Bhumik Shah MD

2 hours ago, Al - Moderator said:

I would love to see a picture of the graft placement on the temple points.

 

Approximately 1900 FUE grafts to restore hairline recession and temples. Patient is on medical stabilization allowing for a slightly aggressive restoration. 

After photos sent by patient (as out of state). I am involved 100% with every surgery and extract and place all the grafts. 

Trimming for a skinny graft vs a chubby graft, (what Al is referring too) happens more at the follicular level but will not be apparent to the patient. 

Trimming or not trimming the epidermal cap, which is what you see in the photo, will not effect the result. This is just "dead" skin tissue which is coming along for the ride with the follicle and has no bearing on the follicle's "health." It just looks cleaner cosmetically in the post operative period, but this is very temporary as everything sheds within 2-5 weeks. 

I think the situation will pass soon. Both are too big a country to continue this ban. 

In my opinion your goal to address the crown and not the hairline is very reasonable. Your expectations also seem to be in line with your situation. 

At 42 you have lost majority of what you are going to lose. You are still going to continue to lose some more hair over the next 2-3 decades, if you don't take finasteride, but most likely it will be a small percent. Planning something conservative will keep you looking natural as you age. 

You should be able to use toppik 2-3 weeks after a transplant without any issues. You will have to discontinue using it temporarily while the surgical wounds heal. 

If you don't want to shave, you should consider FUT. You would be a good candidate for it, as long as you are ok with a scar. 

1 minute ago, GoliGoliGoli said:

That's very interesting - do you know why Google's algorithm does this? 

It considers PRP treatment for hair loss “experimental.” 

3 hours ago, bike4life said:

Hello, I'm looking for a legit PRF or PRP provider in the Boston area. Google results are mostly Med-spas that mostly do botox and minor cosmetic procedures. Does anyone have any advice or experience? The websites of the hair transplant clinics in the area don't mention this service but I'm guessing maybe that might be a good place to look. I know prep is crucial for this procedure to be successful and I've responded very poorly to currently available medications so this is my last hope for keeping my hair while waiting for the next generation of hair loss products to come out. Pharmaceuticals like Pyrilutamide, GT20029, and Scube3 look very promising but I'm not going to have anything to work with if I don't stabilize my losses in the meantime! 

Google ranks down your website from search results if PRP for hair loss is mentioned. If you like a local clinic you can call them and ask. They may still provide the services but just not mentioning it on the website. 
 

Poster,

Sorry you are going through this. You should start out with the least invasive method. Your best bet would be to see a hair transplant doctor who is also a dermatologist. They would understand why you are having the cobblestoning (hair transplant surgery experience), but also have some non invasive tools under their belt to help minimize it (dermatology experience). I think Dr Robert Haber on this forum is a dermatologist who is also a hair transplant doctor. If you tell me your approximate location, I can see who would be good to see close to you.

Unfortunately if the non invasive methods fail then you will have to consider the surgical route. Without getting into too many details there may be a few options all with moderate to high level of complexity. 

Cant speak for your clinic, but never told my patients to "stop" topical minoxidil before surgery and have not had any issues. Hope that puts your mind at ease. 

Everyone's tolerance regarding how acceptable they look post op is different:- some people rock a crazy hair cut with no care in the world, while other patients freak out about the slightest redness. However in general by day 13 your donor area will be well healed and even your recipient area should look relatively clean. 

From what you are stating it seems like the next logical step would be to have a dermatologist do a trichoscopic exam of your scalp +/- a biopsy. Once the problem is diagnosed (if there is any), then they can recommend a solution.

If you tell me some big cities close to you, I can ask around to see if there are any recommended Dermatologists that deal with hair disorders near you; if you want. 

I agree with some of the above posters. Based on your photos, I don't see any evidence of significant thinning justifying a change in medical regiment or another major hair transplant. 

The only bright side of having a poor donor area, is that since the hair shafts are usually smaller in diameter you can use get away with using smaller punches. This can translate into better scaring. However the size of the punch is only one factor in overall appearance of the scar as a lot still depends on your physiology. If I were in your shoes, and absolutely wanted to do a transplant, with plans of shaving it in the future, I would do a small test area of 50-100 FU punch scars, let it heal and see what it looks like with a tight fade at 9-12 months. It is not a perfect solution as you are still left with 50-100 FUE scars but at least it will give you an idea before you take a bigger plunge.

4 hours ago, AladdinSane said:

What about people who get beard transplants? I was told in the hands of a skilled surgeon clean shaving transplanted facial hair (beard to beard, scalp to beard etc), the skin should have no obvious scarring. Because it’s more likely that a beard transplant will be clean shaven, the face would have to be an area where you couldn’t have any obvious signs of surgery.

Facial and beard skin heals differently than scalp. That is why FUE scars are not as visible in these areas.

8 hours ago, Antbite said:

Sounds great. Do you recommend any specific doctors who specialise in this?

I never thought I’d end up in this situation so definitely don’t want to go through it again.

cheers, 

Antbite,

I refrain from making any doctor recommendations due to obvious conflict of interest. Having said that all the doctors happyman mentioned have a strong reputation and should be capable of handling your case.

I will add, not all repair cases have to be long drawn out and expensive. I think yours will be relatively straight forward and most likely one and done.

It is difficult to tell based on just 2 dimensional photos. Even though a lot of them are misangled, i think it would be unwise to try and remove every single one that is misangled. 

Once you add some density a lot of them will blend in and not stand out as much.

As far as relocation you can simply relocate them within the recipient area as you have a lot of empty areas still within the zone. 

Your donor area appears to be good. But you also appear to be very young so you have to plan for the longterm and try to use the least amount possible from donor area for the repair. What is your age?

I would recommend relocating the grafts that are egregiously misangled and are bothering you the most. Then combining that with boosting the density in the triangles drawn should help improve your cosmesis.

We need more cases of people pursuing beard to FUE donor area, and body to FUE donor area transplants to see if they improve the cosmesis of FUE scars. The initial reports have been promising. Also a member here @mustang has had good cosmesis by pursuing the above.

On 7/10/2023 at 12:09 PM, KSA91 said:

Are antibiotics really necessary after a hair transplant?? I know they are issued by doctors after a hair transplant to avoid infection in the recipient area, but after doing research infection is incredibly rare after surgery anyway. So is it worth destroying the healthy gut bacteria in your stomach? 

You are right. The best practices these days suggest not using antibiotics routinely post hair transplant. Having said that there is so much variation in cleanliness and sterility standards between clinics and between different countries that this is absolutely a post op decision you should follow YOUR physician's recommendation and not listen to the forum voice. 
If you have concerns regarding your gut flora, or have a history of any gastrointestinal issues you should talk to your doctor regarding this so they can modify their treatment plan accordingly.

It seems to me that you understand the limitations of hair restoration surgery very well. The question you want answered really depends on what your donor area looks like. If you are not going to take finasteride, erring on the side of being conservative is never a bad idea.

2 hours ago, Yabala said:

OP. You will be surprised how much finasteride can do to reverse hair loss even in areas that look completely bald. Of course everyone responds differently but if you are open to starting medications I would definitely say it is worth it in your case. 

I don’t think it would take a lot. Maybe 300-400 singles max. Probably even less. 

Your donor area appears to be sub optimal. Candidacy for surgery would depend on your expectations. Since you are open to hair loss medications, that is a good place to start whether or not you decide to pursue hair transplant.

If you plant a tree in your garden, you don’t just wake up to a fully grown tree one day. Similarly the post op hair has to go through their growth cycle and with time should thicken up to match your natural hair.