Neil Nelson

Hey Philly! That's a coincidence - I was only thinking the same, that I should get in touch, just this morning. Not much happening for me as yet. Not many signs of growth at all. Where are we - 11 weeks on Friday? I guess it's still early days yet. How are you doing? Any density showing through? It's a tough time for us both just now. Really impatient to see something happening. I have a big social event on April 22, and I was really hoping for some improvement in my hairline before then, but it's "touch and go" right now.

Philly, Paris, Hey guys - just a quick update. I've started to see some initial growth of new hair at 7 weeks. Early days yet, but there are at least a couple of dozen stalks coming through at 1mm and higher now. Plus, just a few remnants of the original transplant have stayed in at the front centre and are growing nicely. Nothing significant to visibly change my original hairline yet, but the signs are looking good. The shock loss patches in the donor area are returning to normal colour and some of the hair around the edges is growing back in, but it's looking like a long haul at the back. However my current longer hairstyle covers that issue completely, so that's okay for now. No point posting pics as yet, but so far so good. Philly, how are you doing?

Robert, thanks for that. It's useful info. I'll keep using the Minoxidil as directed by Dr E, and get the MSM sorted this weekend. Dr E wants me to apply Minox once a day to the donor area, but my hair is so long there now that I'm having to ask my wife to do the necessary from behind. She's already got out a pair of rubber gloves at the ready. Maybe I should clarify just exactly what it is I'm asking her to do... Neil

H, sorry for the belated reply - been offline for a couple of days. Got your mail, many thanks. I've not yet mastered how to reply by PM but I've managed to take a look at the order form and will get things moving this weekend. Really appreciate your help - thanks again. One final question, if I may. Do you use MSM as a substitute for Minoxidil? Dr E is big on using Regaine to encourage recipient hair growth, and has advised me to use it in the donor area as you saw above. I'm happy to do that, but Minox seems to get a mixed press on here, and I wondered if the consensus was either Minox or MSM, or both. Regards.

RTC, thanks. I didn't know that, but now I do I'll track it down. Sounds like it'll be of benefit right now. Thanks again - appreciate your help. Regards, Neil

Hairworthy, thanks. You've posted a tough-worded message, but exactly the one I needed to hear. You've put my concerns in context, which is the value of this site at its best. I'm utterly convinced my choice of doctor was excellent, and Dr E has come back to me with these words: "Neil- I do believe that this is a case of shock loss, as I know that the hairs in the area were not damaged. I recommend you apply minoxidil to the areas once daily, and let's see how soon the hairs in the area start to regrow." Taken with the feedback from you and others on this thread, that's good enough for me. BTW, I assume MSM is Maximum Strength Minoxidil? Thanks again.

Jacob, Not at all, and please don't apologise. Your input added value - I infer from what you are saying that six weeks out is a bad time to be projecting how the final result might look in the donor area, and I might well see significant improvement in the next 3-4 months. And that helps a lot, by giving me hope. Thanks again for your time. Best regards, Neil

Jacob, Thanks for the reply. Let me be clear. I've said repeatedly on this thread that I don't imply any criticism of my doctor, quite the opposite in fact. It's my issue. Yes, it'll be wait and see, but the waiting will be easier if I can put my current condition in context. I'm simply asking if anyone else here has experience of similar shock loss, and if so, what was the extent of their recovery over what period. Just expectation setting, if possible, not a judgement of my surgeon, who has been superb throughout. Regards, Neil

Hey Philly, Saw your recent picture in the other thread. Sounds like you've experienced what we all go through, with shock loss in the recipient region, although it seems to have happened quite late in your case. I know you'll be pretty relaxed about that, and you and I only have about 6 weeks to go now before we should start to see some real grow-back. In answer to your question, my donor hair loss doesn't appear to be connected to my previous scars. From what I can see, I'm like you - the new scar from Dr E is barely visible already, and seems to have excised most of the original scarring in that area. Dr E didn't catch it all, but I wouldn't have expected that - after four earlier procedures there was no way he could have removed all the scarring in one excision. So my answer is no, it looks to be a case of trauma loss. But we'll wait to see what Dr E thinks. Hopefully in the next few days. I'll post again as soon as I've heard from him. Best wishes, Neil

