LaserCap

Nice set of photos. I particularly like the way you comb the hair out of the way so you can really see the quality of the work. Nice work. The naturalness is unbelievable. 4 months? Must have also done PRP to get such quick results post op. This does kind of put to rest the idea that you need multiple procedures to achieve density. Many believe that grafts compete for blood supply and that a separation in between grafts is needed for survival of any given procedure. Some time later, (typically 1 year), patients can return for a second procedure to add density to the same area. With your work, it seems, (and I realize it's number of grafts dependent), you can achieve full density in a single pass. What do you attribute this to? Advanced techniques? More knowledge, more experience?

Restoring a full set of hair will depend on a number of factors including the what pattern the patient is thinning into. Go to the Norwood chart, (Ludwig for women). If you are classified as a 1-2, sure, you can achieve a full set of hair. 5-6-7? No way. Can doing a transplant in an advanced pattern help? Of course! But it is an illusion. This is where the artistry of the doctor comes in. The secret to the whole thing is the concept of shingling. If the grafts are placed in such a way that they are call working together, you can achieve a "fuller" looking set of hair. Can it be the density of the hair you had when you were very young? No. Second, is the caliber of the hair. The finer the hair, the more natural the result but you need a lot more hair to achieve the same density of an individual that has thick hair. Other factors include the size of your head, elasticity in the donor area and others. Lastly....If you've shown the propensity to lose, you will continue losing. It is a constant battle. So, to achieve "fuller" density, the first thing to consider is halting the loss of the native hair. This is why most practices will recommend some type of medical regimen to help with retention and enhancement of the native hair. Have you visited with any doctors so far? What have they said?

Contact Dr. Arocha in Houston. I am aware of many patients that reach out to him with cases similar to your own. You can do a skype consult with him and can at least give you some guidance. Visit his website and view photos of previous repair work.

It could be coincidental. I doubt the procedure had anything to do with it but the derm should help you clarify.

Best thing to do is to go to the dermatologist and have them biopsy the area. This will give you the answer. Additionally, there are steroidal type meds they can prescribe to help you manage the condition. On a side note, if a transplant is done while the condition is active, the condition can also transfer to the recipient area. This is why most reputable doctors will wait until the condition is under control before moving forward. Have you noticed the same in the transplanted area?

I gather you are asking after a transplant procedure. So the question could be phrased better. When can I expect the most benefit from a hair transplant? Most agree that the hair starts growing after 3-4 months. It then starts very weak and, in time, the hair itself strengthens. Most also agree that you will see the most benefit after 12 months. That is not to say that there are patients out there that can take 18-24 months to really mature everything. The problem, however, is that as the transplants are improving, you are continuing to lose native hair. (if you've shown the propensity to lose, you will continue losing). My suggestion is to be patient and to be doing some type of medical therapy to help you retain and perhaps even enhance the native hair otherwise you are NEVER going to see much of an improvement.

First, I am glad you are asking the right questions, and are doing some research before moving forward. Smart. There are plenty of doctors in the US, particularly those listed on this site, that would do a phenomenal job. I am aware that Dr. Arocha, Dr. Alexander and Dr. Gabel see international patients frequently. Their offices can also help you make local arrangements, (hotel, etc). I would encourage you to visit websites and review photos. Tons of them. Call the practice, (you can email to prevent cost), and negotiate a price. You can then do a consult over the phone. You can even face-time and do a preliminary consultation with the Doctor. Good luck.

Some believe that for the first 7-10 days you should pour the shampoo and rinse, (without touching). Others suggest you can just tap up on down but without scrubbing and then rinse. (You can gently scrub the donor area from day 1). The idea is to just keep the area clean. 10-14 days you can gently scrub with the tips of your fingers. What I typically tell patients after the 14 day period is to get under the shower and let the whole area soak for 10 min and then scrub. We need to get the crusts our of there ASAP to prevent infections. At this time you can not hurt anything, The grafts are secured under the skin. After two weeks, go back to your normal routine, (hopefully your hygiene regimen is a good one). How hard or gentle you are makes no difference. Whatever hair you are going to shed, it was meant to shed, This brings up the point of the two types of loss. The hair that you see and the one you don't see......If you see hair in the shower, floor, etc....this is normal. Most believe 100 days a day is normal. This hair typically returns. You are just going through a resting phase. The hair that you don't see, that's hair loss. That's the hair that is miniaturizing, dissipating and going away. Go to the mirror. Look at your corners. Note the shaft of each hair. Some are thick and some are not. Those fine ones, that's the process of hair loss. Eventually that hair does not seem to grow very well and will eventually disappear. This just calls for a bit of common sense. You do not need to scrub very hard to keep an area clean. Nor do you have to scrub in a certain way to keep hair. Whatever is going to happen it will happen naturally. Are you doing any medical regimen to help you with retention and enhancement of the native hair? Talk to your doctor about Propecia, Rogaine, PRP and laser. These can help you slow down, retain and even enhance the miniaturized hair. Or it will help to slow down the loss.

