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2nd FUT - 2527 Grafts with Dr Ron Shapiro - Nov 2020


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My 1st FUT was on April 2014 with Dr Konior, so almost 7 years since then. Here's where my 1st FUT journey is documented at 

Dr Konior had done a good job with my 1st FUT that I never really had any concerns going again for another FUT if need vs FUE. I've also heard that going FUT before FUE can maximize the grafts that can be taken out, so I started looking for my options. No prizes for guessing who my 1st choice was ( sorry, it wasn't Dr Ron as mentioned in my title ) but Dr Konior. I reached out to him and found out that his prices have skyrocketed. Almost 2.5x than before. And a much longer waiting list. Time to be both happy and sad. Sad because his current price was out of my budget and happy since I knew I made the right choice the first time since he has become so much in demand. I then tried contacting those around me since I did not want to take the flight during this Covid . I am in the midwest so Dr Konior, Dr Panine, Dr Nadimi, Dr Wolf, Dr Haber were all within short drivable distance. I had virtual consultations with Dr Nadimi and Dr Wolf. As I tried to look further, I saw that both Dr Cooley and Dr Ron were almost the exact distance from where I live. 

I talked to Matt from Dr Ron's clinic and Lollie from Dr Cooley's clinic. What I understood after all the talk was that none of them suggested me doing my crown since I am still in my late 30's without any medication. And I had a very large area to cover ( as you can see in my pics). I was disappointed since I thought I could cover it all up. H&Wong  gave the most estimated grafts at 3500. A few others at 3000 but the rest of them wanted to be conservative from 2000-2500 grafts to save a few for the future. 

Dr Cooley's rep said 3000 at the max with lighter crown coverage and Ron's rep said 2000 and can push it to 2500 but not the whole crown. My hairline also had somewhat thinned out at places and I liked Dr Shapiro's hairline. And so I choose him knowing that he's one among the best that's out there, and hairline being one of the deciding factor . 

Attaching a few pics of how my hair look just before the 2nd transplant. I'll update soon on the surgery details which I had about a week ago. 

 

 

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I can totally empathize with your situation, my crown is bothersome as well. It would be great to see some post-op pics, etc. happy growing 🙌🏼

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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Operation Day

I had told Matt to let me know of any cancellations so that I could go in earlier. Their normal schedule would have put me into February next year. We kept going back and forth between a few cancellations and on a Sunday night I got asked if I want to come on the following Thursday. I said I can come. I was told to take a Covid Antigen test and an Antibody test on Monday or at the max on Tuesday since they needed those results before the surgery. Luckily for me, Walgreens had a rapid testing center (antigen test)very close to my house and I could get an appointment with a lab( antibody test) close by on Monday morning itself. 

I then travelled on Wednesday to Minneapolis. It  was more than 9+ hour drive and luckily for me, it snowed the day before I drove, but not on the day I drove. I stayed in Hilton which was very close to the office. Hilton had a Clean Stay Seal on the door which apparently meant that they had disinfected the main touch areas and no one has gone in since then. I was not nervous this time since I had already done a FUT before and so I was calm, saw a movie and slept late.

 

7am - 7:30 am Next day morning, I was told to arrive at 7am. I reached there at 7:05 am. Not bad. Their office was on the 5th floor I think. Once I walked into their office, their receptionist welcomed me by name. That was a surprise. They knew whom to expect and they invited by name. My temperature was then taken. I was offered a bottled of water and I signed a few papers. I was offered a choice of what I wanted for lunch and then waited for Dr Ron to come. The receptionist after a while told me to join her to take a few pics. I think she did not want to waste any time and we went to their small photo session room and clicked a few pics. Back to the main waiting area. A few minutes later, Dr Ron showed up and greeted me. He went on to change his cloths and joined me back to the photo room.  I said I had already taken the pics and then we started going through our plan. I think he might have read through my emails before coming since he knew what I wanted.

