3051 Grafts FUE - 17 Dec 2018 - ASMED Dr. Koray Erdogan

[LordBaldwin]

2 hours ago, mixedpanther said:

Looked through most of this but didn't catch/never saw the final cost? I know that's not the most important factor, but it's always good to know. 

2.5 Euros per graft.  The price includeded at least two nights of hotel (or a room in the clinic), breakfast if you're staying in the hotel and all meals if you're staying in the clinic, and transportation to/from the airport and to/from the clinic.  The package didn't include airfare.

[LordBaldwin]

2 hours ago, CosmoKramer said:

Just saw and compared your 9.5 month photos to your 9th month and I do see slight improvement...and even looking at your pre op clinic photos to 9.5 and it looks soo much better than where your started! 👍🏻

 

Thanks.  Yeah, it's definitely night and day from where I started, and that, in my view, is the most important thing to keep in mind.  I'll have a much more detailed rebuttal (science and math-based, obviously) to some of the negative people on here coming soon, but didn't feel up to finishing it today.  Suffice it to say that it should answer some of the questions about yield.

[Kraistoff]

Hello mate 

looks good, the area behind the hairline wouldn’t have been implanted as dense as the hairline for obvious reasons so look like you’re on track. I saw a big improvement at 9/10 months. 

[CosmoKramer]

1 hour ago, LordBaldwin said:

Thanks.  Yeah, it's definitely night and day from where I started, and that, in my view, is the most important thing to keep in mind.  I'll have a much more detailed rebuttal (science and math-based, obviously) to some of the negative people on here coming soon, but didn't feel up to finishing it today.  Suffice it to say that it should answer some of the questions about yield.

You’re welcome.

I don’t think you need to do a rebuttal to any negative comments....as long as you are content/happy/satisfied then that’s all that matters.

And I don’t think the progress is over for you...I saw better thickening at months 12-15.

[LordBaldwin]

4 minutes ago, CosmoKramer said:

You’re welcome.

I don’t think you need to do a rebuttal to any negative comments....as long as you are content/happy/satisfied then that’s all that matters.

And I don’t think the progress is over for you...I saw better thickening at months 12-15.

You're right that I don't need to.  I guess part of it is my desire to determine, with a little more certainty, what the yield situation is, and where the lag might be occurring (it appears to be more of an issue of maturation so far than graft survival, I think).

[LordBaldwin]

13 minutes ago, Kraistoff said:

Hello mate 

looks good, the area behind the hairline wouldn’t have been implanted as dense as the hairline for obvious reasons so look like you’re on track. I saw a big improvement at 9/10 months. 

Thank you.  Yeah, I've definitely noticed improvement since month 9.

[CosmoKramer]

33 minutes ago, LordBaldwin said:

You're right that I don't need to.  I guess part of it is my desire to determine, with a little more certainty, what the yield situation is, and where the lag might be occurring (it appears to be more of an issue of maturation so far than graft survival, I think).

I gotchya....if it’s statistical curiosity then go for it...I’m sure it would be very interesting to see.

[dokke]

Just curious - is there any scientific basis for the "% complete vs time", or is it your own assessment of an expected progression?

Edited October 13, 2019 by dokke

[LordBaldwin]

1 minute ago, dokke said:

Just curious - is there any scientific basis for the "% complete vs time", or is it your own assessment of an expected progression?

It's based on a post by Doctor Bloxham.  I'd have to dig it up, but it gives timing estimates for both pop rate and maturation rate.  I used this to calculate percent coverage change over time.  

[dokke]

4 minutes ago, LordBaldwin said:

It's based on a post by Doctor Bloxham.  I'd have to dig it up, but it gives timing estimates for both pop rate and maturation rate.  I used this to calculate percent coverage change over time.  

Aha, ok. It's almost as one should introduce some confidence intervals to it  Seems like there's lots of variance when reading the forum posts.

[LordBaldwin]

So, some of the feedback I've gotten lately got me thinking...  I wanted to see what my yield and growth really look like, in reality, and without bias, so I took (as you might expect) an analytical approach. 