Philly, Paris, Just to let you guys know, I've posted a topic on the "Questions for Physicians" forum concerning what now looks to be very severe shock loss around the donor scar in my case. Paris, if you read the topic and look at the photos, please don't let it deter you from going with Dr E if you are still strongly considering him for your surgery. The problem I'm experiencing seems to be purely my own scalp's reaction to the procedure. As I've said in the other thread, the irony is my scar line is healing beautifully - which is what I would have expected from Dr E's work. Regards, Neil

Robert, Thank you to you and Telephone Man for your replies. What I take from them is that I'm not over-reacting to the scale of loss around the scar. Quite obviously it's not the norm. The irony is, the scar line is healing beautifully, and were it not for this residual hair fall, it would be pretty much invisible already, after only six weeks. I can only repeat that I attach no blame to Dr E for this issue - it looks like a case of my scalp's reaction to surgery, which could have not have been anticipated. I guess it's possible it could be a complication arising from the repair of my original scarring from earlier surgery. Whatever, it's obviously a waiting game. Hopefully Dr E will come back very quickly with his assessment of the photos (he has always been very prompt and direct with his answers to my emails.) I suspect he'll tell me it's a severe case of shock loss and we have to wait and see how it recovers. I'll post an update when I've heard back from Dr E if anyone is interested, and in the meantime if any more of the forum regulars would care to give me their thoughts, I'd be very grateful. Regards, Neil

Gentlemen, I am seeking feedback from fellow veterans of surgery on this site, some of whom I note are very knowledgeable about the after-effects of HT procedures. You may have noticed I recounted my very positive experience with Dr Jeff Epstein in Miami around Christmas time in a thread elsewhere on the forum, and I should say at the outset that nothing has changed my perception of Dr E being one of the world's best HT surgeons. Thanks to his skill the healing process has been very rapid, following 2000 FUT's to the hairline and frontal regions and donor scar repair from much earlier punch grafting. The new scar itself (ear to ear) is already barely visible in places. However, I have been in consultation with Dr E recently regarding my concerns about what appears to be quite substantial shock loss around the scar, particularly below the scar. This coincides with reddened skin in those areas of hair-fall. Dr E is currently evaluating some photos I have sent him of the scar area to confirm this is simply a case of more severe shock loss than is normal, but at the same time I thought I might post the same pictures here and ask if any of the resident veterans experienced, or know of similar scale of shock loss, if that indeed is the issue. With apologies for some over-exposure in at least one of the shots: Scar Shot 1 Scar Shot 2 Scar Shot 3 Scar Shot 4 What concerns me is that, in at least two places, the bald patches feel totally smooth, as though there are no hair roots at all in the skin - almost as though I would imagine alopecia would look and feel. I must repeat again, in no way do I put this down to Dr E's work directly. The donor scar itself looks to be a work of art to my untrained eye. However it would be good to hear from anybody with stories of similar experiences, who may be able to reassure me that my situation is not uncommon and will resolve over time. Indeed, you may be able to tell me that what I consider to be severe hair-fall is not actually so severe at all, relatively speaking. I should add I am currently exactly 6 weeks post op. Any replies from anyone willing to share their experience and put my concerns in context would be gratefully appreciated. Regards, Neil Nelson

