consequence

A couple additional things I wanted to note or ideas I came across. A few sites recommended not using a cloth towel to dry your hair, but paper ones. This makes sense as cloth towels usually have bacteria on them even if they look and smell fine. I think even safer would be to just let your hair air dry -- it's a buzz cut and shouldn't take more than a few minutes. Why expose your scalp to yet another foreign object. Avoiding certain foods before and after surgery, in particular green tea/jasmine, spices (not just cayenne but things like turmeric, ginger, cloves, etc), caffeine/stimulants, nicotine, alcohol and marijuana (even if taken in capsule or edible form). Many of these have complicated anti-inflammatory and blood thinning effects. This might seem like a good thing until you realize that not all inflammation is bad -- a little bit is needed to stimulate follicles to start growing after surgery. Too much inflammation, of course, and you kill the graft or cause shock loss. It's a balancing act. Dr. Lindsey's site probably said it best: avoid foreign cuisine and just eat bland American food, at least up until your surgery. Be very careful with chewing because your temporalis muscle can contract with too forceful of a bite and pop a graft out. On day 2 I was eating a semi-ripe apple and as I bit in I felt something loosen on the left of my hairline. Literally had a mini existential crises. Don't be dumb like me, eat softer foods and soups for the first week or two. Cracking after surgery. This explains what might have occurred at the mid aspect of my left hairline above (the red arrows). This explanation is from Dr. Feriduni: "When the scalp is very dry or dehydrated after the surgery, ‘cracked lines’ could occur in the recipient area. This phenomenon appears when the scalp returns to its normal condition. It is almost comparable to the cracks in the desert. You could use a moisturizing body lotion to hydrate the scalp (for example The Postoperative Serum from Dr. Feriduni Hair Clinic or a regular lotion)." This is likely what occurred with my scalp. Doing my best to keep it moist. It's a good idea to design a tin foil cover over your head to avoid radiation to your follicles: The reason for this is the dermal papillae is so sensitive after transplantation that any radiation could impact your follic- ..no just kidding. It's pretty easy to overthink recovery but it's also pretty easy to get lazy about it. There's a sweet spot but it really requires a healthy sense of perspective. Don't be part of the tin foil hat crowd. There are a few other points that come to my mind while I'm out and about so I reserve the right to come back and edit this post down the line. Still I thought these might be helpful for others with similar questions. This site and you guys have been a real blessing, thank you all so much for the company on this bizarre roller coaster of recovery.

