consequence

Whenever I see patchy results like this it makes me wonder about tinea. In addition to the big three I might think about a biopsy.

Think about a biopsy.

I mean he literally counted each scab. I'm more skeptical of the numbers you guys reported. Even if you claim that not every follicle leaves a mark, which I don't think is the case, that's just a massive discrepancy.

How are you doing at 8 months?

If you get a chance, could you check the dosages on your Cialis/Viagra? 2.5 mg each and 5 mg of arginine doesn't sound right to me. Do you have a picture of the bottle? Thank you in advance!

I know that coastline! Handsome Ed Sheeran looking mf-er. Congrats on what you've been through, you deserve it.

@travelguy1Don't take megadoses of biotin without high doses of a B complex. It can't work otherwise. Similar to taking vitamin D, where you need an animal based source of vit K as well.

Flawless result on scale with the elites on here. I would walk past you on the street and not even have a clue you've had work. Thank you for the update.

Are you able to get a scalp biopsy? Are you on finasteride, dutasteride, ketoconazole, oral minoxidil? Can you get PRP?

Thanks for sharing your perspective. In how many injections does Dr. Couto usually give the PRP? Does he do microneedling at the same time? Couto varies a bit with whom he recommends PRP depending on their medical history. For 2nd surgeries like yours it seems he really seems to favor it, possibly because scar tissue can impede blood supply and cause caliber/thickness issues. I spent a good amount of time comparing his cases between here and recuperar, and it seems in general his patients that get PRP have slightly better outcomes than those that don't. A limit of this comparison was that sometimes people may just forget to mention that they got it. Not the most "scientific review" but it subjectively felt like there was a consistent effect. The patients that got it usually did so with Couto himself at his clinic, which means they were more often Spanish and had thicker darker hair to begin with. His older cases (like before ~2018) don't ever seem to mention PRP, so I think maybe his clinic started offering it around 2020. There were only one or two cases of his that I could find where an international patient was getting it with a local MD instead of going back to Couto. The reason the specific clinic giving the PRP is important is there are a lot of protocol variations because there are no "best practices" for hair growth yet. For example, one of the things Dr. Couto emphasized to me was that his machine employed a very gradual increase in the blood centrifuge rate over time, not an abrupt increase to maximum speed all at once. The clinics near me don't have the same PRP equipment and their devices seemed to abruptly accelerate to maximum speed, though I'm going to ask to observe the centrifuge next time I go in. I would imagine the more gradual incease in spin rate causes less physical trauma to the blood sample, and presumably less blood sample activation/inflammation. If trauma makes cells burst, for example, they're going to release all sorts of inflammatory debris. The infamous "shock loss" or telogen effluvium. So when you say "It can't hurt." part of me says, "Can we really say that?" 😇 The question clinical trials would answer is whether, in the post-surgical setting: PRP's growth factors rescue and strengthen borderline follicles or Its inflammatory component (ie. physical trauma, incomplete effectiveness of white blood cell removal by centrifuge, etc.) inhibits growth and damages follicles. My guess is when done correctly it is the former, even after surgery. The only time I think it is definitely pointless to get it is at the time of surgery itself, because the actual operation is a several-fold more potent version of endogenous PRP than plasma injections ever could be, so it would be redundant. There are other variables as well. If the clinic uses single needles with evenly spaced injections or numerous mini-injections, the distribution and depth of trauma would vary. Usually the depth of the roller needles is supposed to be too superficial to directly contact the root, which may not be the case with needle injections. On the other hand, some inflammation is needed for growth (which is the reason microneedling is theorized to work). Some places also use Acell or stem cells to augment the PRP, though there's really no evidence either of these have an effect. There's no evidence they don't work either, but that's a slippery slope of a thought process. Also, in the US, PRP is usually offered at private practice beauty clinics, either in surgical or dermatological type settings. From what I've seen, usually the supervising physician farms out their actual injection work for these to their NP or PA. This can make it near impossible to discuss theory or protocol modifications directly with the MD (ie. to make them closer to those of FUExpert). And even if you can talk with them, they're unlikely to know as much about hair as Dr. Couto. My hunch is they're usually just following the directions that came with the PRP kit. These are are unlikely to be as well thought out as what they're doing at FUExpert, and may be more designed for facial PRP (about which there is more research, but skin is very different than hair). At the end of the day, I'm leaning strongly towards getting a few rounds because my follicle survival percentage seems decent but the caliber is low. I think I could go back to Couto, but I'm hesitant to take a 22-hour round trip flight to Spain every 3-6 months. My neurosis wonders if the stress of the flight would increase the WBCs in the PRP sample. 🙃 Also it's a lot of effort for something that could potentially not even matter. Who knows though, maybe. I'll send a message to the clinic and take it from there.

Something in the water out there in Thailand. Incredible early growth. Have you continued with PRP? How many treatments total did you have?

I have to admire your confidence going to two different corners of the world where the surgeons really didn't speak English and you didn't speak either Portuguese or Turkish. And the mustache/beard grafts must have made healing so difficult (ie. eating, talking, smiling, etc). Monster procedures. Please keep us updated.

