalp Therapy (not shampoo), it needs to remain on the scalp for at least several hours for it to be of any significant benefit. Besides Ketoconazole (shampoo), which I understand has a positive effect through its anti-inflammatory, anti-fungal and, perhaps, anti-DHT properties, I do not know of any other proven shampoos that will have the similar benefits. The big three are Finasteride (Propecia), Minoxidil and Ketoconazole.

I am not recommending either. I am currently using the scalp therapy, but it is only 3.5 months since I stopped using Finasteride. This is too early to tell whether the scalp therapy is working for me. I am, no doubt, currently benefiting from the combined effects of Revivogen scalp therapy and the fullness of hair/protection that Finasteride had afforded me. I believe that the scalp therapy has the potential to benefit someone who is a diffuse thinner for a given length of time. Only time will tell - I'll report back in 3 months time on this. The shampoo will be of little benefit in stopping your hairloss. If you like the way it leaves your hair, then continue using it, but there are other much cheaper consumer shampoos that give a similar effect.

Just because something is labelled as "all natural" this doesn't mean it will not cause side effects - False marketing on the part of Revivogen. Black Mamba snake venom is natural, would you rub that on your scalp? The difference is that natural treatments are not regulated by the FDA. I know the mode of action of topical Finasteride is the same as oral Finasteride, such that if absorbed at sufficient levels through the scalp and/or if someone is particularly sensitive to this drug, it could, in theory, have similar side effects. I don't know whether this is the case with Saw Palmetto, but again, and although often marketed as "natural and side-effect free", when taken orally it can certainly have similar side effects in men. Any shampoo is likely to be on the scalp for such a short period of time that the amount of absorption of so-called "active ingredients" is likely negligible. I wouldn't worry about systematic side-effects in this case. If you want to use a proven shampoo that might have some beneficial effect in actually slowing down hairloss, then use a 1 or 2% Ketoconazole shampoo (i.e., Nizoral) several times a week. I have written about my experiences with Ketoconazole and Revivogen Scalp Therapy (so far) here: My Experience and Unwanted Finasteride

Thanks guys. I'm currently very pleased with my results - Particularly as I hadn't expected to have a reasonable density of inch long hairs after only three months! Numerous other miniaturised follicles that are only visible on closer inspection are gradually thickening/darkening.

As promised, here is the right side of my new hairline ONLY 3 3/4 months after the procedure. Not the greatest photo, sorry, I will endeavour to do better when I have more time. The right side of my hairline had receded further than the left (perhaps by 0.5cm), so this gives a better idea of the extent of work that was done. For me, looking in a mirror, the lateral zones appear thicker than they do in this photo. Some residual redness and scarring is still evident, but this is continuing to fade (particularly with some UV exposure). Excuse the brown stain - The remnants of my perhaps delusional Revivogen experiment! Very pleased with the results so far.

Thanks for the photos Spex - Brings back "fond" memories. The after photos is the look I wore back to and around the hotel after my transplant (as noted above, wearing a cap wasn't possible due to the transplant also encompassing the lateral zones). I will take some photos of my progress after 3 3/4 months this week. The shock loss from the lateral zones was minimal and these have now almost blended with the rest of my hair. The hairs in the frontal zones are all pretty much there, but considerably shorter, and with some thickening required.

Just posted my thoughts here: http://www.hairrestorationnetwork.com/eve/161087-my-experiences-2146-fu-strip-transplant-dr-feller.html Sorry to link threads.

Took a while to get onto this site today - I wonder if the recent news regarding an FUE transplant performed at a London Hair Clinic on a certain world famous soccer star, Wayne Rooney, has anything to with this? The reason for this post is that I would like to add to my former post that the HS Hair Clinic at which Wayne Rooney had his transplant done is also the one at which I cancelled a prospective procedure after consultation with Spex and before travelling to see Dr. Feller in New York.* Incidentally (and not surprisingly), their website is also experiencing unprecedented traffic. I have nothing against the staff, they were very friendly/helpful; however, I wasn't comfortable that there would be much room for negotiation regarding the position and nature of my hairline. The Slovakian doctor didn't seem comfortable (from her own experience) that the hairs would point in the right direction if my greatly receded hairline was significantly lowered. This was the whole point of my transplant and a result that was, fortunately, affored to me by Dr. Feller. Secondly, since I do not know how my hair loss will progress, I might require a substantial number of grafts in the future. FUE, which is the only technique they perform, would not have maximised my donor potential. Wayne Rooney has always worn his hair fairly short and since losing his hair, cropped. A strip scar may thus have been responsible for his decision to opt for the FUE technique at this clinic. Only providing FUE panders to typical consumer culture: "FUE is the latest, most advanced technique and everyone wants it"! It may be a useful adjunct to the strip procedure, but is it really suitable for larger sessions and patients that will require further transplants in the future? All of the above fill me with doubts about the HS Hair Clinic. *Note, Spex did not advice me not to go to this clinic, he hadn't heard of it; he gave me other impartial advice that led me to make my own conclusions after further research.

