LeonBlack

This is interesting. Its actually the first time I have ever heard of making a second distinct linear scar.  Most typically 2nd FUT would start either directly above or directly below the old scar and cut out a new strip that includes hair and the old scar.  
 

Presumably, if you heal really well, have good laxity, and don’t mind keeping the hair a little longer to cover it all…. I guess it could be a good idea to get more grafts. Perhaps there is also something distinct with your anatomy and the old strip area, where it is not ideal to do the traditional way after the doctor evaluated it.

that said, I would potentially ask about a variation of a more traditional approach, taking a new strip that includes the old scar and if more grafts are needed, doing some FUE as well. That is what was done with my second FUT.  ~3800 on first FUT, ~2800 on 2nd, plus about 800 FUE.

Today is four months on the temples.  Just under five on the crown. Crown, as I knew would be the case, definitely growing slower than my hairline did.  Progress occurring nonetheless. Included the sides, with scar covered, 3.5 guard a week ago, tapered down below  

I think we all have our biases…

Interesting listening to some of the experts via podcast who do both. Hattingen does not believe in purely FUE for the high Norwood. Hasson has moved to primarily FUE because of patient demand, not necessarily efficacy, in his own words. What Zarev and Pitella do truly looks incredible….. but going to those outer regions of the donor via FUE has not stood the test of time….yet.  Perhaps it will… fue has evolved a whole lot over the last decade, but we haven’t seen procedures like that for the same duration. I don’t know that we have credible evidence yet, besides conjecture, that those grafts at the periphery of the donor will stand the test of time. 
 

in terms of speaking to our biases… I have had about 7500 grafts from my scalp. 2 large FUT and a small FUE for my temples (you can see my thread on it). My donor looks untouched with a 3.5 guard over the scar, tapered down to a 2 guard below. No complaints. 

Not quite a month from prior… But seeing some real changes over the last few weeks. Crown starting to show more visible signs of life at 4.5 months, temples taking some shape at 4 months, and further maturity/thickening of frontal/midscalp region 16 months out on that. Added a couple with a haircut at a 3.5 guard over scar, faded to a 2 below it.
 

 Some baseline comparisons included. I still find the whole process so fascinating to watch develop 
 

I’ve had several scar pic requests. Here ya go. 4 months post op FUT #2.  From back of my head. Measured my finger to give some scale. The light pink area of scar measures 3 mm here.   overall some areas, mainly on the sides, are 2mm. A few small areas at 4mm.  Shock loss surrounding the pink area appears to be lessening and some hairs growing through scar. Covered completely by 3.5 guard. Last time took about 6 months til 3 guard completely concealed it without layering/puckering effect.

10 minutes ago, Silent123 said:

Hey man, keep on posting the updates 

Will do, planning on monthly. 

Temples and crown starting to pop a bit more right on schedule at 3 months on temples and 3.5 crown. 
 

Recipient hair looks great! Sorry to see that your scar stretched like that. 

18 minutes ago, 4chanhrn said:

That's not too bad. How much longer do you think you'd need to fly and how did you get the staples removed?

I drove for all of mine so not sure on that end. I would think fine to fly the day after procedure.  Staples, you can get removed at home. PCP, urgent care, etc. 

8 hours ago, 4chanhrn said:

That makes sense. I was always curious about discrepancy in numbers. I've asked it to Bloxham as well.

I know we've been spoilt by 10k graft transplants, but 4k was a big transplant just few years back.

Also can you tell me how long you had to spend in NYC? I'm guessing till the staples are removed? I'm wondering how much would the hotel costs come to.

2 nights.  I stayed on Long Island near where his office was. Procedure Friday. Stayed Thursday and Friday night, drove home Saturday. 

8 hours ago, 4chanhrn said:

Don't you think I need atleast 4000-4500 for front/midscalp? Bloxham said in total would need 5000-7000 grafts with 2 procedures.

I'm going to consult with more doctors and see what their opinion is. Different opinions are always good.

 

I'm open to other locations if the price/quality of surgeon is much better. Not strictly restricting myself to North America.

I'll contact Konior, thanks.

