While I didn't create an account on this forum over the last couple of years it was invaluable in my research process and I want to pay it forward, especially since I seem to be seeing fewer patient posts with recent dates, at least for Dr. Cooley.
Thus I will try to be thorough here in describing my process. Apologies in advance for the length of the post and the variability of the quality of the photos. I know they aren't the best. I am still only a few days/weeks out and will update this with before photos and after photos from the clinic and exact graft count(s) when I get them and try not to disappear throughout the process.
My Past Situation
I had an ill-advised FUT procedure when I was 21 to address temple recession. I wasn't on meds, it was premature, and I went to a cheap chop shop. CLASSIC, young guy being really stupid. :sigh
The procedure (unknown # of grafts) involved putting grafts on the temples and unfortunately also some around the front of my hairline. It did very little cosmetically unless you count triggering massive loss of existing hair (most of which did grow back in fairness). The only saving grace here is that we were talking about a fairly minor temple area and because of my light hair/skin contrast I've been able to get away with a forward brush hairstyle that hid really poor work. Oh and it wasn't big plugs and the scar wasn't horrendous and avoided being in any disastrous region(s) thankfully.
No matter what you do STAY AWAY from Samson Hair Restoration in Los Angeles regardless of what doctor they currently have cycled in.
Now, 11 years later at 32 with some additional thinning and some recession the previous work was becoming harder to cover, especially when swimming or my hair was wet. Plus, I just wanted it fixed to open up different hairstyles and to get ahead of managing what I believe will be future loss. Almost a gradual "replace" strategy I guess.
In terms of meds, I had been on finasteride w/ no side effects for 4 years but then went off for 5+ years (don't really know why). I went back on 6+ months ahead in prep for a procedure and plan to stick with it this time. Not on finasteride or any other shampoos etc at the moment.
Picking the surgeon
In terms of research this time around I did a lot more homework using this forum as the basis for creating a smaller list of doctors.
Ultimately I narrowed my list and research to consults with Lindsay, Bernstein, Cooley, Bloxham, and Nadimi. I felt these were really great doctors that didn't necessarily require a flight based on my East Coast USA location (I was intrigued by Rahal, Hasson/Wong/Kronior and some of the other staple of well regarded doctors as well but with only so much time felt good with my short list). I did not consider India/Turkey etc., not because I don't believe quality results can't be achieved there, but because I didn't want to take the risk and conduct an extra level of due diligence with respect to many of the practices and I was willing to pay $ for that peace of mind.
Notes on my Consults
During my consult with Dr. Lindsay I felt like he just didn't think I needed a procedure yet. He cited 1200 grafts and it was all relatively cursory. So not a fit for me
Dr. Bernstein was a good consult (worth the cost) where I learned a bit and I felt comfortable with him and his work, but ultimately I wasn't blown away by the results I've seen from him either on his website or on this and other forums
My consult with Bloxham was really terrific and I got a great feeling from him. He was ultimately my #2 but I did not choose him mostly because he is just relatively newer with fewer posted results. And right or wrong, some of the (rare/older) negative comments about customer service/interactions from Feller put me off. I did NOT have any of this sense from Dr. Bloxham and have never met Feller but the posts are there nonetheless. I will also say, they need to upgrade their facility. Not the medical side hopefully, but the rest of the place was old and run down feeling.
Dr. Nadimi was also great (via Skype) and matter of fact but I got the sense she did more FUE than FUT. Similar to Bloxham there are just fewer patient accounts out there that I could find, but based on what I've seen and this consult I was very comfortable and impressed with her
Ultimately, I went with the only doctor I didn't meet/ have a convo with directly in Dr. Cooley. I appreciated the consult with Lollie and a deeper understanding of their procedures and liked what I heard about use of Acell, how he preserved grafts out of body, his hands on approach, the tenure of his techs, and so on. But most importantly Cooley's track record of consistent results and patient experiences tipped me over (including one detailed repair write-up by a Blonde haired individual, of which there are relatively few results). I also literally did not find a single negative review (of outcomes) for Cooley in all my research and I valued that apparent consistency.
Procedure - Why FUT
I knew I wanted FUT as I (a) already had a scar I felt could be improved, (b) wanted to maximize future grafts and survivability, and (c) wanted to minimize recovery time. I am lucky enough to have a lot of Donor and existing hair that can be used to hide a procedure.
Pre-Procedure and Day of
All things posted about Cooley experiences were true for me. I followed pre-op instructions for scalp laxity. I think this helped as I could feel the sides definitely loosen up, and while the back still felt tight Cooley said it was great and helped with suturing (+ sutures out at 2 weeks vs. 3 weeks).
The hotel they set you up in is excellent, easy, convenient and they already know why you are there and what you need. Shuttle drivers, check-in staff, and others there were helpful and discrete and the breakfast and gym is open early enough for day of eating and a last workout.
On the day of the operation we met at 7am, had a calm and not rushed discussion where any other questions I had were answered, and re-affirmed my choice of 2500 FUT + PRP/Acell.