7:30am - 8 am He asked what my areas of concerns were if I had unlimited hair and to rank them. I said my crown, filling in  the hairline and the a few grafts on my sides as it had grown lower. He said the crown is a black hole and can taken a lot of grafts specially if I am not on meds. I then switched back the priority to get the shapiro hairline, crown and the sides. He said he will focus on the upward part of the crown and leave the lower part for later to be conservative. As he kept drawing on my head, the areas he wanted to cover, he kept talking about propecia and the various options I had with meds and how much of an impact it can make. Once done with the talk and plan, we headed to the surgery room. I was given the option to use the rest room if I wanted to.

8am - 10am I was given valium , a blanket , and was told to wait for a few minutes for the meds to take effect. Meanwhile I was given a nice massage on my back with a machine by one of their techs. I was given the injections to numb the donor for the strip extraction. It was just a pinch of pain. I was told to lay with my head facing down for them to start extracting the strip. Dr Ron kept doing his job and once in a while I would just mummm if I felt the hint of any pain and they would immediately inject more to keep the area numb. After it was all done, I got up to strech myself and asked how long it took. 2 hours. It was a long and a carefully time taken phase 1 of the surgery. I think with Dr Konior, it was an hour or so. Dr Ron said my laxity was average and my skin was THICK. 

Dr Ron's strip covered the existing one I had. So I would still be left with only 1 strip. This 2nd strip was 2 parts. It was not one long ear to ear strip cut. He did one half of it, stitched it up and then did the next half of it and stitched it up. 1st strip was about 9 cm long and then 2nd was about 17 cm long. So 26 cm long. And 1.5 cm wide. Which means  39cm2 area obtained from the strip. But since I had an existing scar in the strip from my 1st surgery, the actual hair bearing tissue might be of the range 33-35cm2. He used staples instead of sutures. 

10am-12:30 I was then given another bathroom break and Dr   Ron started the incisions. He started off with the hairline. He kept doing the hairline after which he switched to the backside. He said he likes to do that way and then revisit back and forth. He kept asking his techs how the grafts were coming, how many ones, 2s and 3s for him to plan. Around 12:15 he was done  and asked if the lunch had come. They said it would reach by 12:30. He then went back to doing more incisions. 

12:30am - 1pm  Lunch time. They got the food I ordered. I sat in the same chair and had my lunch. Got some apple juice and mint too. 

1pm- 4:30pm  I had seen how they were cutting my strip into 1s and 2s. By lunch they had done cutting it all out. The number was out. 2527 grafts. I thought with that large of a strip, I might have got more grafts, but this was the range they were expecting before the surgery 2000-2500. Dr then told his techs where he had made the incisions and how he wanted the grafts placed. Only 1s in the hairline, 2s on the sides, A mix of 3s and 2s on the back since I did not have that many 3s. The techs then went on their job placing the grafts and Dr Ron showed up now and then to check on the progress. About 4pm, he came back to see the last part of it. They said they were done placing the grafts and there were a few more grafts left. Dr Ron then made some more incisions on the hairline and elsewhere and they finished off the grafts.  During the last 10 mins, they put a video where Janna - their tech I guess was talking about the post- op things that needs to be done and how to take care of my head later. 

4:30pm - 5pm  Dr Ron gave me a mirror and showed me how the grafts were placed and where it was placed. We then went to the photo room and took some post-op pics. He then told me to think about giving the meds a shot since he saw a lot of Telogen hair. He offered me a sample of finasteride and I said I'll start on a low frequency and slowly switch to the higher one if everything seemed fine. Dr Ron is really a nice guy, very gentle and I had a feeling that he wants the best for his patients. We then went to finish off the payment. I got a kit of things I would need for the next few days. Everything went just as expected and he told me to get back to him anytime if needed. 

Summary

Strip:  Strip 1- 9cm long   Strip 2 - 17cm long = 26cm. Width 1.5cm. Area 39cm2. Actual area due to existing scar (subtract 4-6 cm2) = 33=35cm2. 

Grafts: 2527 | # of hairs: 4967 ( 1st:599, 2's:1416, 3's: 512).   Dr said my hair caliber was very large and had high quality and so could give more density than someone else. 

