HairRun

No, unfortunately I received sexual side effects as well. I wrote a detailed post about it here. I will be trying topical dut next

The Italian pharmacy often mentioned here combines both. If you're doing Xyon, don't, switch to oral min, otherwise the topical min may help absorb the fin systemically.

Great question. One factor I was looking for is who has the most knowledge regarding hair transplants, so they could use that knowledge to prescribe the best course possible for repair. I came to the conclusion that it's Dr Shapiro. Two thinks that were very green flags was his curiosity, and sharing. Curiosity means that he lives/eats/breathes hair transplants and always looking to learn new information. Sharing means that he has learned new things and would like to share his findings and passions for others. I think the other people you mention all have those characteristics, but from what I could find online, Dr Shapiro has the most examples of these. Yup, coming up in the 2.25 month update.

Also, OP may have a chance to do some consults with the top doctors over there. They may diagnose his donor area, and come up with a hairline design that the OP can then spends months to reflect upon.

No, it was from topical fin. Switching from topical min to oral min delayed the onset of sexual sideeffects by a few weeks, but I still received a side effect of a mild ball ache.

Is there good evidence that tretinoin helps?

I'm only two months in, but I wanted to start a draft while the memories of the procedure are still fresh, but I'm going to forgot a lot of it by the time a year is up. I'll be updating this every month or so. When going through possible surgeons for my repair transplant, I always felt that there was always a certain weightiness in how people describe Dr Shapiro. I think he might be the most cited surgeon among top hair transplant industry people. My impression from what people say about him is that he's a guy dedicated to learning and teaching, expressed through the books and research papers he's published. He loved conferences and sharing what he learned and learning from others. From my research, I concluded that he's best in the world for complicated hair transplant cases. I find it really apt that he's in Minnesota, also home the Mayo Clinic, which is often cited best in the world for complicated medical cases. I remember I saw Melvin once describe him as the most ethical person on the face of the planet. I remember seeing Dr Konior once imploring a patient to go back to Shapiro once he found out he was a former patient. Dr Mwamba said his favorite hair transplant surgeon is Dr Shapiro because he still loves to learn from others, even with his many years of experience. He is also said to be a top choice for hair transplant surgeons themselves to get a procedure. I would consider myself a complicated case. I had my first transplant with a surgeon whose techniques were described as bad from other top hair transplant surgeons, and what appeared to me as an inexperienced staff, which left me with a lot of complications. But even within the type of techniques that surgeon is known for, I might have had a low yield , and that I may need a skin biopsy to determine if I am a suitable hair transplant patient, and described in this comment https://www.hairrestorationnetwork.com/topic/63522-has-anyone-repaired-a-procedure-done-by-dr-diep-who-did-you-go-to-and-how-did-it-turn-out/?do=findComment&comment=641083 So I really wanted to go with the most medically knowledgeable guy in hair transplantation, and I felt that it was likely Dr Shapiro, and the procedure lived up to the hype of my research. It feels really good to be in a similar situation where you ended making the wrong decision the first time, then you make the absolute right decision this time around. Also wanted to give a shoutout to his patient advisor, Matt Zupan. Over the course of a year, he must've given me couple of hours of advice for my hair transplant journey. It was all massively useful and I am very grateful for it. Day of the Procedure I show up around 7 and get photos done and then pick my lunch choice from a menu. I then talk to Dr Shapiro. Matt Zupan had provided him with my entire case history. For this procedure, I wanted to go conservative, for a few reasons. First is that I wanted a smaller procedure, just in case I somehow get a poor yield again (by now I think the yield will likely be good), which I knew was very less likely with Dr Shapiro than with my first transplant doctor, but I still had a lingering doubt, especially after that one biopsy comment. 2nd is I wasn't exactly sure what I wanted for my final hairline at the moment. I liked the idea of building up the base, and then going from there. 3rd is that I would have needed two procedures anyway, or at least that was the thinking at the time. At the time they were thinking they wouldn't have time to relocate the badly transplanted grafts, and they would do it in a future procedure. So I figured But they ended up doing the punchouts in that procedure. 4th, I heard FUEis better for hairlines, because they can select the exact grafts for the best overall visuals. 