Rafael Manelli

Good question. A sharp punch has a greater risk of transection, which is especially so for Afro hair because it splays under the skin, and especially for multi hair follicular units. FUE is a blind procedure and requires great skill to do properly, doubly so for those with curlier hair. a dull punch will cause greater torsion on the graft. It stays in contact with the skin longer, and sort of “grabs” the graft. Therefore when the punch rotates the graft can be twisted and damaged. A good doc might minimise this by using careful oscillation instead of continuous rotation. At the end of the day laymen can’t control what punches surgeons use. Many use hybrid punches these days. You are better off just looking for someone who produced good results on Afro patients, instead of fretting over which punch they use.

This has to be one of the most exciting things in hair restoration, thank you for your work Dr Barghouthi.

This. Adding too many “treatments” is likely to reduce compliance. In other words people find it a hassle and give up or get lax with it. Better to take Propecia daily than wear a laser helmet, spend ten minutes a day rolling needles on your scalp, spraying miscellaneous lotions and potions, and miss out on Propecia a few times a week. Keep it simple and stick to what we know works.

If you have that many scalp grafts available without giving the donor a depleted appearance, you will be in an extremely lucky minority indeed. You have won the lottery.

Funnily enough, I actually wrote this poll after reading that very ISHRS census data. It seems a great topic to review on the members of the forum in the current year. The people here may represent the average better educated patient. There seems no contesting that FUE has gained popularity worldwide.

The problem with doing a transplant without meds is you’ll probably continue to lose hair and need more and more surgery just to keep pace

The poll is asking you, for yourself

If you’re scared of the risks of finasteride, why aren’t you scared of the risks of hair transplantation? ED is a rare side effect. ED that continues long after the drug is discontinued is much rarer. Hair retention is the most common effect of finasteride and it may help to try the drug for a few months to see if it works for you. If you notice side effects, they will likely subside with continued use. If you stop taking the drug, side effects will likely dissipate also.

You have a good head of hair. It may be best to avoid transplanting yet unless it bothers you too much, because once you go down that route it’s hard to back out since you’ll have scars and hair growing on those temples indefinitely - even if the hair behind it continues to recede, which would look unnatural. If you want a transplant, consider finasteride first. As for recommendations, Couto is great. Fuegenix too. Dr Heitmann also.

I find it interesting to look through old threads sometimes and see what has changed or if anything sticks out as relevant to the present day. It’s compelling to see how things compare. When this thread was created, Hasson and Wong were among the only doctors doing big megasessions. Now we have Eugenix, Dr Pitella, Zarev, Hattingen, Lorenzo… and more . One could say the industry has evolved a great deal. And Dr Hasson’s comment made me laugh

Interested in which procedure you would rather opt for today, if you were starting from scratch - so you needn’t worry about previous scars, donor damage, or anything like that which would influence your choice. What are the main factors that would go in to your decision?

It would be a good idea to maximise exposure

@DrMunibAhmad has some great results posted here recently

Donor looks immaculate, but to be fair this is expected at this length of hair. However I suspect it would look excellent even with much shorter hair.

500 extracted, 500 implanted and 500 grew is a good result. A bad result would be if the yield was low, or if there was damage to the donor, or if it grew in an unnatural way. if you grow it out, does it cover much area?

That’s what I expected. I love the analogy. The extraction looks exemplary. There is a reason your practice has become so popular these days.

In your view is it ever appropriate to extract hair from such naevi or are they best left alone? What is your reasoning behind this?

I notice he has some bumps and a scar on the back of his head. Did you find this affected the extraction process at all?

Very natural

What was the result of your strip procedure 24 years ago?

I am rarely impressed by SMP, and photos don’t always tell the whole story, but this looks very impressive.

Scalp grafts can contain anywhere from 1 to 5 hairs, occasionally more. The average is about 2.1. Do you know yours?

@A_4_Archan that I can agree with. Plenty of hair mills and bad doctors in the west too. The OP has plenty of time to get a satisfactory result, and any dissatisfaction with the way his operation was conducted on the way should hopefully be moot compared to a good final outcome. He is only a few months in after all.

Seems like a waste of time and money. There are vastly superior alternatives.

I’m not here to play “spokesperson” as you call it. I am merely stating that medical standards vary legally throughout the world. It seems you’re more offended that a country would be referred to as third world, than that third world countries are criticised for their medical standards. Fair enough. To some, it’s an offensive term. He could have chosen his words better.