3550 FUE Nader Mexico and general lessons learned in HT

[txtransplant]

57 days out of a so far good experience with Dr L. Nader. This post will have results, experiences, opinions on my procedure and the process in general. 

1) Decision. Early 40's male with slow progressing hair loss since early 20's and at time of procedure guessing a NW5 . Still had enough hair growing across the bridge of my head for some passable comb over action. Hair loss comes in waves somewhat. And this last wave over the past 3 years it went from presentable. to really thin and debatable if the comb over was helping frame my face, or looking kind of like I was holding on and trying too hard. Basically that point we can all see in other guys when we can safely say they look better just buzzing it and owning their confidence again.  Funny thing is we don't see it easy in ourselves. To that end we have all seen men here completely failing in this department. I watched several guys here who looked really handsome with a little receding hairline rush and get a new one only to look less manly and detract from their looks. Granted, most guys benefit hugely from the front center being there, but sometimes high temples look better with certain guys and they screw it up. Bit the biggest fails I see here are the older guys who overdye and get too aggressive trying to see themselves at 20 in the mirror and it looks BAD. Or the flip side is they get some little tuft of hair three inches too high. It looks good to them, but they would look so much better just shaving it off and waste huge money on a look that hurts their looks. ASK PEOPLES ADVICE.  I was lucky that I have a few really attractive female friends in their late 30's and early 40's and got some feedback. All said the same things! First is they really don't look at guys hair much unless it is bad. Kind of like how women notice each others nails and makeup but guys don't really focus on that. But let's also be honest, some people look good bald, but most look better with hair. A HT isn't going to make you go from a 5 to a 10. But like clothes, really bad hair can ruin you. If it is stringy and receding bad. man up and cut it off. Or if you are a good candidate and can really make a nice look, go with the HT if you can afford it. But only if it really can improve your look. Go bald or have it restored to at least a convincing mature hairline. After looking at 10,000 results I can say anything less will only make you look worse!  To that end, I gave up the struggle with creative combing, hair spray and shading makeup (works great for once in a while when you want to look your absolute best). I cut my hair to about one inch. I hated it at first. Never had it like that before. Crazy thing is after a few weeks of getting used it it I knew I looked a 1000x better. All my female friends I asked were crystal clear they thought it was great short and was an improvement. I know I looked more bald, but confidence is sexy and I looked more confident . even if I didn't feel it. I always thought I would never have the kind of face or head that looked right buzzed. But turns out it's probably in my head and a lot of guys too. I only cut it short to prepare for the HT and see how I liked it since it was going to get cut off anyhow. I grew to like it. Not sure I will choose to grow it back to the 3-4 inches it was ever again. 

 

2)Decision made, now what?  So I am not a rich guy. But I always said when my hair got to the point where I really felt it was an issue, I would look at getting FUE. NEVER FUT. Month's of research and for the life of me, unless you are a NW6 who want's to absolutely push graft numbers to the limits, why would you ever let someone meat clever your head and get a huge scar. DON'T DO IT unless you are in that tight spot going for broke. Even then I think it is foolish. Two big decisions to make. One was what surgeon and  two, how much needed to be done with a FUT procedure. I could not afford to use one of the top 10 big name clinics in the world. They have a huge proven track record of a high rate of good results and are the obvious choice if you have $20-40,000usd to spend. And with so many results you can see each doctor has a look that they strive for. Some are dense hairlines, some  maximizing donor grafts for the best overall look. All are good, but pick one who's style you like and you have made as safe of a bet as you can. No Dr. hits a home run every time. Even the best. But odds are ever in your favor!  HT is not rocket science. I see tons of guys disappointed for different reasons. Sometimes it is a medical failure, but usually an issue of unrealistic expectations, surgeon skill and lack of homework. After having looked at 1000's of results I gained some wisdom. The math does not lie. To get the density I wanted over the area that I wanted with the hair type I have I knew I needed 3,500 Grafts. The numbers are simple really, but ignored by most. The average patient with average thickness hair and average of 2 hairs per FU needs 40-50 follicles transplanted per cm2. installed in mostly bald areas. That is the minimum to have hair that does not look blatantly thin to the average person in front of you. It would probably not look right on a 22 year old, looks okay on a 40y old and up. Now, if you have jet black hair on a white guy, going to need more! It is not hard to measure. I did the math and knew what I needed. Now to find the right Dr. 

