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Hi follicle friends.

I've decided to go ahead with a transplant surgery. It will be my first one.

I'm based in Canada, not far from Rahal's clinic but also open to traveling to Vancouver to do my surgery with Hasson. I've narrowed my decision to these two surgeons based on the research I've done, the feedback on these surgeons in these forums, and because I prefer to do this in my own country.

I'm 42 and think I'm a norwood 4. I've been taking propecia for over six years though had a few breaks along the way. About 8 years on monoxidil also had a few breaks along the way. My hair loss has slowed down significantly since I started loss prevention, but hasn't halted altogether.

Late last year I considered throwing the towel in and shaving my head, then I considered SMP and while researching that I watched a few videos of people's HT surgery results and was blown away by how natural the hairlines looked and I changed my mind and here I am.

I've since started dermarolling, just ordered some Saw Palmetto extract and I've been taking Resveratrol for about 10 months which isn't well known for helping with hair loss... but I think it will help more than most people realize.

Next week I'm meeting with two surgeon reps. One for Rahal, one for Hasson & Wong. I'm going to make a decision between the two clinics and book my surgery for later this year.

What's on my mind ahead of the meetings:

1. Is my donor area in good shape? I wear my hair short and it's in a fade. My hair is going grey so it's looking lighter

2. The mid scalp is really weak and I know you guys call the crown area a black hole for grafts but the area in front of the crown is an area of concern for me, along with:

3. Hairline and receded temples - I'm going to see what the surgeon reps think I should do here but my priority is for it to look natural and better  frame my face

4. FUT vs. FUE - this is my biggest conundrum, the classic internal debate. I really want to avoid the strip scar because I like to keep my hair really short on the back and sides (0.5 to 1.0 buzzcut length as a fade). However the price difference is very real and I've been impressed by some results I've seen of 2nd surgery FUE grafts being placed into the 1st surgery strip scar, and SMP work in and around the scar too.

5. Planning for the future - at this stage I'm really hoping to have a one and done surgery but a lot of people say they started with that in their minds and then did one or two more after that so I'm trying to be realistic about what I'll want to do in the future. However I stick to where my head is at now, it'll be one surgery and be diligent with loss prevention and if loss continues, shave and add SMP and go with the super short stubble head look.

 

I'm keen to hear from others who were trying to decide between Rahal and Hasson and what tilted you to either one. Any advice on questions I should ask the reps when I meet with them?

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Edited by Mark Wolfer

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I hated rahals marketing/outreach team. There was this one guy specifically, aaron bugayong, who literally was the most annoying person I’ve dealt with during my search for a hair transplant, and I reached out to many doctors.

 

the style Aaron used was so sleazy and outright despicable. He would call me during work hours continuously even when I told him im busy and if I didn’t answer he would dial again. Then he would follow up with these used-car salesman like emails if I didn’t answer with titles like “WE WONT GIVE UP ON YOU, YOU CAN STILL GET YOUR HAIR BACK!”

 

I immediately X’d rahal off my list bc of that Aaron guy. To me, the whole team has to vibe on the same level.

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You've two elite surgeons there........but I'd hop on plane to Hasson...........nobody dense packs like Dr.Hasson does the closest out there to one and done........if you've got descent donor and are not trying to be too aggressive with hairline i think a big case FUT(5,000+)  that Dr.Hasson is famous for would really cover hairline, midscalp and slightly into crown

Likewise if leaning towards FUT he gets, along with Konior, the thinnest scars in the business...blade 3 territory.....while H&W now has become 5 star FUE clinic too if you go down that road now or later.

Rahal is great too - but consistency, track record and recent patient reported "home runs" on this forum point towards Hasson still operating at an Elite+ level ahead of Rahal.....havent seen a bunch slam dunks from Rahal recently as used to be the case

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7 hours ago, pre-screened said:

Likewise if leaning towards FUT he [Dr. Hasson] gets, along with Konior, the thinnest scars in the business...blade 3 territory.....

