Prof101

I was just lucky (if it turns out well). Managed to get a consult within 3 months and surgery date within 5 months ... frankly I am worried, even if he s a top doc

Anything wrong with Lorenzo?

Thanks Melvin for the video. It is Couto, not Lorenzo. Ok I will contact a hotel then. I was thinking of an Airbnb so not to have to run many people/discretion. But I really feel like I need a recliner in addition to the airplane pillow.

Two unrelated questions in one topic. Going to Madrid for HT. 1. First - I am debating between applying for Schengen tourist visa vs medical visa. I think both are legit in this case. I am afraid the latter (medical) will cause some delays as they are asking for medical notes from my home country and it is unclear what they want. I do have the note from the surgeon office in Europe. Any experiences here? 2. I am a stomach sleeper and very nervous about post-op. I would like to find a hotel with a recliner bed where I can sleep on my back at a 45 degree angle. This is what is usually recommended for the first few days. I therefore wonder how one would go about trying to find hotels that have such beds? Not sure stacking pillows can do the job as neatly. Niche questions but hopefully someone has some experience with either.

@HugoX what was the density of your donor pre-transplant? And by any chance did he measure density afterwards? What I am not understanding is that I am taking a LONG CLOSE LOOK at the donor areas of those incredible results on his website, and I can BARELY see reduced density in donor. I just don't get it. Did you have like 300 FU/cm2 :)? Or Did Zarev apply a drug that regenerates follicles?!

Congrats. So far the top 5 most impressive results are from the same doctor at the same clinic. People with dense donor were not born yesterday, yet Zarev is making history. I have tried and tried to reach Dr. Zarev. Finally managed to get his assistant over the phone. It sounded like they were inundated with calls. She did not get back to me. So after trying several times I gave up and now going with Couto.

Glad to hear that folks. I will definitely be updating the community. I am going under the "couteau" (knife in french) in September. I got lucky to get in so quickly, not sure why he was so kind with me and spent so much time... Anyway, I am nervous about my really poor density, and I think during my consultation on surgery day I might ask him to be more conservative than the plan he drew. I would rather have a really mature hairline, over having to worry about running out of donor for some coverage for the crown ... His plan is to do the hairline.. let the results come in, come back to him in a year and then schedule a procedure for the crown. He is the only one who sees room for crown... but since he won't be using more donor on the hairline compared to others (all quotes 3000 grafts) I have nothing to lose to go with a more confident doctor about long term prospects... we shall see. I will be one of few on here to document a Couto experience.

just an opinion, contrary to above. If you have sufficient grafts I would actually remove them with electorlysis (or laser works no? ) because it is a bit too agressive, and if you are lacking donor, you can afford to use more grafts in the future in a conservative way.. If you can't afford to lose grafts, them maybe try fue on a few of them and see if they leave scars. The doctor can actually use the smallest possible punch ... Your case reminds us of the need to keep the hairline quite conservative... I hope that is what I will get with Couto will have to try to convince him not to go too agressive

I might not have even sufficient donor for the crown - he wants to see me 1 year post op to decide on how much to put in crown. But seeing many people with baldness limited to the crown (my dad being one) why would that look unnatural? Just getting your thoughts here. I am glad you raised that issue.

Here is a photo. Dr Couto will not touch the crown. Sorry I don't have a picture now of my decimated "hairline". Basically since I have weak donor, he will be implanting hairs right at my current hairline, which is why I call it "fortify". I am hoping this means that I won't have an island ... Thanks to all for the clarifications. I will be taking more before pictures. and document my "journey"

Thanks for your responses. So after reading them and some research let me know if the following is correct: I can start wearing a loose hat 10 days after surgery. And perhaps a normal hat within 2-3weeks? I will have to wait 3 months for the redness to be gone in the recipient area? (some people are more lucky). By the way I am not extending my hairline, just fortifying it. The hat cannot cover the donor area. For how long is the donor area wounds/reddness obvious? Just trying to figure out whether a hat is good enough to hide transplant. I understand that any scarring (white dots) are permanent and I can only SMP after 6 months. Your thoughts are much appreciated.

I was offered to schedule HT in the middle of school year next year (I am a teacher if my username does not gives that away). I would not like to have uneven hair length especially since it is hairline. So ideally I would like to start the semester buzzed down, teach, take a 2 week break (I can), come back with a buzzed look or maybe at least buzz down within a month. And then let it grow 5-6 months later. Is that a problem in that it would not allow me to monitor growth? I can take microscopic pictures of hair sprouting. I am also worried about donor area scars, if I buzz. So I was also wonder whether I can SMP (temporary) the donor area after a month.. Any information about concealing a HT would be great. The good news is that I am joining a new school so if I start the year with a buzz cut and end the year with a head of hair, as long as it is well done with natural results ... I should be fine. Update: The main questions has been answered thanks. Adding a question. From the photo below do you think that conservatively fortifying a mature hairline without doing crown work can look natural? I believe I have seen many operations where the crown was not touched because of insufficient donor and the results did not look unnatural (with mature hairline). But just wanted to double check. Thanks!

