hairweare

Cosmetic surgeons have traditionally at least here in the US utilized in person consultations and websites as major marketing tools. Fees are therefor quite uncommon as it might create an impediment to get the prospective patient in the door so to speak. Many employ non physician "consultants" whose job is to close the deal once face to face contact is made. Ultimately it all comes down to marketing strategy. I doubt HT clinics are much different in this regard.

As someone who is young and likely going to progress to a higher NW class, attempting to fill the crown now may later end up breaking the donor bank when the front and sides become much thinner which will require many more grafts. I have previously voiced my opinion in regard to technician performed FUE particularly at clinics that have not already established a world renowned reputation for excellence.

Dr Erdogan appears to be a good choice but although I think that 5000 grafts should give you an excellent result I am not sure that I would want to undertake such a large procedure all at once. While there are some obvious negatives by splitting it into two sessions I think overall the advantages outweigh them. Foremost is that it gives your donor area the time to recover and recipient areas that may require a second pass can be readily identified and addressed during the follow up session. I also believe that due to both operator and host factors the yield may be ultimately higher if one goes with smaller sessions. FWIW, Dr. Erdogan and Dr. Lorenzo seem to have a mutual respect for each other and as noted on the website Lorenzo has visited the clinic in the recent past.

I would leave that up to the actual surgeon to explain. However by history we know that he has had two failed HTs both performed by experienced operators. Something clearly is not right physiologically.

I agree that if you are younger and heading towards an eventual NW6 or 7 preserving the crown as best you can is essential to keep whatever work was done in the front natural appearing.

FWIW: I would advise going shorter on the sides and back now. You have plenty of hair to conceal the scar and with the downward direction of the hair growth in that region it will surprise you how much coverage results even when the hair is much shorter. Your top will then look much better and overall styling will be much easier. Just my 2 cents.

After seeing the OP other post today, I now believe that there may be both physiologic and psychological reasons not to proceed with a third procedure and even undergoing the second procedure may have been questionable. Tough case and one that is not so easy to resolve.

I'm sure it was discussed between Dr Gabel and the patient, but I am curious as to what the doctor felt to be the reason for the poor growth. Working on a virgin scalp would be expected to be a less formidable task than a repair case characterized by diffuse fibrosis with compromised blood supply and constant graft popping. From what I have seen on this forum Dr. Gabel appears to be a fine HT surgeon and I doubt that there was a gross technical error. If it is not a breach of patient confidentiality, it would be educational for all if Dr. Gabel could give us insight into what he believed to be the problem.

FWIW: Lorenzo's post op instructions advises 1month wait for haircut, no clippers over recipient area for 5 months.

Asking yourself whose opinion do you value more should enable you to answer your own question.

Yes, I have had the same issue with a black umbrella that I own. It seems that every time I take it with me it rains, so now I just leave it at home and it rains far less.

Cryingoutloud the example you showed does not appear to be a follicular unit but rather a epithelial scab with an attached hair. The papilla or bulb of that follicle is still likely intact.

"Does anyone care what kind of paint brush da Vinci used or whether or not Rembrandt's tools where superior? Nah, we just enjoy the masterpieces they created." David, having just visited the Prado in Madrid where I viewed the masterpieces of Rembrandt, Goya and Valasquez, I strongly suspect that they all used natural brushes as opposed to a Wagner power painter. I concur completely with the sentiments of Future_HT_Doc and during my own vascular procedures always prefer the instruments that give the best tactile feel allowing for fine adjustments. The high tech "power" tools in our box now that the initial excitement has waned, have for the most part become orphan technologies relegated only to niche situations. I had a good discussion with Dr. Lorenzo who shared with me what all good surgeons know so well in that cases may start out routinely with an initial plan but one never knows what you are really dealing with until the procedure is in progress. Even after performing thousands of procedures I always felt that even with the simplest ones there was always something new to learn or improve upon. Lorenzo seems to share that same approach and along with his obvious hand skills makes him an even more impressive physician.

The patient had a large area covered perhaps as much as 200cm2 so the density was likely at best 20grafts/cm2 which looks pretty good visually despite the fact. I sure he has enough donor left to get an excellent final result should he choose a 2nd procedure.

Unfortunately, there is not a lot of medical evidence making it difficult for physicians and patients alike to assess the true risk v. benefit equation. In my experience I can think of no medical alteration of the endocrine system that does not result in some kind of a compensatory or downstream hormonal effect because these systems act in a dynamic feedback loop and the location and action of all of the involved receptors are not always initially known or well understood. That said SAs could be dose dependent and or idiosyncratic to a specific genotype. There are a lot of things to consider and so many more questions that need to be answered. Although I believe that efficacy has been established, I am afraid that anyone taking these drugs must accept a certain degree of uncertainty regarding their safety.