5th, also not really sure if this true, but I wanted to focus all of my body's healing into fewer grafts. I'm thinking maybe this might not be the case, but here's a discussion on it https://www.hairrestorationnetwork.com/topic/65893-is-there-an-increased-risk-for-doing-megasessions-lower-yield/ 6th, actually I wasn't thinking of this at the time, but a smaller FUTprocedure would tax the remaining scalp elasticity more. At 2 months post-op, my scalp still feels a bit tight, and the cutout area a bit sore at times. I showed him some pictures from some of my older days, where I was a bit into my hairliness, of where I wanted my hairline to be. He came up with a hairline which I thought was a bit more skinnier than that. I was thinking of maybe asking to widen it a bit but I decided to go for it since I was biased to having a smaller procedure. Dr Shapiro also mentioned they can build up on it later, which was what I was thinking as well. We also discussed Acell and PRP, but Dr Shapiro said Exomes are better, so I opted for that. Next, I can't exactly remember the order of the next steps, but the following happened. I think the next part was considering where to take the FUTcutouts. He mentioned that my previous surgeon took the FUTin too high of a region, and he seemed to be considering a lot in where to take the cutouts. Even before the procedure, I had suspected there there may be other complications that I wasn't aware of, and It was moments like this when I was glad I was doing the procedure with a highly experienced surgeon who has seen it all. I remember he was asking questions about my old procedure, I think not just to plan the current one, but he was just genuinely curious about it. He's been very much described as a curious person, who always has the wheels turning about transplantation, and it was cool to seem doing it in person. For the steps where I was laying down, I can't account every single thing since I was dozing in and out of sleep (I didn't sleep much the previous night) I think the next part was the anesthesia. The whole staff seemed really experienced, and at several points Dr Shapiro wanted to hear their thoughts on how this part was going, which I think speaks a lot about the staff. I was surprised at how long this took, they seemed to take their time and they seemed to be very focused on precision. They asked a lot of questions about what exactly I was feeling on each part of my head. At my first procedure I believe he just gave me some meds and and a few shots, but I didn't feel anything at that procedure either. Dr Shapiro asked me if Dr Diep did a procedure like this during my first transplant, I said they didn't. Dr Shapiro said they probably used a novacaine shot. But actually after the procedure I looked at the record for the first procedure and they did indeed use Anesthesia. I wonder if there was any consequence for the detailed vs rushed procedure. For my first procedure, my scalp didn't have feeling about a year from the procedure, which is normal. However, after Dr Shapiro's procedure, about two months later I have feeling return on just about everywhere on my scalp except for a region at my left-back. So this might be a result of the time they took for the anesthesia step. During this step, I saw a Matt Zupan-looking blur (I wasn't wearing my glasses). I had been speaking to him over phone for a year, but this was my first time talking to him in real life. When I was having lunch, I got to chat more with him (this time with my glasses). Dr Shapiro did all the incisions himself. This step took a while. One difference I noticed between my two procedures is that Dr Shapiro made each of the incisions one at a time. As for my first procedure, I felt that Dr Diep was using a tool that had many points on it, so that he could create multiple slits at the same time. At some point I look up and see a Dr Josephitis looking blur (I wasn't wearing my glasses lol). I recognized him from their youtube videos. Dr Josephitis did the punchouts of the badly placed grafts from my first procedure. He said there was about a 100 on each side, and that he used the smallest punch. I gave him his own review here The last step was the graft placement. This was done by 2, maybe 3 techs (I wasn't wearing my glasses). Dr Shapiro stepped out for a bit during this part. After a while Dr Shapiro came back in and analyzed the progress, then made some more incisions, and planned and guided out what to do with the rest of the grafts. At the end I got to see what it looked like. I was a bit shocked lol because I have never seen my self bald/bald-ish before. It looked like I was out of an apocalyptic future because I looked really old and the recipient area was a bit bloody. I opted for the conservative hairline for this round, but it was a bit surprising to see it in the post-op phase. After this, there was the debrief. Dr Shapiro said that the grafts were in there pretty good but friction, like where you directly rub against them, good lodge them out. From this description, it seemed like they were really in there, compared to my first procedure. I remember after my first hair transplant procedure, I dropped something and went to pick it up, and Dr Diep and his two technicians freaked out because they didn't want me to mess up my transplant. They said that I shouldn't lean over for the next couple days. So it seems like in my first procedure, the grafts were looser than this procedure at end of the day. I think this had to do with Dr Shapiro doing all the incisions himself and being very precise about it. Vs Using a tool with multiple points to create many incisions at the same time (if that's what happened). I feel like with the current transplant, I could probably pick something off the floor and not worry about loose grafts, but I wanted to be safer than sorry so I stayed upright for the first 2-3 nights, including sleeping