BDK081522

I would seriously reconsider this decision for a few reasons. Firstly, you're definitely showing signs of andogenetic alopecia. You have receded temples and show miniaturization along the whole hairline. Secondly, you're young and your hairline will continue to recede even while on finasteride. Fin works wonders for the mid-scalp and crown but most of the time it won't keep a youthful hairline intact. You would get better use of those grafts on your hairline IMO. Also, it's very rare to have scalp hair resemble beard hair when transplanted. Scalp hair is usually thinner and straighter whereas beard hair is coarser and more kinky. Beard grafts are almost always single graft follicles so every multi-graft unit taken from the strip would need to be excised into singles. I'm not sure this particular clinic would have the skill or patience to do this effectively. The hair color is also very different. In addition, I think you would regret the FUT scar from Dr. Diep for the rest of your life. If you're dead set on getting a beard enhancement, my suggestion would be to do an FUE from the grafts under your chin and neck. This hair would match much better and definitely look more natural than scalp hair. I have just had this done with Dr. Konior and it looks absolutely undectable that hair was transplanted. The neck donor area also heals very well due to the amount of collagen present in this skin. Please reconsider going through with your plan.

Like others have mentioned, there is no "best" surgeon. There's only who is most suitable for your goals, budget, and overall situation (donor availability, crown work, hairline, beard extractions, etc). So, you have to factor all of that in when deciding who is the best surgeon for your particular case. The top surgeons in the world are all very capable of delivering an outstanding result but each have their own nuances. With that being said, I think the surgeons who deliver consistently remarkable restorations are in no particular order Konior, Hasson & Wong, Couto, Eugenix, Gabel, and Dr Zarev.

How is May 2024 only 6 months after November 2022? 🤔🤣

This is going to look awesome! Great choice of surgeon and design.

My temple points were also reconstructed with nape hair. It's even finer than singles that are higher up. So if used in the correct area it can actually look more natural. Of course the tradeoff is the possibility of thinning over time but I think this is a relatively rare occurrence.

Most Dr's wouldn't push for a small 2,000 graft FUT on a native NW2 scalp that is already 38 years old. If you are on a preventative medical regimen then you are a prime candidate for an FUE. If you're in NYC then you may have consulted with Bloxham. This clinic is very pro FUT and may be the reason for pushing you in that direction. Use the forum's search function and consult with multiple surgeons that fit what you're goals are. The best advice is to not limit yourself to a local surgeon. There are a great deal of fantastic surgeons in the world and a lifelong result is worth traveling for.

Thanks for updating! Your restoration looks great. It has density and naturalness. Something that is not easy to accomplish in one go. Hopefully coming off fin won't affect your result too much. You will more than likely continue to lose behind the transplant but fin can actually help the transplanted hair remain strong as well.

The FUT closure techniques have not changed in the past 5 years. Possibly even 10 years. The FUT scar is more about going to a reputable surgeon who has a proven track record with scarring. The most important aspect, however, is your own physiology. This will have a greater impact on how your scar heals if everything else is done correctly. Unfortunately, this is very unpredictable and some patients just heal scars worse than others. I think FUT is more of a gamble because the greatest unknown impacting your result is your native healing characteristics. With FUE, as long as you go to a reputable surgeon who is very good at donor management than the healing factor is not as important.

@rocktitan Did you end up getting your surgery in July? If so, you should be growing pretty well at this point. Any update?

Same thing happened to me man. After my Diep transplant my donor looked really rough. Then had my next one with Konior and it actually looked better. I was shocked and didn't even think about that before undergoing the surgery. Low and behold after my fourth transplant (2nd with Konior) my donor actually looks even better because it is more homogeneously depleted. It's kind of wild to think that after more extractions a donor can look better but it's all about extracting the donor to match the density in previously used areas. Some surgeons like Sethi and Konior are masters at it. Very cool to see!

@PizzaWolf that's a great question and one that I can't answer with absolute certainty. I don't have any experience with Dr DeFreitas so I can't speak to his clinic or hair restoration philosophy. However, I will just say that for some surgeons and clinics it's not all about the patient and doing what's best for them. The only logical explanation I can even surmise is that implanting in rows is simply easier and overall it saves surgical time.

Implanting grafts in rows is never indicative of refined hair restoration. This simply does not occur in nature. Of course some surgeons can get away with it if the restoration is very high density with thicker caliber wavy hair. Horizontal rows broken up by finer singles implanted in front can look passable but vertical rows will never mimic the way natural hair grows. There's many examples on the forum but this one comes to mind relatively recently. Yes, when the hair is cut very short this will look very unnatural. Also, as mentioned above the more perpendicular angles also stick out and make styling harder.

