BackFromTheBrink

Firstly, recognise that they are a broker. They're a couple of entrepreneurs who had hair transplants and believe they can add value by offering aftercare advice. They offer fixed price surgeries for 'unlimited grafts'. In the UK they rent premises and have a pool of day-rate doctors and associated technicians. I can't remember the specific doctors in the UK, but in Turkey they use smile. Their customer service seems to be excellent. However, there are inherent risks of using journeymen surgeons and an inconsistent set of technicians. Search on here for reviews of smile clinic in Turkey.

I guess the options from here are: - another procedure for donor homogeneity and density of the hairline. This may still need the very short donor cut you are currently using - donor restocking (possibly using beard/body hair) - SMP - A hair system, though that won't help your donor

That's a good point - a homogenised donor area can trick the eye into making sparse areas look thicker. So while there will be less hairs in the donor area, it won't necessarily look worse/more compromised. What's clear is that you need a very careful approach from here in on, there really is no margin for error.

My experience of Dr M was great. He uses a manual punch and is meticulous about his extractions. The hairline work he performed for me was exactly what I wanted and really improved density. He was also so detail orientated and changed the surgical plan on seeing me in person to make sure I had a natural result. As has been said, your donor does look compromised, so it'll be a challenge for any surgeon to extract from it and hide the signs of surgery.

Everyone will have their own opinion. Mine is that vitamins shouldn't be needed if you have a balanced diet. Finasteride and minox are the only approved not surgical treatment for hair loss. Topical simply means something that you apply to the scalp, rather than taking the medication in pill form (oral). Both can cause side effects, but do not for most patients. Without a doctor to supervise i would take topical rather than oral minoxidil. Finasteride should be easy to feel the side effects if you're going to get them, so i would take it orally.

It's also worth saying that at 26 and such an advanced degree of loss, the first thing you should be considering is medication to stabilise your loss. Then, it's a case of accepting this is probably at least 2 surgeries with most clinics. After assessing your response to medication over 9-12 months, then start consulting with your preferred surgeons. In the meantime, i would start saving so that you can visit the best surgeon possible.

That's true, though it's usually a much lower fee, especially for large payments. Though I'd expect you'd accept a bank transfer for large payments (which wouldn't attract the fee)?.

I'm curious about that. Say I want 4000 hairs to be transplanted. Would Zarev potentially use more grafts (because he'd use partial grafts for a more homogenised donor) than a more traditional surgeon? So, it may take Zarev 3000 grafts opposed to 2000 grafts for another Dr? Would the cost per hair therefore be higher with Zarev (all other things being equal)?

It's a bell curve. There are a few quick growers, a few slow growers and most in the middle.

The problem is that you need to account for everyone, including those slow growers. For then, they could have nowhere near 85% frontal growth at 6 months so would worry them unnecessarily if you set that expectation.

That's really not bank commission. It's tax that should be required regardless of how you pay, but I guess it'll go undeclared if in cash.

What would be extremely useful for patients is for it to compare the before and after. Presumably it would be able to do a good job of predicting what is needed, and having being told what was done, then assessing how many of those grafts grew, the new Vs desired density, and therefore the success of the surgery?

The work looks very clean, and I'm sure will make a good positive difference. It's disappointing to hear you werent listened to as much as you could have been. I'm not sure if you were given the grafts distribution but to me it looks like your hairline was prioritised and so I'd share your concern that the crown wasn't prioritised as you'd have liked. That's not to say there won't be a good improvement there, I'm sure there will be.

Very true. it's a very relaxed and friendly environment. Most people agree the anaesthetic is the worst part of any transplant surgery. They inject section by section and use very small needles so it really reduces the discomfort. He's a top class surgeon and I'm sure he'll do a great job for you.

I think the 1 month rule is for topical minox - there isn't the same limitations with minox.

There's the option of topical finasteride or dutasteride. However, some will invariably go systemic, it's less likely to interfere significantly. If not, I'd also add Hattingen Hair as a lower cost surgery to consider (for FUE or a combo).

What's the logic here? That finasteride reduces DHT to a level that introduces side effects and increasing the starting levels of DHT through increasing testosterone will leave a higher residual amount? If that's the case, I'd carefully monitor both test and DHT levels with a physician to make sure you are getting the desired results, as well as monitoring associated side effects of both.

His character in Jackie Brown has had a hair transplant and talks to her about it in one of the scenes. In interviews he's also been open about getting surgery.

While we wait for Gatsby (who will hopefully agree).. 1) your proposal for the 2 day surgery used more beard grafts. That's because the doctor didn't want to overharvest and to the coverage you achieve in the first surgery 2) Graft numbers don't tell the full story. There is usually only one hair per follicle from beard grafts. You will have an average of 2 hairs per follicle from scalp. 3) given the above, I don't think you'll get full coverage with the 2 day surgery so you'd be back in a year anyway. So, the question is really how much difference do you want the first surgery to make, and how extra risk would you accept for that?

There's also the positive result from taking medical therapy to consider. In this case, finasteride and minoxidil were not used so you're seeing the result for the surgery only, whereas many other cases are actually a result of both.

I think the estimate of 7k grafts is about right. Dr Yaman has suggested two sessions to allow your donor to recover (thus using beard in a one and done). For me, you'll need 2 surgeries for full coverage regardless. I would personally choose your preferred Dr and do about 4k in one session focusing on the front and mid scalp, and whatever is left for the crown. I would then complete it a year later in a second session for the crown.

It's looking fantastic - certainly one of the best outcomes I've seen; I almost said 'from where you started', but that wouldn't do the outcome justice. I do think you've called it a little early though. I would fully expect the crown to continue to mature. It's a black hole for grafts but also seems to grow slower, so there's still potentially months to go... Would love to see it at 18 months after a few growth cycles. Edited to say - did you mean 8 months, seems closer to 10?

Looks like a solid result to me. Realistically it was 6-7k grafts to give full coverage, so I feel this is a natural result and gives the patient the option of a second surgery should they desire it to also fully populated the crown area.

Agree with the above. In terms of graft numbers I was NW5 and much more progressed than you and 3200 grafts made a significant difference in my first surgery. Without any medical induced recovery of existing hairs, I'd have said you need in the region of 4k grafts but it does depend on your hair thickness and the average number of hairs per follicle. That would be 2000 for the front and 1000 each for midscalp and crown, give or take. Whichever you choose, those grafts will be transplanted. 4500 isn't ridiculous but the 3500 surgery could use a bigger punch or have better survival rate and therefore yield the same result.

Well, that's quite the mic drop. Plenty of time to seek a consult with Dr jjalay to validate Dr Zarev's cursory glance at your head. 😉 In all seriousness, you've seen the world's best and will put yourself in the best possible position for a great outcome. I'll follow with great interest - if I'm not mistaken you'll be the first Zarev repair case documented on here.