Recent FUE with Dr Ron Shapiro . Prior FUT patient .

[fortune11]

Hi -

 

As some of you may recall, I have posted prior experiences of my FUTs (2004-Shapiro, 2011-Ziering and 2015-Shapiro). I am basically a diffuse NW6 and have tried to keep pace with my hair loss using HTs into existing hair. While I have used Rogaine almost forever , I did not start using Propecia until 16 months ago (after HT#3) .

 

My scalp laxity during FUT #3 was not great and while I was happy with the grafted result, it did leave a prominent scar on the right hand side (see pic below pre op).

 

Having been " stripped out" , the goal with this HT was to use FUE to

 

1) fill in the gaps in the frontal third (as a consequence of somewhat inadequate result from HT#2) 2) fill in the side alleys and importantly 3) fill in the scar, esp on the right side -- I must say here that I did try SMP into the scar with rather unsatisfactory results (done elsewhere, not at SMG) so this time wanted to use actual hair into the scar to get that coverage

 

We used about 1200 hair from the scalp and ~ 300 from beard, 1500 total. The instrument used by Dr Josephitis (who did all the extractions) was a hybrid punch (motorized). Dr Ron Shapiro made all the incisions. I will not go into procedural details since people are already well aware of the high quality SMG process. There is a video attached below that you can look at for the extractions

 

My donor area was completely shaved for the procedure and now at 10 days post op it has grown nicely to be able to conceal the procedure enough . The only problem I am facing is the shaved areas in the recipient scalp (alleys and frontal third) are taking their time growing back (the original hair , not the new grafts) and I am experimenting with some concealers now to figure out how to make it look reasonable. I am also taking some MSM and applying a liberal dose of Rogaine but so far it doesn't seem to be helping.

 

Let me know if anyone has any questions etc. Overall I am excited and looking forward to seeing the new transplants grow whenever they do , but I am well used to the long and painful wait , having been through it three times before !

 

The pics below are pre op (shaved down) and also during the procedure . I will post the 10+ day post op separately.

[fortune11]

attached below. I am having a hard time uploading the extraction video. If someone can point me in the right direction. It is a .MOV file , size 72MB.

[mosd]

How many grafts have you used in total? And do you have any grafts left?

 

Also did you do any scalp exercise before your fut?

[fortune11]

How many grafts have you used in total? And do you have any grafts left?

 

Also did you do any scalp exercise before your fut?

 

I have used a total of 6500 from the scalp so far (including this FUE session), and then 300 from beard.

 

i probably have one more FUE (~ 1000) left in me judging by how the donor area is healing . but will revisit that only if needed down the road (maybe 3+ years)

 

The results from the second transplant (2,000) were not as good hence some of those 6500 were wasted I feel. Nonetheless , the result now is something I can live with , leaving a bald spot on the back of the crown which is age appropriate I feel. Being NW6 I can never achieve full coverage including the crown.

 

to answer your other question. I did do scalp exercises before those FUTs but I am not personally convinced that they help much.

[fortune11]

I tried to take these against backdrop of natural lighting (how others would see you if you were walking around outdoors) but it was kind of overcast so maybe not the best conditions.

 

The donor is bouncing back as expected but the hair on top is painfully slow growth , probably a result of shock loss . On advice of spex, I have begin taking some Biotin starting today. Lets see what happens

 

Other regimen cocktail includes vitamin B12, vitamin D, propecia 1mg daily, 2.5mg daily oral minox, nightly 5% rogaine topical application.

[don174]

I've had 2 FUT procedures- with my 2nd one, we used a new scar to get more grafts. Iam considering a clinic that only does FUE for a potential future transplant . Is it possible to get FUE grafts if have 2 strips or will that be a problem ?

[fortune11]

Shouldn't be a problem at all generally speaking but you may have to check w your doctor as to how much is feasible. When i went in I had the mindset of getting at least 1600-1800 , but we were only able to safely extract 1200 or so.

 

The two scars maybe visible for a while while the shaved donor area grows back.

[Khop]

Hi fortune11,

Just wondering with the previous fut scar whether you considered transplanting any fue grafts into it to try and disguise it if you ever wanted to try and buzz the sides down a bit lower?

I have a similar fut scar and am wanting to try and disguise it through fue. Just wondering what dr Shapiro suggested if anything in regards to the scar?

