jimcraig152

Two very good points. Redness and some holdover grafts gave me an appearance of a hairline early on.

As for dating, luckily I have some return customers to hold me over. I am going to wait for the hair to get to styling length in my case though. I have to conceal the cornrows. Sucks because, I have a lady in waiting that keeps telling me to come see her.

You know what else I've noticed? You have zero redness in the recipient area. Can any other Konior patients chime in if this was the case for them in the 2nd month? Or is @MagnificentAl a unique case?

2 hours ago, WS2020 said:

I care about my hair but I am not being "obsessed" about it. I believe everyone has their reasons to choose HT but having it done right or wrong is not going to change the course of my life. I am in my 50's now and have been losing hair since early 20's. I am well aware I can look better with more hair but it never affect my confidence on both work and dating life.

Even with my NW4, I still look better than 90% of the guys in my office (comments from my female coworkers in their 20's and 30's.) People has to understand hair is just one of the many elements of once appearance. Since I made a decision from the beginning that I will not take fin for my hair, I focus on what I can control. Prior to Covid, you will see me at the gym doing cardio and weights 4 days a week with at least 60-90 minutes per session. I also spend a lot of time studying and following different clothing styles and make sure every piece of my clothing fits me as good as it can.

My point is good appearance is more about confidence and other elements than a full head of hair. I choose Diep because even his "not so good" results are ok in my book. Since I know what is my baseline, I am fine diving in.

 

I am sure you will turn out fine with Dr. Diep. I am also sure you've set off on a divergent path towards better results with your participation in this thread. Dr. Diep is watching. I know you will have demands that you will carry into your procedure. And if Dr. Diep delivers the same rushed tactics he does with patients that have called out the compromises he makes, we'll all know. So I look forward to your own thread. Take lots of good pictures please.

I applaud you for taking into consideration what other patients have told you. Personally, I think the demands you will be making of Dr. Diep  should be delivered by default by any surgeon this day and age. But I applaud you nonetheless. Patients holding their surgeons accountable should be commended. Not dismissed. At the end of the day, the whole surgical hair restoration industry makes a fortune off of suffering. Think about that stark reality. Standards have been set now at this point in human evolution where we are on the precipice of a medical cure and at the apex of surgical hair restoration. Any reputable surgeon delivering less than those standards, must be held accountable.

I do have an agenda. Besides seeing through my own personal journey and sharing it with others, I, like anyone else, want to leave the paths we travel better than when we found it. How does a patient do that? Simple. Hold their surgeon accountable.

Geez. The donor photo looks like the rear profile of a 19 year-old. A shining example of why one would pay extra for FUE. Seriously, a big smile stretched across my face as I saw it. I hereby award your Israeli MD and you the "Like A Virgin" award. The highest possible honor for FUE work in the world.

I am experiencing some early growth 3 months and 2 weeks in. I had immediate graft growth, then 80% of the grafts shed between week 3-6. Lots of transplanted hair in my forelock never shed. So if my early rebound out of the ugly duckling stage was predicated by instant graft growth, I would say it is a good sign.

I have it all captured here.

Hey @TorontoMan, I'm about a month ahead of you with my 2332 FUE procedure. Redness for me didn't go away until 3 months and 1 week. I noticed in the 3rd month, after a shower, the redness would be gone. Then I would apply Rogaine foam, and the redness came right back. But now even with applying Rogaine, the redness doesn't come back. I've heard of it lasting some 5-6 months before when I researched the subject.

Something that I did apply somewhere after month 2 was this stuff. The lessening effects of redness was instant. I didn't apply it regularly at all though. When I read about it, another member said he applied it every hour and credited it with possibly saving some of his grafts. Not sure about that, but I know it definitely helped with redness.. I used it maybe once or twice a day 2-3 times a week.

I had many transplanted hairs in the forelock that didn't shed just like you did. It's atypical but a pleasant surprise.

Your hair looks good @SWdan. No denying that. Happy for you.

But the compromises Dr. Diep makes certainly has diminished the aesthetic results of many patients. You cannot give a surgeon a pass when transection loss is >25%. When those '90's Bosley-like baby doll plugs are inserted into a patient's head in 2020, you can't give a surgeon a pass either. It's absurd that a patient is carrying explicit instructions into his procedure demanding the surgeon to not extract donors from too small of an area in their donor. Absurd. The surgeon should do this as part of standard practice. Any patient with MHTA should be given the white glove treatment and not have to be the BFF of a hair loss forum moderator to get that treatment.

