Curious25

Aside from the hairline work - you had grafts implanted throughout the vertex and towards the crown - can you tell that this has made a difference to how your hair sits, feels, and styles? Your results from Dr Hasson were good, and seemed to last you well throughout the 9 years, amazing FUT scar aswell! No estimations of remaining donor then ?

Looks great. You had a relatively large space to cover with only 1800 grafts, (however your hair calibre has seemingly compensated for this), and the result looks really nice and natural - good hairline design, and blends nicely into your native hair. . . and don't forget you still have 3-9 more months of growth and maturation. Who was your doctor?

I think you’ve made some excellent points there

Agreed. I guess the point I was probably trying to make (admittedly failing to) was that despite him not being discussed or showcased on this forum, he has already got some sort of exposure in the western world, if he’s in some form of collaboration with JT.

Just came across a JT video in which he showcased a Dr Zarev case. The case was an outstanding NW6 transformation, similar to what you have probably seen online, and JT was as you would expect, very complimentary and in awe of the transition - he mentioned about the vacuum style tool he had invented to extract grafts, however didn't seem very well informed as to how and why it made a difference, he just concluded by saying he had a very unique and interesting approach to his surgeries, and then moved on. JT proclaims to have pretty strict criteria in place when it comes to his associations with the Dr's he recommended and showcases, (I'm not implying this is or isn't the case) so perhaps that will be an extra vote of confidence for people considering this doc.

You're welcome. I'm an FUE patient myself, so always interested in hearing the justifications from other well researched FUE patients for starting out with FUE as opposed to FUT. Maybe its a geographical thing - from what I see across forums and youtube, most of the advocates for starting out with FUT, and then tweak with FUE later, seem to be american based or had their surgeries in america - where most of the legendary and accredited north american clinics are still in favour of FUT, as opposed to Europe, which seems to be predominantly FUE now. The general rule of thumb suggests you should only ever get an answer from an ethical surgeon who can perform both types of surgeries, in which Dr Bisanga certainly can do - so interesting to hear what his reasoning was to advise against FUT for your particular case.

I didn't realise Couto performed DHI. Do you know of any other top clinics/surgeons who are currently performing it? I'm not hugely adversed on the pro's vs con's - I briefly skim read the study you provided a link for, and noted that the implanter pens proved to be superior in terms of the percentage of damaged grafts. Similar to my views on the motorised punch vs. manual punch arguments - my overall instinct would be to conclude that a master of his trade is a master of his trade, regardless of what tools he is using. By that I mean, if a surgeon is getting kick ass results time after time again, to me thats what counts, and thats what I want to see - he could be using his Grandmothers tweezers for all I care.

Looking fantastic @Rolandasand once again, the most honest and high quality documentation out there. Months 5-7 there has been a great increase in visual density, and I am sure you will still have more of this to come over the next few months. Out of interest, 3 questions: 1) What are the next steps, ie what are your plans/goals for the future in terms of your restoration journey - and was this discussed during your initial consultation/procedure? 2) What were your thought processes in deciding to proceed with FUE over FUT? 2) Why do Dr's Lorenzo and BF extract 10% with manual, 90% motorized - I've noticed this a lot from the Injertocapilar youtube vids. It's good to see a real patients review and journey with Dr BF, as I am sure he will be one of the stars of the future after learning his trade underneath Lorenzo. Keep up the good work, and continue to grow well 👍

I will reiterate the above comments. It's a frustrating situation we all find ourselves in, and has been a year that not one of us could have imagined. However I think if you take a step back and few deep breaths - flip this period of time on its back, and you can use it to your advantage. The extra months can allow for you to research more, have more online consultations, save more - and project you into a better position than you would have been earlier in the year, with more financial means and a better knowledge and understanding of your case and doctors suited for you. Hang in there and don't make any rash decisions.

I think age is a big factor with that - a NW 6 patient in their 40's or 50's is probably less likely to continue to bald much more than a NW 6 patient in their 20's. I'm also pretty sure I've read Doctors declaring the NW scale not being a scale of progression - merely an identification of pattern.

