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Tav1

My 4,000 Graft FUE With Dr. Sanusi Umar – April 7, 2015

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For some time now, I’d been contemplating doing something beyond what had become a daily routine of finasteride and minoxidil usage, which, quite frankly, helped me considerably over the past decade. I seem to recall becoming a member of this forum years ago, but email account changes and usernames and all the rest were long forgotten, so I’ve started anew.

 

An aside prior to my transplant story: as long as any side effects are tolerable with the combination of these two aforementioned drugs, I’d still encourage anyone out there with hair issues to give both of them a solid year of dedicated use, taking before and after pictures and objectively comparing results. Everyone is different, as is their individual level of success under the finest/minox routine, but for me at least, it got me through my 30’s and I can honestly say I had better hair at 40 than at 35.

 

Fast forward, and I’m a few years past 40 now (although I really don’t feel it), but my frontal/temporal recession started to continue - along with a slight bit of crown thinning – and the situation just continued to nag at me. I’d made all the usual excuses for not seriously investigating surgical alternatives (work, life, etc.), but something just clicked in my brain earlier this year, I re-discovered this forum, and I began reading pages and pages of posts here. I’d be remiss if I didn’t thank all of you who’ve shared your experiences, and most certainly those senior members, doctors and advisors, whose comments and postings I’ve read many of over the past few months.

 

For most people willing to take the time to read and search this forum, I’d argue you’d be 90% of the way there, with your questions answered here before taking the plunge into hair transplant options. The remaining 10% to get you there is a combination of personal fortitude to start the process in earnest, do a series of doctor consults to assess individual invasive or non-invasive action options, and finally, make the most informed decision and action plan as to what is best for you based on your own goals.

 

All of that said, I can’t really imagine I can offer anything particularly substantial in contrast to the wealth of knowledge already here on this site, but for whatever it might be worth to some, I’ll dive into my experience, and fully commit to updating this thread with photos and observations for at least the next 18 months, if not beyond.

 

Certainly there are numerous qualified clinics and doctors both in the U.S. and abroad. And I researched many of them. It seems as though with FUE in particular, “hot zones” crop up in on a somewhat randomly rotating basis from country to country as Doctors progress in their advancements. And it seems as though overseas remains a very viable alternative for us here domestically. For me personally, where to go for the surgery was of little concern, as I typically travel 100,000 miles or more each year for work, most of it outside of the U.S. Other US cities, Canada, Europe/Eastern Europe, I looked at them all, but to be honest, I felt most comfortable staying local for a variety of reasons both work related and personal. Or maybe it was, since I’m sick to death of sitting in a chair at 30,000 feet for hours at a time.

 

The bonus for me was the fact that Dr. Umar’s clinic is literally ten minutes from my house. The double bonus related to available open dates Dr. Umar had for what would be a three-day procedure – the calendar just worked out perfectly. I finally decided to “pull the trigger” while on a trip in China in mid-March 2015, did all the correspondence with Dr. Umar’s clinic via email, and actually went from deciding to schedule, to day one of my surgery within three weeks time. So good timing and location swung my decision somewhat, and of course a careful review of Umar’s work.

 

Dr. Umar’s original recommendation was 3,500 to 4,000 grafts to restore a solid, but realistic hairline considering my age, address the temples a bit for framing and fill out just a small amount of crown thinning. I settled on the conservative approach of 3,500 grafts. Day one of surgery was April 7, 2015, bright and early (7:15 AM) at Dr. Umar’s clinic in Redondo Beach, California. His clinic occupies two floors – one suite downstairs and one in the penthouse of a multi-use structure which also houses an athletic club. Anyone familiar with the area will know what I mean when I say it’s about 50 feet from the boats in King Harbor. I live at the beach, so no big shakes to be on the ocean, but for anyone prepping for life-altering surgery, positive vibes from the ocean aren’t necessarily a bad thing…

 

So I checked in with one of his staff in the penthouse clinic first thing, got a room assigned where I could change, stored my backpack, etc. Those of you considering a HT do what I did – I wore baggy shorts, flip-flops and a button up shirt. Once you put on the gown and booties, you’ll be confined to various laying positions for hours on end, so wear whatever is most comfortable – trust me, I was glad I did. I brought socks if my feet got cold, and they provided a blanket if the rest of me did. It can be a gigantic pain in the ass to hold still for hours at a time, and the last thing you want is some restrictive clothing binding into your crotch as you lay face down.

