general-etwan

Looks like great work! Happy growing.

5 months after 2nd, 14 months after 1st About what I could have expected at this point, still looking rough and waiting for crown to come in stronger. I think I also see what a 3rd procedure could entail. The area right behind the transplanted temples is now lighter and thinner, so I think a few hundred grafts need to go there both sides combined. I also want them to extract more grafts from my lower sideburns because the hair there is now too thick and dark compared to all the surrounding area. And I think scalp donor could give another 1-2,000 grafts to added density in the crown and/or on the top.

Yes, I'll definitely teach myself to do it at home when needed. Part of me also wants to be able to grow my hair longer in the future. Sort of that medium messy length. We'll see how it goes.

I just meant in the case of which most or all of the beard hair would be moved to the scalp donor area. Massacre as in get rid of all your facial hair. I just wouldn't want to ever do that personally. A little stubble and facial hair can make a man look good sometimes.

Not necessarily any concern at all, I was just curious about the difference in strategies from surgeon to surgeon. Pittella has a lot of great results so I wouldn’t worry off that. Just interesting how he uses a lot of beard right away which is common. I’d say Zarev is more of an outlier in that he doesn’t use any beard until scalp is completely exhausted first.

I don't know which of these pics I've shared before but I was looking back at some of my progress. It seems I really had great early growth from my procedures and then it kind of seems like the progress fell off or even got worse since then. 4 months after my first HT vs. 13 months after March 2022 (6 months after first HT). It seemed the upper sides and lower crown area were regrowing a bit, compared to before and since then: April 2022 (7 months after first HT), outside in the sun:

I understand the math of this, and I don't know for sure about Stewie, but I am not personally a fan of taking beard grafts and putting them in the donor. I think his donor is pretty universally thinned and so it's not a problematic look from a distance at all really. Why massacre the face to put thick grafts on the back and sides of the head? That would just make the back and sides more dense than the top, which is counterproductive to the redistribution goals of a hair transplant.

Absolutely amazing. This uniform extraction strategy looks so clean. I think the length you have your hair at right now is really good too. I know I recently got a shorter cut (my barber insisted) but I kind of regret it as I think we need to have our hair the length you do right now and longer to maximize the looks.

So they eventually agreed to that general plan?

Yea, sorry, not happening! If I do a 3rd procedure, I will push whoever does it to really utilize up to all borders and homogenize as much as possible at this point. I believe even the messy looking hair lower on the back of the neck should be used (the hair that gets mostly shaved by barbers), as Zarev sometimes does. It will at least remain strong for many years.

So the only way it could potentially be effective on old scars (all the ones I already have) is to re-injure the sites and then use verteporfin on it?

Had to read up on it; have been so busy with life I hadn't known about this. Sounds promising but also almost like magic. Preventing scarring and improving skin quality I can see, but regenerating hair follicles? Sounds like something David Blaine or Criss Angel would do. Through all the ideas over the years of regenerating or cloning hair follicles, I could never wrap my head around it logically. To me a hair follicle is a real, tangible object locked in place in matter (skin) and if moved, it remains a single object in its new place and nothing suddenly reappears in its old place. If we could actually produce regeneration in that manner, then I think we have to question our entire understanding of the universe itself. If you totally unearth a tree from the ground and move it, can another tree re-grow in its place? Well, maybe, if seeded. If the sun was completely disintegrated in a massive explosion, could a new one be generated in its place? How can something come of nothing? Well, that's the deepest question of all in terms of how this universe began in the first place, isn't it? 😂 Like others said in the verteporfin thread, even if it just prevents scarring, that's a big deal. Definitely interested in learning more about it. Will be in touch.

Right, makes sense. Unfortunately it was just not doable for me to try to go to Zarev, with both the cost (at least $4/graft) and wait times for consultations not until 2026 with surgery 2 years after that (as Zarev has been saying on Instagram comments). Kudos to those who can make it happen. Yeah, that case makes more sense as many grafts were preserved not working on the front, as not necessary at age. I'm actually very much fine that I chose to do the hairline lowering and temple work in the 2nd procedure, because now I can present myself from the front and like the way it looks, rather than continue to try to prevent people from seeing me face-on without hats. The thinness at the back (crown) is less noticed by people. But now it'll be the remaining focus. They didn't say how many scalp donor I'd have left. Sethi simply said they absolutely were leaving more for future under the assumption I will need them. I think a lot of it is just up to subjective preference and how much redistribution someone wants to do.