Oh, I see. Well, this is common...to feel tightness. Have the doctor look at it and tell you if he feels you have elasticity left. Often I find patients feeling the same way you do only to find that they still have plenty. There are also exercises you can do to improve elasticity. Have the doctor show you.

Here are my thoughts on the subject..... I've had 7 procedures. 4 FUT and 3 small FUE. I started in 1999. I started Propecia back then and I am still on it. What is that, 30 yrs? Most believe that there is more testosterone while on the medication. Why do patients experience side effects? Beyond me. I think, that once the body realizes that there temporarily more testosterone, it will eventually balance everything out. I've had the opportunity to assist the ISHRS show a number of times. It seems that more and more negative info comes up every year....only to find out a few months later, that new studies show that anything previously discussed was non-sense. Consider that Proscar, (5 mg), the parent medication, is used to address prostate cancer. Millions take this medication. Have you heard anything negative about it? Consider that Propecia/Finasteride is 1mg Regardless of what is said, I think of the medication as a positive - and that's what's been for me. Positive. If you start thinking negative, guess what, it will also give you a side effect. I plan taking the medication for the rest of my life. I value the little hair I have. It has served me well. Don't get me wrong. There can be side effects. I've seen them. But without reservation I can say that ALL the patients I've seen experiencing one thing or another started the med under the impression that they would eventually experience a negative side effect. Lastly, the internet. Awesome source of info, but be careful. Lots of mis-information. How many times I have seen patients that were taking Propecia/Finasteride for years. Halted to loss. Read negative info on the internet and stopped the med. They eventually loss the benefit and resumed their loss. First, who wrote it? What was the side effect? Please consult your doctor and get educated! And, if you decide to move forward, always know that you have the option to stop if you do experience something- which will happen right away. This is not a medication that you will take for 10 years and then, all of the sudden, start experiencing a side effect.

You've hit on one of the most basic concepts in hair restoration and one that is truly not explained at length during a consultation. It is rather complicated, particularly when you are trying to guide a young patient during a consultation. Most believe a donor area will have 3000 - 7000 grafts in their lifetime, (some more, some less). Consider that when you are born you are starting out with about 100,000 hairs. By the time you are a teenager you've lost half but still don't realize that you've lost any native hair. So, if 50,000 is full density, you are asking 3000-7000 grafts to do the job of 50,000 hairs. It is truly an illusion and speaks volumes about the doctors in the hair restoration industry and their artistry. What provides density is the shingling effect, hair on top of hair. This is the reason why many consultants, depending on the pattern, will suggest to patients that they comb the hair from side to side. This allows for all the hairs to work together and give the illusion of density. Where this gets really complicated is when you are consulting with a young patient. This patient will typically reminisce about the teenage hairline they used to have and also want to address the crown. What do you do? In my view, and the responsible thing to do is for the Doctor and consultant to educate the patient and start with some kind of medical regimen to help him retain/slow down the loss. Give a plan short term to address the patient's concerns and a long term plan that takes into account donor availability and effect of medical therapy. If the meds work, awesome. If not, the patient will still enjoy a very natural result.

Gray hair? Congratulations! There is more to this than just talk about how difficult it is for the clinical staff to do the work. Typically, if you have dark hair and lighter scalp, there is lots of contrast and the thinning becomes more pronounced. If you are blond or have white hair, consider yourself lucky. Less contrast, it looks like you have a fuller set of hair. While it is true that doing the work is a bit more difficult, it is doable, particularly for those that have experience. If it truly is an issue, color your hair prior to the procedure. Eventually all will return to its true color. Have you had previous work? How do you know that you have no give in the donor area? Did you visit with a doctor? Not sure about the transection rate. The main issue is the fact that white hair is more difficult to see.

