Mycroft

Just now, JohnAC71 said:

@Mycroftdid you also have a ht with Arocha? I Seem to remember you had PRP

Just PRP for the moment, though I've had two sessions now. Since I had diffuse thinning and no true "dead zones" it helped rejuvenate enough of my hair that I was able to put a transplant on the back burner. It's still something I'm considering to strengthen the frontal-temporal areas and I did want to see Dr. Arocha again to discuss options, but then Covid hit and I think for the moment all in-person consults are for imminent surgeries only. I'd also have to drive to Houston from Dallas because the doctor's periodic visits to my neck of the woods also look to be on hold due to pandemic, so I'm in a holding pattern for now.

His office has plenty of photos but what I really need at this point is a detailed look at my scalp to propose a long term plan and discuss donor limitations, as well as see whether risk of permanent shock loss to my thinner areas might outweigh the potential cosmetic impact of surgery at this time. 

Definitely a noticeable increase in hair bulk and strength of the hairline. Was the second procedure focused on fine-tuning the hairline specifically, or adding density throughout the frontal zone?

Minoxidil is basically a growth stimulant. It will help to lengthen and thicken shrinking hairs so their cosmetic value improves to be closer to what it once was, but if you aren't taking a DHT inhibitor like Finasteride you're basically just bailing water on a sinking ship.

Minoxidil is basically a growth stimulant. It will help to lengthen and thicken shrinking hairs so their cosmetic value improves to be closer to what it once was, but if you aren't taking a DHT inhibitor like Finasteride you're basically just bailing water on a sinking ship.

Edit: You look like you've got a lot of hair still and are very early in the process. If you can take Finasteride without any issues you should absolutely start taking it immediately and add in Minoxidil after that if you want. You are catching it pretty early and are in a good position to save your hair.

On 11/2/2020 at 10:08 AM, Melvin-Moderator said:

This gets blown way out of proportion IMO. Thick hair isn’t exclusive to Spaniards. Sure, on average do they have thicker hair, yes. But I’ve seen some British guys with similar hair caliber on this forum @1978matt and @Zoomster one of my childhood best friends is ethically Swedish, and he’s got  some of the thickest hair I’ve seen. 

This is completely true, but I think it's still a fair point to note because it's still of statistical significance. That is, a Spanish patient is more likely to have these characteristics on average, so if Spaniards represent a majority of your patients you're going to be working with those characteristics far more frequently than some doctors.

The reason this is particularly relevant when considering online marketing like YouTube, IG, or even clinic results on this forum, is those results are already cherry-picked and represent the clinic's most impressive work. When many of your patients have a higher baseline to begin with, a prospective patient's expectations may become skewed. It's not that it's a different skill set necessarily, but that it's harder to achieve a good result because the doctor has more factors stacked against them. 

On an unrelated note, I appreciate that you've called out the importance of microscopes in evaluating a clinic. I wouldn't even consider a clinic that doesn't use microscopes in this day and age because that's just plain irresponsible. You still see the occasional hairline multi even from elite clinics examining grafts under microscopes, so there's no way that eyeballing it won't greatly increase the risk. It's stupid and completely avoidable.

This is an interesting case. I'm shocked at how good your donor looks after a double FUT.

5 minutes ago, arussell said:

Mycroft

I know you are aware that many things in this industry are largely unregulated so many of these recommendations come from practical experience.  Many things can contribute to the end result.  Dr. Cooley does not recommend anything added or done in the initial healing so that nothing disrupts the process.  The body thinks of the hair as non essential (the body can live without any) so if something is not exactly in balance then the hair can suffer.  If EXO treatments or PRP were to be introduced shortly after a transplant the brand new "roots" could be lifted.  Some is theoretical but who wants to risk a failure or poor or delayed result?  It also can "muddy" what is thought to be the end result.  We do combinations of transplants and treatments at the same time a lot. The new growth phase is the same for rejuvenated hair or the newly grafted hair.  We expect onset of growth to begin around 3 months.  If you do a treatment say at 2 months post transplant this will reset that growth phase.......

That makes complete sense. Thank you for such a thorough response.

I like what I've seen so far. His results look good and his forum posts are helpful. I know we have had doctors participate on the forums in the past with mixed results, but Dr. Bargouthi has never come across as anything but pleasant and earnest in his desire to contribute.

On 10/29/2020 at 1:02 PM, arussell said:

Dr. Cooley will not agree to either done after a transplant in the initial healing phases so as not to introduce anything that could confuse the cycles.  

This is intriguing @arussell. To make sure I understand, are you saying that the external growth factors introduced during the early healing phase could possibly cause a shed and/or delay the growth of newly grafted hairs due to the signalling "resetting" things? I had never thought about this before but it seems to make sense.

1 hour ago, Melvin-Moderator said:

I believe PRP depends on the centrifuge, not all PRP is created equal, one of the leading surgeons is Dr. Arocha for PRP, speak with @Steeeveand @Mycroft

This is correct. The machinery, concentration of platelets and growth factors, and even the distribution of the PRP into the scalp can all impact how effective it is as a treatment.