3) With my budget in mind, I set out to explore the lesser known options outside of the superstars. This is where it gets murky. Even the 2nd tier surgeons in the US are pretty expensive. Some are for sure second tier because they don't do as good or as reliable work. Others are maybe up and coming and making a name for themselves. You can make your own decisions there. Then there are the 3rd tier places. Basically every city is full of plastic surgeons who will do a HT for you. But unless this is what they do, and all they do, STAY AWAY. It is a very skilled thing and needs a well oiled machine of a team. But for guys who are on a limited budget there is another option. Getting your HT done in a lower cost nation. Turkey is the superbowl of that. If you are smart and do your homework, you can get a world class HT done there at a fraction of the cost. But you really need to do your homework and sometimes roll the dice. I mean if you have a 95% chance of getting a best case result at a US superstar, maybe you have a 90% there at a good place in Turkey for 1/4 of the price. On a budget, that is still pretty good odds. I was going to get a HT in Turkey. The risk to reward on a budget was the next best choice to a top doc here in the USA. I was about to book a plane ticket when I caught wind of Dr. Nader in Mexico. 

4) Why I went to Mexico.  Simple really. I found a doctor I felt confident in who crossed all the t's and dotted all the I's I needed for a practice. His results were good (at least at the time I booked) and of course it was much closer than Turkey. I rented a car and drove there in a day. And of course, cost. I could afford 3,500 grafts there. And more importantly felt confident in his practice. To me it was the next best choice after the top USA doctors. So I booked a 2 day FUE with him. 

5) Why Dr Nader.  I knew I was going to have to get more creative than booking a bankrupting HT with Hasson and Wong. Having researched tons of doctors, medical journals and message boards, I came to settle on this guy for a few reasons beyond cost and location. He does the extractions and incisions himself. In other words, no technicians who you know nothing about doing the work. Sure, people can be trained and you go with the reputation of the practice. But even better if you know for sure someone who has done this 1000's of times is behind the punch putting 1000's of holes in your head. He has the right staff. Dr. Nader had 5 nurses/techs working with him on my procedure. He used a .8mm punch He limits how many grafts he does a day and only sees one patient a day. Very important and a real sign of quality. His website is lacking and marketing is non existent. But with some real effort you can see he had the important things you look for on paper with a good HT surgeon. At the end of the day I really had to look at results. His results are poorly documented. Considering he does this every day and has for over a decade, you would hope for more to go on. But I really had only about 10 results to see. And to be honest some looked mediocre. On the bright side I never saw any negative reviews or bad results. Then came the real hard looks. I noticed every mediocre result was because of low graft counts. Simply put Dr. N was getting really good results with the actual hairs he transplanted, but often patients were not having enough grafts done to start with. At the time of my booking I only could find one person he worked on that had what I would consider a sub-par result. I figured most of the unremarkable results were due to budget. I mean if the patient only has a limited budget, you do what you can and I think he gets a lot of guys who are on a budget. Armed with that information I felt strongly that Dr. N was a good choice and would be able to get the same graft survival rates as any top doctor should.  I will add that right at the time of my procedure several new cases came to light here where his results were week even when the patient had enough grafts implanted. So I kind of got nervous. Though even those results were not failures. But they were not home runs either. One guy may just need more time, the other looks like maybe 60% of it grew. Time will tell I guess. Had I see these before my procedure, I may have gone to Turkey and seen one of the clinics there. It would have been a harder choice. I am glad I saw them after..lol