Oh, now I see what you mean. Up close it's a different story. A couple of things come to mind. Using the rule of thirds, (chin to nose, nose to eyebrow, eyebrow to hairline), where is your hairline supposed to be? If you have a conservative hairline and you can bring down the hairline about a cm, this would allow to stagger some grafts to add naturalness. You could also have some of the grafts punched to make them smaller, (less groupings). Lastly, electrolysis.

You may want to consider doing PRP and laser therapy. The mechanism of action of each of these is totally different and thus, are synergistic when used simultaneously. Give it a year, photos every 3 months and keep track. After a year you can decide if the added benefit is worth continuing the regimen.

What density are you trying to accomplish? How far back do you want to work? The problem is the contrast between the color of the hair and the color of the skin. SMP might not be a bad idea at this stage. What medical therapy are you doing?

Lots of factors to consider, but all things being equal and naturalness not being compromised, I would look at, How many clinical staff members will be placing? Are you doing FUE or FUT? I am guessing FUE. Do you know what system they are using? Are you doing PRP with the procedure? The nice thing about doing it in two days is the fact that the staff will not get tired as easy and it is a far more relaxed experience. You'll leave early on both days and can return to the hotel and get some rest. The worst thing that can happen is you feeling rushed. Eventually you'll question the process particularly if something goes wrong. Swelling typically happens about 3 days after the procedure. This tends to happen when patients get too active after the procedure. Relax for the first few days and follow the post op instructions, particularly sitting up at an angle while sleeping.

Your hairline looks fine and age appropriate for now and the future. If you lower it, as drawn, will give you more of a juvenile hairline. The only people who can carry such hairline are those that have more hair than all of us combined, (and adolescents). If you feel your temporal areas are a bit rounded and not blunted, You may want to bring the forelock (only) down about a cm. and leave everything else the same. The doctor could blunt the corner as well. If this is done by staggering grafts, this might resolve all the issues you have outlined.

Trust is a big component. But there are a few more things to consider.......Review tons of photos....Notice graft numbers and the density achieved with said number. Also, quality of hair. Fine, light hair will typically look more natural but you need a greater quantity to achieve the density of someone with similar numbers but with coarser hair. Next density. Given the instructions of the doctor to his staff, the staff could double up grafts per site. This will provide more density, particularly going farther back into the pattern. A comprehensive conversation with the consultant and the doctor are very important, particularly during the initial consultation. Lastly, look at the place, location, equipment...There is a reason for all these things.

Impressive....And after only 6 months? PRP really helped bring in the hair a lot sooner. And SMP? What a great combination given the contrast between the color of the hair and the color of the skin. Nice work Doc!

My grandfather was bald and I wanted to be just like him. I was not interested at all and was unaware that there were options available. The company I was working for was sold and I was out of a job. I was in Jamaica at the time and, while on return flight, a manager for a hair restoration practice was sitting right beside me. Great guy and we hit it off. That was on a Saturday. On Monday, while gathering my personal things I got a call from the HR department asking me if I would be interested in a consultant position. I accepted and relocated. Lasted 15 years. I have worked for a number of companies since. During my training, (bear with me), the consultant training me said, "if you've never been interested in hair restoration, you will never do research nor know anything about the industry." I believe that. So that brings up a point. How many people out there, considering the millions and millions that inhabit the earth, don't know about hair restoration? It is a very rewarding career. Unfortunately there are many people just getting into the industry that really know little to nothing. It is scary. I feel it is our job to educate and protect the patient. I am grateful for this site and the input...and the fact that you are allowing me to contribute if only sparingly.

Beautiful work Doctor! Did he do PRP at the time of the surgery? Is he doing anything medical therapy wise to help him with retention? Amazing density....

