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I highly recommend Dr. Lorenzo. I've had two procedures with him (see links at bottom of post). Quality experience was top notch and I still get complimented on the quality of his work as the best they've seen. I think a lot of people on the forums don't realise he teaches many other surgeons. Choosing any surgeon is tricky because it's such a big leap you're making. However, I would suggest getting consultations and listening to your instincts.

Following this thread! It looks like a great result is on the cards!

I'm sharing this experience because I couldn't find much information on the topic, and I hope it can help others in similar situations. Last year, I experienced a sudden allergic reaction. As someone without any history of allergies, this was unexpected. My skin erupted in itchy hives, and my face and lips began to swell. I immediately went to the Emergency Room, fearing the reaction could worsen. The symptoms stabilized, and I was given antihistamines. The doctor asked me about potential triggers and whether I was taking any medications. I mentioned that I was on finasteride, which i'd been taking for several years. While the doctor didn't initially express concern, I worried that the finasteride might have been responsible. The leaflet in the box listed hives as a potential side effect, which made me anxious since, like many readers here, I rely on finasteride for maintaining my hair. I decided to stop taking finasteride for a few weeks and, per the doctor's advice, maintained a diary of any subsequent outbreaks, which plagued me for many weeks. Although there were no obvious triggers, the symptoms would randomly recur at intermittent intervals and usually for a few days. Eventually, with the help of the diary, I traced the cause back to rosin oil, a product of pine trees used in numerous household items such as glue, adhesive bandages and, in my case, table wax. It seemed that my skin's contact with the varnished table initiated the hives, with future outbreaks being consequences of the initial exposure. After quite a few months, the hives finally disappeared. Now, the good news: I resumed taking finasteride without any adverse effects. Not medical advice, but if you're concerned about finasteride causing hives, keep in mind that there might be other factors at play. Hope this helps.

I enjoyed reading your report: it brought back lots of memories in vivid detail. I look forward to seeing how everything evolves for you! I haven't gone back yet for the touch up, but I do plan to. Travel was an issue for a while but the world is opening up once more. The less dense area on the scalp is quite small and its one of those decisions along the lines of "that would be nice to have". Hence, i'm thinking of following it up sometime around 2023. Having hair is still such a game changer! I wish you the best and enjoy your new hair! I did pay the difference, yes. Before the procedure begins, the clinic will ask you if you are okay with having a few more grafts inserted for a better outcome. I think this happens once the doctor is operating on you and sees that a few more here and there might make a positive difference. You can also choose to pay exactly what was quoted to you and receive the exact number of grafts. I went to the best! Thank you for your kind words! Thank you! I'm just taking 1mg finasteride a day (err...when I remember!) If I get a touch up, I'll pop back and write a third report.

Update: It's been 1 year and 9 months since I had my second procedure with Dr. Lorenzo. A couple of you have asked for an update, so I have included four photographs I took today (December 2021). Overall, not much has changed in regards to my hair but I'm now sporting a shorter hair cut. I’m still as delighted with the results. I am very happy to have hair; even when it’s mess and needs a cut! I’m also content to have my mistaken when compared to my peers (which, unsurprisingly, doesn’t get old). I've noticed at a shorter length that my scalp is a little more visible when looking from over head in daylight: I typically brush my hair to one side which tends to remedy this. However, when I’ve washed my hair, it tends to spread and sit finely on my head. In this respect, the images I’ve shared here are straight after washing my hair, without any hair product and in direct day light. In the overhead shot, you can see the more dense hairline towards the front of my scalp that was rebuilt. Likewise, face on you can see how the hairline looks. The sides and the back (which are still a little damp) remain dense: I seem to recall that approximately 40% of my donor hair remains, so hopefully this gives a visual indication of what might be achievable. I am likely to get a little touch up here and there at some point in the future. I’d like to get a few more grafts in the crown and thicken it up just a little more. Dr. Lorenzo also mentioned about adding a few to the peak. I’m in no rush, but I will write to the clinic and see what they say. On a side note, I have now been taking finasteride for the best part of five years (5mg tablets, manually divided into approx. 1mg pieces). I recall I was hesitant to what negative effects this medicine might have on my body so wanted to add some insight now I’m further down the path. I’m pleased to report that, at present, there have been zero health issues, particularly testosterone related. I am an active person and train 3-4 times a week (dance, boxing, swimming) and at age 40 I feel as vibrant as I did 20 years ago. The biggest issue have is remembering to take the tablets each day: sometimes I forget! Please feel free to ask me any questions if there’s anything else you’d like to know.

Dr. Lorenzo does his own surgeries; can confirm as recent as 2020. Looking to work with him again in 2022.

Before the procedure and after is often a game of patience. Good luck with yours (it'll come around before you know it!); i'm forward to reading about your experience.

1.) With the exception of the firetrap, I would say at present the temple points now blend in with the native hair behind. I otherwise can't discern a border with my present hair growth. However, you can see this in both of the temporal peak photographs; these were taken 5 months after their respective procedures with short hair and whilst the hair was stick thickening. I suspect if I shaved my head there would be a gradual change in gradient density. 2.) I remember my natural temple points graduating into having soft blonde hairs at the peaks, so I agree with you that the characteristics of the hair changes in this area. In my case the new hairs are not so 'feathered'. I haven't got quite the degree of fine dithering of blonde hairs that I once had (there are some), it is now graded but with darker hair. Post op, I can definitely say the temples behaved as they did when I originally had them. They don't grow faster or slower, or act any differently. In other words, they're completely normal in this regard. No maintenance required, or optimal hair length. They grow at the right 'speed'. Hence, based on this, I would say Dr Lorenzo did a great job in selecting and placing the hairs!

Great question! The temple points were the most uncomfortable area during the insertions. I'm guessing that's because the underlying tissue is very thin in that area. –I'm not sure the exact number of grafts that went into the temples. I recall 250 initially being discussed on each side; but since my right was slightly thinner than the left I suspect the right side got more. I do recall before even considering the second procedure I hadn't assumed many grafts would be required. What I hadn't factored was as the hairline lowers, the temples also have to come forward to maintain the visual balance of the new hairline. The temples before the second procedure were good although he felt they were a little less dense than he wanted. This time round, Lorenzo thickened the temples. I've found a new photo after my first surgery, so I've added that for comparison. I was actually quite surprised to see the progression over time and how much better the new temples look. There is a gap (a 'firewall' as he call it :-) on the left temporal peak. I think this was from either shock loss or a few grafts not taking. The effect is minimal (if the hair falls a certain way its a little thinner but otherwise not apparent). Dr Lorenzo has said that can be fixed quite easily, so I'll likely go ahead and get that done. Overall, I'm really happy with the temporal peaks: they feel natural and well placed. I hadn't considered how significant the effect has been of bringing them forward. This realisation only occurred when the lines were being drawn on my head and I saw how many square centimetres of skin they covered!

No problem! Here's some more photographs that were taken the day after the procedure.

Thank you! It's taken 5,000 grafts to rebuild the entire front of my hairline. I never thought I'd have again, it really is a miraculous feeling.

I believe there was 3-4. Although I can't say the extent of the work each patient was getting. The experience was streamlined, as before. I met fellow patients at different times: mainly during consultations rather than during my procedure. For that part of the day, I attended the clinic late morning (at Dr. Lorenzo's request), had my grafts extracted, then had a break, and then had them transplanted. Hope this helps!

Thank you! Keeping the rest of the body supple and springy is the next task! It's been life changing (again)! I turned up to the surgery and Dr Lorenzo saw me and a couple of other patients. I didn't have to choose between what doctor I would see. I was told in an earlier email that another doctor might perform the work, depending on Dr Lorenzo's direction. I assumed this is so each patient gets the best possible result. I was personally happy with this because I know the skill level of his team. If Dr. Ferreira had appeared then I know i'd be in extremely good hands. However, it turned out Dr. Lorenzo worked on everyone, at his own pace, who came to see him that day. Apparently he's superhuman.

