BDK081522

19 hours ago, Sohail said:

Since ive been looking into hair transplant ive always heard of Turkey

Not really heard of anywhere else

And also maybe because i live in the uk and thought it would be cheaper and easier to get to Turkey

Never opt for cheap and easy when it comes to something that will effect your appearance for the rest of your life. 

Trust me, if it bothers you now, then you won't think it's cool to be bald at 30. You have to realize that if you get a transplant (no matter what age) you're permanently altering your scalp and you will not likely be able to just shave it off. The scarring even with elite surgeons using small FUE punches is still scarring. Without medical intervention, you're too young for a transplant currently. Best advice is to alter dosing regimens of finasteride, use minoxidil, ketoconazole, and even try some topical anti-androgens such as the finasteride or RU. You have to try and stabilize your loss before any surgical intervention is attempted .

Well, it's hard to answer that question because there are many factors that go into coverage value. Hair caliber, hairs per graft, hair texture, and straight vs wavy all play a part. True NW 6's might need anywhere from 6,000-10,000 grafts just to get the "illusion" of a full head of hair when grown out. You have to assume that if you can't take finasteride and you have a NW 6 pattern currently manifesting that eventually all of that hair will be lost. So, essentially to perform hair restoration on a slick bald 6 would take multiple procedures and more than likely you would need to supplement with beard grafts. Even with this type of plan you would be hard pressed to pull off density that allows you to buzz your hair.

Firstly, it seems like your attached pictures are an example of your pattern but not actually you, correct? If that's the case then you're definitely not a NW 2.5. That's a NW 6 pattern and could even progress to 7 without medical intervention. Secondly, what's your reason for not wanting to try finasteride? It helps to strengthen your donor and not just the top of your scalp. So, in high NW patients their donor or traditional DHT resistant areas can actually thin over time. Medical therapy is always the first choice before a transplant. Lastly, most hair transplants do not look great at short buzz cuts. They work by a layering effect to create the illusion of density but can never actually attain natural density. Longer hair helps to create this effect by covering more scalp.  You've come to the right place so just do some more research. 

I would say add Dr. Gabel to your list. He does some fantastic work as well. Also, maybe give some more consideration to Dr. Nadimi. She is newer to hair restoration than some of the big names but her work is very good nonetheless. Check out some of her results on this forum and I think you will be impressed. She is in practice with Dr. Konior and they share the same team. She usually is a bit more conservative when it comes to FUE numbers but I don't believe you need a large session to meet your needs. 

It all looks normal. Those channels happen to a great deal of patients during the immediate healing portion of the procedure. They're usually not noticeable once the hair transplant matures. Just curious, did you go to Dr Diep? It resembles his clinic's work. 

22 hours ago, yalla8 said:

Thanks for the feedback. Yes - I am now looking for round 2 in order to close it out. I will look into these docs. Any reason you recommend Hasson but not Wong?

No reason in particular other than I've just seen more hairline results of Dr Hasson compared to Dr Wong. It seems Dr Wong excels at crown work though. Out of all the surgeons I mentioned I personally can vouch for Dr. Konior because I've had two procedures with him. All the hype he gets on the forum is justified. The man just performs some of the best work in the industry. 

Wait, so you're saying he agreed to perform a hair transplant on you without an in person consultation or an online assessment via photographs? That just doesn't seem accurate for an ethical and well established physician such as Dr. Mwamba. Can you elaborate on your interaction with the clinic?

Your first surgeon tried to cover an extremely large area for only 1700 grafts. You were always going to need more grafts to achieve adequate density. It does look a bit pluggy and could use some refinement. Check out Dr. Gabel, Dr. Bruno Ferreira, Dr. Hasson, and Dr. Konior. They would all be able to achieve a dense natural looking result if you have the donor to sustain it. 

It looks like you might have retrograde. Did Mwamba mention anything about your donor? It does not look suitable for a transplant in its' current state. You don't look like diffuse thinning but rather normal temple and hairline recession associated with Androgentic alopecia.

