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On 2/3/2022 at 3:38 PM, Dr. Suhail Khokhar said:

I am on oral minoxidil 2.5mg daily and oral dutasteride 0.5mg every other day. My biggest regret is not getting on these meds much sooner. 

Dr. I’ve been on fin for over 5 years and it’s done well for me. How do I know if and when I should switch to dut? I am 30. 

17 hours ago, Dr. Suhail Khokhar said:

I am on oral minoxidil 2.5mg daily and oral dutasteride 0.5mg every other day. My biggest regret is not getting on these meds much sooner. 

Dr, can I ask why duasteride and not finasteride?

2 hours ago, GHTJourneya said:

The fact that you can't tell is a good sign I guess. Mostly on my temples, this little red dot is included in the transplanted area, although I am not entirely sure it is one of the transplanted follicles. I lowered the temples but I also added some more grafts further back, so I don't really know what happened

Sorry, I didn’t mean where on your scalp was it performed. I meant where in the world (at what clinic) was it performed? 

Where was your HT performed?

I don't know what accounts for why some grafts keep growing and why some don't. It's a good questions. But your theory isn't true from my experience. After my first HT, I had follicles that didn't grow and fell out, but which resulted in hair growth down the line.

Check out Dr Wong's work at H&W. He is renowned for temple and crown work.

1 hour ago, 1978matt said:

Dr K's techs actually do a lot of work so that he doesn't have to.  They organise everything:  Get the patient all prepped up and all the instruments ready.  He literally just walks into the room, scrubs up and does the work, usually with 3 or 4 techs assisting, or more if it's FUT.

Then on breaks he can go to his office, attend to emails for 5-10 minutes while the patient has a comfort break etc.  The techs then sort everything out for the next session, e.g. FUE extractions from another area.

It's like a military operation.

I watched him perform an FUT surgery for a few hours in 2014, so have observed it both in and out of the chair.

Super important insight! I feel like the perception around here is that he's a one-man shop, so this is valuable intel. Goes to show that techs are critical to any successful clinic.

11 minutes ago, Curious25 said:

It’s more to do with controlling variables as opposed to techs vs docs.
 

An experienced tech & doc team that have a track record of producing good results is fine, as long as you can guatentee it is the same technicians who will be working on your case that day, a long with the same doctor involvement. 

An experienced doctor who does ‘all the work’, and has a track record of producing good results - based upon the knowledge we have as the general public, is a more assured way of being able to control this variable - because how many technicians names do people know of from any of the top clinics? None - because they are often the unsung heroes, and it’s the doctors name who takes credit for the work. 
 

So you are relying on the fact that the technicians on your particular surgery will be the same ones that played the tech roles in producing the good results. 
 

Now this is fine, for the majority of the time, in most top clinics, as they tend to have smaller turn over in tech staff, and less overall numbers of techs on their payroll in general.
 

However - when clinics branch out, start to increase their volume of patients, and grow quicker than they can maintain quality control - this is when it becomes an issue.
 

We saw it happen to Asmed, we see it happen with Cinik, from the vastly varying degrees of success his patients have, and I wonder whether techs have been the issue with the poor results from Dr Arshad recently.
 

Basically, you are counting on the clinics word that they are using their regular techs or experienced techs with you - when in reality you have no way in properly being able to verify this. So, as far as being able to accurately ascertain a clinics success ratio - it is far easier to do so, when the Dr who you have heard of and physically know of, plays a large proportion of the role, as this is what you will be getting. 
 

This isn’t to say tech clinics aren’t as good - it’s to point out that it’s one more variable out of your control/knowledge. 

Totally see your point. I think it comes down to if you trust the doctor's judgement to surround themselves with the best team. What I'm simply saying is that if they do, then I don't see how more, capable people in the process isn't always net positive. So I think we are saying the same thing!

6 hours ago, 5BetaReductase said:

Without going into the details of my case, I went to a clinic where techs were “very involved.” In fact, they did all the extractions. When I look back, I WISH I would have gone with a doctor like konior that’s involved in all steps. I’ll tell you why….

 

A clinic that delegates a lot of its work to techs usually translates to one thing: the doctor is trying to squeeze out as much money as possible and does multiple surgeries per day. Secondary to this, the doctors time is taken up by other activities (tending to other patients, doing consults, or just browsing his stock portfolio in his office because he’s lazy). Time is limited in clinics like this so you get things like rushed consults, overlooked issues, decrease in quality control, etc. If you are a more complex case due to hair/surgical characteristics (like myself) it’s straight up Russian roulette. Your results are going to be messed up: bad yield, messed up donor due to improper planning, etc. 

 

A doctor that dedicates his time solely to one patient per day is worth their weight in gold.

Great points! I don't want to get into a protracted back-forth over this question and hijack this thread --  but maybe it would be interesting to have out this debate on a thread of its own, because I do see it come up often.

