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champybaby

7 years later Doctor Konior, going for second procedure

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Hey all: 

This forum helped me pick out Dr. K and man, am I grateful for that. In short, about 7 years ago I did about 4400 graphs FUT; you can see the before after here (posted on this forum). Needless to say, it was life changing. I've been on Propecia + Rogaine Foam since I got the procedure. My crown has since thinned out. XFusion (like Toppik, but way better imo) does wonders to cover this spot, BUT, I'm really sick of using so much. It started off with a dash or two, but crown has since gotten thinner and thinner and thus I'm using more and more. I'm tired of using so much and being beholden to it. 

So I'm getting my second procedure, but wanted to see what others thought. Ideally, I can just do FUE and then use beard to cover FUT scar. Best case I get about 1500 graphs FUE. Worst case I get 1,000. If I do FUE + FUT, I can probably do 2800 - 3000 graphs, but I'm nearly certain my donor area will be exhausted, and I don't want that. I want to keep something in my back pocket as I age. I am currently 36. 

I see him in about a week and my procedure likely won't be done for another 11 months. Aside, I believe Dr. K's talents are worth the wait.

Plan: 

My plan is to reinforce the front with some more density and then cover up the top of my head while adding some at the very bottom of my crown, which is where I'm pretty much bald. The thinking is I could cover up that bald spot really easy with XFusion, but only using a small amount (I don't mind if it shows it's thinning there, just a touch to make it less noticeable. After all, I am 36 and only getting older, so I'm OK w/ that). 

Below are pics I just took. They were taken with an iPhone 8 and are between 5-8mb.They were taken in a brightly lit bathroom not directly under powerful bathroom lights, but pretty much almost directly under them. I am not using concelear in these photos. 

If people have some expertise, please share thoughts. Thanks. 

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I think 1000-1500FUE would do it and he could probably limit extractions from the FUT region so that is preserved for the future.  He seemed to do that during my last session of around 1100 FUE.

I would go about 500 in the Crown and everything else from front to back, as and where required.


4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013

1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018

500 FUE grafts (TBC) with Ray Konior, MD - 2020

My HT results thread from 1st procedure.

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Thanks man. Your post reminded me a bit of my own situation, tbh. 

When you say 500 in the crown, I assume you mean the very bottom of my crown, yes? 

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The crown is notorious for being a black hole for grafts. I think you will need at least 1,000 grafts to have the appearance that you get from Xfusion, you may need more tbh. 


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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2 hours ago, Melvin-Moderator said:

The crown is notorious for being a black hole for grafts. I think you will need at least 1,000 grafts to have the appearance that you get from Xfusion, you may need more tbh. 

Totally, I've seen others with much worse coverage needing 2K+ for crown. 

I'm fine with a small circle about the size of a quarter or so near the very bottom of the crown; I'd like the left and right sides of this bottom area covered, though. It's the top middle that I'd like have more coverage and of course, the front, too. 

I'm going to have to make some sort of compromise. I'm trying to plan this as I age more versus it looking really good for 3 years or so. Because I'm going to lose more hair. Decisions ... 

Edited by champybaby

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12 hours ago, champybaby said:

 

I'm going to have to make some sort of compromise. I'm trying to plan this as I age more versus it looking really good for 3 years or so. Because I'm going to lose more hair. Decisions ... 

That’s the best thing you can do, once you start using concealer, it’s very hard to match that appearance with hair transplantation alone. If I were you I’d plan to get surgery to use less concealer  as opposed to abandoning them altogether.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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5 hours ago, Melvin-Moderator said:

 If I were you I’d plan to get surgery to use less concealer  as opposed to abandoning them altogether.

Totally, that is the plan. Maybe my post wasn't clear, but I don't mind using some concealer to the lower crown area. I did that before and it was honestly no big deal. Just a dash or two and I was out the door. I also don't mind if the lower crown area + concealer shows some thinning, I just don't want it to be flat out bald. 

It's the top that needs help, as styling my hair is getting harder. What ever is left over would go toward the front. 

IDK what norwood I am, but I'm guessing I'm gonna be a 5 or 6 in time. The propecia + rogaine did really slow things down for me, though (if you look at my PO pis). 

Will be updating this thread after doc visit and in time, after my surgery which isn't going to be for a while. 

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This sounds like an easy solution. Whatever amount you get just split it roughly evenly between the front and the back. If you only get 1000 then put 500 in the front and 500 in the back. If you get 1500 then 750 and 750. Pretty simple to me.

