Considering FUE operation, some questions for transplant veterans

[episode4anewhope]

Hi all,

 

This is my first post here, been a lurker for a while.

 

Brief intro - I've been losing my hair since age 21, tried propecia for a couple of years without significant results, eventually gave up and started shaving my head at age 24 (the Bruce Willis look). At first with a machine and quickly moved to a razor blade shave, which I've had for about 8 years now (now age 33). My hair loss pretty much settled down on a Norwood 5A level.

 

I was content to have this as my look going forward, as I have a decently shaped skull, but recently I've become interested again in hair transplant, as results seem much better than they've been when I started losing my hair. I did 2 consultations, one with Dr De Reys from Belgium, and one with Dr Bhatti from India.

 

Dr Reys recommended 3000 grafts operation over 3 days. Dr. Bhatti recommended 5500 grafts operation over 2 separate sessions (first 3000-3500 grafts, allow the donor area to heal, then 2000 more). The encouraging part is that I seem to have a lot of doubles and triples in my donor area, even if it's not very large (I have a small head overall).

 

After reading many patient reviews here on the forums on both, I'm leaning towards Dr. Bhatti. The cases I read about Dr Reys were all pleased with the results but complained about significant pain during the operation, while Dr. Bhatti approach seems more aggressive with restoration, and it seems his operations are relatively pain free. I think it has to do with the FUE techniques they each use (manual vs. machine assisted). Also, Dr. Bhatti operation is only 1 day as opposed to 3.

 

I discussed the operation at length with both doctors and their assistants, but I have a few lingering questions resulting from discrepancies between the answers I was given, and I'm hoping veterans of FUE transplants here in the community could help me out based on their individual experience:

 

Wait time after operation before shaving again

 

 

• Dr. Reys said it should be possible to shave after 2 weeks (I'm assuming he meant with a machine)
  
• Dr. Bhatti said 6 weeks before shaving with either a machine or a razor. He did say he does not recommend a razor until about 6 months, as donor sites will still be visible until then.
  

 

That is quite a big difference. Not buzzing my hair for 6 weeks will leave me looking quite bad with my current coverage (even 2 weeks is stretching it). What do you think makes more sense? from what I read here on the forums, most people think it's viable to buzz after 10-14 days.

 

 

Also, what is your experience with donor area scarring with FUE? obviously, there's variation, but do you think it's possible to be able to shave again with a razor blade eventually? I want to know if the option exists in case the operation doesn't go as successful, and in the future if I get to that point again.

 

 

How did you wear your hair after the operation, if you could not buzz it for 6 weeks?

 

 

 

Difference in the amount of suggested grafts

 

 

Though they both think 1 operation should consist of around 3000 grafts, the Doctors have different ideas on how to use those. Dr. Reys believes I would be be satisfied with spreading those out on my entire bald area + crown, while Dr. Bhatti wants to use it just for the top area, and use a second operation with 2000 additional grafts for the crown area.

 

 

I sent them both the same pictures. I feel the pictures might be a bit misleading due to the very close distance (tried to make it as high resolution as possible), as it makes my head looks bigger than it actually is. I tried measuring my entire top all the way to the edge of the crown, and came to about 115 sq/cm. Using the density numbers they gave me - 35 sq/cm from Dr. Reys, and 65 sq/cm in hairline all the way to 30 sq/cm in the crown from Bhatti, I feel the truth is somewhere in between, but that Bhatti's over-estimate seems more realistic for a satisfying result.

 

 

Are there any advanced Norwood cases here that can share their experience? I've read many patient reviews cases on the forums, but looking for opinion on the difference in graft numbers. Any other opinions on the difference in numbers are also welcome.

 

 

 

Thanks in advance for any and all responses!

[KO]

You need to get on propecia again, if you didn't feel side effects the first time - I did not see any notation in your post that you did, so it is very important!

[episode4anewhope]

Thanks for the suggestion, I have a doctor's appointment next week and will ask for a prescription. Any thoughts on the questions raised in the post?

[glocktop]

I'm not sure I understand how you calculated your balding area measurements, and the doctors statements about density. Are you saying they estimated the size (length x width) your bald area based on photographs? But you mention density - were they providing estimates of how many grafts they'd place per square centimeter? Or how many hairs they believe to be currently present in the recipient area?

 

I do appreciate your empirical, data driven approach. Could you explain further? Or perhaps post a photo with some captions on it? I don't see a lot of discussion on this forum about pre-op measurements.

 

And dittos on the finasteride. Maintenance meds are equally important as the ht itself.

[episode4anewhope]

Sorry for the late reply -

I read somewhere (don't remember where) on how to calculate the balding area - you put a piece of paper (A4) on top of your head, and draw in the area you would like covered in hair. Then you measure the area in sq/cm, and there you go. The doctors I assume went by photographs, and also used their baseline numbers for this level of balding (Norwood 5A).