This is good to know, I hadn't read about this before, that Hasson has a reputation for very thin strip scars. Thanks for this.

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13 hours ago, LonelyGraft said:

I hated rahals marketing/outreach team. There was this one guy specifically, aaron bugayong, who literally was the most annoying person I’ve dealt with during my search for a hair transplant, and I reached out to many doctors.

 

the style Aaron used was so sleazy and outright despicable. He would call me during work hours continuously even when I told him im busy and if I didn’t answer he would dial again. Then he would follow up with these used-car salesman like emails if I didn’t answer with titles like “WE WONT GIVE UP ON YOU, YOU CAN STILL GET YOUR HAIR BACK!”

 

I immediately X’d rahal off my list bc of that Aaron guy. To me, the whole team has to vibe on the same level.

lol this is funny as I basically the same experience. Ended up having a face to face meeting with Tara who is a very lovely person. I'm in the GTA (greater toronto area) and was told they do surgeries in Toronto every once in a while. Would have definitely booked with them if not for the recent track record of subpar results.

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9 hours ago, bruce90 said:

lol this is funny as I basically the same experience. Ended up having a face to face meeting with Tara who is a very lovely person. I'm in the GTA (greater toronto area) and was told they do surgeries in Toronto every once in a while. Would have definitely booked with them if not for the recent track record of subpar results.

What results are those?  I'm going between rahal and h&w and just starting the consultation process now and not sure who to go with. 

 

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Dr Hasson and Dr Wong are putting out great work.  The designs, the yield, the methods, the ethics seem quite high.  Play it safe, analyze it all really well.  See who gives you good vibes.  Remember, this surgery can make it all better or turn things upside down.  H&W seems like an excellent clinic with great results in FUE and FUT.  best of luck

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20 hours ago, johnto said:

What results are those?  I'm going between rahal and h&w and just starting the consultation process now and not sure who to go with. 

 

If you search through the most recent results on this forum you will notice that in the last couple of years the results from Rahal haven't been too impressive. H&W seem to be doing pretty well and have more consistent results. Five years ago Rahal was having killer results but I'm not too sure what happened. If money was no objective I would definitely choose H&W.

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I've been reading recently about how one theory of why male pattern baldness occurs is due to contraction of scalp muscles that tightens the skin on the head and causes inflammation that leads to hair loss.

So it stands to reason that a strip surgery would further contract the skin on the head and lead to more of the same.

Is this why surgeons check your scalp skin elasticity before deciding which type of surgery you're better suited for?

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1 hour ago, Mark Wolfer said:

I've been reading recently about how one theory of why male pattern baldness occurs is due to contraction of scalp muscles that tightens the skin on the head and causes inflammation that leads to hair loss.

So it stands to reason that a strip surgery would further contract the skin on the head and lead to more of the same.

Is this why surgeons check your scalp skin elasticity before deciding which type of surgery you're better suited for?

Yeah...def throw that theory far into the trash bin

 

male pattern baldness aka Androgenetic alopecia (andro meaning androgens aka hormones and genetic....which as u guessed it is your genes). So, it all comes down with how your hormones activate certain genes which cause you to lose hair in a predetermined fashion. This is why propecia works...it lessens the hormone responsible for activating the baldness gene.

 

if your theory were correct, then you’d lose more hair after a fut transplant from tighter skin. Also, y would the transplanted hair survive and not die from the inflammation caused by the tightness in the recipient? Lots of weird theories out there. Stick to what’s proven by science and studies

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I had my meetings today with James from Hasson & Wong clinic, and Chris from Rahal Clinic (briefly met with Dr. Rahal too which was nice and unexpected). Both of the reps were great, thorough and informative. They both gave me a good sense of the clinic's approaches to surgeries and they both took my priorities into account and gave me a realistic idea of my options.  Both clinics have done a good job choosing their reps!

Now I need to start making decisions. Besides choosing a surgeon I also need to make the choice between FUT and FUE.