upright. When I got back to my hotel room I was still a little perturbed by the sight of me lol, but it got a lot better once the excess blood came off with the ATP solution they gave me. It was a liposomal ATP solution that you're supposed to spray on your head every 30 minutes. Eventually after spray sessions, the excess blood came off and I was looking at a lot better. The next day I went to the clinic for a wash and followup. After the wash, the medical professional said she was going to press any sticking out grafts back in, but she couldn't find any. In fact, she said I was a fast healer, which was cool to hear, especially as I was worried about potential yield issues. The next several days I spend camping out in my hotel room. After a few days, I went to take a tour of the legendary Mayo Clinic. The people who gave me the tour said that they focus on accepting people with the most complex cases. I thought it was a great coincidence because I want to Dr Shapiro's clinic for that same reason. The day of my flight, I went back for a 2nd followup to make sure everything was ok. They're really good with aftercare, and gave me the number of one of the medical professionals to text in case something comes up. There was a few things I was nervous about post procedure. One was scarring, I scar easily and was worried about polkadot scars at my temples. 10 days post I can tell you the punch outs healed without a trace. https://www.hairrestorationnetwork.com/topic/65667-review-excerpt-about-200-temple-punchouts-from-dr-david-josephitis-of-shapiro-medical-group-repair-to-transplant-by-dr-john-diep-10-days-out-and-did-exsomes-regenerate-my-hair-and-prevent-scarring/ There is however, some discoloration, not from this procedure, but from the first one, it's something I've sorta noticed but with the hairs removed it's easier to see. I hope to cover some of it in my next procedure. The final concern was the yield, though one thing that was very promising is that all the grafts grew a bit before falling out. Around 1 month in started feeling new stubble. 2 months in, I'm feeling more of new stubble as I run my fingers through it. I'm addicted to feeling my scalp stubble lol. And this is only month 2, which is technically still the ugly ducking month. The next step for me is to finished off my temples. For my next transplant, I'm going to really enjoy it. I enjoyed the last one a lot since it's been a process I've been fascinated for a while now, but my lingering concerns about scarring and yield prevented me from fully enjoying it. I'm going to really enjoy the next one. Besides the hair transplant, I have some other things to look forward about. Dr Shapiro convinced me to use a laser hat. If someone like Dr Shapiro says it helps, then I'll definitely try it. Dr Shapiro also recommended oral minoxidil. I also started using retinols in my hair (advice from David Sinclair). It's a bit early to tell, but the oral minoxidil seems to making my eye brows thicker, not something I desire lol, but maybe this a promising sign my head hair will follow? Though It may be that I wasn't paying attention before, but it it works out this may allow me to opt for full face framing in the future, with temple point restoration and everything. Finally, and this something I am very excited for, is that I can use my beard grafts. I have a really thick, dense, and fast growing beard, which I am not really into. In my early 20s I tried shaving 2x a day before getting too lazy to continue. I think I would be a really strong beard donor recipient but my issue was (or so I thought) is that I scar easily, and I didn't want to have polkadot scars. So it was kind of frustrating that I had a source of maybe thousands of grafts on my face that I don't care for, but wasn't able to use on my head. But after I saw results of Dr Josephitis punchouts, it's like those are finally unlocked. I can't wait to use them, not only for more coverage on the scalp, but also to make shaving a less pain in the ass. I've been researching a lot about beard grafts since. Something else cool that I figured out is that the neck heals really fast since it's a vascular area. My only issue is that my beard grayed faster than the rest of my hair, especially during the worst of the pandemic. I'm hoping it may be a bit more stabilized so that the black ones can still be transplanted. I've been taking a copper glycerinate supplement 2x a day, eating more bivalves, supplementing with magnesium, and trying to sleep as much as possible. Even without these, I was thinking about being optimizing the front in general. At first I wanted to spare them in case my crown goes, but I've learned that the first doesn't take as many grafts as the crown, and actually the crown is like a black hole due to the swirl. Aesthetically, the front is much more efficient because the front frames your face. I was worried about ending up like Joe Biden, but being more educated, it won't looks like that since there's enough grafts with the mid too. It would more likely end up like Jon Stewart, who also had crown loss, but I think he looks good since he has good framing of the face. Finally, thanks from the bottom of my heart to the community and all the help I received navigating my transplant journey. I found this subreddit by accident, I would have had a very different journey without it. Now for pictures Day 0/1 month 0.5, right before grafts started falling out I wish I took more pictures, but it looks like all the grafts grew right? Might be a good sign for yield Month 2

