DrTBarghouthi

Interesting topic! Apart from the actual medical and surgical aspects of running a hair restoration clinic (surgeries, consultations, follow ups etc), waiting list management is a true operational process. It is not easy to manage it , maintain it and even more importantly control it. While a very long waiting list can mean that a practice is busy, it can also mean that the doctor is away for extended periods (whether he or she has commitments in different cities, or meetings etc), or simply has certain days of the week booked for surgeries only (which pushes the waiting times longer). Nonetheless, while some clients are encouraged to book because of the long waiting list (buying a Ferrari), what you dont know is that we often lose some other clients because of that. So managing the waiting list is an administrative skill. Some clinics can maintain the same load but have a more managed waiting list by being more dynamic about working days, hours, seasonal changes, offering price incentives based on cancellations and even in some cases having incentives for far away dates and keep the ones closer at the normal price. So in Summary, a long waiting list will mean that a practice is busy ofcourse, but a reasonable waiting list could mean that they are efficient in managing it. Ofcourse provided that they maintain the same level of service.

@Kickbuttmario Sorry to hear about your experience and below the par results. In my honest opinion, this is not close to what is expected after 2000 grafts 18 months later. There is definitely not enough growth, unusual angles/direction, multiple hairs in near the temple points (which looks out of place) and density is just low. I also think that the Temple point approach and reconstruction was exaggerated in principle and under managed in practice (big area with low density). Better photos could give a better judgment but the good news is that it can be repaired if your donor is good (which I assume is still is). Another option considering you shave at the moment is SMP. It can redraw everything and make everything blended nicely with less down time and a more immediate effect. You can also use SMP as a temporary route until you do the repair HT.

Yes you can wait a bit longer for the final result, but it seems you will need around 1500-1800 depending on how wide the thin frontal zone is. You will need around 400 single hairs to go between the existing hairline and make it more dense but soft. The rest will go behind that as you need the dense look to match your existing hair. Make sure you’re on good maintenance. The surgeons you listed are great choices.

Best of luck with your procedure. Dr. Devroye is a highly esteemed surgeon and a wonderful colleague. There is no right or wrong once you had your research done. There is no magical number of consultations or countries to visit for consultations. As long as you choose someone with a good reputation, results and you personally "click", then you should go for it IMO. All the best

This really depends on your long term goals. If you are for example considering future FUT, then you should probably delay it until you are no longer having any strips done. However, if one strip is all you’re planning on doing, then I would prefer to get the scar mature enough before doing so (6-12) months. There is no harm doing it before, but it feels better with pigment absorption once the scar matures enough and the immediate redness and healing is over. Also bear in mind that delaying it until all your HT procedures are done could have the added advantage of doing it for the scar and also for all the FUE scars if you decide so too.

I agree with what’s discussed. It is different from one person to another. Usually starts a week or 10 days once the hair can be scrubbed and lasts for 4-8 weeks after that. I am noticing that usually 50-80% shed and some transplanted hairs remain and commence growth stage. I dont know if this is an effect of PRP use intra op. Could be but nothing documented yet.

PRP has still the lowest evidence among the other approved options. Nonetheless, it makes sense to have it given during the surgery. I personally include it with surgery in order to encourage people and the most perceived benefit is a slightly shorter initial resting phase in those who use it. I do not advocate its ongoing use after the transplant as i prefer clients to go back Finasteride, LLLT or regaine for maintenance after.

@gillenatorI agree that FUE gives a nice option of not having the linear scar and also picking softer hairs. Nonetheless, in FUT, grafts can also be trimmed nicely and the scar can be hidden well in females (since they are the majority of clients going for it). The biggest advantage of an FUT eyebrow is the fact that you can keep the hair slightly long and that enables seeing the curl of the hair better than FUE, which is important to plant them with the curl facing down towards the skin rather than sticking up. I am too a big fan if latisse on both lashes and brows. You need a slightly higher dosage for brows though.

I’m not sure to be honest. It might be that the application was not kept on for long or was not enough. Some studies show that caffeine can elongate hair shafts by keeping hairs in the anagen phase for longer. However, it seems that the main positive effect is a suppression of DHT in the scalp. If that is a more significant effect, then other body hairs are not sensitive to DHT in the same way as scalp hairs are and therefore it would be more effective on scalp hairs. Nonetheless, this is just my take on it.

I haven't experienced any positive results with these on eyebrows to be honest. I wouldn't imagine they would work there.

It is usually for the native hair. However, there are some studies showing the effect of Bimatoprost (Lumigan and Latisse) on scalp hair including donor hair and even Alopecia Areata. So there could be a stimulatory effect on donor hair grafts too as it works through another pathway other than the hormonal androgenic path.

You can certainly carry out a U-FUE. Your donor area is already trimmed down by how you style your hair. As for the recipient area, this should not be a problem too as the temple recessions are quite clear and empty. Given the density in your mid frontal zone, I would suggest something in the region of 2000 grafts to match the middle density. As members outlined here before, you should always be aware of the fact that your curls could in some cases lead to a higher transection rate. Few “test” extractions could be helpful.

