Rafael Manelli

Honestly, it doesn’t look that bad to me. For 5 months this looks normal. It has plenty of time to fill in.

1400 grafts may not be enough to fill that area densely on bald scalp but you had plenty of thinning hair there to begin with. As long as that remains, and growth of the grafts is good, you still have a good result to look forward to. Don’t let other people’s comments put you off. They more than likely don’t know what they’re talking about. Your family probably just thought it looks thin, which is does, but that’s normal for 5 months.

On 6/19/2019 at 5:21 AM, bismarck said:

Very strong work. It is a very horizontal design though, though this may be more natural depending on your ethnicity.

Did you intentionally ask them to blunt your temple points?

The slight widows peak does a lot to break up the straightness. I suspect it would look significantly different without it. 

On 7/15/2019 at 9:27 PM, H & W Doug said:

Looking good bossman!

 

For the record Bis, this is not considered a blunting of the temporal angles.  Something less than a 90 degree angle would be.

Can you please provide examples of what exactly you mean by this? 

Stunning result. Nice hairline design. Excellent photography. Super aggressive design for someone not on meds. 

9 minutes ago, BRITA-XL said:

This comment aged well 😂

Bizarrely enough I was reading this thread and thinking the same thing when you commented. 

1 minute ago, mister_25 said:

What makes this one really crazy is that it was done in a single pass. One of the best

I would say this is the highest density I've seen done successfully in one pass. I like the obtuse, near verticle temple point angles. 

Unbelievable result. Hall of fame.

We should actually have a hall of fame sticky topic somewhere... 

This is a super weird case. Who was the doc?

Just now, Hairsonality said:

Longevita have said multiple times throughout this thread that they are willing to engage in open dialect. You've asked a genuine question of there opinion of the result in the picture, no reply given. They know its a poor result, its obvious even from that one picture.

Silence is deafening. 

30 minutes ago, Melvin- Moderator said:

This hairline is perfection 

 

Definitely one of the GOATs not just for hairline design but overall density and coverage 

1 hour ago, Legend007 said:

Already got one from h n w. 3.5 years ago. Doctor hasson did a one n done for me. That’s why I chose them.. other clinics were telling me I might need two operations to make the hairline match my current hair..

I ain’t got time for two operations nor the extra money to spare.. that’s why I didn’t cheap out on my first transplant for fear of having to do another right after.. n that’s usually the case for hairline jobs .. 

even though I’m a norwood one 1, in my early forties, I still feel like I’m going bald, cuz of my thinning hair. But finasteride definitely did maintain my mid n crown.. I really thought I would be bald by 45.. that’s what my stupid noobie doctor at Kaiser told me.. imma be bald like Bruce wills.. that little bitch doctor ain’t even working at Kaiser nomore.. 27 year old doctor don’t know shi.t telling me I be totally bald.. everyone in my family is a norwood one..well anyways .. I’m just sharing my experience. 

Looks good. Do you have a topic? 

I would like to know if you have a particular hairline design that you really like, be it surgical or natural, and also if there are any surgeons who tend to do results that *particularly* stand out to you. It could be a specific case or a general trend of design. But I am hoping to see nice examples. It is easy to list off reputable clinics but I am more concerned with what you like personally.

Some people are able to tell the work of specific surgeons by the way they do micro irregularities, which is an ability I find very impressive. Do you pay this much attention to detail?

Name brands are more reliable than generic. Your best bet for finasteride is Propecia and Proscar. Propecia is a pill you take once a day. Proscar is a bigger pill you cut into quarters or fifths and take one piece daily. It’s cheaper but a little more work to use simply because you have to cut it up.

I would recommend oral minoxidil rather than topical. It’s a lot less hassle to use and it’s more effective. But I don’t know brands.

Where do you stay? There may be a reputable doctor in your are you could book a consultation with.

On 3/10/2023 at 12:53 PM, Gatsby said:

@DBMTT by using medication you are effectively stopping further hair loss in its tracks. That’s the goal. As a Norwood 7 and having had my second repair surgery 6 weeks ago my donor improved dramatically from oral minoxidil. I would definitely recommend starting medication a year before any surgery to see how your hair responds/stabilizes. All the best. 

Most of the time it will not stop it in its tracks but merely slow it to a crawl sadly.

I would not say it is superior or inferior, just that each has its place. Pros and cons. It is good that both types of surgery exist. 

