Few Doubts

[tesla007]

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

 

[LaserCap]

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). 

[tesla007]

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 November 10, 2019 by tesla007

[LaserCap]

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.

[tesla007]

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."

 

[LaserCap]

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?

 

 

[tesla007]

• On 11/11/2019 at 7:28 PM, LaserCap said:

$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?

 

 

Well $1 is around 72 INR so the price comes out to be around 25 INR per graft. But like I have mentioned above no one here goes by the per graft cost. They have made packages. I also visited few of the doctors recommended here but unfortunately they are all after the moolah and no one is really interested in answering the queries of someone. For them we are customers and not patients. I know its all business everywhere but here is no limit for them.

No sir, none of them recommended finasteride and/or minoxidil. As per all of them PRP, if done in like every 3-4 months, will save existing hair.

I asked them, as per the little knowledge that I gained from this forum, the concentration of platelets in every syringe. They were clueless. Hair Transplant is a huge market in India and I haven't found a doctor/clinic whom can be trusted. There are a few but they quoted like $1500-$2000 for the transplant and if I wanted to meet the doctor before the transplant to clear any doubts the opd fees was $200 ha ha

I have shortlisted few of them, like you suggested by checking the photos of the patients similar to me, I will go with one soon. I can start finasteride and minoxidil myself after the treatment. If I do, then should I continue them like forever or stop them after few months/years?

[LaserCap]

52 minutes ago, tesla007 said:

Well $1 is around 72 INR so the price comes out to be around 25 INR per graft. But like I have mentioned above no one here goes by the per graft cost. They have made packages. I also visited few of the doctors recommended here but unfortunately they are all after the moolah and no one is really interested in answering the queries of someone. For them we are customers and not patients. I know its all business everywhere but here is no limit for them.

No sir, none of them recommended finasteride and/or minoxidil. As per all of them PRP, if done in like every 3-4 months, will save existing hair.

I asked them, as per the little knowledge that I gained from this forum, the concentration of platelets in every syringe. They were clueless. Hair Transplant is a huge market in India and I haven't found a doctor/clinic whom can be trusted. There are a few but they quoted like $1500-$2000 for the transplant and if I wanted to meet the doctor before the transplant to clear any doubts the opd fees was $200 ha ha

I have shortlisted few of them, like you suggested by checking the photos of the patients similar to me, I will go with one soon. I can start finasteride and minoxidil myself after the treatment. If I do, then should I continue them like forever or stop them after few months/years?

If the medication works, stay on it for as long as you want to keep your hair.

The medication by the way, is intended for you to keep what you have.  So, if you look the same a year from now, the meds did what they were intended to do.

Take photos and put them away.  Take another set every 6 months so you can keep track.

[Melvin- Admin]

Bargain shopping for a hair transplant, like you would a TV is a bad idea. If you can't afford a quality hair transplant, don't get one done. I agree with Lasercap, trying to find someone who will perform a hair transplant on you for pennies per graft is a recipe for disaster. No doubt, it will probably be done by technicians without doctor supervision. There was a story last year about a Indian businessman who died going to one of these black market clinics.

[Al - Moderator]

On 11/9/2019 at 8:15 AM, LaserCap said:

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).

 

This is the only point I disagree with mostly because he specifically asked about extreme cases. Generally the answer above is correct, but in cases where the patient will eventually end up a high NW level or experience thinning in their donor area then yes he will lose transplanted hair because it will thin and stop growing at the same rate that it would have where it was originally taken from. This will happen to almost everyone to some degree and at some point as they get older. Hopefully it doesn't happen until you are much older, but that is not always the case.

 

[Al - Moderator]

1 hour ago, Melvin-Moderator said:

Bargain shopping for a hair transplant, like you would a TV is a bad idea.

 

I agree, but the reality is that hair transplants can get very expensive, so the cost does end up being a factor. That's just reality. What you need to do is not worry about price so much at the start, while still realizing that it will be expensive and that other countries may have differing price points, and find some quality Drs who you feel can get you to where you want as far as hair line design, density, overall plan, etc. Then when you feel like you know which Drs would be a good fit then you can try looking at which one is cheaper because at that point any of the remaining few you've chosen should be good if you've done it right.

 

[LaserCap]

Agree with BeHappy with regards to pricing elsewhere.  Doctors practicing abroad have to deal with the local economy and what the population can afford to pay.  So perhaps not concentrating so much on the price is not a bad idea.  Do please review plenty of photos, particularly those similar to your own case.

