SuperC

The punches seem clean to me, and mostly reasonable spaced out. Not the smallest punches, but it looks normal to me. I think the scarring you're seeing now is to be expected. You've got dark hair and fair skin. Removing any single follicular unit from your first photo and replacing it with a light-colored extraction scar is going to result in a noticeable contrast when your hair is cut this short.

Based on the photo you've provided, I would consider this normal, but not ideal. It'd be helpful to see some donor photos from just after the procedure, to see what the punches looked like, as it's possible that follicles surrounding the extractions were damaged, causing permanent loss around each extraction.

I went to Dr. Rahal last year and I'm very happy with my experience and results. I felt perfectly comfortable at the clinic in Toronto. They've taken excellent care of me and their post-op care and responsiveness is outstanding, so I never felt alone or concerned during recovery. 1,100 grafts seems a bit low to me, but you can always decide on more that day, or even down the road if necessary. Achieving similar results with fewer grafts is ideal, certainly, but I was more concerned with needing a second procedure later and wanted to avoid that if at all possible. There's no way to guarantee this, but I personally felt better going with a higher graft count. I can't speak for Dr. Couto, but he seems very popular on these forums and his work generally looks good to me. I'm sure you'd be fine going with either surgeon, but to reach a decision, it may be time to weigh other factors such as cost, convenience (travel, etc.), and your comfort level with each surgeon after speaking with them. I'm not sharing the details of my journey publicly, but if you have any specific questions or want to see my progress photos, message me in private and I'll be glad to share.

Hey @Bucky O Hair It's been another 5 weeks or so. Any change?

I'm ~6 months post-op after a 3,000-graft FUE procedure with Dr. Rahal and I'm very happy with my result at this point. I know there is more to come, but I stopped checking for new growth over a month ago. I feel as though I got exactly what I was expecting, if not more. I wondered about this a lot before scheduling my procedure. In my opinion, Dr. Rahal is simply underrated on this forum. Like many other highly-skilled surgeons, he just doesn't have the enthusiastic following that a select few surgeons do. This means he isn't recommended quite as often as I'd personally expect, at least not on this forum. I have to assume that most of his patients come from places other than HRN, and so we don't hear about them here as often. This can also give the sense that a higher percentage of his cases are "disappointments", since unhappy patients are more likely to discover this forum while searching for feedback about their concerns, compared to happy patients (again, amongst those who did not discover Dr. Rahal through the forum to begin with). That's my theory, at least. I don't currently plan to share my full experience or photos publicly on this forum, but if you have any questions or would like to see my progress so far, feel free to message me in private. Note that it's not Dr. Rahal himself, but a representative, who posts here.

Research surgeons, not clinics. At $0.65 per graft, there's probably no reason to continue considering any surgeon at this clinic.

Very impressive work. I think you're going to be very happy with the result. Also, can someone explain the light-colored "scabs" on each graft in the post-op photos? Is this something some clinics do, perhaps to control bleeding, or do some people's scabs just lighter in color when they're fresh? I've always wondered about this.

I experienced a lot of anxiety surrounding this decision as well, and probably "over-researched" a bit, as you put it. It helped me to simplify the decision by focusing on a few key factors. Does the surgeon generally produce good-looking results when treating the area(s) in question? Some surgeons do great hairline work, but mediocre crown work, for example. Find someone who is highly-skilled in the areas relevant to your situation. Are the surgeon and clinic known for good communication and post-op care? If you have questions or concerns after the procedure, will you be able to discuss them with the clinic? Will the surgeon review your photos and provide feedback? I didn't want to be like the people I see asking the internet for medical advice because they went to a clinic where post-op care and communication are poor or nonexistent. Are you comfortable with the travel required? I was not willing to travel abroad for my procedure. Are you? If so, you'll have access to the best surgeons in the world. If not, then your selection obviously is more limited, but still may include some excellent surgeons. I don't recommend traveling anywhere you're not reasonably comfortable. Is the surgeon within your budget? For most of us, the cost of the procedure is a major factor in the decision. As long as you can afford your preferred surgeon, I wouldn't think any more about the money aspect. It's not worth going with your second choice to save a bit of cash. Were you able to consult with the surgeon directly? How did that go? Talking directly with the surgeon should leave you feeling more comfortable and confident in them than before. If this isn't the case, I would reconsider selecting that surgeon. I chose a surgeon who seemed to produce good results in the area I needed treatment, and who was within my price range and travel distance. This was true of a few surgeons, and so I consulted with them and chose the one I felt the most comfortable with. Regardless of how much research I did or how confident I was in my decision, actually booking the procedure was not easy for me. I filled out the forms and then did not submit them, multiple times over the course of a few months, thinking I would find some new information that would help me become 100% confident and schedule the procedure with little to no anxiety, but that never happened. I think the best you can do is make a reasonable decision, cope with the anxiety however you can, and hope for the best outcome. And honestly, any reputable clinic is very likely to produce a good result, so just by not going to a "hair mill", you're already doing 90% of what you can.

