Cristero

A really good outcome.

Congratulations.

4 hours ago, whattheFUE said:

The hairline looks spotty and not filled in considering the amount of grafts used. Konior is usually the opposite.

Am I the only one seeing this?

I agree with you. I think they should have aimed for a better density on the first 1 cm of the hairline and they gradually decrease density while going towards the mid. But as @Curious25said they covered a big area with few grafts and it seems the yield rate has been pretty good.

6 hours ago, Egy said:

@Portugal25 premised , as in all my posts relating to Doctor Pekiner and that for me he is one of the best Surgeons in the world, I am sure that those 54 threads present on that forum are real, I can doubt however ', that some may be missing that of the Russian patient, considering the way that forum operates? 
As for the discount that the doctor offers to his patients who consent to the publication of their reports, I find nothing wrong,

 

The only one missing on the Pekiner's section on the Italian forum is the Russian guy, who did a mess there as well and he has been kicked out.

Other famous surgeons had cases removed (not only one) for patients misbehaviour or because they reached an agreement with the patients and they took it down.

11 hours ago, Curious25 said:

However all recommended surgeons pay a contribution fee to this site.

That's interesting. Is that true @Melvin-Moderator?

I keep hearing the story of people getting a discount for their report as an argument for Pekiner's bad ethic and I don't really get it. It actually shows the doctor is confident to deliver a high-end result and he's not afraid of people showing the outcome on forums. He's trying to build a name, like all the surgeons in the industry.

3 hours ago, Egy said:

@Cristeroread

That's the case of the Russian guy we all know. I've been told the guy was far from being honest, but I won't say anything else, as I just know what I've been told.

On 10/8/2020 at 6:16 PM, Melvin-Moderator said:

In my opinion, Eugenix all day. Pekiner seems to pick and choose his patients and has canceled the procedure on the day of the surgery more than once. 

Melvin, 2 clinics I have consulted before choosing rejected my case, saying I still had too many hairs (being a diffuse thinner) and there was no way to avoid shock loss or that I should be on medication, not having an HT performed. One was a clinic you recommend here. 

Pekiner on the other hand  didn't have any issue with that and was confident implanting between native hairs and avoiding shock loss.

3 hours ago, Egy said:

@Curious25the doctor's ability is not discussed, what the doctor has negative is to let his consultant do what he does.  He is the moderator of one of the most important Italian forums, well, already this is not ethical, he should do one or the other thing.  On that forum you will not see any negative doctor Pekiner threads, (if there are any) because the moderators are good and bad weather, they tried it here too, but with @Melvin-Moderator he found it hard.

Same as above. I think you should go and translate the threads with Google translator to have a rough idea of what is written there. The moderator/rep never did anything to discredit the patients concerns or deleted any comments.

There are 2 cases in particular that I remember: one young guy who lowered his hairline by far and everyone was saying that the doc was unethical etc etc. Then after 6 months the hairline was looking pluggy and everyone saying that was a bad case etc etc. Eventually it grew up really well at 12 months and result was great. No comment was deleted.

The other one is a recent one with a guy that has been expressing his concerns for not growing well at the 6 months mark and everyone was telling him to wait until 12 months, but he was still saying his transplant wasn't successful. He changed his mind completely at 12 months. No comment has been deleted.

There are also several other Pekiner's cases on a German forum and they are all good. Do you want to elaborate a conspiracy theory for that one as well?

23 hours ago, Egy said:

@Portugal25about doctor Pekiner's skill, I have no doubts, but as I have already written once, the 54 threads you are talking about, are on a forum where the doctor's advisor is also one of the moderators, so there, you will never see patient threads  dissatisfied, even if in my opinion, there are few.  Also, on that forum it is forbidden to post links with other forums, as did the member @Cristeroon HRN.

I don't know if you understand Italian, but if you went through the post you could have clearly understood the threads were real because some patients expressed their concerns during the journey.

Also they are updated month by month, it's not guys coming in and posting their before and after.

Several of them were users of the forum since many years, sometimes had a transplant with other surgeons and went to Pekiner for a repair or second pass. So I don't really know how the fact that Pekiner's rep is a moderator on the forum could be relevant. He was a moderator on the forum since many years ago and got his first transplant with another surgeon, then went to Pekiner for a repair.

