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Hi,

I am 30 years old. Have lost the frontal hairline and it is going back day by day. Pretty much like this but mine is worse

The above thread prompted me to post my doubts here. So, I visited few of the surgeons from this list

https://www.hairtransplantnetwork.com/Consult-a-Physician/surgeon-list/IND/India

Darling Buds and Medispa and many other renowned surgeons who are not on the list but people have achieved great results from them. Everyone suggested me around 2500-3000 grafts. All of them were doing the transplant using FUE technique and gave one PRP session along with the transplant. Here are my doubts-

1. I met many patients who came for follow up visits in their clinics. Almost everyone said that they were told say 5000 grafts but in reality the grafts injected were way too less i.e. they didn't get the required density. Any way to make sure that one gets what he has paid for? Someone else has same doubts

2. Everyone said that the surgeon constructed the hairline in the front and the rest of the work was done by their staff. Shouldn't the surgeon do all the work here?

3. All hospitals told me that the existing hair line receding and hairfall will stop after the PRP session which is done at the time of the surgery. But they were mum when I asked that if PRP is that effective then why isn't it recommended in place of propecia or finasteride? Also why isn't the same FDA approved? They had no answers. Any thoughts? This is my biggest concern.

4. All the surgeons listed on this website are super expensive. No one charges for per graft in reality but they have made packages. If one opts a surgeon which is not a member of ISHRS or IAHRS, just on the basis of results of other people, then is there any parameter which one should keep in mind while selecting them?

5. Is it true that DHT does not affect the transplanted hairs? If yes then why?

6. Is it true that in extreme cases even the transplanted hair doesn't grow or they also recede with time?

Please enlighten me with any other points which one should keep in mind while selecting a surgeon, pre and post surgery.

Thanks

 

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3 hours ago, tesla007 said:

Hi,

I am 30 years old. Have lost the frontal hairline and it is going back day by day. Pretty much like this but mine is worse

The above thread prompted me to post my doubts here. So, I visited few of the surgeons from this list

https://www.hairtransplantnetwork.com/Consult-a-Physician/surgeon-list/IND/India

Darling Buds and Medispa and many other renowned surgeons who are not on the list but people have achieved great results from them. Everyone suggested me around 2500-3000 grafts. All of them were doing the transplant using FUE technique and gave one PRP session along with the transplant. Here are my doubts-

1. I met many patients who came for follow up visits in their clinics. Almost everyone said that they were told say 5000 grafts but in reality the grafts injected were way too less i.e. they didn't get the required density. Any way to make sure that one gets what he has paid for? Someone else has same doubts

2. Everyone said that the surgeon constructed the hairline in the front and the rest of the work was done by their staff. Shouldn't the surgeon do all the work here?

3. All hospitals told me that the existing hair line receding and hairfall will stop after the PRP session which is done at the time of the surgery. But they were mum when I asked that if PRP is that effective then why isn't it recommended in place of propecia or finasteride? Also why isn't the same FDA approved? They had no answers. Any thoughts? This is my biggest concern.

4. All the surgeons listed on this website are super expensive. No one charges for per graft in reality but they have made packages. If one opts a surgeon which is not a member of ISHRS or IAHRS, just on the basis of results of other people, then is there any parameter which one should keep in mind while selecting them?

5. Is it true that DHT does not affect the transplanted hairs? If yes then why?

6. Is it true that in extreme cases even the transplanted hair doesn't grow or they also recede with time?

Please enlighten me with any other points which one should keep in mind while selecting a surgeon, pre and post surgery.

Thanks

 

1.  By the late 90's most all barbaric techniques, for lack of a better description, (MPR, use of balloons, rotation flaps, etc) were pretty much gone with the exception of plugs which are still being practiced today. (In my view FUE is a glorified plug, if you think about it. Just a lot smaller and branded with a different name). But the one global idea which remains constant to this day is the belief grafts compete for blood supply and a separation in between grafts is needed for survival. So, during the initial consultation someone will mention multiple procedures.  The second procedure can be done as early as 4 months after the 1st, but most prefer a full year.  This is typically the case when doing as many grafts as you can per procedure.  

In some instances, often due to finances, the patient will move forward with lesser grafts.  This just means he'll have to do more procedures down the road to achieve the desired density. 

