ASMED / Dr Erdogan - High number of FUE Grafts per HT

[Uncle drew]

2 hours ago, Dr. Bruno Ferreira said:

Hi Panamera13,

 

I see from the comments that I’m risking an unpopular opinion here, but I think Dr. Erdogan’s 5000 grafts was the best estimate. 

Maybe I’m unsure of your objectives, but I assume you’re looking for full coverage and a new hairline.

Looking at your photos, I estimate you’d have a recipient area of about 150cm2 (depending on where you place the hairline). With 5000 grafts you’d get an average density of less than 35 units per square centimeter. Now, the photos aren’t good enough to judge your current coverage, but from the top view you posted, it looks like you don’t have much coverage and you have a lot of miniaturization. So, the ~35 grafts/cm2 together with the hair you have now would be *just* enough to get you close to full coverage.

Of course, I can’t say how good your donor area is, how thick your hair is, how many average hairs per folicular unit you have, but from the macro shots it looks okay, even though I haven’t seen your temporal-parietal areas. (CosmoKramer very correctly suggested you post those photos.)

That being said, I’d still first put you on finasteride first at a lower dosage, so you can stabilize your alopecia and keep that hair you have there, whilst also lowering the chances of shock loss when it’s time for surgery. At 40 years old, standard dosage would also be an option, to see if you can get some improvement before surgery. (Edit: Just saw you complained of side effects. So it would be of interest to clear that up.)

I’d do it in two surgeries though. 

So, with the info I have currently available, that’s what I’d plan for you. (All would be subject to confirmation in a live consultation, of course.)

Also risking sounding biased since we work together (and only because CosmoKramer mentioned him), I’d also suggest Dr. Lorenzo. We do advanced alopecias on a daily basis, so I know he’s very experienced in cases like yours.

Quite a few great options and talented doctors were mentioned here though, so I think you’ll be fine with more than one of the choices given.

 

Best of luck!

 

 

#IMO (I should just go ahead and point out that this is just an opinion and not a medical consultation, since it could never be one.)

Dr Lorenzo is a badass one of the best in the world he needs to be mentioned his name even more in this forum 

[Panamera13]

3 hours ago, Dr. Bruno Ferreira said:

Looking at your photos, I estimate you’d have a recipient area of about 150cm2 (depending on where you place the hairline). With 5000 grafts you’d get an average density of less than 35 units per square centimeter. Now, the photos aren’t good enough to judge your current coverage, but from the top view you posted, it looks like you don’t have much coverage and you have a lot of miniaturization. So, the ~35 grafts/cm2 together with the hair you have now would be *just* enough to get you close to full coverage.

Of course, I can’t say how good your donor area is, how thick your hair is, how many average hairs per folicular unit you have, but from the macro shots it looks okay, even though I haven’t seen your temporal-parietal areas. (CosmoKramer very correctly suggested you post those photos.)

That being said, I’d still first put you on finasteride first at a lower dosage, so you can stabilize your alopecia and keep that hair you have there, whilst also lowering the chances of shock loss when it’s time for surgery. At 40 years old, standard dosage would also be an option, to see if you can get some improvement before surgery. (Edit: Just saw you complained of side effects. So it would be of interest to clear that up.) I’d do it in two surgeries though. 

 

Also risking sounding biased since we work together (and only because CosmoKramer mentioned him), I’d also suggest Dr. Lorenzo. We do advanced alopecias on a daily basis, so I know he’s very experienced in cases like yours.

Quite a few great options and talented doctors were mentioned here though, so I think you’ll be fine with more than one of the choices given.

Thx a lot for the detailed reply Dr Ferreira. I wish all the consultations were a bit more technical where they talk about donor area and density vs required area & density. Some of my consultations were you will 2500 grafts and it will cost XXX. When asked about density/area to be filled, which zones to be filled, it was told it can only be answered once you're here on appointment day.

I'll look at Dr Lorenzo as well now. If you know of any cases similar to mine (diffused + high norwood), please do share.

Also, you mentioned that I have a lot of miniaturization, would it be worth spending on PRP + ACELL. It's around 2500 USD here for one session.

One last question for you: Can you tell me which norwood I am. I see many patients like me classified as 5, 5A, 6. Curious to see what you think. Thx a lot for your time. 

[Dr. Bruno Ferreira]

On 9/17/2019 at 1:25 AM, Panamera13 said:

Thx a lot for the detailed reply Dr Ferreira. I wish all the consultations were a bit more technical where they talk about donor area and density vs required area & density. Some of my consultations were you will 2500 grafts and it will cost XXX. When asked about density/area to be filled, which zones to be filled, it was told it can only be answered once you're here on appointment day.

I'll look at Dr Lorenzo as well now. If you know of any cases similar to mine (diffused + high norwood), please do share.

Also, you mentioned that I have a lot of miniaturization, would it be worth spending on PRP + ACELL. It's around 2500 USD here for one session.

One last question for you: Can you tell me which norwood I am. I see many patients like me classified as 5, 5A, 6. Curious to see what you think. Thx a lot for your time. 

You're welcome Panamera13.

I'm not a big proponent of PRP or ACELL, as their efficacy hasn't been scientifically confirmed. Especially ACELL, which in practice seems to do absolutely nothing. The cost/benefit of PRP is also a bit meh. In my opinion, there are better ways than that of applying 2500USD towards improving your hair. Getting back on finasteride looks like the absolute best bet for you right now. I understand you complained of side-effects, but it's best to understand those better and see if you can/need to adjust the dosage.

Diffuse alopecias aren't as easy to classify and the Norwood-Hamilton Scale is just a reference, but I'd say you're on your way to a NW6 (diffuse). Your crown is a bit deceiving as it looks to me from the photos that miniaturization goes deeper down than it appears and your sides look pretty open in the top view.