JakeVig

Jotronic can you give us some more details about your donor hair. I've read that you could have used over 8000+ grafts already and now you are saying that you could have even more to spare? What is your donor density and how long are the strips that H&W have been taking out? how much do you think you have left to spare? Im just a little stunned as I was told that I would probably only have 6000 grafts in total and that my donor density is normal. Having read your website you say that: "2.) My donor hair is not the best. According to Mike, on a scale of 1 to 10, my donor hair is about a 3." Can you let us all know about stats and your donor area? and how H&W is able to harvest so many grafts? are they able to do something different than other doctors?

Robert I would like your opinion on my use of Avodart. Having read the results of the clinical studies that have been done on Avodart it seems like the stronger the dose the better the results over a 6 month period. Using the above information where GSK is considered having patients take a max dose of 2.5mg for 6 months and then later drop their does down to .5mg for the next 6 months. I kind of want to go down this 'experimental route myself' and attack my hairloss hard with Avodart where I want to go on a 1.5mg dosage for 3-6 months and then drop back down to a .5mg after 6 months. The problem is that no doctors are recommending this and that I only got the results of the clinical trials to go with. Do you think this would be too much of a risk and that this approach may cause more harm than good?

Thanks guys, I will definately be keeping my progress including shockloss posted!

Well I actually did want more grafts but they were concerned about my future hairloss and didnt want to add any at the crown at this time. At this point in time I guess I wanted to err on the side of caution and not have my hairline too low which cannot be maintained with the donor supply I have left. So having said that there is not too much else to put it. I am going to start Avodart soon so if my hair stabalizes in the next couple of years I will consider more grafts and a lower hairline. I am also under the personal opinion that multiple HT's would probably be the most optimal use of my donor supply. I believe smaller HT's will cause less trauma and result in less shock loss. But maybe the time spent waiting for these results will change my mind in future. But yeah it gets down to managing my limited donor supply in the most optimal way. It looks like I have a max supply of only 5k left so Im not as lucky as some, so I have to excercise caution with what I have left.