Just by observation of the photos it seems you are not demarcating down on the donor area. That could be the Rogaine working and holding your pattern. I once heard a doctor say that if you use Rogaine twice a day, you are getting 100% of the medication. If you do it once, you are getting 90%. Keep doing it particularly since you can not do Propecia. (You may want to consider 1/2 of the 1mg every other day. Perhaps this will help? Ask your doctor his opinion). Have you tried PRP and laser? Those are two additional modalities you can try. All these work in different ways and are, thus synergistic. With regards to your hairline, it looks good. Too much density starts looking like a wig. Remember, it is a transitional zone. To be a bit thin adds to the naturalness. Add grafts to your temporal areas? NOOOO. Say you do, you create a straighter hairline and then you continue receding, you may end up with a feminine looking hairline. Guys thin out in a parabolic shape. A bit of recession, such as yours, is appropriate for a guy...and appropriate for the age. Straight belong to children. If you are happy with your current density, and you continue retaining, you can them move forward with the crown. Keep in mind that this is the spherical area of the head and because of that it takes TONS of grafts and multiple procedures to achieve density. Most patients are happy with a "dusting" rather than full density. Everyone, by definition, (since there is a whirl), will be thin in that area. Talk to the doctor about the number of grafts he would recommend for you. Good luck.

1. Throughout my career I've heard from many practitioners that the medication is systemic. That is, regardless of where you put it, it is doing what it is supposed to do. Why do I phrase it that way? It tends to be far more helpful in the crown than anywhere else. The problem, as I see it, all modalities are meant for you to retain. People tend to expect. When they see nothing, they feel the medication(s) is not working. So, go ahead and put it one day in the crown, one day off to the side, next day in front...etc....Or just put it in the crown daily. it is working the whole head. Whether or not you see anything, that remains to be seen. I would give it a good year before assessing anything. 2. To just hit the native hair/or the transplanted hair, is going to be impossible. We know the transplanted hair will stay regardless, so the hair that truly needs the med(s) is the native stuff. 3. If you decide to move forward with the meds, it is a long term commitment. Why only do it for 6 months? First, you'll notice nothing in 6 months. Wait, you might see more loss starting out! Your body things you are creating havoc and will shed. Once it realizes this is actually helping, things will return back to normal. And, if you do continue, and stop, you'll go back to where you started. You lost all that time. With the current prices of all therapies, and if your goal is to enjoy a fuller set of hair, this should be a MUST.

Meticulous to the core! AND he does his own extractions which is awesome. Most clinics will have someone else other than the doctor do them. A shame. I am aware the Doctor has a new location and, based on the photo of the reception area, I am sure it is amazing and welcoming. I've met with the doctor plenty of times and his work is outrageously good. Nice work Doc!

There can be a HUGE difference between 6-12 months. First, did you do PRP with the procedure? This helps bring the grafts in sooner and can also help reverse the miniaturization of the native hair. Typically, when hair starts coming in, it is NOT the quality of the hair that is in the donor. The hair will be very thin, almost like vellus hair. It is not uncommon for patients to say, "I don't see anything, I just lost all my money." On top of that, not all hair come in at the same time, it can be staggered by several weeks. Then the hair starts maturing and taking on the quality of the hair from where it came from. How many times I have patients call at 12 months to say, "I can see a huge difference." Transplants do not propagate. Where the grafts were placed, that's where you will see new growth. This does not promote growth elsewhere. NOTHING regrows hair. Medical therapy, and I hope you are doing something, (Propecia, Rogaine, Laser and PRP), can help halt or slow the loss and sometimes can help enhance the hair that is dissipating and going away. I am under the impression that when patients go through the process, do a procedure and add the meds, they will see very positive results because of the patient is being proactive and doing everything he can. At that point you are really taking advantage of everything available to you. With regards to a 2nd procedure, this can be in the same area or on a different area, (say farther back into the pattern or in the same area to add density). This was and still is, very common in the industry. The universal belief is that grafts compete for blood supply. Some doctors will leave a separation in between grafts to make sure everything survives. Months later, typically 12 for most doctors, you can return and work around the separations and "fill in the gaps." By that time the first round is "in" and can not be damaged. The other reason why you want to wait is to allow the donor to heal before harvesting again. BUT now I have seen techniques that I call 3-dimensional. I think this has to do more with how the incisions in the recipient site are made. Instead of being 1 dimensional, (doing the apertures side by side), now they are done in such a way that the hair shingles and works together to allow for more density. It is now not uncommon to achieve great density with just one procedure, all pending on how many grafts you decide to move forward with. You bring up a good point. If you are completely bald and have nothing, the first procedure, again pending graft numbers, the change will be dramatic. The second, not so much because there is hair there already. Take a ton of photos and put them away. 6 months later do it again, and another set at 12 months. If things go right, you will see the change. If you started with some native hair, you better be on medications because eventually you will lose that hair and will have to return to do another procedure to replace what you just lost and not raising the bar of density.