Rahal Hair Transplant

@gaz9318054,

Thanks for your interest.  Yes, this patient definitely had an excellent result.  Since Dr. Rahal now solely performs FUE and has for many years now, he's had a lot of time to evolve and improve his FUE technique.  His donor extraction process in particular has changed, resulting in smaller, even more refined extractions and even fewer signs of visible scarring.\

For starters, Dr. Rahal uses a scientific formula to determine exactly just how many extractions can be taken safely over the course of a patient's lifetime.  To quote him from an email he sent me on this issue during a conversation about donor extractions....

"One thing to mention in these cases is that we calculate the coverage value, based on hair caliber, density of grafts, hairs/per graft, and size of area to come up with a number of grafts that can be harvested safely in life time.  The size of the punch and distribution of extractions make a huge difference".

Dr. Rahal also now uses a variety of tools to carry out the donor extractions based on the patient's individual scalp and donor hair characteristics instead of sticking to only one.  Since he has vast experience with a plethora of tools, he'll select the ones he feels best suit the procedure for that specific individual.  Note that it's not uncommon for him to use more than one kind of extraction tool during a procedure (depending on scalp and hair characteristics in a particular area, etc.).

Since you've asked for them, below, I've provided some recent donor extractions that show the scalp immediately after surgery and only a few weeks later (so the hair is still nice and short).

Example 1 - Post-Op

Example 1 - 2 Weeks

Example 2 - Post-Op

Example 2 - 6 Weeks

On 4/19/2023 at 3:27 PM, Calihome1 said:

How did 2k grafts cover that entire area?

This is a good question And one that doesn’t get addressed frequently enough. In many cases, results will be presented with a lesser number of graphs that frankly, look incredible as if they had 5000 grafts.  This just goes to show that there’s more to hair transplant surgery then just the numbers. Some of these variables can be controlled by the surgeon and others are related to patient physiology

Firstly, numbers do matter but you can’t just evaluate the number of follicular units. It’s equally as important if not even more so to evaluate the number of hairs that were transplanted. This is why a long time ago Pat, publisher of this community developed the slogan, “count hairs, not grafts”.

At our clinic, we provide patients (and this forum) with the number of follicular units, but the total number of hairs transplanted. We also provide a hair count breakdown which includes total number of single, double, triple and quadruple haired follicular units.

In addition to numbers, there are other variables that play a major role in the overall appearance of the result. This includes placement of the follicular units, density, micron of each hair (hair shaft diameter AKA the size of each individual hair as opposed to density which references how close together one hair is from the other) the amount of natural hair the patient has left, hair to scalp color ratio, hair style, length of hair, size/area of the scalp to be covered (for example, an individual with a smaller head or area of baldness to cover Will likely have a denser looking hair transplant than any visual with a larger head assuming all of the variables are exactly the same), etc.

also, how dense and thick a hair transplant appears also depends on current lighting conditions. For example, even the most dense hairtransplant appears a little on the thinner side under harsh bathroom lighting. On the flipside, a hair transplant can appear thicker taken directly with a camera flash or under natural lighting if the angle of the sun is coming from the front.

The above tracks is exactly why we aim to take not only photos showing multiple angles of the scalp under normal lighting conditions, but video showing multiple angles where it’s essentially impossible to use any tricks.  With us, what you see is what you get.

So all that to say, there’s a reason why some patients may have a more impressive result with A smaller number of flickering units then the next guy even if performed by the same patient. Remember, there are a lot of variables that play in creating an outstanding hair transplant.

I hope this helps.

Rahal Hair Transplant

@CarolinaMale,

Yes, it is certainly possible and plausible to undergo a hair transplant surgery without any additional treatments.  That said, you do have pretty substantial hair loss.  Personally, I would like to see some photos of the sides and back of the scalp.  This is the donor area surgeons use and harvest from for transplanting.

Keep in mind however that even with substantial donor hair, you will need to have realistic expectations.

I’m glad to hear that you’re not as concerned about the crown as this area will likely not be able to be touched at all. But in order for the hair transplant to look natural, there should really be enough donor hair to re-create a conservative looking hairline and reach at least the mid scalp section.