I don't know if I agree that mtb and I are clearly distinct NW 6 vs 7. Can you explain what you mean by the borders are different? I think they're more the same than different. If you look closely, we both have characteristics of both 6 and 7, so I think it kind of just ends up blurring together. https://naturaltransplants.com/solutions/norwood-scale/norwood-6/ https://naturaltransplants.com/solutions/norwood-scale/norwood-7/ We both have a had extremely similar very weak remaining lock on the top of the head (black), have a very similar area of final thinning (red), have similar thinning above and behind the ear (blue), and my border, if at all lower than his, is negligibly lower. The small difference seen here (yellow lines) has to account for mtb's image being taken from a slightly higher angle than mine. Call it NW 6 or 7, at the end of the day I say we were both NW6s at the time with very similar final border patterns. A traditional surgeon would look at mtb and say his loss could dip lower with age too, just as they would mine. But apparently Zarev was not concerned with that and/or does not think so as he harvested from that entire area of remaining hair, precisely up to the borders. Yeah, the Zarev patient there got a very high hairline and no temple work. I agree the more youthful approach to me was very necessary at my age, and it still was relatively conservative. I think I have enough grafts for more work to try to homogenous this as much as possible. Some scalp for sure, and definitely beard if needed.

Makes sense that it's donor management, of course, but going forward, I say take the 500 more needed for the temple gaps that show when buzzed. 500 isn't a travesty. 1,000 would be. In that picture, I had gone a few weeks without buzzing the sides and temples. I want to say 2-3 weeks. I just think going forward, I really want to push for maximum homogenous distribution of hair and closing any gaps. Now that these remaining gaps are visible, and I am personally pretty confident that we can see the boundary of where hair loss will mostly stop at the back of the crown (yes we know it can dip slowly over a lifetime, but it's not going to dip suddenly anytime soon because all of my original hair that is significantly harmed by DHT has already suffered that effect by age 30 due to how extreme my loss is and the full pattern can be seen at this point; that's what I believe)...I will need any gaps closed in order to maximize the situation. If things are pretty homogenous then I can always buzz my hair or minimally fade it myself to keep it looking acceptable without having to need complex fades every week. And SMP could then be used all over very subtly to increase illusion of density. You just look at results like this, and say how is this possible...well it must be possible.

Yeah, not too worried about overall patchiness or the retrograde above the ears; not a huge concern. I am focused on the gaps higher up on the head, that are more noticeable. Haven't talked to Eugenix about this yet, been super busy. But def will be topic of focus from here forward.

Yeah, not going to rush SMP that's for sure. But ultimately I expect I'll want to use it in combination. If I can get to a sufficient level of overall redistribution that I'm happy with, then I might be able to get SMP all over to work in tandem with the more homogenous look. But I don't think we're there yet. I'm not sure mtb's starting point is that much better than mine, to be fair. I'm not sure whether you want to call each of us NW6 or NW7 but either way there doesn't look like too huge a difference from starting point. I'm not sure either if Zarev would have ever taken me as a patient at starting point. But I think if he had, his strategy would have been consistent with his other cases in which he is meeting the boundaries together. If just think at this point I will need to get to 10,000-12,000 total grafts moved too before I am fully satisfied with the redistribution. But I will want extractions to be taken right up to the sharpest boundary of hair loss and even down into the nape area, which Zarev goes pretty low into.

It's a tough choice between trying dutasteride vs just not worrying about medication. The hope with dutasteride would be to actually strengthen thin areas, and from what I know cases of actually regrowing anything are rare. No one else in my family has hair loss to the degree I do. No one. I got it the worst by far; there is no comparison to me. My grandfather on my Mom's side is maybe a NW4 at almost 80. Grandfather on Dad's side was maybe NW5-6 by age 40-50. Dad is NW 5-6 by age 50. I was NW6 at early 20s. So far beyond any comparisons I can even make to family. I know that if I were to talk to Pittella, as someone once mentioned here, he would tell me not to worry about taking fin or dut.

5 months next week. I think I’m just a little spoiled because I found that my first procedure hair came in pretty fast and I thought that by month 5-6 I already had most of the result. I know that’s kind of outlier stuff but was hoping for similar again. Back of the head still looking rough. The fade cut was nice for a day but then it enters this length where things are all disconnected and I think it looks poor. I think I’ll probably just let it grow out now for a while. But by the end of this year I want to decide whether to schedule a 3rd procedure or do SMP on its own without another procedure. I’ve also determined that fibers are not for me; and especially not at this length. There’s not nearly enough hair that is long enough to put fibers on the crown; it just goes to the scalp and blots and looks obvious. Can’t use them when hair is this short, and even when it’s longer I am not going to want to be bothered by messing with fibers at all hours of the day according to my irregular schedules.

This is looking like a very good case. Impressed with the early thickness and growth. A little mixed feelings about how Pittella is willing to use that many beard grafts right from the get go. Kind of a very different strategy from Zarev who says he hardly ever uses beard and will completely exhaust scalp donor first before even considering it.

