Dr. Rahal - 2,401 FUE NW2

[TorontoMan]

Background: 28 years old with a NW2 type recession and very mild thinning in the crown. Family history: Mother’s side has great hair genetics (her father and brother had a full head of hair well into their late years), MPB present with my father and his late father, however, slow and gradual loss, my father is 65 and has more so thinned throughout the top rather than lost hair. I don’t have siblings, and my first cousin who I share my grandfather with from dad’s side, is 36 years old and shows no signs of thinning. 

* Important to note - I believe that looking at family history could be relevant to some extent, but should not be relied on. If you have experienced hair loss, 95% chance it is from MPB. It's due to genetic variations, your genetics are complex and unique, and MPB is progressive. It is wishful and naive thinking to believe you may “stabilize” one day or try to determine your final form so to say. 

 

Prevention: 

Propecia - Currently 1mg/ED (every day) 

- Started January 1, 2020 at low dosages, and worked up to 1mg a day. Experimented with 0.25mg EOD (every other day) and gradually increased the dose as I felt comfortable.
- More time is necessary to judge entirely how efficacious finasteride has been for me, but I believe it is maintaining my hair. My hope and goal at the core is prevention, any added density or regrowth would be a blessing. 

Minoxidil - Rogaine 5% Foam 1x per night ED

- Started about 1.5 years ago 
- Love/hate relationship, does occasionally irritate my scalp and other times its fine. The application itself is not a hassle as it takes a couple of minutes to apply, however, I'm not a fan of how it leaves my hair feeling clumped and greasy. 
- Hoping for the minoxidil sulfate test to come out asap to determine whether or not topical minoxidil is ultimately effective for me. (Might switch to oral)

Microneedling - 1.5mm 1x a week, no topicals for 24 hours after session. 

- I use Dr. Pen microneedling device 
- Apply it all over my scalp other than my recipient area for the time being. 
- Takes me around 10 minutes, and I rather enjoy it oddly enough its therapeutic for me 

Shampoos - Nizarol 2% ketoconazole, Regenpure DR 1% Ketoconazole, Selsun Blue 2.5% (extra strength). 

- I alternate the use of these. I aim to use nizarol only once a week at most as it drys my scalp, Might use Regenpure once a week on a different day, and will only use Selsun Blue when my scalp feels irritated/itchy, I find this shampoo to be the best at clearing up dandruff and dermatitis. 

- Otherwise I use some mild organic shampoo without sulfates, that includes all the fancy ingredients like biotin, nettle, tea tree, etc etc & currently using Herbal Glo EOD. 

Hair Mask - 

- Occasionally I put on a hair mask, not for prevention towards MPB (will not do anything to address androgenetic activity), but to moisturize my dry scalp. 
- I use coconut oil, castor oil, pumpkin seed oil, peppermint oil, tea tree oil & I use 1 egg yolk that helps bind all the ingredients together so it's not dripping all over the place. 

Supplements - 

- Not super important in my opinion, as I have tested my blood levels for deficiencies for many years even before I realized I had hair loss. My Iron, B12, folate etc levels have always been intact. 
- Still I recommend anyone to test for any deficiencies as they could be hindering healthy hair growth. 
- I take Vitamin D, MSM, a collagen powder that contains biotin ED. 
- Cleaned up the diet and started exercising more consistently 

Considering: 

Oral Minoxidil - 1 - 2.5mg ED
- Still searching for a doctor willing to prescribe it to me

Dutasteride - Topical or Oral
- 1x a week added to my finasteride regimine 

CB-03-01 
- Topical Anti-Androgen to address remaining androgens in the scalp including testosterone & DHT

 

Restoration - 2,401 FUE with Dr. Rahal on September 9, 2020 

My search for a surgeon was narrowed down to Dr. Hasson, Dr. Bisanga & Dr. Rahal. I told myself I would be comfortable going to any of the three as each were very capable doctors for dense hairline work and had over 25+ years of specialization in the industry. Ultimately I made a decision to go with Dr. Rahal as the pandemic offered a unique opportunity for me in terms of timing to get my hair transplant. Being in lockdown meant that I would have the luxury to recover at home for at least the first 4 months, and likely further to 6 or 7 months as well. Dr. Rahal’s clinic offered a date in September that really worked for me, and being the first surgery after a long holiday period that meant 5 days of rest for him and his staff, while also being the only patient they operated on that day were big bonuses for me. 

Day of Procedure - The surgery went better than I could have hoped for, we started at 6:00 am and finished around 1pm, time seemed to fly by with some conversation with Dr. Rahal and his staff who were all friendly, and I felt little to no pain. Initially I was booked for 2,500 grafts, after drawing up a hairline and doing measurements, they determined they would aim closer to 2,200 grafts. They extracted 2,200 grafts and during the incision process, Dr. Rahal determined I would benefit with 200 more grafts added in for density, they flipped me over and extracted again; to total 2,401 grafts. I was returned the difference as I originally paid for 2,500. Dr. Rahal had two main techs who extracted and implanted the grafts, and I believe I counted 4 other female techs who were under microscopes sorting and analyzing the grafts. The team worked very efficiently and one of the women came over to tell me that “my grafts looked very good”, which was nice for me to hear at that moment and hopefully it wasn’t just something she was saying to make me happy. Dr. Rahal checked into the room once in between extraction and placement, and it seemed he had a lot of trust in his staff. Dr. Rahal’s demeanour is calm and soft spoken, and also gets straight to business. 