In your opinion, how is the hair on the sides and back of your scalp holding up? Have you noticed any thinning back there?

As long as you have the donor hair for it which will need to be evaluated by the surgeon, In my opinion, I could see re-creating a conservative, natural looking hairline with some mild density and then go back as far as possible which I suspect would be somewhere into the midsection of the scalp. You would likely not be able to get any work done in the temple areas given your level of hair loss  

Keep in mind however, this is just my opinion as a patient and advisor, this is not necessarily Dr. Rahal‘s opinion.

Best wishes,

Rahal Hair Transplant

@lostboy182,

This thread is a perfect example of just how effective the right combination of non-surgical solutions can be for the right candidate. Now, not everybody will experience your kind of growth and success from non-surgical solutions alone. However, this certainly should give people hope, especially those that may not be the best candidate for hair transplant surgery.

So it sounds like by switching finasteride to dutasteride, switching topical minoxidil to oral minoxidil, and then adding spironolactone, Nizoral and microneedling facilitated a massive difference in the reversal of hair loss.

most balding/thinning men are lucky if they can slow down or even stop the progression of male pattern baldness. In your case, you’ve seen a massive reversal.

all I can say at this point is, keep doing what you’re doing under the advice of a physician of course. It seems to be working for you and hopefully will continue to do so.

thanks for sharing and I hope and trust that your posts will provide inspiration to others in a similar situation.

Best wishes,

Rahal Hair Transplant

@ajsr8,

Thanks for sharing a detailed account of your hair loss history and what you’re currently going through.  And the good news is, you still have a lot of hair. Based on everything I was reading, I expected to see a lot less hair then I’m seeing in the photos. So that’s definitely a plus.

All that to say, you do certainly seem like a good candidate for non-surgical hair loss solutions. Now, I assume that you’ve been on finasteride for quite some time prior to switching over to dutasteride?  I only ask because it’s usually a good idea to give a finasteride a good solid year before drawing any conclusions as to whether or not you need something stronger.

While your hair loss situation certainly sounds like it calls for a stronger nonsurgical treatment, there’s always that concern about potential side effects. Therefore, I personally feel it’s always better to start with the recommended dosage under a doctor’ advice and supervision and then if the doctor feels more is necessary, to go ahead and switch.  Mikd you, that may be very well what happens I’m just clarifying and giving my opinion.  

Keep in mind that dutasteride blocks both type one and type 2 5-alpha-reductase enzymes whereas finasteride only blocks the second type. Therefore as a whole, dutasteride is likely going to be a more effective treatment and if not strive it also comes with a potential for stronger side effects.

What you said about your hair is likely  possible in that you do appear to have some thinning on the sides and back of the scalp a.k.a. the donor area for hair transplant surgery. Because of this, I do recommend undergoing testing by a dermatologist to see if you have DUPA. I’m not sure if I see signs of retrograde alopecia in the pictures but since you have concerns about that I suggest getting tested for that as well.

In my opinion at this current point, you don’t seem like the best candidate for a hair transplant. But that could change depending on how effective dutasteride is for you.  But given that you are a diffuse thinner and possess some thinning on the signs back on the scalp, it may simply be too risky to proceed with hair restoration surgery at this time. Now, please understand that I am not Dr. Rahal and this is just my opinion as an educated patient and patient advisor.

I hope this helps.

Rahal Hair Transplant 

Hi everyone,

Last week, I presented a case showcasing photo results of a 3002 graft case via FUE by Dr. Rahal.  You can find the original topic by clicking below.

Below, please see the video showcasing his results.  Feel free to share your feedback by commenting below.

Best wishes,

Rahal hair Transplant

@UKLad81,

The way I look at it is this.  topical finasteride is probably better than nothing but I wouldn’t expect that you’ll get the same level of efficacy as you would by taking oral finasteride which easily find his way into the bloodstream unlike topical finasteride which Hass to be absorbed through the scalp first.  How much of the topical finasteride actually finds it’s way into the bloodstream, i’m not sure.

consider also how finasteride works. It doesn’t directly block DHT from hitting the hair follicle.  What it does instead is prevents the production of DHT by blocking the 5-alpha reductase-enzymes w that has to combine with testosterone in order to create DHT or dihydrotestosterone.