 

Next up, blood pressure check, HIV check (they do the OraQuick swab, so no blood needs to be drawn) and the usual pre-op pills in a cup. Blood pressure was a little on the high side (no shit, I’m about to have 1,500 grafts moved from one part of my skull to the other), but nothing too high as to not proceed. Dr. Umar came in, and we discussed the hairline as he marked me up. Upon further inspection, the Doc noticed I have an odd recession of hair that sort of curves in a smallish line on the left side of my head (if looking straight down at my dome) from the midscalp towards the crown. Sort of looks like a sperm facing backwards atop my head. It was hard to spot from my consult pics, as my hair was a little long (for me at least) at the time. Regardless, we decided we’d address it as we proceeded.

 

Hairline now decided upon, time to shave down for the ol' Telly Savalas, then lay flat on my stomach on what looks very much like a massage table. OK, so everyone has a different take on the initial scalp injections. For me, they sucked. And no, they didn’t suck less the next day or the last. They continued the same level of suckage back or front, regardless of day or state of mind. But the Doc did work some solid mojo to make the injections less painful by pinching and messaging the skin, so props to him for that. Lying perfectly still during the extraction process - while the chair remains flat or tilts you slightly right or left - was something I found quite challenging. But the Doc understood this pretty quickly, and they gave me a small injection to help keep me calm.

 

As the hours ticked by, the injections and/or meds started to wear off a bit, so the latter part of each session was a bit tricky for me. I didn’t want more meds, so I just tried to focus on the positive and listen to “hits from the 80’s” the tech decided to pump into the room. Dr. Umar hums along a bit to some of the songs, and quite honestly, that kept me calm. Sort of a “he calm, me calm” sort of Zen thing I suppose as I stared at the floor/the Doc’s shoes/etc. for hours on end.

 

Post the morning extraction, up for lunch out on the killer balcony overlooking the harbor (they order from an Italian sub/calzone/salad joint). Shortly thereafter, back to the chair, facing semi-upright this time for temple/frontal implanting. The Doc does the slits, the tech does the implanting. Dr. Umar’s implant tech has been with him for a decade, she’s got great hands, she’s very serious, and I felt as ease with her. I’d joke around a bit with the other non-implanting assistant techs, but I left his primary tech to do her work. Dr. Umar comes in during this process to look things over, in some cases make a few adjustments, etc.

 

I will say that for me, the extractions and prep process I came to not like nearly as much as the implanting. Implanting the grafts was sort of like getting a very light scalp massage. As an extra bonus, you typically face forward in a semi-reclined position (at least for the areas I was having addressed), so I just caught up on the news on the tube during this portion of the procedure. Around 1,500 grafts give or take on day one. In at 7:15 AM, out at around 6:30 PM.

 

Slept fine all things considered, although sleeping upright on your back isn’t my preferred position. Made a nice mess of the provided pillow covers with all the gunk on my donor however, but that was to be expected. Day two, up, quick neck down shower, out and at the clinic at 7:15 AM again. Otherwise, lather, rinse and repeat as extractions are done and new grafts implanted working back from the frontal hairline placed the first day. Started to become a fan of the 80’s music we pumped into the room again on day two.

 

Although we had originally decided on 3,500 grafts, towards the end of day two, the Doc and I got to talking about the snake-like recession midscalp and small spot on the vertex, so we decided on day three we’d address it with either 500 or 1,000 additional grafts. I left it up to him, and in the end, he decided 500 would do the trick. So to keep on schedule, we did slightly more grafts on day two versus day one, which allowed me to come in again on day three and get out mid-afternoon.

 

Day three mercifully ended with all the usual post-op things – a baggie of goodies, my week’s worth of Cephalexin pills, some pain meds, prescription AVO Cream and bacitracin zinc. Post-op, you mix the AVO and zinc ointment and apply on the donor area twice a day. The zinc ointment once per day on the recipient areas starting day three out from post-op. No issues now in the week or so since this whole thing started, other than annoying donor itch, staring in the mirror and the usual paranoia of losing grafts from sleep, etc. Follow up via email with the clinic has been good, with me asking the usual questions one would expect (although the post-op instructions are pretty specific).

