splitting hairs

Thank you! Fingers crossed 🤞 Dr Lorenzo worked solidly and did all of the implantation.

Hi, I would send pics to your surgeon ASAP. The scabs in the centre are concerning me slightly, as they look a bit like necrosis.

Day 3 Pics

Post-op pics

I have added the clinic photos in the post above.

Hi All, I have just got back home to the UK from Madrid after undergoing my first FUE surgery with Dr Jose Lorenzo, at the Medilor Clinic in Madrid. I have been a member of this forum for many years (since 2009) and I have read many patient threads that have been extremely useful in improving my knowledge and understanding of hair transplantation and in helping me to eventually decide to have surgery. Therefore, I feel that it is only fair that I now share my experience in order to give back to this community. Background I am a 36 year-old male and have been on Propecia 1mg daily for the last 14 years (since July 2008). During that time, my hair loss has remained stable and I have not had any side effects. Why I chose Dr Lorenzo I first heard about Dr Lorenzo on this forum in 2013, when he travelled to Manchester for 1 year, for family reasons. During this time, he worked in Dr Farjo’s clinic and was a recommended surgeon in this community. However, when he returned to Madrid, he decided not to continue his membership on this forum, as he was extremely busy with patients from Spain. I have since been following his Youtube channel, patient posts here and also on the Spanish and Greek forums. Additionally, as I have been following Dr Lorenzo’s work for 9 years, he has shown consistency in his work, making minor tweaks and adjustments to refine his processes. One of the main reasons I also chose Dr Lorenzo is because he has considerable experience in performing hair transplants in patients with scalp conditions. (Check his Youtube channel and video descriptions). I have seborrheic dermatitis and my scalp is generally very sensitive and picky when in comes to shampoos. Therefore, going to a surgeon who has vast experience in dealing with this was a huge plus. Email Correspondence Dr Lorenzo is extremely busy. Being one of the World’s best FUE surgeons, this shouldn’t come as a surprise. I sent in an online consultation in February of this year. The response time for online consults is usually 2-3 weeks. After the initial response, they respond to subsequent emails a lot faster. Dr Lorenzo reviewed my Photos and suggested that I needed 2000-2400 grafts to lower my hairline and rebuild my temple points, which were my main goals during this procedure. He also advised on a management plan for my seborrheic dermatitis and hyper-reactive scalp around the time of surgery. His plan was for me to use Etrivex (Clobetasol 0.05%) shampoo daily for 3 days before the surgery. Additionally, I would need to take oral steroids, Deflazacort 30mg daily for 3 days before and after surgery. His protocol also included taking Amchafibrin (Tranexamic acid) 500mg three times daily for 5 days post-op. This was to prevent excessive bleeding and to reduce the risk of haematomas in the post-op period, as this can affect graft survival. Once I was happy with all of the details, I paid the deposit. The clinic booked and paid for three nights at the nearby Hotel Amura. I decided that I would stay a few extra days to get washes done at the clinic post-op, so I paid for an additional couple of nights. Arriving in Madrid I arrived in Madrid a couple of days before surgery, so that I could settle in to the hotel and have an in-person consultation with Dr Lorenzo the evening before my procedure. Medilor clinic have an arrangement with the Hotel, so that their patients get free shuttle transfers to and from the clinic. It is only a 5-minute drive or a 12-minute walk. I spent the first day exploring the local area and visiting the nearby ALDI supermarket to stock up on food for the room, as I wasn’t sure how much I would be going out post-surgery. In the evening, I met the famous Dr Lorenzo. I told him that I felt like I was meeting a celebrity! I had followed his work for so long that it was a real honour to finally meet him in the flesh! He was extremely knowledgeable, professional and very funny! He answered all of my questions, was very attentive and I felt like I was in very good hands. What I didn’t expect him to say was that, as I am stable on medication and at the right age, that he could be aggressive with the hairline design, if I wanted. This was music to my ears! I expected to have to make some compromises with the hairline design, more so because I was also getting the temple points done. Ideally, at 36 I didn’t really want a mature hairline. I wanted a youthful one! I showed him a design I liked on one of his patients on the Greek forum, which he happily agreed to do for me. He also confirmed that, as my scalp is very picky when it comes to shampoos, that I could use my usual Johnson’s baby shampoo instead of the clinic provided shampoo. I was set. I went back to the hotel, ate and could barely sleep due to a mixture of nerves and excitement. Surgery day It was an early start. As per the pre-op instructions, I showered and washed my hair, ate a light breakfast and avoided caffeine. The shuttle from the hotel took me to the clinic at 7:15. I nervously took a seat in the waiting area before Grace, a nurse from the UK, came to greet me. It turns out that she met Dr Lorenzo when she worked at Farjo clinic in Manchester and decided to move to Madrid to work with him at Medilor. I signed all of the consent forms then went to the small kitchen area to have a snack and meet the other patients who were also having surgery today. There were two other patients, both from Spain, being operated on