Rolandas

Great write up and of course amazing hairline. I'm always impressed by Dr. Ferreira's hairlines as you can clearly see finer singles in the very front. Not many places are actually taking the time to find those finer singles!

I had some fibrin build up after surgery as well, so been spraying a lot of saline (pretty much every 20 min) for the first2 days

48 microns is definitely fine hair. I had 50/51 (just to give you an idea). Average hair/graft is really impressive. This should give you a great density!

Next few months will be with no change after shedding is finished, so grow some patients and focus on other things in life. Once day you'll be surprised to see some movement happening in there!  

35 minutes ago, LondonRamen said:

Yep, seems like it, just worries me because I haven't seen that in anyone else yet. Usually they go from facing straight up to falling off. Hoping it's not because there is something bad about my graft placement 😨

I think you might have been too gentle when washing them off. Did Dr. Ferreira came back to you about this?

11 minutes ago, Guy73 said:

Lol, yeah I had a lot of skin showing that’s for sure. I probably even lost most of those stragglers by now! Lol 

I watch your YouTube channel, so you will definitely get there. Can’t wait for the upcoming  “Rolandas man bun” tutorials!😄

Nah man, my girlfriend keeps nagging me to cut my hair short. Man bun won't going to happen! haha

In any way I'm comparing myself to myself. I'm already ahead of how I looked, and to be honest, I'm already ahead of my entire family haha But nevertheless I'm happy for your result. Truly a game changer and I'm hoping to get "to the other side" soon too

5 minutes ago, Guy73 said:

I had almost a bare front starting out. 
https://imgur.com/a/yNVF9ls

I know for dr. Nader said he would try and mimic a double graft by placing 2 singles close together because of my fine hair. You and me have a similar hair type so I would recommend the same approach even if it takes longer for a finished result. 

Ehh, not that bare  I'm slick bald in the front (had maybe 13 hairs haha)

8 minutes ago, Guy73 said:

Not sure my hair caliber🤔I know I have very fine hair. I do know a .07 and .08mm punch was used. Now as far as grafts per square obviously it’s not the same in my crown as the front but in know in the front all the way to about mid scalp it’s got to be close to 100 grafts per sq. How do I figure that? Simple , Dr. Nader started out conservative in basically all my procedures to have the best possible yield. When he draws out the grid before surgery he marks 35 grafts per grid. He went over the same area 3 times 1 year apart from each. This gives me approximately 100grafts per square. I know he did count some square centimeters in front after the third and it was 100. Some people here say it’s impossible I would agree if you’re trying to do that in one shot but mine were spread out between three different procedures and the results speak for themselves.

The only downside to a conservative approach is going back to get an area reworked. But on the upside the survival rate is better. I’m not sure how he works now maybe he does 40-45 hair per sq cm but I know in my case that’s how it was done. I always knew the first transplant was not gonna be suffice I was OK with going back and planned on it. Also think the DHI approach gives the surgeon a better tool for angles and direction of hair along with the ability to place hairs super close together that traditional fue and forceps might not be able to do as efficiently. Just my 2 cents on that. 

Very good approach. I feel like exactly in the same shoes like you were once. 10 months in after my first round. Had up to 55 grafts/cm2 in the hairline, but because my hair is very thin (~50nm) it doesn't look as thick.
I do believe you on 100 grafts/cm2. Did you have a lot of native hair in those areas to begin with or is it 100% transplanted density?
I'm going after exact same approach. Step by step. With 1 surgery for high norwood level is impossible to achieve outstanding result, especially if hair shaft diameter is fine like ours.
Thanks for your response!

Two words - HOLY F*&K! It almost feels like you came here to troll us all haha

Of course 8300 grafts is a lot of grafts, but damn this looks good! Do you happen to know some finer details of your surgeries? I'm a bit of a HT nerd 🤓, so would be curious to know your hair caliber, average hair per graft, grafts/cm2 in total etc

8 hours ago, deitel130 said:

Looks great. The video is very informative for anyone planning a HT and what to expect in terms of growth month over month.

