Mycroft

1 hour ago, Melvin-Moderator said:

The worst example I can think of is Lewis Hamilton, the guy literally said he regrew his hair off some BS shampoo. It sort of reminds me of these bodybuilders selling BS supplements, when they know damn well their results are all due to steroids.

Agreed. The worst people are the ones who not only blow smoke about the reality of hair loss (re: essentially everyone with a masculine hormonal profile is going to experience it to some degree) but turn around and try to sell you some snake oil they claim is the secret sauce.

7 hours ago, qui bono said:

I dont think either of these comments are very helpful. Most guys dont admit to getting a HT and this guy, while I dont know him, is very open about it. Ive never told anyone about my 3 HT's and I wish I did ... maybe I would feel less shame about what I went through.

He mentions the surgeon at 0.49 (Dr Kahan?) in Beverly Hills. I dont think it looks like a a wig either ... I think its just how he wears his hair. Looks like he had a no shave procedure. 

I can't evaluate his result based on what we see here, but I agree with you. I wish people were more open and honest about hair loss and less prone to bullshit, especially celebrities. These guys would be doing so much good just saying "I've kept most of my hair thanks to Finasteride" or "my hairline was receding but I recently had a hair transplant"

I don't think anybody should be encouraging people to have surgery (that leads to young guys jumping the gun and not doing research), but opening the proverbial door at least allows hair loss sufferers to start researching.

3 hours ago, Melvin-Moderator said:

I agree with your assessments, I really wish they’d take a scientific approach and measure hair density, as opposed to using flash photography.

I think it's important to have the photos as well, but it's imperative that they attempt to make those photos as "scientific" as possible, including trichoscopy.

Like we discussed in your oral minoxidil thread, it is possible to have statistically significant improvement in hair count without it amounting to much in the way of cosmetic benefit. Ideally, I'd like to see numbers indicating count of vellus and terminal hairs, including vellus hairs that have become terminal, trichoscopy photos of the same area, and then some photos of the head to see the impact. 

It would also be valuable to have an overall percentage indication of responders, maybe into a few tiers like minimal response, moderate response, significant response, and true non-responders. The most interesting thing I took away from oral minoxidil studies was that there were virtually zero non-responders which is very different from the topical.

There's definitely something going on with either the lighting of the contrast, but for this particular instance I'm not sure it matters either way.

If you've seen what this YouTuber looked like before any work was done you know he has severe hair loss without a bunch of native hair remaining, and at this point he's had a few surgeries that may have reduced the number of native hairs further still. All accounts of exosomes seem to indicate that they generally work like PRP in that they strengthen miniaturized hair to improve its cosmetic impact, and it's extremely rare to see dormant follicles that haven't been producing hair suddenly start kicking again. This guy was almost certainly going to have little to no response right from the start.

Right now with everything I've seen I would probably put exosomes in a similar category to PRP with the one stipulation that exosomes sourced from a quality company are probably more consistent than PRP because you don't have as many variables to deal with. However, that X factor of the patient's physiology is just as fickle with this as it is with PRP. Some people seem like they respond very well, others have very little to show for it.

Interestingly, Connor Murphy is one of the earlier internet "celebrities" to come out and admit to a hair transplant, well before showcasing and documenting your transplant became kind of a fad on YouTube. I actually found his candor on the subject refreshing. He essentially said he had a good head shape to just shave it off and wasn't opposed to the idea, but felt that his physical image was very important to his career and that was what made him decide on a transplant. I remember thinking the work looked pretty good and wondered who the surgeon was. That one may have been Doctor Arocha as well.

We are starting to see public figures talk about this sort of thing a little more openly now, and I honestly think that's great. One of the biggest problems with hair loss is it's still a "socially acceptable" form of mockery and ridicule, and I honestly think that's perpetuated when celebrities have work done or put on hair systems and try to claim they grew it all back after they stopped using hotel shampoo. That kind of misinformation is harmful for young guys just starting to lose their hair who might be in a position to save most of it if they have a little education and aren't ashamed to ask for help.

I appreciate the clear and thorough photo documentation. Multiple shots pre-op and post from multiple angles showcasing various states of the hair. For cases with areas of diffusing that were worked (as shown here) it can often be tricky to appropriately represent the cosmetic differences before and after, but these photos certainly do the trick.

I feel like I've seen a number of cases where the shocked native hair isn't permanently lost but does take an extended amount of time to resurface.

My assumption is that this is because the miniaturization process in part involves the resting phase of the follicles becoming longer and longer, so shocked miniaturized hair, even if it bounces back, may take longer to do so because it's on an extended rest cycle and needs more coaxing. PRP could theoretically help this as well. Was that treatment done recently when you spoke with the doctors?

19 hours ago, Melvin-Moderator said:

He has diffuse loss, if he grew his hair out, it would look a lot denser. 

Yeah, you can see in the video how the odd pattern clinic has marked off for transplantation vs areas that are maybe too dense to put many grafts into.

I just watched the video showcasing the patient's result. Very impressive to see it holding up to the part test in multiple locations.

Wow, yeah. That's a lot of early sprouting clearly visible, and three months is very early. The redness doesn't look too bad either.

Thanks for updating. At the three month mark it looks safe to say that you haven't suffered much in the way of shock loss to your native hair. I'm very interested to see how this turns out.

It depends on whether this is the result of actual hair loss or just a naturally high hairline.