that day. They were both coming back for 2nd procedures with Dr Lorenzo. The first was a guy in his early thirties, from Madrid. He said that he had surgery with Dr Lorenzo 18 months ago and had 4000 grafts to his hairline and crown. His hair looked fantastic! I saw his before pics and there was a dramatic improvement. He was coming to get a small touch up of a couple of hundred grafts to increase the density in one area. The second patient, in his 50’s, was from Bilbao. He had previously had his hairline and frontal third done by Dr Lorenzo and was coming back to transplant his crown. Again, his hair looked great. “Dr Lorenzo is the best!” he exclaimed, in his Spanish accent. I was given my Diazepam 5mg tablet to take with my snack whilst, one at a time, the other two were taken into another room and then into theatre. Next, it was my turn. I was taken into a small room and asked to sit on a stool. I recognised the “injertocapilar.com” background from Dr Lorenzo’s Youtube videos. The Doctor then combed and parted my hair, wet it, then started drawing on my scalp to highlight weaker areas that would need grafts. Next up: the big shave! I had been dreading this. Out came the clippers and a few moments later, all of my hair had been shaved. They analysed my donor area using a USB microscope and I was told that I have thick hair! I was then taken into one of the operating rooms by a nurse and directed to lie down on my side on the cushioned operating table. One of the Spanish nurses started with the anaesthetic injections, before performing the extractions. I diligently informed her if I was in pain, which resulted in more anaesthesia. She was using a manual punch to score around each hair follicle, then gently removing them from my scalp using tweezers, whilst at the same time pressing a foot counter to record the number of grafts. She placed each graft into a petri dish, which another nurse was kindly analysing and placing in solution. The extractions went on from 10:30am to around 4pm. I was then given some lunch and 20 minutes later, I was back in the operating room. This time Dr Lorenzo, the Magician, was working on me. As I lay down, he took a number of measurements of my facial proportions before he started drawing a hairline for me. I was so excited! A few moments later, he handed me a mirror and asked what I thought of the design. It was lower than I had expected. But I liked it. A lot. I agreed to the design. Then there was more anaesthesia! One of the nurses loaded each of my grafts into a Li-on implanter and handed it to the Dr. He then proceeded to insert them in to the recipient area, whilst ensuring the correct depth and direction. This went on for ages. I drifted in and out of sleep and lost track of the time. When we finished, it was 10:20pm. Dr Lorenzo handed me the mirror, whilst I could feel everyone in the room watching my reaction closely. I loved it. I finally had a hairline! A hairline that I had dreamt of. I quickly changed and was given my post-op pack and told to use the saline spray every hour whilst awake, for 3 days. Dr Lorenzo called the hotel shuttle for me and then escorted me to the van when it arrived, advising me to be careful not to bump my head. Sleeping that night was difficult. I still had a band-like pain around my head and my donor area was tender, despite waiting the advised 4 hours after surgery before going to bed. I did manage to get a few hours, though. 1st Wash The next morning, a shuttle took me to the clinic at 10am. I was greeted by one of the nurses, who took me into a room to go through all of the post-op care. I was given written instructions, saline spray and a cap. Dr Lorenzo came in to see me. He inspected his work and commented that I had a bit of fibrin on my recipient area. The nurse proceeded to shampoo my donor area and used saline spray on my recipient to remove the fibrin. Dr Lorenzo came back in, re-inspected and was happy. He answered all of my questions again and only left when he knew that I was completely happy. 2nd Wash The next morning, I returned to the clinic for another wash. It was Friday, which is the clinic’s consultation day. No surgeries are performed. They just see new patients or have follow up appointments for existing patients. The same nurse washed the donor area and cleaned my recipient with saline spray. She asked me to wait in the seating area, as Dr Lorenzo wanted to see me before I left. A few minutes later, he appeared and asked me to come into his office. He was happy with my recipient area now and reminded me to send him photos on day 3,5,8 and 10 post-op, so that he could make sure that everything was going smoothly. He also reminded me that I would need to send photos to him at 2 and 5 months, then come back to Madrid for a review in 10 months. This was also a condition of his warranty. I thanked him for the great care and experience that I had received at Medilor clinic, to which his response was: “Thank me at 10 months. First, we need to see the result.” Overall experience I had an excellent experience throughout the process. Dr Lorenzo is very honest and ethical. He is also very realistic and explains that hair transplantation is surgery and that there are risks involved. If a hematoma develops, it can affect graft survival in the affected area and a free touch up may be necessary. I also like that he wants follow up photos, as opposed to saying “see you later, Have a nice life!”, as some clinics do. All of this is very reassuring and makes me feel like I am in the best hands. I plan to post monthly updates of my results. Just now, I will post the pre and post-op photos that I have taken myself. As soon as I receive the photos and stats from the clinic, I will post them too.

