JoeTillman

This is a nice result for so few grafts. Obviously there was a boost from medication but it is a prime example of how medical and surgical treatments working in tandem can have a significant cosmetic improvement.

There is no such thing as a best surgeon. There are too many variables for there to be one so there is none.

Blake, Thanks for your answers. In my experience, I've seen many results of both FUSS and FUE where the yield was sorely lacking and this poor growth would manifest in patches. I'm not saying that it would be ONLY patches but you could say that there would be areas of visibly higher growth vs. areas of visilbly lower growth. Some cases, in fact like the one I was dealing with today through my website, are generally thinned out but have areas of bare patches of zero growth. It was his first FUE but his second procedure. I'd love to chat about this more, but I'm exhausted:( Good night!

Blake, I understand 100 percent and that is a good presentation with the 5000 grafts. But consider this; if you take 5000 grafts and you get 80% growth (4000 grafts) what makes you think it will automatically look good? Graft failure does not occur in an evenly spaced out pattern of two grafts missing for every ten grafts placed (assuming your 80% number). Graft failure will usually occur in spots where one area isn't as dense as the other and the issue does become noticeable because that 20% failure is not spread out evenly, it is most likely going to be concentrated in a smaller area that draws attention. Is it a game changer for the patient? Sometimes yes, other times no, depending on too many factors to discuss. In addition, I get what you are saying about the fibrotic tissue. It was Dr. Feller that first mentioned the "confluence of scarring" issue years ago when the initial FUE debates were raging but to be fair, where are the cases of compromised 2nd procedure growth after successful first pass procedures? Yes, the argument can be made that no second surgery is guaranteed, and I know PLENTY about how the donor tissue does indeed develop underlying scar tissue from FUE much more than from FUSS, but I just don't see the fall out from such developments that theorectically hinder subsequent procedures. I'm not saying this doesn't happen but I am saying of all the cases I've followed and/or been involved with I can't say I've seen this being an obvious, much less continuous issue. I think that ulimately, at this stage in the game, it comes down to donor management and maybe NOT putting 5000 grafts in the front for young NW3's and NW4's. Too many times that "wow" factor can be just as impactful for bad growth as is for good.

Blake is absolutely correct, but in the end, all things being equal these discussions about the survival rates are meaningless. The survival is enough with FUE from good doctors that the final result means the only difference, and the ONLY difference that matters, is whether or not there is a strip scar. Period. Every other debate or discussion is for the sake of one upmanship and kool-aid induced cheerleading, and in some cases, not letting go of the past. I have no problem with my strip scar as I can have short hair cuts and I still have damn near 10,000 grafts, with 60% of those most likely not available to me through FUE. Strip served me extremely well, but for many others, FUE is the only option to consider for the obvious reason.

Chrisdav OMG!! I had to laugh out loud when I saw that:) I forgot I posted that some years back. It is a bad photoshop job if I ever saw one but I made it to make a point in a similar discussion. If I recall, that was the estimate of what a 5000 graft strip would look like if it were laid across the top of a bald scalp after removal. This is to give everyone an idea of how much hair we're talking about in one session of 5000 grafts and how the strip represents full density in a sea of bald scalp. The area of loss is that of a full blown NW6 which is a bit better off than I was when my loss was at it's worst. This shows how a strip of full density hair must be distributed over a massive amount of bald skin to achieve what we like to call an "illusion" of density/coverage. Thank you for pulling this out of your archives as it illustrates my point perfectly:)