Dr. Cinik is correct in saying that PRP can often lead to earlier growth as well as strengthening of native hairs after a transplant, but I don't know enough about his protocol to say whether it works. I would say a good starting point is probably to ask him what system he uses, whether a grafting matrix like Acell is used, and if he has any patient results he can show you exhibiting early growth from his PRP.

Good luck. Although I can only speak to the non-surgical experience, Dr. Arocha and his team have always treated me well. You're in good hands.

I'll try not to parrot the helpful posts from others in this thread.

Put simply

Do not: have a transplant right now.

Do: start Finasteride ASAP and stick with it. There's a very good chance you will have a bit of regrowth because you look like you're pretty early into thinning. If Finasteride alone isn't enough there are some other options like @LaserCap mentioned. You really don't look like you've lost enough hair to justify what is definitely a major surgery.

You aren't still developing in any way that will be impacted by Finasteride. Your brain is still reaching the end stages of development but you've already been through puberty.

Nice. Office light is the most brutally honest lighting I've encountered in everyday life and your result is definitely holding up under pressure. Congratulations.

On 10/20/2020 at 6:38 PM, Steeeve said:

@MycroftI thought the exact same thing!

I was wondering if they were all on the same cycle. My understanding is that that’s not usual. Maybe it is. What do I know?🤷🏼‍♂️

I also think that I noticed it toward the end of the shed because it seems to have recovered very quickly. I think it had been happening for awhile and I just hadn’t noticed it until it was screaming in my face.

I’m just glad it’s sorted itself out for the most part. 

There was an interview with the doctors from Eugenix where they discussed a tendency to see true results looking a little less dense from around 18 months onward because that's around the time the hair cycles have started to desynchronize and you're looking at your "true" results. 

As you said, it seems to have sorted itself out and is looking good. The spot you've highlighted is actually one that I consider to be key aesthetically. I personally would sooner have thinner temporal corners if it meant stronger density in the anterior point of the hairline and just behind. Not only is it easier to style but front and center of your hairline is by far the least forgiving part of your hair because people are constantly looking at it straight on.

I feel like in your situation, if you're truly unhappy with the way the top of your head looks right now, I'd probably attempt the repair because with your current situation you're already keeping your donor area pretty short as it is, and at this point you're probably not going to notice the remaining grafts missing from the donor cosmetically, but they may be able to help your recipient. If you're unhappy wearing your hair as it is right now, a repair is your only option other than trying a hairpiece. I assume you've already ruled that out.

21 minutes ago, Steeeve said:

I agree; I believe those add longevity. My hair hasn’t shown any sign of fall from PRP and it’s been a little over 18 months, however, I know it won’t last forever. I’m hoping to go in for my next procedure prior to noticing it thin out.🤞🏻🤞🏻

Is that Cooley case on his website or the forum?

I believe he had it on his site back when I was doing my initial research. It's likely still there because it's a noteworthy result.

Right now my hair is looking stronger than ever and I'm actually still seeing revived baby hairs here and there which may or may not grow to more cosmetic significance. I've been meaning to email the doc and ask about driving down for another treatment since I doubt he's coming to Dallas any time soon, but I may also use this time just to test how long I can truly maintain the results.

I know Dr. Arocha recommends every 12 months just as a rule of thumb, but I recall a particularly striking case from Dr. Cooley where a patient was still maintaining his results two years after a single treatment. I'm actually a little past the 12 month mark right now myself and I haven't noticed a reduction in hair quality, so it's not like you hit 12 months and instantly regress. Worth noting I'm also on a Finasteride and Minoxidil at this point, so I'm sure those add longevity.

Just now, living_tribunal said:

Oh that's great to know. So does Dr. Arocha travel to Dallas from time to time? If so, that works out great. I could get the follow up injections here in Dallas. Do you think there's the possibility that PRP will help my existing hair as well? Also, I've always wondered if PRP is permanent or if you you need to do follow up treatments (not talking about the first 3-4 sessions as apart of the initial treatment) every couple of years or so? I'm sure it's different for transplants but it might be something to consider to maintain what I do have.

Lastly, does finestaride maintain hair re-grown/thickened up from PRP as it does hair normally? finestaride has done an amazing job of effectively slowing down the MPB process by about 80% for myself. I'm curious if the gains made by PRP would hold up that well. If so, it might be something I only have to do every 5 years or so with my current hair.

He hasn't had a visit since Covid issues started as you might imagine, but prior to all that he was coming up to Dallas once or twice a month.

There is absolutely a chance PRP can help your existing hair. I had pretty significant results and I've had about two treatments in about two years. For me it thickened existing hair, giving it more body and color, and it even gave me some growth in areas where I had no visible hair. I'm actually still seeing small Improvements but it's a slow process.

