Davis91

Congrats on identifying all the critical issues —future donor management, thinning donor vs system wearing etc. As a red haired person you will have less hairs per sq/CM. It’s quite possible FUE will leave your donor threadbare and I think you might have less beard donor than you think. You might be able to achieve a shaved spikey hair look with 2,000 grafts in the frontal third from the head and maybe 500 bearD FUE. But will that be enough to satisfy you ? If yes then think of it as kind of Zidane shaved look just before he fully shaved down to the scalp and this might be achievable. Combine that look with good health, attitude, and pumped up body and you could come away with a new mature look—and the good news is you you won’t seem to change much to the outside world between the ages of 35-55 while your peers age more rapidly. You’ll have framed your frontal third and maintained your options for a hairpiece and not thinned out the donor too much. you could also try for the temp SMP on your shaved head and see if you like that look as stand alone option or in combo with the above FUE. Otherwise...you have to assume that you are going to progress in the hair loss. Medication doesn’t always work forever or you might have to get off it at some point for whatever reason. You have an asset insofar as you have worn systems before and they are indeed easier with a donor that is intact. Hair systems are getting better all the time...wear one with pride and even with the ability to joke about it to others and you might find yourself loving all the new looks you can rock that non-system folks can’t understand. People love the ability of others to poke a little fun at themselves—it also puts YOU in control of the situation. The point is—-you are young. You have options—rock a system, shave, SMP, or try a LIMITED initial FUE. Be very careful about the amount of grafts you use on the first cut—as others have said, donor management is key.

Hi Melvin for those that are NW4 and above, what is dr Hassan’s recommendation on how to apply the single 1ml dose across the whole area ?

I’m not sure it can be “either or” as the medication needs to be applied efficiently over a certain CM area of scalp unless you have a very small area to cover. So if this formula could be reduced (microdosed) tonsat .25 or .0025 or whatever per 1 ML then we could know—but they have already stated they formulated this based on efficacious response, which is 2.5 per 1 ML. Melvin: sorry to ask again—but for your instagram with dr Hasson weren’t you going to post the before and after pictures he allowed you to share with viewers for the Topical? Or did they ask you not to after?

What’s quite interesting then is that the comparing amount seems to be the 1 mg propecia pill. Anyway it would be great to see some pictures of before and after of the patients the company mentioned.

My friend is trying to order from Xyon and asked the question on dosing. Here is the company’s reply: “The liposomal gel formulation, compounded with the 2.5% finasteride, was designed by Dr. Victor Hasson to provide an alternative to men who are less tolerant of the FDA approved 1mg oral form of finasteride. The base gel was designed and optimised to limit the absorption of medicines such as finasteride into the circulation with the specific aim of lowering the risk of adverse side effects. Dr. Hasson landed on a 2.5% finasteride concentration as the optimal concentration in the SiloxySystem liposomal gel formulation, balancing efficacy and side effects. Apart from the efficacy observed in almost 600 of his patients to date, Dr. Hasson has also performed pharmacokinetic (PK) testing in a subgroup of his patients. The results confirm that men using the 2.5% finasteride in the SiloxysSystem liposomal gel, have a lower circulating finasteride level in the blood compared with what's reported with the 1mg oral finasteride as well as a more preserved circulating DHT level measured in the blood. These data support the laboratory work Dr. Hasson had conducted to generate the optimal liposomal gel formulation and ideal finasteride concentration at 2.5%.”

Yes I’m confused too. As the poster said above at 2.5% with 10% absorbing isn’t that like taking .25 of finesteride systemically with each application? Melvin: in addition to above question you mentioned on your chat with Dr Hasson that you would post the photos of the patients that were displayed right after the talk. Have you posted those somewhere yet? Thanks.

Any reason you are not showing placement of the grafts from either operation ?