Ah let me add that I met Dr. Sethi from Eugenix in NYC and he gave me a really good impression. If I was a high NW, I would have gone to Eugenix or Dr. Zarev in Bulgaria, but for a refined job on the hairline, I decided Dr. Pekiner was the man.

I've had my transplant with Dr Pekiner 3 weeks ago and I can confirm the doctor ethics and skills.

I had 5% of miniaturized hairs on my donor but the others were thick caliber and he used those for the hairlines and crown. I've never seen better and more natural hairlines done by anyone else, apart from Dr. Couto and Dr. De Freitas in Spain. You can see it by yourself in an Italian forum through real patients reports:

This forum is a it biased negatively towards him due to the bad behaviour of his rep in one case.

Then my HT could still be a failure, I'm in early stages, but I can tell you the doctor has been proven to be super professional and really human.

12 minutes ago, Gatsby said:

With the greatest of respect to Dr Zarev as a surgeon I have a lot of doubts. Firstly;y because he will not reveal his 'technique' to other world class surgeons and keeps claiming that it is 'currently awaiting patent approval.' The other thing is that I believe he himself wears a hair piece, but you be your own judge.

2 objections to your claims:

- If you have found a revolutionary way/tool in your industry that brings you to the very top of it, why would you share it with your competitors? Do you think surgeons are doing their job for the sake of balding people mental health? If that was the case, you would have seen much different prices;

- even if he wears a hairpiece, what does it have to do with his ability as a surgeon or his credibility? I'm not following your logic here.

9 hours ago, Curious25 said:

I think the forum needs and quite frankly deserves some clarity surrounding safe/unsafe extraction patterns, and how doctors are able or unable to ascertain this. 

It seems as though it is acceptable to nit pick at this particular Dr who isn't recommended on the forum, for his larger use of the donor region - however when other recommended clinics are doing exactly the same, its accepted that not all hair loss patterns are the same, and for some patients (and rightly so) who are NW5/6, surgeons are able to be a little more aggressive with the size of the donor area that they extract from.

I'm pretty sure I read one of the clinic reps (I cant remember who) on here talk about Dr Zarev's seminar at one of the conferences, and allude that his extraction pattern went out of the traditional safe zone - yet only a few days ago the rep from one of the leading hair restoration clinics in the world informed me that there is no such thing as a traditional safe zone, every patients hair loss is different. 

So what is it . . some doctors are rightly or wrongly more conservative and risk averse than others, or other doctors are more confident they can pretty accurately determine final loss patterns? 

If this is the case, then we need absolute clarity as to why and how this can be determined - because we have the likes of Dr Bernstein and Rassman preaching that extractions only from NW 7 regions of donor should be utilised, to avoid the risk of the patient progressing to that extensive level (risk averse) and then on the othrer hand we have showcases of other world class doctors such as H&W extracting right up until just below the crown. I've also noticed this a lot on Dr Diep cases, however won't use him as an example because I know some of his techniques are questioned by quite a few of the community regardless of this. 

I've not came across this trend as much with the European FUE surgeons who get a lot of postings on here, which again makes me wonder. 

Essentially, I want to know what mine and others donor estimations are based on, and how this should be done - conservative NW 7 extraction patterns, or NW5/6 - because the difference is going to be quite a few thousand grafts, which would quite considerably change ones restoration goals and plans if this were to be the case.  

On a final note, I don't think its a fair or appropriate comment to cite a Dr's nationality and/or location as being a reason as to why he wouldn't be able to pioneer anything in the hair restoration industry.  

 

Couldn't have said it better myself.

Also, I'm not Bulgarian, but I need to point out that Bulgaria is the leading country in the CGI and VFX industry. Softwares that are used for Hollywood's high end VFX have been developed in Bulgaria by Bulgarian people. There are studios which did the whole special effects scenes for the main movies in the past years.

So if they mastered that industry, I don't know why it's not possible for a Bulgarian talented doctor to be one of the best in the world.

Another thing that makes me think Dr. Zarev is legit is that got the endorsement from Dr. Rassman.