My  pushback to your point is that you're jumping to the conclusion "if the doc is involved, it will come out better" without any supporting evidence. Totally agree that if the team (eg doc + techs) is unprofessional and untrained, then the procedure is a game of Russian roulette. However, the same can be said if the doctor is untrained as well. But if the team is well trained, then I would argue that more people is only additive to the process. As one anecdote, I recently had a second surgery at a top clinic and there were 4-5 techs working alongside the doctor. These techs had a combined 50+ years of experience working with this doctor.

With regard to your point about economic motives, while I see your point, I also disagree. Yes, more more patients per day = more revenue. However, it also means higher variable costs like real estate and labor (if each patient requires a team of 4-5 techs), so the math isn't as clear. Of course, it all depends how the clinic is set up. Hair mills will try to squeeze the most out of their spaces and techs to reduce these costs. But at top clinics that use techs, and in my experience, the team that was with me did not feel rushed and were assigned to my case for the entire day.

At the end of the day, I don't think there's a "best practice" on this question. I think it has to come down to the particular case.

1 hour ago, BDK081522 said:

Cutting corners and Raymond Konior should not even be in the same sentence. Cmon mate, you're certainly entitled to your opinion and obviously chose someone else but don't negatively speculate about someone's work ethic that you truly have no firsthand experience with. His lead tech has been with him for around 20 years. Do you seriously think she would still be there if he was that difficult to work for?

Yes you are certainly right!  

I’m just sharing how his unusual approach to patient management made me feel as a potential customer, since that is what the OP was discussing as far as outreach.
 

As with yours, most of Konior’s work I’ve seen on this forum is  outstanding and it speaks volumes that he has devoted patients like you. I do stand by my thoughts about teamwork though.  I will edit my post for clarity - thank you. 

5 hours ago, 1978matt said:

That's why he's very good value, even at $15/graft.

This is just my opinion, and it probably won't be popular here (!), but it actually struck me as unprofessional that he didn't have a patient coordinator...  or for that matter utilize many technicians. I understand the argument that his hands-on approach can lead to more personalized attention and detail, but another way to look at it is cutting corners or being difficult to work for. I think in a labor intensive surgery like HT, it is important for doctors to surround themselves with a capable team. Specialized teams almost always perform better work than individuals in any field. Having been in the army I analogize it to a military operation. Even the very best combatant is nothing without a supporting team. For that reason, among others, I actually decided against Konior. All that said, many of his results are terrific and emphatically do not appear like a doctor who cuts corners. 

It is a large area to fill at high density for 2K grafts. Depending on your goals, you may be happy or you may opt for a second pass. I'm no expert but the work looks fairly clean in the back. The hairline appears a bit too straight for my taste, but that can also be adjusted in the future if you'd like.

Sorry to hear of your struggles man. Good news is that I think what you describe is very doable. I was recently looking into repairs as well and found that in addition to Konior, there is Cooley, Shapiro, and H&W to consider as well. I don't think you can go wrong with any of them! Something important to me was time frame, and some of these docs are scheduled out over a year.

IMHO there's no objective measure of "best" surgeon. It's not as if there's a competition where they compete and get ranked by a panel of judges. 😅 I've noticed there's a mentality on some parts of this forum (and others) where particular doctors and clinics attract a lot of attention and get hyped up as the "best"...  But you'll be grasping for straws trying to crown a winner because it comes down to so many factors. Plus, the vast majority of transplant patients do not post their photos on the internet for the world to see - so keep in mind that you have a significant sample bias.  What I would say is that you should identify the top 5-10 clinics (some of which are on your list), then base your decision on a number of personal factors like timeframe/availability, cost, proximity, dr's bedside manner, travel restrictions, etc. For my first surgery I did not go to a top clinic, and I kind of regret it now. But if you go to any of the top clinics then I think you'll be set.

Thanks all. @Ryan Rap@BDK081522

I reached out to Konior but he said his surgical fee would not justify the number of grafts needed. While his colleague Dr Nadimi looks promising, I would prefer to go with a surgeon that has a few more "reps" under his or her belt.

I would like to find the best hairline FUE surgeon in North America for this issue. So far thanks to help on this forum, I've narrowed it down to:

• Dr Wong (or Dr Hasson -- for some reason I was paired with Dr Wong when I reached out for a consult)
• Dr Cooley
• Dr Shapiro

Anyone else I'm missing? Between these docs, are there any discernible differences? I'm ideally looking for greater density and naturalness. Feel free to post here or PM if you have a private opinion.

Many thanks!

1 hour ago, BDK081522 said:

Your first surgeon tried to cover an extremely large area for only 1700 grafts. You were always going to need more grafts to achieve adequate density. It does look a bit pluggy and could use some refinement. Check out Dr. Gabel, Dr. Bruno Ferreira, Dr. Hasson, and Dr. Konior. They would all be able to achieve a dense natural looking result if you have the donor to sustain it. 