One of the finest examples one can see of a nw6-7 restoration. Great photos that are honest. Also kindly request photos of graft placement Thanks

I am trying to post again, lets see if the moderators allow this one as for some reason my reply was not allowed on last time (despite being very polite). I agree with ThatOldChestnut. "Perfection" in HTs is often the enemy of good, so its a risk. Matt thanks for the videos. What I would really love to see going forward in addition to the good quality of the videos (nice) is full views of the crown even when restoration mostly frontal third. That would put the Rahal clinic in the category of most transparent like a few of the others. JeanLDD and Matt and everyone--celebrities are out there to look at for sure, but the average HT patient looking for celebrity comparisons needs to be very, very careful. Celebrities often have access to stylists and use top-line concealers that completely cover up ANY hint of hair loss, and many use partial and full pieces (I do think Clooney has a piece also). Ronal Reagan was exceptional but the point anyway is he had no mid or crown loss. Its not a thoughtless comment--its a comment that comes with experience and wanting make sure the "Average" HT PROSPECTIVE patient understands that this result is not the norm because many people will not have the grafts or genetics to allow it if they are correctly screened. I DO think it would be weird to recede with a perfect hairline and potentially not have enough to restore the rest. A good public example of a high NW that had a appropriate HT (good planning for its day) is former VP Biden's one. He got a high NW2 restoration and is an NW7 elsewhere and he pulled it off because the hairline is not perfect--it is appropriately receded. The danger is that many clinics do not have the ethics or skill to do what is on display. So a patient reading this forum and seeing this result may demand the same and some doctor will give it to them. And they will recede. And they may end up in trouble down the road. Dr. Rahal is known as an ethical guy so he and the young patient made the decision. Not all clinics have the same ethics. So, please please please for you new patients out there, do your research and be very careful with making comparisons to this case.

Thanks for the videos Matt Jean LDD—i disagree. It is a thoughtful comment not a thoughtless one. I said it “may” look weird and indeed it may—that is the reality of the situation. This is a forum to educate and inform and indeed many posters in the original thread say the same. Please remember many new patients come to this site and are starting from scratch. Many may be higher Norwoods with poor donor or other. The patient selection critteria for this Rahal patient allows for this Norwood 1 restoration. Yes, an adolescent hairline at 70 may look weird. A good example of (for the time) a planned hair restoration is VP Biden’s one. He has a high Norwood 2 restoration and is an NW7 elsewhere. It works because it was a limited restoration well planned. Reagan was an exceptional hair guy without receding elsewhere. But the danger for many patients is exactly what you are proposing as comparisons —George Clooney, Brad Pitt etc. These are professional actors who have invested a ton into their appearance more than possible to do for even the average hair restoration patient. (I also agree Clooney is likely wearing a rug). Brad Pitt and many of those guys either have had work done or wear concealer. HT doctors —ethical and unethical ones —(Dr rahal being ethical according to all general consensus ), are in the business of selling a product. Most of the videos of high restorations above don’t show the crown. Why? Because they focus on the area of restoration. But you can bet it’s not a complete restoration. Does the new patient know this? Doe they understand ? Again we are hear to educate and inform. I stand by my comment that technical competency aside, (which is evident here), the average hair restoration patient needs to understand that this patient was the exception, not the rule, and runs some risks with this approach which will need to be managed. Thanks

PLEASE potential HT people watching this refer to the original thread and how many people questioned why the patient got a HT. This is a RARE outcome of a patient at a normal Norwood 2 going to a Norwood 1. He will have an adolescent hairline forever which may look weird when he is in his 40s. Please understand this result is not hard to achieve under the circumstances of this patient. Matt: good video quality. Do you have a single Norwood 5-6 patient video of any quality from Dr rahal that you can post ? Thanks

I have had several consults with Dr. W and a PRP treatment. He is a top notch in terms of customer care, knowledge of industry trends, explaining the science in layman's terms, and being open about results and expectations. Great office too in the heart of NYC. Very high marks for the man.