By local anesthesia do you mean a ring block? I don't think anyone is injecting lidocaine directly. Also not sure I understand your comment about "sessions" -- are you suggesting a single session with a large volume to be more effective than multiple with smaller volumes? How many cc's are you saying specifically? Alllegedly Acell helps the PRP stick around. It's just dried up powdered pig bladder. Supposed to reduce inflammation in wound healing. Not sure it's a great idea to gunk up the area right after surgery when blood supply can be so delicate. Also PRP at the time of surgery makes no sense to me. The surgery itself is essentially endogenous PRP at a much greater scale than the PRP itself. It makes more sense afterwards, though there is no good formalized research as to the best time course. Platelet reduced fibrin is the new thing, though I would worry that it's too inflammatory.

Did you have a ring nerve block with it or just took the PRP directly? Many small injections or just a few larger ones spaced out? There are two clinics near me that offer two different techniques. Any add ons with the PRP like acell or stem cells? Same questions for @A_4_Archan. How many treatments total? My growth is lagging a bit at 5 months.

Did you happen to check your blood pressure before and after taking this? Did you have any issues with orthostatic hypotension? (ie. standing up too quickly and feeling light headed)

I wish @stockholmare would come back for an update. Now at 5 1/2 months and my progression looks really similar to his. Wondering if Couto's touch up worked or if there still were density issues.

Looking great. Please keep us updated.

Very classical inheritance pattern for hair loss. I wonder if switching to low dose oral minoxidil (ie 2.5 or 5 mg) would help your recovery. What a monster case! He did the implantation and the extraction himself? Or did techs help with the extraction? Please keep us updated.

Thanks brother. I'm having some difficulty being complacent with the left frontal hairline being a bit whispy. I'm going to look at Couto's other cases at the 5 month mark and then at a year to see if I'm on track, or if people that were thin at this stage just generally stayed thin at the end. The actionable purpose behind this would be to have an idea as to whether I should start trying other things like laser helmets/PRP to thicken the shaft caliber or if I should just lay and pray. So little is known about these add-ons, but I suspect there is a window of opportunity with their use (ie. they may have more impact within the first year when the follicle is first establishing blood supply, etc. as opposed to afterwards). There's also uncertainty about differences in the PRP protocol used at Couto's clinic vs ones near me. It has been difficult to get the full details of their PRP protocol via e-mail and to have a local MD follow the same approach -- ie. activated vs non-activated, leukocyte depleted or enriched, centrifuge rate, how many injections and how far apart (as far as distance). The consistency with PRP use across different centers is basicallly non-existent. So many variables and so little is known. I will probably give the clinic a call later this week to touch base after seeing where I stand relative to his other patient posted cases.

Zarev certainly is doing something remarkable but 8 patient submitted cases is not enough for me to put someone in the top of 2023 category just yet. Perhaps I'm using the search function incorrectly, but if not -- how much credit would you give a product on Amazon that had 8 good reviews? There have been too many instances of surgeons on here with an initial burst of good cases that ended up just being flashes in the pan. Perhaps there are more patient submitted cases of his on other forums. I don't think Konior's FUE results really match up to his FUT, but he was really doing something spectacular with strip back in the day. Also, his prices are just exorbitant; I was quoted $30k for my procedure. Sure, his designs are good, but not $30k good. I would also give a mention to Keser as I think he's the stand out amongst the Turkish docs, though this is a little bit like being valedictorian at Gonzaga State. Hattingen is excellent as well. The other names previously mentioned are generally on point. Need to look more at Ahmad and Zarev more carefully -- really great to see new names on the list, and also interesting seeing older names drop off as compared to years past. I remember when everyone would list Feller or Lorenzo at the top, but they've aged out of the list it seems. And to respond to the underlying motivation of threads like this: no matter what you do, hair transplantation is always a bit of a roll of the dice. Do your research but it's an exercise in insanity to try to control what you can't control.

Have you healed normally from other surgeries? Is your blood pressure normal? Have you had a nutritional panel to see if you have any nutrient deficiencies? Would recommend Chris Masterjohn on Youtube.

Here are some other other concerning possibilities - What if global warming causes the clinic's air conditioner to overheat and make all the techs pass out? And what if the global supply of oil runs out preventing the plane from flying you there? Or another global pandemic with a virus that causes hair to fall out making everyone turns into bald zombies? These are important points to keep in mind, the only solution is to perfect cold fusion so that we have unlimited energy supplies and world peace ensues. Otherwise your surgery date is at risk don't even bother reserving.

It's an embarrassment of riches in Spain and Portugal, their hair transplant industry is just insane. You would be just fine with either of them. I would note that they generally have different hairline designs, Pinto is much more conservative on average and Freitas gives everyone kind of the same "Freitas stamp". Which is good but just make sure that's what you want. I also get the feeling that Freitas is much higher volume, at least from how many of his patients post cases on recuperarelpelo. This may mean higher tech involvement, I'm not sure. Sure you can talk with them beforehand, but look carefully at their past patients' temple points and frontal line placement to have a good idea of what to expect.

I'm in the top 1% of Onlyfans

There are some names that come to mind, Cooley had a really impressive repair on here, Feriduni patients have posted a few solid revisions, Mwamba patients as well though sometimes he does some pretty wild things with stitches that I don't fully understand. There isn't anyone that really stands out to me though. Who do you all favor?