DrTBarghouthi

I'm really sorry for what you've been through. It is important to consider things like SMP or hair systems. They can make a huge impact.

Switching formulations or even starting new hair loss medications can induce an early stage of temporary loss. It is seen with minoxidil, LLLT and even finasteride in some cases. It may well be that or even seasonal shedding which is quite common this time of year.

1] Do I really need a HT? I mean I know I can get one, but will I experience shock loss? Given your age and the recession in the hairline/ loss in crown, then you are eligible for it if you feel that it is causing you difficulties styling/ anxiety etc. There are candidates that we try to avoid / discourage from transplanting due to several factors, but to me you seem like a suitable one. 2] My hairline is really quite far back, difficult to style frankly and that's where I'd like to focus my efforts with minor work in the crown. I believe the hairline/frontal zone will need a bit more than 1200 grafts. However, I would hold from doing the crown at this stage. Doing few hundreds is still a fair option. Being conservative with the crown is key here. 3] I've been on finasteride for 5 years and have had no troubles. I will continue to stay on it regardless of transplant. This is advisable so as to maintain your crown as much as possible and prevent further hairloss elsewhere. 4] I'm young at 28 but none of the doctors said i'm not eligible, is that a bad sign? In general, most patients over 24-25 are potential candidates. In some cases even younger. Proper examination and consultation is needed to assess. Best of Luck !!!

3 main issues here: 1. This area will definitely need at least 2000 grafts if not a bit more to achieve a nice density (if that was your aim). 2. You do have thinning areas that were not addressed at the time of surgery it seems. It is too early to make assumptions as your hair calibre and quality might make up for any reduced density and you might end up being happy with the overall result. It is also not a failure to go for a second procedure if more density is needed. So hopefully these grafts grow well. 3. It is really hard to justify or even explain the price as other members commented. Best of luck.

Ketoconazole based for some evidence of hair maintenance, or simply a mild shampoo for frequent washing.

Sounds like a good choice to get the touch up with her as you had a really nice result. I think what you’re really looking for is that illusion of depth in the midline. So a hint of a peak in the mid section will give a pointed look, the illusion of a lower hairline and there will be no need to mess around with the hairline elsewhere. It will not take a significant number of grafts too. Best of luck.

Crown transplants can take longer to progress. Usually upto 18 months. Keep monitoring and dont be concerned at this stage.

Usually a week after surgery is the estimated time.

I totally agree @Melvin-Moderator @andrew r Please don't be concerned by some of our observations. It is definitely early for any assumptions. It is great you came to the right place for advice and this will help a lot. It is important to follow what other members here have advised in terms of cleaning the dried blood.

It is important in industry standards to make sure that dried blood or scabs are cleaned frequently and regularly. This is because the hair follicles within the first week of implantation rely mainly on blood supply by diffusion and dont have a developed blood capillary yet. So you really need the area around each graft as clean as possible with no solid obstacles in the way if you know what I mean. Did your surgeon do the entire procedure including implantation ? I agree that the density is lacklustre for this area and the number of grafts can be done in one session usually. What concerns me the most is the post op instructions that you were given, which to me raises some concerns.

We personally do some selective cases of long hair SMP on both males and females. It usually involves certain areas that have mild to moderate loss. Not recommended for advanced loss as it is important to have some hair around to give the illusion of added density. It is important to also pay attention to maintenance so as to prevent further hair loss and further loss where possible. I still believe that SMP is best for a shaved head look, for scar (FUT and FUE camouflage) and for quick density touch ups after a HT if needed.

Not a big fan of the ARTAS system personally. I dont see the price of the machine or the kits used per patient justified. There are far more superior results achieved in the hands of skilled doctors.

I agree that these terms are all related to marketing and trying to attract patients by giving the perception that a new technique was invented. I think the method that a clinic is comfortable and skilled at performing daily is what it's all about. Provided the general rules of proper extraction, holding solutions, cooling and implantation techniques are adhered to. I personally like the sapphire blades for example. But these tools should never be used as marketing tools.