Actually I did last video on my exact timeline month by month  

What's up guys, I'm a bit late with my update, but here we are.

Month 10

I've put together this short video with a recap of my journey so far and how I felt along the way. Of course at the end usual close-ups.
Overall It's still thickening up. It feels much thicker than it was a few months ago!

Currently talking to Dr. Ferreira in booking my 2nd surgery. So far closest day is end of May 2021, so either will get on cancellation list, or wait until then  Also once I will figure out plan for 2nd surgery, will make sure to update this thread!

I'm sure you answered your own question correctly.
Why don't you try to pull them out right now with your fingers? If they supposed to go, they will go regardless, so might give it a try.

6 hours ago, JohnBob said:

Not only stitches, but the strip means you make two huge horizontal cuts that will for sure damage a lot surrounding FUs too. I wonder why that's never talked about? 

Your though process makes sense, but I would like to question the premise being used. Why is the consensus that you can't extract a high number of FUs via FUE (2000 in your example)? Too many tiny little scars all over the scalp can damage the skin and cause shock loss? This is an assumption that has been thrown without much scientific evidence IMO.

 

Doctors like Zarev are pushing the limits of what can be done with FUE and are harvesting 10,000+ follicles while keeping the donor aesthetically good. So the dogma that FUT is better than FUE for high numbers of donor harvesting should be challenged. 

Don't buy into Dr. Zarev hype. He is one of the best surgeons, but it doesn't mean he consistently does 10,000 fue. It all depends on donor characteristics and if one has very high average hair per graft ratio, then of course it's easier to get more grafts in single session.
Also let's not forget hair loss pattern. I was referring to NW7 where relatively small donor area is available. Since FUE requires to spread it out to extract more grafts in single session, this sets huge limits.

Besides, Dr. Zarev is doing multiple fue sessions as well. If I recall his biggest is something around 7k grafts in single surgical session, which still is mind boggling, but to be fair, he is using very wide extraction area on NW5 or so with perfect donor conditions.

And yes, shock loss is the biggest factor. Not sure why you need scientific evidence of it. It's happening consistently in shit cheap clinics. Extractions are done too close causing shock loss.

Of course let's not forget how long such surgeries will take. I had 3659 grafts in 1 surgery over 2 days. Surgery lasted full day from 7:30am to 5:30 pm. I wouldn't like my surgeon to get 6000 grafts via FUE in one go and later to discover that most of it didn't take. Much safer approach with smaller surgeries.

15 minutes ago, Steeeve said:

Your transformation is truly stunning. Everything looks so natural. Congratulations! 

Appreciate that! I can confirm whenever I look close up at my hairline I always tell myself "holy shit this looks so natural", even though I've seen it hundreds of times

10 minutes ago, JohnBob said:

Why? Why taking FUs in bulk is better for your donor than taking each FU individually?

You brought up really good points on FUT stitches causing transection of surrounding grafts. Never heard much about it to be honest, but it's an interesting theory.

Imagine someone NW7, he has very thin donor area. How many grafts would be safe to extract in one surgery? 2000? The patient would need to get 3 surgeries to get only 6000 grafts (considering donor management while extracting was spot on). There would be still chances of permanent shock loss. There are no guarantees it won't happen even in best hands.
6000 grafts on NW7 is good, but not enough. 6k grafts could have been extracted in 1 strip. Of course chances of shock loss are there too with fut, but overall chances are smaller as the patient would have only 1 surgery as opposed to 3.

Of course all these numbers are just random, but hope this show my though process.

4 minutes ago, 1978matt said:

I believe this was the Shapiro study from 2 or 3 years ago.

One thing that occured to me is that the FUE surgeon gets to choose which grafts he takes versus FUT where you use whatever is in the strip.  Therefore, the FUE could select a greater proportion of stronger looking (less miniaturised) hairs, even if they were restricted to the same numbers of 1,2,3 & 4 hair grafts.