I spent the night at their guesthouse, and my family and I expected to find accommodation at a hotel in Ottawa the following day as I didn’t know what to expect in terms of recovery, however, to my surprise I felt nearly no pain and we left immediately after the post-op the following day (4.5 hour drive back to Toronto from Ottawa). Fun fact, their clinic in Toronto is a total 7 min drive from my home, but the date they had available in Ottawa that week worked much better so we made the trip instead, which we rather enjoyed anyway. Everything considered, I was very happy with my experience on the merits of the work and attention I felt I was getting, minimal pain & swelling, and overall the immediate recipient area looked clean and dense and the donor looked good and healed quickly. My recovery was standard, I took a high level of precaution for the first two weeks, followed their instructions to the T and the post-op rep was always available to answer my questions. 

 

Why I chose FUE - For a few reasons. Every doctor I consulted with, including Diep, Zarev, H&W (consultant), Pradeep Sethi, Bisanga and of course Rahal told me I was a great candidate for FUE. I was told my donor had a fairly high capacity that I could tap into in case there was some more recession even on medication. The extracting tech ended up telling me he suspected I could achieve approximately up to another 6k, so in total 8k grafts. The other reason is that ever since I started getting haircuts as a kid on my own, I always kept my sides very short, I’ve always faded my hair and there may not have been a time since I was like 13 that my sides were longer than a 3 or 4 guard. So it was important to me to have this option. Lastly, I felt that FUE may offer a greater exit strategy if down the road things didn’t go according to plan and the Norwood Reaper wins the battle. It might be easier to shave down having done an FUE vs FUT, however, I don’t believe it would be easy with either. 

 

Surgery Details: 

Total grafts: 2,401 

Total hairs: 5,458

Average hair per graft: 2.27 

Graft break down: 

Singles - 407

Twos - 1,034

Threes - 857

Fours - 103 

Recipient area size: 43cm^2

Recipient graft density: 55.8cm^2

 

Photo Dump:

Clinic Photos:

 

Day 3:
 

Day 10

Day 14

1 Month 

2 Months 

Month 3

 

This forum helped me get through this process and I'm grateful for it & I wanted to play it forward. I'll try to update month to month, any feedback is appreciated and welcomed. Special thank you to @Melvin-Moderator & @Raphael84 who were very helpful answering the many questions I had. 

 

 

Edited January 4, 2021 by TorontoMan
Order of photos

[TorontoMan]

Month 4:

 

[Britanium]

That was the most comprehensive write up I have read 👏 very interesting indeed. You chose a excellent Dr. I’m jealous of your pre ht hair, let alone how it’s going to end up 😌

Safe to say the growth has kicked off for you already. This is going to be a awesome result, I have no doubts ! 👏

Edited January 4, 2021 by JohnAC71

[DenverBuff1989]

Nice! When did you first start noticing growth? How is the transplant hair texture/shape/behavior in relation to the native hair?

Edited January 4, 2021 by DenverBuff1989

[TorontoMan]

35 minutes ago, JohnAC71 said:

That was the most comprehensive write up I have read 👏 very interesting indeed. You chose a excellent Dr. I’m jealous of your pre ht hair, let alone how it’s going to end up 😌

Safe to say the growth has kicked off for you already. This is going to be a awesome result, I have no doubts ! 👏

Thank you John. I’m trusting the process and staying optimistic 🙏🏻

[TorontoMan]

32 minutes ago, DenverBuff1989 said:

Nice! When did you first start noticing growth? How is the transplant hair texture/shape/behavior in relation to the native hair?

I would say I’m still in that noticing growth stage. The hairs you see have probably started growing between month 3 and 4. I see more hairs sprouting slowly and hopefully there will be more coming. Right now the hair is thin and whispy and it will take the full year for them to mature and thicken. Atm I keep my native hair forward and it covers the thinner recipient area well enough 

[DenverBuff1989]

Just now, TorontoMan said:

I would say I’m still in that noticing growth stage. The hairs you see have probably started growing between month 3 and 4. I see more hairs sprouting slowly and hopefully there will be more coming. Right now the hair is thin and whispy and it will take the full year for them to mature and thicken. Atm I keep my native hair forward and it covers the thinner recipient area well enough 

nice! I'm at 2.5 months post-op so will shortly be on the growth phase myself. 

[TorontoMan]

3 minutes ago, DenverBuff1989 said:

nice! I'm at 2.5 months post-op so will shortly be on the growth phase myself. 

Yeah truly the hardest stages are 2-5 months I’d say. Just stay present every day, and good things are coming. 

[Melvin- Admin]

This looks like a home run already, Rahal’s hairlines are spectacular.

[MachoVato]

Looks great so far! 

[giegnosiganoe]

Nice work, you're a very simple case.

