DrTBarghouthi

Hi @louisianatransplant I read your thread with great interest and I do have few concerns. I am personally not familiar with your desired doctor, but I’m not here to discuss a specific doctor, but rather to discuss the decision to go ahead with surgery. I do believe that you should hold off for now. First of all, you are 24 and your pattern looks like it will be advancing further. I would suggest doing maintenance meds as much as you can and give yourself sometime before going ahead. You do wear a hair system and therefore you are practical enough about it. Therefore delaying a procedure for sometime would be ideal. I personally think 2800 is a small number for what you might need- although I am only basing that on photos. My main concern however is the fact that you wear a hair system. Hair systems give densities that can be unmatched by surgery at times. Therefore, replacing that with a transplant would technically mean multiple SUCCESSFUL procedures in most cases. The reason being, is that you will always have a mental image of the density of the hair system and any transplant not at par with that will be easily seen as unsatisfactory by yourself. I would consider all of this before going ahead with surgery.

Both clinics/Doctors are excellent. Please keep us posted on how the consultation goes.

Technically with improved blood flow there could be good reasoning to apply to the transplanted area. I don't discourage it at all. Might even help reduce any shock loss etc. I came across one study about that. If I happen to find it I will share it here ofcourse.

Finasteride can technically never be stopped before or after the transplant.

Depends on where the maintenance areas are. However no harm if it comes over the transplanted areas too.

Sorry I may have posted twice. I tend to recommend the foam because absorption is better and less irritating. However, you can use the liquid but I would personally prefer to delay until 3-4 weeks after surgery to avoid irritating the scalp.

Thanks for the mention @digi23 Yes it doesn’t look like necrosis to me. However l, do you have immediate post op photos? In some cases it can be an area of dense incisions that have opened up and caused larger wounds. I would use the antibiotic on it and this will eventually peel off once the skin under heals.

I strongly urge you to grow the hair longer and to possibly get someone to see you in person to assess the donor. The photos may or may not be helpful. To be frank, I will not recommend any surgery by looking at these phots. However, proper assessment and maybe some growth can help make a better decision.

Wow! So many concerning things here: 1. Speed in itself is not the main concern as you would get occasional cases where extraction might be easier and fast in general. However, I note that they never do any testing of random grafts to see that they’re in the right angle with no transections. It is good practice in my opinion to check every certain number or if in doubt about angle, direction or depth. 2. Too messy. The gauze is just too bloody and the surgical field is not kept clean. 3. Too densely extracted. I can literally see no hair follicles left in some of the areas if not most. 4. I also am not a fan of using one forceps to extract the grafts. I prefer having two as this reduces the pulling and shearing effect on the grafts. Yes disturbing overall I agree.

I think now and before going to bed is better.

I would stick to the oil for now. The saline might make things more itchy at this stage. It does look much better. Well done.

No do the olive oil and wash daily. Just leave some good gap between applying the oil and the wash.

Thanks @Melvin- Moderator Did you by any chance hit bang your head against anything? (Car door, oven hub etc )as with reduced sensation it can easily happen. I think there was more bleeding there. It doesn’t look like necrotic tissue to me. I tend to use olive oil at day 8 and let it soak overnight for 2 days and then do the 10 day wash. Try applying olive oil on it for a day or two or anything that will soften it. Eventually that scan will fall when skin underneath is healed better.

Thank you. I have checked with an ophthalmologist colleague and will look into it further and possibly do a small trial on it to see. Will keep you updated ofcourse.

Thanks again guys. I have cone across this before and I’m actually researching the original paper to look for any limitations of use etc. Nonetheless, as long as it is safe, I’ll be willing to give it a try to see the effect on scarring and any possible hair regeneration in the donor area. Even if scarring is improved alone, that would be good news to many. Visudyne is the marketed name for the eye medication. Again, I’ll read a bit more about some safety issues and update you all on that. I’ll be keen to give it a go if safe to do so.

Thanks for the tag. I couldn’t go through the posts but will share my opinion shortly.

Not at all Sir. I have sent you a message to clear out few things and I hope this makes it a bit clearer to you 🙏🏻

You’re welcome 🙏🏻🙏🏻

Well if you think about it, if someone goes for future hairline lowering, the previous hairline is in no way considered mid scalp. It will still be part of the frontal zone. The single hairs in the old hairline will be forming 2-3 mm band which will not be noticeable when you create more singles and multiples in front of them. I guess the question is: what would look more obvious? An aggressively low hairline with ongoing loss further back and the inability to provide nice overall density OR the unnoticeable band of single hairs in the frontal zone?

Agreed with @LaserCaps. If a hairline is lowered down the line, the transitional single hairs can stay there and as they are surrounded by other groupings of hair, they wouldn’t influence the density. It is less effective to extract them all than to leave them blend with the new lowered hairline.

Thanks for the comment. It does depend on the case to be honest. I always believe that adding more in the future is a safer option for the patient given that no one can predict future hairloss or even compliance with maintenance meds. So making an improvement with a more conservative number can come handy in the future. This gentleman is in his late 20s. Donor is good but not great, so I’m sure he may be looking for mid section or even some frontal or crown work in the future. Having an aggressive hairline for him at this stage might prevent him from reaching his full goals. If there happens to be room to lower it in the future then that’s no problem ofcourse.

Dear community, This is a 28 year old gentleman who had an FUE procedure done in April 2021 . He is a NW 4 pattern with a family history of the same. His donor area is of good quality. We did around 1784 grafts for both the frontal and temple recessions. He used finasteride intermittently but is not being compliant with it. He was recently switched to topical finasteride/minox 5% Photos were taken at around 7.5 months from surgery. He was advised to strictly comply as delay of any further progression is vital and would help with any early thinning in frontal and ms zones. Surgical details: FUE 0.8 mm punch Hairline :400 refined single hairs 2's" 450 3's: 699 4's: 235 Average of 2.43 hairs/graft. Sites made using 0.8 mm and 1.4 mm Sapphire blades. Before photos: Planning: Immediately after: 10 days after: 7.5 months after: Comparison photos: Combed back photos:

Please share more details. It is too soon to judge a hair Transplant if it was just done recently.

Thalassemia minor is only a carrier for one of the genes and doesn’t mean he has thalassemia. Therefore, surgery is not a contra-indication in his case. Necrosis can potentially be due to making too many sites and /or to excessive use of adrenaline containing tumescent fluids leading to vasoconstriction of small blood vessels in these areas. Parts of the scalp are only supplied by end branches of vessels and can be more sensitive to excess trauma (too many sites) or to prolonged vaso constriction. Ironically, one of the documented areas for having a poorer supply is the region of the frontal tuft and this is ironic as it is usually an area where maximum density is needed. The latest photos are showing that it is on it’s way to healing by secondary intention. There will be some pitting and scarring and hair growth will be less in those areas or possibly non existent. However, this can be addressed with adding more at a later stage once the full result is out. Wishing him a speedy recovery.

You do seem to be on a good maintenance regimen and with the biopsy you are even covering more angles than routinely needed. I wouldn’t recommend much more as you seem to prefer tablets in terms of ease of use I would say. I can say that dutasteride/ finasteride tablets and minoxidil tablets is probably the strongest combo you can be on and you already are doing that.