NB. This is my SECOND procedure with Dr. Lorenzo. My first was in 2017 and you can read about it here: THE first time I ever walked into Dr. Lorenzo’s clinic I wondered why every patient already had a full head of hair. Mine was showing signs of recession, so I had a genuine reason for being there. But these guys? They already had great hair and I couldn’t fathom why they would be in a hair transplant clinic. Fast forward to March, 2020. I’m now sitting in Dr. Lorenzo’s waiting room...again. It’s been almost three years since my first hair transplant and –this time– I’m now sporting a thick wad of hair, looking like I’ve no reason to be there other than waiting on a friend. My first hair transplant was a great success. Receding became reseeding. I went from the anguish of having a high, vanishing hairline (what could be called a Norwood IV) to a happy, youthful head of hair, courtesy of 3,501 transplants. So why come back? Italians. I blame Leonardo Da Vinci. I was reading Walter Isaacson’s biography that documents Da Vinci’s interest in anatomy. I learned that, to improve the accuracy of his work, Da Vinci measured the human form in countless ways, determining that the face can be divided into equal horizontal thirds: i. From the chin to the tip of the nose; ii. from the nose to between the eyebrows; and iii. from between eyebrows to the hairline. By this simple measurement I could determine that my hairline was slightly higher (and more mature) than I wished it. –My initial procedure had been life changing: 3,501 grafts had transformed my appearance. And now I had been given time to get used to having hair. I understood how it sat on my head, how it behaved when I styled it and how it framed my face when it grew. Hence, I wondered if it would be possible to lower my hair a fraction more. Contemplating The Second Procedure I wrote to Dr. Lorenzo, who promptly replied that it would probably require approximately 1,000 hairs to achieve this goal. I had a secondary goal of thickening up my temporal peaks a little for when I wore my hair short. My recession had stabilised. I had enough donor hair. Yet, this still wasn’t a straightforward decision to make because I this time I now had hair; hence, I was now motivated by aspiration rather than the unhappiness that had led me to hair restoration the first time round. I contemplated the trauma to my scalp and what the effect would be to my donor site of having another 1,000+ transplants removed. In the end, I knew with Dr. Lorenzo I was in safe hands, so I decided to proceed and get my hair to as damn near perfect as I could! This time round, I made a point to load up on Vitamin D3 and K2 ahead of the procedure (D3 10,000iµ; K2 100µg). I understand they may have some benefit to the immune system and figured every little helps. Before I turned up to the surgery I had calculated that I wanted my hairline lowered by 13 millimetres. I arrived at this number through the scientific approach of asking friends, drawing dots on my forehead and eyeballing my hairline in the mirror. When I finally spoke to Dr. Lorenzo he suggested we lower by about 9-10 mm. This would be the absolute lowest he’d recommend. According to the Doc, any further and it wouldn’t look right, specifically creating a teenage hairline. Not good. I learned that lowering the hairline isn’t just a case doing a ‘drag & drop’ to bring the hair down to a specific spot. You have to take the muscles of the forehead into account, your unique face shape and the location of the temporal peaks as well (plus many other factors, I’m sure). I have to give Dr. Lorenzo praise here. He truly understands the optimal measurements between temporal peaks, scalp zones eye brow position and such. I followed his suggestion and I knew Leonardo would approve. Surgery Begins The first part of the surgery went well. Standard affair: pop a valium, head shaved. Photos taken and calculations made. Then lie on your side whilst your hairs are individually extracted by a team. The process lasted just under 3 hours. It was quite a systematic experience. Anaesthetic was applied by a motorised needle to a patch on the scalp. Selected hairs were removed. The process repeated from the right side of the scalp to the left, in a horseshoe fashion. Although I never saw the vibrating anaesthesia device, the jabbing sting of the needle was unpleasant. The pain was that type where you’d either yelp or swallow it. Surrounded by three female nurses, I kept quiet. “Anaesthesia” the technician would whisper in dulcet Spanish tones. “Breathe” I would purr to myself, which was more constructive than “Jesus Christ, here it comes” Happily, this process got better. I started to laugh as I heard the whisper of the seductively prophetic anaesthesia voice and the whirr of the anaesthesia gun. Having a thick head of hair for two years now I knew that this part of the process was totally worth a few hours discomfort for a lifetime of hair. Then it was over. Food was in front of me. Lunchtime. I nommed. The break lasted for an hour. Then I was back on the slab, this time under Dr. Lorenzo’s focused gaze for the second part of the procedure: transplant. Dr. Lorenzo administered the anaesthetic to my forehead in one go. This time the process wasn’t as uncomfortable as my previous transplant. Very quickly, the front of my scalp numbed to the point where I felt like I was wearing a crash helmet. The the insertions began. Dr. Lorenzo achieved samurai zen and found his flow state. I felt the pressure of each graft being added to create my new hairline. There was no pain. I relaxed. Then I fell asleep. Of course, it wasn’t a deep sleep. Being prodded over a thousand times sort of prevents that experience but it was not a stressful affair. The anaesthesia worked wonders. A timer on the wall clocked up 3 hours as the artist did his work. All the while, his technicians looked after my hair, spraying