I took 22 photos of the transplanted area of my scalp with a digital microscope and overlaid a box 1/9th of a square cm over each one (see Figures 1 through 22 below).  I then counted the hairs with roots inside the box (mature hairs tagged with yellow dots at the hair bases and immature hairs tagged with orange dots).  I tried to place the boxes where I could clearly see hair bases, so as not to count hairs from outside the sample areas.  I entered these values into a model that scaled them up by 9, estimated total follicular units per square centimeter, and compared against my expected targets for this point in time (see Charts 1 and 2 below).  I know this seems like a lot of work -- possibly too much -- but it felt like a better use of my time and energy than sitting around handwringing.  Plus, to be honest, I kind of enjoy it.

Anyways, Chart 1 below shows how far along I should be, in general, based on normal hair transplant growth timelines.  It also shows how many follicular units and hairs should be in each square centimeter based on that information.  Chart 2 compares where I actually am in each sample area to where I should be at this time, then projects forward into the future. 

It would appear that graft survival is probably not my issue.  There are some areas that are weaker than others, but on average, there are about 46 follicular units per square centimeter.  If there were no native hairs, but a 90% yield rate for transplanted hairs, I'd be expecting 45 follicular units per square centimeter.  If I assume that all the hair is transplanted, rather than native, this means that I have a 90% current yield rate and will have a 92% final expected yield rate at the end of 12 months.  I think 46 follicular units per square centimeter would normally be enough to provide a dense appearance.

On the other hand, while the number of popped hairs seems to be on track, maturation appears to be where things are lagging a bit for me.  At this point in time, if I were a normal grower, 78% of the popped transplanted hairs should have been mature.  However, across all the sample areas, only 65% were mature, on average.   

Dr. Koray's coverage formula, if I remember correctly, is [follicular units]*[number of hairs per follicular unit]*[hair caliber]; you need a coverage value of at least 5 for the hair to appear dense.  In order to estimate my coverage values, I assumed my immature hair was half the caliber of the mature hair.  Currently, about half of my sample areas meet the threshold of 5, but the average coverage value for the entire area is 5.1, which is passable (but barely).  However, when I factor in the extra months of growth I have ahead of me (both extra popping and maturation), at least four more of the sample areas should flip to exceed the coverage value threshold of 5, and my average coverage value increases to at least 5.75.  Note that I'm assuming at least 50% of the "immature" hairs I counted are actually miniaturized native hairs which will not thicken and grow; if I assume that all of these small, fine hairs are immature transplanted hairs, I could end up seeing an average ultimate coverage value of 6.31 with my current yield of 92%.

In short, I think I still have good reason to be optimistic, in spite of what some people on here may believe.  Not everyone is done developing at 9-10 months (in fact, most people aren't).  Since I appear to be a "slow maturer," or at least slower than normal, I'm going to wait until around 18 months to make a final judgment.  That gives me another 8.1 months of maturation from today.

 

Chart 1

 

Chart 2

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Figure 22

[LordBaldwin]

10 Months

I think I've seen substantial improvement in density over the last month.  Note that I have puffy, fine-caliber hair and I'm not taking finasteride.  Also, for perspective, I've included images (at the top) that show me before my procedure.

Before Procedure:

 

 

Current, indoor, with indirect natural light:

 

Indoors with indirect natural light and flash:

 

Outdoors with direct natural light:

 

 

Edited October 17, 2019 by LordBaldwin

[LonelyGraft]

I admire the work you put into your latest analysis, I assume you have a stats background?

 

anyway...it looks like you are counting individual hairs as “grafts/cm2” when in reality each graft has multiple hairs per graft. So I’d say you likely need to recalculate your numbers.

[LordBaldwin]

37 minutes ago, LonelyGraft said:

I admire the work you put into your latest analysis, I assume you have a stats background?

 

anyway...it looks like you are counting individual hairs as “grafts/cm2” when in reality each graft has multiple hairs per graft. So I’d say you likely need to recalculate your numbers.

Thank you.  I'm not in stats, per se, but I do work in STEM. 

Anyways, no, I'm not counting hairs as grafts.  I counted hairs per 1/9th square cm, then multiplied my 9 (since the box shown is 1/9th of a square cm), then I divided by my average hairs per graft (2.44 hairs/graft).  The result is the average number of grafts per square cm.

Edited October 17, 2019 by LordBaldwin

[CosmoKramer]

Hey @LordBaldwin How is your progress coming along now that you should be at your 11th month post op?

[LordBaldwin]

On 11/18/2019 at 7:51 AM, CosmoKramer said:

Hey @LordBaldwin How is your progress coming along now that you should be at your 11th month post op?