No, it doesn't. I'm referring to the person that started this thread. I said that he won't be able to have a low aggressive hairline and meaningful crown coverage with 5000 grafts in one session and qualified this by saying it may happen if he has above average characteristics such as a small head or thick hair shafts but again we are getting back to what should be expected for an average patient. It's black and white. I stand by what I said because as I've already stated I was going by the information at hand and combined it with what I know to be true for the average patient. We're not talking about above average donor areas. We're not talking about body hair. We're talking about what has already been stated and recommended by the member doctors, whom are both well respencted. I really don't see how you can debate that. Yes, I know. That's why I said... The number of days it takes for "one session" is irrelevant. 5000 grafts is 5000 grafts and if the OP wants a low hairline and significant crown coverage as a NW5 it isn't going to happen. Two days, four days or two weeks to get 5000 grafts does not change this. What you are talking about with regards to the potential is dependent on getting far more than what the OP said himself was recommended by the two doctors he consulted with. You keep talking about 7000 or 8000 grafts but those numbers have nothing to do with this case. Why do you keep saying this? We're not talking body hair, we're not talking about any numbers higher than what the OP said WAS RECOMMENDED by the doctors. Maybe you are confusing the issue of what is possible with 5000 grafts vs. what is possible for final graft counts and what can happen if these counts are pushed to their maximum. These are two competely different discussions. I can appreciate this point but you are asking me to be careful to not lower expectations? Seriously? Let me repeat what my website slogan is. "Think. Learn. Apply". This means that one should think about what I say, learn from what I say and apply it to their own situation. If it makes sense, great. If it doesn't then they are still thinking, they are still learning, and they are still applying whatever they learn to their own situation. This is all I ask of people and if they think it makes sense for them then so be it. If they do not then I wish them all the best but to say that what I'm telling the OP is irresponsible is, well, irresponsible. I'm urging caution and realistic expectations. As far as me being a representative for Dr. Karadeniz, I am not his representative, so I have no interest in getting into the political clinic battle you are trying to start. Been there, done that, no thank you so please don't try that route with me. I will be crystal clear on this point. I am my own person. I have my own opinions and I will not be swayed or influenced by anyone just because their name is in my signature as someone I work with. Dr. Karadeniz is my colleague, not my employer and we choose to work together. I like body hair as filler (much more detail deserves to go with this but ask me later) but whether or not Dr. K performs body hair transplantation is irrelevant because body hair is irrelevant to this discussion. I'll repeat, the OP said his recomendation was as high as 5000 grafts. He is a NW5. That is all that is relevant. That is all that matters. If my very educated and very experienced opinion clashes with your opinion that is fine, everyone is entitled for sure, but I'll remind you that my postion would be considered as the responsible one of the two as I'm promoting caution, reason and reality that should be expected for the average patient. What you are promoting is the dream of what might be possible if all of the stars align properly. I will not be associated with such promotion because as I said earlier, been there, done that, no thank you as the stars don't align as often as people hope they do. Both doctors mentioned do really good work but I'm positive both of them would agree with me if they were to pitch their respective opinions in this thread. I don't know if you could say the same. And this isn't a slight on the abilities of Dr. Koray or Dr. Doganay. They both appear to be fine HT doctors and have happy patients. I feel this should be made clear.

Busa, Well, let's explore this further. First, why did you capitalize the letters "ASS" when said I was "ASSuming". If you re-read what I said, I did not say it would rob the patient of "ANY" chance of addressing the crown as in EVER. I'm talking about one procedure which is why I said it is good to sometimes break these things up into two sessions. Concentrate in the front in one session, then concentrate in the back for the second session. A true NW5 has a huge crown to deal with and 5000 grafts (which was the high estimate) will not make a huge difference, if any, if a low hairline is to be rebuilt. When I talk about having a "lower hairline" I'm talking about what most people ask for in that they want closed temples and something resembling what they had before loss started, including temple recession. This can mean about 2000 grafts or more in addition to what would be necessary if they opted for a more mature hairline that still makes a huge improvement in facial framing and gives a more youthful appearance. The more mature the hairline the smaller the area to place hair. The smaller the area to place hair with the same number of grafts the higher the density will be. It's simple math. Since we're dealing with estimates of up to 5000 grafts then any crown coverage, again going by the NW5 category, will be weak at best with a low hairline. In fact, it would be a waste of time. Even with a higher hairline, in my experience, 5000 grafts leaves the patient wishing for more crown attention more times than not. And no, I don't know what his donor is like but neither do you. I'm simply going in the information at hand and my own experience. He's had two consultations with two well known doctors so I cannot "ASSume" 6500 grafts are available in one procedure if neither of these doctors recommended as much and neither can you for that matter. In fact, I'm not sure where you got this number to begin with as no one else has mentioned it in this entire thread. The chances of him getting 6500 grafts in one procedure are next to zero and I don't need his photos to see this. I'm going on averages here but that is also why I invited the OP to use me as a second opinion resource because I'll tell him what the truth is regardless of whom he's dealing with or what he's been told. It's nice being able to talk about what's "possible" but in reality we have to deal with averages and not assume the upper crust of anything. Full coverage and a low hairline on a NW5 with 5000 grafts is not going to happen for the average patient. Maybe the patient has a small head. Maybe he has rope like hair shafts that are four times the diameter of the average hair shaft but this cannot be assumed and I have every right, and even the responsibility, to ASSume he's not an excpetional surgical candidate above and beyond what is average. My mission is to tell people the truth, not what they want to hear, because in the end the doctor doesn't have to deal with the outcome, the patient does.