Consider that over time it is quite possible that the hair in your parietal-occipital zones will continue to recede leaving a very unnatural gap between your recipient hair and the later recession. Once lost it is very unlikely to come back even if started on finasteride afterwards. Hair loss is nearly always progressive but does not necessarily occur in a linear fashion. One might stabilize for many years only to accelerate suddenly to an even higher NW class or regress so slowly after a successful HT that it is not initially realized until it is too late.

Sorry, I am only a formerly university based triple board certified physician so I will defer to your vast experience and greater expertise on these matters.

While it won't put you at risk of bleeding to death or requiring a transfusion, you will bleed a bit more making it messier and more time consuming for the physician who you will undoubtably piss off as he pushes down with his sponges in order to achieve hemostasis.

I would concur with gillenatator's comments and would add that it is not really possible to know how the donor area responds until the procedure has been completed and several months have passed allowing for recovery. One could be surprised either way in that there are more or less grafts available for future procedures. This is a good reason to start with a smaller conservative session to see one individual characteristics and then go more aggressive on the second one if there is excellent recovery.

I agree that even if the pt had shed his scant remaining native hair in the recipient region it would not explain the resultant poor growth. I don't think the visible blood is necessarily an issue as good blow flow is a necessity for the grafts to take. I do concur than despite the less than dense packing there appears to be considerable popping. Unusual scalp characteristics or fibrosis from previous surgery could account for that. Yes the post op pictures are very concerning.

Olmert, I perform invasive cardiac procedures and your statement about robotic surgery or new devices is flat out incorrect. Again, one must wonder why so many ophthalmologists do the procedure but don't undergo it themselves. I have been a contact lens wearer for over 30 years and every doc I consulted with told me to stay the course since I have had no problems. It is the same in all surgery, once you are cut, you have irrevocably lost your virginity so to speak.

I always wondered why so many of my opthalmology colleagues wear glasses but could never get a straight answer. Below is a post from a medical forum that may partially explain why. Posted by omar193 on November 18, 2014 - 11:35PM EST Author Specialties: Ophthalmology A 46 year old caucasian female presented to the Emergency Room complaining of a foreign body striking OS approximately 3 days prior while driving with her window open. Past Ophthalmic history is notable for myopia status post LASIK in 2002. Visual acuity OS 20/200. Slit lamp exam reveals a a lasik flap with nasal hinge, vertical striae adjacent to the hinge, and a nasal 3 x 4 pericentral epithelial defect. CT orbits was negative for radiopaque foreign body. No foreign body is detected on comprehensive anterior and posterior segment ophthalmic exam. The remainder of the ophthalmic exam revealed no intraocular abnormality. A bandage contact lens was placed and the patient was urgently scheduled for exploration and repair of the cornea. During the surgery the LASIK flap was easily lifted and a large sheet of epithelium was peeled from the stromal bed. The bed was cleaned with a corneal spatula and the flap was repositioned stretched and smoothed back into anatomic positon. The patient's original record was requested and the patient had undergone LASIK OU for 4 diopters of myopia using a mechanical microkeratome in 2002. Estimated flap thickness OS was in the 90-100 micron range.

I have very wavy hair especially in the back and despite the relatively crude techniques used in the 90's to my amazement the wave pattern in the recipient frontal area looks quite natural. Even the recently implanted beard hairs placed in my occipital scar seem to have grown in conformity to the surrounding hair. I think more of a problem are grafts that are placed at too much of an obtuse angle in areas where they should be acute. This can be overcome if not too egregious by adding more density with subsequent grafts which are correctly oriented.

How many follicles are transected from the scalpel along the incision line? I assume it is also possible that the sutures could also to a much lesser degree damage follicles as well. Nonetheless, I would agree with Mickey85's assessment that the yields of the best FUE and FUT surgeons are likely quite similar. I personally would never consider going to a clinic that doesn't specialize in FUE or relies on robots. For North Americans that certainly limits the choices.

After 3 FUT's I was told by my original HT surgeon that my donor supply was depleted and at best would only yield 500 grafts from another strip which would fall way short of covering the thinned out hair line, top and crown, now that my native hair had nearly completely shed. A conservative approach of 1500 FUE grafts to the frontal 1/2 along with 300 beard grafts into the linear scar resulted in significant improvement. The shave down was not too bad as the thin 1.5" of hair that I had on top was left un-buzzed. I waited 2 weeks before going in for a trim to blend the top and sides and within 2 months I had returned to my pre-op appearance. Now at 8 months out I am looking at a second procedure of 1500+ more grafts to the back and perhaps 50-100 singles to the hairline? I am anxious to hear what Dr. Lorenzo suggests and will post his pictures after I get back from Madrid.