stockholmare

On 5/19/2023 at 2:53 PM, stockholmare said:

Hello All,

not much to share at the moment. i am almost 4 months in and very few grafts have sprouted, mostly on the right side, while left is showing almost no signs of growth.

I am posting pics later, but there will be no visible change vs the pre-op.

I am trying to be confident that this time i will get a good result.

To some of the comments: the doc did all the implantation himself, while extractions were performed by the same tech who di them in my first procedure, so not an apprentice for sure.

I honestly felt very well taken care of and, as I said before, the Doc goes really above and beyond to to his job: I perceived he was not doing it for the money (he absolutely does not need it) but because he cares about his patients and his reputation above all else.

I may not be happy after the second procedure and a bad respondent to HT in general, but in all honesty I would still recommend Dr. Couto to anyone who asks me: capable, trustworthy and integer professional.

Hello I turned 4 months a few days ago.

The right side is (as the first procedure) showing some signs of growth, although nothing major. The left side has almost no growt, I counted 3 hairs in the hairline and behind, which exactly what happened the first time. At this point I believe I am a bad responder to HT. There is no other explanations.

Wishing all future Couto’s patient the best results (which IMO he really can deliver).

On 5/21/2023 at 7:32 PM, Escanor said:

Thanks for the info. Im going to see Doctor Couto on January of 2024 and im very excited to see how he works. 

I am sure you will be satisfied. I probably am a bad responder to HT, but the doc is a very good professional (and man)

On 5/22/2023 at 12:49 AM, consequence said:

Thank you for the update.

Are you taking minoxidil and finasteride still and at what dose? Have you considered 2% ketoconazole?

 

5mg Oral minox as instructed by the doc and finasteride 

Hello All,

not much to share at the moment. i am almost 4 months in and very few grafts have sprouted, mostly on the right side, while left is showing almost no signs of growth.

I am posting pics later, but there will be no visible change vs the pre-op.

I am trying to be confident that this time i will get a good result.

To some of the comments: the doc did all the implantation himself, while extractions were performed by the same tech who di them in my first procedure, so not an apprentice for sure.

I honestly felt very well taken care of and, as I said before, the Doc goes really above and beyond to to his job: I perceived he was not doing it for the money (he absolutely does not need it) but because he cares about his patients and his reputation above all else.

I may not be happy after the second procedure and a bad respondent to HT in general, but in all honesty I would still recommend Dr. Couto to anyone who asks me: capable, trustworthy and integer professional.

On 4/8/2023 at 12:27 AM, BaldingEye said:

Hello @stockholmare looking as it should for 10 weeks. So many things will happen from now on.

How is your donor looking?

thanks so much, I really hope so! The donor is looking better now and keeping my hair slightly longer helps concealing: if I went for a number 1-2 buzz cut scars would be quite visible, but I think that's normal and expected

On 4/9/2023 at 12:26 PM, consequence said:

Who recommended that you do this after surgery? I have seen some clinics trying it, but so little is known about PRP, particularly in a post-operative setting when the dermal papillae are so fresh, I'm not sure this was a good idea. Looking through Pubmed, there aren't many randomized trials about this (of the two I found, one was done intra-operatively and had some benefit and in another it was used for cicatricial alopecia and there was no benefit). At this point it's basically the wild west.

I would be inclined to say that if the majority of Couto's patients don't do PRP around surgery (which I believe is the case) and the majority get good results, just stay in the middle of the pack and don't try anything too crazy.

Reminds me of that other poster from India on here who was trying crazy nonsense like standing on his head for an hour every day after surgery to "improve blood flow" and and ended up having a subpar result. Sometimes less is more.

Also, did you do PRP 1 month prior to the procedure this time as you planned?

The doc suggested I did a PRP the first time, when I asked him if that could have had an impact he said that it is unlikely given I did so after 1.5 months, but it is impossible to know because he did not perform it (I went to a clinic closer to home).

I did do a PRP treatment 3 weeks prior to the surgery this time, suggested by the Doc as a "preparation session" that would have all the growth factors activated for the grafts to have higher survival chances.

Hello everyone,

Sorry for the latency, I have been very busty with work and family.

Today marks 10 weeks after my second procedure. Everything feels fine, I must say the pain and recovery time was way less vs the first procedure (number of grafts was also roughly 25%, so kind of expected).

My temples/ hairline were the weak spots and at the moment I have not noticed any early growth/baby hair.

Hopefully that will start soon, as I am now well into the 3rd month.

keeping my fingers crossed 🤞

All the best

On 2/14/2023 at 2:50 PM, BaldingEye said:

Dr Couto is by far the best and your result would be great. 