No one doubt that Dr. Diep can produce good results. There is no denying either that it is a dice roll where MHTA patients shall end up on which side of probability. The reason for this? The compromises he makes to save himself time so he can leverage the time to increase his revenue. Thus, the man's work is polarizing; that cannot be denied either.

On 11/10/2020 at 6:09 PM, anotherhairlosssufferer said:

Something I am thinking about - why does it matter how big the punches are? Each punch will extract a graft (1/2/3/4 hair graft) so no matter who you go to you will have the same issue - a certain number of grafts will be gone and your ability to wear your hair shorter will be affected the same? The only issue I see is if a doctor doesn't distribute the extractions randomly and evenly across the whole donor, but the size of the punch shouldn't matter.

EDIT:  Looks like my math may be wrong. I may have put the incorrect values into Excel. Deleting the math part for now and will revisit this later.

Outside of ethnicity that have follicular characteristics that require a larger punch, hairs of larger diameter, or body hair excisions, there is no advantage at all for the patient when the surgeon uses a larger punch. Other reputable surgeons all use 0.9mm or smaller punches for straight-hair patients and also achieve high density. The advantages are all for the surgeon. He/she can be less precise and thus can move faster. The disadvantages to the patient however increases:

• Increased pain and length of time for recovery
• Increased risk of infection
• Increased chance of shock loss, some of which the patient might not recover from
• Increased risk of transection of surrounding hairs, thus diminishing donor supply to treat future progression
• Increased surgeon speed can lead to increased surgeon error; increasing transection loss which we've already discussed

Who knows how it will look on a patient by patient basis. But the math is undeniable. By testimony, a smaller punch reduces or eliminates the disadvantages listed above. Read and see them for yourself (here, here, here, and elsewhere).

Probably a rhetorical question, but any pain in the donor area?

If we isolate the scenario to a single patient as a case study that has the option to go either FUT or FUE. Increased cost of FUE is not a factor for this case study. Preference is to go with the procedure that offers the greater donor supply. Is there a ballpark numerical advantage in donor supply FUT vs. FUE?

46 minutes ago, ShadowMoon said:

Hey @jimcraig152, I only just realized we had basically the same procedure. You had 13 more grafts than me, and we have almost identical placement, albeit mine is a bit more conservative. I wanted to throw in my 3-day post op as contrast:

I think objectively, I like your hairline design more than mine. I think your age and pattern afforded you a bit more wiggle room. I think the temple closure I got is about as aggressive as I'm willing to go at the moment. 

No doubt about it, Dr. Diep places hairlines well. If only he truly made it about the work and the patient in the procedural chair, and not about the paper, he wouldn't be so polarizing. He'd have to give up >50% of his revenue stream to achieve that though. Knock it down to one surgical patient per day. Put back say 2.5 hours he spends a day in consultation back into the one surgical patient per day. Reinvest the time into that one surgical patient per day. EDIT: and uses a smaller punch. Not make those compromises. He might be able to make back some of revenue charging $14 per graft and charging a mandatory consultation fee.

Thanks for the contrast. Trust me when I tell you though, we as canvases are totally different. I have a big ass melon for a head :). Your work looks great though. When internalizing my own issues, I always relate to the fundamentals I've learned over the last 3 or so months:

1. With any surgical hair restoration, the primary goal is naturalness.
2. If paying the higher premium for FUE, the primary goal is less visible scarring to allow for shorter hairstyles. The secondary goal is low transection loss (5% or less), as higher transection loss leads to more visible scarring.
3. If choosing FUT, the primary goal is to maximize donor supply. The secondary goal is to minimize the linear scar. The tertiary goal is cost savings.

Though your hairline may be conservative, it is appears as if Gabel's surgical instrument was guided by Mother Nature herself. And you're much younger than I am. You'll need to maximize the donor for the road ahead. Your FUT scar is imperceptible. And I am sure you paid 30% less. All initial goals met. Now it is the waiting game for the results. Can't be easier if you stick to the fundamental goals.

@Noodles123, next time you get a fresh haircut, please post nice photos of your donor (I don't mind if you post in my thread). I've seen your post here, but the pics are a little fuzzy. Maybe ask your barber to take the photo. Thanks!

Thanks @tressful11.

Fear not. I am actually quite level-headed now since about the 6th day after the procedure. I see improvement just about everyday, but struggle with the oddities as a result of the compromises taken by my surgeon. I am just being honest about my journey and responding to the dialog as it comes. You can see, past MHTA patients are chiming in with supporting details with their experience. I find it amusing to be called biased and insane, because on the flip side, I could clap back and call those that do, myopic.

I very much appreciate that you recognize that we are brothers in the struggle. I hope that I am not coming off as too combative. We are all well aware of happy Dr. Diep patients. I am in private dialog with several members here and elsewhere who are like-wise MHTA patients and thankful for my honestly, the investment I've put in, and thoroughness of my updates. I don't need to do this at all. But we are brothers in this struggle and it's been expressed that exploration of my journey helps them.

But you bring up a very interesting point that presents me with an opportunity to respond. In any profession, in any field, the well is not in-exhaustible. How many more games do you think LeBron James has left in him? How many more passes does Tom Brady have in his arm? How many more kicks does Messi have left in him? How many more emails do you think you can read, meetings you can attend, fire drills you can put out? It is not infinite.

I've been in the presence of Dr. Diep three times now:

1. During my pre-consultation
2. On the day of my procedure (interestingly enough, it feels as if I spent the least amount of time with him here)
3. In the follow-up meeting via Zoom

When I saw him the first time, he looked remarkably older than he looks in his videos. When I saw him on the day of the procedure 8 months later, even older (given he hadn't had a hair cut in months likely due to COVID). And in the Zoom meeting, he looked really old. As Dr. Diep and I are both Vietnamese and probably very close in age. Youthfulness is something Vietnamese dudes tend to retain well into middle-age (aside from my hair loss, of course). But in looking at the man last, his skin was heavily pock-marked. Corners of his eyes folding over. And swaths of gray all throughout his hair. He looked worn out. I spoke earlier of the toll MHTA patients pay in chasing the results Dr. Diep is known for. Well, Dr. Diep's paper chase is taking a heavy toll on him.

There might have been a time where Dr. Diep might have been able to pull off more consistent results even with two procedures a day. Or he might have never been able to do this, and people just kept giving him a pass because they assess the situation pragmatically--as black & white, as before vs. after, or remind themselves "I was bald and sexless a year ago now have hair and female interest today", "I was down-trodden a year ago on top of the world today." But clearly that well he is drawing from is running dry.

2000-3000 grafts is equivalent to 2-2.5 points on the Norwood Scale then, right? So if you are NW5 or 6 and want closer to complete coverage, FUT is the way to go. If you want FUE for the flexibility afforded to wear shorter hairstyles, then you'll likely have to concede to have a thin crown.

But if you are up to an NW5, FUE should be the way to go as long as you can afford it.

Is that pretty much the consensus?

2 hours ago, anotherhairlosssufferer said:

It might not be perfect in some cases but that is fixable.

No reasonable person would even take their car into a shop known to do bad work, let alone their hair. Using the term fixable as a superlative to describe an HT surgeon's work even in passing isn't even an indictment; it is condemnation.

Think about it.

5 hours ago, Noodles123 said:

Jimcraig152.... I also highly suspect that Diep extracted far more grafts than he implanted in my case.  I had authorized him to only extract up too 1200 grafts due to budgetary constraints.   When the surgery was done I saw that he had extracted 1500 grafts according to my paperwork.  I was alarmed because I thought I would be charged for the grafts but he said he just gave them to me for free which made me very puzzled.  What I have always suspected is that he extracted many more grafts because there was a very high transaction rate.   The fact that he extracted 300 grafts over my limit suggested his transection rate on me was 20%.   

When I have posted my pictures here before people have told me they guessed that the number of grafts implanted was closer to 1200 which coincides with my suspicions.

Ding ding ding! Winner winner, chicken dinner!

The high toll that I speak of has nothing to do with him venturing out of the traditional safe zone. It's math. For your procedure @Noodles123, the rate of Transection Loss is actually 25%:

• 1500 punches - 1200 grafts = 300
• 300/1200 grafts = 25%

By all recognized measures in the industry, 25% Transection Loss is Turkish-scam/Black Market level of deficiency. I am, and some members too, witnessed to an instance where the rate of Transection Loss was at least 45% from Dr Diep. So getting back to fundamentals. Does anyone remember why one would pay the extra premium for FUE? Anyone? Anyone? Bueller? Bueller?

Furthermore, extracting follicular units is a delicate process that cannot be rushed. Otherwise the primary goal of FUE is defeated:  to have less visible scarring allowing for increased flexibility to wear shorter hairstyles. Look at this video here at even how brisk Dr. Gabel performs the activity, there would be no way Dr. Gabel could complete 1000 excisions in one hour. But there are testimonies from patients where with Dr. Diep, that is exactly what happens plus the graft incisions and anesthesia is administered within that same hour! Go read them for yourselves (here, here, and here). We all know a Diep FUE patient's donor looks eviscerated after surgery. There is no doubt of that. Even happy patients don't deny that. Thus far, this has been contributed to Dr. Diep using a large punch. But behold!!!!! Here you have it, a patient telling you he had 25% Transection Loss!!! The higher the transection rate, the more visible the scarring. Dr. Diep rushing to get to his other patients waiting in the other procedure and consultation rooms means he is playing darts with the surgical punch and your donor supply is the dart board.

When I mentioned earlier to you @anotherhairlosssufferer to go see if the math adds up, now you know what I mean. Just do a search and look at donor photos of MHTA patients. Download GIMP and start counting the excisions. See if the math adds up. Right now, I can't help but to think you really are one of the court officials sent by the Emperor to check on the status of the cloth. Remember, it is very easy to please a balding man. Some are happy just wearing rugs on their heads.

Well placed hairlines and density is not an exclusivity of Dr. Diep. Plenty of skilled surgeons can achieve these things and far surpass what Dr. Diep can do (and many can do it for less money even factoring in lodging and travel expenses). And if you put in some time before your procedure, you can pretty much draw the hairline you want and work it out with your surgeon to achieve it. But time after time, it is proving to be that eviscerated donors might just be the price you pay for what Dr. Diep does well. Just take a look:

• The Harvey "Two-Face" Dent donor treatment,
• The "Border-crossing donor treatment",
• The "Leopard Print" donor treatment",
• and everyone's favorite---"The FUT Scar from a FUE procedure donor treament",

Yes, I am being cheeky with the those descriptions. But that is just the thing that comes to mind when I look at the donors of those fellow hairloss sufferers. On top of that, the man saves himself time by barely lifting his surgical tool as he lays out the graft incisions in a straight line in rapid fire succession. Resulting in the infamous corn rows! And if you are really lucky, you'll have the same tech that worked on @rocknrollman, @Dadda, and @Tentpole91 incorrectly sorting your grafts into 1's, 2's, 3's, and 4's, then placing baby-doll plugs in your head. True, some patients get results. But it is a dice roll. A factor of there being only 24 hours in a given day and Dr. Diep squeezing in as much productivity as possible for MHTA to amass revenue. That revenue is first and foremost what MHTA achieves above all other clinics. The patient's needs........I can't even say comes second. Time in surgery is split with other patients, then is further divided with consultations. Compromises must be made. Those compromises affect the aesthetic qualities of the surgical hair restoration results you are seeking and paid a hefty price for. And you might be doing yourself a disservice in the future as you'll likely need to treat progression and will have less donors available to you when that time comes. Perhaps, those that have good results had the other patient cancel that day? Perhaps a flock of consultations canceled that day, then Dr. Diep's admin whispered to him he didn't need to be out of surgery within the hour. And it is those lucky patients that have better results. Perhaps it is just a dice roll. What more must we have to tell you? What aren't you seeing? 🙈

6 hours ago, jjsrader said:

All you OCD-anal types earning big $$'s considering Diep - can you obviously not see that you are paying premium prices for mid-level results?  Stop rationalizing 'cause you either live close or his results aren't that bad.

Just pick from at least 5-10 other very outstanding very experienced surgeons in N. America who are way more meticulous & typically only do one patient per day & have outstanding staff & follow up & bedside manner.

It is clear at this point - learn from those that are just as anal/OCD that have paid the price & given you good guidance.

Good luck & good growing.

Word. Eloquently put.

5 hours ago, WS2020 said:

Thanks for all the great pointers here. This is the list that I will bring in with Dr Diep this week for my HT:

1. Use single hair draft for the hairline
2. Don't get all the donor hair on one side of the head
3. Don't go to far up for the donor hair
4. I did bring up the corn row concern with him during my initial consultation. He gave me the same explanation about the density. I may bring it up again.

Otherwise, I am diving in. Btw, I am neither OCD nor take life (or hair) too seriously. Not having too high an expectation going in and hope for a pleasant surprise. Actually, if my front looks like Jim, I am good. 

See what I mean when I say it is very easy to please a balding man :).

One word of advice, get those 4 bullets/conditions in writing and signed. Also, realize the absurdity of needing to pose these things to your surgeon, OMFG.

Looks reallllllly good. Brothers have a hard time achieving density. So all the best on your journey.

The decision to connect is a no-brainer. Who was your surgeon, btw?

Now that I see your pics, FUE with Konior. No-brainer.

I think for FUE, 8000 +/- 500 is where it tops out. Of course, you are going to need a surgeon skilled enough to keep transection loss down to the low single digits to get to that number. But I cannot imagine being able to get much more from FUT alone or FUT + FUE.

So in terms of total donor availability, what is the numeric advantage of FUT or FUT +FUE over FUE alone?

Honestly, if I were to gauge a cut-off for FUT over FUE, I would put that at north of 3200 grafts.  Given your age and progression into MPD at only a NW2, I don't see why a 2000 procedure FUE would be a problem. There is the thought that there is an upsell opportunity for surgeons to press patients for the more expensive FUE procedure. But your procedure only calls for 2k grafts which doesn't cross into the larger sessions that call automatically for FUT. Konior has a reputation for ethics that is beyond reproach. Plus, getting a HT from Konior is equivalent to a bride getting a gown from Vera Wang. Did Cooley also state that your procedure calls for 2000 FUT grafts?

Your an NW2 in your late 30's with or without finasteride?

Konior is the "Ip Man" of surigical hair restoration; the sifu of Bruce Lee himself. It was a rhetorical question. Your donor area never looked painful at all. My recipient had a feeling of pressure pushing from the skull through the scalp around the 2nd month. It would last for 2 hours or so around the evening time, then went away, then would repeat the next day. It was like I could feel the grafts pushing through the skin.

As for the envy thing, I'll trade you my early progress for Konior's work. Deal? LoLoL!

3 hours ago, anotherhairlosssufferer said:

@jimcraig152 - your donor looks pretty ok now don't you think? Plus I don't really see the corn rows any more - never saw them in your case actually to be honest. The density could be better but it's been only 4 months, you're too early, and the density is something we all agree Diep does a good job on.

I tend to take these photos in the best possible setting. Always, they are taken after a shower, after I've applied Rogaine foam, then soon after everything is dry or near dry. This done in a bathroom in the house where I can close the doors so sunlight doesn't make for inconsistent photos. When I look at myself in my other bathroom, the story is different than what you see in the photos.

Here is my donor 4 days after the surgery where I can illustrate the problems with my donor:

1. Encircled in red is my vertex where I had some thinning already
2. Encircled in yellow is where extractions went really high right next to the vertex and I feel too many punches were taken from too small of an area there
3. Encircled in purple is an area where donors were heavily harvested from too small of an area

So now is how these things look in a different light (from my master bathroom):

Extractions near vertex. Also notice the surrounding donor. Virgin areas are at the absolute bottom of the photo for you to compare. Also those virgin areas are the thinnest part of anyone's scalp naturally.

The band of overharvesting towards the bottom of the donor. Also, notice the state of the surrounding donor.

As for the corn rows, he is a photo closer to what I see in the mirror everyday. I do know it is early. This should fill in at the end of this. But compare those rows to the surrounding natural hair.

As for the density thing, I know things are early. But even with Diep patients that have come to full term and have good density, I believe there is a high toll paid for that density. My procedure was for 2332 FUE grafts. Go take a look around this forum at donor areas for 2000-2500 graft procedures s and see if the math adds up for you.

Did you ever experience any pain or discomfort in your donor area? Any intense burrowing sensation at all as the nerve endings reconnect? I am guessing no or not much as you have not mentioned it.

Also, I think you've reached the bottom depths of the ugly duckling stage and you did so quickly. You'll probably be there for another month before you start to rebound. So for Thanksgiving, might just go with a zero fade hairdo.