Cristero

On 8/8/2020 at 10:05 PM, Namsak said:

I have a question guys: how will finasteride be any helpful if the quasi totality of Portugal25's hairs are implanted hairs. I thought finasteride was useful to preserve native scalp hairs.

This.

Portugal, you know me and we spoke in PM several times, but I have to tell you that your choice to jump on finasteride was dictated by panic rather than logic.

There is no need for you to stay on finasteride, since your native hairs were all gone. It may actually be counter-productive since you had beard grafts implanted.

Looking really good and natural. Congratulations!

I saw cases from Dr. Couto covering the frontal third with a great dense effect with only 1.8k grafts.

While I believe these are the exceptions, we are talking about more than the double of grafts to cover a way smaller area.

Considering the patients is pretty young and no one knows how his AGA will progress, in my opinion that was a bad call. 

I agree with the guys above. 4k for such area is an overkill.

Hopefully the patient loss won't progress more, to the point where another procedure will be needed.

On 6/9/2020 at 6:02 AM, Gabreille Nelson Mukhia said:

Finasteride is the one medication that can prevent baldness from progressing. Minoxidil, multivitamins, PRP therapies, Meso therapies, laser therapies, herbal remedies, headstands etc. have never and will never substitute Finasteride. 

Finasteride decreases the production of dihydrotestosterone from testosterone. This in turn stops further miniaturization of hair. People do take Dutasteride and Saw Palmetto extracts that can help prevent further balding.

Anything else (Minoxidil, multivitamins, PRP therapies, Meso therapies, laser therapies, herbal remedies, headstands etc.) can only be counted as supplementary. From increasing blood circulation, providing nutrition and stimulating the roots - they can help in other miscellaneous ways.  They will never control the production of DHT in any manner.

I wish I could scream from the rooftops about the importance of Finasteride to everybody! This one simple pill can save us from so much of mental stress and multiple procedures. 

Also, the medication is demonised and it's side effects exaggerated beyond proportion. In our experience, we have hardly seen anyone have real side effects with the medication, i.e, at the prescribed dosage of 0.5 to 1 mg. The very few cases where patients complained about erectile issues, decreased semen, decreased libido, drowsiness, chest pain etc. all proved to be psychogenic. Almost in all of the cases where the side effects were reported, they stated only the side effects that they had read about.

In almost all cases Finasteride plays an important role. Only after a certain age, once the baldness stabilizes, the intake of Finasteride can be reduced significantly or stopped. 

Do you agree with me?

No I don't agree with you.

You definitely need to do some research on pharmacology and endocrinology before coming out with such bold statements. Your post can be read by young dudes that will believe the bro science you are spreading. Finasteride is an anti-androgen, that can have devastating effects on a male endocrine system, it's not an aspirin. And the more you age, the more you will be at risk for side effects, since the body will be producing less and less androgen once you reach 30.

Topical, both in an alcoholic solution and in a liposomal form, goes in the bloodstream, even if in lower doses.

On 5/16/2020 at 9:17 AM, Portugal25 said:

@kapiper you must do more research here at HRN because there are many threads informing that Asmed and Hair of Instanbul are turkish hairmills with technicians doing surgery on 8 patients per day so your results will depend on the tech you get when you check-in at the hairmill.

A technician at a hairmill could have been washing dishes at a restaurant 2 months before doing your surgery.

Turkey is the world capital of botched hair transplants and there’s only 1 option in Turkey where you are almost certain to get a good result - HLC Ankara (2.7€/graft). They do manual FUE which is limited to 1500 grafts per day with a technique called stick&place which means they extract the grafts and then make 1 hole/slit and immediately implant the graft  so that the hole has no time to start closing or accumulate fat or blood (this technique provides a quicker recovery time). 

If you are on a budget then you won’t find any other doctor with the skills Dr. Arika (Eugenix) has charging 1.8€/graft w/tax. 
They do a technique called DHT which reduces the time the grafts stay out of body because they make all the holes/slits first and then proceed to extracting the grafts and immediately implanting them so they don’t stay out of the body for more than 30m. 

If you want a closer option then Dr. Bruno Ferreira is in Porto and charges 2.5€/graft. He also works with one of the best FUE docs in the world Dr. Lorenzo in Madrid but there you pay double price. 
Dr. Ferreira does the most recent technique DHI which is similar to stick&place. First he extracts the grafts then he uses implators pens that are loaded with the grafts, these pens make the slit/hole and implant the grafts at the same time. This reduces the handling of the graft and the doctor can make smaller holes that provide quicker recovery times.

Dr. Konior is considered the best in the world and does manual FUE with stick&place. 
Dr. Juan Couto is considered the Doctor with the most amazing results and does DHI (like all Spanish doctors). 