Here's what I learned today:

1. My donor area is not terrific but also not bad. I have approx 6,000 to 7,000 available grafts

2. I have enough scalp elasticity for FUT

3. According to James I have retrograde allopecia above my ears. This was news to me and I've started reading up about it. I get my haircut every two weeks, in a fade style and always have very short back and sides so I am used to seeing a lot of scalp in this area and hadn't noticed what James was pointing out before. Interested to hear if others agree with this assessment, and what I can do about it (should I apply rogaine here? dermaroll the area?)

4. Hairs on the lower nape of the neck are not advised for FUE extraction because the lack of density makes the punch scars more obvious (makes sense but I have a lot of growth on my lower neck and have to shave there every few days so I was hoping to get these moved topside)

 

Recommendation from Hasson & Wong

An approx 4,000 graft FUT session to fill in the temples and bring my hairline down slightly and build through the mid scalp while leaving the crown untouched. This should leave ~1,500 or more grafts for a future surgery to fill in progressive loss of native hair in the front to mid scalp or if I've truly stabilized on my meds then to work on the crown. FUE is also available at a higher cost per graft but James advised FUT first to maximize future donor availability for a second surgery down the road.

Recommendation from Rahal

An approx 3,200 graft FUE session with similar objective as above, leaving the crown untouched. I learned today that since January of this year, Dr. Rahal is an FUE only clinic. The clinic also offers Scalp Micro Pigmentation (SMP) and Platelet Rich Plasma (PRP) which James recommended also. SMP at approx 4 months after the hair surgery to the crown and mid scalp to minimize the scalp contrast showing through the thinner areas. The SMP client before and after pics of patients looked really good. Four PRP sessions were recommended to help with scalp health while the transplanted hairs are taking hold.

 

My thinking so far

I don't want to make the FUT vs. FUE decision based on recovery time or the embarrassment of showing up to work with visible staples or scabs or scars in my donor area. It will only be a temporary phase and I can take two weeks off after the surgery for the worst of it either way. What I need to decide is whether I'm okay with the strip scar and the tighter scalp skin afterwards or if I'm willing to lose out on possible grafts through FUE but avoiding the scar and tighter scalp.

I also have to pick a surgeon and if I decide on FUT then based on what I heard from Dr. Rahal today he's not an option for that.

I'm going to take a few days to decide. Obviously money is a factor but I've been convinced by reading through the advice in these forums to put a high value on being happy with the result and thinking ahead for my previous donor area.

 

I've attached the photos that Chris took today, my hair was a bit wetter than my first set of photos and gives a better idea of the areas that are thinnest.

 

 

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Edited by Mark Wolfer

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Seriously? Rahal is a FUE only clinic now? I’m not discrediting you but I am shocked to say the least. That would personally put me off of Rahal. FUT still has its place in hair restoration and it worries me, he may go only FUE to maximize profits and push patients down their own path.

Im personally eyeing up H&W and am in a similar situation to you. I go back and forth between FUT and FUE all the time. My heart says go FUT but my head is telling me FUE.

Part of me thinks I will go FUT. Hope for a good, concealable scar, that can still have a fade to it from a .5 to like a 3.. Having a different hairstyle is not as big of a concern as we age when we are trying to gain hair in other places

Edited by hairlossPA

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19 minutes ago, hairlossPA said:

Seriously? Rahal is a FUE only clinic now? I’m not discrediting you but I am shocked to say the least.

I've noticed that each clinic takes their own path with options and this was a recent change for Dr. Rahal's clinic. I spoke with both James and Dr. Rahal directly about it and he said with the graft success rate he's having with FUE, the demand for FUT was so low last year that the clinic was only doing it in specialized situations like male patients who had already done FUT before and were on a second surgery or female patients who didn't want to shave the back of their heads for FUE and obviously have longer hair and no chance of the strip scar being visible. For what it's worth I didn't feel like I was being pushed at all and I can understand a clinic choosing to specialize in a type of surgery based on changing demand from patients and innovations and improvements in FUE results.

