ScottishGuy21

A trip to Dr Couto maybe?

1 hour ago, mr_peanutbutter said:

how many grafts does klopp need for crown?

 

He’s already had to work done to his front but that seems to have thinned out. Hence especially in winter months the almost permanent cap.

Big improvement. Yes if you’re being picky the front could do with a minor touch up but he’s done a very good job.

1 hour ago, h_kovacs said:

I have never experienced hair loss when going back to the gym and I have been on and off for years

I have also not noticed any hair loss while taking creatine

Everybody is different.
 

As you touch on the gym won’t have a massive impact on hairloss but there’s a fairly wide scale debate and scientific studies into the impact of supplements. Creatine seems to be the big one but I’m glad it hasn’t impacted you adversely.

The gold standard of hair transplant quality, also the gold standard of presentation too.

Bisanga towards the end here suggests if untreated it can lead to hair loss.

Like with most things I guess early treatment is key. SD can lead to inflammation which in turn we know does cause hair loss. 

2 hours ago, NeonDemon said:

I had an online consultation with Dr. Guerreiro this past monday in which he said medication before the transplant would not be necessary but it could certainly help. Those are his words, as far as I recall. I also became quite surprised at this radical difference in opinion between one doctor and the other. The reasons given to me by Dr. Guerreiro were that he believes the medication would not help me regain my hair nor would it make a huge difference before the transplant when it comes to density, for example. He seemed genuinely confused as to why Dr. Pinto asked me to do the medication for a full year before a physical evaluation and suggested that perhaps, because they have a long waiting list, it would serve as a way to keep me in that list as I waited for the medication to take effect.
I am currently hesitant to post pictures as I am wary of my privacy, however, I have been diagnosed with a Norwood 5 by Dr. Guerreiro. I have nearly no hair on my front, just a tiny patch in the center and my crown's portion is extremely thin, despite having more hair than my front. At least my sides have rather thick hair comparatively speaking, to the extent that, when I wear a beanie, people think I have good hair because I place the sides across my forehead to disguise my hair loss, haha. I was also told my donor area is good and I should have around 8000 grafts in it. When it comes to family history, both my father and grandfather had more hair loss on the crown than the front, with my father having had more hair on his front even in his later years compared to me! Even on my mother's side, my grandfather had decent hair in the front but lacked in the crown area.

I appreciate your honesty and do not consider it to be negative, but rather, realistic and cautious, which is exactly what I was looking for by coming here and asking for people's opinions. So thank you.

It does seem so far that taking the finasteride plus minoxidil for a year is the way to go. My main concern, however, is if my alopecia does not stabilize and in 2025, Dr. Pinto refuses to do the surgery. Then I will feel like I am a year older and back to square one. The patient coordinator for Dr. Pinto did say that it is "very rare" that a patient's alopecia does not stabilize after a full year on the medication. Let's hope I wouldn't be one of those unlucky few...

If he thought you weren’t a good candidate like all reputable surgeons he would have said there and then. Encouraging medication may actually save you money if you respond well. I’m guessing he thinks the crown especially may benefit from Minoxidil. Waiting a year will also give you a degree of certainty about the longevity of your transplant. Have either mentioned their approaches? Nw 5s often take more then one sitting.

I was in a very similar situation to yourself if you check my post history, with 8000 grafts available in the donor it will be more than enough to make a radical difference. I know this stage of the process is such a daunting position to be in but you are doing the right thing and doing your research. Good Luck

I’m a little alarmed here. Dr Guerreiro seems to be rushing you into the chair. The passage on medication  personally is a big red flag.
 

In order for a hair transplant to be successful long term medication is important. You mention you have aggressive loss at only 32, you really do need to stabilise these losses before any surgery. Dr Pinto is absolutely correct to remain cautious and see how you respond to medication. First and foremost you need to give them time to see if you develop side effects. These can take months to surface. The other big factor to consider is what happens if you don’t respond positively and continues to recess? On the flip side you could be a hyper responder and it would significantly lessen the work you need doing. Without photos or a detailed history of your family patterns it’s hard to tell but maybe consult with a few other surgeons to gauge their plans and see if there’s and outlier to the advice given.

I don’t mean to be a voice of doom btw. I had my first transplant at 34 and know exactly how you feel. You want it done asap and to regain confidence . But trust me 1 year is nothing in the grand scheme of things . It’s far far far more important to get it right for your long term prospects.

I’m surprised Dr Pinto is still so cheap comparative to those surgeons operating in Western Europe with similar reputation. €2.60 a graft is a steal.

UK prices also now stack up competitively too. It’s still a mine field though so research is vital. Daily I see targeted adverts from pop up UK clinics in my feeds.

The lists above are all solid choices 👍🏻

€900 for a 3 hour in person consultation using world leading tech I don’t think is unreasonable. Some clinics charge €100 just for the Dr to look at your file.

He’s one if not the world’s best for higher Norwoods. I’ve no issue with him charging some cases at a higher premium to queue jump. Given he’s booked up until 2027 (and in a world of large inflation ups and downs) those bookings / prices are locked in for 3 years now, so it also makes business sense. 
 