This is very nice work and it is always nice to see patients with early growth. It is interesting that you are noting the single hair units that were created for the placent and that you documented this. It is good to know these things. Thank you for sharing.

You seem like you have a decent grasp on your situation. I can honestly say to you, uncategorically, that having a lower hairline will rob you of any chance of having a positive cosmetic impact on the crown. I've not seen your photos (forgive me if you posted them somewhere) but if you are a NW5 or so then having a low hairline means you still have a bald crown. Having a more mature hairline and even light coverage in the crown means you are no longer bald, just mature. In fact, having a mature hairline with good density/coverage for the top and foregoing the crown for a second procedure is also a good idea. This allows for more grafts to be concentrated in one area each time. It's just one option but I think it is the safest. Too many times I've seen patients get a healthy number of grafts only to think the result is too thin because they wanted everything done in one procedure. It's something to think about. Btw, since you've had consultations already you are welcome to use my second opinion service on my website. I do this for patients of all clinics.

Agreed with Ailene and I think it is most likely because they were stuffed into incisions too deeply and possibly handled from the shaft of the hair and not from the surrounding tissue.

Yesterday on another forum you said you had 3000 grafts placed however this looks like barely 2000 were placed, if that. On this forum you are saying it is 4000 grafts. Please clarify.

Glad to help. Currently you have Shapiro Medical in Minneapolis and SMPLooks in New York. More clinics are opening this year and next so your options will improve soon.

Well done, Dr. Wesley. Nice use of the grafts and it looks completely natural.

As a 28 year old NW5 you can't afford to go aggressive from the start. Someone was making the argument that milliions of men keep their hair till they die. This is true but HUNDREDS of millions of men dont. Regardless, you can't look like those millions of men because of donor hair limitations. Having a low and aggressive hairline takes away from the crown which requires more grafts than the front. There are always exceptions to the rule but I don't think it is safe to assume you are that exception. Go the safe route, get your result, then decide if you want to lower your hairline later. You can always lower a hairline, you can never take it back up.

Sorry, I haven't had much time to reply. I'll try to answer all the questions. Abit, First, I had another look at your initial post and I overlooked where 2400 grafts were recommended. I think that for you get enough density to be happy you'd need more than 2400, closer to 4000. It is difficult to tell with your hair so short in the photos however so I can't say for certain. Considering where you had this estimate I am certain 2400 isn't enough. It rarely is with them. 29 isn't too young at all btw. It's a fine age but stay away from FUSS (strip) surgery. SMP can help with donor scars, both strip and FUE, but it is not a guarantee with that either. Scar tissue is different from skin tissue and I've seen SMP literally disappear inside of two weeks inside of scar tissue. When it works it works well however but it is still something you should now rely on if you have surgery. The cost of SMP is significantly less. For you, temp SMP would probably run well under a grand. Depending on how it fades for you you're probably looking at an annual touch up bill of the same or half of your original fee. SMP applied to a scalp with hair that has length is only effective if a certain amount of hair density already exists. Abit does not have that density and I think that an every other day zero guard shave would be the idea way to move forward. Once the length starts to kick in then the positive effect of SMP for the "shaved effect" is completely rendered useless. Topical finasteride can help with reduced or zero side effects but it is difficult to get even with the required prescription and it's efficacy is anectdotal at this time. I've see it work but the number of people that have used it is extremely small.

