consequence

Please let us know if there's an update!

How's everything looking @Ryan Daniel?

Any updates? How many PRP total did you have?

Update?

12 month update?

What I don't quite get is don't the stiches leave scars as well? I guess his reasoning is that the stiches leave less of a mark than the follicle hole but I would wonder if glue or dermabond or something would be a less invasive way to achieve the same thing. Interesting stuff.

If you can, try to take it easy as you valsalva when you cough/sneeze and can dislodge the implants. More risky if you've had strip as it could lead to scar widening.

I believe her mentor Dr. Konior is charging $15 per graft. She has decent results but that's just too hefty. I believe she may do the entire procedure herself? Regardless, there are other surgeons -- both in the US and abroad -- getting similar results at a more reasonable cost.

Meaning both extraction and implantation. The names I've heard before are Zarev, Lorenzo, Keser and Konior, though I'm not sure if this is still the case so any recent patients please chime in. Who else?

This is a recent published article from Johns Hopkins about Acell (urinary bladder matrix) causing blindness in a patient because of embolization into the retinal artery: Study OD means the right eye. Probably similar to how you can get embolization from injecting filler or a nose job. This is only a case report so no way to know the actual risk until larger studies come out but yikes.

How are things looking after a year? Touch up for density or live and let live? Thank you for sharing your journey.

Any update?

Can you post a shot of your hairline (ie with your hair combed/held back)?

If you ever come back please update!

I know you don't want to post pictures but hopefully after a year you are more comfortable doing so. It would really add integrity to your review and help evaluate the sincerity of your complaint.

Wow. Incredible. ^also my questions 😀

Very discerning eye. The whole multis in the hairline thing is such a telltale sign of a surgeon's expertise at the hairline, and ultimately why some surgeons charge so much more than others. It's a reflection of the organization of the clinic and the experience/thoroughness of the surgeon. Like Van Halen and the bowl of brown M&Ms. And of course with darker haired patients we all give a caveat of good genetics when talking about yield, but wow this guy was done at 4 months. There really seems to be a 'Brazil Spring' going on -- a good number of world class results have been popping up under patient submitted cases as of late. Probably following suit with India, Spain, Portugal etc. as an emerging economy with asymmetrically inexpensive labor (ie. for real estate, PAs, techs, etc.) but able to charge international market prices. The labor differential and lower cost of living outside of the west as made this an extremely lucrative surgery to focus on.

I guess if you define a revision as going back in and extracting follicles then sure, but it's a little bit of semantics. Definitely look into the other names I listed. Bayes theorem might suggest broadening your horizons.

To clarify what I mean: most DHT comes from the liver and prostate, not from the hair follicle. This study showed a 10-15% difference in growth rates for oral fin vs topical (oral being better) and a 21% difference in serum DHT (55% vs 34%). So almost a 1:1 ratio, allowing for variations in measurement accuracy. The finasteride was being absorbed from the scalp systemically, just not as well as orally, and had an impact on hair that was roughly proportional to this decreased efficiency of intake. In any case, good luck whatever you decide, hope your hair growth is as fertile as your tinder lay count. 🫡

Wow @win200 the amount of patience and persistence you showed throughout this process is incredible. Stellar results.

The first two are the same, just the first link is the full paper. You want to avoid crystallization because it reduces scalp penetration. This is a quote from the study:

The way to tell if your hair's improvement is the topical dut or not is to look at your systemic levels of DHT. I don't think the medication has much regional effect, it's mechanism is more likely systemic -- ie. oral minoxidil for me was much more effective than topical. But doing biopsies of your hair and immunofluorescent stains is probably not in your practical budget so until head to head studies come out this is all just inductive reasoning and podcast level broscience. 🫠 I think you should let your hair loss pattern stabilize with a consistent medical regimen for at least 1 year before considering another procedure, which it sounds like you're doing if you're waiting till Nov 2024. Otherwise you're filling a bucket of sand with a hole in the bottom. Focusing on docs with a track record of patient submitted cases showing repairs similar to what you're looking for is also a good idea. Gabel, Cooley, Feriduni and Couto have had some superstar level revisions on the forums. Also no more perms. 😇