Since as another member indicated, the majority of the production of DHT occurs in the prostate, topical finasteride has to absorb into the bloodstream in order to prevent the conversion.  Once the conversion occurs, I believe it’s too late and any DHT that hits the scalp will do its damage to the follicle regardless of topical finasteride being present.

so again, while top it off an astroid is likely better than nothing, I wouldn’t expect it to be nearly as effective as oral finasteride - even if the quantity and potency of the finasteride is much higher than that of oral.

I hope this helps. 

Rahal Hair Transplant 

There have always been surgeons who do not require shaving for the recipient area.  That said, I personally believe that shaving enables a surgeon to densly pack follicular units more closely together and is optimal for the overall result.

On the flipside, not shaving the recipient area adds a degree of difficulty for the surgeon/clinic and as a result could potentially compromise the end result.

All that to say, historically, there have always been exceptions to the rule and some surgeons for example we’re still able to produce good quality results even without requiring shaving of the recipient area.  I don’t know if the same surgeons I’m thinking of now require shaving or if they still don’t require shaving.  But I don’t think it was an extra fee associated with their procedure for not shaving.

At the end of the day, to answer your question, not shaving the recipient area is legitimate as in, some surgeons don’t require it. But in my personal opinion, shaving the recipient area makes it easier for the surgeon/clinic and also provides the greatest chance for the best result.

I hope this helps  

Rahal Hair Transplant

@AnonymousOpinions,

Also if possible, I'd love to see some clearer photos - some of these are coming out a little blurry.  Do you have a better camera or can you take these under better lighting?

Best wishes,

Rahal hair Transplant

@AnonymousOpinions,

Your results are coming in very nicely so far.  As you already noticed, 5.5 months is only the beginning and while it's normal for patients to worry and experience concerns, this threat is a perfect example of how going the distance will yield the results you want and deserve. Clearly there's an exceptional difference between 5.5 and 7 months and there's still more growth and maturation to come.  This is why I always tell prospective patients and patients that new transplanted hair growth only typically starts to grow between 3 and 5 months.  So at 5.5 months, you were only in the beginning phases.  Now you are further along but there is still more to come :-).

Do you feel more confident now at 7 months than you did at 5.5 months when you had some concerns about density and growth?  

I'm looking forward to seeing how your results continue to blossom over the coming months :-).

Best wishes,

Rahal hair Transplant

@Hannah-M,

Sorry for the delay in my response.  I don't have a private message from you but I know you said you were having some difficulty with this.  I believe Melvin (the moderator) did grant you access if you wanted to send me a PM. 

While female patients aren't Dr. Rahal's most popular candidate (in that he performs surgery on mostly men), he's exceptional at re-creating natural looking hairlines.  That said, he'd have to make an assessment as to whether or not he feels you are a good candidate, which is true of any surgeon you decide to undergo an information session with.

If you are interested in more detail, feel free to send me a private message and I'll be happy to set something up for you.

Best wishes,

Rahal Hair Transplant

@tudare,

Since it’s been a month since your FUE hair transplant, then I agree that it’s safe to use Nizoral or any other medicated shampoo unless you are experiencing any extended postoperative inflammation  or redness.

Just keep in mind that Nizoral 2% is recommended to use two or three times a week under normal conditions because it can dry out the hair and the scalp.  Assuming they still make it and haven’t changed their ingredients, the only shampoo that contains ketoconazole that I’ve seen that is gentle on the scalp is Revita.

for those who’ve recently undergone hair transplant surgery, it’s far better to use a shampoo that’s gentle on the scalp especially for the first couple of days after their procedure (true for either FUT or FUE).

Baby shampoo is real gentle on the scalp for obvious reasons and may be a good choice for the first three or four days after surgery.  after that, any normal or regular shampoo that is not medicated would be advised for the next couple of weeks to a month.