Dr. Rassman added on a comment to a thread on Reddit:

"To get 14000 grafts from the donor area without causing significant depletion and a see-through look, you would have to have a coarser hair with high density, a rare combination of metrics. I saw his presentation in Europe and the patients who had these high number of grafts has (1) very high donor densities and (2) he harvested outside of the permanent zone which means that some of these hairs are subject to apoptosis (death from genetics) something I do not do. There are some doctors who believe that since the Class 7 pattern is rare (about 7% of the population) most advanced balding men will end up as a Class 6 pattern. Under that assumption, harvesting the donor area of a Class 6 pattern of balding yields easily 60% more grafts. If the doctor is wrong, and these patients fall into that 7% group, then the 60% of the hairs that were transplanted will fall die and fall out. Being conservative, I don't go beyond the Class 7 donor area and that is why for advanced balding patients I generally recommend Strip (FUT) surgeries rather than FUE surgeries. By the way, I coined the term FUE and published it with the first paper ever on the subject which you can read here: https://newhair.com/wp-content/uploads/2018/11/mp-2002-fue.pdf

William Rassman, M.D.”

We can all agree that, even if the insane results are only 41 as it has been said, I never saw any clinic getting even closer to that. I'm just curious to see if there are patients reports online. 

On 9/5/2020 at 1:51 PM, BeHappy said:

The good: He is getting some very impressive results while leaving the donor still looking good.

The bad: He is using the entire donor area without allowing for any future hair loss and he is going way out of the safe area which will cause a high percentage of these patients to lose a lot of transplanted grafts over the next few years without having any available donor hair to use to fill in anywhere. You can see he goes right up to the current bald area all the way around their heads and all the way down to the nape where retrograde thinning will occur in a lot of these man. Remember these are almost all NW 6 patients that were shown, so there is going to be a large number of them who start thinning in the donor area, have their bald area widen, and start losing from the nape upwards. You can't say it only happens to a small percentage of men because we are only looking at NW 6 men. We aren't looking at the general population where many of them won't progress to this level in the first place, so the chances of it happening on men who are already NW 6 go wayyy up.

 

 

Those are the same areas where H&W are harvesting and a couple of us on this forum are trying to understand the reason for that, especially on patients that are not even in their 30s.

So it's not just Dr. Zarev doing that.

18 minutes ago, Flash10 said:

@CristeroI think you spelled his name wrong unless that's a different surgeon.  Assuming it is the same person, it seems like he does great work. I also assume you had it done recently if your are still waiting for pics, so I look forward to following your progress! Hope you have been healing well buddy.

Yup, fin definitely isn't a magic cure, but its the best thing we got. And assuming you use it safety with a doctor monitoring your testosterone levels periodically, it's our best shot on having a full head of hair.

Money wasn't a big factor to me. I am by no means well off unfortunately, but I view a hair transplant as a lifelong investment, so a bigger expenditure to reduce the risk of being unhappy and increase the chance of success is a no brainer for me. Plus the peace of mind of knowing Dr. Hasson did my ht is really reassuring during the ugly duckling phase .

Yeah man, all we can do is try to educate ourselves on this complex topic before making a decision that will affect us for the rest of our lives. All the best bro.

Ha! Yeah sorry, I wrote it wrong.

I agree completely with you on the money part. I chose Pekiner for the full manual FUE procedure he's experienced on and for the great patients report I've seen. Also my main target was the crown and I saw him doing an insane crown reconstruction that finally convinced me to choose him. We will see if I took the right decision.

Good luck with your journey pal and hopefully you will have a great regrowth and be done with this cross.

18 minutes ago, Flash10 said:

@CristeroCongrats man! When did you get this done? Did you make a thread? If your crown is similar to mine I would love to see the results of work done on a crown similar to mine. As I said, the ethical surgeons I spoke to warned that the shock loss may be worse than the new hair growth. I hope this is not true for you and would be curious to see. 

