DrTBarghouthi

Thanks for the mention. Yes you do seem like a NW4 to me based on photos. Donor does seem favourable and with a decent surface area. Is the crown something of concern to you? Would a low dose finasteride be something that you would consider?

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. 

3 hours ago, Sqwilliam said:

Hi digi, thank you for your input on my situation. I had the same outlook on surgery as you did before I had my first procedure. I am on finasteride currently to hopefully retain and slow my hairloss and am considering oral minoxidil. I would agree with you if I had less hairloss and only wanted to creat a perfect hairline. That is not my goal from hair transplantation, my goal is to fill in my mid scalp area and have a conservative hairline approach. Coverage is my main concern and something that I see as achievable. I want something that will age and look good in my 50’s. My hairline is and was high a lot of my life and I do not intend to lower it at all. If I was completely bald as of now then I could immediately have a surgery because then there is nothing to worry about, because the doctor is working from scratch. That’s idea of not having a transplant young because how can you plan exactly how someone’s hair will progress? What I’m saying is I have very extensive loss as it is diffuse thinning especially for my age. What I want to do is have a good transplant with combination of my native hairs to create a better result. Respectfully  5+ years for me doesn’t seem like a option I would consider I would wait 1 year at least post op to consider my next options. If I had my second procedure with one of these clinics I have no problem going back when I feel I need to. I think you are right in that most people should wait until the age of 25. For the ones that have significant loss I don’t think applies, to someone chasing perfection. I understand that I will need likely additional surgeries that’s why I opted for fut and will for my second. That is why I am seeking a dense packing of my mid scalp and tightly packed hairline for my second procedure. This is what I wanted from my first procedure. I made a mistake choosing the clinic that didn’t densely pack and am trying not to repeat my mistakes and find a ethical doctor who will work with me throughout the years. This is why I reached out, for help on which clinic would be a good fit for me. I appreciate the concerns but would prefer opinion on the two clinics mentioned.

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

Just now, rambunctious said:

No harm, but is there a known benefit in the transplanted area? Quicker growth, etc? 

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. 

1 hour ago, Mountinvan said:

Is it possible to re-start topical propecia with minoxidil post-op--or is it better to just stick with the foam minoxidil? Same 3-4 week post transplant time frame?

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

1 minute ago, rambunctious said:

Do you place the foam in all areas of the scalp including the transplanted area? 

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

15 minutes ago, alex85 said:

My surgeon advised me to restart my minoxidil 15 days post-op. In my country (the Netherlands) you cannot buy Minoxidil Foam, only the 'regular' version, so with propylene glycol and ethanol (96%).

Can the variant with propylene glycol and ethanol damage follicles? Because I read @DrTBarghouthi only recommend the foam, at least for the initial phase.

 

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. 

On 12/19/2021 at 10:10 PM, Berba11 said:

That's absolutely horrendous to watch. Looks too fast, imprecise and messy to me.

@DrTBarghouthi, what's your expert assessment of this video clip? Would be interesting to hear your professional opinion.

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. 

27 minutes ago, SLA said:

Much appreciated @DrTBarghouthi- It could be revolutionary and since it is already an FDA approved drug, it could be imminent for use in HTs if deemed safe.

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. 

11 hours ago, BlokeFromStoke said:

Latest updates, still not sure if to expect to much more growth? Not getting my hopes up, but looks promising.

2 things

1.) @Melvin- Moderator thanks for your YouTube videos!! I know it's not apples to apples, as your talking about sparseness after transplants, not meds. But knowing things are never perfect, settles the mind.(the looking weekly and thinking is this it? I would have thought is the same)

2.) @DrTBarghouthi @Doron Harati I think I owe you both an apology! Having consultations, but being in limbo of will things/won't things improve. If indecisiveness or just general being a bit of a  kn*b from not knowing what to do, I'm sorry.

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 🙏🏻🙏🏻

47 minutes ago, Curious25 said:

I understand about the ability to create a transition zone, so there not being an issue with it standing out as such. My point more so was, if one was to restore a patient from a ‘blank canvas’ . . then they wouldn’t place a band of singles and finer hair in this mid section of the design, as it wouldn’t make sense - therefore retrospectively, if hairline lowering is carried out on a patient at a later date, their graft utilisation and efficiency wouldn’t be as good as what a pre planned full restoration of a patient would provide ? 

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?

2 hours ago, Curious25 said:

Just a question out of curiosity - and this isn’t specific to you, or this case . . If a patient opts for a frontal hairline restoration such as this gentleman, and a higher, more mature hairline is deemed to be the best approach at the time; if in 5-10 years down the line, and the patient has maintained with little to no further loss, and wishes to then lower his hairline - would this have essentially created a waste of utilising the band of single and finer haired grafts in the original restoration, and they will now serve less of a cosmetic purpose in what would become more of a mid section of the patients hair? Or would it be best practice to re-extract these same singles, and re-utilise them in the new hairline? 

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.

13 minutes ago, Curious25 said:

Nice improvement with such little grafts. 
 

Is your philosophy within hair restoration to be conservative in general, or were you working with limited donor in this case ? 
 

By no means a critique, I’ve just noticed your results to be less aggressive designs, using low graft numbers relative to the amount of loss that patients present with. 

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. 

4 hours ago, ciaus said:

 

Agree with others about naming the clinic and doctor. I googled 'thelasemi minor' and found this. I wonder how much of a risk factor this is for hair transplants. Especially in circumstances where an infection arises and you have reduced red blood cell functionality. Based on the definition it sounds like this could be a significant amplifier in terms of cell and tissue death. 

To any doctors reading this, like @DrTBarghouthi, how would someone having this condition factor into your decision on qualifying them as a good candidate for a hair transplant? And if you do take them on as a patient would you limit how many grafts you do at one time to limit the trauma? Not seeing anywhere how many this patient had done.

------

Thalassemia is an inherited (i.e., passed from parents to children through genes) blood disorder caused when the body doesn’t make enough of a protein called hemoglobin, an important part of red blood cells. When there isn’t enough hemoglobin, the body’s red blood cells don’t function properly and they last shorter periods of time, so there are fewer healthy red blood cells traveling in the bloodstream.

Red blood cells carry oxygen to all the cells of the body. Oxygen is a sort of food that cells use to function. When there are not enough healthy red blood cells, there is also not enough oxygen delivered to all the other cells of the body, which may cause a person to feel tired, weak or short of breath. 

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.