Gentlemen, I am seeking feedback from fellow veterans of surgery on this site, some of whom I note are very knowledgeable about the after-effects of HT procedures. You may have noticed I recounted my very positive experience with Dr Jeff Epstein in Miami around Christmas time in a thread elsewhere on the forum, and I should say at the outset that nothing has changed my perception of Dr E being one of the world's best HT surgeons. Thanks to his skill the healing process has been very rapid, following 2000 FUT's to the hairline and frontal regions and donor scar repair from much earlier punch grafting. The new scar itself (ear to ear) is already barely visible in places. However, I have been in consultation with Dr E recently regarding my concerns about what appears to be quite substantial shock loss around the scar, particularly below the scar. This coincides with reddened skin in those areas of hair-fall. Dr E is currently evaluating some photos I have sent him of the scar area to confirm this is simply a case of more severe shock loss than is normal, but at the same time I thought I might post the same pictures here and ask if any of the resident veterans experienced, or know of similar scale of shock loss, if that indeed is the issue. With apologies for some over-exposure in at least one of the shots: Scar Shot 1 Scar Shot 2 Scar Shot 3 Scar Shot 4 What concerns me is that, in at least two places, the bald patches feel totally smooth, as though there are no hair roots at all in the skin - almost as though I would imagine alopecia would look and feel. I must repeat again, in no way do I put this down to Dr E's work directly. The donor scar itself looks to be a work of art to my untrained eye. However it would be good to hear from anybody with stories of similar experiences, who may be able to reassure me that my situation is not uncommon and will resolve over time. Indeed, you may be able to tell me that what I consider to be severe hair-fall is not actually so severe at all, relatively speaking. I should add I am currently exactly 6 weeks post op. Any replies from anyone willing to share their experience and put my concerns in context would be gratefully appreciated. Regards, Neil Nelson

Hey Philly, Glad it's going so well for you and you've had such good reactions from people in the know. To be honest, literally only 5 people in the UK knew that I'd had more work done (almost everybody I've ever met in the past 15 years knew I'd had earlier transplants - see above!), and they were astonished at how well the new grafts blended in with my original hair. I didn't have to use Toppik at all (the crusts were hardly visible and came away on their own after 6 days), and I wore my hair perfectly naturally on Christmas Day (day 7) in the company of others, without anybody noticing. And as I said above, the donor area was completely invisible because I'd grown my hair to around 2 inches long pre op as you saw on the day. Right now you wouldn't know I'd been to Miami, save for the scar under the hair - I'm just looking forward to seeing the new hair come through over the coming months. Just occasionally I wonder if it will all work out as well as we hope, but then I check in on Dr E's website again and look at the stacks of testimonials and photos, and I know I made the right choice. You too I guess?

Hi there Philly, Glad to hear it's going so well. Just my two cents on the donor area - pretty much all the soreness in the scar has died down now, after what, 26 days today? I haven't looked at the scar for a few days, but it certainly feels better, and the expected numbness above the scar is starting to abate - much more feeling there now. Interesting that your hair fall has picked up pace now - I've pretty much lost all mine already, save about 1% or 2%, if that. I'm applying the 5% Rogain twice a day as prescribed. Paris, if you're concerned about post op appearance, for what it's worth I grew my hair at the back to about 1.5 to 2 inches pre op, and as a result there has been absolutely no visible evidence of surgery to the outside world. In actual fact I've now decided to let it continue to grow longer at the back, and cultivate a "Bono" ageing rock star style this year. I'm going to call it my "mid-life crisis" style! How cool (or not!) this looks will depend on how quickly and well the new hair grows in at the front, enabling me to sweep my hair back from the hairline. If this works it will mean I can forget about the scar for a good many months until I decide to go short again. Unless of course my Company threatens me with disciplinary action on my appearance in the meantime!

Notsohairy, Thanks for your input to my thread. When you're three weeks post op as Phillyhair and I are, and I'm asking "did I dream it?" knowing it'll be at least two more months before any grow-in begins, it's great to hear such positive feedback on Dr E's work! I have 100% faith in Dr E, but still it's a good time right now to hear the great experience of people like yourself who are six months further ahead. Regards, Neil N

Okay Philly, thanks. I'll be interested to see your photos after the buzz. You're correct though, that my problem might be what is left of the original scarring. Intriguingly I asked Dr E in person and in an email post op, but it's the one question he's been somewhat "surgeon-like" in answering. I guess maybe he's gently encouraging me to wait and see after the scar healing process has run its course, which I suppose is fair enough. But like you I'm curious to know what length I can get away with at the back (and therefore the front of course). Your results will give me a pointer, but I'm a good way behind you at the moment in scar healing.