Perhaps that is one factor which led to slightly better growth.

But this is the reason why fue might be superior technique than fut right?

Of course if someone is NW6/7, then definitely FUT will be the way to go regardless of survival. Donor management is still they key.

Most of you probably heard that FUT has higher survival rate.. But is it?

I found one study that shows otherwise! Imagine, they cut FUT strip on the right side of his donor, and FUE punches on the left side O_O

Of course it all depends who is doing your surgery, so don't jump into conclusions too early! What do you think?

Btw here's the study https://www.ishrs-htforum.org/content/28/5/179

1 hour ago, Melvin-Moderator said:

@LondonRamen

Thank you for sharing your review, this is gonna be exciting in 6 months 👍🏼
 

@Mycroft

In my experience, my first procedure I had 0.8mm punch and a total of 1,800 grafts carried over two days. The healing was about the same. Unfortunately, the results were not that good. But I do think allowing an extra day or two does help with the scabbing. 

Interesting...

Do you think Melvin it's due to patient healing ability, or there's something more to it thats happening during the surgery? I'm just genuinely curious.

1 minute ago, Mycroft said:

From what I understand he has a relatively low daily graft count per day. If I remember your thread correctly @Rolandasyou had around 3,500 but spread over two days. If a small punch size is being used and total punches per day is kept low, possibly this leads to a faster healing time because the total scalp trauma at one time is kept to a minimum.

 

This can be it! Makes absolute sense. Punch size is pretty standard, but less trauma per day, thus body can recover easier and faster. Didn't come to my mind

24 minutes ago, LondonRamen said:

Hmm, hard to say. I'd say a bit of both. He clearly takes a lot of care such as when he switches between manual and motorized fue depending on what he feels is better for the situation.

Yours was quite clean too as you say, but your hair, similar to mine was around 50 microns so he can get away with smaller punches that perhaps promote donor healing better.

 

 

From what I've seen 0.8mm & 0.85mm punches are quite common. Some surgeons like Dr. Zarev are using even smaller like 0.65mm. I think maybe it's due to hair growth angles. If it's growing straight in the back, the hole overall would be smaller than sides for example where hair growth is more steep (at least for me it was very steep)

I'm curious if Dr. Ferreira is doing something different in terms of extractions or it's just patient physiology. What I've noticed recently is everyone is healing in donor exceptionally fast. Your back side of donor looks incredible in just 1 day!

Glad to see hairline wasn't lower too much as you could expect from shit Turkish places. Very appropriate design which will work long term + enough available grafts for the future.

My donor in the mid area healee extremely quickly too. On my second day of surgery when I came in they immediately noticed that my donor scars are closed down in central area.

Looking forward for your updates!

15 minutes ago, JohnAC71 said:

Amazing as ever 🤩 as you have had so much success on the frontal third I’m guessing another ht is on your mind? It would complete it. And that’s taking nothing away from how far you have already come. 

Oh absolutely! That was the plan all along since the beginning, 2 step approach. Can't wait to get my second done. If not current pandemic I would have booked it already for January 2021

9.5 months

First of all I want to say a huge thanks for everyone who keeps supporting me during my journey so far. It's really been a life changing experience and I truly can't wait to get second one done and leave this finally behind me!

Right now I'm still struggling with thinning mid scalp and crown, but also I still see more hair getting thicker.

In this video I will cover:
- What's happening with my hair transplant right now
- How my hair looks non-washed for 3 days, towel dried & brushed forward
- How I'm currently styling them with this length
- Close-ups of my HT (direct light | indoors | outdoors)
- Donor area

Hope you guys find this video informative!

Wow this looks so good, especially when you compare to where you started. You've been pretty much completely bald!
I would be curious to see how your hair looks right now when you spike it up a bit just like you did in month 8. Is there a difference?
Other than that, a touch of hair fibers and you have a full set of hair!