'I used to come on here a few years ago and he was a big poster and used to really help people' - advertising plug. 'Ive been on his website SpexHair but not getting a reply. Anyone got email for him ?' - website plug, with the hope someone would offer an email plug. Then the rest of the posts were just defending every negative comment made with regards to 'Spex', asking for people to provide evidence and back up their claims with threads and quotes that he'd written - you don't have to be a rocket scientist to realise this wouldn't be normal behaviour from a new forum member who as he put 'never really used to post on forums and just read as too often drama and hostility' You won't see GeorgeE's hair transplant pictures with Dr Hasson I'm afraid, because Spex has never had a hair transplant with Dr Hasson.

Some excellent points already made on here which basically summarise the situation you have. The ability to extract 12k + grafts via FUE, and not leave a depleted looking donor is predominantly down to good donor characteristics that are - high donor density, thick hair calibre, and high HGI (number of hairs per graft). The variables a doctor can control are the extraction pattern, size of punch, and the size of the 'safe area' they deem fit to extract from. This is important - because if you're solely extracting based on the area that would be left in a NW7 patient, available grafts will be a lot less than the amount of grafts a doctor could utilise if they decided to extract from a NW5/6 pattern. I'm not saying that this isn't good practice, because advancing to a NW7 pattern is ultimately rare, and there are many who do just end up at NW5/6 - however for younger patients, it is sensible to remain within the NW7 region at first. His results on high NW's are outstanding, so I agree with you that he is definitely doing something right, but I think that the main contributing factor is the patients having exceptional donor qualities - and he's maybe slightly more aggressive in terms of depleting the donor than some of the more conservative doctors we are used to seeing. If your virgin donor density is 80 FUcm2 - some doctors would only be willing to extract 30-40FU's per cm2 - however perhaps Dr Zarev is willing to extract upto 50 FU's, therefore one of the methods he does differently with regards to achieving higher graft numbers. One of the reasons I really like FUE is because done right, it ends up creating a homogenous scalp. When my hair is grown out, my sides and back are still a lot more thick and bushy than on top, and they always have been - therefore for any physic students out there, think of it like areas of high pressure moving into areas of low pressure - ultimately when I'm done, I will hopefully have similar densities across every region of my scalp per cm2 - Due to the nature of which hair sits on your donor region, laying downwards, and the reflection of light tends to be quite favourable, IMO most could probably get away with only having 30FUcm2 without it looking depleted (given the extraction pattern has been evenly spread. Like others, I would love to see some real patient results, and threads - perhaps have a look on the international forums? Having youtube superstar Dr's like himself and Couto recommended on here one day would be great, but we need a good collection of patient results for that to happen!

Is Dr Arocha going to answer the questions from the Q&A thread that was opened up a few months ago?

Hey no intentional drama caused on my behalf man - if you read back through my posts I have been nothing but supportive and in awe of the results achieved on here - as I have with your thread Aswell. The only inflammatory comment I perhaps made was in regards to the plot thickening earlier on today - which admittedly now, probably wasn’t necessary. I’m here to learn as much as everyone else is - which is why I love having the opportunities to ask questions on threads such as these and debate topics that don’t always make sense to me. In this case - I can now see from the WhatsApp that Dr Pekiner has conceded that it may have some adverse affect on the BHT grafts (which was what I initially queried) but is seemingly more preoccupied with the benefits that it will bring - the next part of the puzzle for me would be to understand what benefits these are, and why they would take president over potential detriment to the BHT grafts. Apologies in advance if these questions are causing unnecessary drama - have a look at my posts over on melvins NW6/7 thread and you can see I was conscious that the discussions on here were potentially taking away from an otherwise amazing NW7 transformation. Nothing but love and admiration for anyone who posts threads of their journeys - we’re in this together after all.

PS I don’t agree nor disagree - I don’t know , hence my intrigue. Logic however, would suggest that inhibiting an enzyme that converts testosterone to an androgen directly responsible for the growth of a particular type of hair follicle, that has been used to aesthetically improve ones appearance, wouldn’t be of benefit, but more of a negative 🤷🏻‍♂️ But WTFDIK . . I’m not a doc 😁

Maybe you misunderstood, but I was alluding to my interest surrounding the same doctor (Pekiner) reportedly giving conflicting advice to @duchaine and @Portugal25 with regards to this matter. Anyway, I don’t think it’d be a productive use of my time arranging consultations to discuss the impacts of 5AR inhibition on BHT grafts, considering; a) the doctor seems to be a little unclear himself b) the fact I don’t use 5AR blockers, or have transplanted BHT grafts c) I am lucky enough to have access to a global forum consisting of a wealth of information, threads and knowledgable contributions, that usually provide sufficient enough input to answer these types of questions 🙂