Konior top notch….. but 35k/procedure 

19 hours ago, 4chanhrn said:

Do you know why Bloxham's numbers(how much he can extract) from 1 session are much lower than H&Ws? I'm just 

 I have seen a few 5K+ from HW on this forum. I don’t think I’ve ever seen over 4K from Bloxham here, or his YouTube videos. my strip goes from here to ear, actually a bit past the ears. Couldn’t be any longer. Only way is to take a wider strip.  perhaps some patients have the scalp laxity for that and/or a they use a different closure technique to maintain a thin scar without too much tension leading to stretching. On my second FUT, he used internal sutures, in addition to the usual staples, to maintain a thin scar. That one was just under 3K.
 

If he said he could’ve safely gotten me 5k+ on a single procedure, I would’ve paid and done it. Granted full coverage needs 6-8k+, so needs 2nd procedure either way for high Norwood. Larger was not advised for me. 

1 minute ago, LeonBlack said:

 

2 hours ago, 4chanhrn said:

For me they are just 4 hr drive away. They are quoting me 4000-4500 grafts for first 1/2 to 3/4 scalp w/ FUT and it comes to 16.3-17.9k USD w/ taxes.

Bloxham wants to do 2500-3500 grafts for 14-16k USD(plus flight/hotel costs?) for as much as possible starting from the front. Plus another FUT procedure later down the line if required.

H&W is cheaper but I liked Bloxham's planning better. He was also very good answering questions and putting effort into the consultation. I'm looking for a long term plan to address my hair loss(especially because I'm not on a 5ARI) vs a 1 time procedure.

Currently for me both are viable options. I'm taking my time to decide who to go with.

Same as mine. Planned to do “as much as safely possible” on first. Ie max size strip while minimize stretching risk. Got ~3800. Wasn’t sure I’d ever want to do crown…. Til 6 months later when I saw how good front looked and accentuated my bald crown.  Always very responsive via email with questions and concerns pre and post op. 
 

travel time with days off work (if production based), hotel, airfare, etc do jack up the price though

18 hours ago, krusher7 said:

Hey @4chanhrn ... I was a NW 5/6 in a similar type scenario of hair loss like you. Do a mega session with Hasson & Wong in Vancouver. You won't regret it!

Probably what I’d do if lived around there. 

9 hours ago, Bucky O Hair said:

 

I think people underestimate how important it is to wear your hair short on the sides and back, and how it creates the appearance of more volume on the top of your head.   You would lose this with a scar.  Then again, I have seen some great SMP in the scar (@gatsby being one of them) so this would mitigate any scar visibility as well. 

 

 

 

I agree, regarding the effect of keeping it short on the sides… Except, don’t forget that with a properly placed FUT scar, you can fade it down below as low as you want. I go from a three over the scar down to a 1. Also, being mindful of age and profession. Not all lend themselves to keeping the sides buzzed up tight all the way

14 minutes ago, 4chanhrn said:

You're not hijacking the thread. It's a good discussion to have. I don't think you need finasteride. I feel it's a good thing for you to lost the hair more susceptible to DHT before you started your journey. I wish the same happened to me lol. Then I can start from a clean slate.

I feel planning for you was really well done so you don't need meds as much as others. I'm really impressed.

I've filled out Dr. Bloxham's consultation form looking at your case. Do you know what sort of wait time I would be looking at for Dr. Bloxham(or for other clinics)?

Also I started Pyrilutamide today.

Sorry, but I’m not sure what his wait time is like. For my most recent, I specifically requested a date that was about six months out (working around my schedule and holidays) and it was open. I did not look into first available. 

8 hours ago, Gatsby said:

If you can tolerate Finasteride I would recommend taking it (I’m not a doctor). It will preserve your hair transplant and donor area. After all that money spent on surgery it’s a cheap investment. 

I do agree that would be the wise decision. Don’t intend to hijack this thread… But I acknowledge I have not made the optimal decision on that aspect. I used topical minoxidil for over a decade. definitely noticed I would lose more hair whenever I briefly stopped it. Hair loss nonetheless substantially progressed from Norwood 2 in my early 20s to I believe a 6 before my first hair transplant, as seen in my linked post.  I tolerated finasteride somewhat, not perfectly, but not terrible. It was stopped for one to two years at a time, directly before/after having each one of my kids. Perhaps that was misguided, but it made my wife feel safer. Frankly, don’t know that I saw a difference on it, even when steadily taking it for a year or more. Perhaps I could’ve switched to dutasteride, or if more recently,  added oral minoxidil. 