 

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I'll  bet you have a lot more available fue grafts than you think.

Keep us posted.

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Dr K is fantastic.

I would suggest a minimum of 1000 into your crown. Extra grafts to reinforce and add density to your hairline will have a great effect.

You are in a good spot overall.

Im sure Dr K will again take the best of care of you!

Wishing you luck! Keep us updated!


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I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

My Hair Loss Website - Hair Transplant with Dr. Rahal

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Just an update here from me: 

I met with Dr. K this morning. The man does not slow down. Surgeries every day + a few consultations in the early morning. For those who don't know, he hired an equal a few years back, Dr. Sahar Nadimi. She does consultations a lot, much more than Dr. K. She also did a procedure for one of my friends; I recommended Dr. K, but he didn't want to wait so he saw her instead. His HT looks excellent, fwiw. And he's very happy. 

Concerns going in:

Went through what was perhaps the most challenging thing in my life about 3.5 months ago and I began shedding quite a few hairs, much more than usual. I figured I either had retrograde alopecia or telogen effluvium, which is caused by extreme stress. This concerned me as it would limit my donor area ... Well, it looks like I have the ladder, which is a relief. He said my donor area is "excellent." 

Game plan:

I initially had about 4400 graphs done via FUT about 7 years ago. My game plan is to maximize my donor area. I'm basically planning my HTs to fall in line with how I age. I am not looking for a few years of looking fantastic and then a bunch of years looking weird. That said, I'm going with the FUT as it will give me more hairs over my donor area's lifetime. 

Dr. K said I have 2,000 hairs for FUT. Knowing him, he'll likely find 2,200-2,400 during day of surgery (it's what i hear from others on this forum and it is what I experienced day of my first surgery). 

The game plan is simple: The back is bugging me, but it doesn't have to be a full head of hair. So I'm doing a 60/40 split, with the bulk going toward the front. My surgery is likely a year from now, but I'm on the waiting list. I plan on letting him shave my head. I'm going to look bad no matter what after surgery, so I personally don't care if I look funny for an additional month. He says that results are better when the patient allows him to shave their head, which makes sense.  

I also have 1K+ in my beard + FUE in the future. I'm keeping that in my back pocket. I may use the beard hairs to cover my scar in near future. We'll see.

This will be my second procedure. My guess is over my lifetime, I will likely need 3. I'm pretty much going to be 100% bald eventually, or a Norwood 15 or whatever the worse one is. 

Dutasteride

I've been on Fin since I got my procedure seven years ago. I hear people talk about its side effects. I personally never had any. In fact, and you guys will laugh at me for this, but I get erections so frequent that they wake me up in the middle of the night because I'm so hard it physically hurts. (It's funny, yes, but it sucks waking up every 2 hours, which isn't unusual. I mostly just have to get up and walk around a bit for them to go away). Aside, it's my opinion that Fin's sides can mostly be attributed to a balding man's psyche. If men stayed much more active, ate/drank healthy, and had strong self confidence that they wouldn't be experiencing sides. Not looking to start shit, but I believe this is the case most of the time. It's ok to disagree with this. 

Anyway. I asked him about Dutasteride over Fin. He said a couple of his patients take Dut if they can handle Fin, adding that DUT is more "potent." So I got a script for Dut. Fin seems to have peaked for me. I'll update here re: how effective it is. 

That's about all I got. Follow this as it will be where I post stuff about this surgery. 

Edited by champybaby

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Thanks for the update.  He suggested 2000 FUT was possible the last time I asked!

I hope this last one I'm having will be me done for at least 15 years.  Fortunately my rate of loss has been very slow the last 6 or 7 years.


4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013

1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018

500 FUE grafts (TBC) with Ray Konior, MD - 2020

My HT results thread from 1st procedure.

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Great game plan, 

Dut is definitely powerful. I’d try and take it at the lowest possible dose.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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38 minutes ago, Melvin-Moderator said:

Great game plan, 

Dut is definitely powerful. I’d try and take it at the lowest possible dose.

Are you supposed to break it in half or something? 

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1 hour ago, 1978matt said:

Thanks for the update.  He suggested 2000 FUT was possible the last time I asked!

I hope this last one I'm having will be me done for at least 15 years.  Fortunately my rate of loss has been very slow the last 6 or 7 years.

By the time I get second procedure, I'll have gotten 8 years from my first. 