What I don't understand however is how come my donor area has the appearance to be thick (I even get complements on it) if I have BOTH low density and thin hair. That part I never figured out. Only two docs told me my hair caliber (but not density) is good: Mohebi and Feller.

Fully agree. I don't believe in miracles either. Which is why I had to pause and think of why Couto is more optimistic. But my thinking is as follows. All doctors agree that I have 3K and that they would use it effectively for front/top. And that is Couto's plan in the first surgery. Therefore his optimism about the possibility of a second surgery is currently immaterial however alluring. I will probably not go for Vertex unless I am convinced I have the supply.

Yes, Mwamba responded with the plan. A nice long write-up. He estimates I have 45 FU/cm2 in donor area (although this is lower bound, he found some areas up to 60). He calls it below average but to me it sounds like it is VERY LOW!! Which is why I am really surprised that Couto thinks he can do more than 3K with me. (3K in front and more for crown later...) But My plan is to go to Couto, and if donor area looks depleted then go to Mwamba for FIT. I think the last thing that a hair surgeon want is a depleted donor area, as this becomes a major reputation concern ... "do no harm" So Couto must know what he is doing, being a top doc with impeccable reputation apparently.

Thanks. do you have a link to these Spanish forum?

Here you can see what lies underneath what appears to be a a solid donor area .... is a not so solid one. I think Dr. Feller and Dr. Mohebi here were right, I have a certain level of waviness of thickness that are underestimated. And they hide the poor numbers.

Thank you for the responses. I hope you understand that after seeing world class surgeons - but clearly not all , I am at a point where I would benefit most from comments about the questions/thoughts I raised rather than suggestions of new clinics. I reached a capacity limit for new consultations I attached a picture of the donor area. It is deceptively plentiful. No matter how much it lacks of density, my hair characteristics are such that my donor area looks good. It is far from see through. The sides are poor though, I admit. I don't have a picture of them (that is discrete enough), but the sides won't handle more than 20% of loss and my surgeons know that. Thank you!