6)Procedure. His office is 2 miles from the USA. Really no big deal and he sends a car. Nice office. Everything they say about the man here is spot on. He is kind, professional, knowledgeable and you can not help but feel in good hands and like the guy. Very down to Earth. We talked about my goals and what we would be working towards. He also talked very candidly about his own struggles with hair loss and why he chose this profession. Even some American doctors who he knows personally as he is active in the community of HT surgeons.  I also learned quickly why many of his results look thin. It really comes down to each surgeon is a bit of an artist too. His aesthetic is very conservative. To say he is NOT money driven is an understatement. He tried to convince me I only needed 2500 grafts even though it would still take up the two days I was booked for. So he would have lost thousands of dollars because he was advocating for me and what he felt. He could have safely transplanted the 3500. He just said it  was not needed to have a nice result, and save my money. So two awesome things there, One, you start to realize this Dr.  in his mind thinks thin hair looks age appropriate. There is no right or wrong there. Two, he proved to me that he is not money driven, but results and compassion driven. Regardless of my final result, I completely respect and feel confident in his ethics. Ultimately I was steadfast in wanting to get the density I was aiming for and knew I needed to hit for the look I wanted (low 40's per cm2). He agreed to implant to a as high a density as possible where we were still 100% safe and not pushing it. We ended up with about 500 extra grafts since I was insistent on harvesting 3500 and he truly didn't know how dense he could pack safely till implantation started later. So we put the last 500 in the crown. He also ended up with about 100 more grafts than I paid for, but told me not to worry about that. Very classy operation.  Procedure was over two consecutive  days. Not painful and pretty standard for a HT. Each session of about 1800 grafts took about 6 hours from first punch, till last implant. That's well within the safe zone time wise. He also uses a upgraded storage solution, but only mentioned it when I asked. These are things he could easy market on his website or cheap out on techs. Nope, he just likes what he does and cares for his patients. The first night I took some Advil. Night of 2nd day or surgery I didn't even have to take anything. It was as pleasurable and painless as you can hope for. It is really not fun though and let's not sugar coat it. But not so horrible you can't watch TV or grit your teeth and get through it.  At the end of the two days we had implanted 3588 grafts. Nearly all were 2 hair grafts. My hairs according to him were on the thicker side of average. I have average donor density in back, so I probably have 2-3000 or so in reserve for the future.  Most of it went into the frontal 1/3 and quick math shows we implanted at a density of about 43 grafts per cm2.  We went with a fairly conservative hairline that we agreed looked good. Though he felt I could have left it about 1/3 inch higher on my forehead. I wanted it a bit more forward and that's what he did and I don't regret that. 

Edited November 15, 2018 by txtransplant

[txtransplant]

Here we are before surgery. The drawn on hairline here is my own design while doing math. But is very close to what we went with. Don't laugh when I say this....but I cut my hair and saved some of it to use to design a hairline. It was great being able to adjust it looking 100% real. I was actually surprised that I found a widows peak looked as good on me as a more straight hairline. SO GLAD I did this. Took the guesswork out of designing a hairline or leaving it to decide on a surgery day. In retrospect I would have rather those 500 extra grafts gone to bring those temples a bit forward than gone in the crown. But you do the best you can at the time.

 

First and last pic is the comb over. One pic is me buzzing it all off 2 weeks before surgery to get used to it,  Also in case I liked it so much I might choose another option.  The middle two are when it got good feedback from everyone. Of course it is a mess and pulled up and back to see the hairline. But was a big improvement over the comb over. Didn't take a pic of the front when I want pretty much clipper bald. But didn't like it. Glad I went with a HT even if it is just to put enough there to frame my face. 

Edited November 15, 2018 by txtransplant

[txtransplant]

Oh, I have a small head. So 3500 grafts went a good distance. I know this will not be a dense head of hair. I see really dense doctors doing 3000 grafts just in the front. I am okay having it on the thin side, but not see through. We shall see. I will know in maybe 10 months if we need to add a bit or we are good.  Pic of donor area is about day 7. Last two pics were I think day 7 and day 11. 