Pre and post op pictures of my HT with Ron Shapiro. I had about 800-900 grafts placed to fill in my receeding hairline and the rest placed behind my front tuff to add density to my 'horse shoe' thinning. Initially opted for 1200 grafts but ended up with 1344. Ok guys I have officially joined the club! as of the 14/06/06 when I had my first HT with Ron Shapiro of SMG. My initial consultation with Matt Zupan was only 1200 grafts to fill in the receeding hairline. First a little bit about my journey. I have been considering a HT for the past 8 months ever since my receeding hairline was so severe that I was very self conscience about it and hated looking at the mirror every morning and tried to avoid having my picture taken. At this point in time I knew I wanted a HT since I have been on propecia for the last couple of years of which time I had lost most of my hair. During this time I had severe dandruff to the point that I was literally scratching my hair out trying to cope with the itch. I just thought that this was the process of balding. But now I think that If I used Nizoral earlier my hair would've been in a much better condition than it is now. I was initially going to just go to the best HT doctor I thought in the UK since I didnt think that it mattered much since a HT was just a typical procedure that everyone was capable of performing. Boy was I glad I did some more research and found this site - it is an absolute godsend the information found here I invaluable and I believe helped me assess the best path with the limited donor supply I have left. My hairloss has affected my self confidence greatly. To the point that I would happily trade all my material positions to have a full head of hair and not be susceptible to MPB anymore. This is why I dont understand how some people would not go on the meds because they are too expensive. Proscar and generic minioxidil is the most effective and inexpensive treatment for hairloss. Cost should never be an issue as you can always get more money in the future - this is not the same with your hair. There maybe other reasons why people would opt out of using the meds but cost should definately not be one of them!!! I sent out a few consultations to some of the best doctors recommended on this forum and they quoted me between 1200 - 2500 grafts. I ended up choosing Ron Shapiro because for me cost is not an issue and I appreciated the fact that SMG recommended only 1200 grafts initially since I am young (just turning 27) and they dont know how far along my balding would progress. After a few years if my hairloss has stabalized than we could consider going even lower. Before the consultation I decided to completely shave my head with a razor to see if it was an acceptable look since I know that I would not be able to shave my head after a HT. Unfortunately it is definately not for me so I continued with my HT. I dont think anyone should shave their head with a razor maybe a #4 buzz cut or something to get an idea of how they would look - but never completely bold with a razor. My hair grew back so thin that I never think it will ever grow back as thick as it was before I shaved it (as seen in the previous 2 pics) - Im not sure why this is, but I can only recommend that people dont do it. Initially my 1200 grafts was only to fill in my receeding hairline and to lower my hairline a tad. But after seeing how thin I was after a month of hair growth I decided that I only wanted to fill in the receeded hair lines and add some more density into the thinning 'horse shoe' behind my tuff of hair. ------------------------------------------- My Procedure with SMG ------------------------------------------- My first contact with staff at SMG was with Matt Zupan it was comforting to know that they knew who I was and was already expecting me (a benefit of only having one HT per day). Being that this was my first surgery I felt that Matt's positive attitude helped alleviate my initial nerves about the procedure. Then I met Ron Shapiro who came in to draw on my head until we were both happy with the procedure. He was initially more conservative on my hairline than what I had in mind but because they didnt exactly know of my future progression he said that I may have to laser off some of the hairline in future to bring it back to a natural look. The thought of having to laser hair (i.e. wasting grafts) in future did not sit well with me as I wanted to make the most optimal use of my limited donor supply (unless I am 100% sure of hair multiplication or gene therapy in future). So we ended up 'negotiating' a hairline that we were both confident that we could maintain in the future - so we were both happy. Adding density behind my 'front tuff' was my idea of 'future proofing' the HT as I imagined that I would just get thinner and I didnt think that the meds would help at all in the hairline. Ron did suggest that adding density in the mid scalp area rather than at the hair line would decrease the aesthetic impact of the grafts (So I dont expect my result to be as good as someone else with the same no of grafts). but I was happy to trade a little higher hairline for adding some 'future proofing' to my HT. Adding density is actually a hard thing to do and in order to do this my hair needed to be cut really short and Ron had to use his state of the art 10x magnification to find spaces for the grafts without affecting the native hair - which is the reason for my bad hair do My donor hair is average at around per 90 grafts per sqm. (Normal density is between 80-100 sqm). And my hair is of medium coarseness. With that being said I was a little disappointed that it looks like I only have 6000 grafts in total. So I think I only have at 5k left. I am so jealous with people like Jotronic and Bobman being able to get 7000+ grafts, no wonder they have a fantastic results! Its hard to imagine that Jotronic could've even have more hair had he gone to top surgeons for all his HT's. Anyway Ron took a strip of around 10cm x 1.2cm strip from only the right half of my scalp (expecting around 1200 grafts). I believe his reasons for doing this rather than making the strip symmetrical is that it leaves me with a completely virgin half of my scalp to use later as I wish. As well as being able to use stronger back hairs as well as weaker side hairs to blend in to my hairline to make it appear more natural. I was happy to find out my strip ended up yielding 1344 grafts! Another great thing about having a leading surgeon like Ron Shapiro operating on you is that you get to pick his brain. I asked him about a million questions I felt I should've also been charged a consultant fee for his feedback As has been documented many times the most painful part of the procedure was the application of anestecia. The good thing about knowing the HT process before having one is that we know that the anestecia is the worst part and that it is basically the rest is smooth sailing from there. One thing that I liked about Ron is that he approaches the surgery like an artist, he will ask for some strong 1's put them in the hairline and then get ask for some weaker 1's. Then takes a look back and makes his next request. Im sure this is standard practice in most top surgeons he uses different size incisions depending on whether he is putting in 1's 2's 3's and 4's - so the slits fit perfectly. I ended up getting around 50 grafts per cm for my receeeded hairline and a similar count (including native hair) to the area behind my tuff, so it should blend in well with my existing tuff. Basically Ron does all the incisions and places the hairlines himself. The area behind the hairline is placed labourishly by his friendly experienced technicians. Even though I had a relatively small number of grafts my HT ended up taking a long time, finishing around 6:30pm. I believe this is because of the time and dillegence Ron spent in adding density making sure not to affect the native hair. I believe the after care was excellent as well I was able to go back to SMG a couple of times to get the nurses to shampoo my hair. Each time Ron came in to check on the progress to make sure everything was going well. Although he didnt recommend it Ron was happy to prescribe me Avodart and prescription strength Nizoral shampoo upon my request. At the moment Im just a few days post op and believe am progressing well, using the Graftcyte spray and other meds dillegently as instructed. I believe I have learnt a lot from Ron and Matt at my time at SMG. I believe some of their thoughts are contradictory to what is being said here I will try to add everything I've remember in a different thread. Anyways I will try to keep my pics posted as I progress.

