BDK081522

I'm sorry but we are just going to disagree as I can tell you are steadfast in your theory of FUT being far superior to FUE yield. You state you're basing your "opinion" on scientific facts right? So, let's take a closer look at what you stated in your rebuttal. You said "The facts of the the science behind the surgery is that FUE grafts have less supportive tissue due to the small punch size which decreases the likelihood of graft survival and takes less stem cell from the transplanted grafts." This statement shows me you know nothing about the "science" behind hair transplantation. There are no stems cells in hair transplants. You are simply removing a mature hair follicle from one location on the scalp to another. The follicle remains exactly the same as it was in its' previous location. Stem cells are cells that have yet to determine where their genetic code is going to lead them. They quite literally can become any cell, organelle, or organ in your body after the differentiation sequence. The follicles that are removed and implanted with hair restoration have always been and will always be hair follicles. Hopefully, they were taken from an area that was DHT resistant. Also, I'll humor you and we'll say that FUT always yields better than FUE for arguments sake. If this were true the percentage is so nominal that it could never be detected at normal human interaction distances. As an example, we'll say FUT yields 2% better than FUE. For a 2000 graft restoration that's 40 grafts. It's imperceptible and irrelevant and I actually don't even believe it to be true. This prospective patient doesn't want the FUT scar. He has his reasons as many other patients do as well. He's about to give up hope because of what you're suggesting to him. That's just not right in my book.

He said he didn't want it lowered under where his current hairline reaches so not sure why you would give him this hairline. Also, you thinking 1500 grafts will give adequate density dropping his hairline 2cms is just plain wrong. Please don't take this advice.

Just spray the grafts when the itching becomes unbearable. You'll get some relief but it doesn't last long. Spraying won't hurt anything so feel free to spray as much as necessary. It will eventually dissipate but the first week is difficult for sure.

FUE being hit or miss is an antiquated take on a very viable extraction technique. It comes down to surgeon selection. If a patient does their research and chooses an ethical, well established surgeon with years of experience then the technique doesn't matter. Both will yield similar results in the hands of of skilled surgeon. Now whether or not you think a patient needs to start with FUT to maximize donor capacity is a different argument. That usually comes down to donor characteristics and not actually dependent of extraction method. Your experience with FUE may have been negative but I don't think it's prudent to be telling prospective patients just starting their journey to disregard a surgical option based on your own bad experience. Once again if you went to a top tier clinic you would probably be happier with your result.

Kind of a misleading representation due to the patient's hair being wet in the before pictures. Wet hair will always appear thinner but nonetheless still a very nice result.

Firstly, he wouldn't be "wasting grafts in the forelock". If you look at the first cm of his hairline you would see that these are miniaturized hairs that are on their way out. Any transplant around the hairline could potentially shock these out so you have to reinforce the area or else he could end up with strong temples and a receded midline. This equates to unnatural. Meaning doesn't occur in nature and will draw attention. The goal is to recreate a hairline that is undectable or "natural" thereby not drawing attention to the restoration. Secondly, a blanket statement about FUE being hit or miss is kind of ridiculous. I'm not getting into an FUT vs FUE argument as it's an exhausted topic. The reality is if he goes to a quality surgeon he will get a quality restoration regardless of extraction technique. FUE cases of 2000-3000 grafts are routinely being done with extremely high yielding results.

You have zero signs of hair loss. The area above your ears is slightly thinner but that's common and not at all indicative of you having retrograde. I think you're mistaking nape (neck) hair for retrograde alopecia. Your nape hair simply extends very low down your neck. Advice is to stop thinking about hair loss and enjoy your 20's.

I don't honestly know the physiology but my guess is that it has to do with the revascularization of the area. Skin thickening over time may help as well.

The reason why I mention the density issue is that your hair behind your hairline looks relatively thick. So to have a dense wall of hair behind a sparse restoration might not meet your goals. If you don't mind the thinning look then you can always go with a lower graft count but a surgical assessment by a top doctor is your only way of getting an accurate depiction of what is achievable in your case. Konior is the always the best option but many are turned off by the long waitlist or unable to afford his prices. Just FYI he doesn't necessarily charge by graft either. It's more of a generalized surgical fee based on a proposed graft count.