TL;DR: The ranges for recommendations regarding a return to full exercise activity levels range from 3 days to 1 month. About 60% of the more recognizable names say "light exercise" (ie. about one-third of usual effort, not working up a sweat) is okay at 2 weeks with full exercise at 4 weeks, 30% say full exercise at 2 weeks and the remaining 10% have varying or ambiguous recommendations. -- It's pretty bizarre the lack of uniformity across different surgeons recommendations for post op care, particularly for exercise. The general party line is to follow your surgeon's recommendations, that way if something goes wrong you can at least lay it at their feet. But I think for the sake of discussion we can get to a more granular consensus. Exercise too soon and you could dislodge a graft or get folliculitis, but wait to resume activity too late and you impair circulation and suppress your growth hormone response. The lack of uniformity suggests that most really don't know (because the research hasn't been done yet) so they're just "guessing" based on their patients. There really is no barrier to entry for a physician that wants to do hair restoration so you're just rolling the dice agreeing with a random website otherwise, especially as there are literally hundreds of different hair transplantation sites on the internet that each offer their own set of instructions. To cut through this Gordian mess I restricted my search to the docs that have more of a presence on different forums through patient submitted cases and ordered them roughly in order of consistency of their results by my estimation: Couto: No physical effort or contact sport in the first week. Can do contact sports at 15 days. Feriduni: After 1 week: Cardiovascular training: jogging, walking, swimming (salt water). These activities could be resumed at 30 % of your usual effort. Sexual activity is allowed, just be careful with your head during the first week. Use of a baseball cap. / After 2 weeks: Cardiovascular training: jogging, walking, swimming (chorine water). These activities could be resumed at 30 % of your usual effort. Use of a wool cap / After 4 weeks: Heavy power lifting, teamsports such as soccer, basketball are allowed but keep avoiding hard hits to the head until 3 months postoperative. Wearing a (motor) helmet is again allowed without any restriction. / After 12 weeks: Contact sports (boxing, kickboxing, MMA,..) Konior: If you’re a runner, you’ll need to keep your running shoes off for about 14 days. By the end of that 14 days, you should be able to return to most of the usual activities you did before the hair transplant. Even though you can’t run for the first 14 days after hair transplant surgery, you can still do very light cardio to improve circulation. Walking in the first couple of days is a good way to stay semi-active. As you get closer to the 14-day mark, you can increase the duration and distance of your walks, though be mindful of sweating and overheating yourself. Remember, you’re still healing. Even though that 14-day window is over, that doesn’t mean you can get back to running at full speed. It’s important to ease back into your running routine just to be extra careful with your healing scalp. While jogging may be approved after about 14 days, some kinds of exercise may not be approved at that point. Light strength training is usually okay at this time, but major weight lifting routines should still be avoided until the four-week mark. Swimmers could need to wait some more before they return to the water. True & Dorin: Generally, most patients will want to wait about two weeks before they lace up their running shoes again. This will give the scalp ample time to recover. By this point, patients should be able to return to most of their normal activities they enjoyed before surgery. Even though you can’t run until you get the approval from our NYC hair restoration surgeons, you can still walk to stay in shape. Keep the walks light at first just to promote circulation but not break a sweat. As you get closer to the 14-day mark, you can increase the distance and duration of your walks. Continue to keep the activity light just to be on the safe side. While jogging may be okay after two weeks, other exercises may need additional time. For instance, resistance training with light weights is okay two weeks after surgery, but you may need to wait for a month after surgery to return to heavy lifting and intense strength training. Swimmers may also need to wait before they return to the water. Cinik: In general, and depending on the donor area, you should avoid any kind of physical activity that could cause you to sweat for the first week. After that, you may engage in some light physical activity like brisk walks, household chores, and stretching for another week. Two weeks after the procedure, you can slowly get back to your regular training routine at the gym or things like running and cycling. However, if you play more intense contact sports like boxing, wrestling, and rugby, or run triathlons, you’ll need to wait at least 4-5 weeks before getting back to your regular training routine. Eugenix: You can start heavy physical exercise after 6-7 days. Epstein: 1 week: You may resume your normal activities, including light exercise, provided your surgeon doesn’t advise otherwise. You can resume your regular routine, including swimming, exercising, and washing your head like normal. You can resume your regular routine, including swimming, exercising, and washing your head like normal. Maras: The following day from your transplant procedure, it is advisable that you stay home and rest. The following 3 days you can begin taking on, light day-to-day work. At the same time, you should