and preparing it. I was indeed in safe hands. By the end of the surgery, a total of 1,501 grafts had been added to my hairline and peaks. The whole process from start to finish took 7 hours. Dr. Lorenzo was very happy with the outcome. I was happy, too. I knew Dr. Lorenzo might have used some additional grafts to get the best possible result (his team checked this beforehand) and I was happy that another 500 had been put to optimal use. I ‘headed’ (hyuk, hyuk!) back to my hotel, with my new hairline. My head was swollen from anaesthesia and surgery. Ironically, making my forehead appear larger than before the procedure. Yet this wasn’t my first rodeo and I knew the swelling would subside. The next morning, I arrived at the clinic for a check up. I met another patient who turned out to be… an actual hair transplant surgeon! I learned this doctor had not only been taught by Dr. Lorenzo but had visited Madrid to get his own transplant done “by the best”. Quite the accolade. My new friend looked at the work I had done and remarked the quality was “fantastic”…adding “…getting the aesthetic was unpleasant, eh?” This informal second opinion was reassuring on both counts. Dr. Lorenzo examined my scalp and reiterated his satisfaction with the result. I flew back home for the next part of the process: healing. Recovery Starts I followed the aftercare instructions to a tee, including, no tea. I carefully washed my scalp twice a day with the shampoo provided. My mission became one of not bumping my head. I lasted 48 hours before taking a knock in the shower. There was some light bleeding to one graft but no visible damage. I guess I just shook it up but I wasn’t worried. The first 10 days of aftercare was less intense than my previous transplant. The itching that had troubled my donor area during my first experience was minor, perhaps because I had less hair transplanted this time. Conversely, I still found myself excitedly admiring my new hairline in the mirror. The novelty of new hair was just as strong as before. “Hey, there’s a mirror..I’ll have a quick look at my hea—…wow! I look great!” Despite still having a significant number of hairs transplanted, the recovery seemed more gentle compared to my first procedure. Taking care of the hair also seemed easier the second time round, probably because I knew the path ahead. Interestingly, I noticed some shock loss around the temples, where the existing hair looked thinner. The transplanted hairs started growing right away. By Day 23, my hairline was starting to look red where some of the transplanted hairs began to fall out. As with my first transplant I kept my hair trimmed short during the ‘Ugly Ducking’ phase. I’d forgotten how convenient daily life was after returning to a shaved head. Minimal effort required when stepping out the shower or house and a neat look, guaranteed. As the warm days grew longer I wore my cap, religiously. I’d been told to keep my scalp out of the sun because the rays have a detrimental effect to the new hairs and scar tissue. I didn’t want to take any chances and my cap suited my daily long boarding habit. Staring in the Mirror Since this was my second transplant I was already excited and found myself keenly waiting for new hairs to emerge. I think anyone who has had a hair transplant (or is currently at this point of the journey) can relate to the slow passage of time at this stage of the recovery. After two months, I sent some photos of the transplant for Dr. Lorenzo to review. Everything was good but he observed that my skin was still quite red in the transplant area. Dr. Lorenzo suggested applying aloe vera gel each night before bed. To my surprise, this simple treatment did the trick and the redness faded after a few days. At two and a half months I was waiting patiently for new hairs to appear. Because the transplants were at the front of my scalp in mirror town, and because I’d been through the procedure before, I was a little impatient. “When–oh–when will they appear?’ was the quiet sentiment. Photographs appeared to confirm that some little black specks of hairs had become more numerous. This wasn’t crazy growth. Bald spots in the transplanted area remained but a small hint of progress was encouraging. Perhaps some very faint blond hairs might be appearing too. One hundred and four days after the procedure I noticed lots of soft blonde hairs appearing in my hairline. I’m sure they hadn’t been there a couple of days prior. No matter, this for me was the moment of relief that something good was happening in the transplanted area. A new phase was being entered into. Three months and a half months had felt like seven. Around this time the sensitivity of my scalp fully returned. My first procedure left me a little numb in the transplanted area for a few months; and this procedure also did the same. Hence, I had wondered if a second procedure in the same area might add a little too much punishment for my body to fully restore but this fear was unrealised: my scalp healed up very nice –as if the operation had never occurred. Farewell (Again), Ugly Duckling By month four my hair line was starting to look more consistent and defined. The patchiness of the Ugly Duckling phase was more or less behind me. The donor sites had also appeared to thicken up and naturalise. It seemed lots of hairs had sprouted when (ironically) I wasn’t paying attention... there's probably some lesson there. Any remnants of redness along the hairline were absent. Some small patches of shock loss were apparent near my temples where the hair was a little thinner; I wasn’t concerned because I knew they would likely grow back in time. With my five month check up looming I decided to grow my hair out. I spent a few weeks delightedly stroking my new hairline and getting used to the way it now framed my head. I felt handsome and happy. Month Five & Onwards Due to the flu pandemic, the turmoil of