Mycroft

@Melvin-ModeratorI have seen some decent results shared by clinics so far, but your comparison to PRP isn't far off. If you visit Dr. Cooley's site his description of Exosomes is essentially that they're a greater concentration of the beneficial elements one would find in PRP, which generally leads to faster (if not stronger and faster) results. I've been keeping tabs on the treatment because of my favorable PRP results. Even a "boosted" PRP might be great for my specific case. I have been debating an experiment myself but as you said the number of favorable results thus far isn't quite there yet due to the current pandemic and the fact that the treatment is relatively new. @Style22 I do hope you will share your results with us and take some good before/after pictures so we can see how effective or ineffective it was for you. I absolutely recommend that you don't stop Finasteride though. The exosomes don't do anything to inhibit the effect of DHT on hair.

The safe zone is only a theory, but it's worth noting that doctors are typically referring to those hairs as DHT resistant and not DHT immune. If you look at older men, the hair on the back of their head usually looks like it has thinned out a bit, though not to the same extent as the hair on top. Likewise, we see patients with DUPA who have thin donor zones but will see thickening in this area in response to taking medication. In other news words, if you can tolerate medication, you should be taking it. The people who come to these forums saying they want to get a hair transplant having never tried medication and arguing that they don't want to take it for the rest of their lives are ridiculous. No way of knowing if Wayne is taking medication or not, but even if he has had some additional thinning of native hair Melvin is 100% right about the use of concealer in some of these pictures.

The donor looks fine in this picture although for donor in particular the thing that really matters is the in person eval from the person operating. It looks like you could get 2,500 FUE without issue but it doesn't address some of the other questions. What will you do if you lose more hair behind your transplant, or if you have a subpar result? Are you mentally and financially prepared for future procedures? Even with moderate hair loss history in your family you could always be the outlier who goes further, and if you've watched the hair transplant mentor videos you know not even the best surgeons cannot guarantee a success. If you went in for 2500 FUE tomorrow and had a subpar result, would you be able to live with that? Do you have any images of the area you're looking to have worked on? I'm not telling you any of this because I want to scare you, but I do want you to understand the risk to reward ratio before you jump into surgery because once you do you can't take it back and you're locked in for life.

I'm around your age and I've certainly had many of the same thoughts. I have had some pretty good results with non-surgical methods that will hopefully delay if not stave off my need/desire for a transplant. 1. This can absolutely happen, and it's a possibility that you have to consider before going into surgery. Do you have a plan if this (or another bad turnout) happens to you? Will you be able to live with that plan? Do you have the donor and the financial means to try again if you need repair work? 2. If they decide you haven't lost enough hair but already took your deposit I would hope that an exception would be made by an ethical surgeon and a refund would be given. This is also good news for you because it means your hair loss is truly negligible. On this note, I see you saying you've already booked. Did you consult with multiple surgeons to get a few different opinions before locking in? If all of them seemed to be on the same page you can probably be a bit more comfortable with the recommendation. Did any of the surgeons comment on prediction for future advancement of hair loss? Does male pattern baldness run in either side of your family? If so, what does that hair loss look like? Candidly, if you are content with the way you look right now you should not have a hair transplant. Things can and do go wrong even with the best surgeons doing top notch work, simply because certain factors like patient physiology can be unpredictable. You should really only be considering surgery if you're unhappy with the way your hair looks and it is something that eats at you on a regular basis. Since you took consult photos maybe consider sharing them here to get some thoughts from other forum members and definitely get second opinions from other doctors if you haven't already. Bottom line though, even if we pretend surgery has a 99% success rate, which it doesn't, you could still be someone that falls within the 1% failure rate. The only question is whether you think it is worth the risk based on the factors that you can control.

I can't tell if it's just something with the camera focus or the lighting, but the hairline is looking fuller in this latest set of photos than the last. Assuming this isn't a photography discrepancy I'd say this looks on the right track. The transplanted hair looks a bit thicker and seems to blend better with the native hair than in your previous update.

It's a bit harder to tell when looking at the front, but based on the photos the crown is looking noticeably better. Seems to be more hair towards the front in the hairline area as well, with the rear part of the frontal zone lagging a bit more. Granted, pictures can be deceiving, but I agree that part of this could be slow growth or lack of hair maturation. Just hang tight for now and see what the doctor has to say.

The side sweep is a good look. The way you have it styled in this latest set of images definitely seems more flattering for the crown as well. As always, interested to see how your journey progresses.

One thing I've always been curious about is how the clinic determines which surgeon a patient is assigned to. I do notice that most of the results we see are Dr. Hasson's, so I wonder if Dr. Wong makes a point of only taking on specific types of cases these days. H&W shares a number of larger "mega" session results for severe cases and the general philosophy seems to be to do as much as you can in one pass. What percentage of past patients do you see coming back for additional work, whether it's just to add more density or to address further progression of their hair loss?

With this result you'd never know this was a repair. Any idea how many grafts were burned in his failed procedure?