6125 is already a lot of grafts for one session, so a follow up would be good to finish the rest.

Hair Transplant Cost | How Much Does Hair Transplant Surgery Cost? (hassonandwong.com)

1 week on, 1 week off sounds like a great idea if you've previously shown sensitivity to finasteride.

"I will be using 1ml 5% topical minoxidil every night before bed." In my experience this caused it to give side effects when I combined with topical fin. I would recommend going oral min instead

Just cancel, and then when you're done order the next batch. It's how I handle my amazon subs lol

Update to my last edit, both are 1ml so amount should be the same. Perhaps, but I think the best next experiment to try is Dr Mwamba's topical dut. Actually, I am going for topical dut next. I've heard topical dut has a less chance of going systemic due to higher molecular weight. I wouldn't call it pain, I've seen it called 'ball-ache' so that's the term I've used, it's mildly painful but more annoying than aggravating. But with all three formulations I've tried, it always takes a few weeks for the sexual sideeffects to kick in. I was hoping it wouldn't happen with this one due to the better formulation. All three I've tried are much better than micro dose oral fin btw, where I would get side effects in a week, though I can't really say if I were taking an equivalent dose, since I'm not sure if all of it gets in your skin, I think a fraction sticks onto your hair. But I think for those with finasteride sensitivity, for sure the safer trial is micro dosing on topical finasteride. Luckily I didn't have post finasteride syndrome, but if I were a completely new to fin, I would start with an even lower dose than anything I tried before, say 0.1% or even 0.05% finasteride, do a few weeks of 1 application per week, then a few of 3 applications a week, and slowly build up. In my case, it always takes a few weeks to feel the full effects of the sides.

I am looking to finish off my hairline and I am searching who is the best of the best for this. From the Top threads, I got Cuoto, Freitas, and Pinto. From my own search, I also added Vila and Reddy on there as well. Added Perkiner and Nader as well. Is there anyone else who you might consider best of the best for hairlines?

You had Dr Diep right? I did too and also have a wide scar. One of the surgeons that I consulted with who was pretty familiar with Dr Diep's work said it's a common trait of his work When I had my procedure done with Dr Shapiro, he asked me if I went back to get my sutures removed, I said I didn't, they just fell out. He said those types of sutures tend to cause inflammation. I watched a youtube video on the best scarring treatments by a dermatologist. She said silicone gel has the most research behind it. Hydroulic acid is pretty good too, which is pretty much in all good quality lotions.