Technique is not as important as the Doctor because a bad doctor using a great technique will still get you a bad result.

I advise you to chose a great doctor with a great technique and with real patients posting their amazing results. 

This is not like buying a car that you can change after a few years, this is a permanent medical surgery and you have a limited donor area so every graft is precious and should be used the best way by a highly skilled Doctor.

I saw you only advised HLC in Turkey, while you had yours with Pekiner.

What happened? Aren't you happy with how your transplant is coming out?

Pekiner results are way better than HLC from what I've seen online.

As an FYI, if someone is considering him, De Freitas finally replied to me, quoting me for 1400 grafts for the crown, but he wouldn't touch the temples. But, as many of his colleagues, he doesn't proceed to surgery if you are not on fiansteride.

On a side note, I forgot to mention I met Dr Pradeep Sethi here in NYC on Sunday and he strongly disagree with surgeons not proceeding to surgery if you're not on finasteride. Especially in cases like mine, with above average donor area, he said it's stupid. He told me he could have extracted easily 6000/7000 grafts without being noticeable on my donor.

Take him in consideration if you're not willing to get castrated with finasteride.

No, but her assistant sent me an email, after I told them I booked with another surgeon, saying they felt the urge to warn me that surgery is pointless if I don't take finasteride.

As finasteride is the solution to all the AGA, which we clearly know it isn't. 

Please, don't transform my thread into a discussion of Pekiner vs dredd77. You have the original thread for that. Thank you.

@Portugal25 I will post on the Italian forum most probably.

7 hours ago, baldblonde said:

I was set on Pekiner a month ago, but now I'm confused....

I will let you know how my experience will go. I don't think you have anything to be afraid of.

As a FYI, Ximena Vila told me she refuses to proceed to surgery if I'm not taking finasteride 10 months prior. Hoping one day surgeons will stop with this nonsense.

I will probably post my brief opinion about the surgery, without pictures if that's allowed.

And I agree with everyone saying that the doc behaved ethically.

I hope you guys here don't advise people on this forum going to Asmed anymore. The results I've seen recently are seriously embarrassing.

1 hour ago, Melvin-Moderator said:

You do realize his rep is Italian right. That’s why certain forums are flooded. Good marketing doesn’t equal good ethics. We no longer host topics discussing this surgeon, cause of questionable ethics.

Either way, wish you luck. Remember there’s no guarantee to surgery, ethical standards are important, in the event that the surgery may fail. 

I've replied to you in a PM. Yes, I'm aware of the things you mentioned and I still don't think it's unethical to offer a discount to patients willing to showcase their case on a forum. He's a young surgeon trying to build up a name.

I'll report my experience if you wish when I'll be done. I won't have any issue reporting a bad case if I won't be satisfied and I'm usually quite picky with everything.

1 hour ago, Melvin-Moderator said:

I would research a little further on this forum. Don't let time be your deciding factor. Just because a surgeon can squeeze you in faster, does not make them better. Wish you the best either way. Also, you need to realize some reps of certain doctors, also manage foreign forums, so take everything you see on these foreign forums with a grain of salt. Are you seeing fair, balanced, and objective results? Or are you seeing what the doctor and the reps want you to see? 

I've searched enough and I've spoken personally to people who had surgery with him. They just said good things about him. 

I've looked into every single surgery he did, that were published online, and I liked all of his results, apart from two: one was a thread of a user that has published his story here and another one is an Italian guy who had a less than optimal result, but still a good one. All the others were really good. I've seen an amazing crown reconstructions by him and that's what I was more interested into.

Also there's a thread by an Italian guy who did 12 hair transplants (yes 12), one including the really expensive Dr. Wong. And he said Dr Pekiner was his last one and best so far.

More expensive doesn't mean always better by any chance. Pekiner seems to have all the requisites to do a good job: manual FUE, stick and place, split the surgery on more days and he uses high end equipment.

Then it's a surgery still, and God knows if it's gonna go all well or not.

Booked in with Pekiner eventually for the end of March. He had this opening and I thought now or never.

Thanks everyone for your suggestions and advices.

2 minutes ago, TrixGlendevon said:

I have already suggested you have in person consultations with Feriduni and Hattingen as the in person consultations are very different to video and photo ones.

Hattingen told me the best thing would be to shave my head to see how I look like. If I wanted to shave my head and get away with it I would have done it already. About Feriduni, I've already said I don't like his results, sorry. And he doesn't come cheap.

9 minutes ago, Portugal25 said:

I only used for my first HT with Rahal in 2008 and never touched the dammed thing after 2009 (reason why my hairloss progressed to my crown, midscalp and even lost transplanted hairs). 

Which means transplanted hairs are not immune from AGA, as many surgeons claims.