 

A couple of tips for what it’s worth: first, as I suggested earlier, wear comfortable clothing. Trust me. Loose fitting, comfortable stuff. I’ve learned this from years of airplane travel, but it really came in handy with all the “staying perfectly still” that is required for a successful procedure. Second, leave a bottle of water (or in the case of Dr. Umar, they gave me Gatorade) with a straw in the room during the procedure. One of the techs will simply hold it under the table so you can suck up some fluid while on your stomach, or otherwise while lying on your back. Saves everyone time, you don’t have to get up, and the Doc and techs would prefer to keep moving to stay on schedule while your meds are still effective. Third, don’t drink too much liquid night before/day of surgery – it prevents interruptions due to numerous restroom breaks. Forth, since I live at the beach in California and it’s pretty much been sunny every single day for the past year, I purchased a really soft bandana that provides UPF 50+ UV protection. Better than a hat, particularly as I’ve had work done on the temples, making hat scraping nearly impossible. I’ve gotten clearance to work from home for the remainder of April, so I might hit the deck for a little vitamin D once in a while with the dome adequately protected.

 

Notes on Doctor Umar/clinic staff: there is no “sell job” involved here. No patient coordinator or sales person to encourage anything, sell anything or talk you into anything. Some might consider that a positive, others a negative. I considered it a positive, as I’d done my homework and didn’t need any further encouragement to take the plunge. Doctor Umar has been reviewed on this site before, and he’s pretty much as described – low-key, friendly, mostly business and professional. I’d describe the vibe this way: by the time you make your appointment and get to the office on day one, you are there to get the work done, and they are there to do the work. Not that there isn’t banter and whatnot, but it is a clinic that does the work efficiently without a lot of needless handholding.

 

For the three days I was there up in the penthouse office, it was me, the techs and the doc – never saw anyone else, patients or otherwise. As has been discussed on this forum before, Dr. Umar does leave the grafted areas “unmolested” post-op for the most part aside from essential cleaning (as to not disturb the grafts), and you leave the office each day with nothing covering your head. So immediate post-op isn’t necessarily sexy. He also subscribes to the method of keeping the grafts moist with ointment for the first week, and this makes things a bit messy as well.

 

That’s it for now. Including a good number of pre-op pictures to give you an idea of my “before” situation, but at this time, I really only have one post-op picture, as I can’t for the life of me find my camera. But I’ll get additional shots up soon. Again, I most likely can't provide more than many here have already outlined as to the experience, but if you are looking into Dr. Umar, I can certainly help guide you with what to expect.

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Tav1,

 

Welcome and thanks for sharing such a detailed and interesting account of your hair transplant with Dr. Umar. Not enough can be said about how personable and professional he is.

 

I wish you the very best of luck and I hope you'll take the time to update us on your progress in the future.


David - Forum Co-Moderator and Editorial Assistant

 

I am not a medical professional. All opinions are my own and my advice should not constitute as medical advice.

 

View my Hair Loss Website

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Thanks David. I'll most certainly keep this thread updated with progress photos and updates with the idea that whatever I can offer might potentially assist someone in the future.

Edited by Tav1
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Thanks farmcat - just getting through the first week or so now, and oddly enough not really concerned about shedding the grafts or looking strange - just don't care. For me, the tough part is over, and at this point, I'm happy to wait out the months to start sprouting.

 

Rawkerboi, Umar's pre-op instructions noted that Minoxidil be stopped at both the recipient and donor sites two weeks prior to surgery; on the post-op side, the clinic provided propylene glycol (PG-free) Minoxidil and suggest applying it three days after surgery, then continuing the PG-free stuff for four months before switching to whatever brand of Minox foam.

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This is going to be an interesting transformation! Happy growing.

 

We are only 3 days apart from our procedures.

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zx_toth - saw your thread on your HT and wish you the best as well. The (hair) race is on dude!

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Please keep this thread updated with photos, I want to see your progress. Great write up and looking forward to seeing your new look.

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Thanks wylie - will do. Just a day shy of two weeks. Going in for a two-week check-up with the Doc tomorrow, which will be exactly 14 days from my last procedure. Mostly going well, with the usual donor itch, a few stubborn scabs, and a bit of swelling that sort of moves down from the forehead to around and under the eyes. Nothing out of the norm, as I understand.

 

I did develop a little bit of an infection - about the size of a dime or quarter - in the frontal region around day 11 following the loss of a few grafts while patting my head post shower. You can see it in the crap "selfie" I took - it's on the right frontal portion, just back from the hairline. Very strange, as I was doing everything correctly.

 

To be honest, I'm a bit concerned, as I've followed all the post-op procedures to the letter, so I'm not certain what the cause might be. I'll report back tomorrow after my visit with the clinic. I was told not to touch or massage the area, but to simply apply Bacitracin Zinc to keep the area moist.