Without a doubt H&W results are amazing from a coverage and results point of view with what can be achieved with 1 HT - the results clearly speak for themselves. I think there is 2 points being made here, 1 being that the lateral technique seems to provide H&W the ability to perform mega sessions. The other being what would provide the most optimal naturalness and illusion of density where maybe a number of different slit techniques would provide an optimal result. The only reason why I suggest this is that Ron Shapiro used a number of techniques I didn't even know existed! And having seen the before and after photos in terms of naturalness I believe the results are truly undetectable. I believe all results from H&W and SMG are excellent so I guess its just a comparison between excellent and most excellent In the end only the results matter.

We'll having had my HT with him yesterday I asked him about his thoughts on them. He said that there wes a study to indicate they may have similar benefits to Propecia. Although he personaly doesn't believe that it is as effective as propecia his position is that if the cost is not a factor, you might as well give it a try as it cannot hurt. Laser Light therapy has been known to stimulate cells. Either way SMG plan on selling them at their office next month.

Mrjb, We'll using Finesterade or Minioxidil you will have to use that for life anyway. There are clinical studies saying that laser combs promote stimulate cells and can promote healthier hair. I would only consider it if money is not a factor as it may prove to be beneficial.

tkerr22, You raise an interesting point. After talking to SMG from what seems like hours he did mention a a couple of other doctors he regards as excellent but I dont recall every hearing about before. Just goes to show that although there are very many poor doctors that you have to be careful of but there are also a few other excellent doctors that dont get a mention. The only way to find out is to inspect their results especially in person.

Hi Kevin1234 I would also advise that you also have a consultation with Ron Shapiro, he is regarded as one of (if not) the best in the world for hairlines. I had my HT with him yesterday and so far am extremely satisfied with my new hairline and my procedure overall. I also needed to add more density. He was meticulaous and used the best equipment available (10x maginification) with his density placement and even though I only had a small number of grafts (1344) my procedure ended taking an extra couple of hours than normal because of his dedication. The thing I appreciate the most is that he really takes your future into account, and will let you know what you will be able to achieve in future with the donor hair that you have left should you hair loss progress further. With the new hairline that I wanted he said that it was possible but if I progressed to a NW6 than I would probably need to have some laser hair removal to bring it back and look natural. In the end we agreed on a hairline that we were both confident with and one that I could maintain in future with the donor supply I have left. So I ended up being very happy!

Hi Jotronic, that sounds great but I dont think that the lateral technique is the best to use all the time. Let me explain, I have recently (i.e. yesterday had my HT with Ron Shapiro from SMG - will be posting my experience on another thread). I asked him if he was going to use the lateral slit technique, he said that he uses a variable number of techniques based on the patient and recipient area, whatever gives the most natural look and best illusion of density. Basically he approaches every patient individually and makes up his mind at the time what would look best. Im not sure if this is also standard practice or not but he also uses varying needles as low as .6mm - to .9mm depending on if he is putting in 1's, 2's, 3's or 4's grafts.

Personally those prices seem a little high to me. In the end the propecia product will still be the same. Though out of principal I personally would not purchase anything from a soley profited motivated outfit like Bosley. The cheapest option by far is just to get Proscar and split it into 1/4's. It contains the exact same active ingredient and costs a lot less. Just to give you an idea, you can get 112 proscar for around $155, cutting it up into 1/4 (so you will get on average 1.25mg - propecia is only 1mg of Finesterade) will give you 448 pills which is enough to last you nearly 15 months!

Irish Homer, Either your unusually lucky or your shedding is starting late (knock on wood)!!. I remember another poster claiming that he still had most of the grafts after a few weeks. He reposted a week or 2 later and said nevermind most of the hair shed in the end. So I guess stay happy with what you got, but dont be too disappointed if they start shedding late - like everyone else .

Looking good - though the pictures are a little small to get a good idea on how things are. Is there any chance you can upload larger sizes of the same pictures?