In terms of hairline we were on the same page to opt for a conservative/mature hairline though Cooley jumped straight to the need for work on the temples which he said he does not always do. This process of agreeing on this was FAST as a lot of it was bridging existing hair and the past work plus a little bit of pulling temples out/down.
In terms of PRP, Cooley was candid that for me he didn't know if PRP would make much of a difference as he didn't see a ton of minituraization but (a) I'm paranoid and think there is more than there is/I have very fine hair already, and (b) I am hopeful that it will help somewhat with avoiding shock loss or speeding up recovery. I know there's no real scientific evidence to back that up, but I was willing to spend the $ on the chance it helps.
I will say that to make sure you get what you need before surgery begins you should 100% come prepared with your questions. For example in my consult with Bloxham he indicated that my past FUT scar had a small area branching into the danger zone for donor and advised forking the scar near my ear. I really did NOT want to do this, so asked Cooley about it. He decided to implant 10-15 hairs in the end of the old scar as part of the procedure and end the new scar in a safer location. I do not think we would have ultimately done this if I had not asked. H/T to Bloxham for noticing it in a really thorough, caring consult.
I also asked about a few grafts poorly placed in the front of my forehead below the 7CM mark we agreed to for the new hairline. He said if I was OK With it that he would remove those with electrolysis which I agreed to and am relieved about as they were definitely not natural looking.
Overall, it was a good conversation. I, like most others, felt comfortable and cared for by Dr. Cooley and all of his other wonderful team members. I do think the clinic could get better about having all their pre and post op documentation organized and sent in a big PDF but that's super minor overall and has nothing to do with the in-person interactions I had. One other area that I felt could be improved is in discussing recovery times. The clinic (not Cooley himself) were fairly aggressive in terms of discussing post HT recovery periods and timeline (no redness 5 days, not visible procedure at 8 days etc). It's not that they are totally off, it's just that they are definitely giving the aggressive, "best-case" scenario in my opinion and shaded this as an absolute vs. discussing the potential ranges of recovery times based on patient characteristics.
Still thus far in my case it has proven to not be too far off the mark so far (devil's always in the details though isn't it).
From the Cooley consult we moved into the procedure. Numbing/valium etc was painless. Unlike others I don't think I really went fully under for the ENTIRE duration of the procedure, I even heard a nice little "ripping" type sound on removal, but no pain whatsoever. By 11:30 the donor was removed, there were 5-6 technicians on the microscopes, I had had PRP and he had done the few electrolysis removals needed. I stopped for lunch and then we carried on.
Cooley performed all of the donor incisions, with Brandi hovering nearby, and was present for probably 90% of the graft placement. I know for sure he was doing all the immediate hairline grafts. I believe he left for a little over an hour in the middle of the procedure (basically the length of a movie), but I'm not 100% on whether he popped his head in a few times during that time or not. While he was not actively working on my head Brandi was performing graft placement and I believe Amy also worked on placing grafts. Cooley returned and was essentially there the rest of the day long after many of the other techs had left post dissecting the grafts (easily 4-5+ more hours). It was clear he reviewed and had ample time to change, correct, or ensure any grafts not placed with him in the room were to his liking.
Like others have mentioned it was clear throughout the day that this was a well-oiled machine, with team members that had worked together for years (decades even). Everyone was friendly and taking a dedicated and personalized approach to the operation, and I couldn't imagine going somewhere with a doctor doing multiple ops in a day. Throughout the process Brandi was constantly checking Cooley and making sure anything "controversial" about his approach was discussed (a few graft placements here and there, reminders about how many grafts were left etc). All of this was reassuring. I am sure the reverse also happened.
Ultimately for the 2,500 graft procedure Cooley was able to get over 3,000 grafts (I will get exact counts later) and we did not finish the day until a bit after 7pm, meaning I was there for nearly 12 hours. This extra time and attention, plus the grafts that were not something I had to pay extra for, all speak to his long-running record of caring about his patients and working tirelessly to get results. I am obviously grateful for this.
Post Op - Healing, Pain, and Experience (Week 1)
Donor got painful at the end of the day during the operation so I was numbed up again before I went home. I was obviously a bit red and beat up but it wasn't as bad as I was expecting and they had already done a pretty good job cleaning a lot of the blood off. Plus I was wearing Saran wrap + a hat so able to avoid any weird looks. On night 1 I took some Tylenol but nothing stronger--which is good because I didn't get the prescriptions until day-of for stronger meds.
Cooley's post-op care uses an ATP spray + saran wrap to increase moisture and prevent any graft damage and antibiotic ointment on the donor scar. You basically spray every hour you are awake and wake up and spray every 2 hours for the first 2 nights along with taking some preventative Prednisone for swelling. I followed the instructions religiously here and I think it really helped calm redness and speed healing. On night 2 I was falling back asleep pretty quickly so it didn't feel too onerous to keep getting up. For sure it kept the itchiness to a real minimum in the first 6 days.