If I can get 8-10 from my second, I'll be happy, with the intent being the third some minor fill in work. 

Edited by champybaby

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10 minutes ago, champybaby said:

Are you supposed to break it in half or something? 

I believe most guys take dut once a week and continue to take finasteride daily. That's if you want to be on the lowest possible dose. There are some guys who replace fin for dut but in my opinion, the risk is unknown. FDA didn't approve it as a hair loss drug for a reason. 


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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2 minutes ago, Melvin-Moderator said:

I believe most guys take dut once a week and continue to take finasteride daily. That's if you want to be on the lowest possible dose. There are some guys who replace fin for dut but in my opinion, the risk is unknown. FDA didn't approve it as a hair loss drug for a reason. 

That's good to know thank you for sharing. I will follow up w/ doc on that. 

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What about the transplant you had 7 years ago, what % would you say you have retained since then? Is it normal to experience some loss of transplanted hairs with time? To be honest your current photos (from the front) look almost identical to the ones you took in the months just after the procedure.

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15 hours ago, tofuparty said:

What about the transplant you had 7 years ago, what % would you say you have retained since then? Is it normal to experience some loss of transplanted hairs with time? To be honest your current photos (from the front) look almost identical to the ones you took in the months just after the procedure.

 I would say I've kept the vast majority of the hair transplanted, but the crown has since become significantly thinner; the crown was not operated on during my first procedure* 

Edited by champybaby

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On 11/8/2019 at 1:37 PM, champybaby said:

 the crown was not operated on during my first procedure* 

i thought you had (according to Konior) a " full zone restoration with a single session of 4478 grafts. The primary focus of graft placement was directed to density enhancement in the front half of his balding regions. "?

I just had a 2nd pass at my hairline with Konior a few months ago so i suspect you;ll be more than happy with your future gameplan.

And thanks for coming back and updating your status. I look at results like yours as some kind of indication of my future. Nice to know it still looks great 

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On 11/7/2019 at 6:37 PM, champybaby said:

 I would say I've kept the vast majority of the hair transplanted, but the crown has since become significantly thinner; the crown was not operated on during my first procedure* 

So you and @Spanker had surgery around the same time. I believe he has a thread of his crown he updates every so often, seems like finasteride has really worked for him. Not everyone has the same results though. I think it depends on DHT sensitivity.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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It's great to see updates so many years later. I've often wondered what the results are like further down the track.

Edited by tofuparty

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On 11/9/2019 at 5:02 AM, tofuparty said:

It's great to see updates so many years later. I've often wondered what the results are like further down the track.

EDIT: So I'm booked for Nov. 4, 2020*. Told him to also keep me in mind should someone cancel. 

Honestly, what can't be seen with the pictures is the "perimeter" of my head from the back to the half way point of the front. I define the "permiter" as the DMZ zone or in between the side of my head where my hair will not fall out and the top where it will fall out. 

The perimeter is starting to thin, but is easy to cover up and hard to see with pics. In time, however, I will really look weird once this portions thins out/falls out. 

My priorities: 

  • Take an "as I age" approach to HT
  • Fortify "perimeter" (it won't need much)
  • Address crown with 40% of grafts, with emphasis of filling the very bottom of my hair, in the center, with some grafts. Think a bald spot with some hair about the size of a half dollar in the very back of my head. This can be tackled with concealer; I don't mind using a dash or two of concealer at all. What I do mind is the amount I use today.*
  • Improve density up front with 60% of grafts

Dr. K described something like having a limited amount of paint. He said if you started at the center of my head you would run out when you got to the edges. So he's starting from the outside and working his way toward the center. I agree with this approach. The way I style my hair will also be put into consideration this time. 

In the meantime, I'm on DUT at .5mg daily. If I start to experience sides, I'll switch back to Propecia. But so far, so good. Hopefully the DUT does something. 

Edited by champybaby

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Nov 2021? Wow i think Dr K's waiting list keeps growing.

I think the perimeter you reference is called "the halo of baldness" in the literature, where a patient continues balding around the rim of his transplanted hair and it leaves a bald halo. Its incredibly hard to predict for patients under the age of 40, but i suspect it also wouldnt take too many grafts to at least give the appearance of thinning or density in that region. It's interesting but i cant really see it in the photos (which at least gives me some personal hope as i had an unethical doctor place hairs in my crown and this "halo" is my own fear as I want to avoid any further surgery).

Im guessing its more noticeable when your hair is wet/sunlight etc

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