I'll definitely be keeping tabs on your progress. I think you can certainly still look forward to a thickening effect as existing hair matures even if you don't see many new sprouts coming in. I definitely appreciate you sharing your experience. I wear my hair short like this on the back and sides as well so I'm always interested in quality of donor when viewing results and clinic documentation is never as thorough as a patient's. Thanks again.

Nice to see a Eugenix case with this hair type. The donor looks amazing and honestly if the recipient didn't change at all from this point I'd still say this was a big success for you. What guard length are you taking it down to on the sides and back?

Hope all is well down in Houston with everything going on. I've got a couple of things I've been wondering about. 1. As mentioned I have had positive success with non-surgical processes like PRP. There's been a lot of talk about exosomes lately, so I was wondering if you had considered offering this treatment or had any early thoughts on its efficacy compared to PRP+Acell as an adjunct to surgery or a standalone treatment. 2. I know your surgeries typically use unshaved recipient sites. Was this the way you originally learned hair restoration or did you transition to this approach later on? 3. There are several pros and cons for FUT and FUE beyond graft survival rate, such as the higher total graft count using FUT or the non-linear scar for FUE. I know with FUT there are some situations where a doctor can perform a perfect scar closure and the patient follows post-op instructions perfectly only to have their scar stretch due to the uncontrollable factor of the patient's physiology. Are there ever any clues prior to surgery (like a surgical scar from something other than hair restoration) that you may be dealing with these unfavorable characteristics?

Great hairline design on this one. Any idea how many of the grafts went into the crown vs the frontal areas?

This looks amazing for six months, and with a pretty short hairstyle on top of that. Couldn't have turned out much better for him.

I'd say you're more likely to tangle and yank hair out with a roller than with a pen. The roller is also going to cause more damage to your scalp (in a bad way) than the pen. Sure, you may clip some hairs when you're using the pen, but you're not doing any damage to the follicles with the needle depth recommended for this sort of thing so any clipped hair will just keep growing just like after a haircut.

The extra RPM basically just means the needles punch your scalp more rapidly, so in theory the higher the RPM the more micro wounds you would make dragging the pen across your scalp in a line one time. I have the A7 and I cannot say whether this has had any tangible improvement on my results, but it's hard to say. I have tried the higher pin counts. Your logic is more or less correct but there are a couple of downsides to consider. 1. You will have to increase the depth of the needling to compensate for the fact that the distribution of force is wider. In other words, 12 pins at 2 mm depth is probably going deeper than 36 pins at 2 mm because of distribution of force being spread out. You'd maybe want to up the depth to 2.5 to compensate, etc. 2. I've found that the higher pin counts are more likely to snag in my hair and this makes the whole process extremely frustrating. The only way around this is to do the lift and press approach rather than dragging the pen across the scalp. Right now I'm experimenting with using a 12 pin to do rows across my scalp and then going back into some of the weakest areas and doing a lift and press with higher pin count to see if I can boost my results.

This one is beautiful, and a perfect example of why I find diffuse loss so frustrating. I appreciate how the work largely maintains the natural shape of the hair and focuses on adding thickness/density to the pattern. Nothing was radically redesigned here but the patient's hair now looks healthy and strong rather than "sickly." The donor pictures are great to have as well. I honestly wish that was a requirement for all presentations on the forum. Did the patient split the front and the back across two procedures or was the second pass more a general focus on adding density throughout the scalp?

Do you have any other pre-op photos showing angles other than straight on? I can see that a fair bit of the native hair looks like it may have been in bad shape before the surgery but I can't tell for sure with that limited perspective. If Dr. Bisanga is correct and you are indeed suffering diffuse tellogen effluvium then PRP and Mesotherapy could indeed help because they tend to coax hair back into anagen phase growth. I have limited knowledge on the efficacy of this approach after a surgery but I would say clearly your scalp is sensitive to the trauma of surgery and jumping into another procedure without examining non-surgical options is probably rash.

Nice result for this patient. If the frontal zone didn't show any additional improvement (and it likely will) this would still be a nice look. The vertex is looking pretty good too, and I think a little more maturation should really help that area pop. Is the patient taking medication? I do see he'd lost most of his native hair but I'm of the belief that medication is still important to ensure transplanted hair and donor hair remains as thick as possible as we age.

The growth looks great for six months. Does the patient have enough donor left for future procedures given that he is not able to take preventative medication?

If this is your second transplant it's probably going to take longer for it to grow than it did the first time around because the tissue isn't as pristine as it was before any transplants. I wouldn't worry just yet.

Good growth so far, and the donor does indeed look great. Looking forward to watching it mature.

I squinted for the sutures since you called them out. Is that the strip scar right above the FUE extractions? Usually we just see the standard central donor strip with FUE extractions around the linear incision. Very interested in what influenced the placement if that is indeed the strip. Edit: I was also wondering how many total grafts were used for this case.

Looks great for only four months. There's already a dramatic change in your appearance and I can't imagine you won't be happy with the final result.

Great to see the doctor working with the patient and being flexible where possible. Patient comfort post-op isn't always something we talk about on these forums but it's definitely something I'd consider to be important. Thanks for the insight.