Edited by Mark Wolfer

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I like Hasson and Wong's long term surgical plan in this scenario (and I'd say they have an edge over Rahal in general), though the use of SMP is an interesting idea. You also look like you have just the right amount of hair in back for hair fibers to make a huge difference.

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Hasson and Wong’s long term surgical plan looks quite reasonable.  

if you had super thick and wavy hairs that may survive fue extractions better, being out of body for longer hours inside a dish better, id say that would be good.  especially, with the motorized extraction tool.  

But based on your hair type and texture. the plan to maximize with fut with more robust grafts and proper slithering would be an advantage.  This can add a higher probability of yielding more surviving grafts in recipient zone.  
 

best of luck with whatever you decide

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Just my honest opinion

I understand both FUE and FUT have their place but from my perspective all of us are going to go bald to various degrees at some point in our lives. The idea of having a scar on the back of your head even at 60 or 70 years old doesn't sound very appealing.  

At least with FUE you can mask the dot scars with smp when your older If you have to. Id honestly rather go bald than have an FUT scar.  

I mean if you wanted to play it safe and yeild is an issue why not just do the FUE over more than one procedure?

 

Edited by johnto

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3 hours ago, johnto said:

I mean if you wanted to play it safe and yeild is an issue why not just do the FUE over more than one procedure?

What I've heard argued is that FUT first is a more reliable way of getting successful grafts from the donor area. More donor grafts don't survive in FUE and the FUE extractions ie the punches in the donor area can damage surrounding unharvested hair

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10 minutes ago, Mark Wolfer said:

What I've heard argued is that FUT first is a more reliable way of getting successful grafts from the donor area. More donor grafts don't survive in FUE and the FUE extractions ie the punches in the donor area can damage surrounding unharvested hair

Not true

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Slight graft survival advantage with FUT, some clinics claim there the same most will admit 3-5% advantage for FUT over FUE

Think whats universally accepted is that FUT followed by FUE in a future - increases your total available lifetime donor hair numbers significantly

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1 hour ago, Mark Wolfer said:

What I've heard argued is that FUT first is a more reliable way of getting successful grafts from the donor area. More donor grafts don't survive in FUE and the FUE extractions ie the punches in the donor area can damage surrounding unharvested hair

I understand.  But once you have that scar on the back of your head there is never going back.  It looks like you keep your hair on the back and sides.  This won't be an option after an FUT to the same extent as an fue

Everyone loses hair density to various degrees over time.  Even people who "never go bald".  What do people do when they have to at some point shave their head but have the fut scar?

 

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41 minutes ago, johnto said:

I understand.  But once you have that scar on the back of your head there is never going back.  It looks like you keep your hair on the back and sides.  This won't be an option after an FUT to the same extent as an fue

Everyone loses hair density to various degrees over time.  Even people who "never go bald".  What do people do when they have to at some point shave their head but have the fut scar?

 

agree with you on the first part depending on the size of the procedure Tho. Don’t forget you get scaring from both. But with fue you get scaring and donor loses density. 
 

if your going to shave your head what’s the point of getting a hair transplant. The chances of you having to shave your head because of not having any more donor will happen more with fue vs fut just going off of more grafts available and survival. Even if the survival rates at a 3-4% difference. mathematically doesn’t make sense unless your a nw2 and can say for sure you won’t lose anymore hair. 
 

I rather have a fut scar with fue or smp in it and knowing I have a lot more hair on head than fue holes with smp and less hair on head and donor. Period. 

Edited by Tbcruz

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This is the hairline drawing that Dr. Rahal suggested. Was a quick one just to get an idea. I think the forelock area could come down a wee bit from what's drawn here. I'd be okay with the temples curving in more along the current receded line on the left side of the pic.

I'm lucky in that the temporal points haven't receded or thinned but my temples themselves are receded and my forelock is thin so quite a lot of density will need to be transplanted.

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