The hairline you have is where a lot of transplant patients end up getting to. I agree with Spanker it might benefit from about 1500 to stabilize it ONLY under the condition you consult with a few ethical docs like Shapiro or Hasson and Wong or many others here skilled at predicting your future hair loss. Also agree that you may not need anything yet, So you may wish to consider hair meds and/or seeing a doc that does PRP which may work to help with diffuse thinning. If you are worried go get informed. Finally make sure to get a thorough medical check with blood work and get educated on nutrition and hair loss—inflammation caused by diet can certainly contribute. More than anything—don’t panic. You still have lots of hair currently and to work with in the future.

Sali I’m going to give two pieces of honest advice: 1. You should not have been advised to get a hair transplant without understanding that you had minimal chances of a decent restoration with that donor—you are are heading to an extreme NW7 with a Thin donor. If you are content with getting a little on top that you could comb back maybe that is fine. It will sort of be like Joe Biden. What exactly were you advised would be the plan? 2. You are now going to need a plan for extreme restoration if you go further.That will likely mean a combination of totally maxing our your beard and body hair and using SMP. This is going to take a while and you will need to be in very experienced hands. At least you did FUE so you can keep your hair shorter.

What sound do sheep make ? Baaaaah? I'll make that sound for now but not because I am following Dr. Feller. I will make that sound because I have heard first hand from multiple top docs on here that yields are getting better but are not the gold standard nor close to replacing on average the results of strip. ON AVERAGE. There are no doubt excellent FUE docs who are pushing the envelop. New research is coming out all the time. Boundaries are being pushed and FUE is the popular kid on the block. But it is one tool that may be beneficial to use for patient outcome and efficacy SOMETIMES. I do not believe FUE megasessions are the norm in 2017. How do we define megasessions and is there any data to back that up? I am amazed at those rare cases of NW6 being transformed by FUE. A lot of factors need to be looked at in these cases including donor density, scalp hair quality and characteristics and scalp size (not all NW6s are created equal in terms of diameter needed to be covered). Yes the case of the doctor you posted is horrible and I would run far far away from him. Have you looked at Dr. Umar's cases ? I give him credit for posting his results. Because he shows the LIMITS of trying to restore an NW6 with FUE only. He taps into body hair quite a bit mixed with scalp hair and the results in many cases are far from complete or even partial restorations. Again I do not get my reason and evidence from Dr feller. I've never met him. I get my reason and evidence from a combination of sources and it all started with MAJOR top docs in the USA and Canada telling me they are following the research on FUE and basically saying the exact same thing Dr feller has. BTW some of those European FUE docs are pushing the envelope and taking grafts from potential non safe zones and making calculations of xxx years before a patient recedes in those areas, using topical propecia as mitigator, using rogaine etc. Here is my gold standard: what do you need to complete YOUR goals; what is your likely donor count; assume propecia or rogaine may not work so you aren't screwed if they don't down the road; find a surgeon who is experienced or well trained by an experienced doc; one who is willing to show you an average result from his clinic; one who will give you an opinion about what is best for you (I wanted FUE but was talked out of it by multiple surgeons --all of whom had the staff to do FUE--ethics ! And hopefully as a bonus a doc who is following the research and willing to adapt and offer new options if proven. It's what Dr feller said : will ONE doc or two or even their reps please stand up to counter what he is saying?? Will one confirm ?? Dr. Lindsey actually comes close as he publically states Multiple times inhis videos and posts that FUE just isn't there yet. Spex where are you? Probably sleeping but you will see this when you get up. Respond . Any others?? Come on it's for patient education. So step up and debate!

JeanLuc Good grief man what quantitative evidence is out there on FUE hair yields by this European doctors ? Qualitative photos are really SO subjective regarding yield and result. Do you know how few docs even list the vital stats on graft counts broken down at time of extraction on this site ? Minimal. Some of those Europeans doxsndo it well but man photos are just not a good way to evaluate, sorry. There are few clinics willing to post an "average" result. Pictures rarely show punctate scars, transacted grafts, potential donor area deforestation with FUE. How do photos shows subdermal scarring that may compromise a further round of FUE? They don't. It would take a hands on approach by an experienced hair transplant surgeon. Or what about the well documented phenomenon of Spanish /Italian stronger density? How does that affect the results ? Are the Spanish FUE docs playing with a stacked field by virtue of their practice location? See how complicated it is ? It's is nor as easy as you make it out to be to assess results. You are not qualified to do so.