Edited November 15, 2018 by txtransplant

[txtransplant]

So this brings us up to right about two months. I got lucky! A lot of the hairs that were implanted just kept growing! This is a great sign in two ways. One, nice to get some results. Two, you would assume the hairs were handled well and my body didn't go to war with the implants. I can tell exactly what grew and what shed because I still have a few hairs shed if I run my hands through it a few times when holding a piece of paper under it. Usually 2-3 very short hairs will come out. They are all the same 3mm long. All those shed hairs clearly went to the resting phase after surgery like is normal, and are just sitting in holes in my head now. VERY few are left like that as most fell out in week 4.  The ones that are clearly growing are now about 3/4 inch long and growing like weeds. A few you can see where the hair follicle thought about taking a vacation (hair gets thin) then thicker again close to the scalp. It's like some had a rough time and got skinny for two weeks of their growing, then back to fat. It actually looks better in person, especially when you are not inspecting hair, but looking at a person as a whole. I have no idea what % stayed and what shed. My guess is a little over 50% the hairs in the front 1/3 stayed and grew.  The hairs that went into the crown mostly shed.  Would I be happy is this was the final result? Heck no! By my eye, I need pretty much all of the shed hairs to sprout eventually to have a result I like.  Reality is if Dr. Nader hit the benchmark of what most quality surgeons realistically do (90%), I think It will get where I can just move on and be okay with my hair. For sure won't be a hair model, but that was never the goal. Worst case from where I am now, even if nothing new grows, I can go anywhere and get 1000 grafts put in and for sure be good. That's a much different place than 2 months ago with a completely bald front, large bill and big unknown surgery in front of me. Also many unanswered questions with a natural fear of disaster.  I am happy so far! But feedback both positive or negative is very welcome and appreciated. Ultimately this is for the guys in my shoes a few months ago trying to figure it all out. I was torn for a bit between Dr. K in Turkey (my second choice and was about to book when I found Nader)

Edited November 15, 2018 by txtransplant

[txtransplant]

Basics and recovery.  Was uneventful and not worth going into detail the day of stuff. I drove 5 hours the night  the surgeries were done with no problem. Very little pain, no meds needed. I did take an anti inflammatory as prescribed. Swelling on forehead was kind of not cool and got worse till about day 5 post procedure. No pain, just looked goofy. And my skin on my forehead was really oily too through that and for maybe 2 weeks after. The surface of my implanted area was completely numb for a while. Still is pretty numb right on the surface, but slowly improving and not a really big deal at this point. Got really bad hiccups after the surgery for 2-3 days. Turns out that is a sometimes side effect. Plus lots of dead skin on the surface. Also, even now, the skin that was implanted it very slightly "off" compared to virgin scalp. I am sure a lot of it is just like when you skin your knee as a kid. It heels up pretty quick, but the area the skin is a little different for many months after. Not that extreme, but if I shaved my head now, the recipient areas might be a little different looking at close inspection. I think there are also tiny scars (very tiny) where the implants went in. Small like the pores in your skin, but a little bigger. I suspect that is just what happens when you make tiny holes and shove tiny chunks of skin in them. Not really a big deal,  though something you never see mentioned. My guess is over the next year that will become even more invisible. But if I ever wanted to have a shiny shaved bald head, it might or might not be an issue.  Biggest issue was my donor area just got really angry! Not pain so much as just raw and unpleasant. Where even a breeze the first 2 weeks was pretty unpleasant. To this day it is still a little irritated and bit sensitive. At week 5 I started getting big pimples on the donor area. I am guessing those were transected hairs growing out. Mostly over now and was maybe 25 of them. Makes sense that's what they were as you always get a few of them in the punch process. I can see Zero scaring from the .8mm punch. So that was a relief and because I went FUE, if all healed well I can buzz my hair down to a few mm and all look good. I never want shiny bald or razor it, so this is all okay with me. I am pretty sure though that the donor area will be so well healed that I could clean shave that area.  

Edited November 15, 2018 by txtransplant

[pidds]

Great review thus far!  I had very similar experiences with Nader. He is very caring and skilled doctor!  Nader’s work looks great. 

[JohnCasper]

Wow, what a great narrative on your experience!  A .8mm punch was used during my surgeries as well.  I’m posting this picture (as I have done many times) so you can see what your donor area will look like about 2 years after your surgery.  This photo was taken an hour before my second FUE surgery to touch up some areas.  This area yielded about 1,750 grafts two years earlier.  There really is no discernible scarring to the untrained eye.  

 

[hairlossPA]

keep growing! good luck 

[Kiwi Guy]

good luck with the growing, looks like good work.

[JohnCasper]

Keep us posted with new pictures in a few weeks “Txtransplant”.  You have plenty to look forward to. Keep growing!