That being said at €9 a graft any large Norwood case is going to need close to €100k. Elite surgeon but yes gradually becoming one only exclusively for the wealthy.  I wonder what he’ll do when his book re opens ? 

I’ve noticed over the last 6-9 months Rooney has almost religiously wore a hat. At Birmingham he wore it 24/7. 
 

Last few months he’s relaxed that a little. Today he’s on Sky with a thin but more reformed hairline than previously. No doubt he has fibres but I wonder if he’s opted for additional SMP or some Beard/body grafts to boost what he has left?

Interesting discussion 

So what by rule of thumb is the no go level for surgeons ? I assume age also plays a factor in that too?
 

For example if someone has say a density in the donor of a lowish figure like 50-60 in their 30s that’s massively different to that of someone in their 50s when planning a surgery.

You were slick bald as you say so 3000 grafts was never going to be enough. But if you discussed this with your surgeon and the plan was to simply add some hair then fair enough.

 If I’m honest though I’m not sure why your surgeon has opted for a scatter gun approach if your wish was to get frontal coverage to frame your face. With 3000 grafts you could have solely focused on the frontal third and achieved a dense result.

How is your donor holding up now? As previously suggested another small tester procedure may be a good idea to gauge if your scalp is ok.

I’d also consult with a few other surgeons to see what they think / suggest too. Although there’s some very knowledgable people on here and it’s great you are using this as a tool you can’t beat the input of a few surgeons with 1000s of cases behind them. Theyll be able to advise better what could have happened in the first procedure.

Research the Dr not the clinic you wish to go with.

Every clinic is different, go with your surgeons advice 

I had a gentle wash / clean on day 1. First wash was day 3 but very gently just pouring water. No rubbing or rough contact during a wash until 1 week.

I wasn’t advised to keep my scalp inbetween (Not that unusual, think Pittella is the same with his advice) 

As Melvin alluded to earlier I think it’s a case of him being  a bad candidate rather than the clinics fault. 

4 hours ago, asterix0 said:

I haven't really seen too many cases of slow growers to be honest. 

The texture of the hair can change between months 9-12 too which alters the result. Mine was quite frizzy until around month 9, growth was good but it did stand out a little. Between 9-12 months it reverted to my natural hair characteristics and blended in much better.

May also be worth changing shampoos even if it’s just for a day or two a week. Hair can become accustomed to the same shampoo over time.

And yes definitely ease off the Nizoral, personally wouldn’t use it more than twice weekly max as it’s quite harsh on the hair.

Great listen

Ted touches on an important point. We often obsess about the punch and sizes Dr’s use but ultimately the tool is only as good as the skill of the hands using it.

I like the way he’s also interested in pushing boundaries. If rules are set in stone with no deviation the industry doesn’t progress. 

17 minutes ago, Bucky O Hair said:

Yea, my hair is fine and I just had a procedure with Dr. Munib three weeks ago. 

However, my procedure was for the crown (not the hairline), and surprisingly he only used 1750 grafts for a pretty sizeable area (whereas all quotes from other docs I consulted with were in the 2400-4500 range as I am a NW5).  It looks great so far in terms of coverage.  The guy has great artist skills.

I wish I had my procedure with Munib for my hairline though.  It's not that my first HT with Rahal was bad.  It looks fine, but I think it could have been better.  

In terms of who I think the best HT docs are...I would say Munib and Zarev are a step above the rest.

 

 

 

 

I’d wish you good luck but with this Dr you know for certain it’s going to be a home run 🤣.

He’s a master of his trade you’ve made the best choice you could have.

Both are world class but for raw talent Munib wins. His planning is obviously in depth but nowhere near the level of Zarev’s (Because his talent means it doesn’t need to be), there isn’t an over reliance on technological tracking of grafts. It’s more natural if that makes sense. As you’ve pointed out he can use 50% or more less grafts than most surgeons but achieve a result twice as good.

In terms of using grafts economically I think Couto is up there too.

Dr Munib edges it for me though as he regularly takes on patients with finer hair that produce equally good results. 

Great result and in only one sitting too. 🙌🏻

18 minutes ago, mr_peanutbutter said:

looks you will end up norwood 6/7 and will lose the hairs on top eventually with relatively high sides but a crown that dips deep

 

so you should pick a surgeon which is specialised on high norwoods such as pittella or eugenix

Agree with this

it will be an expensive road so be mindful of that. It’s also a risky process where expectations should be managed. As above it’s important to go with a Dr who is well versed in higher Norwood cases

You’ll need to protect every hair you have left in order for the procedure/procedures to be successful long term.Donor hair isn’t bullet proof, even from the sweet spot. Hair naturally thins with age so any help to preserve it you can do is important. Given you are only 37 in my view it’s important to jump on some sort of DHT blocker.
 

But like anything on forums this is just advice based on our own experiences and knowledge. It’s always better to consult with a Dr for final assessment. 

How old are you and are you on medication if you don’t mind me asking? Long term planning key as with any transplant.

2500 seems on the high side to fill in the corners. Are you looking to lower the hairline also? If so I’d be very cautious about doing this too aggressively.