Melvin, the work looks impeccable! You chose very wisely and I think doing the temple points and changing the V shape will undoubtedly make your transformation surreal as a NW6. The live feed was really interesting to watch. Even as a veteran of 4 hair transplants myself you never really get to see the work in detail while it is occurring on your own head. (Nor get to remember much bc of the valium) So, it was very cool to see a detailed presentation and hear the thoughts of the surgeon while the operation is occurring. Thank you for that and all the information you disseminate to the community. You've come a long way from the HTSoon days lol! This community is privileged to have a moderator that is willing to document your whole experience so candidly. You'll definitely notice a difference in the hairline angles that Dr. Sethi placed compared to your previous transplants. They look like they will lie very natural and much more acute (flatter) than before. Great decision on the clinic, design, and graft amounts for your situation. You're close to the end of your journey it seems! One thing that I underestimated about the beard donor area was how much acne/pimples occur when the donor is healing. I'm 4 months post-op from beard grafts and still getting large angry pimples that are quite sore to the touch. Just a heads up to be aware of this when you start to grow in 3-4 months. Beard donor heals fast but the pimples last for awhile. Anyway, congrats again and keep us updated on the progress!

You literally can't be allergic to epinephrine. It's an innate native hormone that is produced by your own adrenal glands. It works on alpha and beta receptors and may increase heart rate and blood pressure through its potent vasoconstriction. Seizures or convulsions would be a potential side effect from a local anesthetic overdose or vascular injection with large doses.

Also, you definitely have androgenetic alopecia. There is miniaturization in the hairline and it will continue to recede if not on an anti-androgen. A healthy lifestyle literally has nothing to do with MPB. Eat all the vegetables, exercise every day, and you will continue to lose hair if you have a genetic predisposition to it.

There is no scarless surgery. Do not think you can just shave your head if you don't like the result or don't want to commit to life long medication or future transplants. There is no one and done in hair restoration. Do not get a transplant thinking you won't care about your hair past your 20's. You're exhibiting all the classic signs of someone who should not get a transplant.

@Melvin- ModeratorDoes this sentiment still hold true as well?

@Melvin- Moderator Have your views on this changed now that you've presumably had your last procedure with one of the world's best clinics?

I think that he certainly could deliver a superb result on a NW 6 but I think there are a couple reasons why we don't see many mega sessions from him. I think the main reason is how meticulous he is with each aspect of hair restoration. He takes his time with planning, and every extraction and implantation. Every decision is calculated to get the best aesthetic result and this approach simply takes time. To get 5-6K grafts in one restoration would probably take 3 days. I had around 2,000 grafts on my first with him and I was at the office from 0630 until 9:30p. My second was around 700 head and 700 beard grafts and I was still there about 12 hours. So, it is time prohibitive. In addition, I think another reason he doesn't do it is because it is cost prohibitive for most of the population. That amount of FUE grafts in one transplant would be very difficult for most people to afford.

Great result! However, it certainly looks like he has miniaturization and recession occurring along the hairline. Nonetheless, the result looks extremely natural.

It seems that all of your post-op pictures look relatively normal to me. There is one or two that show what could be a bit of an infection but it's only on a couple of areas and should not have affected the whole recepient zone. While we'll never know the answer for why your transplant failed I think it's safe to rule out infection as the sole cause. I would not recommend going back to Dr Diep for a scar revision or repair. If he left you with a scar like that and such a disappointing result the first time what's to say it wouldn't happen again. Sometimes it's just unexplainable why low yield occurs and it does happen to almost every surgeon. However, the issue with Dr Diep that is solely on him is his implant angles, hair direction, and rows. In your photos, where he closed off the temple angle above the temple point, the hair direction is completely wrong. He angles the hair straight backwards. All the surrounding hair angles down and slightly forward. This should never happen with an elite surgeon.

Sorry to read about your situation @HT1404. While I agree that higher quality pictures may help to decipher what went wrong here, I think that we can all see the result is not where it should have been given the amount of grafts extracted. Your result in the hairline and mid-scalp should have been better for what you paid. You mentioned that you may have had an infection, however, from your 1.5 week photo it doesn't seem like there is any active infection going on. The recipient area looks very normal for 1.5 weeks post-op. Maybe there was something that isn't coming through in the pictures which led to the topical antibiotic that he prescribed but it is hard to tell. Dr. Diep does tend to get more scabbing then other elite surgeons for a couple of reasons. I believe he uses larger incisions and meatier grafts with less intraoperative cleaning (spraying). This tends to lead to more scabbing but generally speaking this shouldn't be an issue with yield. Your case certainly demonstrates a lack of density compared to what was implanted (yield issue) and a very large FUT scar in the donor area. I think that it is pretty standard to remove FUT sutures around the 2 week mark so I don't think anything with this timeline and your healing incision seems off. Scarring is a very individual entity and it is hard to predict how they will heal. However, there may have been too much tension on the closure or just not enough scalp laxity to take such a big strip. Both of which should have been noticed by Dr. Diep beforehand. There are many great repair surgeons available to help get you the result you deserve. I think your course of action should be an FUT scar revision (if you have enough laxity) combined with an FUE for the most pleasing result. Consult with Dr. Gabel, Hasson & Wong, and Dr. Konior and they will get you where you want to be.

I never experienced any additional redness from minoxidil use post op. RU has been working well for me. I'm essentially using it to prevent further loss so I can't say it has regrown anything but I can say it hasn't hurt anything. No sides and my hair is holding strong so no point to discontinue use.

I had two procedures with Konior and his instructions were Minoxidil is recommended starting two weeks post-op. I did it for mine and had no issues.

Can you post a picture with your proposed hairline? This will give the forum a better idea of what you're looking to achieve, total graft count, and if you're a currently a candidate for hair restoration.