If you're planning for another surgery, you could reconstruct temporal peaks and put some in crown and it will be a home run. Plenty of beard grafts as donor for extra density in mid scalp.

On 11/1/2020 at 1:34 AM, giegnosiganoe said:

Looking good as always. Keep up the vids man. I'm curious, do you know how long Dr. Ferreira has been practicing for? How many cases does he have under his belt, whether that's with Lorenzo or in his own clinic?

I don't know exact numbers, but from what I've heard he has something around 7-10 years of total experience as HT surgeon.
He started working in Dr. Lorenzo's clinic from around 2017, and in his own from 2018.
No idea about the cases, but looks like he is doing 3-5 surgeries a week (can be 2 day surgery like my own), so should be around 156-260 cases a year. How true is this idk, just did a simple math

10 hours ago, giegnosiganoe said:

I don't think I've seen anything too conservative from Dr. Pekiner's extraction patterns. Sure he doesn't usually go as high as someone like Dr. Hasson (just picking an example), but I think he spreads out the extractions far enough. I'd be interested in finding out his reasons for suggesting BHT in your case. Maybe he just didn't realize you had so many grafts in your donor?

 

See this extraction pattern from @kiokbs, I don't think it was too conservative.

Perhaps if someone is NW3 or so then he goes wider.
I've been in touch with him for quite some time, and by the end his representative said "Dr. Pekiner thinks you need X amount of scalp grafts and X amount of beard grafts. He won't change his mind". I've tried to negotiate and say that i don't want to use beard grafts in the first surgery, but this response was the same "he won't change his mind", so this put me away.

Once I had surgery with Dr. Ferreira i was very thankful that I've decided not to go with Dr. Pekiner. Reason for this is Dr. Ferreira's assistants showed me my grafts under microscope, and guess what - they were short! I'm 100% sure Dr. Pekiner would abort my surgery as well.
During the surgery I asked Dr. Ferreira is this a bad thing to have short grafts, to what he replied - "no, it's quite rare, but nothing to worry about. All your grafts are just short".
This lead me to believe that Dr. Pekiner's diagnosis can be incompetent in certain cases.

Although I really like Dr. Pekiner and always suggest for people to look at his work and think for themselves, this thing just planted the wrong seed in my head. 

5 minutes ago, Abi28 said:

Looking at where you started from it looks great. From my own experience Pekiner tends to give you less estimates of how many available grafts you have in your donor, there is no way you only had 2000 grafts available.

When I went to Pekiner he told me multiple times that my donor was depleted and that I only had 400 grafts left for a future procedure and if I wanted to remove more grafts I would need SMP done. I was a bit devastated because I had a large area to cover so it wasn't enough. After my surgery I started consulting with other doctors to see if my donor was still good enough for another procedure, I contacted HLC and Demirsoy and I was told the same thing, I can still get around 2000 grafts from my donor, I was upset because I was told that my donor was finished, a few weeks ago I decided to go with Demirsoy and he was able to get around 2250 grafts from my donor and told me that I have some left for a future procedure and he also mentioned that I had areas in my donor that were not touched which was a big surprise to me. Obviously it's still a bit early but I am now a few weeks post op and my donor has recovered well and there is nothing alarming and everything seems on track.

Pekiner is obviously skilled but the diagnosis and estimates that he gives can be off compared to other doctors, he is very ethical and great at what he does and he did a lot of good things for my hair by removing old plugs etc

If I were you I would contact other clinics, even though you might not need another procedure since the crown usually takes longer to fill in, in a few months you might be satisfied but I would ask other doctors to see how many grafts you have available because I guarantee you there is another 1500-2000 that can be used. 

Overall I would still call your surgery a success, good luck!

Dr. Pekiner extracts only from the safest area of the donor, considering worst case scenario you would progress to NW6/7. This is not the case with most people, but that's his approach. He proposed to me 3000 grafts (2500 scalp and 500 beard) on my very first HT.
I went with Dr. Ferreira, and he estimated around 9000-10000 grafts available before donor depletion. No beard needed.