There are quite a few surgeons who recommend this strategy. There has been a case report published about a patient who was still losing hair on Finasteride daily, then switched to Finasteride 6 days per week and dutasteride on the 7th day. He saw significant regrowth. In reality, you will probably experience a shed, but stick with it and it should grow back thicker.

I asked Dr Lorenzo this question and his response was that it doesn't stop being effective. Just like some people's blood pressure keeps rising and they need more than one blood pressure pill, some people's hair loss is more aggressive and needs a stronger treatment. Finasteride reduces DHT by 70% so if you have a family history of aggressive hair loss, then the chances are that the additional 30% will still do some damage slowly. His explanation makes a lot of sense.

I wouldn't bother doubling your finasteride dose tbh. The DHT inhibition between 1mg vs 5mg is not very much. However, a lot of surgeons now advise taking finasteride 6 days per week and Dutasteride on the 7th day. There was a case report of a patient losing hair on finasteride that did this and regrew a lot of hair. I'd add in dut 1 day per week and see how it goes. You can keep adding a day in at a time if necessary.

I'm going abroad for a hair transplant and just got normal travel insurance. Any medical issues, the clinic should take care of anyway. Its mainly just for other benefits.

It's completely fine and is normal to have surgery over two days when the graft numbers exceed 1500 to 2000.

https://www.hairtransplantnetwork.com/hair-restoration-patient-shares-his-hair-transplant-surgery-day-experience-dr-feller Don't know why the title is wrong, but this is the article I read at the time.

I researched this extensively a few years back when we were trying for kids. Basically, the information is based on a study in rhesus monkeys. The main reason that warnings are issued is because it could affect the development of male gentilia in a fetus. Formation of male genitalia happens somewhere between 12-15 weeks of gestation. Ultimately,the levels of finasteride in semen are too low to have any real effect. But just to be safe, we used condoms as soon as my wife became pregnant. We now have two healthy boys. Best of luck

Use a nit comb on wet hair to check if you actually have head lice first. Only treat if you do. I would probably be inclined to use a dimethicone based treatment as it basically just coats the lice and suffocates them, as opposed to a pesticide.

You can email her in English. I have had a response from her in English previously.

It wouldn't affect the transplant, however, a flare up can cause temporary shedding. Best to get it under control with your treatments.

No evidence for PRP helping folliculitis. Consult with reputable clinics and they will steer you right.

It could be that you have developed seborrheic dermatitis post op. Best to get an assessment by your surgeon and see what they say.

I think from the photos that you look to have DUPA/BUPA. I would suggest consulting with Dr Lorenzo who has many documented cases with such patients. He may advise adding Dutasteride. Maybe send him your pics and see what he says.

Your hair looks great tbh. I don't think you need any more grafts. Just enjoy it now!

Do you have any pre-op photos? Remember that a hair transplant is an illusion of density. Wait the full 12 months and if needed, a touch up of a few hundred grafts can be done.

Excellent result!!!

Very nice result mate!! Do you know who your surgeon was? I know that from the Greek forums, Dr Lorenzo goes out to this clinic and performs procedures a few times a year. He is usually only there for a weekend, I believe.

The reality is that most of the top clinics use technicians to do extractions. Hasson and Wong have 4 technicians doing their extractions, as per their website. Freitas uses technicians, Lorenzo, Ximena Vila uses Tech's too. FUE is very labour intensive and a surgeon doing all of the extractions, implantations etc can lead to fatigue which may also affect the outcome. However, if technicians are going to do the extractions then they must be suitably trained. After all, we are paying for a top service and we should get it. Asmed has gone downhill a lot over the years. I think this is because they cared more about quantity of patients than the quality of their results. At the moment, I'm only aware of Dr Ferreira and Dr Couto doing all of the extractions.

Hi, It looks like you had necrosis. Dr Lorenzo has presented on this and how it should be managed.