Obviously you can use regular shampoo beyond one month but if you intend to use any medicated shampoo such as ones recommended above, I think reading a month would be a good idea to allow for the scalp to heal a bit. This includes any postoperative information or redness that could be easily irritated by medicated shampoos.

I hope this helps.

Rahal Hair Transplant

@Hah6788887,

I would actually say that this is true for the vast majority of patients. In fact, most patients don’t start seeing new signs of hair growth until the 4th or 5th month which is why I always tell people that on average, new growth typically starts between 3 to 5 months.  And since new growth only typically starts around that time, the vast majority of growth and thickening will occur between 5 and 9 months just as you suggested.

I hope this helps.

Rahal Hair Transplant

Nick18,

it’s times like this that I wish I could just post as a patient member and not as a representative of the clinic. Because frankly, I’ve always been impressed with Dr. Rahal’s hairlines Long before I started formally working with him.  In fact, I’ve met several of his patients in person at various ISHRS conferences and one from the forum just happen to live local to me.   I met the one local patient prior to his hair transplant and literally followed his progress from the day of surgery onwards since he became a personal friend of mine. His hairline was absolutely spectacular and at the time, it was literally the most natural hairline I have ever seen. That was over 10 years ago and Dr. Rahal’s hairlines have gotten better if that is even possible.  While his technique was already that’s perfect as it could get in my opinion, the fact that he performs exclusive FUE is likely the reason for the refinements sense a surgeon can cherry pick which hairs to use.

But don’t just take my word for it.  Simply re-search “the hairline king“ and “best hairlines” on this forum and she for yourself what his patients are saying.

Best wishes,

Rahal Hair Transplant
 

Note that all of this was long before I formally started working with them.

@Hannah-M,

While most of the members posting on this forum our mail, we do see the occasional female member posting and are usually in very similar situations as you are.  you’ve definitely come to the right place for research and since you have used the words “hair mill“, I can see that you have already done some research which is good.

Please be careful if you decide to undergo hair transplant surgery in Turkey.  While there are some good doctors in turkey,  you need to be very careful as turkey is a hotspot for botched cosmetic procedures.  But turkey is a very attractive place for individuals to get cosmetic surgery because it’s very cheap. And while cost doesn’t necessarily indicate quality, it is true that sometimes you get what you pay for.

In my opinion, spend time researching hairline specialists because as a woman with no hair loss,  your sole Focus is on creating a natural and dense looking hairline that suits you. 

Now, if you look at my posting history and you’ll see that I rarely directly suggest individuals to strongly consider Dr. Rahal because it just comes off as a sales pitch since I work for the clinic.  Though admittedly, I work for Dr. Rachel because I consider him one of if not the best in the world.  I have a long posting history on this forum prior to working for Dr. Rahal and have seen and been extremely impressed with his work for over 15 years.  

All that to say, Dr. Rahal did not obtain the nickname “the hairline king“ for no reason.  So in my opinion, I would strongly suggest considering him and if you’re interested in setting up an information session, just send me a PM and I’ll be happy to get the set up for you. The session is free and there’s no obligation.

Best wishes,

Rahal Hair Transplant

@alexmillne,

Minoxidil doesn’t necessarily diminish in effectiveness over time however, it is possible that overtime, individuals may not respond as well as they used to.  in other words, it’s less about the minoxidil and more about the individual. As individuals age, physiology changes, etc., non-surgical solutions are sometimes not as effective as they used to be. That said, it’s possible that minoxidil will continue to work as long as you use it matter how old you are.  This  is also true of finasteride.

I hope this helps.

Rahal Hair Transplant

Note also that the reason why we do require shaving of the donor area and recipient area is because it will help to provide you with the best result. Some surgeons may not require shaving but it’s more difficult for the surgical team to work around existing hair.

And while I know there’s a mantra that says something like “do was best for the patient and not what is easiest for the surgeon“, adding levels of complexity to a surgical procedure may ultimately impact the end result.

So at the end of the day we believe shaving is best for the patient and it has been proven that this is the case over and over again.