Philly, Ron, One question I'd like to ask you guys, which I've not been able to discuss specifically with Dr E, is how short you feel you'll be able to cut your hair in the donor area when the scar heals, and how long you expect to have to wait before cutting the length down in that area? I think because of Dr E's repair work on my earlier scarring, my new scar is still very red, sore and crusting at 20 days (significantly more so than yours, Philly, from what I gather from your most recent photo). It certainly would not bear razor cutting at this stage. I wondered if Dr E had set any expectations with you as to how closely you can "buzz" your hair (is that the correct American expression?) when the scar has fully healed and the surrounding shock loss has grown back in, and when that would be?

Happy New Year, Paris. Bit of a long story in answer to your questions, so I'll try to keep it brief. Prior to consulting with Dr E I had at least four transplants over a period between around 18 and 10 years ago. I'm vague on the specifics simply because of the length of elapsed time since then, and I'm afraid I don't have any pictures going back that far. I started with surgery before my hair receded too far, and have since used Minoxidil and Finasteride to arrest further loss, so I have always benefited from original hair to complement and disguise my surgery. The first two procedures were for plug grafting, the second two for sectioned grafts. I used a high-profile clinic in the North West of England for the first two procedures and a private surgeon working out of West Yorkshire for the second two. In total I had around 2000 grafts, which Dr E told me would have required the equivalent donor hair for around 6000 FU grafts today. Perhaps what the pre-op pics do not convey very clearly is that even with a good number of the smaller sectioned grafts in the frontal areas, my hairline undoubtably has a "grafty" look. It simply does not look natural in a face-to-face situation, and people's eyes are constantly drawn to my hairline rather than making eye contact with me. In addition, four "old tech" procedures had left me with very severe donor scarring which means I have to have my hair cut very carefully at the back, with very limited style options. The goals Dr E set with me were to rebuild my front hairline (which Dr E noticed wasn't even level on either side when we consulted in person) with a softer more natural line, disguise the original plug grafts behind my hairline and remove as much as possible of the original donor scarring by "going in" on these scars for the FU donor hair. I have high hopes, even though virtually all the newly grafted hair from my procedure with Dr E 18 days ago has now fallen out. While it was in place, up to 9-10 days post op, the aesthetic improvement in my hairline was dramatic, and if it grows back to that extent I will be delighted and 100% more confident in my hairline's natural appearance. Equally, the new scarring in the donor area is still very "angry" (red and crusty), but from what I can inspect thus far, most (although I suspect not quite all) of the original scarring has been removed. However it will be some months before I'll feel comfortable to attempt a shorter hairstyle in the donor area. Regards, Neil

Hi there Philly, Happy New Year to you. Yeah, it looks as though all my new hair will be coming out - I'm down to less than 10% right now (probably 5% tops), having robustly washed my scalp today (day 16 like yourself). Maybe you are being more gentle with your washing? I've been fairly vigorous because I still have some deep crusting and tenderness in my scar, which I think was deeper than yours due to Dr E's revision work on previous scarring, which was very extensive. I was advised to remove my "deep stitches" at 14-16 days, but I think I will leave them in for another week until the crusting and tenderness has worn off further. I'm fairly relaxed about the graft hair loss, having been there before, although I have to say it's tough to look in a mirror right now and see my hairline looking pretty much the same as it did before I came over to Miami! I'm just focusing on Spring time, which will hopefully bring the new hair back as the growing season kick in! Keep in touch my friend. Neil

I thought you might be interested to see my own pre and post-op images. The one month pre-op were the right and left sides of my hairline with none of the usual additives in my hair (hairspray, gel etc). Image 1 Image 2 Image 3 Image 4 The following three images were taken at 12 days post-op. Hopefully they convey the speed of healing, residual grafted hair and already a more natural appearance to the hairline. (In fact, the 12-day appearance was exactly the same at 8-9 days.) These have a small amount of gel lightly pasted on top of my original hair in order to comb it back, but there are no additives in the hairline itself. Image 5 Image 6 Image 7 I would estimate that around 15-20% of the newly-grafted hair remained when these images were taken at 12 days. At the time of posting this message, I would estimate 10% or less of the new hair remains in place. However even this has softened my hairline from its pre-op "grafty" look. Or so my wife insists.

