ADuckwithNoHair

To be honest, I don't know what to think of Dr. Diep lately. There's no doubt he's achieved some fantastic results for his patients. But I also share your concern over some cases of poor graft harvesting, not to mention his grid-like implantation pattern.

You might lose ground, just because you can never really sure how much the medication is doing. All the hair that Minoxidil has been maintaining will shed.

Thank you for the update! You're right, the results look incredibly natural. How is your donor? Hoping you get even more growth as you approach 1 year. Congrats and enjoy

Users of this forum are (correctly, IMO) very conservative about recommending hair transplants, especially to someone who might not need it. Surgery is always a last resort and risks and rewards should be considered carefully. However I also believe that the risks and rewards should be assessed accurately, without weight for or against surgery. You obviously have fantastic hair, but I think there is room for cosmetic improvement should you wish for it. @ciaus has a nice markup of some potential work that could be done, namely a lowering of the hairline and filling in of temples. There's been good cases posted on this forum of people with generally strong hair who have had a procedure to lower their hairline slightly such as: Dr. Bloxham also has cases with minor loss, turning good hair to great hair. The problem is that dropping the hairline is pretty graft-costly because you NEED density to match the thick hair you have behind it. In your case that will probably be over 2,000 grafts.

Those are all top tier doctors. You have some great choices in NYC for sure. Personally, I've narrowed my choice for my own HT surgeon down to Dr. Bloxham and one other. Dr. Bloxham is young, but his talent is astronomical. Every result I've seen from him is better than the last (case in point, his latest published video [at only 6 months!]) As for pricing, Dr. Bloxham is very transparent, which is a breath of fresh air (https://fellermedical.com/hair-transplant/costs/). As for surgeons in NYC, aside from Dr. Bloxham I've only had a consultation with Dr. Wesley, who is also excellent. I think his level of patient attention and thoroughness exceeds even Dr. Bloxham, though at a result level they are about equal. I don't have a full pricing schedule for him, but his costs are definitely higher, and not by a tiny margin.

What if I don't need that many grafts? An FUT procedure for me would probably take 1600-1800 grafts. Will doing stretches in that case just be for the benefit of a better scar?

Great info. A lot of people speak of FUT like it should go the way of the dinosaurs now that FUE is around. ~2,000 extra lifetime grafts is pretty significant and should be considered carefully, especially for younger guys whose future hair loss is uncertain. Before I joined this forum I was 100% convinced that FUE would be my first procedure just because the "scarless" marketing works so well.

Hasson & Wong have great FUE results. Eugenix also is worth mentioning.

Exactly. Depending on the procedure you get different kinds of scars. FUT leaves a linear scar: FUE leaves small punch-like scars: If done by skilled surgeons, the areas where hair has been harvested are practically invisible. But they are there. The finite number of donor hairs that can be transplanted is why we must make cautious and intelligent use of every single one of them. Those are all you'll get for your entire life and once they're gone they're gone.

Another thing to consider is that it's really hard to price shop for FUT hair transplants since it's generally rarely offered in low-cost countries which massively favor FUE. People seeking their first transplant and trying to save a buck should think about this carefully. I was watching the H&W talk with Doug and he reiterated the common advice, strip first before FUE can yield ~2,000 more lifetime grafts (obviously, in some cases more, some cases less).

They don't 😞. Otherwise we'd have infinite donor and everyone could have thick NW 0 hairlines lol

Great spacing on the donor and nice dense pack at the hairline. Have not heard of the surgeon but his work looks very good. Good luck 👍

Holy multi-hair grafts! You see the grafts with multiple hairs sticking out? Those are not supposed to be up there in the hairline like that because that's not how hair normally grows. It results in a pluggy look that just seems "off". A skilled surgeon using microscopes is able to get true, single hair grafts for a natural look in the hairline. So to answer your question, it's not your fault, but your surgeon was totally inept, and he has no right to suggest that the procedure could not have gone better. The good news is that, if you wish, it should be possible to refine and soften the hairline with true single hair grafts

It's really really hard to say. From what I know, the 20's are typically when hair loss is most aggressive and also typically when your balding pattern emerges. After that point what happens seems to be anyone's guess. Maybe you'll never recede another inch, maybe it will continue to progress at a slow rate. I will say though that usually if you don't have really aggressive loss in your 20's it doesn't suddenly kick into gear in your 30's unless you have some other health issues or start steroids. The safest thing to do is continue on with preventative medication.

Sure, there is theoretically a way to extract individual follicular units in way that is practically scarless, with minimal trauma and enough tissue around hair roots to avoid the "skeletonized graft" problem. I think that's supposed to be the concept behind Dr. Wesley's Pilofocus technique which has been in development for quite some time now. If such a procedure were to become mainstream then that would be the final nail in FUT's coffin.