[tesla007]

On 11/16/2019 at 10:12 PM, LaserCap said:

If the medication works, stay on it for as long as you want to keep your hair.

The medication by the way, is intended for you to keep what you have.  So, if you look the same a year from now, the meds did what they were intended to do.

Take photos and put them away.  Take another set every 6 months so you can keep track.

So, why did Dr. Resul recommend the medications for 8-12 months and not for a much longer period? I can understand that the patient's existing hair might not be falling, if it wasn't then what was the need of the meds in the first place?

 

[tesla007]

On 11/16/2019 at 10:21 PM, Melvin-Moderator said:

Bargain shopping for a hair transplant, like you would a TV is a bad idea. If you can't afford a quality hair transplant, don't get one done. I agree with Lasercap, trying to find someone who will perform a hair transplant on you for pennies per graft is a recipe for disaster. No doubt, it will probably be done by technicians without doctor supervision. There was a story last year about a Indian businessman who died going to one of these black market clinics.

Thanks for chipping in Melvin. I have visited like 5 of the doctors recommended by this forum and trust me I did not see a doctor-patient atmosphere anywhere. Everyone in those clinics, or as they like to call it lounges, is money minded. I talked to several patients who had gone for them and the reviews weren't motivating like they said no invoice was provided to them, it is needed in case something goes horribly wrong, they also said that there is no followup whatsoever after the transplant. In every clinic one thing was common that if one had gone for a transplant from a clinic and if he refers someone to them then they will give the referral a free PRP session. One of these clinics quoted me 80000 INR, they kept on calling me to deposit some amount in advance and eventually lowered the price to 65000 INR without me even asking for it. So, you can guess how these so called clinics work here.

I am ready to spend a little more and go to the most expensive one recommended by this forum but they also said that the front line will be done by the doctor and the rest by technicians.

Yes, I read that story. According to his doctor, he wanted 9000 grafts in one sitting so shit happened. Can't say whether he was qualified or not.

[tesla007]

@LaserCap @Melvin-Moderator

Can you guys share some more photos like the one attached here so that I can ask the doctor the kind of hairline that I hope for

Final question, may doctors do the transplant for 2 consecutive days if the grafts are more than 2500 but majority of them tend to do it in one sitting. Is there any science behind this?

 

Edited November 19, 2019 by tesla007

[tesla007]

Very informative video Melvin.

My hairline started receding at a very slow pace in around 2011. Started finasteride and minoxidil, did not experience any side effect. But the meds didn't stop or slowed it down so stopped them after a year and a half or two years. Due to some personal problems, and this is my opinion only, the receding skyrocketed since last year. Now the hairline is gone and is going back day by day. All the doctors here say that they won't recommend finasteride or minoxidil just PRP after every 4 months after the transplant. Your thoughts?

On 11/16/2019 at 10:21 PM, Melvin-Moderator said:

Bargain shopping for a hair transplant, like you would a TV is a bad idea. If you can't afford a quality hair transplant, don't get one done. I agree with Lasercap, trying to find someone who will perform a hair transplant on you for pennies per graft is a recipe for disaster. No doubt, it will probably be done by technicians without doctor supervision. There was a story last year about a Indian businessman who died going to one of these black market clinics.

 

[Melvin- Admin]

15 hours ago, tesla007 said:

Thanks for chipping in Melvin. I have visited like 5 of the doctors recommended by this forum and trust me I did not see a doctor-patient atmosphere anywhere. Everyone in those clinics, or as they like to call it lounges, is money minded. I talked to several patients who had gone for them and the reviews weren't motivating like they said no invoice was provided to them, it is needed in case something goes horribly wrong, they also said that there is no followup whatsoever after the transplant. In every clinic one thing was common that if one had gone for a transplant from a clinic and if he refers someone to them then they will give the referral a free PRP session. One of these clinics quoted me 80000 INR, they kept on calling me to deposit some amount in advance and eventually lowered the price to 65000 INR without me even asking for it. So, you can guess how these so called clinics work here.

I am ready to spend a little more and go to the most expensive one recommended by this forum but they also said that the front line will be done by the doctor and the rest by technicians.

Yes, I read that story. According to his doctor, he wanted 9000 grafts in one sitting so shit happened. Can't say whether he was qualified or not.

We have an agreement in place with all of our recommended surgeons, that members of this forum who select them, should automatically be opting for the tier in which they’re involved. 
 

Some surgeons offer various packages to remain competitive with the surgeons in their region- this is especially popular in India and Turkey. However, always notify whoever you’re consulting with that you found them through this forum and this will give you the automatic highest tier.