Your hair loss will not stabilize without an anti-androgen protecting your follicles. Does that mean you can't restore your hair through transplants? No, but you have to have the resources to sustain. You can be a NW 5/6 and essentially lose everything up top and still get a nice restoration. The key is you have to have the available donor to support. Meaning high density, high caliber, coarse hair in the occipital region and adequate beard hair. A restoration without medication can only be as good as your supply of donor hair. Keep in mind though that high Norwoods usually don't have this type of donor so it is rare to be able to achieve a great result without medical therapy. 

That's a great decision! SMG is top notch and I'm glad you're sticking with them. They have presented a very wise strategy and you'll be happy in the long run. 

The work looks immaculate! From everything you've been through you deserve a great result! Excellent choice. Look forward to following your journey. 

A word of caution here. You're still relatively young and received a fantastic result from SMG. It's a hairline that will look great for the rest of your life. The design works because it matches a matured hairline with eroded temple points. If you decide to go lower it may start to look a bit unnatural if you didn't address the temple points. To my eye, a key giveaway of a transplant is a lower hairline with receded points. That just doesn't occur in nature. If you lose your temple points it's inherent that you have recession in the hairline. So, if you did lower the hairline, even a cm or so, you would want to recreate your temple points with this restoration. Now you're looking at around 2,000 or more grafts and may still lack the density you desire. It's a slippery slope so just be careful. As you're well aware your donor is a finite resource so sometimes accepting what you've already been given is the most appropriate choice. 

3 hours ago, Fue3361 said:

Can we have a discussion about the advantages of DHI and Stick and Place, when compared to premade slits using an implanter pen?

From my understanding (what I read on another thread), the issue with implanting into premade slits is the following (I'm quoting @BDK081522 )

"Using this technique, the surgeon uses larger incisions to account for the wounds closing before grafts are placed."

 

DHI has no premade slits, so no wound closing, and Stick and Place has the graft implanted immediately after opening the incision (again, no would closing).

 

I can totally understand how a would closing would be an issue if you're working with forceps.  BUT, why would this be any kind of issue if you're using an implanter pen.  Why would you have to make a larger incision at all?  A constricted wound will still open up and stretch to accommodate an implanter pen just fine, regardless of size, and there should be no more trauma to the hair graft here than there would be in DHI (maybe even less, as you're implanting into a premade slit, instead of breaking the skin using the implanter.

You bring up a valid point. It very well may be the case that pre-made incisions can be kept smaller if the surgeon is going to use an implanter pen instead of forceps. I didn't realize that surgeons were using this technique but it seems to make sense. As Melvin mentioned all techniques have merit and the surgeon ultimately chooses which technique is appropriate for each individual patient. I think rather than implantation technique, what's more important is surgeon experience and how comfortable they are performing the operation the way they've been taught. Ultimately results dictate who are considered the elite surgeons and this takes years of experience. The focus should be on which surgeon produces results that you find personally to be the most aesthetic and not so much about which tool or technique is used. 

We would need immediate post op pictures of the full extraction zone to see the pattern. With this information we could make an educated guess as to what you're dealing with. In my opinion if the extraction zone was the full donor area and not just the left side as shown, then it's shock loss. However, if all 2800 grafts were taken from just this area shown there's potential it was over harvested. 

53 minutes ago, ybism said:

Thanks mate, hard to hear but I need to hear it. I think it has pretty much stabilized now as I dont have more then 20-30 hairs falling off in the shower or when washing. 

 

Sorry but there's no way you've stabilized if you're not on finasteride with such aggressive loss at 26 years old. You really need to think this through. Think long-term. What's worst case scenario. Well, that would be getting a transplant by a low cost clinic at a young age (26). There's potential for overharvesting, shock loss, unnatural appearance, and many others. When you lose your native hair behind the transplanted hairline it will look unnatural and you will be wishing you just shaved it instead of dealing with the scars and ridiculous island of hair. Sorry to be so harsh, but you're exhibiting all the signs of a  young man distraught with hair loss that wants a quick easy fix. Unfortunately there is nothing quick or easy about hair restoration. If you can't afford any of the clinics mentioned than it's not time for a transplant. Try different dosing regimens of fin and save up some money. 