I went back the next morning for a post-op clean and got the all good from Dr. Cooley. During this cleaning Amy took time to answer any questions I had about the next week of care and was patient with what I am sure are the same questions everyone asks. In terms of the documentation they gave me to follow, I actually think it could have been a bit more detailed. It wasn't that it was bad, but I felt like an "FAQ" or just more exhaustive detail would have helped. For example, I asked about caffeine / alcohol / ibuprofen which were not listed (Cooley says moderate amounts of both are fine), and it doesn't give you much about how to sleep (when can you sleep sidweays on the grafts) and so on.
To give you a sense of how smooth this was, I drove almost 7 hours home the very next day, which was completely fine and painless.
Overall I found the post-op regimen easy to follow, the spray and saran wrap seemingly very effective even if I did probably use it too quickly/aggressively to try to get it through the native hair as I ran out a day or two earlier than I think the clinic expects.
One curious thing with post-op care from the clinic is that it seems that Cooley's overall instructions,are more aggressive than many other docs (like the timeline to shampoo (next day) and return to regular shampooing (7 days) . I'm sure this is because Cooley is confident in the healing/quality of the grafts and incisions etc and has refined his approach over time but it does make me just a little nervous when looking at the instructions online from so many other places that are much more conservative. But he's my doc and I'm in his hands and so far so good.
On night 3 I slept poorly but not really due to pain, I think I just missed exercise. On night 4 and 5 I had more pain when putting the back of my head on pillows (I slept elevated with an inflatable travel pillow partially inflated these nights to help with any potential swelling) and I did take a valium one night and the other pain killer + tylenol combo prescribed drug the fifth night. It almost felt like the donor was a little more stretched these two nights with whatever position I could find that didnt have too much pressure. If this continues I'll call the office to make sure it's normal. Some posters here have mentioned this as the return of nerve sensation but I'm not sure.
Otherwise I have had some very very minor swelling which made me break out some ice on my forehead and eye area a couple of times and take ibuprofen periodically as well. It was never uncomfortable or especially noticeable to anyone else however.
Last point, I am using the Hair Shake protein. I don't really think it'll do much but I've used protein powder a lot anyway so I don't mind and if it helps at all with speed of growth or minimization of shock-loss, then it's worth a couple months of it for me. I am not planning on using it long term and no one at the Cooley office actually mentioned it directly despite having it stocked there and having it listed as an optional part of the post-op procedure.
Post Op Appearance - First Week
The scar in the back is perhaps slightly visible with wet hair (first 3-4 days) but completely hidden with normal dry hair. As mentioned it wasn't giving me much trouble the first 3-4 days, although of course everything felt really "tight" there. At night or with pressure on it day 5-6 it actually has felt a bit worse and I've taken some of the prescribed meds just to make sure I get decent enough sleep. We will see of course on final healing and appearance, it is early days.
Redness in the recipient has subsided each day, and now at day 6 is not bad at all. It's probably worse in the pictures than in real life. I am fairly pale skinned but had a deep tan going which some say can help. There is definitely scabbing, it is super mild/light and looks like when I return to regular shampooing and rub the grafts a bit it will easily flake off and be gone within the 7-10 day timeframe that they gave. In any case, it's really mild and not that noticeable. I have used their given shampoo and started leaving the conditioner in a bit longer which I think has helped. I have a couple spots of dried blood left but overall it's pretty clean and I haven't noticed anything remotely like grafts falling out. Really, not even many/any hairs yet.
The kicker here for me is that I 100% had to hide from the world during this time because I was (a) spraying every hour and (b) couldn't style my existing hair for fear of touching/disloding existing grafts. So you could see the grafts taking hold and small stubbly hair, plus weird caked native hair that was a bit long already awkwardly plastered to my scalp. So all in all, a real lovely mess. Now had I managed this aggressively with a blow dryer on cool or if I was more comfortable touching and styling my scalp in this period I am sure I could have made it look better but I didn't want to take any risks. On Day 6 I did a bit of finger styling and with my existing hair I can make it look decent (see 1 of the pictures).
Decent is not invisible however. The temples are harder to disguise and any close inspection things are definitely still visible so I feel I am very much still in hat land. To be fair, my wife says it's pretty hard to tell unless you get up close and personal already. We will see if my extended family at Day 11 notices anything.
Summary of first week
So far the difference from my first procedure has been remarkable. Basically instead of an immediate "oh shit what have I done" I felt more like a "I'm already looking better than I expected 12 hours later. and everything is going exactly like they said" It's nice to already feel like I made the right choice.
The recovery seems to be text book according to their expectations, but I most certainly don't want to be out and about without a hat yet as it would be noticeable. The things I am worried about are (a) appearance at 10 days and masking it, (b) avoiding shock-loss as no work was done in the middle of the frontal third, and (c) continued management of the donor scar pain. All the rest is of course the standard, hurry up and wait, concerns about linear scar etc that we all have but if I can avoid shock loss I feel comfortable looking like I did for 6+ more months.
I hope this is helpful and of course any feedback on the pics and actual quality of the work is welcome as well. Again, apologies on the photo quality I will get better ones from clinic later. I will try to post periodically as I hate the posts where people disappear but I also intend to try to live my life and not obsess over the progress over the next few months.