35 minutes ago, Portugal25 said:

@Cristero I also had horrible side effects that ended up with me going by ambulance to the hospital but still I took that awful pill for 18 months (6 months before surgery to 12 months after surgery). Just bite the bullet and take the pill for 18 months. 

I became hypogonadal thanks to it and I'm on hormone replacement therapy for the rest of my life. It's not just about the side effect, it's about the long term issues the drug causes. Many men don't understand the importance of androgens for overall well being, it's not just about sex issues.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064044/

Also, if you stop it after 18 months as you're doing, you will go back to square one soon.

3 minutes ago, Portugal25 said:

@Cristero you will be in great hands with either @Dr. Bruno Ferreira, Pekiner, Freitas or Ximena.

Still need to convince them to do the surgery without finasteride though.

1 hour ago, OliverAtom said:

Cristero,
So, any news about who? What happened with Freitas? Did you get an estimate?

About Finas, I believe most doctors would recommend you to take it ... which is good for them so that the final result looks great... however, as you say, woould be great to find another way... and the best option would just go for a second surgery after a few years I think..

Hope you find the best fit for you!

Hey, I'm waiting for a quote from Freitas still.

I've also contacted Pekiner and waiting for his reply. The results he posted on the Italian forum are solid.

But, as I said, all the top surgeons wants me on finasteride, so I'm telling them I would rather have a second surgery than taking finasteride anymore.

So at the moment I'm waiting for Ferreira, Vila, Freitas and Pekiner thoughts on having the surgery without taking finasteride.

Dr. Michalis Georgiu gave me a good discount as well and he's willing to go on without me taking finasteride, but I don't like his results.

This is one of the bad surgeries of Feriduni  I would say:

https://bellicapelli.forumfree.it/m/?t=65008601&st=150

Crown didn't regrow much and the donor seems depleted.

1 hour ago, TrixGlendevon said:

Feriduni told me about post-finasteride syndrome, which I hadn't heard of before. I am also not up for taking meds. He told me I was sensible and that I shouldn't go on them unless absolutely essential. I would honestly consider an in-person consultation with him. Great results, very ethical and really knows his stuff. Online and picture assessments are only so good.

I'm glad there are still surgeons like that. I don't know what other evidences they need to see to get convinced of the dangers of 5ar inhibitors drugs.

But as I said before, I checked his work on the Italian forum and I'm not a big fan. He's way too conservative and also a bit expensive. I would spend those money only for Couto.

But I take my hat off in front of doctors brave enough to warn against the danger of a castrating drug.

Update - Dr. Vila said I would need 1800-2000 grafts, which is the number I was expecting since the beginning. Problem is that she wants me on finasteride before and after the surgery and she wants me to go to Madrid for a face to face consultation.

Dr. Ferreira sent me a thorough examination of my case and he's been the best so far. Unfortunately he wants me on finasteride as well, starting from 6 months before the surgery. I replied to him saying I would rather do a second surgery later on, than taking that junk.

Dr. Michalis Georgiu quoted me for 2000-2500 grafts, and he didn't mention any necessity for me to be on drugs. Unfortunately I don't like his results.

I tried to push back with both Vila and Ferreira about finasteride and I'll see what they say. If they can't do without, I will have to look somewhere else.

In general, I'm fed up with this attitude of pushing patients to use finasteride, but I guess they just want to be sure not to have an unsuccessful case in their portfolio.

Update - HLC gave me an estimate of 2000-2500 grafts for the hairline and 1000-1400 for the crown.

This is definitely the worst plan of all the clinics contacted until now and makes absolutely no sense to me. Filling my temples with 2500 grafts it's a serious overkill.

Dr. Ximena Vila assistant told me the first available date for a consultation is October and the surgery roughly 8 months after. It's almost the same waiting list Couto gave me.

The first one has results a 

6 minutes ago, duchaine said:

I'm Italian so I can read what they wrote.

one cases is at 2.5 months. How can you judge the result?

The other case is a 6.5 out of ten. Not bad not great but his last pic is at 10 months so there is still time to improve.
The patient is not complaining about his result and the only comment is "wonderful" (I do not agree anyway).
Anyway, the hairline rebuilding was really hard, because the patient had lost all this hair (he had no tufty al all).

there are some clinics choosing only "WOW!" patients. HLC is not one of them.

The first one is at 10 months and a half for the hairline, and 7.5 a half for the vertex.

So I don't know where you saw 2 months and a half.

The other one is 2 surgeries if I'm not wrong and years after the surgery.

I was getting that result I would have been quite pissed off. 

https://bellicapelli.forumfree.it/m/?t=75575118

https://bellicapelli.forumfree.it/m/?t=70210123