DrTBarghouthi

On 12/3/2021 at 8:07 AM, Eugenie said:

@DrTBarghouthi Thanks for your advice. Do you recommend any other medication (oral or topical) to stack on? FYI, I'm 40, and have been gradually thinning since I was a teenager. Medication history: I started on 1x1mg/day finasteride February 2021 then switched to 1x0.5mg/day dutasteride since September 2021. I started on 1x2.5mg/day oral minoxidil March 2021 and then increased it to 2x2.5mg/day since September 2021.  I am awaiting my 2 biopsy diagnosis to confirm the health condition of my hair-scalp at the frontal scalp and temporal side before I take any action. Thanks for your recommendations.

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. 

Yes it seems there was an element of necrosis and skin has now revascularized and is healing by secondary intention (on it’s own). The scab will begin to fall as soon as the skin under it is closing. There will be a bit of a groove in the skin initially. These are my expectations from what I have come across. No need to be concerned healthwise. Make sure the ointments stays on until the skin is back to normal. Make sure the clinic knows and possibly a nearby GP for proper assessment. 

I would prefer for you to stick to the medication for the next while prior to considering any HT. You do seem to have thinning in the Donor as @JC71 mentioned and in that case it is best to wait and see. 

Yes you do need to get it seen in person by a doctor (preferably someone with knowledge about hair and hair transplants. I can’t say it is necrosis for sure as it seems like in an area that had heavy scabbing since day one. Did they use methylene blue too?

I personally tend to do all extractions first (in most standard cases) as this allows me to leave a gap of time between anesthesia for the donor and recipient areas and allows for the body to metabolize some of the anesthesia before giving more for the recipient sites. Moreover, it gives us more time to sort the grafts and trim any that we need for the hairline as the technicians can start working away on the extracted grafts early on. Finally, if for any reason, the donor doesn’t seem favorable for surgery and the procedure is aborted, at least the patient won’t have thousands of pre-made sites done already. 

Looks great. Take the interview next week. If the interviewer spots it, there is a high chance that he might be interested in having one done and that would be a great ice breaker for you :)))

I just came across this post. I strongly urge you to be on finasteride for 6 months and keep a close eye on the donor. You do need a good number of grafts and the donor would better be in its best form before jumping in. 

Very nicely said @Melvin- Moderator

I think it answers many of the uncertainties out there. I think that whatever method the doctor and the team is proficient in is what matters most. 

Yes I agree. Commence on medical therapy preferably finasteride given your age. 

5 minutes ago, FLEngineer said:

I am 25 and I am from Florida.  Of course, now from reading these commentes I'm concerned they depleted my donor area too much.  Hopefully a repair is still feasible.  In the meantime I'm skipping finasteride and going straight to dutasteride, topical minoxidil and RU58841 to ensure my hairline doesn't look too fake/stupid.

I don’t think you should be concerned about depletion as it does seem that numbers are low generally. Their understanding of donor area is a bit awkward too as it seems it started quite high. I’m sorry to read this and i hope you get to at least reclaim your financial loss. 
Get past the waiting phase and hopefully a second procedure will get you back on track. 

This absolutely disgraceful. Definitely under 1000 as your photos are quite clear. The worrying thing is the donor looks like more has been taken by the punch marks. I hope I am wrong since less donor grafts taken will mean a fairly straightforward repair hopefully. 

2 hours ago, Eran said:

Hi guys,

I hope to find some information maybe here:

Father of a friend of mine is interested to do a hair transplant.

But- he did a couple of years ago a heart surgery.

I’m not sure but we understood the local Anastasia could be an issue for him.

someone know someone who did hair transplant after heart surgery maybe or know where I can find some information (except to ask his doctor).

because we understood some hair transplant doctors will proceed and do the transplant and some of them, won’t.

 

thanks!

Thank you for the mention @Melvin- Moderator

There are some protocols for anti coagulation therapy prior to hair transplants. In general, it is possible to proceed with surgery whether the therapy for thinning the blood is discontinued, lowered in dose or even completely stopped for few days. The decision on whether to continue with the medications or stop them or even reduce the dose depends on what type of condition he has, how long ago he had the disease and what sort of intervention he had done (stents etc). It is also important to see of he is a high risk or low risk individual for any recurring events. Nonetheless, the consensus is that surgery can be done even with medications that thin the blood. 
Furthermore, epinephrine use should be minimal and diluted in tumescent fluids. Injecting diluted tumescent fluids in the right layer of skin will help reduce bleeding without having to inject a lot of epinephrine. 