Why the doubt buddy? The studies I have seen showed that someone can experience hair growth and improvement for a three year period. And I read that if there is no regrowth there is still a very good chance of long-term stabilization. I have been on it almost a year now and have seen nice regrowth and I am optimistically hoping for more. Propecia was a  huge part of Dr. Hasson and I's conversation and long-term planning. He's a huge advocate of the medication being on it for more than 20 years himself. 

I thought this way at first as well after looking at the countless cases with high graft numbers. However, after comparing cases with similar size recipient areas it seems evident that Hasson gets greater density with greater graft number. Therefore, it seems like Dr. Hasson's magic isn't a higher survival rate than other surgeons, rather the ability to achieve nearly the same survival rate at higher densities. I am not sure if other surgeons are comfortable performing transplants with the density Dr. Hassson aims for.. but, it just shows me that Dr. Hasson has lots of experience with high density work vs. other doctors who seem to not even attempt the level of density he achieves.

My nono (mom's side) had a full head of hair when he passed away. My nono (dad's side) and dad are N5 - nono is now probably N7, but he's 90+. Realistically it would seem I am on the same path as my dad, which is cool - he's a good guy lol.

 

With dr Peniker in Ankara. I will create a thread when I'll have the pictures from the clinic.

Because DHT is just part of a bigger picture and oral finasteride just take care of a percentage of it in the scalp. You still have testosterone miniaturizing, along with the normal aging of all the follicles throughout the years. A good number of people still lose ground with finasteride.

That's why I said a good European surgeon would have used less grafts, aiming at a better survival rate, making you save a good amount of money as well. In any case, it seems you did an educated choice, so I hope everything will go well for you and you won't head towards NW5 like your dad. Maybe you inherited some genes from your mom and that, along with medications, will preserve your hairs and donor.

13 hours ago, H & W Doug said:

Hi Curious25,

Thank you for the question. I would not say the extractions are outside of the traditional safe zone. Each "safe" zone varies from patient to patient. For instance, a stage 6 will have potential or realized loss farther down below the crown whorl and therefore less area to harvest from compared to a stage 5A. The lower the number on the Norwood scale, the larger the safe zone will be compared to say a stage 7. Unfortunately, conversely the higher the number on the scale, the smaller the safe zone. Maybe a more accurate statement might be: Donor capacities via FUE for Norwood scale 2-4's may be double that of stages 6-7.

How do you establish a "safe zone" for a 29 years old though?

I guess the patient needs to provide a family history of AGA progression in his relatives or pictures. Is that correct?

12 hours ago, Flash10 said:

Hard to argue with a world class surgeon bro.. time will tell, but hopefully it works out..

I'm not sure how bad your crown is, but the crown is always a pain in the ass due to angles and lighting.. it always looks a little thin when I buzz it down.. makes sense considering light is hitting the scalp at a 90 degree.. looks good when grown out though.. also hoping propecia adds some density and helps it stick around for a couple more decades..

How bad is your crown man? If your crown looks like mine and you're considering a ht on your crown i would strongly recommend not to touch it. Both Rahal and Hasson personally took a look at my entire head and said they would only do the hairline. No ethical surgeon would touch a crown that looks like mine (their words not mine). 

I've already had my procedure done and I did a dense pack on the hairline (50 grafts per cm2) and rebuilt the crown with the swirl. Time will tell how the HT will turn out to be.

What I was trying to say is that you can clearly see in your case (like in my case) that the whole NW6/7 area is being affected by miniaturization, with hairs being less dense and thinner than the rest. Hence why I was saying that they extracted too high in my opinion, in an area that isn't really safe. I truly really hope for you that finasteride is gonna maintain as you said for 20 years, but I highly doubt it.

I'm not a big fan of any North American surgeon to be honest, as they do great FUT, but I never saw good FUE results, unless they use an unnecessary high amount of grafts. And I'm talking mostly about H&W. I know many will disagree with me, but that's my opinion. Without considering that you would pay at least the double of the price of an experienced FUE European surgeon.

What's the history of AGA in your family?

Does anyone else think that some grafts were harvested too high?

The OP is clearly a diffuse thinner like me, you can see the whole "horse shoe" being less dense than the occipital area and the sides.

They went to extract right at the border of the thinner areas.