The title is a bit confusing. Was it 5 hair transplants or just one hair transplant 5 years ago? If just one for 1500 grafts your donor looks like many more grafts were extracted. Nonetheless, you are here and have made a great decision to ask members of this forum for help. Ferudini, Bisanga, and Mwamba are fantastic at repairs and I think you couldn't go wrong with any of them. If finances aren't an issue and you want the best possible solution moving forward I would add Konior to this list as well. 

9 minutes ago, JC71 said:

Yup, much as I like Dr Bloxhams work he always veers toward FUT regardless of the grafts needed. And yes the reasoning seems off. And as I mentioned earlier, I would also look at another Dr/Clinic for stage 2. 

Completely agree! I think he does some very good work but it seems he always suggests FUT. I'm not sure if he's just not had the appropriate FUE training or just truly believes that FUT provides a distinct yield advantage over FUE. Regardless of the reasoning, I think a top surgeon in the year 2021 needs to be a master of both techniques. I'm not bashing FUT as I think it definitely still has it's place in today's industry. It's been proven for higher Norwoods that you can get more lifetime grafts starting with FUT followed by FUE. However, for a first surgery, on a low NW, utilizing only 1500 grafts I believe FUE is the appropiate extraction technique. 

I actually think Dr. Bloxham pushes patient's toward FUT too much. For a 1500 graft surgery you shouldn't have to have a scar like that. It's actually wider than most of his scars. Since we don't have graft placement photos it's difficult to determine if it was low yield, low density, or improper planning. Also, it makes no sense if he said since the first FUT was "lower success rate" (i.e. poor yield) to suggest another FUT because in his eyes it gives better results than FUE. He still harps on the antiquated take of FUT yields being much higher because the grafts aren't skeletonized as with FUE. The study is out there. With today's FUE techniques the yields are almost identical. So, it doesn't make sense to suggest another FUT when he said the first one didn't grow particularly well. Honestly I would look for a different clinic at this point and go with FUE. You probably only need about 1000 grafts or less to enhance your density and could even fill in your scar if you're so inclined. 

1 hour ago, Melvin- Moderator said:

I don't believe that pre-made slits means you're not a top doctor. There are many top docs that do pre-made slits. Dr. Konior, Dr. Wong, Dr. Hasson they do pre-made slits. Techniques are only as good as the people doing them. 

Just for clarification, there's a difference between pre-made slit techniques. Most clinics that use pre-made slits do all the incisions and then break while grafts are sorted. So the time between incision and implantation can be a couple hours or more. Using this technique, the surgeon uses larger incisions to account for the wounds closing before grafts are placed. There's also a pre-made slit technique (non implanter pen/DHI) called stick and place. After the grafts are trimmed and sorted the surgeon makes each individual incision with a graft immediately implanted. This reduces time between incision and implantation so the slits can be made to a more accurate size for each individual graft.  Dr. Konior uses this technique for example. 

Listen to the members of this forum. You may be about to compound your first mistake by going to a surgeon that isn't known in the hair restoration community. This decision could drastically effect the rest of your life. Use the search function and choose someone recommended here. Your donor is a finite resource and should be treated as such. Many of us here went to a subpar clinic/surgeon for our first transplant. The key is to not make the same mistake twice as you could end up in a worse situation then now. 

Are you on finasteride? If not, then you definitely should be on it for a year before thinking about a transplant. You're a NW 3 currently with potential to become a 5 if not on medical therapy. Out of your 3 choices I would undoubtedly choose Nadimi. 

It's great that you started medical therapy 1 year ago but this is aggressive loss for only being 25. Your crown is dipping low. Might even be headed toward NW 7. Finasteride should definitely slow your loss but probably won't stop it completely. It's imperative if you want to go the surgery route you plan for a high Norwood level even on medication as your very sensitive to the effects of DHT. I'm not suggesting you're not a surgical candidate but you have to plan very wisely. This includes going to a clinic that manages donor well and has success with higher Norwood cases. As others have mentioned it might be beneficial to start with FUT then go FUE later to maximize donor.  Look into Hasson & Wong, Hattingen, Eugenix, Bloxham, or Konior. They're all very ethical clinics and will steer you in the right direction. Know however, you're looking at spending more than $10,000 with most of these clinics for your level of loss over your restoration journey. 

I've been on finasteride for 20 years and I haven't noticed any effect on beard hair or body hair for that matter.