Yes it is advised to use minoxidil post transplant. a general rule is to use maintenance meds for as long as you care :))

This does look like a normal progress at this stage. It doesn't look at its best around this time. Patience my friend. Best of luck!

Hi,

Just came across your post. You do seem to have an early/intermediate degree of male patttern baldness. Your donor seems good. You will definitely need to be on good maintenance given your age. However, I do think that restoring the front is possible with around 2500 grafts. Do not lower the hairline too much and definitely no crown work at this stage. 

Hi,

I do have some concerns about your donor based on the photos. I might be mistaken, but I would definitely consider finasteride first for few months and then if this shows good response, then one procedure to restore the frontal 2/3 for now. 

3 hours ago, JC71 said:

@Dr. Suhail Khokhar@DrTBarghouthi may be kind enough to comment. However a DHT blocking shampoo wouldn’t be recommended for use for about 2 weeks after a ht. Every Clinic gives different after care instructions, but normally it’s around 2 weeks. 

I would only recommend a mild shampoo for the first month. Normal shampoos can be used after that, although I would like to add Nizoral (ketoconazole) shampoo, once or twice weekly after that. 

5 hours ago, akmhtc said:

thank you all for your opinion .i didn't booked with cinik and i will not , now i am trying to connecting with dr Dr. Taleb Barghouthi and i will see what's going to happenied

Thank you. I’ll be more than happy to assist by contacting us directly by email or whatsapp or even through the forum if you prefer. 

On 11/3/2021 at 12:49 AM, Sleeplessinsf said:

Thank you so much for this list! How come Pekiner is not on it ?

Also Dr. Taleb Barghouthi is interesting to me, anyone on the forum recommend him ? My mother lives in Amman, Jordan and will check him out. 

Thank you for the mention. I will be more than happy to assist you or her via direct messaging or through here. Our details are available on the signature footer. 

Dear Community,

This is a 49 year old gentleman with isolated crown loss. He has no known medical issues and has been placed on finasteride for ongoing maintenance. He underwent an FUE procedure in February 2021 as follows:

Total grafts: 1548

Hairs/ graft: 2.66

Extraction done using a 0.9 4mm serrated hybrid punch.

Incision using 1.4 mm sapphire blades.

Photos show the status before, immediately after and at 8 months following. As you know, with the crown, we expect further improvement upto 18 months generally. 

Before and planning:

Sites creation:

Immediately after:

3 Months:

8 months after:

Sorry to jump onto your post @Samirjz

Certainly nice to see your result posted here. Allow me to give some more info to those wondering. I will also update the photos with the more recent ones from your recent visit. 

Procedure is now around 10 months. The posted photos were 3-4 months old so I have recent ones which I will share here if thats ok. 

Total FUE grafts: 3655 to address the crown and frontal zones, including lowering the hairline slightly. 

Average hairs/graft : 2.29. 

Maintainenance on finasteride 1 mg mostly on alternate days. 

As mentioned will update recent photos if OP is ok with that. 

Hi,

I just came across this post and I agree with the general feedback that other knowledgeable members shared. Your husband is 29 and is keen on a very good coverage, which is very challenging given his donor area. Ofcourse an in person evaluation is always best, but in my humble opinion, he will probably lose more hair in his donor and taking any decent number can be quite risky. He will need to start on finasteride once your IVF cycle is done- best of luck with that!

2 minutes ago, BlokeFromStoke said:

@JohnAC71 cheers John saved me some leg work there 👍

Yes that’s quite tough to judge. I would say leave it for 1-2 weeks before assessing it properly via a consultation. 

I agree the donor looks quite unfavourable. May well be A DUPA case or a potential NW 7 given your age. I suggest SMP or simply a hairline/hair system combo if longer hair is what you desire. 

1 hour ago, BlokeFromStoke said:

@DrTBarghouthi thanks for the quick reply! My age is 28. How long will the donor need to be for you to judge clearly?? Sadly I shaved it off, after taking the pictures Friday. So only have a few days growth currently.

 

Glad to see you seem positive in general though

Please feel free to share donor photos currently. Might need a week or two of growth to see better, but might be able to give a hint now anyway.