Dr. Wesley suggests low concentration Minoxidil solution may accelerate the healing process after a transplant. As for oils, I'd stay away. As long as you don't have any huge nutritional gaps in your diet, multivitamin's probably wont help much, but they also certainly wouldn't hurt so IMO a good food-based multivitamin with biotin is not a bad idea.

Assume a 1mm punch. If you had a 2000 graft procedure, you would have about .8 mm^2 of scarring per graft (probably more since the trauma would affect surrounding tissue) multiply by 2000 and that's 1600mm^2 of scarring distributed around the scalp. The advantage FUT is it clusters all those scars into one area and takes advantage of your inherent scalp laxity to strip them out, leaving only the linear scar where the strip was removed. Generally unless there is very bad stretching, the area of this scarring is much less than FUE. FUT scars vary in quality, but check Dr. Bloxham's Youtube channel to see how invisible they can be. With low numbers of grafts the scarring is not as apparent, but with FUE alone you will reach that critical point where the donor is visually affected much sooner.

Seriously? This is really a terrible idea and it shouldn't take you 7 years to figure out why. Flap surgeries are totally superseded by modern follicular unit surgeries.

Seems like such a bizarre move. I understand wanting to expand your repertoire but why completely stop performing the procedure you built your reputation on?

Huge improvement. For 1,500 grafts the appearance of density in the hairline is fantastic!

Is there an agreed-upon set of best practice for post hair transplant care? As we all know, the 10-days post procedure are critical for ensuring the transplanted grafts root themselves in the scalp. After reviewing numerous post operative instructions from leading clinics, it's surprising to me that there's such little consensus on how to maximize graft survival. For instance, I've read to wash frequently, rarely, or not at all. To spray frequently with saline, keep dry, or use water-based surgical lube. Some clinics even have their own secret sauce that you're supposed to use... Dr. Wesley seems to like Arnica Montana supplements to promote recovery. I've been trying to create an "ideal routine" based on weighting by how I judge growth rates at various clinics, but it's quite a task. What are your guys opinions?

Best in NYC are Dr. Carlos Wesley, Dr. Bloxham, and Drs. True and Dorin.

I'm in a similar situation to you too, teetering on the edge of committing to a procedure with Dr. Bloxham. I think that from a technical perspective, Dr. Bloxham is at an elite level. He has a lot of documentation of his scars, from average to best case scenario and they're all exceptional. I also think his dense packing technique is top level. All of his work is extremely refined. My only concern is whether he has the artistry and subtlety of elites like Doctors Hasson and Wong, especially for hairline design where I'm not sure there's a substitute other than years and years of experience. Keep in mind also, his cost/graft is even higher than Hasson&Wong

H&W - Top tier surgeons. From what I've seen of their results, they are extremely consistent, and use grafts in an intelligent way to maximize coverage. Hairlines look great. They seem to be pushing more for FUE lately (they suggested FUE to me in my online consultation), but they are obviously one of the best at FUT Dr. Bloxham - His video documentation of results is the best, bar none. I highly suggest checking his Youtube channel to see what he's capable of. He specializes in FUT so if that's the procedure you want, you're in good hands. Very talented and capable of good work but in some of his cases I think his hairlines come out a little too unbroken and artificial. His scars are practically invisible. Dr. Diep - I think he has a great sense of aesthetics and hairline design. If your concern was getting temples/hairline he is superb. I don't think he is as good as H&W at optimizing graft usage to create density in the midscalp/crown. I've seen dubious harvesting for FUE from him, but if you're going through with FUT this is something you can overlook anyway.

First of all: OMG. The improvement you achieved on Fin and Min alone is unreal. You're a great responder! Regarding your questions: The main drawback of undergoing a procedure at a young age is that the progression of your hairloss as you age at this point is very uncertain. You might have suffered the worst of it, or you might be destined for Norwood 7. The permanent hairs that you place now might look very out of place as your hair loss advances. In worst cast scenarios, you see young men who fill in their temples in their 20's left with two tufts or "horns" of hair as their balding continues behind the transplanted hairs. Yikes! 9 months is good. As a rule of thumb I see a lot of clinics ask for patients to be on meds for 1 year prior to a transplant. It's obvious from the photos you've posted that you're responding excellently to Fin and Min though. I think the traditional philosophy of graft maximization is to FUT first, then punch out what else you can with FUE. Dr. Bloxham has some good background reading on this: https://fellermedical.com/young-hair-transplant/ . There have been some stunning results lately with pure FUE though that have shaken my belief in the yield possible with pure FUE. Check Dr. Zarev, who does 11,000+ graft FUE gigasessions and donors still look pretty good. Don't know if he's seriously that good or if he is cherry picking patients with God-like donor regions.