Women often show signs of diffuse loss, even in areas of the donor that are considered safe for men on average. Hair loss in the frontal area alone for women might also be indicative of a scarring alopecia, which can be problematic for transplants. Women who otherwise have no hair loss are probably less likely to be satisfied with the density a transplant provides, particularly because many transplants don't look as good at a longer length. The longer hair weighs more, and with less than natural density, it's more likely to lack volume and appear "flat."

As a final point, I don't think a woman with a higher hairline would be subject to the same level of social shaming that a man with a receding hairline would be. I'm sure they will suffer some mockery in their lives, but I don't think it's really comparable. Envision a 20 year old man and a 20 year old woman, both with this same hairline and both otherwise reasonably attractive. Which one has better prospects socially?

I feel like we don't see many scar revisions posted here on the forum, but this is a great improvement. That scar is a fraction of the size it was before, and pretty impressive in general considering this is technically a fourth op.

3 minutes ago, williamsburgh said:

Hi Dr. Khokhar,

I am applying minoxidil twice per day. I am not currently on finasteride because I am concerned about side effects.

What do you think about PRP during the transplant itself?

Thanks!

As a starting point I'm going to say that it's absurd to be making plans to undergo SURGERY but being afraid of side effects from Finasteride that you may not even have. If you're concerned about shock loss and haven't even tried Finasteride you're making a mistake.

Good PRP may indeed speed up early growth and reduce chances of shock loss. I found it to be beneficial for my hair independent of surgery, but the most impressive results I've seen for it all come from users using some manner of DHT blocker as a foundation. If you can't tolerate Finasteride due to known side effects that's one thing, but if you're not even willing to try you're severely limiting how effective growth boosters like Minoxidil or PRP will be for you.

4 hours ago, Curious25 said:

Donor density. There’s no clinic who would transplant at 75 grafts pcm2 in one pass - regardless of that density not being necessary. 
 

Also - from the real estate covered in this case and the number of grafts used - there is no way this could be planted at 75 fu pcm2 

Right, that's why I was asking. Graft survival rate would likely have been in the toilet in a situation like that, but I don't want to assume. It's possible it could also represent the average density of recipient if you're also factoring in the native hair, but the original post isn't totally clear on that.

If it is indeed donor density that's a really nice figure to have when evaluating donor post-op. It's one of those things most clinics don't share but can definitely impact a patient's result.

4 minutes ago, RandoBrando517 said:

Great results what’s the cost?

This clinic has a few tiers of pricing. There's a full breakdown on their website, or at least there was the last time I checked.

For the sake of clarification, is the density number referenced here indicating density of grafts in recipient or total density of hair including both grafts and native hair?

1 hour ago, RMancini said:

Normally the price is 4,50 €/grafts, but if you have had a previous procedure with poor or bad results and you want to repair it, the price will be 5 €.
I think that when he makes reconstructions of the temples points, which by the way is a master doing them, the price will be 5 €. 

I'm not sure, but I seem to have heard that, for example, if you have already had a frontal surgery and need another procedure for the crown, you may have some discount on the second procedure.

I assume you mean if you need a repair from a transplant at another clinic? Surely he wouldn't charge more to touch up one of his own cases that had subpar results?

Wow! Letting it grow out a bit was a great idea. Those waves in his hair really enhance the result.

I'm impressed with the level of detail in his feedback. Not just general idea of grafts per cm but also explaining why that amount was chosen and what it should average out to with native hair or areas that were previously grafted. It's super nerdy, but it's also a level of disclosure and candor that I find impressive. I appreciate you taking the time to share those details with us as well. 

Your frontal zone already looks so good that I have to imagine it's going to look phenomenal with an extra 500 grafts or so in there.

Very early to see this kind of improvement. I have to imagine he's on track for a good result.

I see a few bio-adjuncts were used. Has Dr. Dorin noticed a correlation between their application and early growth?

1 hour ago, ciberxtrem said:

Hey, yep he is a top doctor.

He used only around 600 follicles in the crown area, in fact that area has been untouched in this second operation as the Dr Heinicke told me that for the moment it was not necessary to spend more grafts in that area and better save them the for the future and then lets see how it evolves.

Good decision for your case, I think. It wasn't all that bad to start with and after those 600 were placed I think it looks really good. The fact that you still have donor to spare after such a luxurious reconstruction of a large area bodes well for the future.

The wavy characteristics of your hair really help enhance the results. Very natural. I've seen some cases from this doctor on the Spanish forums and I generally like his work.

How many grafts were used for the crown area in the first surgery? It looks like a modest amount and your loss in that area wasn't nearly as bad as the front.

2 hours ago, Curious25 said:

That’s unusual - what’s their rationale behind that? 
 

1200 grafts is going to do very little for you in terms of cosmetically improving you. You would have a very thin frame of the face at best. 

OP has a lot of hair on his head, even if that hair is miniaturizing. The amount of space between hairs where grafts could be safely placed is probably limited and he is likely looking at a diffuse placement pattern in the frontal area. On top of that, smaller procedures are much safer for someone with diffuse thinning because it minimizes the trauma to the scalp and reduces the risk of permanent shock loss.

Honestly, if I was a doctor I wouldn't even consider operating on a case like this if the patient wasn't willing to at least TRY Finasteride.

Some before pictures with the hairstyle in question would probably help, but in my opinion this looks like a win. Aesthetic hairline, good crown coverage, and probably grafts to spare if you decide you need to hit that mid scalp area.

Obviously you are the only one who can determine if your satisfaction levels balance against the monetary cost and hassle of recovering from the surgery, but I would not be surprised if that satisfaction level rises as you see other guys around you dealing with hair loss and wondering why your hairline isn't budging.