Dr. Bruno Ferreira

If surgery was done on the frontal 3rd, I usually let my patients sleep flat on their back on the first night. I don't see an outright need to elevate the head. Most patients report sleeping well on the first nights.

Haha! Funny how the doctor selling the miracle cure is bald. 😄

Maradona was definitely blessed in the hair department. Not to mention football talent! This thread reminds me of when I was a teen and wanted to grow my hair long and do a perm, 90's John Petrucci style. 😁

Wow! Just, wow! Melvin was kind and diligent enough to bring this to my attention. I came to this thread expecting to feel quite distressed and annoyed as I read it. I take my work and the trust that patients put in me very seriously. Just thinking that a patient might be unhappy with how his/her hair transplant is evolving would ruin my day, regardlessly if I believe the surgery and result was a success or not. Yet, I feel humbled. I am left in awe and gratitude. I am truly amazed with how knowledgeable this community is, and how supportive you have all been to Ittiaz. Ittiaz is going through a rough time. I can definitely understand what it is like to invest much of your time, effort and money into something that you want so badly to go right. It’s really hard to just wait for progress to come, especially when it isn’t within what you expected. It’s really frustrating and disheartening. Therefore I am very grateful that you all gave him a massive amount of support and guidance. I’m definitely doing all I can to reassure Ittiaz that not only it’s too soon for us to make any conclusions, but also that I will be with him every step of the way. I don’t want to discuss too much of Ittiaz’s specifics (or post photos for that matter) without his proper authorization, but I believe I can say he is currently at day 178 post-op of his hair transplant. I completely understand and validate his concerns as well as say that in fact, I would like to see more growth now, but also that it’s not out of the ordinary to have slower growth and that we can’t really come to any conclusions or make any decisions now. We just need to be patient. I’ve read what Ittiaz has written and, aside from the title of this thread, I believe what he’s said has been mostly fair to me. I can understand disappointment as that is a subjective emotion, but I can’t really agree with the word “results” as this is not a result. It surprised me a bit as I have a really good relationship with Ittiaz. He’s a really nice, well spoken and gentle man with good spirits. I remember us discussing football and boxing during his surgery. I even remember him explaining me how to throw a few punches while we were in my office. But I really don’t blame him. He is simply manifesting his frustration and I don’t take it personally. I’m actually glad he came here because now he can benefit from the support of this incredible community. Apart from that, I’ve always stood and will stand by my work. Nobody wants a surgery to have an amazing result as much as I do (and nothing makes my day as much as that either). Therefore, when the time comes, if the results are not up to par, I am happy to invite Ittiaz back to our clinic for a touch up at no extra charge. And all my patients know this (and Ittiaz can confirm this too because I tell this to each and everyone): At the moment of the initial consultation I always say “As with all hair transplants, an additional procedure or a touch-up might be required afterwards, albeit it’s usually not needed.” And speaking in broader terms, as with all medical procedures, sometimes things can go wrong. Even when you do everything diligently and even when you prepare yourself the best that you possibly can. Lewis Hamilton still crashes his car and Cristiano Ronaldo still misses penalties from time to time (and by saying this I don’t mean to compare myself to their greatness). But I don’t need to explain this to most of this community. These people here know a lot. As for the “stubble” Ittiaz mentions. I really didn’t mean to evade anything. As I explained, the photos and descriptions he sent me weren’t clear enough for me to offer an answer that I’d be happy with. I will work with him to get better photos and together we’ll understand what he means. Ittiaz is lucky that this community exists. I’m lucky that this community exists. We’re all very lucky for all the people who come here to help others and themselves everyday. Thank you all.

That's an interesting question. Having a congenital "unaesthetic" hairline is definitely a possibility. It's definitely subjective though. Some people may be dreaming about having the OP's hairline. After understanding that there is no androgenetic alopecia, but rather just genetics, the easy solution (easy for me to say) would be to tell the patient to simply accept his/her hairline. At such a young age, it wouldn't be a good idea to jump into surgery. So if it bothers the patient a lot (and looks like this is the case), shaving the center of the hairline into the shape he prefers is a possible solution. It requires a bit of upkeep, but can buy him many years until he feels his native hairline is more fitting or a hair transplant becomes a more sensible solution.

This is a fun topic. I won't add some of the ones I've spotted, but will gladly bring out the popcorn for the discussion. 😜

This is an excellent reply. I always try to get rid of faint cowlicks as they just don't provide as much coverage or styling options (plus patients usually have been hating them for their whole lives anyway). Double (or even triple) crown whirls are also detrimental to coverage and I'll try to keep only one...this is of course, as BeHappy said, if the hair is already very fine and weak or non-existent.

Looks very nice. Congratulations!

You're welcome Panamera13. I'm not a big proponent of PRP or ACELL, as their efficacy hasn't been scientifically confirmed. Especially ACELL, which in practice seems to do absolutely nothing. The cost/benefit of PRP is also a bit meh. In my opinion, there are better ways than that of applying 2500USD towards improving your hair. Getting back on finasteride looks like the absolute best bet for you right now. I understand you complained of side-effects, but it's best to understand those better and see if you can/need to adjust the dosage. Diffuse alopecias aren't as easy to classify and the Norwood-Hamilton Scale is just a reference, but I'd say you're on your way to a NW6 (diffuse). Your crown is a bit deceiving as it looks to me from the photos that miniaturization goes deeper down than it appears and your sides look pretty open in the top view.

