Dr Abhinav Kumar

Thanks for uploading your pics

I wish to comment on your case 

1) You had High grade baldness NW grade V going to NW VI

2) The Safe donor area  was extensively breached and the grafts quality was not good in donor. Ofcourse that's number couldnt be achieved without breaching the SDA. It's a compulsion.  Even before the extraction, there was lot of see through in donor area as seen in pics.

3) Non interlocked hairline - means grafts are placed behind each other so there is see through. They are in columns. But the final outcome of the hairline at 12 months is good.

4) definately some of the grafts have failed definately at hairline and at many other places that's becasue they were thinner in calibre. Thin grafts  have higher chances of failure.

5) you had a larger area to cover , thinner grafts and the scattering of grafts is way too much beyind the mid scalp according to my opinion , thus none of areas got good density. May be you wanted that. A basic coverage beyond mid scalp.

6) Hairline could have been little higher considering donor and bald area ratio and thin graft calibre to cover more area behind the  dense hairline.

7) overall it's not the best result but not poor either considering the limitations. The poor graft quality has a role to play in it. Stick with finasteride for longevity of the transplant and to prevent progression of baldness.. 

Were beard grafts taken in your case? The results can be improved if beard grafts are mixed.

All the opinion are personal and it's not a medical opinion  

Regards

Dr Abhinav

MD dermstologist 

FUE Hair Transplant Surgeon

10 hours ago, bruce90 said:

I'm pretty sure Dr Abhinav is one of the doctors at Eugenix. I don't have any problem with that but I'm not sure why he hasn't told any of the forum members this.

 

I have deleted my reply.

1 hour ago, karatekid said:

Hi guys, very interesting thread about those methods. I myself wonder which method should I choose for my coming procedure. I get the pros and cons, but interested on the practical matter - If I go for FUT, what is the minimal guard number I can have on my donor, without the scar be visible? I seriously consider FUT since Im not going to shave my head to zero guard ever, just not suites me, but I do shave my back and sides a bit closer than the top, so I was wondering.  Assuming average scarring, from reputable surgeon of course. I also have fair skin with dark hair if it matters.

FUT is still the best approach if u consider longevity of surgery. The strip dissection  should be good and so shoudl be suturing after proper assessment. IF YOU are planning for a smaller surgery with say 1600 to 2000 grafts, FUE is also good option, As downtime is minimal and results come faster in FUE. Only thing is graft quality shoudl not be extremely  poor as thin grafts may fail in FUE due to less tissue around graft and pressure of pull and thermal damage while extraction. In that case trumpet punch based extraction is better in FUE. My personal experience. Some FUE may also be needed with FUT to get good single grafts. Advantage of FUE is , u are never limited by the strip for the scalp donor.. a combination technique is also adopted in some cases.

On 1/4/2020 at 9:22 PM, LaserCap said:

Dr. Kumar,  I want to take a moment to thank you for your 

 

 

I have deleted my reply  😊 

On 1/4/2020 at 4:26 PM, Portugal25 said:

Dr. Abhinav, you started of by saying “that’s not the right way of choosing doctors” but then inform “according to ISHRS guidelines extractions should be done by doctor.”  
Therefore I don’t understand why you said that my suggestion of choosing a Doctor that does the entire surgery and has a lot of patients posting results to prove his long years of experience is not the right way to chose the Doctor.

Should we be looking for a Doctor with good technicians instead? but how do we The Patients, know which Doctor is currently working with a good tech team?

As a patient I can only directly compare results from Doctors that perform the entire surgery because I know I can get a similar result if I chose these doctors as they don’t rely on techs to achieve their results. 

Doctors that use techs can have good results in one year and bad results the year after simply because they lost a good technician and the new tech is not on the same level. 
We have a saying in my country “Good help is hard to find and even harder to keep”. 

I understand that for a Doctor it’s very demanding to be a part of the whole surgery and a tech team allows a Doctor to have more patients per day thus doubling, tripling or quadrupling their clinic daily turnover. This is the reason why many Doctors start off doing the whole surgery to establish a name for themselves and then switch to tech teams to quadruple their daily  turnover (ex: Dr. Acar at Cosmedica Turkey). 

I have deleted my reply.

I deleted my post😊

8 hours ago, 1978matt said:

Thank you doctor, that sums it up very well.  I wish you all the best in your career going forward.