What exactly was Rahal's involvement - was it the hairline design and incisions?

[TorontoMan]

9 hours ago, giegnosiganoe said:

Nice work, you're a very simple case.

What exactly was Rahal's involvement - was it the hairline design and incisions?

That’s right 

[Raphael84]

@TorontoMan

Congratulations on your surgery.

Thanks for the mention. It was my pleasure. Wishing you all the best and looking forward to following you progress.

All the best.

[UnbaldEagle]

@TorontoMan, I can't believe I missed your post, buddy.

The work looks state-of-the-art! Well, you had amazing hair to begin with, so I can only congratulate you for choosing Dr. Rahal, because frankly you need a very dense and natural hairline that matches what's behind it and who's better to provide that than the Hairline King. 

I wish you happy growing but I'm 100% sure already it's going to be stellar! 😍

[TorontoMan]

5 hours ago, UnbaldEagle said:

@TorontoMan, I can't believe I missed your post, buddy.

The work looks state-of-the-art! Well, you had amazing hair to begin with, so I can only congratulate you for choosing Dr. Rahal, because frankly you need a very dense and natural hairline that matches what's behind it and who's better to provide that than the Hairline King. 

I wish you happy growing but I'm 100% sure already it's going to be stellar! 😍

Thank you 🙏🏻. Lots of growth to come for both of us. And yeah high density was important to match the native hair & hopefully it becomes a hairline king trademark 

[TorontoMan]

Quick look at donor, yesterday my buddy gave me a hair cut, 0.5 clip nearly shaved, first pic is under normal lighting conditionsthe side of my head and the second is under the harshest light and very zoomed in. 

 

[Britanium]

Your donor looks fantastic 🤛

[deitel130]

Donor looks good. You look like you have no hair loss elsewhere so this 2400 should hopefully make you really glad you did it.

Had a question about adding Dutasteride 1x a week. Was this prescribed by Dr. Rahal or your family doctor? Out of curiosity what made you add Dutasteride to your Finasteride regimen?

Edited January 9, 2021 by deitel130

[TheManeMan]

Can I just say how mind blown I am at your donor region? That is EXACTLY what I want out of a transplant, practically undetectable, especially for over 2000 grafts. I hope all of his patients are like this, thinking of getting a consultation. 

Looks like you are experiencing quick hair growth too; this seems more common among finasteride users from the brief research I have done. Excited to see where you are at in the coming months.

[TorontoMan]

On 1/8/2021 at 9:16 PM, deitel130 said:

Donor looks good. You look like you have no hair loss elsewhere so this 2400 should hopefully make you really glad you did it.

Had a question about adding Dutasteride 1x a week. Was this prescribed by Dr. Rahal or your family doctor? Out of curiosity what made you add Dutasteride to your Finasteride regimen?

Hey I’m sorry I missed this. I’m not on Dutasteride, I just wrote that I’m considering adding it once a week to my finasteride protocol, which is 1mg MWFS (4x a week). Currently still looking into adding topical Dutasteride, as I’ve been reading because of its molecule size and weight, it has a more localized effect rather than going completely systemic. Still need to research more about it but there are clinics that offered the topical formulation. 

[TorontoMan]

7 hours ago, TheManeMan said:

Can I just say how mind blown I am at your donor region? That is EXACTLY what I want out of a transplant, practically undetectable, especially for over 2000 grafts. I hope all of his patients are like this, thinking of getting a consultation. 

Looks like you are experiencing quick hair growth too; this seems more common among finasteride users from the brief research I have done. Excited to see where you are at in the coming months.

Thank you! Yeah I am definitely pleased with the donor so far and it was a concern for me coming into it. But the photos are my hair buzzed down to even slightly below a 0.5mm clip, which is just above a bald fade really. The tech who worked on me was a younger guy, but the clinic vouched for his ability and he was very keen and professional. 

[TorontoMan]

4.5 months with some fibers. First time I’m applying fibers post surgery as I wanted to see if I could lose the hat on occasion if I step outside and in fact it looks pretty good already. I wanted to share this cuz I’ve seen guys create posts asking when they could expect at least decent enough coverage for different things, like their upcoming weddings and such. Little bit of styling with fibers took me a long way today. 
 

[deitel130]

5 minutes ago, TorontoMan said:

Hey I’m sorry I missed this. I’m not on Dutasteride, I just wrote that I’m considering adding it once a week to my finasteride protocol, which is 1mg MWFS (4x a week). Currently still looking into adding topical Dutasteride, as I’ve been reading because of its molecule size and weight, it has a more localized effect rather than going completely systemic. Still need to research more about it but there are clinics that offered the topical formulation. 

Where do you plan on getting topical Dutasteride in Canada?

[TorontoMan]

1 minute ago, deitel130 said:

Where do you plan on getting topical Dutasteride in Canada?

Dr. Mwamba’s clinic offers it. I haven’t ordered it yet but I’ve been in contact with them. 
 

you could email them at info@fueclinic.com

[deitel130]

Isn't that in Europe though? I think customs may be an issue. I've been looking to see if there is something within Canada.