Does Dr Lorenzo not still do it too? And you've listed only the reputable names. How many shady hair mills are out there doing huge fue sessions and ruining patients? I don't know but it's definitely too many. FUE lowered the bar for entry to perform surgeries, while also having a higher skill requirement for good work. It has both a lower floor and a higher ceiling which means more variability and risk for patients, who must be extra careful picking a doctor. 

I think many FUE surgeons are still extracting the last graft before implanting the first. But I don't have statistics on it. Nothing wrong with this method as far as I'm concerned but it means more time out of body which is a factor in megasessions. 

I'm with you 100% that gigasessions are risky period. But with FUE especially. 

You need to have realistic expectations and should consider a scalp biopsy to test for miniaturisation and for things like scarring alopecia 

If your donor is weak due to male pattern hair loss, you may strengthen it by taking finasteride.

If it is weak for another reason, you must consider other options. 
 

What texture is your hair? Men with very curly hair, such as Afro texture, often have low density, which makes the donor look weaker than it really is when cut very short.

You must pay attention to your hair. Ideal dosage of finasteride varies because follicular DHT sensitivity varies.

You want to use the minimum dose necessary to prevent hair loss. Enough to get the desired effect, but not too much to risk increased side effects.

If your hair loss continues, you may try upping the dose.

Avoid the sun and don’t be a pale skinned ginger.

And try asking your doctor

15 minutes ago, hairman22 said:

that would vary among individuals.

Of course.

The claim that with FUE you can extract and (almost) simultaneously insert the grafts only applies to the DHI method which I don’t think has shown significant superiority over the traditional FUE methods otherwise all top FUE docs would be using it, whereas in fact many (most?) seem content with storing them in a solution like saline or ATP or hypothermosol until implantation.

Time out of body is important, but that’s one reason why chunky grafts fare better. They survive outside of the body for longer.

I don’t know how much time grafts are spending out of the body in FUE gigasessions such as those performed by dr Zarev and Pittella. I think vast majority of doctors should not even think about attempting sessions that large, at least.

If you are doing a gigasession FUE, you not only have the three forces of torsion traction and compression (and skeletonisation, and transection) but you also have another potential force which is exhaustion. I would guess if you’re doing 9000 Fue grafts, you would not use a large punch, because 9000 large holes spell disaster for the donor. So docs are extracting upwards of ten thousand grafts with a tiny punch. Can you imagine the time spent out of body for such grafts in an operation this large? Or the stress and fatigue it risks for the staff? And how they must go into the riskiest areas of the donor to maximise graft count?

I am not saying it can’t be done. But it is an exceptional challenge and very few are equipped to take it on.

1 minute ago, Mango said:

thanks Rafael, yeah i'm hoping to keep taking the photos under the same outdoor light in the same spot. Hopefully get a good comparison month on month. 

Your crown has a very pronounced clockwise swirl pattern, which Dr Das has followed faithfully with the graft angulation. It’s looking natural even this early on, I look forward to seeing the evolution.

2 minutes ago, Melvin- Moderator said:

I haven’t heard this since Dr. Feller was posting. The skeltenozation was an old study published by Dr. Beehner, it was his own FUE work. He was also not a surgeon who regularly performed FUE. I don’t believe there’s any merit to that at all. 

To contrast, slivering is something that most technicians don’t know anymore. If you sliver the grafts wrong, you’ll end up with poor growth, so just because a technician is dissecting grafts under microscopes, doesn’t guarantee anything.

This was my biggest issue with Dr. Feller’s claims, he made it seem like FUT was fail-proof, it’s NOT. Today, I think you’ll find it very difficult to find technicians who can dissect a strip properly. The old studies comparing FUT to FUE should be dismissed. The only credible study in my opinion is Dr. Shapiros, he regularly performed both techniques. 

It is unfortunate that technicians and doctors are not learning how to properly sliver a strip these days. These are not “golden age” clinics I supppse. Properly trained techs slivering a strip under microscopes and illumination are the best way to ensure robust healthy FU grafts.

The degree of skeletonization will depend on the punch size. A bigger punch will leave more protective fatty tissue for cushioning, but also tend to leave correspondingly bigger scars, which can lead to confluence of scarring in megasessions. Something to be aware of.

1 hour ago, mr_peanutbutter said:

id choose fut if i would know if my scalp has good laxity

 

unfortunately there doesnt seem to determine this at home and doctors dont even have a standardized way to measure it themself. just squeezing and pushing around the scalp for a couple of second, the rest seem to be gut feeling

This, admittedly, is a good and overlooked point. Not everyone has the laxity for a decent strip, but there are exercises for improving it.