Thanks

[SADbutTRUE]

Congrats on recent surgery, why did you change docs after 1st surgery, just curious since you went to dr.ron for 1st. heal well and heres to great growth.SMG is one of my favorite clinics.

[fortune11]

Hi fortune11,

Just wondering with the previous fut scar whether you considered transplanting any fue grafts into it to try and disguise it if you ever wanted to try and buzz the sides down a bit lower?

I have a similar fut scar and am wanting to try and disguise it through fue. Just wondering what dr Shapiro suggested if anything in regards to the scar?

Thanks

 

We did transplant into the scar as well , thats where many of the beard singles went actually. Right now you still see that scar line because there seems to be some shock loss right below where the grafts were put in the scar.

 

I expect them to cover the scar (thats the intent) but Dr Ron said that we might need to still do some SMP down the road if needed . My goal is to be able to buzz down to a 3 or 4 . Right now anything less than a 6 shows the scar on the right.

 

Like with all previous transplants, I am reserving judgement on this one until at least one year out when I see the results develop .

 

Hope this helps.

[fortune11]

Congrats on recent surgery, why did you change docs after 1st surgery, just curious since you went to dr.ron for 1st. heal well and heres to great growth.SMG is one of my favorite clinics.

 

Thanks . I changed docs as Dr Ziering was somewhat local and I had some issues w travel around that time.

 

But to be frank with you , the best results came from #1 and #3 . that explains why I went back to Dr Ron for #4 as well. As you know he does not do all the FUE extractions himself - it is actually Dr Josephitis - but he makes the incisions and designs the plan and is intimately involved with the whole process.

 

The only issue is the scar from #3 was a little too big on the right side for my taste and in hindsight , maybe we could have been a little less aggressive in taking the strip on the right side where the scalp laxity was poor . But we are fixing that now with this FUE .

 

Ultimately , my biggest issue is getting good coverage given the poor donor availability and being a NW6 . HT #1 and #3 went a long way in giving good coverage with relatively few hair . I credit Dr Ron's planning , design and placement techniques for that. I am hoping this FUE gives me the same results as those prior FUTs .

[fortune11]

Also I must mention the scar area is really tender compared to rest of the scalp. And since grafts were placed into the scar , there is quite a bit of lingering pain there which will probably fade away with time but there is that constant sensation of tightness along that region in the meantime

[fortune11]

Update -- I am now little more than 3 weeks post op . Some new experiences this time around (compared to prior HTs) --

 

1) Beard hair extractions resulted in some ingrown hair / folliculitis for which i am taking anti biotic as prescribed by the dr. also started applying an anti infection cream.

 

2) For some reason, the hair neighboring the transplanted area has started thinning as well and looks off balance when compared with the hair on the back / donor that has grown back in a more normal fashion. Per Dr culprit could be shock loss , or it could be a combination of oral and topical minoxidil is causing faster shedding (and hopefully faster regrowth later) . Hair below the scar (where grafts were put in) is also experiencing some shock loss.

 

I have been discussing these regularly w Dr Shapiro who has been immensely helpful every step of the way.

 

Hoping that these issues resolve themselves within a month or two. Concealment is becoming a real challenge now considering the client facing nature of where I work.

[mosd]

do you have any grafts left? How many?

[fortune11]

The doctor did say I have some hair left for one more transplant . If I had to guess based on current density , I would cuff it at ~ 1000.

 

I may save them for a future emergency fix transplant if needed way down the road, but nothing in the near or medium term.

[jimbrann]

Any update on this procedure and are you still on oral minoxidil?

[fortune11]

Any update on this procedure and are you still on oral minoxidil?

 

I have actually stopped oral minoxidil a few months ago and switched completely to topical -- both for minoxidil (back to old regimen) and also for finasteride (topical solution from Italian pharmacy). Oral minx did not suit me and I didn't want to continue after getting some early side effects like increased restlessness etc .

 

I am due for my 6 mo consultation with Dr Ron shortly. I will post something here after that along with pictures.

[jimbrann]

I've never heard of increased restlessness on oral min. Could you expand? And how long were you on it for, any regrowth at all?