Background: I am 42, heading to NW6 or even NW7 but on meds and been +- stable for the last 5 years. In fact some improvement the last year after dermarolling and massaging. My problem is that I have LOW donor density. Most doctors (Feller, Mwamba, Hasson, Mohebi,..) estimated that my absolute max is 3.5-4K of grafts. On the lower range Hasson will not do more than 2.5-3K. Therefore I either need to think about FIT (harvesting beard hair in the donor area) OR a magician. Which is why I paid visit to Dr. Mwamba and Dr. Couto lately, respectively. Dr. Mwamba in 2022 (in person consultation) I have seen many surgeons in the US, and no one has spent any time measuring anything on my scalp except for Dr. Mohebi. Dr. Mwamba is most thorough on this level and I really appreciated it. He took his time with the scope to count my density in various areas, measure the potential progress and tally up the donor area. He found that I have nearly 9K of available donor hair and he is comfortable using 3K. He said he can restore the mature hairline and top with 3K. He is open to FIT in order to do a second procedure for the crown. Harvesting 2K more donor but replenishing the donor with beard hair, which is plentiful. For this to look good however we talked about me having to keep my hair short on the sides and back. As otherwise the beard hair would stick out the more we use of them. The more FIT I do, say I need 3K, the more I would be looking at having to wear an upper cut type of haircut. He is very nice and answered all questions. He said the office will type up the findings and send me that together with the recommendations. (I am nervous they have not been responding but hopefully they will soon). I asked him about scars. He said the FUE punches these days do not leave scars (which I believe because I have seen many cases on this forum without observable scars), and that applies to the beard as well he said. He said the beard is even better at healing than the scalp and it is very rare to see anything after. The consultation is not free but very affordable and worth every penny. Dr. Couto in 2022 (in person consultation, free) I have long been impressed with Couto's results and I really feel lucky that I managed to get an in person consultation with him. He is known to have wait lines of 2 years + sometimes. Also there is an aura of mystery around him, similar to Zarev: unbelievable results online, but not many reviewers online. I think now I know why. He is about one of the nicest and down to earth doctors that I have seen and he spent a FULL HOUR with me. I really have no idea why he was so generous with his time. I ran out of questions and things to talk about, and he showed me around the office and so on. He began asking about medications and we talked for about 15 mins at least about the importance of making sure that I am taking my medications. He used the scope to look through the scalp, and also examined the skin itself. He did not do the type of counting that Dr. Mwamba did, but he did look closely at my donor area. I received one bad news after another: Low density (I knew), my FU have mostly 2s and not many 3s-4s (did not know), my hair is thin (the opinion has been split on this), my head is wide and needs more grafts for a good result, and I have high contrast. But the worst news of all is that he said FUE leaves scars, as I will explain shortly. I asked him about how many grafts I have in total. He said he does not like to make such estimate like this. He said in the op room when they shave my head and start looking at extraction spots and so on he will get a better idea. Plus the availability will depend on how my hair will look after the transplant. So to his mind it is multi-factorial and I might have more than 3 K (he thinks most likely). So I was surprised when he said he is willing to take me and drew a hairline and showed me what he would do (same as Dr Mwamba's idea): Hairline and top, stop short at the crown. THEN wait a FULL YEAR, and go at the crown with whatever we have. He thinks most likely I will have some left for the crown (reiterating that I might have more than 3 K). To him FUE does leave scars. The reason is that he is meticulous about making sure to have near 0% transection rate. So he wants to use the smallest punch (0.8mm I think), but not smaller to a point that it could cause transection. He wants the full follicle with the bulb (where the stem cells are). This issue is one of two issues that are giving me a pause. Unrelated but important: contrary to me prior belief, according to him I would be better off with a longer cut when harvesting is aggressive. I actually thought that those that adopt an upper cut after HT do it to hide any thinning in donor. Would appreciate thoughts on this. As for the before and afters and the website mystery: I have seen people on here wondering why he does not have his website up, and why he does not have many real cases on this forum. Some suggested (as they do in the case of Zarev as well) that he is very selective in the cases he shows, implying some subpar results or something like that. Well, I can happily report that he scrolled through HUNDREDS of cases in front of me, organized by day of surgery as part of his own in-house portfolio. He also scrolled through his offline website. I kept saying wow wow wow. "How did you manage to do this?", etc. I was really shocked by how good everything looked. He told me when they had the website up they will literally get 300 emails every day. I believe him. Not many surgeons willingly open their folders for you. So my theory as to why we do not have many reviews on him is that most of his patients are from Spain/Portugal and nearby countries, that they usually would not come to english speaking forums and that they are sufficiently happy and don't feel the need to look elsewhere. I cannot say however whether he makes people sign wavers (I am merely mentioning it because a couple of docs in the US do it). He then went and introduced me to someone who is on a checkup 6-months post op visit (from spain). Unreal ... as his pictures. But it is true that people in Spain tend to have denser donor areas. So that also explains why there is less drama about HT here. If you got the money you go to Couto or Lorenzo and be done with it. In terms of methods, what separate him from the rest is that he does not do more than roughly 1K per patient a day. He only has 2 patients every day, 1K in morning and 1K in afternoon. He explained to me that he wants the grafts to spend the least amount of time outside the body. Also the less trauma to the donor in one day the better. The wait is very long (Waiting to hear back on dates). But I do not mind that. My main issues are this now: - All previous docs saw a max of 3K and therefore did not see the crown as being remotely possible without body hair. It seems (if he is honest) he tends to disagree. While he did not promise how much there will be left he said "you have more than 3K" and he wants to wait and see how much we can use. Normally I would be suspicious but for someone who has an excess demand, I don't think he is trying to win me over. I am a difficult case, while he only has to turn on his website for a month to book a full year. - Second, I am someone who, if medications fail one day, might end up NW7 in worst case scenario. So the issue with FUE leaving scars (dotted points) is problematic for me. I am assuming that beard to donor grafting (in case I decide to shave it off one day) would completely resolve this issue of scar visibility? I am not too familiar with the tattoo business either. So the allure of Dr. Couto is not only his natural results but his Zarev-like magic. Perhaps his super efficiency with grafts usage and survival rate will make a meaningful impact on overall outcome... Alternatively I can go with Dr Mwamba and not worry about the scars and work with someone who is ready to replenish the donor area as we go along. But Dr. Couto does some magic similar to Zarev and it is really hard to turn down that opportunity. Thoughts MUCH appreciated and I hope that me review was helpful as there is a lot of interest in him, with few sources.

How to contact Dr. Coutou's office? Their website says it's under construction... He is worth the wait, if he offers a good consultation(?)

Thank you Melvin!

I Know for example Dr. Zarev (who is impossible to get) uses tools to accurately measure donor density in each zone, hair caliber, recipient area size etc. He does the arithematics and has a software for that apparently. Since I can't reach him, any other doctor in Europe comes close in terms of relying on objective data? I know Zarev is an outlier maybe, but what is the next best clinic in that regard? Thanks

lol When I first of BHT you can imagine my excitement when someone saiid they grow more like head hair... they do not unfort

a picture of my body hair. Have a thick beard as well. But I would never use them on top. Curious about fit farming as the only other possibility, but. concerned about the outcome. Not a very common procedure, so I have only seen a couple of them.

@Melvin- Moderator you did also BHT? How much, which thread would be best to see the BHT outcome. Where did you put them those body hair?