It looks like you have significant miniaturization in at least the first centimeter of your forelock. So that would need reinforced along with filling in the completely hairless temple areas. You could probably get away with 2000 grafts but it wouldn't have significant density. For a dense result with reinforced frontal you're probably looking at 2500-3000 grafts.

Completely arbitrary question because we can't see your hairline and have no idea if you want to lower it or just fill in receded temple area. Take more photos with hairline exposed and a tentative hairline placement drawn.

Don't recommend ibuprofen as the lingering redness isn't due to the inflammatory process. Only time will reduce the redness. You can try aloe vera. It won't hurt anything but probably won't speed up the dissipation of redness either. All three of my transplants were red until 2.5 - 3 months. I used aloe for one but didn't seem to make much difference. Only time my friend. Try growing out the front to cover it up if it's that bothersome.

The redness could last anywhere from a couple weeks all the way up to 6 months. It just depends on your own physiology and how dense the grafts were packed.

If you're asking if the hair doesn't immediately grow after implantation (before shedding) has it survived? Then the answer is it can survive and not immediately start growing. If you're asking if the graft doesn't immediately revascularize will it survive then the answer is no it will not. Poor circulation is anecdotal. It either gets adequate blood or it doesn't. If it doesn't it shouldn't grow immediately or in the future. Think of the hair follicle like a tiny organ in your body. It's genetic code is destined for one thing, to produce a hair shaft. If it has the right environment and blood supply it lives and can perform it's only function. If it's missing something it cannot perform what's it's code is destined to do.

The revascularization process starts to occur very shortly after the graft is transplanted. If there is impedance to this for some reason (too dense packing - competition for blood supply, too much trauma during implantation, incision site inadequacies such as wrong depth) then the graft will not survive. If revascularization doesn't occur then there is no growth. I think you're confusing shedding with failure to yield adequate blood supply. Shedding happens only to the hair shafts because of the "trauma" the follicle just went through. Being ripped from your home, put in solution, then reimplanted is a traumatic experience and as such the hair shaft goes into the telogen phase after a few weeks. Most grafts will grow a bit before entering telogen so that is a good indicator that blood supply is adequate and growth will return in 3-4 months.

Without meds you’re definitely going to be a Norwood 5/6. The pattern is already evident. With that being said you have a great donor and a hair transplant is not out of the question. As long as you stay conservative with the hairline you can achieve an acceptable result if you go to the right surgeon. Do your research on this forum. Look at results of patients in a similar situation to you to get an idea of what is achievable through hair transplantation. Don't let travel or finances limit your search as you'll be living with the results for the rest of your life.

Even a dehydrated mishandled graft can "anchor" to the scalp. All that is required for the graft not to fall out is the epidermis closing around it. That doesn't mean the follicle survived and will receive blood supply to initiate growth. There's many factors at play and if they aren't all done with precision there is always a small chance of failure.

I would seriously reconsider going through with this plan. So, without Finasteride you're going to continue to thin. In fact, implanting in between existing hair can exacerbate the loss of surrounding native hair. You could actually permanently shock out some of your native from the trauma of surgery. Your net gain wouldn't be very noticeable. Dr Diep extracts very high in the donor and what could be considered out of the safe zone. I don't believe you would have another 1000 left after getting 2000 from him now. Your donor already looks very thin. Dr. Diep uses a 1 mm punch and he doesn't particularly take a sensible approach to donor harvesting. He doesn’t extract uniformly and wherever he extracts from is going to be thin. You probably won't be able to keep your sides as short as you have them in the most current pictures. Just be careful man this is a slippery slope.

The fact that you narrowed it down to these two surgeons shows that you've done a significant amount of research. They are both fantastic and are honestly the two best clinics in the world in my opinion. You will get a great result with either so it comes down to the details that you value. Hasson uses techs for much of the procedure. Is that a negative? Not necessarily. If the clinic gets outstanding results doing that on a consistent basis then the argument is null. If you have a strong opinion about the surgeon doing most of the work then the choice is easier as Konior is one of the few that do. I think the argument about one clinic (H&W) achieving more density or going more aggressive is also shortsighted. Do a thorough search of Konior's results and you'll find some extremely dense and aggressive hairlines. The reality is he bases every case off the individual patient's desires, donor capacity, and propensity to lose in the future. If you want dense and aggressive, have the donor to do it, and aren't heading to a NW6, he can deliver aggressiveness. All while managing the donor immaculately and giving a soft naturalness to the hairline. I have no doubt Hasson can get you a result you'll be happy with but my experience with Dr Konior was unmatched and I can only speak to his character as a surgeon and a caring medical provider. His attention to detail and meticulousness is really unbelievable. He genuinely cares about his patients and wants the best for them. In addition, I wouldn't hold value in the comment about not going with Konior because of his waitlist. Yes, it is over a year but this will affect your appearance for the rest of your life so there's merit in waiting if you want it done right. I'm saying all this about him without even having my result yet. That's how high a regard I hold for his character and how I was treated throughout my whole experience. I have 2 other differing experiences to compare it to as well. If you need additional information don't hesitate to reach out.