Another explanation could be patient driven.  If, during the consultation the patient tells the doctor he wants hair all over his head, the grafts will be placed diffusely throughout.  The problem with this, particularly when the patient has a very advanced pattern, is the fact that people typically do not lose hair in this fashion.  The patient ends up looking like he's sick.

Lastly, the use of medical therapy.  Native hair, by definition, helps density.  But if the patient has lost, he will continue losing.  Adding grafts will offset some of this but it's a losing battle.  If the patient does medical therapy and keeps what he has, then the procedure will bump the density bar.

2.  During the procedure you'll typically have the doctor and the clinical staff which includes a nurse.  The Doctor is in charge of all that's surgical.  Placing is normally done by the clinical staff. Everyone works under the umbrella of the doctor.  He is the responsible party at the end of the day.  (There are plenty of reported cases - staff doing sites, harvesting, etc). Unfortunately this is not regulated and thus will continue to happen.

3. PRP is fairly new to many doctors. Unfortunately most fail because they just don't know how to do it, what amount is needed, etc.  When done properly, it can help bring results in sooner and it can help reverse miniaturization of the native hair.  It is yet another modality against this debilitating condition. But, like the others, it has to be repeated at certain intervals to maintain the effect. (Hopefully one day all doctors will get together and share their trade secrets. In the end the patients will truly benefit from this particular modality).

4.  What's expensive to you? Perhaps a better question...What do you want to pay?  What do you think is reasonable for this service?  $3 per graft? How about $1? 

At the end of the day it is always about results.  Look at plenty of photos, particularly cases similar to your own, and then decide which you like better.

5. Testosterone is broken down and the result is DHT.  This is what many believe to be the culprit. I've often heard DHT is only good in early years and at puberty.  After that it becomes an issue. 

Most of us do have a donor area.  This area is dominant and the hair is not susceptible to the effects of DHT.  This is why it is the area all doctors use to harvest.  If it's permanent in the donor, it will be permanent wherever it's placed.

6 Incorrect.  Grafts will remain.  It is the native hair that's dissipating and withering away. To the patient, however, it will seem like he's losing grafts. (Your question prompts me to believe there is lots of confusion out there. Mostly because patients interject and give their opinion.  All anecdotal of course, but just adds to the confusion.  "Dr X did my procedure and I lost all my grafts." And, in actuality, the patient had 600 grafts to the corners, did not do medical therapy, and ended up losing all the native hair.  Do you think all his friends will go to the same doctor? (Can't believe everything you hear.  Do some fact checking before making any decisions). 

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18 hours ago, LaserCap said:

Thank you for replying.

1. Thanks for replying it so well. But my question still stands, I have talked to many patients from various clinics and all of them said that they are not sure that the number of grafts which were told to them were actually planted. I have seen many people asking the same question here. Anything that you can add to this?

2. Thanks

3. Then I guess that FDA should do some extensive research and should approve it asap.

4. No one charges here for per graft, the per graft quote is just for their website. They have made packages. One of the clinics quoted me around $990 USD for 2000 grafts and they charged around $940 USD from someone who got 3500 grafts. They charge as per their own liking.

You are absolutely correct about the before and after photos as per my case. Let me look into this thoroughly and I will get back to you.

5. Thanks. Dear DHT go to hell.

6. Thanks

7. Another question, none of the clinics said that they recommend anyone finasteride and minoxidil after the transplantation as the PRP is more than enough. But I have seen many threads on this website where people were recommended to take finasteride and minoxidil for atleast a year after the transplant. Like I have mentioned above there is no per graft cost, it is all business here in India with no accountability whatsoever, so is there any factor which determines that a person does need finasteride and minoxidil after the transplant?

 

Edited by tesla007

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1.  There has to be trust from the get-go.  No way to verify other than to ask for copies of all the documents in your chart.  If done properly, you'll find the names of all involved in your case, numbers of grafts, type of grafts, (2-3 hairs etc), and even where the placement was done.

During the procedure it is common for a staff member to do the count while the doctor is making sites.  The patient, by this time, is under local and will not remember this part of the procedure.

4.  Most of the groups I know charge by the graft, except when dealing with eyebrows.  Those are typically at a package price.