I guess I'm out of the topical finasteride game for good now. Here is my breakdown of the 3 topical finasteride treatments I've used. California Specialty Pharmacy's formulation was .25% if memory serves me correctly. Both Farmacia Parati and Xyon were at 2.5%. California Specialty Pharmacy (CSP) This what Dr William Rassman prescribed. He said it was based off an Italian formulation (which I assume is Farmacia Parati) and he worked work California Specialty Pharmacy to compound the medication. The medication has minoxidil as well. It's the cheapest to get out of the three since it's made in US, if you're shipping to the US. It has an off putting chemical smell, and texture sort of like whipped cream. You need to rub it in well to prevent white cast. I tried the recommended dosage at first and got sides, which was 4 pumps a day. Then I did 4 pumps every other day. And then 2 pumps every other day. Then tried 2 pumps a week. For the last dosage, I lasted over a month at least before I got sides. I wish I tracked the specific number of applications, but it was 4-5 applications probably. tl;dr, lasted 4-5 applications at 1/10th dosage as Xyon and Farmacia Parati Farmacia Parati (FP) This is what Dr Ron Shapiro prescribes, this is something he has researched quite well. I was talking to his patient advocate, Matt Zupan, about my previous trial with California Specialty Pharmacy, and he recommended giving Farmacia Parati a try. From my research, Dr Ron Shapiro has the most indicators that he is the most seen-it-all guy in hair transplantation, so I wanted to give it a try. Like CSP, it also has minoxidil in it. It is 2.5%, which surprised me as it is like 10x of CSP, but he said that's what they start off most people with so I went for it. Unlike CSP, it has a very mild smell, and whatever smell it does have, is actually on the pleasant side, so I can apply it anytime without worrying about my scent. It also has a much better consistency, like lotion, very easy to rub in and no white cast. I started with 4 pumps a day, every other day. Got sides, then switched to two pumps a day, every other day. Then finally, 2 pumps a week. After 4 applications I got side effects again, I think about 2 days after my 4th application. So maybe about the same number of applications as CSP, but at 10x the dosage. So from this, maybe the FP formula has a better liposomal formula. tl;dr lasted 4 applications same dosage as Xyon and 10x dosage as CSP. Xyon This was a formula Dr Victor Hassan worked on with a pharmacy that I can't remember its name. This formula has the strongest theoretical foundation. This formulation does not have minoxidil in it. My first trials were a disaster because I was trying to juggle this is topical minoxidil, as from my experience, the minoxidil causes fin side effects. I tried a half pump on a Saturday, and then didn't do minoxidil until the following Friday, and shortly after, I got side effects. So it feels like the carriers in the topical minoxidil causes the formulation in the Xyon formula to break down or something, and the fin gets absorbed. I didn't want to give up on min, so I just left it in the fridge. After my procedure with Dr Shaprio, he prescribed me oral min. I also didn't want to use topical min because my scalp is healing from the procedure, so this would be a good time to give Xyon a try. This time I was doing half a pump 1x a week, so that the dosage would be equivalent to FP. The first may have been off, because it's tricky to do half a pump. But the 2nd and 3rd times, I just took out a full pump and threw away the rest. This time it lasted way longer than the first trials, so maybe I was correct in my theory about topical min interfering with it, but unfortunately the formula still didn't work for me. I has 3 applications, and then 3 days after my last application, got side effects. This one really bummed me out. It was my last chance at being on the most effective medication for hair loss. tl;dr lasted 3 applications same dosage as FP and 10x dosage as CSP. Conclusions I think the main conclusion for me is that topical finasteride is probably not for me. As for the best formula for others, there may be some interesting observations but there are probably limits to what you can conclude, since this is one sample size of data. For example, there might be something unique about my physiology that makes the Xyon formula not work with me for some reason. I'm just armchair sciencing it this point but maybe my defensive cells didn't like the formula and attacked it, total armchair science but my point is there could have been other factors rather than it just being a less effect formula. For anyone in the topical finasteride game, I highly implore giving Xyon a try, I think you got to. 400$ is a small price to pay to check if a very potent form of retaining hair works for you. If you think about it, say that the formula saves you like 3000 grafts worth of hair, at 8 dollars a graft, from this viewpoint, you gained 16,000 dollars, but these are extra grafts that you get without hurting your donor or anything like that. I would think of it as a low risk, high potential reward investment. I also implore giving Farmacia Parati a try as well for this same reason. At least for me, it seems to work about the same or better than Xyon. It'll be interesting to see the results as more reviews come in for people who tried both and found which one is better. Next Steps for me I think I'm out of the fin game. I've been trying various formulas and dosages since 2019. For some people, a microdose may be all that's needed to maintain hair, but for me during this time, I continued to lose it. Most of the time during this period, I has side effects. I didn't have post finasteride syndrome. The side effects went away about 2 weeks, 3 weeks top every time I stopped using it, I just continued to trial it in search for a regimen that might work for me. Perhaps there is a microdose so small of topical that it helps with a small percentage of loss, without noticeable side, but to me it's not worth it. There is one more think I can try. topical dut. The theory is that it's a much larger molecule than fin, so it doesn't get absorbed as easily. Perhaps I will try this, but probably not. Besides those, I think I might go back to FP for just a pure liposomal min. Dr Hassan said people on Min have weaker skin, and there's a theoretical bases for it, interfering with production of collagen. But just arm chair sciencing it, what if it's the carriers in topical min. They tend to have alcohol, which I think also messes up skin. I read it causes something like glycation of the skin, Advanced glycation end-products in patients with chronic alcohol misuse - PubMed (nih.gov) So topical min might help. Also liposomal formulas might help deliver min directly to the follicles better than current formulations. There may be benefit to direct contact, in addition to oral ingestion. Again, totally armchair sciencing it, but it's one of those very low risk, high potential reward things. EDIT: After I posted this, I realized that I may not be accounting for the total dosage of each application. So both FP and Xyon may be at 2.5%, but what if Xyon, since it's more effective, has 2x the total dosage because the amount is higher. So that with FP, it gets a total of 0.5 grams of fin per application, but Xyon gives 1.0 grams. So I may not have been giving an apples to apples comparison. Luckily I still have some FP bottles in my fridge. When I get a chance, I'll need to see if I can calculate is Xyon's dosage is indeed higher. If so, that'll make a lot of sense, since it has a stronger theoretical foundation. EDIT 2: Both are 1 ml