@stockholmare as TorontoMan is asking you, could you take a photo less zoomed in so we can see a more encompassing photo of your situation? Could you share some indoor or outdoor photos?

How is it going? As you know, it's time to be patient. From week 3 till month 4, I was extremely nervous. But time goes by really quick.

@BaldingEye@TorontoMan unfortunately I do not have pre second surgery pics that clearly show the situation: this is because I wore my hair forward in a way that would conceal the situation after my first procedure.

Overall I am feeling well, trying not to think about it and waiting for the shedding and ugly duckling phase to start (saw several shafts today during the shower)

I am slightly concerned as I still feel some pain in the recipient/donor, but I figure it it fairly normal at 3 weeks post op.

Does anyone know if it is ok to go for (non-challenging) walks within the first 24/48 hours after surgery? I did so to increase blood circulation, but now I question my decision.

So here I am at 10 days post surgery. Scabs removed just now and normal life about to begin again ✌️

the surgery:

As son as I arrived at the clinic The doctor assessed about 400 graft to fix my situation, which I was happy about. We ended up doing a bit more than that (460-470) but still very reasonable amount: the strategy was not to pack too much to avoid ultra blood-competition among implanted hairs and optimize for survival rather than perfect density.
I bled a lot during the surgery, due to some dermatitis I have: this was not good and dr Couto told me that straight away: hopefully this will not affect my regrowth badly but it is not possible to tell.
I must say I really felt taken care of, regardless: the doc had planned for a quick touch up of my hairline and corners, and because of the bleeding, we ended up implanting for about 3.5 hours: he did every single graft himself. He offered me a lift back to my hotel (legend) but I really had my accommodation just behind the corner 😂.

We agreed I will probably need a final round in one year from now (100 grafts if everything grows back this time🤞).

Now what:

I will start oral minoxidil and some supplement (zinc, b complex, d, etc) tomorrow as indicated by the doc.

I will start praying and hoping that this time my growth rate is in the 90%

some questions for this community:

is it normal to have some hair shafts come out with the scabs during the scab removal washing?

is it normal to feel some pain (bruise-like pain) in the recipient area at this stage?

Pics
below the pre op, immediate post op, 7 days and 10 days (most recent pics are last). 

Hello dear forum-friends, 

I am posting with my heart full of hope, as I will soon leave to Madrid to touch up my first (unsuccessful) procedure with dr Couto. I am now 13 months post-op, as the first surgery was carried out in Jan 2022. For reference, you can find that thread here

So, tomorrow I will undergo another procedure, with him again to add the density that failed to stem from the first surgery.

Backgroud:

After the 2000 grafts procedure, according to the Dr, my body failed to provide enough blood supply to the transplanted units, thus delivering low yield: the doc will assess the exact yield and needed grafts for this second surgery once I’ll be at the clinic. In my personal opinion my yield was about 30-35% (I am unsure tbh), but I hope he will bring some of his magic and not to need too many grafts, because I would like to keep some for future needs, should there be.

Looking forward:

I decided to go again with dr. Couto because, despite the low growth of the first procedure he struck me as a very integer person and professional, who truly cares about his patients and their happiness, and whose skills are second to none.

I will update this regularly for your reference.

Attached is the 13 months post op situation that I hope dr. Couto will be able to fix🤞🤞

Wish me luck!😄

14 minutes ago, splitting hairs said:

There looks like quite a bit of fibrin in your immediate post-op pics.  That can affect gract survival.  

could you elaborate?

On 11/21/2022 at 3:55 AM, 5BetaReductase said:

It looks like there has been some further improvement with some more to likely come. Has couto shared his thoughts with you? What’s the plan for the future?

H thinks the main reason is that my blood vessels did not re-vascularise well enough to sustain the transplanted grafts. He will do a touch up with lower density, in order to allow for every graft to survive. He also suggested to do "activated PRP" 20-25 days before the HT, to prepare the tissues.

pics here

Hello All,

some time has passed and I wanted to give an update about my case.

Posting 2 pics taken a couple of weeks back (so roughly 9.5 months) and it is now clear that I will need a repair. No major aesthetic change vs 6.5 months.

I would like to get opinions on what could have gone wrong, below some things that I am "suspicious of":

I washed out the scabs with 2-3 days delay vs what suggested by the clinic

I have always had some dandruff: the Dr was not concerned about it and I did not have any post-procedure infection, but I wander if that may have played a role

I did a PRP session 1.5 months after the procedure: could an unexperienced nurse damage the grafts during a PRP session?

I had a sense of slight pain when touching the recipient area well through month 4 - I thought it was normal but by reading around, it seems not the case.

Please let me know what your opinions are and fee free to ask any question.

Thanks

By the way I would like to point out that the doctor is kind and professional and offered an afternoon session at the beginning of next year for me to be satisfied.

14 hours ago, Vann said:

I think you’re asking great questions just at the wrong time. Just kick back and relax, regardless of any touch up you do, repair, or anything you want to remedy your current situation. The best thing you should do is wait. Just remember you already took the first step in getting a hair transplant so let it reach that 12 month potential then call it a success/failure.

 

melvin is a good example to reference for his slow growth in ht’s. As a matter of fact his most recent one shows some massive growth in his crown in the last month compared to before. 
 

just remember you cannot undo anything so what’s done is done. However, you could continue to stress yourself currently without anything to result from it since your best option would be to wait nonetheless. 
 

but remember no matter what answer you get from why it is currently not 100% wouldn’t make a difference because even if you know the answer your full potential for the procedure can’t yield that fast and there’s nothing you can currently change unfortunately. So I would just recommend you continue your daily life and try not to overthink it (you’re past the ugly duckling phase) so enjoy your present.

I am trying not to think about it, the Doctor also recommended to do so - it's not always that easy thou

2 hours ago, 5BetaReductase said:

Who extracted your grafts? A tech or couto himself?

a tech

13 hours ago, sukh123 said:

Hi how long after consultation we’re you able to schedule the procedure ?

a bit less than 2 years

19 minutes ago, Gramatik said:

Guys if you check the graft placement of Dr couto's results in youtube and compare them with this case of the OP, you will see that the graft placement density is similar to the OP's graft placement density, but his result lacks of density while these on youtube do not and they do look too dense. Dr Couto follows the same plan in simillar cases of small norwoods and so the graft placement density is simillar to every of them.

Anyway he should wait some months until 12 months maybe to see if it gets improved, other wise he will do a second hair transplant to fix the lack of density. But why Dr couto already admitted to the OP, that he is dissapointed with the result ?

 

 

thanks for posting this case and for your comments, Garmatik

to your Q of why the doctor has already said I will probably need a "touch up": the way I got to "know him", he struck my as an ultra-perfectionist that takes huge pride at what he does. And when I say pride, this person lives of pride, literally: he needs no money, no fame, nothing. You should have seen him with his former patients, there were at last 7-8 of them in the clinic for check ups: he was taking me to each of them and showing me their progress like they all were his creatures. I really wish I could be one of those one day

18 minutes ago, Fue3361 said:

I'd usually agree with you here Melvin, but looking at this here:



I'm not an expert by any means and accept than I could be wrong, but does the density not strike you as very low post in this post op picture for an area that has zero natural hairs growing there?  There's no tape measurer to judge exact grafts/cm2, but that looks like 20 to my naked eye (area right above new hairline).

As to OP's concern, I'd say still wait the 12 months, and if you need the touchup/revision surgery, go back with Couto.  He's still world class, and you can't find much better hands than his.

 

Thanks for your comment Fue, I also thought that when posting, but the left pic is at 10 days post op, before removing the scabs:I think some grafts were actually "hidden" by the thick scab/skin layer I removed after taking the pic. If I compare the left pic with a post op one, the post op looks denser to me.

10 minutes ago, BaldV said:

1.Arent there before pics from the clinic?

2.How old are you and are you on medication?

3.How much donor you have left?

1. I do not have them, will ask

2. 38, fina since 10 years (zero side effect) and oral minox since 1 month post op (as prescribed by the clinic)

3. I am not sure, the doctor said we need to see how I heal before judging that - I feel I healed very well btw

13 minutes ago, Melvin- Moderator said:

6.5 months is hardly enough time to judge a result. Do not listen to forum trolls. There’s growth, and it’s improving. You’re only halfway there, so definitely too soon to judge the result. 

Thanks Melvin, your support and experience is much appreciated. The doctor however said he is also disappointed by this result and explained a "touch up" could be needed.

I am stuck with the question of why this below average likely result: 

Looking back:

I did not loos a single graft

I did do the PRP treatment a couple of week after the suggested date (6.5 weeks vs. 1 month post op)

I not go to saunas or swimming pool for 6-8 weeks

Did not smoke (ever) nor drank much alcohol for 3 months

I did not change anything specific in my diet, just added some multivitamin and biotin

I did wait 4 weeks before lifting weights and did not play contact sports

So I cannot think of any other reasons than:

a) high transection rate: would that be possible? a motorized punch was used

b) the method (pen implanters) does not suit me

c) I do not respond well to HT in general

What are your thoughts, what else should I look at/think of?

22 minutes ago, THE TRUTH said:

 

Thank you. I received it. 

First of all, I am really sorry for this experience....

Man it's really hard to comment on this....

Considering Dr. Couto's aura and the fact that many  including myself would put him in "the discussion for GOAT status", I must say this result is indeed very disapointing even for only 2000 grafts....

The density is just not there....and like other members said it was obvious straight after surgery. 

I wouldn't call it a "botched job" though.

But I think the appropriate and fair term would definitely to subpar/mediocre/disappointing. 

Again this is a cautionnary tale that every clinic in the world even the very best ones have subpar results... This is something that I keep  repeating on this forum all time.  No surgery is guaranteed unfortunately and every surgery is a gamble per definition no matter who you go to. 

This is the sad reality of this industry. 

This is maybe the 3rd subpar result from Dr. Couto I see in many years...

I am glad that Dr.Couto stands by his work by immediately offering a free repair. That is a positive news and shows that he is ethical. 

I am generally not the kind of the guy to say "oh don't worry just wait till 12 months this is only 50% bla bla bla....". 

From my experience, the 6-months result is generally a lot more than just 50% and very indicative of the final results HOWEVER there is still a chance that it will improve at least marginally until 8-9 months so yes I would give it a bit more time before making a final conclusion. 

But yeah doesn't look great overall...

And  if it remains the same then obviously a 2nd procedure is going to be required... 

I generally NEVER advise people to go back to the same place which didn't deliver for their 1st surgery. 

However I do believe Couto has some of the best and most natural results I've ever seen so far thus he has a reputation to defend. I mean he isn't considered one of the best in the world for no reason, right ? 

I remember one case from the spanish hairloss forum who had a density issue from Couto and he fixed it for free and then everything looked fine. 

Did Couto mess up here ? He clearly did... No doubt about that. 

Can Couto makes this right ? I believe he can. 

Is it a good idea to go back to him ? Well....this time around I really don't know...  Every other clinic has had subpar cases so again doesn't mean that they'll necessarily do a better job than Couto. 

It's your personnal decision but there is an element of faith that you will have to put into this if you decide to go for a repair with the same doctor. 

Couto was able to repair several botched jobs from Erdogan. 

But here's what I'll tell ya if you have the slightest doubt about the outcome of a 2nd repair surgery  with the same doctor then it's  better not to go...

thanks 

19 minutes ago, Gramatik said:

I feel sorry for you man. This does looks like a bad result from Dr couto. Poor yield, and too many multiple grafts were inserted in your hairline instead of single ones. Your now need a repair procedure to another doctor, that specialises in removing multiples from a hairline and putting soft single ones in order to look natural, while having high yield of grafts. Even if your doctor offers a free procedure, i would not trust the same doctor after the result you got from him. I hope you find a solution to fix this pluggy hairline. Whats the explanation of Couto for this poor result ?

I believe the multiple grafts in the HL may be a consequence that the very first line did not grow, thus making it look so (?)

Regarding the reasons provided by the doctor, he said it could be "the dense packing" and the competition for blood among transplanted hair follicles: I do not think the packing was so dense, but I also started to take oral minoxidil after 4 weeks of the procedure, as per prescription from him

16 minutes ago, Vann said:

Well I wouldn’t be too pressed on that. If those grafts do yield a good amount you can always “address it again” it sucks but sometimes there’s less competition for blood supply like dense packing would do. So if you do get another procedure you can add more density and potentially fill in other areas. 
i know that’s probably not what you want to hear right now, but I think you should spread the word on your case, and look for other cases that are similar to yours. 
one reference you can use is Melvin the mod he had a lower yield ht (his 2nd I think) but he is also someone I would consider that has slow hair growth.
another one I like to reference is gatsby. His case is an emotional and psychological roller coaster. Don’t fret too much on what’s already done but look at others who have been in your position and plan ahead from there.  
 

don’t forget this isn’t the full result just yet. 
 

edit: meant to multi quote the 2 comments above mine (in case of any confusion)

thanks Vann, this is very helpful - I'm reading those stories for sure!

6 minutes ago, Vann said:

Idk if it’s me but the density doesn’t look that great. It looks like the punches are kinda big and spaced out behind your hairline.

you may be right, however I am not getting a much of a growth despite the grafts are spaced out