Yes, Finasteride will help maintain any hair on your head and may very well prolong the cosmetic efficacy of the PRP treatments. Generally you'll probably want to "renew" your treatment periodically but my how often this may need to be done can vary from person to person (though again I think medication helps). Think of it kind of like fertilizing your lawn. Eventually you want to fertilize again but how often probably depends on a bunch of other factors.

4 minutes ago, living_tribunal said:

Excellent information, thank you! It seems like prp is a quick and painless injection. I'm kind of working out the logistics of having these post op PRP treatements (would have to drive down to Houston from Dallas).

Was this your experience that it was pretty quick? How soon after they take blood samples were they ready to inject the plasma into your head? Also, if you don't mind me asking, how much was each session?

I'm in Dallas myself. I had actually been thinking about going in for another treatment but I've been dragging my heels because of the whole Covid situation.

The treatment is very quick. It takes about ten minutes to "spin" in the machine they use and then it will get injected into your head. While you wait they'll inject your scalp with a little anesthesia. It was quick enough that I was able to pop over to his satellite office in Dallas 5 minutes away from my workplace during unch and go back to work like nothing happened. If you're going for a surgery I believe Doctor Arocha can give you the PRP during the same sitting as your procedure.

Cost of the procedure may actually be less for you than it was for me because mine was standalone. It may be discounted if it's part of a surgery, so @Steeevemight be able to give you a more accurate reading on this. 

Okay, so I will preface my post with the fact that my PRP was a standalone and not an adjunct to surgery. Having said that, I did a fair bit of research on it prior to my first treatment and obviously have seen its impact on my native hairs.

Early growth is indeed something that clinics usually talk about when offering PRP with their surgery. I could definitely see this being a possibility because PRP at its core is a growth promoter. It can kickstart resting hairs into a growth phase and expedite healing of sounds, so you can see how this could be beneficial to your surgical results. There's a very good chance that it could shorten the "downtime" between your initial shed and the growth of new hair. It may also improve survival of grafts and the healing of your strip scar which I would also view as an upside.

If memory serves Dr. Arocha has shared a few early early growth cases here where PRP seems to have induced earlier than average growth in his surgical patients. You should ask if he can show you some case examples of this during your consult.

For me personally I would say the PRP was definitely worth it. If I was going in for surgery I'd almost certainly opt for that add-on if only to hedge my bets in every way possible. I'm happy to answer any questions based on my experience though it's obviously a little different than what you're going in for.

My experience with Dr. Arocha is he's very ethical and typically conservative with his work.

If he says he's able to work with what you've got he probably can, but he's warning you about the donor area for a reason. Odds are you won't be able to wear the sides and back much longer than you have them now, and if you have any spots that have suboptimal growth for some reason he won't have anything to work with in terms of giving you a touch up. You need to think about whether you'd be okay with that.

Your hair is pretty short in the photos so I'm not sure what it looks like grown out. If you didn't change anything about your current situation would you be more likely to keep it short like it is now or grow it longer?

That's a pretty significant shed but it looks like the area has largely recovered. I wonder if this was just synchronized shedding due to the transplanted hairs mostly being on the same cycle.

2 hours ago, MNIK said:

I think they would if you insist on it. But i went with what Dr.Pradeep felt would be better for me keep the future hairloss in mind. 

This is the right decision. Your hairline placement looks good and going lower would likely have required the temple points to be adjusted and that would have required more grafts. Since you have a larger pattern it's best to be cautious, and your hairline is still very youthful.

On 10/14/2020 at 4:30 AM, Raphael84 said:

Thanks for the further comments and education discussion. Always helpful.

Generally speaking, european caucasian hair with a diameter of 0.04 - 0.06m would be considered fine, 0.06 - 0.08 normal, and anything above thick.
By comparison, Asian hair is generally quite significantly thicker and despite an average lower density, are able to have the visual of fuller hair.

Diameter of the hair shaft will change quite significantly in different areas of the scalp. The auricular area for example will be finer than the occipital. Some of this patients hair will fall into the fine range, and others into the medium range, hence the medium fine description to respect that detail. As detailed, the micron measurement was an average.

Interesting study @1978mattThanks for sharing that. It does give a base idea of varying ethnicities and the average diameter of hair shaft. I did read that - "Hair diameter was assessed in 823 volunteers (33% male, 67% women) from 15 countries of Africa, the Americas, Asia and Europe" 

As this is a very small test group in terms of world population, it would be interesting to see how this scales.

It may be an idea to begin a new thread to discuss findings of microns and hair thickness with an appropriately named title to attract more relevant interest and comment. 

This patient has kindly allowed us to use his photos and video showing his full face which really does add a further dynamic to the result that allows us to appreciate facial features, distances etc...

The patient is understandably thrilled. His transformation has taken years off him and Im sure has given him a new found confidence.

I would definitely be interested in such a thread.

Great patient result. The face framing is night and day.

That last set of photos really shows how strong the hairline has gotten. That zoom and lighting can be unforgiving but your hair holds up with no issue.