Best wishes,

Rahal Hair Transplant

@Simpson21,

I know at our clinic you don’t have to shave the entire head.  That said, we do require shaving of the areas that are being transplanted and the areas that are being extracted from.  Some patients do decide to shave the entire head because to them it’s easier to conceal as it’s usually harder to keep your hair looking natural when certain parts of the scalp are shaved and others aren’t. If you’re wearing your hair longer, you may be able to comb over the shaved / transplanted area.  However, if you are wearing your hair short, it may be hard to conceal the shaved areas.

I hope this helps.

Rahal Hair Transplant 

@consequence,

I traveled about 7 to 9 hours by flight with a connecting flight for my last two hair transplants.  I was alone both times and everything went well.  I know that it’s always good to spray your scalp with saline solution but it’s not required for your hair transplant to grow. Now, some clinics/doctors will include this in your postoperative instructions because it helps the area stay clean. But if you have the area covered such as by wearing a loose fitting hat or a bandanna that’s not putting any pressure on the newly transplanted grafts, then you’ll be fine. Your scalp will also stay relatively clean for your flight. You can always spray your scalp with saline solution when you get home to help clean your scalp of any sweat, etc.

I hope this helps.

Rahal Hair Transplant

@Yan bio,

It doesn’t look like necrosis but it does look like you’re scabbing up a lot. Did your doctor provide you with any postoperative instructions on how to gently remove the scabs? If so are you following those guidelines? Because usually most people at 7 to 10 days don’t have any scabs left although it’s still possible obviously. In my opinion, make sure you are following your doctors  postoperative instructions for scab removal and everything should be fine.  I wouldn’t expect it to turn into necrosis or anything but keep your eye on it.

best wishes,

Rahal Hair Transplant 

@larry7381,

At only two months postop from a hair transplant, you are still healing so postoperative redness is very normal even at this stage. The amount and time it takes for redness to disappear varies from patient to patient.  I’ve seen some patients with no postoperative redness or inflammation as early as a week or two after surgery and I’ve seen others with redness For several months after the procedure. Using products such as aloe vera can aid the healing process and even alleviate any scalp itch or irritation. So you can always try using this to see if it helps in any way.

I hope this helps.

Best wishes,

Rahal Hair Transplant 

@MAL87,

It’s really important to note that the Norwood scale of hair loss is not an exact measurement tool but a guide to be used to determine approximately how much hair loss one has experienced. Most people don’t fit exactly or perfectly on the Norwood scale of hair loss.  So while a classification can help you and your surgeon discuss your hair loss graphically and use it to help plan your surgery, don’t get too hung up on the number you currently fit into. If you haven’t seen it, I suggest taking a look at the following link and then determining for yourself where you think you fall into currently. 

https://www.regrowhair.com/the-hamiltonnorwood-scale/

Keep in mind also that androgenetic alopecia is progressive and will continue as long as your genetics dictate. It is impossible to predict exactly how far this will go but one can make an educated guess by looking at an established hair loss pattern.

Also, I don’t think it is up to forum members to determine which approach is best for you as an actual strategy and plan should be created by the surgeon who is working on you. I understand that you are still researching so this may be confusing at first.

But ultimately, typically those with advanced hair loss are done in two passes at our clinic. While we certainly do large FUE sessions, there is something to be said about waiting to see how the first procedure grows in and heals and how much further your hair loss will continue in an 8 month plus period.  

While Dr. Rahal is very scientific and methodical, he is also very artistic.  Artistry is equally important in determining the final outcome and result.  For example, at our clinic, we will provide you with all the numbers including

* grafts per square centimeters (FU/cm2)

* hairs per square centimeter (H/cm2)

* Area of the scalp to be covered

* total # of grafts

* total # of hairs

* hair count breakdowns

* hair shaft diameter (in microns)

All of these numbers and variables will ultimately determine the result along with placement and angle of the transplanted follicular units, determined by the recipient decisions made by the doctor.  This is where artistry comes in which is determined by skill and experience.