 

Keeping my fingers crossed it's nothing serious...

 

Happy growing -

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Let us know what you find out, I hope it's nothing serious. I'm sure Dr. Umar can handle it regardless.

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I'm a little late with this progress report. Unfortunately, I've had to deal with a small bit of necrotic tissue, which I sort of suspected from my last update. I didn't freak out, saw the Doc, and we are taking care of it with a combo initially of Cipro for seven days to make sure there is no further infection, then also (and longer term) with Nitro-Bid mixed with Bacitracin Zinc twice daily.

 

Dr. Umar was surprised, as I don't smoke and have not had any previous work done in the impacted area, but it is what it is. To his credit, I am seeing him weekly going forward to make sure things are on track. I think I'm looking at around six weeks for this situation to resolve itself, then the Doc will suggest when some grafts can be implanted (if and when necessary) into the impacted area.

 

I've been promised that there is no further expense to me for any of this - either ongoing care for the necrotic area or for new grafts to correct/address the issue, so props to the Doc and his practice for that approach. The rest of my head looks just fine - nothing out of normal for being around three weeks post op at this point, so this little situation is a bit strange, but from what I understand, it does happen rarely, and unfortunately, I'm one of those rare instances.

 

I've taken photos, and happy to post them up if anyone is interested.

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Yes, I'm very interested. I've only rarely seen cases of necrosis. I know that Dr. Umar is a dermatologist and was right on top of your issue, but I'd still like to see pictures. I remember one case years ago by a recommended doctor and the patient left the country on a vacation, posting pictures as the days went by. It was pointed out he might have a serious problem and a month later finally sought treatment. The end result was fairly ghastly and disfiguring. There is another gent who has a blog about a doctor in St. Louis who butchered him and left him with a bad case of necrosis that took months to finally go away and also left him disfigured. I have no idea if ever case had any satisfactory conclusion, either.

 

It happens to the best doctors, and the worst doctors, and immediate treatment neither of these patients ever received.

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I appreciate your concern wylie - I'll PM you a few pics. And yes, I believe it's a good thing that Umar is also a dermo.

 

Cheers.

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It has been one month and one week (as of tomorrow) since the last of my three-day FUE procedures totaling 4,000 grafts in early April of 2015. The donor area is healing just fine as would be expected with FUE - really can't tell anything had ever happened to the donor area at all as of now - just waiting for the hair to grow out a bit longer. But I don't anticipate any lingering impact visually or otherwise, and Im fairly certain I can buzz down as much as I'd like based on whatever future hairstyle I want down the road. There remains just a little bit of random itching and tenderness (nerve endings?) on occasion in a few random areas, but otherwise, things are looking/feeling good in the back of my head.

 

As for the recipient, things are mostly healing nicely. I bit pinkish as to be expected, most of the transplanted hairs have now shed, and I'm entering that awkward stage many of you know so well. On to the more recently concerning issue: necrosis. As I outlined previously, I unfortunately experienced an area of necrotic tissue a week or two into my transplant recovery. Neither my Doctor nor I can pinpoint how it occurred, but quite frankly, since it was identified, I've always been more concerned about the treatment rather than the cause.

 

The necrosis was initially identified during my two-week follow-up. Dr. Umar immediately put me on Nitro-Bid, which I use twice per day. The good news is, after two weekly follow-ups, the area is healing/repairing nicely, and I was actually able to skip this week's appointment and see the Dr. next week, as things seem to be on-track. We assume that once completely healed, I will need a small FUE procedure in that area. I'd certainly like that to happen soon, so that all the new growth is more or less coordinated from a timing perspective.

 

For whomever it might help in terms of identifying/looking out for potential necrosis, I'll post four or five pictures that sort of demonstrate the progression from immediate post-op, to identification, to the worst of it, to how well things have healed. Will do so tomorrow morning at latest.

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Attaching photos outlining the area of necrotic tissue. The photos follow left to right and are labeled from development, to full blown necrosis, to healing, and finally, a most recent shot showing (what I hope is) a solid recovery. The Doc originally anticipated a six week recovery period for the impacted area, however I've been diligent with the treatment, and finger's crossed, I'll be pretty much fully recovered by my appointment next week, which will put me just shy of one month since this situation was fully diagnosed and treatment began.

 

Regardless, based on my progress thus far, I'm 100% confident all will be well by week six. So then the next question is when we go in and do a small FUE to the area - hopefully I'll find out soon enough...