avoid any form of exercise for the first 15 days, especially lifting of heavy objects. After 15 days light exercise e.g. use of treadmill or swimming in sea water is ok. Erdogan: Exercises should be avoided for the first 2 weeks after the hair transplantation. Two weeks after the operation, you can start with light exercises without weight lifting. When you complete the first month, you can go with regular activities, and in 2-3 months, you will be free to do close impact sports such as football, basketball, martial arts, etc. There are no restrictions regarding your daily life (going to work, shopping, walking, etc.) Mohebi: You can resume all of your regular physical activities and sports after day 5. Armani: No strenuous exercise for a minimum of 14 days. Try not to lean your head forward to type or read for the next 2-3 days as this will increase the chance of swelling around your face. DO NOT drink alcoholic beverages for two days following your transplant. Shapiro: It is not necessary to wait a full two weeks unless you kick boxing or doing some other sports wherein you might get hit in the back of the head (we have had some ju jitsu experts get a hair transplant procedure) and again, we side with caution. It's fine to resume heavy lifting, but for dumbbells of 50 pounds or more, it's better to wait the two weeks so that we are sure that you do not strain so much that you tear the suture area. (This did happen once, but only once in in twenty years.) Asmed: If you exercise on a regular basis, you may be eager to resume your regular fitness program following your hair transplant operation. However, it is critical that you limit your exercise for the first 14 days after surgery. It is recommended that you take it easy for the first 5 days after your hair transplant and get as much rest as possible. You might be surprised to learn that your regular workout regimen can usually be resumed two weeks after FUE surgery. After one week, you may begin taking baby efforts to incorporate a mild activity that does not make you sweat back into your everyday routine. Feller: At the 10 day mark, the grafts are fully anchored, the staples are removed (meaning you can trim the rest of your hair if desired), the transplant truly looks like a clean buzz-cut, and most patients now go back to school, work, et cetera without much unwanted attention. Most clinics will also now allow patients to resume normal exercise activity. Longevita: It is recommended that you completely rest for a couple of days after the surgery. However, if you feel like it, you can take short, light walks. Here, it is important that you do not make yourself sweat. So, make sure to walk in a cool area, out of the sunlight. You should also walk slowly so that your blood pressure doesn’t rise. And the moment you feel like you can’t do any more of it, you should rest. It’s a good idea to take small walks because they can promote blood circulation, which can supply oxygen and nutrients to the healing grafts. However, you have to be careful about not overdoing it. As the days pass and you feel more like yourself, you’d want to take long walks. For at least 2 weeks, you should only consider walking only (while making sure that you’re not sweating). After that, you can engage in some different activities. / 2 Weeks – Post Transplant 2 weeks after the hair transplant, you can start doing some light exercises. As far as “light” exercises are concerned, it may be any of the following: Cycling Yoga Pilates Golfing Rollerblading (careful not to get injured) Tai Chi Rowing Elliptical Sweating is not a concern after 2 weeks have passed. That’s because the wounds on your scalp will have closed up by then. Still, you’re in the early stages of recovery, and your skin is sensitive. That’s why it’s better to only do light exercises only from 2 weeks to a month - You still need to be careful about not hurting your scalp. In the case of a FUT hair transplant, you’d have to be more careful about exercises that require stretching. That’s because any exercise that makes the skin of the neck stretch can make the healing wound come apart. Your doctor may recommend you to wait a little longer than 2 weeks to start doing light exercises. / 1 Month – Post Transplant One month after a hair transplant, you can resume your normal exercise routine. This means that you can go back to the gym and do exercises like: Shoulder press Deadlift Chest press Push-ups Squats & lunges High-intensity interval training (HIIT) Jump ropes Climbing stairs/step-ups This list is not exhaustive. You can also start swimming after a month has passed. If at any point you feel unsure about a particular exercise, make sure to consult your doctor about it. It’s understandable that patients want to go back to their old routines as soon as possible. However, these exercises will make you sweat, increase your blood pressure, and can cause injury. That’s why it’s best to wait till the grafts are secure in place. / 2-3 Months – Post Transplant If you play contact sports, you need to wait for at least 2-3 months. That’s because this kind of exercise after a hair transplant has a high risk of injuries. If your scalp is impacted any time before that, the skin trauma can end up damaging the hair grafts permanently. Before performing any of the following sports, make sure to consult your doctor: Wrestling Football Basketball Karate Lacrosse Hockey Rugby Handball. Rassman: After 3-4 days, short of swimming, you can do any exercise you want, even run a marathon. heaving lifting is ok. <-- this is almost certainly bad advice -- Would be interested to hear the recommendations of your own surgeons and the post op regimen you ended up following. Happy growing folks.

Jesus Christ look at this thread. Feel bad for OP's surgeon.

Oh wow, he didn't even mention the PRP bit to me, though I may have missed it because my Spanish comprehension needs a bit of work. If you can make it work, take the earlier date though I personally picked a date in May because winters tend to be a bit drier and I wanted some moisture for my follicles in the operating room and early recovery. Was there anything else he mentioned about post op recovery? Now I'm worried I missed all sorts of things 🥺

Can you show us a current pic of your hairline without your hand holding it down (like in your first few pics). Hard to see what’s going on with the hair pulled taut? I appreciate your frustration. It’s disappointing to see people act unethically when you’re in such a vulnerable state. I know people have financial restraints but in general it’s not a good idea to give the ball back to a guy that fumbled it in the first place.

May I ask your age and what other meds you’re on? This is your first transplant? Please keep updating.

What meds are you on and at what doses? LLLT? And your age? Have you considered a scalp biopsy? Who at Eugenix did your procedure? Tough case and disappointing result. Having had prior strip I would have continued with that approach if possible.

Thank you guys. One thing to add -- When I sprayed the moisturizer spray given to me by the clinic after surgery, I made sure to use my right hand to do the right side and left hand to do the left side. This allowed for a more symmetric distribution, particularly at the temple points.

Hello friends, wanted to summarize my recent FUE procedure with the esteemed Dr. Couto in appreciation for the incredible help I've gotten from this forum over the years. I'm now 10 days post op from my trip to Madrid. I began looking into transplantation ~10 years ago and always loved Dr. Couto's temple points, I think he's one of the best in the world when it comes to imitating mother nature. Medical history: Age: 47, non smoker, no other medical issues Dutasteride 0.5 mg/day for 10 years Ketoconazole shampoo 3-5 x/week for 17 years Minoxidil 5 mg/day for the last 6 months. 2 past PRP sessions, not recently Intermittent laser helmet use over the years Logistics of the trip: I flew to Madrid on a non stop 11 hour flight from the United States with Iberia Airlines. My packing list included: A wedge pillow from Amazon in addition to my neck pillow, vacuum sealed in original packing (so it would fit in my suitcase) for sleeping after surgery: \ Neck pillow which was crucial in allowing me to stay on my back when sleeping and avoid rubbing my temples against the pillow in case I accidentally turned. ZIppered hoodies to wear after surgery as I didn't want to deal with buttons post-op. A lot of sterile normal saline wound wash so I wouldn't have to use tap water after surgery for the recipient. Probably unnecessary but I wanted to reduce the risk of infection. Melatonin to help with rest after surgery as I am not a back sleeper. Recuperation is crucial and having something to knock me out was much more necessary than I anticipated. Surgical caps for going out, though I really didn't end up using these and my neck pillow was sufficient to allow me to avoid contact with the airplane headrest on the flight back. I also only left the hotel once in the first 7 days after the procedure (other than for my return flight). - My hotel was La Gran Hotel Ingles, based on its reviews across different travel websites. (I stayed at an AirBnB when I had visited a few years prior for my consultation, but despite having great reviews it was a little dirty so I opted for a hotel on this stay.) It was a nice stay, clean and quiet despite being in the center of downtown. - If you want to be extra careful, you can ask the maid service for new sheets each day, or if in an apartment you can wash your sheets yourself to reduce risk of infection. I came across this suggestion on some random website and thought it was interesting, though probably a bit cumbersome to do on your own after surgery. Initial consultation: -I sent him these pics at my initial e-mail consultation for the design I wanted, Julius Caesar headband courtesy of my mom: - He generally agreed that this was feasible and quoted me 1400 grafts, though he ended up putting in 1700. This is the design he impromptu drew on the spot in his office at my initial consult. He is the best in the world at temple points in my opinion ("entradas" in Spanish) with Konior being a close second: - The office is located in what looks like a really nice area of downtown Madrid in a ground floor corner office. Be careful of banging your head on the hanging lights over the reception desk after the procedure, they are literally RIGHT at transplant level. - There wasn't much difficulty in getting to and from using Uber. Another popular ride app in Spain is called "Bolt" and sometimes is faster/cheaper depending on time of day. - Dr. Couto is exceptionally charismatic and has a "larger than life" personality. I remember at my initial consultation I had just walked in the front door of the clinic and he was coming out of an operating suite. I think he could tell I was a bit nervous and he walked up to me right in the waiting room and gave me a quick but very detailed assessment before he went back inside to continue his surgery. My actual appointment was an hour later where he elaborated further on what he said, but it was really remarkable to see him do this off the cuff. I felt like he was an older brother trying to help me through high school when I met him. Very comforting and confident. - He reminded me a great deal of a somewhat more ebullient version of Dr. Konior. You can tell he holds himself up to an extremely high standard and takes a lot of pride in his work, but also just generally a cool dude. Also not that it's important but he's a good looking fella, looks a bit like Ricky Martin. - Here is a montage of the initial surgical pictures. I don't have the pictures from the clinic yet; this was the best I could do in my sedated valium'd up state. I can send Dr. Couto's pics when I get them: - Day 1 he did half of the left side and midline (60% or so) and day 2 he did the remaining 40% on the right. I noted that he had placed the widow's peak/frontal forelock slightly asymmetrically and he explained that he did this because he found that most natural widow's peaks were not symmetrical. He even added that he had kept the right temple point slightly larger than the right for the same reason. I was resistant to this at first, but have since spent some time looking through Google images and realized he was spot on. - It was raining a good amount after surgery and one of the surgical techs, Paola I believe, allowed me to take her umbrella even though it meant she would go home in the rain. Don't be a dope like me, plan for weather. - Esteban, who's been there 10-15 years I believe, was the one that did the extractions. I had seen him mentioned in a lot of posts on the various forums so I was glad it was him. Super chill with a good sense of humor. - I wasn't very good at staying still during the extraction -- it was a little painful and I was restless. Day 2 was easier but I'm just kind of a physically anxious person. I got scolded by Esteban (as I should have been) for moving too much, and I kept getting paranoid that if I fell asleep my head would jerk but I did my best. - The extraction was the toughest part of the procedure (other than the swelling on day 3 post op) and even then it wasn't that bad. Be mentally prepared for this. The implantation was much easier to deal with, probably in part because Dr. Couto was so personable during the procedure -- like literally at one point we were all jamming to Queen and singing along to Bohemian Rhapsody as he put together my hairline. - Here are images of my head after the first day and again at day 3. My donor site was pristine by day 3 though unfortunately I had severe facial swelling at the same time (I tried to crop the blur so you could see. My vision was about 60% impaired which made it extremely nerve racking to avoid hitting my head on things): -Incidentally, I know it seems obvious when you read "don't hit your head on anything after surgery" but when your vision is impaired from the swelling and you're groggy from anesthesia you need to be careful. These have been the 4 horsemen of my post transplant obstacle course (the third image is a reading light on the airplane head rest that was just begging to stab me in the donor during my return flight): - This is a little odd but the way I avoided them was literally by putting my arm or hand in front of my head any time I went through a door or sat down on a seat. Literally like I raise my right arm up before entering my car and let that touch the door frame first, then I would slowly lean into the car: I am trying to take care of these grafts like they're my children! - The original hairline was flawless. At 1 week post op and I've noticed some "gaps" appear in the hairline on the left: - This worried me initially, but it looks much better after 85% of scab removal today: - There's no way to tell whether this is significant until a year so I'll just try not to think about it too much until things evolve down the line. - Regarding post op instructions, they told me to apply a baby shampoo/aqueous mixture in a 1:5 ratio on day 10 (they gave me a special bottle of shampoo), let it sit for a few minutes and then gently but firmly work off the scabs like how Melvin showed us in his post transplant care video. - I am currently day 10 post op on the left and day 9 on the right. So far things looks fuecking amazing and I pray to the Hair Gods that the final hairline follows suit. - Physical activity recommendations that I intend to follow are as follows: Week 1: no exercise. Week 2: light activity as long as it doesn't raise my heart rate/blood pressure. Weeks 3-4: light exercise is okay but no weight lifting or high intensity cardio. > Week 4: Weight lifting and cardio okay. - For the first week I was pretty strict about staying inside and avoiding physical activity as instructed. Luggage was tricky to deal with at the airport because of this (had to wait for porters or ask other travellers to help me) but I didn't want to pop any grafts. Also ended up getting detained at immigration on the way back for a few hours, which really sucked. The agent told me it was random selection, but I'm not sure if my head cover and post op appearance had something to do with it. - For food, groceries, medical supplies delivered to your hotel room or apartment, they use an app in Spain called "Glovo" that offers same- or next-day delivery. I used this to order bags of frozen peas to keep the swelling down after surgery. Also if you get a chance while in Madrid, try Tierra Burrito. Some of the best Mexican food I've had in my life, especially helpful if you have any nausea post procedure but want to have some basic nutrition in your stomach. Uber eats also works in Spain, though it is slightly more expensive and you can't do the non-food stuff. The downtown area of Madrid, especially around my hotel, was one of the most vivrant walking communities I've ever seen in my life, reminded me of Rome or Paris. Didn't get to experience it much, but I will be returning for sure. - I've heard some docs like Feller say you can travel the day after surgery. This might be okay for a one day procedure and short flights, but I didn't want to travel with open wounds and draining lidocaine/blood into a gauze wrap while on the plane during my 11 hour transatlantic. -My facial swelling was fairly severe on days 2/3 and I've heard the altitude of a flight can make it much worse, so you really have to watch your window of opportunity for travel. Once my face ballooned up like a rubber water bottle I wasn't able to get around for a few days. Even flying back on day 6/7 was a little tricky, though much better than it would have been earlier in the week. I took 2 weeks off from work, though I think today (days 10 on left and 9 on right) I would have no issue returning. Still, better safe than sorry! Sooooo that's my summary thus far. Kind of experiencing that weird cocktail of hope and fear that probably everyone who's had surgery here understands. There are moments where I just stand in front of the mirror and think "please, please grow!" as if I'm talking to a house plant, but otherwise doing pretty well. Occasional throbbing along the hairline but pain has been fairly manageable with nothing beyond the regular Tylenol they gave me. This community is a really special and unique place on the interwebs; thank you all a thousand times over for sharing your advice and personal experiences! Any feedback is sincerely appreciated and I will do my best to keep you guys updated.

You're really shooting from the hip to make that conclusion at 4 months, especially for a revision. Pictures of your entire hairline not taken with a phone on selfie-mode from 6 inches away would be helpful (ie. set it on timer mode or have someone else take the photo). Where are the clinic's pictures? And just some general troubleshooting -- are you a smoker? Do take any other drugs or medication (recreational or prescribed)? Also what does of finasteride are you on? Could you consider switching to avodart and adding 2% ketoconazole? Last, people have mixed opinions about this, but if you have symptoms of dermatitis a biopsy might not be a bad idea to see if you have any tinea/malassezia hiding in there somewhere. I really appreciate you sharing your case with us but I wouldn't give up the ghost just yet.

This is correct. I also found oral minoxidil to be more effective than topical for me and w fewer side effects, though I haven't looked too much at the literature about this.

The picture you posted is stable from 1 year, not "getting better over time". So I can again correct your misinformation and tell you you're wrong. The study is only in Japanese men. Merck's original studies were in a larger and more general population and showed a lack of getting worse for many, but that about 15-30% progressed with time regardless of fin. Spend more time on the results and methods sections and resist the impulse to just cut and paste sentences from the abstract. Remember the evidence hierarchy. Poster presentations from a conference are never going to be vetted as carefully as meta analyses and position statements from high impact factor journals.

The reason for this is that follicles become much more sensitive to DHT and inflammation with aging. As a thought experiment think about the flip side: if you gave a 70 year old man anabolic steroids vs a 20 year old man, the older man would experience AGA at a much more aggressive rate than the younger.