Hey, sorry, I've been a bit distracted by other things lately.  I'll try to post some pics this weekend. 

[LordBaldwin]

Month 11 (approximately)

Here are my month 11 images, give or take a few days.  The forelock area has thickened up reasonably nicely, but I still have mixed feelings about the density at the very front of the hairline.  As I've said, I'm going to let things go until 18 months and see where I am at that point.  I may need a small touch-up in front to get where I want to be. 

I've been thinking about it a bit; given the fact that progress is so slow, it's very easy to forget where you came from prior to surgery, so you never really feel the full impact of the improvement the way you would if you suddenly woke up one morning with month 11 or 12 results.  Things are far better for me now than they were a year ago, but I still feel the obnoxious call of hair greed.  I want to look the way I did before any thinning started, even though that may not be a reasonable expectation.

      

 

  

[hairlossPA]

not bad... not great... good luck with the rest. impressive analysis

[CosmoKramer]

I do see some more slight improvement, yeah, looks like the hairs are maturing and thickening up, I saw a bit more maturing and thickening even up to month 15 so 🤞🏻! 🙂

 

I agree,  could use a bit more density in your frontal 3rd...but looking at your pre op photos the fact that you had a forehead or five head (😉) area was so large I think it’s quite the improvement. 👍🏻

[LordBaldwin]

49 minutes ago, CosmoKramer said:

I do see some more slight improvement, yeah, looks like the hairs are maturing and thickening up, I saw a bit more maturing and thickening even up to month 15 so 🤞🏻! 🙂

 

I agree,  could use a bit more density in your frontal 3rd...but looking at your pre op photos the fact that you had a forehead or five head (😉) area was so large I think it’s quite the improvement. 👍🏻

Thanks.  I appreciate the positivity.  I have to try not to let perfect become the enemy of the good.

[Kraistoff]

Good day mate

You must be over the moon. Sometimes I think a little bit of not so dense makes it look more natural! 

 

[CosmoKramer]

8 hours ago, LordBaldwin said:

Thanks.  I appreciate the positivity.  I have to try not to let perfect become the enemy of the good.

You’re welcome!

Exactly! That’s one of my favorite famous quotes. 👍🏻

[hairlossPA]

@LordBaldwin sorry if I missed this, but I noticed you are counting yellow and orange dots that are extremely close together for that sort of magnification. Some of your dots are literally right on top of eachother. are you taking into account that these could be a 2 or 3 follicular grouping and not individual follicles?

Question for the forum - if you implant a follicular group of 2 or 3, is it possible for only lets say 1 or 2 hairs (respectively) grow out of that grouping when its implanted? Only 1 of a 2hair follicle survive? or only 2 of a 3hair follicle survive?

am I making sense? lol

[LordBaldwin]

2 hours ago, hairlossPA said:

@LordBaldwin sorry if I missed this, but I noticed you are counting yellow and orange dots that are extremely close together for that sort of magnification. Some of your dots are literally right on top of eachother. are you taking into account that these could be a 2 or 3 follicular grouping and not individual follicles?

Question for the forum - if you implant a follicular group of 2 or 3, is it possible for only lets say 1 or 2 hairs (respectively) grow out of that grouping when its implanted? Only 1 of a 2hair follicle survive? or only 2 of a 3hair follicle survive?

am I making sense? lol

I was counting individual hairs, scaling up by 9 (because the highlighted area was only 1/9th of a square cm), and then dividing by the average number of hairs per graft (so, to answer your question, yes).  I realize that some of these hairs are coming from the same follicles.

Also, yes, I think it's possible that a follicle, after experiencing shock, will not sprout as many hairs initially as were originally there.  However, I think odds are fairly good that they'd eventually come out if the follicle survived.

[LordBaldwin]

11 hours ago, Kraistoff said:

Good day mate

You must be over the moon. Sometimes I think a little bit of not so dense makes it look more natural! 

 

Thanks, bud.  I kind of feel like it actually looks better in person than in pics...I'm not sure if it's because the camera increases contrast, or what.

I was having a rough few weeks (for other reasons), which perhaps had negativity influenced my feelings about this.  Yeah, when I look back at my pics from a year ago and remember how bad it was, I definitely feel relieved.  There's no question that it's significantly better than it was then.