I'm not sure which studies @mxnprettynice was referring to but these are a few that popped up after a quick google: Minoxidil application study 1 Minoxidil application study 2 Minoxidil application study 3 Minoxidil with microneedling study I think the idea is that once the minoxidil crystallizes its "thermodynamic activity" decreases. That being said, ethanol is also caustic and I'm not sure as to the effect of having alcohol sitting on your follicles for a longer time period -- these studies are in vitro, not in humans, so there's no way to know whether they affect hair growth positively or negatively. Minoxidil dilates blood vessels by working as a free radical (nitrous oxide, which has an unpaired electron). In a one year time span, 5% is more effective than 2% and microneedling with minoxidil seems to have an effect. Here's an odd quote from that 4th study: I don't know that there's a study looking at usage with @mxnprettynice's protocol of using a hat specifically, though presumably one that's waterproof would allow the minoxidil to stick around longer: Also @duchaine makes an excellent point. PRP, minoxidil or pretty much any hormonal/non-hormonal treatment for hair will have different effects depending on age because they all, to one degree or another, use inflammation as a tool. Inflammation has profoundly different effects across the lifespan because the follicles themselves are physically different and respond differently. Give anabolic steroids to someone in their 70s and they will experience much more aggressive hairloss than someone in their 20s, for example. But @Der3k7 you had a rhinoplasty while you were still recovering from FUE, and this would be a massive potential source of telogen effluvium/inflammatory stress, both from the surgery and the general anesthesia. Did you see any impact on hair growth? If not then you have your answer.

This is a very old debate that has been discussed extensively around these parts and on the interwebs in general. The extraction method is different with strip than FUE. This is the alleged reason for different yields with the two procedures. You can read posts by Bloxham or Feller to see the discussion, particularly the FUT vs FUE megathread that Feller started awhile back. Wesley also gave a lecture about this awhile ago that you can look up when he was talking about his piloscopic approach to scarless FUE. There have been a scattering of small studies over time on both sides of the debate: Beehner saying FUE is inferior, Tsilosani saying they're equivalent, etc. No large scale studies as far as I know. The obvious response to any surgeon's criticisms of FUE is, well you're talking about your FUE. The theory is that the dermal papillae at the base of the follicle has some soft tissue surrounding it that supports growth. There is more risk of trauma or transection of this tissue when boring out each graft individually vs together as a strip, and the grafts tend to be more skeletonized. This is a slide from Wesley's lecture showing more robust strip follicles above vs more barren FUE follicles below: Strip proponents argue that these effects result in lower yields and the development of more narrow caliber follicles with FUE. This means more grafts are required for the same degree of coverage -- ie. the less dense implantation that you could "get away with" with FUT is more difficult to achieve with FUE. Some docs try to make up for the alleged limitations of FUE with things like PRP or limiting patient selection to those with high follicle caliber which obscures the issue further. The recommendation on this forum for a long time was first to strip to the limit of scalp laxity, then shift to FUE for the greatest amount of lifetime graft yield. This is probably the correct approach if you're never going to shave your head. But it's based on anecdotal data and inductive reasoning. There's no way to be certain until large peer reviewed, double-blinded, long term studies are done, which are cumbersome, expensive and probably not happening any time soon. The reason most people get FUE now is patient preference based on the successes of European surgeons (particularly in Spain). This drove a worldwide market shift from strip to FUE, and North American surgeons followed suit. For myself, I went with FUE to avoid the scar. I take dutasteride to preserve my hair, but have a feeling that if I were to stop the rx my AGA would rapidly progress to a high Norwood, and I wanted to retain the option of shaving my head. Now looking back I realize that I might have sacrificed graft caliber to maintain an exit strategy that I may never need. Hard to predict the future.