enforced quarantines meant that arranging international flights was difficult. I took the next best step and did my check up online, sending the Doc some photos and a video of my hair line. He was quick to reply and seemed pleased with the result. He highlighted some small concern over the thinness in my right temporal peak (this time in a slightly different patch) where I think I experienced some shock loss. “Let’s review how it looks in five months when we know the final result” adding that we may need to do a little touch up in the affected area and that I should keep taking my finasteride. I wasn’t too perturbed by this development because the affected area was minimal and I already knew how much transplanted hair changes over a year. Looking at the photographs now I can see how patchy my hair was. The best case is the hair would grow out. The worst case was another trip to beautiful Madrid and aaaanaaesthesia. As month five swung by, I was looking forward to bering slightly less cautious with covering my hair from the summer sun. Likewise, being able to use hair clippers again meant saving a bunch of time in the grooming department. As the weeks progressed, my hair line continued to fill out and I let my hair grow out. My scalp was starting to vanish from sight as the density of the hair increased; and by month six I was once again looking at a new face in the mirror. Er...my face, but a nicely framed version of it. By September (6.5 months after the procedure) I noticed new hairs continued to emerge. I correctly reasoned it would be several months before these new hairs grew and thickened up, which meant the situation was very much a positive work in progress. I was looking forward to the future. This month also gave rise to my first haircut in almost 10 months. The shaved head had given way to a thickening hairline and I enjoyed my inaugural visit to the barber’s for a ‘short back and sides’. At 7.5 months, I noticed that my hair had thickened up even more. I was able to make this discovery by comparing photographs. When you see your hair in the mirror every day, it is difficult to observe subtle changes that are occurring but keeps snapshots relieves any doubt. Beyond this point life carried on. My hair grew and my hairline matured, framing my face as I’d hoped. Getting My First Proper Haircut Post Surgery At 9 months, I decided to splurge and get a proper hair cut at a swanky salon (one of those places where they have a real wash basin). The jovial barber was fascinated by the procedure (...without fail, they always ask “How much?”). He called his colleague to look at the hair and both of them marvelled at the craftsmanship. I learned that his workmate had got a transplant himself in Turkey, but thought this was the best result he’d ever seen. I felt very lucky but something even more profound happened that day. You see, I growing up I never really understood how to style my hair…and by the time I got the knack it had began to thin. Styling became more like a cover up than a display. So…for the first time EVER I stepped out the barber shop with my hair styled to celebrity level perfection. If there was a word to describe this moment it would be “phwoar!”. It’s hard to articulate the feeling of joy from not just hair but having actual bonafide dream hair. That’s what 1,501 extra transplants did for me; metaphorically upgraded my hair from gold to platinum. The 'Final' Outcome It's at the 10 month mark when the full result of a hair transplant will be realised. However, during my first procedure I discovered that my hair continued to mature right up to eighteen months: it not only got thicker and changed colour, but behaved differently. Jolly good; perhaps it will happen again. Nevertheless, I figured at ten months (which is the time of writing) I could review my results with some degree of confidence. In my case, those ten months came round reasonably quick. Flights into Madrid were still at the mercy of lockdowns and red tape, so I took some more snaps and sent them for Dr. Lorenzo to inspect. He expressed his happiness with the result (“Wow. Very nice!”). He suggested the the left temporal peak had a firewall behind and a couple of touch ups could be done; without needing to shave the head. I enquired how many grafts this might require. His estimation based on photos was around 150. I’ll be honest, it’s something I might consider for that final 1% reach toward perfection. I’ll enjoy my new hair for a while before making a decision. In the mean time, I am ecstatic with my result. Dr. Lorenzo has rebuilt my hairline from scratch. It continues to be life changing. I couldn’t be happier. For 15 years straight I had felt anguish over my hairline. It came to a turning point when I saw the full extent of my recession in 2015 and decided to push against the pain and do something about it. Looking back in 2020, having navigated the waters of finding my surgeon, deliberating over the procedure, recovery and medications involved –and two transplants later – I can once again say this was the best decision I made and the best money that I have ever spent on myself. My hairline came forward a small amount, but it has also been thickened up, which you can see in the photo (I seem to recall 55 cm^2 was covered). I feel it now frames my face even better than before and i'm really please with how it sits. The hairline sweeps around my head more naturally now without the corners of the forehead being as prominent. I feel that subtle change has a significant effect to how I 'wear' my hair and style it. In short: I'm pleased I got this second surgery. Every day I look in the mirror and see myself looking back. And I’m young again! My hair is a mess. Hooray! It’s a great feeling. I’d do it all again in a heartbeat. I highly recommend Dr. Lorenzo and his fabulous team. So that's the update to my story for now: i'm happy to answer any questions.

