DrTBarghouthi

1 minute ago, JohnAC71 said:

Thanks for responding to the tag 🙏 would you be able to approximate how many grafts could be there ? I know it’s very difficult to tell, just curious 🤨 

Probably around 3000 imo. 

Just now, Sbiza said:

 

ok good, I was really worried about it! I didn't had that much pimple in my life even while I was a teen! lol

I think that they simply inflated the number (I hope). 

 Thank you Doctor, I really appreciate your opinion!

Pimples can occur after a transplant in both donor and recipient areas. Usually Sporadic  and non painful. 

7 minutes ago, JohnAC71 said:

Be interesting to hear @DrTBarghouthiopnion on the above. 

Thank you for the mention. I agree that it doesn’t look like 5000 grafts- which I hope is the case as this means there is some donor left. 5000 in 7 or 8 hours is quite difficult. Might be possible but certainly will  be quite rushed and hasty and that will affect quality. Also 5000 grafts will mean grafts staying out of body for longer hours and that can affect overall survival too. I personally cap our day at 2000-2500 grafts maximum. 

20 minutes ago, dtap said:

Hi Doctor. Very sorry, but I need some clarity. When you mention epinephrine do you mean you use it as a medicine? Or do you mean its a pesky hormone that contributes to shock loss which needs to be reduced from affecting the scalp?

Epinephrine is present in all anesthesia that we inject. It is possibly one of the contributors of shock loss among other mentioned factors. 

5 minutes ago, dtap said:

Hi Doctor TBarghouthi. Its a pleasure receiving your professional input.

In your vast professional experience, do you know if theres a way to reduce epinephrine (adrenaline hormone) and/or other contributing factors/hormones to reduce trauma and in turn reduce shock loss?

IMHO, I strongly feel shock loss is the BIGGEST enemy in the hair transplant world. Once thats mitigated completely out of the picture for good, hair transplantation as a surgery becomes a godsend for the leery patient.

Awaiting your feedback doctor!

 

Ok that makes sense. Appreciate that gillenator.

I'll be sending you my pics soon. Just give me some time. Always appreciate your honest feedback!

Thank you for your message. Ofcourse you need to be cautious with the amount of anesthesia and epinephrine used. We have to use enough to numb the area but not to over do it. Also the use of tumescent fluids helps with being able to use anesthesia and epinephrine in diluted amounts. I personally use triamcinolone (steroids) in my tumescent solution which has a potential effect in reducing swelling and shock loss in some studies presented by colleagues.

I’d say around 500-800 depending on how it looks in real life. Maybe a bit more on your right side since you seem to comb it slightly right to left. 

Use some olive oil and leave it to soak overnight. I usually ask patients to start that at day 8 for 2 days and then come in for a wash at day 10 if they can. If not, a normal shower will flake most of these out. I find olive oil very helpful in getting most of them out from the first proper scrub. 

I think there is always a small chance of it happening. It depends on several factors but seems epinephrine plays a major role. I find it happening in 2-5% of patients in the donor area and the majority happening in the area behind the ears. 

Hello and thanks for tagging. A double crown is not considerably different than a single whirl. The main thing is to recognize it and mimic the directions. Yes the directional change might make more the scalp showing rather than the typical cross linking effect. Might need a bit more grafts but if a surgeon is used to crown work, there is not much difference except for the planning part and maybe a bit of more work getting to work with the various directions. 

Thanks for your message. Given the existing weakness in the donor and the progressive thinning following FUT - I don’t recommend undergoing surgery. I would however suggest SMP or a hair systems (combined with some transplam ) for you.

1 minute ago, EvoXOhio said:

Whoops you forgot to blur his eyes out in out of the photos 

Thanks for pointing it out. I’ll act on it. 

Hello. Just a quick update on the 1 year progress:

2 hours ago, 5BetaReductase said:

I must also add that the temple point hairs added blend in very well.

 

do you use pre made incisions for temple point hairs?

which motorized system do you use for fue?

Thanks! Yes I tend to premake all temple point incisions using a small sapphire blade. Might add in between at the end as a “stick and place” 

As for systems, I use my customized motor device which is a modification on the PCID system. I use all the other systems, but I am leaning towards this custom made one. 

4 hours ago, JohnAC71 said:

@DrTBarghouthiwow where has that year gone. Remember his early growth and now look. This is a excellent result ! He must be one happy chap 👌 thanks for the update 🙏

Flew by I know!

3 hours ago, Berxedan7 said:

@DrTBarghouthi Hi! I am on no medications because I have heard too much about side effects. What medication would you recommend and how would it help me? My family history is that my father has hair loss on temple areas. My uncles are mixed. Some have thick full hair and some have hair loss and are bald. This is sadly just a gamble of genes.. Either you got hair or no hair. For me the worst part is the front hairline. It kills my confidence alot.

Thanks for sharing. My number one recommended treatment is finasteride and it doesn’t have to be on a daily dose. You can try topical fin too as I’m sure it would work better than not using anything. This helps preserve as much existing hairs as possible given your age. 

Yes I do at the clinic. These I just shared the ones I kept on my pc unfortunately. 

Hello again, 

just saw this gentleman for his yearly check up. Here is his almost one year update. He remains on finasteride on alternate days. 