[txtransplant]

I will try and get some pics in the next few days. At 4 months. The numbness is completely gone in the recipient area now. I would say = completely normal sensation has been restored since a few weeks ago. Also the donor area was a bit irritated and even a few pimples still through early parts of month 3.  As for growth. In retrospect I think about 65% of my implanted hair never fell out in  the frontal area. In 2 days it will have been a full 4 months. Several things are happening.  The hairs that stayed are all healthy now and normal diameter. I am sure there was a tiny bit of shock loss to the little hair I had. Right on schedule wispy very fine hairs are coming in and they get ticker closer to the scalp. So this is new growth from either shocked native hair or grafts. There is not a ton of it and my gut tells me this these new sprouts are pretty much the beginning of the end of the "what to expect" part. I am sure they will make a nice impact when these baby hairs mature the next few months. But reality is that even if they do, the frontal 1/3 will be a bit thinner than what would look good. It has a bit of an unnatural look with thick hairs spaced too far apart and even throughout the recipient area.  Also not good are that some of the hairs appear to be growing out of large pores. I think these are grafts that healed a tiny bit below the skin level and it is not noticeable with even my thin hair. Pretty sure it would look a bit off if I shaved my head. Hopefully it will heal better over time. Some of this bumps or pits stuff was noticeable by the temporal peaks  where the implants were placed. But in the last month they look 90% better to the point you would just would never notice the temples even if razor shaved it. But for sure some tiny imperfections. Overall I am happy and it is a huge difference. But time will tell if it I truly will get away with only this one transplant. 

[txtransplant]

Took some really poor quality shots. But it really illustrates where I am in the regrowth.  Striking, isn't it!  The first pic is with bright overhead light!  Even from the front it looks really thin under this. Even more so than sunlight for some reason. I suppose it really looks this bad from the top down under natural light. Though not many people are looking at the tip of my head under bright light.  The second pic is truly how my hair looks under most indoor conditions. That is a huge improvement and the hair on my head is about an 1" long. Last pic is one with a flash from the top. I would say this is is the best to worse on conditions of where my hair is now.  It a complete Jekyl and Hyde thing.  I usually wear my hair 2 inches long. So I am pretty sure it will look a heck of a lot better with twice the volume of hair covering my scalp.  No matter what, for my expectations I think I will have a presentable head in another 4 months between some new hair coming in and my hair just growing after being buzzed for surgery.  

 

  I still think the small area of the crown that was implanted has not come in much yet.  We went for low 40's in grafts per cm2.  All my research said that should look reasonably full. So either everything I read was wrong, my expectations of "reasonably " are too high, or we are just not seeing low 40's on here yet.  My guess is a bit of all three. Safe to say though that even if I just get a little more growth here it will be good enough to meet my needs in all ways except maybe 700-`1000 additional grafts to thicken the peak area. I could see myself getting that done possibly. Time will tell. 

Edited January 15, 2019 by txtransplant

[txtransplant]

 

Edited January 21, 2019 by txtransplant

[txtransplant]

So I took some better 4 month pics.  I have my hair sticking straight up. I never wear it that way. But it lets a ton of light in and these pics are in the worst possible light. In other words, so you can see the actual clinical situation.  We are nowhere near where I wan't to be and I have realistic expectations. But I think they look pretty good for 4 months considering how bad the front 1/3 had been. The middle pic in the red shirt and the last one in the above post are more accurate representations of how I look in normal bright indoor light during the day and night. I can now see in pics that it looks like maybe 1/2??? of the implanted grafts are growing and never fell out. Guess will just have to wait and see what happens.  On the flip side, photos here are tricky. This is me today standing by the window on a sunny day with the miniblinds closed. You can see it looks okay when combed forward and down how you might meet and view me in daily life. I would not call it a comb over as my hair is barely over an inch long. 

[CosmoKramer]

Great write-up and nice progress so far man.

Lighting definitely changes the appearance of the new hair growth, know from experience, some days and in some lighting it looks great an dense other it looks ok.

Good luck and happy growing!

[aWidowsPeek]

You'll be looking really good in another 4 months or so TXtransplant. 