A doctor consultation usually costs money, though Timothy Carmen did a consultation with me for free.

Failure rate was not the most accurate term, I was thinking of an engineering term but failure sounds like very little yield, so I updated the comment to say flaw rate.

One clarification, it wasn't the dosage that eliminated the sexual side effects, it was not using topical minoxidil. I remember on my last trial, I did a half pump of xyon on a Sat, and then waited 6 days and the very next Friday I did topical min, and the sides hit pretty fast, within the same day or next day. I am on oral min now, and so far 2 weeks / 2 applications, so far ball aches but no sexual side effects.

I was considering Eugenix due to their experience with beard grafts. I would have been ok with the flaw rate if it was the same team each time with heavy doctor involvement, so they can pin point what went wrong each time, but it seems to have a high number of technicians, and the doctor only seems to be there a fraction of the time, so in those conditions it might be harder to pinpoint what went wrong. I could be wrong with how I eliminated them from consideration, but like Melvin said, you need to be 100%, it was the approach I took towards repair and it has 100% worked out for me.

I can't agree with this enough. There were several clinics where I was mostly sure of, like 99%, had the opportunity to put down a deposit, but since it's such an important procedure, I didn't go through with it. So glad I did, it was the absolutely right choice each time. I eventually ended up with the best possible clinic for my case and wouldn't have done that if I just went with one of the 99% clinics.

Yeah but what if you want to be a bit more mature than that? I wish I took pictures of my hairline every 6 months or so during my early 20s so that I have an exact reference t

I am looking to finalize my hairline design and I would like to learn as much about it as possible, so that when my surgeon makes his suggested hairline, I'll know where he's coming from, how it'll turn out, and how it'll be perceived. And if for any reason I have a suggestions, it's from a well informed foundation.

Anyone know Reddy's prices and wait times?

What are his prices and wait times?