Thanks for the feedback. Yes - I am now looking for round 2 in order to close it out. I will look into these docs. Any reason you recommend Hasson but not Wong?

59 minutes ago, SadMan2021 said:

curious why you opted for a no-shave procedure? 

The doctor said he didn't need to shave the entire head for the transplant. He did shave the whole recipient site though. In retrospect, I wish I had shaved my head entirely because it took a while for all the different regions to look proportional.

3 hours ago, gillenator said:

Can you share some pics so we can see the area?

Of course. Here is a progression for reference...

Pre surgery:

Immediately post surgery:

12-18 moths post surgery - a variety of views in different lighting / haircut styles:

Hi friends,

I was on this board about a year ago to document my first procedure. 18 months have passed now, and overall the result is OK -- better than it was before. But there are aspects of my new hairline that I want to improve. In particular I want to add density and more naturalness to the very front. In some lighting and positions, the first row of grafts can look a little pluggy. I think my original doc did a fairly good job with 1700 grafts in taking me from point A to point B, but now I want to go to an expert surgeon to really complete the look. Based on some initial research and outreach to top surgeons, I've been told that I will need about 1500 more grafts and possibly have to reposition some of the existing hair based on the new hairline.

With that said, I am seeking recommendations for who is the best in the industry for my particular case. So far I'm interested in Dr. Wong and Dr. Cooley based on reading reviews on this forum. Does anyone have thoughts on who else I should into? Thank you very much.

9 Month Update

Thanks to folks for expressing interest in my journey here. Contrary to some people's speculations, things are going great  In fact, I haven't posted or been active here because I don't have any need to be anymore. It's been a wild ride - with some weeks feeling great, others feeling low. But all in all, when I look back at my pictures from before the surgery, I am very satisfied with how things are turning out. The result looks so natural that nobody (even close family/friends) have been able to tell. Thanks to all who have helped along the way.

There were points at which I thought I would need a small touch up in some areas, but I don't feel that way anymore. I actually still feel some stubble on the very front of the hairline, so I think I'll continue to see growth over the next few months. 

Attached are some update pics in different lighting from the past month.

Can you share photos please?

It would be nice to see the donor area.

2 hours ago, DrTBarghouthi said:

I do believe that a hairline, since it is not really a straight line, would generally be more than 15 cm usually. I usually use consistently around 400 single hair grafts for the transition zone. This is usally 2-3 rows along with some micro and macro irregularities (which increases the surface area). For some reason, this number is generally satisfying to me in terms of the areas covered, the irregularities and the density. Yet it just doesnt extend too far back. The third or even fourth row usually has singles with some doubles blended in too. If you think about it, 15 cm requires roughly 150 single hairs if you go every mm with a graft. Multiply that by 2 or 3 and you get roughly at least 300-450 hairs needed depending on the various variables. 

In your experience, do single grafts grow slower/differently than multigrafts? I am 3 months post FUE and for some reason, 1-2 rows of singles on my left side have not started to grow... whereas they have on my right side.

There is clearly a diversion tactic being played in this thread by those coming to the aid of Dr Diep. All of this "whataboutism" with regard to some good results doesn't negate the bad or mediocre ones. After all, as @jimcraig152 has eloquently pointed out, the mark of a good surgeon is his or her ability to produce good results consistently. 

The beauty of this forum is that it provides free information for people to make an independent decision about who they want operating on their body. The laws of supply and demand have a way of working themselves out in the long run. Only with honest criticism and self-reflection can Diep improve his practice and help men regain their hair. After all, that's why we're all here! So let's be thankful to those who point out flaws and stop trying to cover for a doctor instead. 

3 Month Update

Thanks @cpfm for the reminder to post my update. It's been on my list, as this week marks the 3 month point in my journey.

Overall, things are progressing well I'd say. I had my first haircut since the surgery last week, and my barber couldn't really tell I had anything done. He just assumed my hair was a mess because of the lockdown! After that haircut, I had a boost in confidence because my new hairline was coming in, and it was imperceptible that I had any work done. I no longer wear a hat out in public.

I think I'm an early grower, because I've seen a lot of growth in my temple points. In fact, I had growth starting from the second month. Still, I see new hairs sprouting when I check in the mirror every day.

The one area of concern that I have is my left frontal hairline, where the doctor implanted 2 rows of 1 hair grafts. For some reason, this hasn't come in on my left side while it has started to on my right. I'm trying to stay positive about this, but it worries me given the growth everywhere else... why not here? 

Attaching photos below, including one of the donor (shout out, @jimcraig152). Happy to answer any other questions.

Here is Month 2 for comparison: