consequence

It seems different surgeons have different post op routines. For those of you that have had surgery was wondering what your doc advised. In particular, am curious as to how some docs use a thick viscous ointment after surgery that looks like petroleum jelly to me and how others recommend saline spray every 2-4 hours. What have your post op experiences been and is there anything you would have done differently looking back?

Their aesthetics are a bit different. Ferreira loves those angular and acute temple points, almost along the lines of what you see with Eugenix though not so sharp. Pinto is a little softer at his points and tends to be more conservative overall. Not as cautious as Lorenzo but certainly seems to stay a bit higher. Both have great track records and strong yields (ie. about 90% of their cases seem to turn out well on recuperar). It's really a matter of personal preference/aesthetics.

That's kind of where I'm sitting with it. It also seems like some studies show activated to have more effect and others non activated. I'm also not sure how it would affect the scalp in the setting of surgery. It's not just is there a benefit, but also could it hurt results? It seems like the surgery itself would induce a massive native PRP type response regardless. By mesotherapy what do you mean specifically? Injecting dutasteride into the scalp? Or taking dutasteride and injecting something else?

A few questions for those of you had that have used PRP in conjunction with surgery: How has it been for you? Did you use adjuvant Acell or stem cells? What was the time frame of your use and how many treatments overall did you have? Any other relevant information such as other medications you're taking, age, Norwood, other medical conditions like diabetes/high blood pressure etc. Was your PRP activated or non activated? This one might be trickier to tell as most practitioners don't bother telling their patients and their staff usually doesn't even know. The way to find out is by googling the specific brand name of the PRP system your doc used and activation (ie. "AcCellerated Biologics +PRP +activation" or "Cellenis +PRP +activation") Was your PRP leukocyte enriched or leukocyte depleted? (similar to above) It seems like practitioners are packing the PRP in Acell (ground up pig bladder) to make it stay in the scalp longer. I guess this makes sense, but there are no studies in the peer reviewed literature that I can find on this point, just "case reports" from individual surgeons' websites which are essentially worthless. Hair caliber and follicle density need to be objectively measured and quantified. You can't do this with pictures from 3 feet away. Also, when using it with surgery, I'm not sure have having pig protein sitting in your scalp while your hair follicles are trying to sprout is a good idea -- would a gunky mesh of protein impede blood flow? Particularly at a time when the newly transplanted follicles are so delicate. This is an interesting round table discussion about PRP in general from the ISHRS, with some of the names being pretty well recognized in the field. I favor the opinion of Bill Haber -- there's just a void of scientific information right now, particularly in the setting of surgery (literally 2 studies on all of Pubmed, one of them being cicatricial alopecia which is a very different process than androgenic). I disagree with Cooley's suggestion that the scientific method cannot be applied accurately to see if it actually works due to concomitant medication, bell shaped response curves, etc. Confounding variable and response curves are built into any scientific study. That's how the scientific method works. The real issues are funding and time. To do a large randomized double blinded trial would be expensive and time consuming. Until the market for the treatment can be shown to be more fertile, there's no large pharmaceutical company that will pay the millions of dollars it would require to push a randomized double blinded trial through. One thought is to do a large trial where half of the scalp with surgery is injected with PRP and the other half with saline, with the patient and surgeon both blinded to the results. But I don't see any study like that even remotely on the horizon. And that leaves us caught in the middle, as is so often the case with cutting edge medicine. Of course the people that offer it will say "in my clinical experience, it works" but that's essentially worthless without the scientific method. Their wallet depends on what they're saying and they're only making judgments on pictures, not objective hair counts or caliber measurements. So with all that being said, I would like to know your experiences. I had a single session without surgery and am on the fence as to whether or not to do it before my upcoming FUE. I had a minor improvement in density (perhaps between 1-5%) over the next few months though the effects seemed temporary. I'm not sure how this would translate into its impact on post operative healing or yield.

No

Who recommended that you do this after surgery? I have seen some clinics trying it, but so little is known about PRP, particularly in a post-operative setting when the dermal papillae are so fresh, I'm not sure this was a good idea. Looking through Pubmed, there aren't many randomized trials about this (of the two I found, one was done intra-operatively and had some benefit and in another it was used for cicatricial alopecia and there was no benefit). At this point it's basically the wild west. I would be inclined to say that if the majority of Couto's patients don't do PRP around surgery (which I believe is the case) and the majority get good results, just stay in the middle of the pack and don't try anything too crazy. Reminds me of that other poster from India on here who was trying crazy nonsense like standing on his head for an hour every day after surgery to "improve blood flow" and and ended up having a subpar result. Sometimes less is more. Also, did you do PRP 1 month prior to the procedure this time as you planned?

I can't believe how much progress you've had by 5 months. You look like a different person. How is it at 7 mo?

Someone mentioned this earlier but just to reiterate, your first procedure looked so flawless. This seems like a reinforcement of the previous work but almost not necessary. What was it specifically that bugged you about the first pass? I'm going to assume it was something not translating well with your pictures. Was it density along the line? Softening the temple points?

How's everything going?

I've taken it for about 6 months at 2.5 mg, just bumped to 5 mg. Hair has thickened throughout. No side effects of which I'm aware. Haven't been measuring my blood pressure but I've also lost weight over this time so that number's going to have dropped regardless.

You are coming along. Please keep us updated and be patient. Try not to look at it every day and if you figure out how share the secret 🙂

I don’t think you’ll see this but congrats on your xformation! Do you have any pics of when Ferreira drew your tentative hairline?

I just saw your post later in the thread. Wow, Pinto, wow.

Do you have before pics with your hair grown out to compare to your after results?

I agree with Melvin here. It's a little frustrating, to be honest, to see how aggressive and critical the forum can be sometimes. You established a new "line in the sand". Your density wasn't perfect, but looking at the pre-op I don't think it was a yield issue. From my armchair perspective Couto implanted you less dense to start with: That doesn't look like 35% to me, closer to 80% - but really who the f can tell from 2 dimensional jpgs on a forum. My hunch is he thought you had a fibrotic scalp with limited blood supply and wanted to ensure graft survival. I'd be curious what your hairline looked like without high magnification and with a non spiked hairstyle. Also, not to nitpick, but you started oral minoxidil a month after the procedure, when most of the immediate healing and engraftment was completed. If folks could spend some time on the Spanish forums they'd realize that not every case Couto publishes looks like a home run (he's at about 90%). What really stands out, though, is his sense of accountability and ownership of his results. And to that end, I've never once seen a bad outcome of a revision with him. I suspect you're going to come out of this looking like a rock star. Please keep us updated.

Yeah, your ex wife is gonna be pissed at the new piece of ass you're gonna pull with this hairline. Congrats. You deserve it after all you've been through.

Sometimes it's easy to get into your head without outside perspective. I hope things get better -- I'm sorry you have had such a rough go of it so far.

You should be about 6 months out by now. Would love to see your progress!

These are two redundant forums that shouldn't be separated. Makes it harder to search for surgeons' cases and the post content is identical. The separation makes no sense. Can we combine these? It wouldn't be difficult from an IT standpoint.