All that said… At the time of my first hair transplant, the only residual hair I really had was the miniaturized patch in the mid scalp.I asked my doctor his opinion. He did not think it was worth taking medicine for the rest of my life to preserve that small area that was already on its way out.

At this point, reasons I could think to take it would be preserving the lateral humps, and back of crown, just in case I was destined to go from a 6 to 7. Also, possibly prolonging the lifespan of my transplanted hairs. I have made the conscious, and perhaps unwise, decision to just let it ride, given all that. Several thousand scalp graphs left available via FUE, not even including my thick beard. 
 

9 minutes ago, 4chanhrn said:

Solid results and very solid long term plan. Planning for you was very well done.

I think we are very similar cases. I think it would be actually better to lose existing hair before surgery so that I can start from clean slate.

Are you on medication now? I remember coming across your post on reddit thread that I had posted.

I think I'm going to do a consultation with Bloxham and look at what he says. 2 FUTs might be the way to go.

Thanks. Im definitely happy with it thus far. 
 

re meds…. I am not. Used topical min for years and fin intermittently ( I know wasn’t optimal). Continued to progressively lose. Was so far gone pre HT that I didn’t see the point of indefinite meds. 
 

Example of a high Norwood with FUT x 2 for full coverage (me). Cost about 30k. Frontal half grown in, back half 3 months post op.  Small FUE shortly after for temples. Plenty of donor in the tank if needed, ie I progress to NW 7. 
 

I am super impressed by what Zarev/Pitella are doing, and acknowledge I have my biases….. but I think it’s still TBD if the FUE grafts taken from outside the conventional safe donor zone will stand the test of time. 

Nothing terribly exciting, but will start monthly updates to document. Some early growth on temples at 2 months. More sprouting on crown at 3 months. 14 months after front half. Pre op for baseline. 

Pictures 2.5 months out from FUT crown, 2 months FUE temples, 14 months frontal half FUT, after a haircut with 3 guard over the scar, tapered to 1.5 below. 100% hair on top of my head is transplant at this point, residual miniaturized midscalp is gone.  Added baseline, 1 year post first FUT, post op temple to consolidate this long thread . 
 

I included some current (2.5 month post op) scar pictures, showing both the remaining shock loss around it, trichophytic effect with hairs going through, widest area in the back at 3 mm, hard to find on the side, about 1 mm.  Can still see some layering of hair effect over the scar at this point, with the shock loss.  That disappeared after my first procedure about four months out. Now just waiting on the growth over the next few months… 

I’ve gotten several messages about scar pictures.  Here are some from the side and last one is the back.  It’s harder to find now that it is getting lighter.  Also picture of the donor on same day, 9 weeks after 2nd FUT and 6 weeks after FUE. Need a haircut… but I don’t think there’s any evidence of surgery except the small remaining shock loss in the middle of the back. Doctor placed a few deep absorbable sutures, in addition to usual staples. The areas with sutures had some localized shock loss below them.  I’ll post some more pictures soon after a haircut with a 3 guard over scar and fade shorter below it. I presume I’m out of the Wds regarding risk of significant scar stretching at this point.   Overall, I think my donor looks pretty good for having 7400 grafts removed. 
 

Also, as trivial as it may seem, I am seeing more early growth start in the crown. Lots of dark little hairs in between the longer residual wispy miniaturized native hair. I think the small red splotchy areas are evidence of “activity“ and more hair is ready to sprout. I find this whole process so interesting to watch develop!

44 minutes ago, shiba1985 said:

My only criticism would be, those are some huge punches to extract follicles for temple points. Most can do it with a 0.85 or 0.9 . Those look almost like a 1.0 punch

Got it. Any other negative consequences of that besides potentially slight bigger scars if I shave down too low?   
 

Typically I buzz down to a 3 over the FUT scar and taper down to a two or 1.5 below.  Will see how that looks now in a couple weeks after hair.  With only 800 FUE I would presume imperceptible.  

Seeing how everything has grown in re the hairline…. very glad I did the temple points.  Excited to see them grow in over next few months. 

Here’s a shot of 2 months post FUT on crown, 14 months hairline, 6 weeks temple points (all shed, native/receded here). Can see the faint outline of residual redness. To me, the donor looks untouched despite the 7,400 grafts. if my lateral humps or crown dipped further in the future, I should have plenty available via FUE.