1. There is a benefit to using minoxidil and finasteride together. This has been shown in multiple peer reviewed studies. 2. Minoxidil is a nitrous oxide free radical inductant. Theorized to work by dilating blood vessels, particularly in areas with early scalp fibrosis. 3. Finasteride decreases in effectiveness over time because the follicles become more sensitive to DHT and inflammation; remember, fin only reduces DHT by 70%. This was shown with Merck's original long term studies and follow up data has endorsed it. There is even progression with Dutasteride, which reduces DHT by 95%, though to a lesser extent than finasteride. 4. Finasteride works for both the crown and frontal line. It can cause regrowth at the crown, but more slows recession at the frontal line. With dermatology literally being the most competitive subspecialty of any field in medicine to get into in the USA, it's very surprising that he wouldn't know these points as they are extremely basic medical facts that any second year medical student would know. Are you sure he was an actual MD? Was this somewhere outside the states? And are you sure that you completely understood what he was saying? I've never heard of a study endorsing this view and it makes zero mechanistic sense. You're really spreading a lot of misinformation on the forums. This is in direct contradiction to Merck's own gold standard studies from years ago. Provide a peer reviewed double blinded trial from a high impact factor journal. Otherwise lighten up on the broscience.

Incorrect: Not as strong as dutasteride or even fin but for me it had more impact than minoxidil in degree of slowing progression/regrowth. Fin/dut is probably the most important though.

I don't care what people think, I just don't want the grafts to get infected by contacting that gross unwashed airplane seat headrest. I have an 11 hour non stop flight, so probably will doze off and let my head drift to the side at some point whether or not I want to do so.

2% ketoconazole shampoo

I would be cautious getting surgery so young wtihout the big 3 medications on board.

I will be flying long distance home 6-7 days after my transplant surgery. For those of you who did this, how did you protect your grafts and donor area on the flight home? I have read not to wear a hat/cap for the first two weeks though as it seems with most things regarding post op care the recs for this vary dramatically between different surgeons.

OP's username checks out.

This is a good point. Maybe to put it differently, it's probably not a good idea to get a transplant until your hair loss has stabilized for some time and this is less common unless you're on fin/dut. Like buying the lowest water front apartment in Venice -- there's a good chance your investment is going to get flooded.

I think then it's best then not to lose the forest from the trees and assume they probably know what they're doing. Ultimately, no matter how good a surgeon is, there's always a roll of the dice and a small leap of faith required as admission price to the operating suite. Remember, though some things are more likely than others, there are no guarantees in surgical hair restoration. Just too many variables.

You've already had FUE so there's probably not much harm in trying again if you are patient. Your hair isn't that bad though. That being said, getting hair restoration requires a bit of thick skin to deal with all the ups and downs of recovery. You probably don't want to hear this, but you seem to have a little bit of psych component mixed in. Shaving your head and leaving hair restoration behind in general might give you some peace there and avoid another emotional roller coaster, it's not totally unreasonable.

I think it's probably hard to tell at 3 months but have you noticed any slowing of hair loss or regrowth? (ie. how many hairs you see in the shower in the morning, pictures etc)

It used to be a general rule of thumb that if someone wanted to maximize lifetime grafts, they would "strip out then get the FUE out" or some such cute phrase -- ie strip as much as you can then FUE afterwards. FUE proponents have questioned this over the years, but I think there's a pretty good chance that it's true. For me this didn't work because I'm a diffuse thinner as well, and I'm hanging on to what I have with a strong regimen like yours. I figured eventually I will want to have kids and probably have to go off the dut (and presumably go to at least a NW5), so I'm just keeping an escape hatch open for a shaved head when I one day just go full hermit as an old man. I didn't want to burn my boats once I crossed the water, so to speak. Everyone has their own preferences with this and it sounds like you've thought your choice through with a careful premortem. Something combination of "What's the most likely scenario? / What's the worst case scenario?" is usually a reasonable approach. Hasson's FUT yields are some of the best in the world, he's sort of the "Konior of Canada" though every now and again he's had patients post some odd experiences (ie. bizarre hairline designs, lack of f/u, etc.). Regardless of these occasional hiccups, his graft survivals are phenomenal.