Make sure that the poster(s) that are giving glaringly great reviews are not being otherwise compensated for their postings. We have had to purge posters from this forum for this very kind of action. While I police these forums daily for just these types of incidents, there is a plethora of misinformation out there. Take everything you hear with a grain of salt and get the facts to back up the claims. That being said, Dr. Epstein is a very fine physician. I have heard and seen evidence of great results coming from Dr. Epstein's clinic time after time. Sir, If you have any concerns about my thread here, referencing my treatment with Dr Epstein, I may be able to allay them by stating my intent to post some pre and post op digitals in the next few days. Regards, Neil Nelson

Guys, Just a quick update at 9 full days post-op. The recovery process has been what I can only describe as astonishing. Now I recognise that I am a fairly quick healer, and I had decent coverage to begin with, but I can tell you the graft crusts began falling out at 6 days without any rubbing, and on day 7, following a confident but still careful hair wash, there was hardly any sign of remaining crusts, and I was able to socialise on Christmas Eve (day 7) and Christmas Day with just a light layering of my usual hair gel and no Toppik or other artificial covering. There are now no visible signs whatsoever of any lingering crusting. What is even more astonishing however, is that around 40-50% of the grafted hairs in my hairline have remained in place, thus giving me an immediate and significant improvement in my original "grafty" hairline. In short, I am where I expected to be after 2-3 months, with the more natural hairline and self-confidence that goes with it. I cannot speak for any other surgeon, but what I am seeing in a mirror after just 7-9 days post op with Dr Epstein is nothing short of miraculous. Phillyhair, how are you progressing? Have you enjoyed a similarly short recovery period?

Hi there P_C, Speaking for myself, I totally respect your efforts to research your choice of surgeon, however I have not been quite as thorough as you in my own research so I'll answer your questions as best as I can. Phillyhair may be able to provide more direct answers because I know he did some very thorough research like you. I didn't speak to previous patients of Dr E in person simply because of the logistics involved, but what I can tell you is that I looked extensively at the patient photos on Dr E's website and, critically, when I asked Dr E in person (via email) what the chances were of me achieving a natural hairline he offered to put me in touch with reference patients without me asking directly. The digital images, plus that unsolicited offer, was good enough for me to have a high degree of confidence in his work. Density I think is very much an individual issue, and depends on what natural density you are starting with. What I am seeing immediately post op is several areas of very dense incisions in and around the centre of my hairline, which still contained natural hair. Dr E's strategy was to build this central thickness in order to draw attention to it when people look at my hairline. Certainly, the overall density of grafts in my front and frontotemporal areas looks to be very high post op, and "graduate" in thickness back towards my crown. I underwent scar repair treatment in addition to new grafting, and from what I can "feel" at this early stage, Dr E seems to have been very successful in removing and closing up the previous scars in one single, neat scar line. I don't believe all the scarring will have been removed due to it's extensive nature in the donor area, but so far the new scar feels neat and clean, and I can feel very little of the original scarring. On shock loss, my own experience at 5 days post op is that I have suffered very little from what I can see. I have washed my hair gently but confidently in the bath in the past two days and have seen very little hair fall. In actual fact, my existing hair looks very strong and the new single hairs have stayed in place up to now, giving me an immediately thicker appearance in the frontal areas, which has surprised and delighted my wife. I hope these comments give you some reassurance, P_C, and they are the kind of feedback you are looking for. I'd love to show you some images, however I don't have access to a digital camera just at this point - as soon as I do, I'll post some up-to-date images. The most important advice I can give you though, is to engage Dr E and his Office Manager Roxy in a direct dialogue, and ask as many questions and speak to as many patients as you feel you need - they will not "strike an attitude" with you if you feel the need to press them hard. I would say, though, that from my own experience and what I have read from Phillyhair and others on this site, if you choose either Dr E or Dr Shapiro, you will be working with one of the best two HT surgeons in the world right now. Sometimes a decision comes down to "atmosphere" and "attitude", and when I arrived at Dr E's surgery and throughout the day of the procedure, everything just felt "right". I believe Phillyhair has made a similar comment in his own recount of his experience last week. Please come back to me if you have any more questions I can answer for you, and good luck with your decision - you will make the right one! Best regards, Neil