Gasthoerer

19 hours ago, FaganBecker said:

Also a question for anyone still bothering with this thread! 
 

is a hair transplant always obvious in direct light? Is it something that is always lighting dependent and will never look like it has good density on a sunny day?

This are two separate questions:

1) In a single pass the transplanted density is always below the juvenil density. Typically only around (45-60 % for the hairline). Under certain light conditions this will automatically lead to a see-through effect (the famous bathroom lightning). 

2) Still the transplant itself can look undetectable as it can appear that there is just a "normal" moderate thinning. 

Therefore the first goal is always naturalness first and density second. 

Regarding your other question: Yes, after 8 month there can be still improvement e.g. singles becoming doubles or an increase of the hair diameter. 

Thanks for sharing your case.

In my option you should get at least one (better two) consultations with clinics who have a strong reputations in hairline design (e. g. Shapiro - US; Feriduni - Belgium; Heitmann - Switzerland; ...).

From my point of view the biggest issue is not the growth and not the doubles in the hairline (even it is an truly annoying issue) but the hairline macro design.

The hairline has a (too) strong V-shape (surprisingly this cannot be seen from the immediate post op pics) which does not match your facial features and might be even too low in the middle. Also the connection to the temporal peaks is not ideal. Just adding singles in the front might not be the solution. 

Nevertheless, it is not terrible and can be fixed with a good plan. 

My 50 cents:

1)There are some infos missing to make a clear recommendation for next steps (age, meds, donor, etc.)

2) You focus too much on the availability of the clinic. This is a long way, couple of month make no difference.

3) Meet with several clinics for a personal consultation. Mark the recipient, make pics, review them at home, discuss different options.

4) Decide which plan of 3) you like most and consider to go in 2 steps: Conservative hairline first and after a good result, have a more aggressive hairline and temples. 

5) If money is not an issue my short list would be: US - Shapiro; Europe/Switzerland: Heitmann, Feriduni; 

Good luck

On 10/16/2023 at 8:45 PM, EvansLawrence said:

 

 

 

 

 

We had this discussion in the previous thread but in here the pics are even better.

This is not a repair, independent what Couto writes on his OR report (This can easily be politics). Your hair in the pre-op pics (2nd surgery from Couto above) look great. I understand the demand for perfection (more density, temple work), as I have this itch myself. But calling the first result a disappointment is not right and gives wrong expectations for newbies.

Nevertheless: The new hairline design looks very good (but also very aggressive) and I am sure it will come out great. But you have now used almost 5000 FU while being 30 (?) years. It is a risky path as most people continue to lose even when on FIN. 

Looking great! Going to follow this one. 

Amazing result! It proves that naturalness is much more important than super high density. 

It is always good to post pictures. 

You do not need a hairline specialist, but a clinic focusing on large cases. 

How old are you? 

Are you on meds? 

What is your goal? 

From Cooley I have seen very natural results, De Freitas focus is IMO spectacular over naturalness. 

I would add to the list:

- Shapiro

- Heitmann

- Feriduni

But to give a real recommendation, it is preferable if you share you case in here. 

Works looks clean, and 2000 grafts will look extremely dense. Wish you the best of a journey in the next month. 

Questions:

- The 35 K is a fixed price nowadays?

- Do you have a pic showing the facial proportions?

You can have this (your) opinion that these clinics are three of the Top5, but for sure it is not "definite. I (just as an example) do not share this opinion.

But my point is another one: Even if the would be Top5, they are not "miles ahead" of everyone like just mentioned regarding Zarev and previously mentioned in a similar fashion of Couto and Konior. They are not "miles ahead" of clinics like Heitmann, some of the "belgiums" (like Feriduni) or other of the "spanish/portugese" clinics (and I am sure I am missing some countries/names).

That is my point and if your opinion is different, then well, that is how it is.  

We should be carefully with such assessments. Until last year Konior was the undisputed King, then Couto was the Wizard of hair, now the flavor of the day is zar zarev. The power of great numbers is very important in hair transplant industry. 

I am not saying zarev isn't great but let's see more results until we make final judgments. 

Congratulations to you journey which hopefully comes to its happy end. What is the color of your smp? How do you match it with your current hair? 

I think that it is better that you present you case in the "classic" way incl. pics, background info and you goals. Not every NW6 is the same and especially the decision to go FUE or FUT is a major factor in recommending a clinic. 

Exactly, there is a bunch of top clinics and which is the best depends on your individual case and expectations. 

I am sorry for what happened.

For me personally, this is very poor planning from the clinic and in general unacceptable behavior. I would honestly visit a few other clinics and get their opinions and also take some time to reflect about the different options. 

One last shot might be everything you have left and you need to choose wisely where to put how many grafts. I would really like to see some better all around pics (maybe even with shorter hair on the sides). 

4 month is too early to make any conclusions. Most patients have close to zero growth at this stage. 

Anyway, the poor result of the first surgery, seems to be not a growth issue but poor planning and too low planted density.

Why do I say "seems": 2000 grafts should have been sufficient for your case, but the pics do not look like 2000 grafts at all.