To the posters here: I have consulted with a ton of the "top" physicians here. First, a bunch who tried the ARTAS machine refuse to use it anymore and they do so because the results are not close to expected. These top docs have conscious but if ARTAS worked well I am sure many would continue to use it. It does not work well. Stay away. EVERY one of those docs admitted privately that strip is still the best to ensure results. All offer FUE and use a variety of methods depending on the doc (e.g. manual punch, drill, even innovative beneath the scalp extractions from the "bottom up"). There is ongoing research as to how many grafts can be safely extractedl before compromising density, how to regenerate grafts, etc etc, All agreed for those needing major grafts (oh maybe between 3500-,8000) then strip in a good docs hand is still the best bet. I've had the strip removed multiple times. It is intimidating. But it was the right thing to do for my case. If I need a small case to top off areas yeah sure maybe I'd risk losing some grafts via FUE--but I know it won't be as good as strip. And I've got pristine areas above and below the scar to explore if needed via FUE or MFUE. Now would I like to be able to cut my hair shorter and not expose the scar? Sure! But I would never have gotten the grafts I needed with FUE---as told to me by multiple docs.

Dear Dr Feller Good posts. Agree with everything you said. Are you still actively performing surgeries ? I called your clinic about a month ago and asked if you were available for a consult and they said you are not practicing much anymore. Thanks

Dear Spex How do you reconcile your views changing after you started working for another doctor ?

Kids, don't drink and text. Bill what is a "Scott to the song" and "extended closer to the scalp"?!?! I'm joking of course we've all mistyped and with auto-correct these days it's even harder to respond quickly. There are a lot of postings on this topic--brief exposure really is not bad but there are instances where even brief exposure can cause redness--21 days after my first surgery I stepped out briefly in the noon sun in August and sure enough my sensitive scalp turned red at the surgery sites. It did not affect outcome but any significant burn in the first months could require intervention quickly to minimize inflammation which can damage newly growing transplanted hair (let alone regular hair). Intervention meaning anti-inflammatories or even a steroid shot--I think one of the doctors here actually related exactly that story regarding a patient getting a steroid shot after a burn to his scalp after a transplant. Anyway Goblin you will be fine based on what you reported.

Janna It's a good result but you should show the usual post-op graft placement pics to be fair. That will help viewers understand where the grafts were concentrated. The before and after pictures don't match up because he is employing a partial combover in the latter.

Again this is a great repair for where he started. Focusing on where you worked makes sense. But then why show at all the left full side profile,right full side profile, and top down shot and not show a direct 1:1 comparison after? You also say you want to show how the patient looks in everyday life with a video which only shows him from the front basically. So you are saying in everyday life people will only view him from the front ?? Since you offered please show aftershots full right side and left side, and top. Dr. Bloxham you know exactly what I am referring to--please help us trust your relatively new surgical skill set (which looks quite good) by combining it with gold standard videos and photos that make you the most honest and transparent of the new generation of HT docs. Make that committnent early in your career and you will be justly rewarded. Thanks.

Very frustrating video. First-- great repair job. No doubt about it. Well done. Second--as you Dr Bloxam were a moderator on this very Forum why would you discuss the strip repair, show a top down photo before , show full profile right and left, then in the comparison shots you only focus on close up on left and right profile so it's not 1:1 with the old shot for comparison, no top shot after, and no donor area shot. This is deliberate. My question is WHY? This is an educational video so why do you skip crucial comparison shots ?

For that age and level of loss, honestly, that's about a perfect result for a HT. Really well designed. Great job, design, and tactical coverage.

Yes, I've had beard extractions and subsequent ingrown hairs. Transection can be an issue but also trauma in a concentrated area can cause issues. Please see my PM.