Interesting to see reports of conflicting advice from the same doctor. I guess you can take comfort in the fact that you have had a second opinion from Dr BF confirming the advice to start finasteride. I’d be interested to understand why or how surgeons are confident that the levels of DHT inhibition from propecia/finasteride, aren’t significant enough to adversely affect BHT grafts, however significant enough to reduce miniaturisation of scalp grafts - are there studies and research surrounding this? I would imagine it is ultimately very dependent on dosage and the individual. Another bemusing observation is the seemingly lack of regard towards the coverage the BHT grafts are providing in this case - the crown area. Balding on the crown is usually one of the more sensitive areas that men face, so to prioritise lateral humps from potentially miniaturising (which can be covered from combing over hair from the top if needs be) , at the expense of the crown BHT grafts - with the outlook that, oh well at least the donor will be strong enough to re-transplant later down the line if needed .. sounds a little bit counter intuitive, 1 step forward, 1 step back, if you like?

Picture quality isn’t great , but it looks a nice improvement and very age appropriate! A nice Full head of hair, good facial framing, and most importantly no signs that you were ever balding.

The plot thickens . .

It does intrigue me as to what hair loss surgeons true beliefs are regarding dht inhibitors. If you base your judgement from the available research journals and studies that have been conducted, then statistically, negative side effects are clearly in the minority, therefore it would be fair to advocate the medication from a scientific standpoint. I am extremely conscious however of the following two factors; -The largest ever study has been conducted by the manufacturer of the drug -The hair retention effects actively compliment the work and goals of hair surgeons For me, probably more in relation to the first point, as opposed the to the second - there is clear incentive to downplay negativity. For as much respect and gratitude I have for hair loss doctors, and the understanding that they have completed basic medical degrees etc. it ultimately isn't their field of medicine - this was the main reason I actively searched for, and paid a lot of money to run bloods and speak with a top urological consultant, in the same sense that if I were to be told by my GP I had high blood pressure - I wouldn't be phoning up Dr Konior to help me out with that one. My levels of intrigue are in relation to the fact that the hair restoration surgeons and doctors are bound to have friends and peers in urological fields across the globe, so I would love to know what their views would be in regards to taking the medication themselves.

Correct - this excess testosterone however can then seek its ‘escape route’ via a different pathway utilising aromatase, converting into oestrogen - increasing oestrogen levels, thus creating a further change in the patients normal hormone equilibrium.

A lot of people are bringing up the two Australian doctors who present the hair loss show on YouTube in regards to discussions on finasteride. The elder doctor, actually discusses in one of the videos that he started started finasteride at the age of 50, because in his words ‘he didn’t have the same head of hair as he did when he was 30’. He then discontinued the use of the drug, because he realised it wasn’t MPB he was suffering, it was general age related thinning - and this is something that finasteride doesn’t prevent.

I'm sorry to hear of your fathers passing. I agree with the above, strongly advise you to speak with a urological consultant and have a full screening to check all is in good health. At the very least, it will be good for you to speak with someone regarding your medication routine over the years, and look into other options if thats the avenue you wish to eventually pursue. Wish you the best!

I think thats an important point to bring up. A lot of focus always seems to get placed on sexual dysfunction whilst discussing unwanted side effects, and as important and obviously worrying that is for the majority, in reality it is only one area of your body's requirement for DHT. Your hormone profile is fundamental in making you the person that you are.

In contrast to what someone mentioned on here or perhaps another thread in regards to age being a consideration whilst assessing ones likelihood to experience unwanted side effects, I believe it was the user @Cristero - anyway, he mentioned the older one gets, the more susceptible they are to experiencing negative side effects due to the combination of forced inhibition alongside the natural decline in their androgens. To me, that logic makes sense. However at my recent consultation with the urological consultant, he had observed side effects to be less severe with age, something which he attributed to be potentially down to a more 'experienced' endocrine system, one that is perhaps more in tune with the body (similar to as wisdom comes with age), and able to tolerate attacks and tampering with 'a more mature approach'. This theory is not scientifically proven or researched at all, and was simply an observation from his experience over the years, and an offering of a potential explanation, when I probed him as to why this was.