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TorontoMan

If this is possible, why medicate?

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I know we all like to fall victim to clinics marketing their results on YouTube, especially that of dr. Couto, but if a result like this is possible with that many grafts, are we getting to a point where transplants are good enough to suffice for restoration? 
it seems to me that this guy will get complete coverage even if his loss continues. Is this rare? How far could someone expect their donor area to take them?

i ask this of course because if hair transplants could give us all our coverage back, we likely wouldn’t ever medicate, even with less density. Are there a lot of cases where patients opt out of medication and just play their chances with donor management ?

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What works for one patient won't necessarily work for another.  This patient appears to have strong donor characteristics (no retrograde alopecia), a favorable hair loss pattern (his crown is still intact), and he still has native hair in his frontal tuft.  He'll probably be ok without Fin.  However, I'd like to see where his lateral humps are in 10-15 years and if his frontal tuft looks this good after the native hair falls out.  And just because the crown looks good now doesn't mean he won't lose more in that area.  To your point, he has great donor hair to deal with these areas should he continue to lose - not every patient is this lucky.  Still, if you can hold on to your native hair I think you should.  

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He still has a lot of hair left to lose, his crown can open, and his sides can drop. 


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

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Idk if we can say that about his donor characteristics given the video mentions the patient has thin hair and the skin contrast is high. That is if we are to believe the video. 

In terms of the result his hair is quite long so it definitely helps gives the "illusion of density." Ive also had doctors tell me 4000 well placed grafts in the hairline and midcscalp should be enough to get good coverage. So if Cuoto can achieve that result with that few a grafts it does says something about his surgical skill and growth rates. 

But to answer your question about patients opting of medication to "play their chances with donor management" its worth mentioning that the donor thins over time and medications do help retain the strength and quality of the transplanted hair and (like other posters have mentioned) he still has more hair to lose. He will likely have to undergo another operation in the future to handle more loss, but probably not for a while. Time will tell I suppose.

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Usually couto shows also a video of the results while brushing through the patient's hair, I wonder why he didnt do it here. This is much better demonstration of the quality than a simple picture

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"Donor density 80+"  well it could be 100 for all we know.  It certainly looks dense.

The patient has a slightly egg shaped head which is advantageous since the bald area to be treated will be smaller.

The lighting where these videos are taken is always favourable.

I havent checked for a while but there wasn't more than about 100 couto results posted like this over the last 10 years.  If he's doing at least 250 a year then these are the top 5% result.

A good reality check is when walking around, observe the donor areas of people in their 50s, 60s, 70s...


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

763 FUE grafts (2,094 hairs) with Ray Konior, MD - January 2020

My results thread from 1st procedure.

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21 hours ago, TorontoMan said:

I know we all like to fall victim to clinics marketing their results on YouTube, especially that of dr. Couto, but if a result like this is possible with that many grafts, are we getting to a point where transplants are good enough to suffice for restoration? 
it seems to me that this guy will get complete coverage even if his loss continues. Is this rare? How far could someone expect their donor area to take them?

i ask this of course because if hair transplants could give us all our coverage back, we likely wouldn’t ever medicate, even with less density. Are there a lot of cases where patients opt out of medication and just play their chances with donor management ?

Baldness is unpredictable and it also depends on the family history of each individual to what extent he might lose hair. As even in the index patient depicted in the video, he seems to have a lot of pre-existing hair. A transplant would definitely cover the entire scalp in the first sitting itself since he seems to have a good donor. But with age, the hair on the periphery can start to miniaturise. Sure, he could opt to go for multiple procedures as he keeps losing hair but his donor is not going to have the same amount of hair. Plus if a patient is looking to have a considerable density on his scalp after the procedure then less donor can mean a thin coverage and no volume. Also, going for multiple transplants is a hassle as it involves the investment of capital, emotions and time.

For patients who have a lot of pre-existing hair, Finasteride would be highly beneficial if they are comfortable to use it. It is a great medication and can completely stabilise the progression of baldness. They would not only have their hIr maintained but the medication would also revive certain hair that might've been in the process of miniaturisation .


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On 6/30/2020 at 11:49 PM, transplantedphil said:

In terms of the result his hair is quite long so it definitely helps gives the "illusion of density." Ive also had doctors tell me 4000 well placed grafts in the hairline and midcscalp should be enough to get good coverage. So if Cuoto can achieve that result with that few a grafts it does says something about his surgical skill and growth rates.

This patient had 1521 triple hair grafts and 449 four or five hair grafts. That's a total of 1970 triples or higher out of 3225  grafts. The total hairs transplanted are 8601. That's one part of what allows this patient to get great results from 3225 grafts. I would have gotten only about half that amount of hairs from the same number of grafts. Then there's the fact that he has very high sides with little to no crown loss. Third he still has some hair in the area that was covered which helps the overall result.

 

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On 6/30/2020 at 10:58 PM, TorontoMan said:

it seems to me that this guy will get complete coverage even if his loss continues.

This person is classified as a NW 4. You need to take a look at some actual NW 7 people and remember that at some point earlier in their life they had a full head of hair. Then imagine if those NW 7 men had a hair transplants when they were at NW 3 or NW 4. Do you still think those men would be able to continue having transplants to keep full coverage? I'm attaching a picture of Steve Balmer to give you an idea of the difference in the amount of hair between him and the NW 4 patient who got 3225 grafts.

 

1370010889_SteveBalmer1.png.5b1165354480405f02d87ca38ae24699.png

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Here is a random bald guy pic I pulled off the internet. What if he had a hair transplant when his sides were much higher up and he didn't have any crown loss.

 

1629118271_RandomBaldGuy.png.f1cccf29f74273c42a00c52301925b77.png

 

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NW7 pattern loss is actually a pretty uncommon stage to reach, for the majority of AA sufferers. 

A decent donor region, with good hair characteristics and groupings, combined with 750-1000 BHT grafts should provide a NW6 patient with a visually nice head of hair under a skilled surgeon, FUT or FUE

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1 hour ago, BeHappy said:

This person is classified as a NW 4. You need to take a look at some actual NW 7 people and remember that at some point earlier in their life they had a full head of hair. Then imagine if those NW 7 men had a hair transplants when they were at NW 3 or NW 4. Do you still think those men would be able to continue having transplants to keep full coverage? I'm attaching a picture of Steve Balmer to give you an idea of the difference in the amount of hair between him and the NW 4 patient who got 3225 grafts.

 

1370010889_SteveBalmer1.png.5b1165354480405f02d87ca38ae24699.png

You’re definitely right if everyone who has AA will reach that point. My father is 64 and went as far as a NW4 pattern. His hair is generally thinner throughout now which is normal given his age, but we laugh that if he got a transplant now he’d look 20 years younger 

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