BackFromTheBrink

I'm only two week post surgery so am far from the end result! Im waiting for details and pictures, then I'd planned to start a thread on it. Its looking pretty promising so far..but just waiting for the dreaded shedding!

The hairs per follicle ratio is unusually low. I had 5500 grafts as a Norwood 5 but had a ratio of 2.5 ish which meant I had about the same number of hairs transplanted as this patient. I'm assuming he also has significant loss to the crown (but there are no pictures to show that)

I'm not sure I agree. The surgical plan is pretty much identical to (I was a straight Norwood 5 so slightly more native hair) and the density was adequate.

Are we still promoting the use of robotic extraction? I believed the general consensus was that a skilled surgeon is better at extractions than current robotic technology?

Agreed. A maximum of 4k for the entire scalp seems more reasonable to me.

I suspect that when grown, the hairline and midscalp will give a reasonable amount of coverage (and not require a comb over). However, it's hard to tell since you cannot really judge the thickness of your hair with it being so short. I'm assuming you have relatively fine hair? However, the vertex is noticeably less dense since you didn't have hairs implanted there.

Can't think of a better place to avoid sunburn 😉

It really can be a debilitating situation and I really do feel for you. All that you can really do is continue to communicate with your surgeon and wait for the deadline they have set for a result - 12 months. At that point I would schedule a follow up assessment and discuss what is next. I have confidence that your choice in surgeon will mean he responds ethically and gives you the best route to the outcome you desire.

Looking really good, and very early growth. How's is the top of your head looking? I know you focussed on the hairline. Does your hair blend into your mid scalp and vertex ok?

@streethawk you're right on track. You need to be careful with sun exposure to minimise the scalp redness, though some is to be expected.

Density is determined by how the grafts are implanted, not the method of extraction. There are some surgeons who have extracted 14000 grafts using FUE due to their ability to take over 60 percent of hairs in the donor area and distributing them to achieve homogeneous remaining hair cover. However there are only a few surgeons capable of that, I'd guesstimate most surgeons would be able to extract about 10 percent less follicles using FUE over FUT.

That's not what I heard. He can't recommend it because there have not been any large double blind trials. i.e he doesn't have enough evidence to make a determination of the risk/reward. There have been several large retrospective analysis of patients using oral minoxidyl and no serious safety concerns were reported from any of the patients. They're not poor clinic studies, they just do not meet his standard of evidence to make a recommendation to his patients. If anything, the evidence he presented would make me more likely to take the medication. I can understand him being very cautious, just as it sounds like he would be with oral dutasteride.

I'd agree. I has slightly more loss but also was a NW5. I had 3100 and 2500 grafts in 2 sessions.

Ideally you'd do both - take the medication to give the surgeon more options when planning and to strengthen miniatured hair to ensure its not lost during the trauma of surgery. In terms of timescale I would suggest 6 months at least to show you can tolerate the medication and to see if there are an green shoots of recovery. They say finesteride can improve hair for up to 2 years (but will obviously continue loss prevention after that). I would say there's an extremely low probability of regrowth on your hairline, but the crown often can benefit.

Have you considered finesteride and minoxidyl? They may be able to help slow down your loss, or even regrow some hair. There are plenty of threads on here about the pros and cons, but id personally suggest going into it with an open mind knowing the alternative is chasing losses through multiple surgeries.

Are you currently on any medication - it'd be a good place to start. In terms of recovery, wearing hats is only really possible after 2 weeks. Shaveless FUE is generally the fastest surgery to recover from but is frowned upon by many.

On the contrary - I think you're recovering well. The redness is significantly reduced in both donor and recipient areas and hair has started to grow on the previously bare areas on the side of your head. Give it another week and I predict it'll look much better.

I'd always thought it was between 2 and 6 weeks. I don't think there's a hard and fast rule though and 10 days doesn't sound like it's beyond the realms of possibility.

As an starter for ten, I'd guesstimate 2000 grafts for the crown and similar, maybe slightly less for the hairline.

I think the simple answer is no - it's not clear what determines how much hair is shed. It's also no indication of the end result. Logically you'd assume it's related to the amount of trauma the graft was exposed to during surgery and individual physiology. I'm yet to see a case of the alleged 5 percent of people that don't shed, and I must have looked at hundreds of results. It could even be an urban myth...

Usually there's more density in the back of the head. It's pretty hard to assess with your hair so short, but it's worth getting your donor assessed to get a good idea of the number of grafts available. I'd say the main difference in Eugenix is their good use of non-scalp hair (preferably beard of which you appear to have plenty). There are some very good surgeons in Turkey so wouldn't put you off that, if you choose wisely.

My 2 cents would be that your budget isn't the issue (directly), but your donor area looks relatively scarce. Given that, id personally wait until you can pay for a more experienced surgeon who to increase your chances of good use of your precious grafts. Eugenix is a good call.

Boot are a chain of stores in the UK. They sell a range of products from sandwiches to suntan lotion to nappies and toothpaste. They are also a general purpose pharmacy. At best they're generalists, and certainly not where I'd go to get prescribed hairloss medication. As I understand it, the FDA approved minox lotion up to 65 years old and foam to 49. Most pharmacists will do the math and figure either can be prescribed at least to 65.

Yes, and no. If I remember right, minox was trialed using patients in a specific age range and it was approved on that basis. The fact you're marginally outside that range is not likely to make any difference to efficacy, but technically there isn't enough evidence to support that so that a doctor will prescribe it. Id bet that an online pharmacy like Dr Fox wouldn't have the same reservations.

At my first clinic they said 14 days post surgery. For my second it is more nuanced - 15 days for cardio and 30 days for heavy lifting. The two issues they're trying to mitigate is excess sweating (which could lead to infection) and high blood pressure in the scalp which could lead to grafts popping. Personally I think it's generally understood that grafts are anchored after 14 days so that's probably the time I'd be comfortable with exercise and moderate lifting, working back up to heavy lifting as I feel comfortable afterwards.