This is an interesting thread and I personally have a special interest in administration of anaesthesia. Anaesthesia has a role in reducing pain but also in vaso-constriction of the blood vessels when administered with adrenaline so as to reduce bleeding. While there is no evidence of injections causing any damage to follicles while injecting, I have recently switched to blunt cannulas under the skin for administering the local anaesthetic. I have run my own research about this on our clients and it showed a significant drop in pain scores. i also think it is safer for follicles as it is a blunt tip that only spreads around follicles rather than puncture anything. I will share the full paper with you as it is currently pending publication.

I agree. The industry is generally unregulated. Even attempts to regulate it in some countries leads to even worse consequences. An example is limiting hair restoration practice to dermatologists and plastic surgeons, which I find to be completely illogical- as there is no guarantee that being part of these specialities guarantees superior results. It is a field where you need to be an MD/DO to do anything invasive to the skin (extractions and incisions). At the same time, you need to have the ethical framework of doing what you and your team do best. It usually helps when the practice is solely focused on hair restoration in my opinion. I know there are exceptions to this rule but I think if the team is fully focused on hair restoration as a practice, there will be a higher chance of delivering consistently good results.

Ideally we prefer that your donor doesn’t show any signs of harvesting. SMP can be used to cover FUE or FUT scars but it is still a process that you have to go through and doesn’t mean that it makes over harvesting a donor justified. You also would need to continuously touch up your SMP.

Best practice is for the doctor to do all pre surgical planning including drawing, marking the donor, extracting all grafts and making all incisions. Experienced techs will place and the doc should also supervise that closely.

Yes If you’re happy shaving, stick to it. Nonetheless, the photos with your hair all grown out are very encouraging. Hard to really assess the donor though as it seems a bit low in density and dipping in the middle.

Hi there. Yes please take the advice of everyone here and get it properly checked. This is a typical Male pattern baldness, most likely stage 3V heading to 4 given your crown thinning. You can see the fine hairs in the temples and this is classic DHT effect. It could be someone in a generation that you never met that gave you the genes so having no one that is bald in your existing family means nothing. Styling will not cause this. Furthermore, given that you are 21 and no on any active maintenance is a big No to surgery currently. The reason is that your pattern is not yet predictable in terms of where it will be heading. You dont want to end up with a low hairline and ongoing mid section baldness and an insufficient donor area. Get it checked. You are lucky you received good ethical responses from the clinic you consulted and from this forum as you could’ve easily been operated on already by some blackmarket clinics otherwise.

PRP has no solid evidence when it comes to Hair transplant procedures. There is weak evidence that it might shorten the resting/dormant phase minimally. Nonetheless, a good hair transplant should lead to results with or without PRP. Unfortunately, many black market clinics provide you with instructions to take PRP frequently in order to make up for the slashed prices they offer for the procedure. There are no clear guidelines or evidence regarding PRP usage as of yet.

This issue really comes down to the regulations in place and to the "ethical" ethos of the clinic. Harvesting more than 3000 follicles in one session of FUE is overly exhausting- to everyone working. So the main issues to look at in such scenarios is the out of body time of the grafts and the comfort of the operators. It is usually difficult to have more than 2 or 3 technicians during the implantation phase. Therefore, even large numbers will have to go back in using the same number of technicians in all clinics. It is therefore unquestionable, that 4000 or 5000 grafts will take few hours more per day. It is convenient for the client and the clinic (to maximize their turnover), but it might not be the best practice for graft survival. Ofcourse, we are assuming that they actually harvest such big numbers. I do see personally a lot of cases where clients are told that 5000 grafts will be transplanted, when in fact 2000 were harvested and divided into singles and doubles. This is ofcourse an ethical problem which is quite hard to fight because it is simply built on lies.

To get a feminine hairline design in your case, I would suggest around 1500-1800 grafts. It is mainly to close of the temple recessions and create a curved female hairline.

Hi @anon707 Can you share some pre and current photos? The rough rule is that 70-80% is achieved by this time but some people are slower and some are faster. These are very rough guidelines. Some photos can help

What is your current age may I ask?

6000 grafts or units in 8 hours is technically difficult and potentially dangerous if true. I have my doubts based on the photos. To me it is more like 3500-4000 grafts possibly. Could it be total number of hairs? Many clinics use this number to try and boost their total number. I personally still think that 4000 grafts in a single session is too much. Keep us posted and kindly post your current photos.