Thanks buddy... A true surgeon is never biased about the technique he does. Every technique is good in hands and poor in poor hands. Do comment or rate on my community reputation , so that commercially unbiased answers gets credibility. 

16 hours ago, nordicwarrior said:

@Dr Abhinav Kumar what do you suggest is the best option for people wanting to do a buzz cut later?

It has to a very conservative FUE with around 1200 to 1800 grafts. See the follicular groupings are different in different people so a conservative surgery with FUE can also make donor look scarred if extractions are not eide apart.  A better approach is FUT in a good clinic if it suits u, for  people wanting to have buz cut.... go for conservative FUE with less graft number and base your on those conservative estimates.

13 hours ago, 1978matt said:

Not sure you understand what this means, it means you cannot FUE out all of the upper shaded region below, otherwise you would be left with a patch of bare scalp.  FUT allows the highest proportion of this to be removed with the edges joined together to form a linear scar:

 

This is the same nonsense that gets parroted by the FUE-only brigade when they have lost the argument.  It can easily be flipped on its head to apply to FUE:

• The main advantage of FUE is for the doc, and is motivated by money and workload.
• In many countries it is not illegal for technicians to cut the skin of patients.  All the doctors have to do is mark the patient hairline and then come back to do the incisions.  Maybe spend 1 hour in total on 2+ or more patients and then pay technicians minimum wage to do the extractions.
• And if the patients really wants full coverage, overharvest them!  The more money the better!
• Most docs don't want to or aren't capable of learning how to do FUT...they are lazy and would rather watch technicians on a video screen.  It is easy money!

I have never seen a Couto patient posted result, only the cherry picked ones on youtube where most of the donor densities are off the charts.

I totally agree with you. I am exclusive FUE surgeon. I am young and 32 yra of age with experience of 200 FUE surgeries. This surgery was being taught to me and learnt it diligently. FUT being a old technique was not taught to me by current surgeons cum mentors. That limits my capability . I agree that FUT if done right is the way to go. Both the surgery types are technician dependent and using qualified technicians is not bad. Scoring of grafts shoudl be done by doctor and implantation by either assistants or doctors. No surgery is humanly possible without assistants. The only thing is they should be qualified not some low cost labour. Although Dr counto  results are wow.. it will well evident that safe donor area is breached for the results for high density. The density can dip after 3 to 4 years as thinning happens even when you are on finasteride. 7 to 9 months results is no guarantee to longevity of results. 

 

Finasteride 1mg, in humble opinion and  experience as a surgeon definitely works in improving the donor. I have seen in so many cases. Minoxidil will also help but it will increase bleeding, so should be stopped atleast 7 days before surgery as it's a vasodilator. The point is hair which have improved with finasteride may thin out again when transferred to the transplanted site when u stop finasteride. It better to take the best possible hair from the safe dono zone and approach surgery accordingly than to artificially thicken the thinned hair which are prone to thinning . This will result in your transplanted area being a mix of finasteride responsive and  resistant hair and u will lose density once u stop finasteride.

The  names listed above are definitely good Hair transplant surgeon. Hair transplant is a team work . A clinic may be known  by one surgeon's  name as he is spending the most on his own branding, somehow there are other doctors in his clinic who are doing good work as well or there are other doctors as well listed on their website. A review of the google business page gives the right idea. An experienced surgoen will become more and more conservative or find the middle path in the  hairline and try to give you the maximum with the minimum use of the graft but using artistry like widows peak . An experienced surgoen will give him about the idea of future surgeries required and possibility of thinning of transplanted hair and repair needed. An experienced surgoens will counsel you , regarding need for another transplant if u dont take finasteride 2 to 4 years down the line. An experienced surgeon will recommend the  best possible technique to the patient accoridng to his needs , donor status and will not base his decisions on which type of surgery he is doing. An experienced and good surgeon will be unbiased in his approach towards hair transplant network patient and general patient. There should be no difference in doctors' involvement in patient who posts on forum and who doesnt . An experienced surgeon will also say No to the unrealistic demands of the patient. 

Great work , Dr Konior

On 12/28/2019 at 7:41 AM, HelpfulFriend said:

Cheers Phil,

That's kind of what I was contemplating. 

It's difficult as there aren't a lot of patient stories on this site, but I assume he would have more non-english speaking clients. 