Apologies to those who have read this in the Drugs sections, but in that post I covered both my experiences with trying to stop my hairloss over the past 10 years and my recent transplant. The thread was becoming confused by the two subjects, so I have also posted (and edited) again here. I believe Spex will follow with some pre-op photos. My goal throughout the past ten years has always been to regrow my hairline naturally whilst maintaining elsewhere. Hair loss greatly affected my confidence, but I tried to focus on building my confidence regarding my physical appearance in other ways, such as keeping fit in the gym (aerobic and weights), dressing "well", attempting to fulfill life aspirations and, ultimately, trying not lose sight of the whole. That said, there were many occasions when I obsessed over hairloss forums seeking answers. I tried many treatments, including snake oils out of desperation, but none were successful in regrowing anything that significantly changed the appearance of my hairline. Whilst certain proven treatments strengthened my hairline and perhaps brought it foward slightly, I continued to style my hair in such a way (essentially, short curtains with a quiff) so as to minimise the appearance of my greatly receded hairline and thus any cosmetic results I achieved remained hidden. I did go through a phase of more often than not wearing a hat socially, but that makes matters worse as it is more evident that one is trying to hide something. Prior to my transplant (see below), all my hairloss treatment experiments had always been done in a very methodical manner and after much research. I am a scientist, so have plenty of experience in scientific research. In my early twenties, my frontal recession was pronounced and the hair on top my head felt very fine and limp, but with no obvious thinning to the eye. My hairloss (and perhaps thinning) was accompanied by soreness and itching, a bed full of hairs, and a deluge of hairs falling out every time I rubbed my head. It has always been evident to me when a treatment is working as these things stop or are less apparent: http://www.hairrestorationnetwork.com/eve/161072-my-experience-unwanted-finasteride.html On 21st Feb. I had a 2146 FU (strip) transplant done by Dr Alan Feller in NY. A wonderful experience, a fantastic doctor/team, and after three months the fine hairs are currently covering the transplant zone and slowly maturing. I now wonder why it took me so long to make this decision. Basically, I couldn't come to terms with doing something "unnatural"; and this is despite having had numerous operations in the past for other (non-cosmetic) reasons. I took advice from various people, including Spex (see his guide here: Maximum Hair Minimum Loss), before embarking on this journey. I combined my trip to NY with a short holiday, so also had a five days to enjoy Manhattan and Great Neck, Long Island. I arrived 4 days before my operation and departed on the second morning after the operation. I walked to the unit housing the Feller Medical Centre during the evening before my operation as I wanted to confirm the location. Fortunately, I had also planned to walk to the centre on the morning of my op., as it had snowed heavily. Despite what others have suggested, the walk is beautiful, along wide leafy avenues and took me 15 min. in the snow. I thus arrived for my operation early, refreshed and buzzing (albeit slightly wet from the snow); it was also where I had wanted to be for some time, so there was no sense of trepidation, just hope. My transplant included the frontal, temporal and lateral zones. Dr Feller and I designed my hairline beforehand and chatted about the world in general as each member of his team battled their way through the snow to arrive on time. The most painful part was the local anesthetic injections into the frontal/temporal areas (particularly on the left side - apparently this is common). Dr. Feller suggested that he would be willing to cut me any time as he didn't need to use the cauteriser. I initially took this as a complement, but realised afterwards that "sticky" blood is not necessarily a good thing! My operation was all finished by 1pm as my physiology also meant that graft placement was very quick and easy! I grew my hair long on top, so with the exception of immediately after the transplant, it covered the transplant areas. Immediately after the transplant I had no choice, but to parade my transplant zone to all who past me in Great Neck (I caught a taxi back to the hotel). The extent of my frontal transplant mean that wearing a cap was impossible without undesirable forces being exerted on the lateral transplant zones. Despite this, and after years of trying to hide my receding hairline, I felt strangely proud as I stood chatting to the bell-boy as he inspected my bloodied scalp, before hibernating in my room the following day during my post-op blues. I didn't sleep particularly well the night after the operation; this was less to do with pain and more to do with being a side sleeper propped 2ft up on pillows with an additional neck pillow to stop me from turning and dislodging grafts. I washed my hair the second evening after the operation as described. I experienced some swelling (or bloating) of the forehead from draining of the anesthetic fluid, but this wasn't particularly pronounced. The bruising also wasn't too bad. After three months, the donor and transplant areas still feel abnormal (slightly numb and sore in places), but this is slowly fading. I still have some frontal scarring, but again, this is also slowly fading.