@Melvin-Moderatoranswered your initial question. As for growth treatments for eyebrows, many doctors use bimatoprost eye drops (brand name Latisse) as an off-label use topically. It is FDA approved for eyelash growth, but it is being used on eyebrows too with good effect.

Yes you are correct. We were just trying to interpret whether in the Original description is meant 3V or 5

Yes I meant taking medications to maintain as much as possible. Based on your expectations and styling preferences, I see that it is best to focus on the front with good density. I do believe that if you maintain what you have you might eventually be able to transplant the crown. Remember that if the crown is not transplanted and you end up shaving your head, then SMP will also be a good option for the crown down the road.

Your frontal zone is probably around 70 cm2. Considering you have some hair in the mid-frontal zone, then an average density of 40-50 grafts per cm2 will be great imo. Maintain what you have aggressively, ignore the crown for now and aim for around 3000-3500 grafts for now. This is only my opinion. 1200 is a bit far off what you need.

True. The reason being is that it is not technically different than a conventional FUE. Just needs some planning of the donor area and the procedures are staged. Option 1 is more technically challenging as it needs specific slitted punches and non rotating machine or a manual extraction. Nonetheless, it is being done by some.

I agree with the previous answers. If a clinic you are considering has different service levels, then make sure you see the results. Although if you think about it, if you see results from the package that had minimal doc involvement, then how would you guarantee that the personnel involved are going to be the same? As a HT patient myself, a clinic offering different service levels (in terms of surgical involvement) is something that will make me reconsider. Having packages for accommodation or travel etc is fine, but not for surgical involvement. Thats only my personal take on it, with no disrespect to anyone’s business model.

The standard practice is to shave the donor and recipient areas for both FUT and FUE. The shaved portion of the donor area for FUT is minimal and hair above usually covers the scar initially. The recipient area can be minimally shaved depending on the size that needs transplanting, the pattern of hair loss and your current style. Clients with longer hair and only minimal recessions or some crown work can hide this pretty well. Nonetheless, nothing is 100% hidden and redness and shedding will always occur. Now, more recently, a trend to do more “hidden” work has emerged. This is usually divided into two techniques: 1. Preview Long hair FUE as the name implies involves extracting long haired follicular units and transplanting while maintaining the long hair shaft. This is done by some clinics and gives you an immediate “preview” of what the end result will be and also avoids shaving the donor. The downside is that those hairs will shed in few weeks (might be more upsetting to some clients seeing that happen after seeing an almost fully grown set of hair), but also might be satisfying to some. The main downside is probably cost and the fact that the yield per session is smaller. It is a more time consuming process and probably yields 1000 grafts at most per session. 2. The other way to sort of avoid a full shave FUE is to have your hair long in the donor and to shave several strips of hair (similar to FUT shaving) and extracting those grafts from there. The hair over these strips will hide the areas being extracted quite well. Again, the yield is less per session and we usually plan the procedure in stages every 3-4 months so that you can extract from different areas every few months and make it look undetected. Usually 1000 grafts per session (depending on how long the hair is ofcourse). The longer the hair in the donor, the wider the shaved strips can be and hence a bit more per session can be done. This one works well in my opinion, but it’s important to have it well planned because you need to have a uniformly extracted donor by the end of the sessions. I hope this helps. Different clinics can name these techniques differently so I wont get into the different names that can be given to these procedures.

Very nice result. Yes clearly what was meant is a class 3V (vertex) loss.

It's a tough call at times to base the decision on photos. I think in such cases a live consultation is the best, where the donor area can be properly examined and also the areas of hairloss and then an appropriate plan can be drawn.

It is completely normal to feel in such a way. The main thing is to feel ready, be a suitable candidate and to do your research as to who should be doing your procedure. It is also important in your case to commit to maintenance therapy to avoid a great deal of progression. Once you're happy with that, there is no reason to be worried or concerned. If getting bald bothers you, then fixing it right is one of the most rewarding/satisfying things ever. Best of luck to you!

I agree with @spex that there is a lot going against you having an FUE. If you plan on having it buzzed then SMP is a more sensible approach.

I do agree with you @Lennney that the actual technicalities are not a determining factor and perhaps shouldn’t be asked. I guess I put the list based on what I encounter daily and these came up along as some people who researched would usually ask about these. I don’t mind them asking about the broad differences in technology as it does show some level of research and knowledge of the procedure so I do answer and discuss why I use this over that. I think people generally have an innate tendency to question, show off their knowledge and are simply curious at times regarding techniques. The questions I mind would be the too “markety” ones such as specific device names etc as you rightly mentioned.

Thanks. It is different ofcourse from area to area. I dont think there is a set protocol on how to proceed, but yes infection is one of the concerns after HT on Imuran and especially in a big FUT scar. It might be wise to do a small test area first and proceed from there. This way you can assess how your excision sites and recipient sites heal and also the overall hair growth success. I also quoted the link Melvin sent about consulting one of the recommended surgeons online.