Hi Abit, I'll do what I can to answer your questions. 1) I'm thinking about going with FUE because I would like to be able to cut my hear short. Am I wrong in this? You are probably not wrong but given your skin tone, can you say with confidence that you won't have dot scars that are lighter than your normal skin pigment? Can the doctor you choose guarantee this? If this happens to be the outcome, where you do get whiter scar tissue, it may cancel out the option of cutting your hair very short. It is something to keep in mind and I don't like seeing guys going into surgery not understanding the possible outcome. 2) I'll probably have the HT this summer. I'm going on a 1 month vacation to the middle east. Is it better to do it before or after? That's up to you but I think for most it makes sense to have one after your vacation. You don't want to be worrying about bumping your head and dislodging a graft for the first several days. Having a hair transplant just before a vacation can on the other hand be beneficial for laying low during the recovery. 3) I wouldn't mind getting back on minoxidil after the HT but I don't want to take finasteride at all. Is that possible? Yes it is possible, just don't expect this to be a powerful long term solution for preventing more loss. It is not a matter of "if" you'll lose more hair. It's a matter of "when" you lose more hair. 4) Are there any other things to consider after the HT e.g., maintenance, side effects, life style changes? Possible bad or no growth. Possibility of chasing the loss with multiple surgeries. Possibility that your donor scarring is more visible than you bargained for. These are all possibilities and I've seen them all come to fruition. The one option that I can guarantee is that if you do not have surgery then you will not have to be concerned with any of these issues. None. At all. Ever. I think because you have a good head shape you should consider keeping the shaved look and try temporary scalp micropigmentation. If done right, it can make a huge difference for the better. You won't have to worry about the issues above and if you ever get tired of SMP you can just leave it alone and it will disappear. Never ever get permanent SMP. Ever.

I've had ten thousand plus grafts from my donor area. I know others that have had more.

Abbie, You statement was made as an absolute, in that without the use of Ugraft raised scarring would result. I think it is fair to ask for examples of this raised scarring that, according to your "if/then" logic, will happen without the use of Ugraft. I'm only referencing your own statement and asking for reference. If this is an issue that occurs without Ugraft then every patient reading this should be made aware with visual references. Why is FUSS even mentioned? It is irrelevant to the discussion. I think I will. Thank you for your answers. I'll email Dr. Umar about this today.

You should take new photos without a flash. In the second image, the flat of the crown is at a 90° angle to the camera lens so the flash is bouncing off of the scalp and reflecting directly back into the lens. The area just below the occipital hump is at an angle leading away from the lens so the flash is not affecting it as much and in fact it is potentially creating a shadow effect on this inverted downslope which makes this area potentially look thicker. Use good ambient lighting with no shadows and it will be more accurate. I also think your hair should be a bit longer as hair that is too short can be difficult to assess.

Hi Abbie, I was hoping there would be more information about the raised scarring that traditional FUE leaves behind. If this is a problem then readers and patients need to be alerted. To reiterate, the links you helpfully provided did not mention this issue so some sort of reference with photographic documentation would be appreciated.

I'm not sure why it is but I've seen it enough and heard enough patients tell me straight up that they have noticed a difference and this was before I was even talking to them about it so there was no subconscious influence. I had one pharmacist tell me that I was right and he explained to me why but I don't have enough time to go into it at this time. I've spoken about it before so maybe a search will turn it up. I've always said if one is on generics and they feel it is working then it probably is, and the majority of patients will experience results no different than from name brand, but I know what I know and so do Dr. Wong and Dr. H as they specifically changed their prescriptions to state specifically that there are to be no generic substitutes.

By "consistent" are you referring to efficacy? Dutasteride is stronger but ironically I have not seen it work consistently better than Proscar/Propecia. In many cases where I know someone has switched from Proscar or Propecia to Dutasteride the improvement has been obvious. But yes, I would recommend more than generic.

I have seen many cases where generic was not as effective as the original name brand Proscar, so yes, I personally think it is a more consistent medication.

Then go see a local dermatologist but the short growth is indicative of a shorter growth phase. Also, I would suggest switching from "finasteride" ,assuming you mean the generic, to name brand Proscar.