 

I have actually stopped oral minoxidil a few months ago and switched completely to topical -- both for minoxidil (back to old regimen) and also for finasteride (topical solution from Italian pharmacy). Oral minx did not suit me and I didn't want to continue after getting some early side effects like increased restlessness etc .

 

I am due for my 6 mo consultation with Dr Ron shortly. I will post something here after that along with pictures.

[fortune11]

I was on it for. about 4 weeks total if I recall correctly. By restlessness I mean just that , had trouble sleeping, and generally felt more stressed . Nothing related to work and the symptoms persisted even when I was on a mini vacation. I didn't see a reason to continue oral when I already had no side effects from topical rogaine.

[Speran28]

Any update on your case? would love to see the results!

[fortune11]

This one (FUE , #4) unfortunately is not turning out as I had expected based on my prior results from FUT #1, or FUT #3.

 

At the 9 month mark I had expected to see better growth in the area behind the hairline and the side channels , which were the focus of the hair transplant, but as I told Dr Ron Shapiro, I am willing to patiently watch the result until 1 + year to see the extent of full growth.

 

Maybe it is the fact that it was FUE this time and not FUT, maybe it is the fact I have switched from oral to topical finasteride, maybe at this stage and after 4 hair transplants, luck simply runs out. Whatever it is, right now I am not getting the improvement I expected from this process. Anyways as I said, lets give it some more time before passing judgement. And I will post pictures as well.

 

The acne side effect is something that I had never experienced since I was in my early 20s and thats where I think the beard hair extraction is the culprit. I have been on antibiotics for more than six months now and it is clearly not a good long term solution. One dermatologist I consulted has even recommended going on accutane (that I once took as a teenager) to fix this problem.

 

Again, I have had good success with prior HTs (#1 and #3 esp) so can't really complain but this is a good reminder to me that there is a limit to what one can achieve using hair transplants. I am what people would consider a veteran (13 years and 4 HTs). I still hope it all works out . I will keep you guys posted. Dr Ron has been helpful and supportive as always.

[Speran28]

Thanks! Would be great to see pictures of where you are at currently around 8 months or so.

[acting]

Hi fortune11

 

I had work done with Dr. Ron Shapiro. Like you, I had multi HT's (7) dating back to the late 80's. I too contacted Dr. Ron around the 9 month mark concerned about my result. He re-assured me, particularly because I had multiple previous surgeries, that 9 months was far too early to asses final result. Things really started to look up around 17 months and continued to improve right up to 24 months. Be patient...

things will improve!

[fortune11]

Ok. Here are a few photos taken today. This is at the 9 month mark after my FUE with Dr Ron.

[fortune11]

I had a quick chat with Dr Ron Shapiro yesterday and explained the issues that I have been having .

 

Quick reminder -- I am a NW6+ to 7 diffuse thinner who has been chasing hairloss for the past 13+ years via successive FUT transplants, best of which has been the hairline work by Dr Shapiro back in 2004.

 

1. Acne all over the FUE donor region - a) beard and b) back of the scalp. My dermatologist has now put me on accutane - which is the most severe, last resort (google "accutane" and you will know) as the antibiotics had gone on for too long (5 + months running) and wasn't good for long term health of stomach etc.

 

2. Lack of growth at this stage - in fact I am hard pressed to see any growth at all and my hair at this stage looks somewhat worse than the day I went in for surgery (in December) with thinning even in the previously decent-looking transplanted regions. My goal with this transplant was to 1. fill in behind the hairline to be able to style my hair better 2. fill in the side channels above the horseshoe to add thickness. Both these goals seem to be out of reach (at least for now) and in fact there is some more separation as you can see in the picture on the left side , where the horseshoe permanent hair is starting to show separation from the top transplanted hair.

 

On 1. Dr Ron recommended a topical remedy, I will likely apply it once I give the accurate a few days

 

On 2. , I agree with acting, I have reason to be patient since these things can take year + to develop. I did panic a bit as to why prior good FUT hair was also thinning and here Dr Ron suggested a possible cause may be switching from oral to topical finasteride. I have gone back on Propecia now and will see if that makes any difference

 

Obviously, I am not satisfied with the acne breakout or how my hair looks at this stage but I will have more to report for you guys at the 1 year mark. Right now, I am inclined to think my luck has finally run out with the transplants but I am keeping some optimism and waiting for the 1.25 to 1.5y mark before I decide what to do next.