Would you mind sharing some photos from just before/after the procedure, and maybe some progress pictures around 3 months, 6 months, etc.?

This doesn't seem to be too uncommon, so I wouldn't worry about it. I'm nearly 6 months post-op now and still have a little bit of numbness. About a 1" circle at the very top of my scalp, just behind my recipient area, is still completely numb. Nerves are weird.

Have you consulted with Dr. Sahar Nadimi? She works at the Chicago Hair Institute alongside Dr. Konior. From what I read, the experience and quality of work will be similar, but the cost will be a bit lower and you'll likely get in a little sooner.

I was allowed to take anti-anxiety medication before my procedure and that helped a lot. I'm not good with pain and I normally struggle to sit still for longer than a few minutes, and I was super chill for 10 straight hours with my meds. Even fell asleep for a bit during the procedure. Ask your surgeon if you're allowed to take anything beforehand, or if they can provide something. Also, if you've not already found a medication that works for you, perhaps your doctor can help you find something ahead of time so you can go in feeling confident and as relaxed as possible.

I genuinely think being mindful and overly cautious makes us more likely to bump our heads, unfortunately. The night before my procedure, I was a bit anxious and thinking a lot about how careful I'll need to be for the next few weeks, and moments later I accidentally hit my head on a nearby lamp. Quite hard, in fact. Luckily this was before the procedure and not after it. You'll be fine, even if you bonk your head again. Just try to take it easy for a few weeks and you'll be in the clear in no time. Oh, and the work looks good, by the way!👌

I wouldn't worry about it. Lots of people bump their heads during the first two weeks of recovery, and I don't think I can recall a single one where the results were affected by the incident. Generally speaking, no blood, no worries, but you may want to contact your clinic and see if they have any concerns or advice.

It's more of a comfort thing than anything. I stopped using it around 4 to 6 weeks post-op. That's when I no longer felt the tenderness or dryness in my recipient area. There's no harm in using it as often as you want, but if you don't feel the need, that's fine too.

Then maybe it's worth the risk for you. It's definitely not for me, but that's our own call to make.

Yes. No one can tell you how likely it is, though. If you can mitigate the issue safely, such as taking a doctor-recommended dosage of Finasteride, for example, then that's generally the way to go. My hair loss has been perfectly stable since my early 20s and I'm 38 now, but I still take Finasteride because otherwise I'd be risking the time, effort, and money spent on having my transplant. Is there some concern with doing so for you?

Why risk it?

If you want to get technical about it, too much of anything can cause damage in extreme cases. A gentle breeze will eventually erode mountains into canyons. We're not invincible, and our actions and behaviors can wear on our bodies. However, under normal circumstances, including above average amounts of hair combing, washing, rinsing, shampooing, etc., you are not going to permanently damage your hair follicles. If you are having trouble letting this worry go, I'd consider talking to a professional about it. Otherwise, go live your life and stop worrying about everyday tasks like brushing your hair. It's fine.

Nope.

Once the transplanted grafts are 100% secure (~2 weeks post-op), the risk becomes about equal to that of your native hair. That is to say, you can damage the hair itself and cause breakage, but you aren't going to damage the follicles or cause the hair to stop growing altogether. Scientifically, it's because you're not interacting with the follicles directly. They are safe under your skin, so don't worry about it. Just take care of your hair and enjoy it.

I did this a few days after the transplant, just out of curiosity. I found that the new hairline received about 45 FU/cm^2, and my native density outside of the thinning/receding area was around 70 hairs per cm^2. I haven't bothered to count since it began growing in, however. If I were unhappy with my results, I might do some spot checks, but it's not really a concern for me.

There's certainly still time. I've seen plenty of cases where waves of new growth occur after 8 months. Hopefully you'll be one of those. I just hit 5 months post-op and I'm really happy with my results so far. Like you, I'm still hoping for some new hairs in the next few months, and I can see quite a few that are still just barely poking through the skin, but I'm trying to keep my expectations realistic and avoid setting myself up for disappointment. I know it's still quite early for me, but even if this is all I get, I think I can work with it. It's so, so much better than what I had before.

You can relax now. I'd recommend still being gentle, but at 21 days post-op, you don't need to worry about casually touching the recipient area.