The clinic can charge whatever they feel they're worth.  If you're the owner of the clinic and have the best transplant doctor ever, would you charge $1 per graft. I doubt it.  You have to figure into this, rent, electricity, equipment, staff, doctor's time....etc. And, if they are over priced, no one would visit.  

If they are not willing to work with you on the price, go elsewhere.  There are plenty of competent doctors in the industry.

Everyone with this debilitating condition should consider a medical regimen, before, during and after.  The medications are intended to retain hair.  So, you keep what you have, you do a procedure - the result will be more density.  Not doing medication.....you do a transplant, you keep losing native hair, now you have do to more transplants just to replace what you lost and never increasing density.  Eventually you'll run out of donor and now you're stuck.

All modalities work in different ways and are thus, synergistic.  To say that PRP is more than enough is coming from someone who does not truly understand the process.

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13 hours ago, LaserCap said:

1.  There has to be trust from the get-go.  No way to verify other than to ask for copies of all the documents in your chart.  If done properly, you'll find the names of all involved in your case, numbers of grafts, type of grafts, (2-3 hairs etc), and even where the placement was done.

During the procedure it is common for a staff member to do the count while the doctor is making sites.  The patient, by this time, is under local and will not remember this part of the procedure.

4.  Most of the groups I know charge by the graft, except when dealing with eyebrows.  Those are typically at a package price.

The clinic can charge whatever they feel they're worth.  If you're the owner of the clinic and have the best transplant doctor ever, would you charge $1 per graft. I doubt it.  You have to figure into this, rent, electricity, equipment, staff, doctor's time....etc. And, if they are over priced, no one would visit.  

If they are not willing to work with you on the price, go elsewhere.  There are plenty of competent doctors in the industry.

Everyone with this debilitating condition should consider a medical regimen, before, during and after.  The medications are intended to retain hair.  So, you keep what you have, you do a procedure - the result will be more density.  Not doing medication.....you do a transplant, you keep losing native hair, now you have do to more transplants just to replace what you lost and never increasing density.  Eventually you'll run out of donor and now you're stuck.

All modalities work in different ways and are thus, synergistic.  To say that PRP is more than enough is coming from someone who does not truly understand the process.

Thanks for replying again and for your valuable inputs. Visited the last of the remaining clinics in my state last evening. They quoted me around $1100 USD for about 3000 grafts. I guess I will have to go for the one which has posted good results with the patients similar to my condition. They also said that finasteride and minoxidil is not recommended but told me to go for a PRP session once in every quarter. Can I start minoxidil and finasteride few weeks before the transplant and continue it for few months after the procedure? I know everyone would say no but the clinics here won't recommend it for reasons best known to them. The below still remains a mystery to me-

" Everyone with this debilitating condition should consider a medical regimen, before, during and after.  The medications are intended to retain hair.  So, you keep what you have, you do a procedure - the result will be more density.  Not doing medication.....you do a transplant, you keep losing native hair, now you have do to more transplants just to replace what you lost and never increasing density.  Eventually you'll run out of donor and now you're stuck."

 

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8 hours ago, tesla007 said:

Thanks for replying again and for your valuable inputs. Visited the last of the remaining clinics in my state last evening. They quoted me around $1100 USD for about 3000 grafts. I guess I will have to go for the one which has posted good results with the patients similar to my condition. They also said that finasteride and minoxidil is not recommended but told me to go for a PRP session once in every quarter. Can I start minoxidil and finasteride few weeks before the transplant and continue it for few months after the procedure? I know everyone would say no but the clinics here won't recommend it for reasons best known to them. The below still remains a mystery to me-

" Everyone with this debilitating condition should consider a medical regimen, before, during and after.  The medications are intended to retain hair.  So, you keep what you have, you do a procedure - the result will be more density.  Not doing medication.....you do a transplant, you keep losing native hair, now you have do to more transplants just to replace what you lost and never increasing density.  Eventually you'll run out of donor and now you're stuck."

 

$0.36 per graft?  Where at you getting this done, at the flea market?

Finasteride and Minoxidil not recommended? What do they do, breast implants?

1 PRP per quarter tells me they are doing very little per quarter, possibly a syringe's worth.  Ask them what equipment they use, and about the binding matrix. Have them show you photos of results for each quarter.  Doubtful you'll see any results.

What would be the sense in starting meds if you're going to stop them?

 

 

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