Blade: 1's 0.7 | 2's 0.85  | 3's 0.95   slightly larger incision needed i think because or larger caliber grafts

Follicular Density:  2527/33 to 2527/35 = 72-76cm3. Dr said the average is 75cm2. I was slightly less than average but expected for the 2nd procedure.

Graft Placement: 599 to the hairline |   ~200 2's to the sides/ left temporal recession down to the crown | 100 2's to the side/right recession area behind hairline | 1340 to midscalp and the crown . 

Recipient Area Size: About 80- 100 cm2. 

Density: Few areas 20-25 and other 10-15 where there were pre-existing hair as we go further back to the crown. He said he kept more density in the aesthetically more important places.

 

Attaching a few pics taken on the day of the surgery.

 

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Edited by phantom777
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  • 1 month later...

Night after Surgery

I had bought a neck pillow which helped me avoid touching the pillow directly. Very light swelling on the forehead which I wasn't even aware of until I saw the pics. I sprayed the ATP spray which Dr Ron had given me, every 30 mins or so and then maybe a few time at night whenever I was awake. 

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Posted (edited)

Day 1

I travelled back to my home, the next  morning, about 10 hr drive. I had the option to do a first wash at the clinic this day but then it would delay my drive which I did not want. My wife had accompanied me. I did drive half the distance and I did not feel disturbed at all. No pain or discomfort. My wife continued spraying the ATP spray on my head every now and then while I was driving  😀 Reached home safely and my wife helped me with the first wash. Dr Ron had given the shampoo which I should use along with the ointment that needed to be applied on the strip.  

My 1st surgery with Dr Konior had stiches along with scar vs staples with Dr Ron. I guess that was the reason why my sleep wasn't good now vs lesser discomfort with Dr Konior. I could feel the tension all along the strip. I slept inclined on my bed with the neck pillow. It was an uncomfortable sleep that night due to the staples. No swelling or other pain. 

I also started taking Finasteride. MWF 1mg. My 1st surgery was before my marriage and I did not want to take a chance, but now that I am married with 2 kids, I thought I'll give it a shot. 

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Edited by phantom777
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Thanks JohnAC71.

Dr Ron had asked what I was nervous about before the surgery. I told him I maybe a bit nervous about driving back after the surgery but that I wasn't worried about the surgery at all since I knew I was in good hands.  

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Day 2

Pretty much the same as the 1st day. Same bothering pain along the strip while sleeping, otherwise it was fine. I did not take any medication for the pain though Dr Ron had given some meds to take if I had pain. Not swelling at all. 

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On 11/24/2020 at 2:36 PM, deitel130 said:

Looking forward to see the pics. Are you on any meds? Did Dr. Shapiro use the same strip from the first procedure? How many grafts do you have remaining?   You seem to have thick donor hair which should give you some excellent coverage. 

I just now started using finasteride MWF right after the surgery with Dr Ron. 

Dr Ron used the same strip from the first procedure. I think this was a longer strip than that of Konior's. Now I have just 1 scar. 

Dr Ron told that I might have around 7000 grafts. That would leave me around 1500 hair grafts and then some beard grafts. 

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Following this thread super closely, we have pretty much the same issue. I use concealers at the moment, but I’m hoping to fix it soon. 

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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Was the strip taken from the same area so it included the first FUT scar?

I'm considering going for a second surgery to do the crown...but the doctor indicated that the scar would be larger on a second round.

Excited to follow your progress and hope the best for you!

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7 minutes ago, baldforalongtime said:

Was the strip taken from the same area so it included the first FUT scar?

Yes, the 2nd strip was taken from the same area as the 1st strip.

The 2nd strip was 26x1.5=39cm2 , but due to the 1st strip scar being a part of the 2nd strip, the actual strip area reduced to 33-35cm2 instead of 39cm2.

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27 minutes ago, Melvin-Moderator said:

Following this thread super closely, we have pretty much the same issue. I use concealers at the moment, but I’m hoping to fix it soon. 