How many grafts that can actually be harvested and transplanted safely during a single procedure and over the course of a lifetime will depend on many factors   Dr. Rahal uses a formula based on each patient’s specific characteristics to determine what t can be safely harvested and transplanted without making the donor area too thin, etc.  

Long story short, in order to provide enough coverage and density in the front and back, you will likely need at least two passes assuming you have enough donor.

 I hope this helps 

Rahal Hair Transplant

@spartacus7,

i’ll be completely honest with you.  Your post makes me very nervous for you. Because as much as I would love to tell you that hair transplant surgery is inexpensive and that you can get an amazing hair restoration transformation with next to no money, that’s simply not the case. Hair transplant surgery is an elective procedure and takes a great deal of skill and experience in addition to an entire surgical team working on you all day to get you the results you want and deserve. 

As a result, I totally agree with Melvin that if your budget is only $3000 that you’re better off doing nothing. In my opinion, if you’re not already doing so, I suggest talking to a doctor about non-surgical solutions that can help you maintain your existing natural hair.  You can focus on saving money and then undergoing hair transplant surgery if you are a good candidate when you are able to afford it.

Plan on spending on average about $6 to $7 Canadian ($5 to $6) per graft.  Yes, you can find reduced rates in turkey but be very careful. I’m not saying that aren’t some good doctors in Turkey but Turkey is a known hotspot for botched cosmetic procedures.

Best wishes,

Rahal Hair Transplant 

@JonDoe,

Technically, you can start wearing a loose fitting cap or hat immediately after surgery.

In fact, a number of hair clinics will even provide you with a hat or a bandanna to wear after surgery to protect the new grafts.

That said, just make sure it’s loose fitting and doesn’t press up against the newly transplanted hair.

After approximately 10 days, the newly transplanted grafts will be fully secured and routed securely underneath the surface of the scalp. At that point, you can wear any cap or hat tightly or loosely

i hope this helps.

Rahal Hair Transplant

@HariKishan,

Selecting a quality hair transplant surgeon takes time and research. Many members will have their own opinion about which doctor they prefer but at the end of the day, it’s important that you select a doctor based on their proven track record of producing outstanding results.

The way to ensure this is to research surgeons on this forum and online and view results posted by real patients and surgeons you are considering.

I know you are from India but that doesn’t mean that you have to select a surgeon directly in India. In my opinion, it is far better to select a surgeon that you are most impressed with based on results and then use price and location as the last determining factor.

Many prospective patients travel hundreds and even thousands of miles to undergo surgery with a world renowned surgeon because at the end of the day, hair transplantation is a lifetime investment. It is far better and cost-effective to get it done right the first time.

Below, I presented some information and steps on how to find the best surgeon for you.

—-

Rahal Hair Transplant 

How to Select an outstanding hair transplant surgeon. 

1.  Start by looking at the surgeons recommended by this community, in particular the Coalition of Independent Hair Restoration Physicians.  Surgeons recommended by this community have met a demanding set of standards and are approved based on meeting those high standards.  Many online hair surgeon memberships don’t have any criteria other than to pay a membership fee.  Furthermore, physician members of the coalition have met an even higher and more demanding set of standards and have proven to be amongst the best of the best in the profession.

2. Now even amongst a list of outstanding surgeons, not all surgeons are created equally. Therefore, while it’s tempting to select a surgeon based on price or location, try to avoid this as many individuals travel great distances to undergo surgery with an elite surgeon they are most impressed with. Thus choose a surgeon based on their proven ability to produce outstanding results rather than because of cost or location.

3. Narrow your selection down to 3 to 5 surgeons you are most impressed with.  You can do this by using this discussion forum and others to view examples of patient results posted by both the clinic and their patients.  Speak with and meet with real patients in person if possible. If not, video chat works pretty well.

4. Come up with a list of consult questions to ask each surgeon/clinic you are considering. I’ve created several different posts on this forum with good questions to ask doctors.  If you need help coming up with a list of good questions, please let me know.

5. Consult with each doctor you are considering and ultimately, choose the surgeon you feel can best meet your goals.

I hope this helps  

Rahal Hair Transplant