8 minutes ago, Melvin-Moderator said:

If you want to share your report and it’s authentic, go ahead. I had to ban his rep, because he was all around shady. I had to keep a tab, because I have a feeling there was a couple of fake reports floating around. 

@Melvin-ModeratorYou know me since a while now, and you know I was looking for a surgeon and then eventually decided for Dr. Pekiner. I'm glad I did and I hope the results will turn out to be good. Time will tell.

Thanks @Portugal25 for the encouraging words. Now it's all about patience and taking care in the post-op. Biggest challenge for now is to stay away from lifting heavy weights for a while. Feels like a torture :D.

Did you see any further progress with your HT btw @Portugal25?

Not sure @Portugal25, but this is what I got from @Melvin-Moderatorlast time I spoke with him privately. That Pekiner's patients report weren't allowed on this website anymore.

@Melvin-Moderatoris that correct?

Just to chime in after coming back from Ankara, where I had my procedure with Dr. Pekiner. I will skip the report with him as per Melvin's policy, even if the doctor is truly amazing and I would advice him to anyone.

I asked specifically about the topics we have been discussing here. His opinion about transplanted hairs is that they don't fall. What happens to some of them is that they get thinner with age and AGA and that's why I was having 5 % of them on donor that were miniaturized. But they remain full length, unlike what's happening on the recipient area. He told me that there are different opinions among surgeons though and this is just his opinion. So basically we don't know, but it seems that surgeons are moving away from the concept of so called immune hairs.

Regarding the topic of treatments and beard grafts, he wanted to implant some beard grafts in the beginning, but when I told him that I'm under treatment with clascoterone and other topical anti-androgens, he changed his mind and we decided to leave the beard grafts for the future if needed. That means he is fully aware that hair loss treatments are counter productive for bears grafts, but he evaluates case by case.

1 minute ago, LonelyGraft said:

Sorry, I think you need some schooling Bc YOU clearly have a bias and don’t know how interpret what’s In front of u

 

all I was stating is that a well controlled study with 19k participants is nothing to look over. Your meta analysis does not only look at prostate disease, rather dht inhibition as a whole

 

your second link simply states that SERUM Androgen levels likely have no effect on prostate cancer development. (Duhhh we all know 5ar is located in specific sites including but not limited to: the liver, hair follicle pilosebaceous unit, sebaceous gland, prostate, etc) serum levels tell us nothing otherwise we should all be getting blood work to see how finasteride is working for our hair. It’s all about the local activity of 5ar.
 

Keep ignoring key points 🙃

You are getting all heated up for no reason and acting like a child.

I didn't say your study is something to look over. I've actually been the first onn to say that new studies debunked the high prostate cancer link to 5-ar inhibitors, but I wans't too convinced of them yet. And the reason, once again, is that things are still up in the air, with a lot of may or might.

What you are saying on the second link is something I've been talking about since a while with people obsessed about DHt serum levels and something Italians dermatologists know since a while. Some of them request a serum 3a- androstanediol value to understand enzymatic activity in tissues and even that is not giving you the whole picture. You would need a scalp DHT biopsy to understand what's going on.

In any case, even if the latest studies didn't completely shed light, how can you categorically exclude it, when some doctors are still reluctant to prescribe 5-ar inhibitors?

And most of all, what's your contribution to the topic? This is not a post about finasteride side-effects, rather a thread regerding the alleged usefulness of finasteride on the donor.

3 minutes ago, LonelyGraft said:

Directly from your first link which go in line with the study I linked as well as the urologists comments:

 

However, the published data contradict this argument and suggest that 5-ARIs are safe in terms of prostate cancer risk and mortality, and the new research findings from Unger and colleagues⁵ and Wallerstadt and co-workers⁶suggest there might be true long-term benefits of 5-ARIs in preventing prostate cancer. What remains to be addressed is whether the safety warning should be removed from 5-ARI labels, as the benefits of 5-ARI therapy might far out-weigh any potential risks related to prostate cancer incidence.

That's what we have been saying. The actual studies didn't figure it out yet and, as you can see, the conclusion is still to be found. I see a lot of "might". The jury is out there regarding the impact of 5-ar inhibitors in terms of prostate cancer, while you are clearly taking a side.