Your temple points are fine. If they were really receded it would be a straight line up from the most anterior position of your sideburns up to your temporal parietal angle. You clearly have advancement in the temple point area. Any honest and trustworthy surgeon wouldn't come near your illustration as it's just not natural at all for Caucasian men. The hairline might seem slightly high to you but this will suit you well as you age into your 30's and 40's. Stick with the meds and don’t do anything right now. Here's a picture of truly receded temple points and what a well thought out restoration looks like.

I have the same exact problem as you after a Dr Diep hairline restoration. Overall the transplant looks pretty good. But it’s the little nuances that bother me. The hair that was implanted was definitely two perpendicular to the scalp. Where my natural hair meets the transplanted hair it is very obvious that the transplanted hair sticks straight up and the natural hair wants to lay forward. I believe this is to Dr. Diep not using a very acute angle with his implantation. If you look at some other surgeon's work they implant at a flatter more acute (closer to the skin) angle. This is how natural hair grows and actually helps with camoflouging. It's a win win for the surgeon to implant the follicles flatter to the scalp. I believe this takes more technical skill and is more tedious and that's why it is not done all the time. Temple point restoration has to be implanted extremely close to the skin which is why very few surgeons are actually successful or willing to do them. I too have temple transition grafts that didn't grow. One side is much thinner then the other. It seems like all the rest of the transplanted hair had good yield except where he transitioned to the temple area.

I would advise you to definitely cut your hair short a couple of weeks before the procedure. Buzz it down to a 4 or 5 gaurd and use some Toppik to make it appear thicker. This will allow people to get used to seeing you with a buzz cut prior to the transplant and hopefully not spark curiosity afterwards when the grafts start growing and it appears thicker. The redness should be more apparent after the grafts shed but you can try to apply some cover up makeup after about a month to reduce the look of redness.

I highly doubt that there is any hair restoration clinic in North America that employs a nurse practitioner. NP's don't make sense for hair restoration clinics. They can diagnose, write orders, and prescribe meds. These duties can all be carried out by the physician who has to be a part of the clinic. Why pay an NP a higher salary then a nurse to only do nurse duties such as assist during surgery or clerical work? The comment about top docs imparting there wisdom on nurses only to have them leave with that knowledge and open up their own clinics doesn't hold water. Nurses are not nurse practitioners. They receive a master's degree to become a nurse practitioner. That means school/clinicals for at least 2 more years after receiving a 4 year bachelor's of nursing degree.

@Melvin-Moderator I didn't share my results. I had a small FUE from Bosley before finding this site. I then was led to Dr Diep by results posted here and his YouTube channel. From a macro perspective the transplant looks okay and the casual observer wouldn't notice anything out of the ordinary. However, I'm extremely detail oriented (picky and slightly a perfectionist) and can't help but notice major flaws. My donor looked bad. Punches were extremely large, bloody and he left a linear line at the bottom of the extraction zone that almost looked like an FUT scar. I had to have had smp to my donor. Some of his angles in the hairline were too perpendicular and when my hair is shorter it sticks awkwardly up. He did a small section on the temporal side were the hair should have been oriented down and forward. He placed them angled straight back.

Natural hair grows in randomly. Not in patterns. Lately, Dr Diep's techs have been implanting in rows for some unknown reason. There's a few results over the last couple of months that have been showing more of this. I had a transplant with him in 2017 and there was a slight row on one side in my hairline. There's some fine singles in front that slightly camoflouge it but I still notice it. The patterns are definitely getting more prominent in his recent work though. Just my two cents.