Sorry to hear about your terrible experience, I hope it ended up okay in the end!  

I might put out a message for any patients and see if there are any stories I can gather.

Thanks for the advice, really appreciate it.

On 12/28/2019 at 7:41 AM, HelpfulFriend said:

Cheers Phil,

That's kind of what I was contemplating. 

It's difficult as there aren't a lot of patient stories on this site, but I assume he would have more non-english speaking clients. 

Sorry to hear about your terrible experience, I hope it ended up okay in the end!  

I might put out a message for any patients and see if there are any stories I can gather.

Thanks for the advice, really appreciate it.

Absolutely... the behaviour of doctor towards patient quoting that he is coming from hair restoration network is different from those coming directly. Remember , the questions which you ask with their counsellors should be direct and precise and should be about each step of the surgery. The good clinics will clearly tell which steps will be done by surgeon and which step by assistants. The good clinics will also tell number of surgeries of your operating doctor on that day, whether the assistants are exclusive to your case or shall be moving around in multiple OT like in an assembly line clinics. A hair transplant surgeon will do the extractions himself in most of the times or his best possible assitant doctor will do the extraction. Implantation will be done by assitant or the doctor himself. A good surgeon will spend the maximum possible time before the surgery understanding your goals and discuss the hairline with the patient. A good surgeon and clinic will learn to say NO to your unrealistic expectation irrepective of the money you pay. See general reviews about the clinic on google business page as well along with the clinic postings on Hair restoration network. A good clinic will not differentiate between any patient coming from forum and coming directly without the forum. Their protocol will not change or so will the commitment. 

These opinions are unbiased and for general patient information as I am a veteran of 3 FUE surgeries, and hair transplant surgeon myself with extensive face to face  counselling expeirence, a co-author of the book- "Step by Step Hair Transplantation" where I majorly contributed in text and planning of the book and have done independent 200 FUE surgeries.  I m in the process of getting ISHRS membership in next few years.

need better pictures. 8 to 10 degree environment cant cause prickly heat rashes. Are you on rogaine or any other stuff. It may be a allergic phenomenon. Do consult your surgeon as i shouldnt give medical advice from here. 

Dr Abhinav

Seeing your hairline- The only possibility is Male pattern baldness. Sometimes the loss is more on the parting side due to continuous traction. Baldness may be assymetric. The only rare possibility is frontal fibrosing alopecia, which can be confirmed by biospy. However frontal fibrosing alopecia is more common in females and usually involves the eyebrow, which is not your case. However to remove any doubt, a scalp biospy by a dermatologist is not wrong and is harmless. I would not need such doubt clearing though but its for removing patients doubt and for legal safety. Sometimes , you dont know why the results havent come. I have seen two such cases in my career, but rest assured 99% , its male pattern baldness. You are 33 and your baldness is not more than Norwood grade IIa. You can go for hair transplant for sure. A receeding hairline cannot be stopped by finasteride though . A aggressive face appropriate hairline seems a possibility in your case. However i would recommend , now going too low as it would look age inappropriate at later age.

regards

Dr Abhinav

HT Surgeon

MD dermatologist

Hello , I am Dr Abhinav Kumar , a patient of 3 FUE hair transplant and FUE hair transplant surgeon myself in India. I m not an ISHRS member but attended my first ISHRS conference in Bangkok this year. I am a doctor in the process of getting ISHRS membership. I have written a text book on FUE hair transplant as one of the co-authors who has majorly contributed in the text- "Step by Step Hair transplantation". I have an experience of doing more than 200 independent FUE surgeries with great results and assisting more than 500 cases. First and foremost understanding of race is critical for a hair transplant surgeon- for example  Negroes don't have deep frontotemporal angles and lack crown whorl, People of korean and east asian orgin, require an aggressive hairline and dont like a mature hairline. The forehead is flat in East Asians, the hairline needs to be flatter.  The hair texture is more silky in East Asians and hair is usally straight. Understanding of these finer points is critical apart from analyzing the donor number, the approach of surgery - FUE or FUT, family history of baldness, patients expectations and finally what you want. An experienced surgeon irrespective of the place of origin and who can show that he has done east asians to some satisfaction is the right criteria. Dont go by just degree, go by the approach of the doctor, whether it justifies your brain, consistency of the results.