These are good data points but i think it's important to break each of them down a bit further; especially if they're being used to make a decision on what clinic, or doctor to pick. My replies to these points are as follows: 1. RE: successful surgeon in the world. Successful based on what? Did he make the most money? Do other surgeons line up for advice? Happiest clients? Are his results deemed better than anyone else? And by whom? Does he have the best marketing? My point here is its tricky to measure "successful" beyond a generalisation; unless a specific context is added. It's certainly reasonable to say you feel he's the best, but what are you basing that on? 2. RE: a long waiting list. How is he acquiring his clients? Does volume of clients equate to quality? Perhaps his marketing in his home market is best? 3. RE: He is full of patients. Perhaps this implies he needs a better admin system for handling them all? To me it reads he is crammed. 4. RE: He is not interested in this [forum]. Does that mean he does his best work with his home market? Does the Mediterranean client base have a specific hair type that he deals best with? What I mean here is that if I'm going to get something as important as surgery, I want to know i'm looked after (ideally in my own language) and not pushed through a hair mill; regardless who the operator is. 5. RE: You will regret cancelling. There may be regrets ...or not! It's difficult to discern what 'better' means. I have previously read (perhaps incorrectly?) that Couto packs in grafts to hairlines to create a powerful result. I'm not a surgeon so I can't say if that's a good practice; however, I would consider IF that is indeed correct, what the implications are to the rest of the hair through the lifetime. Perhaps there is less donor hair to use in future; or implications we don't fully understand. Something to investigate further. I think there are surgeons out there who do great work and create impressive results. It seems Couto is one of them. However, due to a lack of English materials (which again, probably isn't his target market) it isn't clear where: 1) his strengths are beyond testimonial videos; 2) what the overall experience is in working with him; and 3) what relationship to expect during the process.