Melvin, No one would say you have hair loss ( looking at your face). I guess that's why they say to frame the face first because that makes the biggest difference :)  Growing long hair to cover my crown became a hassle for me, specially whenever the wind blew. Hoping to get rid of this issue by next year. I am also curious to see if the fin will make any difference to my crown. So far no side effects. 

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19 minutes ago, phantom777 said:

Yes, the 2nd strip was taken from the same area as the 1st strip.

The 2nd strip was 26x1.5=39cm2 , but due to the 1st strip scar being a part of the 2nd strip, the actual strip area reduced to 33-35cm2 instead of 39cm2.

Did you do anything for scalp laxity and how is tightness now? I have this irrational fear that me hairline gets pulled higher and higher with each strip removed from the donor area. Kinda like a facelift from the back

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58 minutes ago, baldforalongtime said:

Was the strip taken from the same area so it included the first FUT scar?

I'm considering going for a second surgery to do the crown...but the doctor indicated that the scar would be larger on a second round.

Excited to follow your progress and hope the best for you!

Perform scalp laxity exercises. It helps. At my consultation for my second surgery I was advised I can get 2200 grafts but was advised do the scalp laxity exercises and after about 4 months on surgery day I got 3500. I would have had more but I had a lot of scar tissue from my first strip which had to be removed.

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12 minutes ago, deitel130 said:

Perform scalp laxity exercises. It helps. At my consultation for my second surgery I was advised I can get 2200 grafts but was advised do the scalp laxity exercises and after about 4 months on surgery day I got 3500. I would have had more but I had a lot of scar tissue from my first strip which had to be removed.

What are the exercises they gave you to do?

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43 minutes ago, baldforalongtime said:

Did you do anything for scalp laxity and how is tightness now? 

I had asked Dr Ron to put me on any day a cancelation occurred and so I guess I got a month to do scalp massage which I might have done for maybe 10 mins a day, not religiously though. 

On the day of surgery Dr Ron he should be able to get 2500 after inspecting the laxity but he took 2 hours to take the strip out and staple it. After the surgery he said he injected hyaluronidase, which is something used to loosen the skin to get more grafts. He said I had a thick skin and maybe that's why he had to use that injection. 

I  am finding my scalp loosening hw tightness as the days are passing compared to those initial days after the surgery. 

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1 minute ago, phantom777 said:

I had asked Dr Ron to put me on any day a cancelation occurred and so I guess I got a month to do scalp massage which I might have done for maybe 10 mins a day, not religiously though. 

On the day of surgery Dr Ron he should be able to get 2500 after inspecting the laxity but he took 2 hours to take the strip out and staple it. After the surgery he said he injected hyaluronidase, which is something used to loosen the skin to get more grafts. He said I had a thick skin and maybe that's why he had to use that injection. 

I  am finding my scalp loosening hw tightness as the days are passing compared to those initial days after the surgery. 

Agree the first month the back feels tight but it then starts to feel normal again. Myself, I was spending about an hour each day doing the exercises.

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1 minute ago, deitel130 said:

This was the same video Hasson and Wong had sent me for the scalp massage with the initial assessment quote and graft estimate. 

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32 minutes ago, deitel130 said:

 At my consultation for my second surgery I was advised I can get 2200 grafts but was advised do the scalp laxity exercises and after about 4 months on surgery day I got 3500. I would have had more but I had a lot of scar tissue from my first strip which had to be removed.

Wow , that's a lot of grafts for a 2nd FUT. You really did well with your massage. I got bored after 10-15 mins of massaging my head and my hands started feeling tired, but I guess it paid off for you for your dedication. 

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2 minutes ago, phantom777 said:

Wow , that's a lot of grafts for a 2nd FUT. You really did well with your massage. I got bored after 10-15 mins of massaging my head and my hands started feeling tired, but I guess it paid off for you for your dedication. 

It was definitely not something easy to do but I really wanted to get the most grafts I could. I plan to get my crown filled in next year, I need about 1500 grafts and the plan is to do another strip. I'm gonna try to start the scalp laxity exercises much more in advance.

With Finasteride you should most likely see thickening of thinned hair in the lower crown area. 

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