Hi Panamera13, I see from the comments that I’m risking an unpopular opinion here, but I think Dr. Erdogan’s 5000 grafts was the best estimate. Maybe I’m unsure of your objectives, but I assume you’re looking for full coverage and a new hairline. Looking at your photos, I estimate you’d have a recipient area of about 150cm2 (depending on where you place the hairline). With 5000 grafts you’d get an average density of less than 35 units per square centimeter. Now, the photos aren’t good enough to judge your current coverage, but from the top view you posted, it looks like you don’t have much coverage and you have a lot of miniaturization. So, the ~35 grafts/cm2 together with the hair you have now would be *just* enough to get you close to full coverage. Of course, I can’t say how good your donor area is, how thick your hair is, how many average hairs per folicular unit you have, but from the macro shots it looks okay, even though I haven’t seen your temporal-parietal areas. (CosmoKramer very correctly suggested you post those photos.) That being said, I’d still first put you on finasteride first at a lower dosage, so you can stabilize your alopecia and keep that hair you have there, whilst also lowering the chances of shock loss when it’s time for surgery. At 40 years old, standard dosage would also be an option, to see if you can get some improvement before surgery. (Edit: Just saw you complained of side effects. So it would be of interest to clear that up.) I’d do it in two surgeries though. So, with the info I have currently available, that’s what I’d plan for you. (All would be subject to confirmation in a live consultation, of course.) Also risking sounding biased since we work together (and only because CosmoKramer mentioned him), I’d also suggest Dr. Lorenzo. We do advanced alopecias on a daily basis, so I know he’s very experienced in cases like yours. Quite a few great options and talented doctors were mentioned here though, so I think you’ll be fine with more than one of the choices given. Best of luck! #IMO (I should just go ahead and point out that this is just an opinion and not a medical consultation, since it could never be one.)

In my personal opinion, it's definitely minor, but you're stable on the medication, your hair loss isn't aggressive and you're not happy with how it looks right now (and assuming your donor area is at least average)...I'd say do with your donor area whatever you want to. You'll still have plenty of it for the future and if you'll enjoy your hair and your look better. My recommendation for this type of work is definitely Dr. Rahal.

I mostly agree with what has been said. But I'm definitely a proponent of a case-by-case approach. I don't think there's necessarily a cut-off age. If a teenager has a terrible scar that can be corrected with surgery, or congenital triangular alopecia, why not correct it? Why let them suffer through their teen years (which everyone knows can be pretty hard)? Of course we have to do adequate planning and bear in mind the need for further surgery in the future. But ask any teenager suffering from having this or that ailment that hinders their image-of-self, and I bet you almost all if not all of them will say they would prefer to have a couple of surgeries instead of staying the same for 5 more years, waiting for one in the future. (Unless that one in the future is considerably more beneficial, i.e. better technology, etc, of course) I've transplanted hair into burn scars, congenital triangular alopecias, aplasia cutis congenital scars, craniotomy scars, etc, in young patients. All with good, long-lasting results. This still means we have to be smart of what we're doing. If the scar is on an already low hairline, and you look at the patient's dad and he's a Norwood 7, then maybe you should hold back for a while. For androgenetic alopecia patients, we have to firstly know that they have to be stabilized asap, since alopecias that are very evident at a young age, are usually pretty aggressive, and I'm not afraid of using 5alfa-reductase blockers on young patients. I've done so with very good outcomes. Then, if everything goes ok and we reach stability, we can start talking about a possible transplant. But I'd never do surgery on a young patient without proper stabilization and spending some time talking to him, making sure of his maturity and that he thoroughly understands the implications of surgery. Usually when that talk comes, I'm already pretty sure he's a candidate though. There's also not a cut off point on the opposite side of the spectrum. My oldest patient was 86 at the time of the surgery. And I operated on him...twice! He must be over 90 right now. 😃 Such an enthusiastic and positive man he was.

Some patients get more redness than others and for some it's more persistent. Whilst there's nothing wrong with having redness in the recipient area, all my patients leave the clinic with a bottle of 99% aloe vera gel. It's soothing. Helps with healing and the redness. So that's my recommendation. 🙂

You're fine. 😉

Yes, I believe so very much. You can't stress the suture like you can after an FUE extraction, or you'll risk dehiscence. Abstaining from vigorous activities after FUE is a precautionary measure. After FUT it's mandatory. I'm not an FUT expert though, so I'll leave those post-op recovery times for someone who is.

Ok with light weights after 8 days (50% 1RM with 5 RIR should be ok). After 15 days go as hard as you want. Very Important: I only perform FUE, so these recommendations are for FUE only.

I recommend patients wait about 8 days for light running and a light workout. After 15 days they can do more vigorous exercises/running. For contact sports I recommend 21 days to a month and for sports that require a helmet or water, 30 days.

Hi, I don't see an issue with it. Hair fibers are supposed to go on your hair and not so much your scalp. Of course some always gets on your skin, but I don't believe they clog your pores. I recommend patients start using it about 15 days to a month after the surgery because I don't want them adding to the debris and scabs they already have and avoid handling their hair too much in the first month. We want to let everything heal properly. But for example, if the recipient area is the hairline and they want to use it in their crown area, they can start using it after a couple of days. That being said, I shave my patient's hair 95% of the time, so this isn't really an issue at least for a couple of months.