Robert have you got any thoughts about the long term effects of Avodart and whether or not if your body builds a resistance to Avodart that you have no other (more effective) medication left to move to?

Yeah Dr Epstein is good! Why such a low graft count? was it just to refine previous work? or was that all you needed? and finally did he do FUT or FUE?

Hi future doc, who was your doc? and how many grafts did you have? was it to recreate the hairline or to create more density?

Hi Jerry, Did you have any other consults with other surgeons as well? The only reason why I ask is that it looks like 1000 grafts will not make that much of an aesthetic difference over that area. I would've thought along the lines of 2500 grafts. What are your expectations for this HT and is there any reason for the low graft count?

Hi andy, I can't tell you for sure but I have read a lot of posts that say early use of steroids or creatine can advance Male Patterned Baldness.

Dr Elliot I just want to say thanks for posting on this open forum and letting us all know your thoughts on how you have approached sure34's HT. Now that we have both sides of the story we can make up our own mind on whether or not your thoughts were justified. You have to understand that Pat (and all of us) are justified in thinking that you may not produce consistent results if only patients that believe they have received a poor result post their experiences here. Having said that though I have spent countless hours on this forum and have read many other patients that have received a good experience from you. Letting us know about your experience (30000+ HT's) and hearing that you are using modern techniques will only be received positively here. You should encourage your patients to post their photos and experience here. Good results will raise your profile and give all of us here more confidence in your abilities. But threatening court action will definately not be received well by people here. It does sound like you do not know about this forum as you were not aware about being able to post anonymously using aliases, etc. For this reason we can forgive your initial hostility towards this forum of open information. You like most of us should know that a HT is a life changing experience and that a bad HT can cause a patient severe depression. Before reading this forum I like everyone else new to HT's would have thought that any Plastic Surgeon can perform a HT and expect the same result. As you know this is not the case, not every surgeon doing HT's is sufficiently skilled, not everyone is doing FUT/FUE's, can perform the Tricho closure and a near undetectable scar, uses specialized equipment and can provide a truly natural result, etc. This forum is a life saver for many of us and also provides us an invaluable support group to give us confidence to actually go through with it in the first place. Just to reiterate, this forum is a hell of a lot more than the promotion of surgeons in the Coalition, it is an invaluable resource to most of us here. It has provided us extensive knowledge about the entire HT process - how the entire operation is performed, how long it takes to heal, exactly what to expect after the HT (scabs, shockloss, 3+ months for signs of regrowth, etc). What results patients can expect in terms of grafts, density and coverage, etc. You have to agree that a well informed patient with realistic expectations is going to be a happier one. If you are a HT surgeon for the right reasons, i.e. to make a different in peoples lives and to give them back confidence and a happier outlook on life (as opposed to being purely motivated by profit) spend some time to research this forum you will soon find out that this forum strives to achieve this goal as well. I believe that if you refer your patients to this forum as part of your after care service they will be better off knowing that they are not alone and that there is an invaluable support group willing to provide invaluable information should they have any questions. Dr Elliot, I wish you and your patients well in the future and look forward to your posts in future.

Thanks Marino, I will ask for the suture kit and book my GP to remove it for me. I was just worried that I would need someone who was skilled so it does not affect my donor scar. I am going to the Shapiro Medical Group in Minnesota to have my HT with Dr Ron Shapiro. Im having my HT on a wednesday so I was wondering if it would be ok to get it removed only 9 days post op as it will be a friday otherwise I will have to wait till monday.

Hi All, I am about to travel overseas to have my first HT next week, I just want to know who I should get to remove the sutures/staples since I will have returned back home after 4 days. Can I get a GP to remove my sutures or do I need to go to a plastic surgeon or a HT doctor in my area?

Unfortunately the amount of shedding will vary from person to person. If you are concerned about looking like you are going bald you can always try concealers like Toppik and dermatch. They do miracles for giving the appearance of a full head of hair!

It would be like an acceleration of male pattern baldness where the 'hair cycle' is accelerated, most of the shedded hair should return.

samy_dram, I would also recommend adding Nizoral shampoo to your hair care regime with propecia. I just learned today that the clinical trials with Propecia included the use of Nizoral shampoo 3 times a week. Apparently Propecia without it may not be as effective. I really wished I learned this earlier. I hope you can benefit from this information as you are just starting out.