[JohnCasper]

Yes, lighting can make a big difference in photos regarding perceived density.  Thanks again for your comprehensive narrative.  Keep growing....I think you will continue to be pleased. I had plenty of growth in months 5-6.  

[bman3082]

1 hour ago, JohnCasper said:

Yes, lighting can make a big difference in photos regarding perceived density.  Thanks again for your comprehensive narrative.  Keep growing....I think you will continue to be pleased. I had plenty of growth in months 5-6.  

When did sprouts stop coming through for u?

[txtransplant]

On 1/23/2019 at 11:38 AM, bman3082 said:

When did sprouts stop coming through for u?

I did not have a huge shed. I truly don't know what percent shed. But enough stayed that I could not really tell when sprouts started happening. I am a few days short of 5 months and mixed in with grafts that never shed I can see a number of short thin hairs that are clearly grafts that shed growing a new hairs. They are bout 1cm long.  So I guess my best answer is at around month 4 is when grafts that shed and went into the resting phase started to produce new hairs. It is not a ton of them, and some are longer or shorter meaning each shed graft has it's own ideas on when it is show time.  

[JohnCasper]

Good luck during your “anagen phase” of the hair growth.  You should experience about a 1cm or nearly a half inch of growth per month.  Thanks for the update.

[Icklezz]

@txtransplant Great write up, through and informative! thanks for sharing.

Any update?

 

[txtransplant]

Thanks for the prod to post an update.  A few days shy of 6 months. Going to be an update, but also a addendum to the ongoing debate on density and illusion of density going on in other topics here. Good read if you guys have not already. 

So far I am thrilled with the change in my appearance. But not so much with the density v what I had implanted. Clearly there has been some thickening up and let's hope it continues. But implanted density was in the low to mid 40's and I don't think we are there yet. Closer to 30 at best from what I can make out.  I am truly at the point in the right situations it can look great or a mess. Pics taken today, no gel or product or any kind. 

First two shots, fairly typical indoor daytime lighting from a normal viewing distance. Sunny day, windows partly closed and overhead light. Typical office lighting I would say.  Next shot in a shaded corner. Much more typical of night indoors if no direct overhead light. 

 

 

[txtransplant]

Next four demonstrate how it really is. Direct bright light is a bad look. Shows the worst flaws. Good to send to your doctor for evaluation, not so good for your ego.  Second is with less intense light. Better, but my days of spiked hair are over and dead. 3rd is the classic pulled back centerfold shot. last one here is in the same light, but hair down and obviously letting less light in. You can see that even with low density, it can look like I some passable version of hair. 

[txtransplant]

Last three shots. First is in a very well lit hallway full of sun. And of course to have this perspective in real life, you would have to be over a head taller than me. Next is outdoors on a sunny day, but not bright sun directly over head.  Last is the same spot outside on a sunny day from an angle most people would view me. Actually that is not even true. You would have to be very tall to have this view. But you get the idea. The illusion is better when you look sideways as me rather than down through my hair from above. 

So far, my review of the transplant is everything is healing well. Some tiny "pores" in the transplanted scalp that seems to be common, but not talked about. I am not even sure it would be noticeable if buzzed my hair off. Probably would be slightly if I shaved it. All feeling has returned and happy with that. We are at just under 6m and rationally they almost always get better, even if just a bit from this point. I don't see any new growth, so not terribly optimistic much will change, but time will tell.  It seems like almost 1/3 of the grafts just have not sprouted yet. Will have to wait and year and see, since it is to early to know for sure. 

 

Surgery aside though. The reality is under MOST lighting conditions and viewed from the normal angles people interact with you there is a big difference. Therefore this has had a nice impact on my life and is a good example of what the realities are for a man with average to thick caliber hair implanted at around 30 cm2 can be.  While I am not thrilled with the growth rate so far.  For guys who have a lot of area to cover...this is what you can expect with around 30 grafts per cm2.  Far from great hair, but good enough to frame your face and make a nice presentable look where your hair loss isn't the defining feature of your look. In other words, if someone was given instructions to look for you in a crowd, bald, or balding isn't one of the adjectives they would use. 

 

[VicTNYC]

Any update on your progress?