It also looks less clean and refined as a typical top clinic post surgery result looks like. It also appears that there are no pics from the clinic from either surgery - if this is the case it is unacceptable for a top clinic.

Please ask the clinic for the surgery pics. I think then we should be able to make a proper evaluation. 

Yes, you should get an opinion from a top clinic abroad. If you are UK based Belgium would be my first choice to get an opinion. Feriduni, Bisanga and Lupanzula are all easy to reach. No need to fly to Canada for such a first evaluation. 

Sorry, for singing a slightly different tune than the other users. 

I am not 100 % convinced by the hairline design and before you go for a touch up with this clinic, I recommend that you visit a top clinic. Lets see what they say/recommend and then plan your next step. 

From my knowledge and experience it is very unlikely that someone is a topical responder and a non-responder on oral minoxidil. The other way around is quite common though, as minox does nth for hair growth and has to be transformed in the active form first. 

On 4/13/2023 at 2:11 AM, 2Bulls said:

Question: do you think unshaven transplants can produce lower yield? I know if can effect angulation, blending, naturalness, etc.

Yes, I thinks so. And I think the clinic which I went to agrees too, as they insisted on shaving the recipient even for a small 400 Graft surgery on virgin skin. And it is not about money, as my initial surgery was anyway much more expensive per graft. 

I think unshaven recipient is an unnecessary risk and should only be used for very limited cases. A large area repair case from a patient at the limit of his donor capacity, is not an ideal case for unshaven surgery IMO.

For me this goes way beyond this case. But even here the patient also had good growth in previous surgeries with a shaven surgery both with FUE and FUT - why change that?  

We are not the "international-psychotherapy-network" and therefore we should concentrate on what we do best: give advice about "hair-restoration" and hold clinics responsible. This is a dirty business and patients have to stick together.

The TO's initial question was: 

1. Should I be concerned after reading this case? 

2. Is H&W the right clinic for my case? Well, he did not ask this question, but maybe he should have.

Regarding the first questions:

- Obviously, the issue in the presented case is large scar from strip and poor growth only (!) in the areas where a non-shave method was used and supposedly a tech did the incisions etc. 

In case the TO goes for shaven FUE and gets confirmation that the incisions are done by the surgeon, the other case is almost unrelated to his own. Anyway (independent of the discussed case), unshaven surgery should be avoided in my opinion and the slits should be done by the surgeon. 

Regarding the second question:

- Which clinic is the best can only be answered when more information about the case is presented. This is what the TO should do (present his case) and what we should have asked him to do from the very beginning. In general, H&W are not in my personal Top5 for smaller FUE cases and there are better options out there. Whatever "better" really means. 

Of course we also have to hold the clinic responsible, but the focus should not be at that case particularly. The questions to the clinic should be more general, but based on what is presented:

- Do they let techs to the incisions in certain cases e. g. unshaven cases or other cases?

- Would they generally perform unshaven (recipient) surgery and if yes, also for repair cases? Why?

- What is the reason for such a strip scar especially after a good one before? Bad luck or the boundary conditions like initial surgery? If the latter is true, would they inform the patient that there is a higher risk?

H&W are in the game for a long time and one result should not change our mind of a clinic, especially if it is a case of poor growth (as this happens with any clinic). Poor craftmanship or poor ethics have to be rated more critical. 

My feedback is therefore more based on my general observations: 

- I am not sure if H&W can (still) be seen as one. Maybe we have to separate Hasson and Wong. The issue is: This is difficult based on their website.

- They seem to be prone to taking huge risks (extreme long and wide strips, high densities, and obviously also non-shaven procedures on repair cases). This is also part of the "wow" factor when it works, but if it doesn't it is devastating. Personally, as seen by my story, I am preferring conservative approaches. 

- For FUE there might be options out there with much more (longer) experience for smaller or similar price tags. 

- Saying all that: Having a tech doing the incisions is a no-go for a top clinic

Fantastic! One of the best one time hairline results in the net in terms of density IMO. Most GOAT like results are 2-3 surgeries. 

Would like to see more pics with the hair free flowing, but what I see is amazing. 

On 1/29/2023 at 4:07 AM, Gatsby said:

The initial mapping and planning stage. 

Seriously, this is unbelievable stuff. I thought, I have seen it all but if this grows, we have a new GOAT. Your before Status was already better than what I believed was possible. Great example to never give up on your dreams... 

20 minutes ago, NegativeNorwood said:

I respectfully disagree with you with regards to the conservative approach. The prominent temples are a necessity for optimal aesthetics IMO. Please read my two posts above. The conservative approach sounds "safe" but the aesthetics of a well framed face are a big PLUS. 

That a well framed face supported by prominent temples is an aesthetic plus does not (!) contradict with what I have written. 

I am saying: if you go too aggressive on the temples - to much forward, to straight which equals a juvenile hairline, benefit risk ratio is getting worse. Besides that: most Caucasian do not have such a hairline after puberty even without  (major) hairloss. Brad Pitt is an example you have given yourself.