May I ask you about your age? It seems reasonable in many cases to delay the crown work for various reasons: shock loss of existing hairs, ongoing outward loss, limited donor etc. 
I also agree that PRP is not the ideal maintenance regimen. I use it during surgery but not to do with the result itself. 

@SD1984by the looks like of it, your donor would probably yield around 5000 grafts if not more with FUE. Ofcourse not all should be done in one go. Depending on actual examination, it might yield more based on head size and hair density. But I dont think it will yield anything less than that to be honest. 

@solooplease share some photos if possible in order to give you further feedback if needed. 

Hi @Berxedan7Are you on any maintenance medications? and what is your family history like? Can you post some photos of your current state? It is important at your age to be cautious and probably conservative. Please feel free to share some photos here or through a DM. 

17 minutes ago, pomloe said:

@DrTBarghouthi@Melvin- Moderator@BHRClinic Any thoughts on my donor?

Yes the donor looks patchy and rather depleted. How many grafts were extracted ? Can you share some more photos of the result and also the beard?

1 hour ago, ML488 said:

This really should be something that is considered more. Looks amazing, and without the worry and maintenance of the hairline, it saves so much time and worry imo.

@DrTBarghouthi Is the system applied with tape or glue?

It can be applied using different tapes or adhesives depending on preference, allergy testing and hair presence (or not). I find tape to be really good if no hair is present at all. For other cases I use a sort of a foam or liquid adhesive. 

4 hours ago, rob7331 said:

Hi HRN friends. The time has come to decide where to go for my second HT.

I'm a Canadian and our international travel laws are still quite strict, so I'm looking at a date in November.

More pics: https://www.dropbox.com/sh/r61n4tou8gymwm1/AADTb5Ry6JjwmcOHqqDkMT7Ca?dl=0

29 years old, been on fin for 4 years. Hair loss has stabilized.

The wet pics really illustrate how thin it is in the midscalp and crown. On top of that my hair is quite fine. It'll be a decent sized job; almost definitely a third op will be required for the crown. I think 3500 is a good goal.

Clinic shortlist

Demirsoy

I've been researching for a couple years and Demirsoy has repeatedly blown me away with his affordable and consistent results. I've followed tons of testimonials here and on other forums, and have seen minimal bad results (every clinic has them so it's expected). That coupled with the heavy doctor-involvement and patient focus throughout the day puts me in a very comfortable position considering him. Lastly, he seems proficient at getting "general head coverage" and tackling multiple areas at once, something I'm looking to get done with a reinforcement of the hairline, filling of midscalp and sprinkling in crown.

On the less good side, I've noticed he doesn't seem to go that dense, and his hairlines aren't always as "soft" (sometimes they are, but not always) as some of the upper-scale artist doctors out there. That said, I would be absolutely thrilled if I got a result like @GLHF, @JST07, @Sijac09, @Mikeycrfc, and the many more on this forum and others.

Eugenix

We all know about Eugenix - they kind of exploded on this forum over the past couple years. I felt that @Zoomster and @paddyirishman really put them on the map, then @Fluffhead blew us all away with the natural artistry he achieved and for an affordable price. Eugenix just gives the sense that they really know what they're doing and care a lot about their patients. This was further concreted to me when @Looking for HT posted his saga and the clinic kept their customer service top-notch, instead of blaming or dismissing like I have seen other clinics do. Lastly, @Abhinay Singh posts results for Eugenix constantly - they are one of the most actively involved clinics I have ever seen.

I'm confident Eugenix could handle my case well, and likely provide coverage over my entire head. My main worry for them right now is the Coronavirus situation, although I'm hopeful by November things will be much better.

Pekiner

Admittedly I know a lot less about Pekiner than the other clinics I've mentioned. At 2.5 euro a graft he is also at the max of my budget - but to reference my favorite quote by @Melvin- Moderator - "You're getting a hair transplant, not buying a dishwasher". The work Pekiner has done is nothing short of amazing; his density is off the charts (check out @Tug's post op), he can get wide head coverage like he did for @qnt2019 and he is experienced with a variety of transplant work (beard, repair work, etc). That said, I wish there were more Pekiner results on this forum to help me make an informed decision. More research is required.

For cons, the infamous 'chance of being cancelled' on the day of is scary, I'll admit. Also, given my large area to cover I'm not sure if Pekiner's dense approach would fit best for me. Although I'm pretty confident he would reinforce my hairline/midscalp area spectacularly, I'm really hoping to get at least something in the crown on this op.

Thank you all for reading, please let me know if you have any kind words of advice. I'll be sending out consultations to all doctors in the next couple weeks. I'm also open to hearing about other doctors that might work for my hair characteristics, etc. Have a great Wednesday.

I agree that you do have favorable conditions including that of hair color. I do believe 4500-5000 grafts for the entire area is manageable and would give you the results needed. I’m not sure if I missed whether you’re on any maintenance meds? 

Go for whatever your doctor is consistently getting good results with. In many cases several techniques may be used in the same setting. I, for example, like the Sapphire blades and have been using them for more than 5 years. However, I do a stick and place in almost most procedures. I leave around 50-100 grafts at the end for “icing the cake” and going into areas that I feel may need more emphasis. This is usually made through visual inspection but also based on what the techs would also see during the implantation process. in some cases I do all sites before extracting even.