Thanks for comments everyone. Yeah, @Melvin- Admin, I usually buzz my back and sides every week or so rather than go to the barber every few days, but would definitely have to practice on proper fades and set up some kind of place with proper mirrors to make sure I can do it well. @Xanadu The high fade on the guy in that video works because his hair density is very homogenous across the scalp. Mine still is not. That guy could do a high fade, or have the longer hair dip lower on the back...whatever he wants, it'll look fine because the density is homogenous. This may go back to what I expressed very early on in this journey. My wish to be aggressive in homogenizing the hair density as much as possible across the entire scalp may have been naive but yet at the same time it seems to still be a goal. Especially when wearing my hair shorter. The longer hair is, the less noticeable differences in density across an area are, but at shorter lengths, it's very noticeable. I feel like I now have a situation where I don't even know if I want to go for an SMP consultation because maybe I will want to have yet another HT to address some problems that seem to remain. Here is today, 5 days after that fade that looked nice last Friday. Note that I put a "dramatic" filter on the images to enhance the contrast between the areas I want to show, and taken under harsh lighting: ^Circled in black are gaps that have no full-strength hair. The hair that remains there in that region (that they didn't implant into because they still "saw" hair there) is actually significantly miniaturized and will never be recovered. So now this area is not homogenous and it is visible at short length. I wonder if this area could be transplanted into in the future. I don't think I've ever seen a case like that. Circled in red are areas of retrograde alopecia which I've had there since my teens. Has remained about the same for many years now, but again, wonder if that area could ever receive any grafts to attempt to homogenize things. ^ Here you can see the still significant contrast in donor area vs recipient area, so visible just 5 days after the fade. On the right, the longest black line I believe is my "safe zone" based on my own opinion. Looking at old pictures, that boundary appears to have remained unchanged, as there is a pretty clear drastic sudden change between the miniaturizing hairs above and the dark thick hairs below that black line. The red line is what Eugenix harvested up to; not fully up to the edge that maybe for example a Dr. Zarev case shows. Circled in black is the area of retrograde alopecia again. Circled in red is the temple implantation, behind which I seem to have lost more hair since just the summer, because in pictures earlier in the year I had darker hair in that gap. Not good. Also, Zarev seems to harvest right to the very edges of the nape area, whereas almost all other clinics seems to stay about 1 cm inward from the edges. Dr. Sethi to his much fairness did inform me during our lengthy consultation in June that as the thinning hair in the lower crown continued to miniaturize, I may need more attention over the years, but that he didn't want to implant too low in this 2nd HT because it could cause too much damage to native hair remaining. But I really didn't think I would need to be so concerned about that for a few years at least. It seems the implanted hair from June isn't quite coming in as quickly or strongly as that of my 1st HT. Just trying to evaluate what my options will be going forward. Someone like @mtb who is a NW 6/7 like me and went to Zarev already had the gap seemingly completely closed. And of course, is up to 12,000 grafts, so the math there seems to make sense. Also, it is shown that Zarev uses a smaller punch size for scalp extractions than most clinics, which is how he keeps scarring so minimal. I believe Eugenix uses a 0.7mm punch for beard extractions (the beard scars on me are completely gone, invisible). So if they use 0.7mm punch on the beard, why can't they use it on the scalp too as Zarev seems to? If I have to explore another HT to address these unusual and rare situations of non-homogenous looks, I sure will. Honestly, I understand that hair loss is a progressive condition, but at the same time it makes more sense to me to maximize homogenous density now, and then just accept more homogenous thinning over the decades, rather than keep having these visible gaps and contrast that prevent the head from looking properly balanced for more than 3 days at a time.

Yeah, understandable. Let’s do talk more about my case comparison on my thread; I don’t want to clutter @mtb’s thread. Will be watching this one closely!

Yeah, I didn't want to just suddenly derail the excellent thread here with a picture, so figured let Melvin do it first! lol In all seriousness, yeah, hopefully he doesn't mind. Will try to be brief with this; just thought it could be useful comparison. Here's a better pic of my crown after my surgery. I feel like Zarev would have harvested another cm up in the back and just gone a little lower with the implantation. Dr. Sethi explained to me that his vision is he didn't want to implant lower because of risk of causing damage to the remaining hair. But I feel like that small ring of white was pretty much already bald, and Zarev probably would have gone right up to the boundary of dark donor hair starting. Oh well, for me it's a constant analysis of how I can maximize my situation.

Makes me worry about the gap I have on my situation at the back. I am trying to analyze up close to compare exactly mine to this case. It seems like on me, Eugenix filled in pretty much down to the bottom of the "bald" area but did not harvest the upper 1 cm of donor hair on the border.

Very hard to find examples it seems but I’m definitely looking into into it for my case. I won’t be shaving all my hair down to no length but I do want to be able to sport fades without the dreaded horseshoe pattern being so visible. So my plan is to get SMP in the crown and top recipient areas to help balance out the illusion of density.