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Thanks for posting your pics. Tav, glad to see that area is looking normal again. That seems like a pretty quick recovery if you are looking like that in one month. You're in good hands with Dr. Umar.

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Thanks for the support wylie. It's a little difficult taking "selfies," but the area has really responded well to treatment, and I'm feeling much better about things versus a few weeks back. Dr. Umar never panicked, and his calm demeanor help keep me the same.

 

I consider it fate that I decided to "stay local" and also that Dr. Umar is also a well-regarded Dermatologist - both of those factors worked in my favor in this situation. I'll update this thread with what's next after my appointment next week.

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Update: saw Dr. Umar today, and he's cleared me for takeoff, so to speak. The previously necrotic area is almost completely healed, so for the next two weeks, just Bacitracin (no Nitro-Bid) on the impacted area - just to be safe and finish healing. The plan from here is to see the Doc at my four month mark in late July, at which time we'll discuss any grafts that might need to be placed in the area.

 

Dr. Umar was very positive about my recovery overall, most of my other grafts shed naturally, and as for the impacted area, he doesn't think it will take more than 10-20 grafts to fill. As I stated before, he's doing any additional FUE at no additional charge, which is very nice to hear. I'm assuming we can do non-shaven FUE for such a small repair, so I don't believe I'll miss a beat in terms of growing and/or appearance.

 

Lastly, as FYI for you guys in the same stage of growth as me, my Doc indicated that if I did get any "pimples" or "in-grown's" as the new grafts attempt to pop through the skin in the coming months, I should let him know, and he recommends a script for antibiotics to make sure any of it doesn't get infected or impact overall growth.

 

I must applaud Dr. Umar once again for his professionalism, his ongoing concern and his calm, reassuring demeanor. I'll update with a few more awkward "selfies" at my two month mark, which is in about two weeks time.

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Glad to see you have recovered so quickly from that situation Tav. Thanks for posting the update and pics, real information from real patients is definitely the best source to learn from. Looking forward to your future updates.

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Thanks for the support farmcat - now just entering that "completely shed phase" so I have to look back at my immediate post FUE pics to realize that (hopefully) that hair will reappear in a few months!

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Great thread man, really detailed and informative. Sorry to see you had some infection probs but great to see in the pics that it has all cleared up. That must have been worrying at the time. Looking forward to seeing your progress, happy growing mate :)

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Yes KconK - that was a pretty rough couple of weeks, but all good now. I wanted to document the issue for any folks who may be concerned following their HT, see any symptoms and subsequently search the forum for "necrosis" or "necrotic tissue." Truth is, as scary as these situations sound, caught early and treated appropriately, the world doesn't come to an end after all!

 

Cheers!

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Two month update: it's been eight weeks since my last FUE procedure and six weeks to the day that my necrosis was initially diagnosed. Well, good news/expected news - good news is my area of necrotic issue is around 99% healed and redness in the transplanted area has decreased a good bit; expected news is the 99% of my transplanted hair has shed. Damn, they don't call this phase the "terrible twos" for nothing!

 

I still get some donor itch, and now just starting the occasional pimples (a first for me) at both donor and recipient. And I've continued my regimen of twice daily minoxidil, along with once daily finasteride 1.25mg.

 

Oh yea, I also purchased a bullhorn, and I wake up in the morning and proceed to scream my f@#ing lungs out to try and wake up my dormant hair. It's early days, but I figure why not try it.

 

Next update in a month, which hopefully will start down the path towards some initial visible growth.

 

Cheers.

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Three month update: it's been three months to the day since my last FUE procedure. My necrotic area has healed, and luckily, there are a few grafts and original hairs that seemed to have survived the incident, but as I've stated before, Dr. Umar will fill in any impacted area free of charge down the road a bit. He's asked that I come in for a checkup at the end of this month, so we'll see where it stands at that time.

 

I've gone through some pimples in both the donor and recipient, and actually, got quite itchy over the past few weeks. The donor has healed nicely after what I thought originally might be a bit of shock-loss. Looks completely normal now.

 

I'm continuing with Fin and Minox, as well as yelling at my hair with the bullhorn I bought last month. Sorry for the single and not so good pic, but I'm running to catch a plane for the 4th holiday. The crown looks good, although you can't see it. Promise proper pics at month four.

 

It's very difficult to see, but I've sprouted those "translucent hairs" pretty much all over the donor area, so I'm hoping month four starts to fill in a bit.

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Edited by Tav1

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