 

Too bad I threw the page away - I would've uploaded it. But you can do it easily yourself. To make sure I was getting accurate figures, I also used a string to measure exactly the distances from front to back and side to side, and compared it to the results on the paper.

 

I've since went to an in-person consultation with Dr. John Diep in Las Gatos, CA, and after hearing his explanations on how he scientifically builds the hairline and calculate density, I'm leaning much more in using his services, despite a much steeper price. His portfolio of patients with a similar profile as mine is very impressive as well.

[scar5]

So I'm too late for this but just wondering, did Dr. Diep suggest a zone by zone approach or an all-areas approach from stage one? Guessing no, but I think it is a relevant, question for all HT punters - risk the transection with a diffuse-then-denser approach, or put up with the oddness and treat another zone next time, with, who knows, different techs, new tools etc.

[KO]

So I'm too late for this but just wondering, did Dr. Diep suggest a zone by zone approach or an all-areas approach from stage one? Guessing no, but I think it is a relevant, question for all HT punters - risk the transection with a diffuse-then-denser approach, or put up with the oddness and treat another zone next time, with, who knows, different techs, new tools etc.

^ Could you please explain what you mean, I am very curious about the two approaches.

[episode4anewhope]

He suggested to first focus on rebuilding the hairline and filling out the frontal third. A second operation will then address the crown.

[glocktop]

You should inquire if he will extract donor grafts from the entire donor area, or just one side of your head (left or right). If I recall correctly there was at least one patient on here where Dr Diep extracted from only the right half of the donor area.

[bismarck]

episode4, from what I've seen, it is unlikely that you would be able to shave with a razor again without the scarring (tiny "dots") being visible, even with the best of FUE.

 

I've asked multiple surgeons this same question, and gotten the same response. You could buzz down without a clipper, but a razor would be less likely.

 

Think Jason Statham, not Michael Jordan.

[episode4anewhope]

Weird, since I got the opposite answer, from multiple doctors. All assured me I should be able to shave with a razor within several months after the redness disappears. Anyone here has any experience with shaving with a razor after an FUE operation?

[bismarck]

Sorry my friend, you will probably still be able to see hypopigmented dots. Any time you violate the epidermis, scar tissue is created. I suspect your surgeons were thinking you meant buzzing down to a 0 guard, not a clean shave.

 

Scalp tattoos may help, but the ability of scar tissue to take up pigment can be variable.

 

I said this elsewhere, but to paraphrase one prominent hair transplant surgeon, "If you're planning on shaving your head in the future, hair transplantation is not for you."

 

Inherently a catch 22, as you obviously can't predict the future to know if this will be needed down the line, but there is a message there. If you check other threads you can find pictures of shaved heads with FUE, or on google images. The scarring is less obvious, but it is still scarring. Even the best cases, to my understanding, are not truly scarless. Certainly better than FUT in degree, however.

 

There is a new technique called piloscopy being developed that may truly be scarless, but it seems at least some years away.

[episode4anewhope]

No, I made it very clear I meant a razor blade shave and not a machine. Of course there are going to be scars, however, with time and exposure to sunlight, small scars blend completely into the skin. For example, I have a scar on the back of my neck from a big mole removal (around 0.8cm in diameter). You can't see it anymore, even though I can feel it with my finger - it just blended completely in the skin after several skin renewal cycles and some sun.

 

The doctors I consulted with told me it's dependent on individual healing factors, but it's quite possible for FUE operation to be completely undetectable even on a 0 shave, unless you are looking for it. Of course, the size of the punch used to extract also affects this. Also, check the donor area on the patient shown in this thread - http://www.hairrestorationnetwork.com/eve/169499-pros-cons-fue-myths-dispelled.html - there's some redness, but no obvious white dots.

 

I decided it's a risk I'm willing to take, and worse case scenario I'll just keep it buzzed on 0. Hopefully, after the operation I won't need to

[chrisdav]

Also, check the donor area on the patient shown in this thread - http://www.hairrestorationnetwork.com/eve/169499-pros-cons-fue-myths-dispelled.html - there's some redness, but no obvious white dots.

 

 

That picture from memory is work by Dr Gho. The punch size is a lot smaller but his results are not very good. That is an example of compromising the final result on top of your head for minimal scarring.

 

None of the surgeons who do top fue work use punches that small so that example is an exception.

Edited October 4, 2014 by chrisdav

[scar5]

Weird, since I got the opposite answer, from multiple doctors. All assured me I should be able to shave with a razor within several months after the redness disappears. Anyone here has any experience with shaving with a razor after an FUE operation?

Yes, I can shave my FUE areas, no problem. A lot of people who were sold s

strip scars in recent years rationalized their choice on the assumption that there is no escape from obvious scarring. Bit tje caveat is skin tone.

[scar5]

nd extraction pattern is important...seroiously. They dont have enough time to ensure it will be good. Time is money and u can b left with areas of no color in the donor because they just dont spend enough tome considering the patern they leave behind.

[bismarck]

scar5, do you happen to have a picture of your donor area shaved?