My story: 2580 FUE, May 10, 2021 (Microscope diary beginning October 27, 2021)

[Lightmare]

Here I am at the 12 month mark! It's been a roller coaster emotionally but I notice a big improvement from where I started.

Here are some photos of me pre and post op, and now. The first set of photos has my hair parted to isolate the problem areas. The second set of photos is how I actually style my hair (assuming the wind doesn't mess it up).

Here are some pictures with my hair up (the hairline was nonexistent before).

 

Edited May 10, 2022 by Lightmare

[Lightmare]

I also met with my surgeon for my 12 month appointment! They told me that the surgery was a success given the number of grafts planted, a 9/10 result. Overall they were pleased with the growth, and told me that I could wait another 4 months to see the full results of the oral minoxidil upgrade before any more surgeries. They said the finasteride benefit is about 95% apparent by now (12 months of taking finasteride), so the only thing to really wait for is the oral minoxidil (started 2.5mg/day back in March). They believe I have another 2500-3000 grafts left before my donor starts to thin out.

My doctor recommended a couple of options:

1. A second surgery of ~1500 grafts focusing on the front through the midscalp, and extra density for the thinner areas, mostly leaving the crown alone. They mentioned this would really make the result 'pop' just as much as if not more than the first.  Another highly recommended clinic here mentioned recommended that a second surgery would be 3000-3500 if I use beard hair for 500 of those (over a photo consultation) if I wanted full thickness pretty much everywhere.
2. Another option is SMP for a density treatment. They believe I have the hair density needed everywhere except the crown for a pleasing visual thickening effect and recommended an SMP clinic they have sent clients to with good results after their HTs. If I wanted some extra grafts in the crown, a couple hundred could help fill it in and boost the SMP effect back there too.

Given what my doctor said about my available grafts (less than I thought) and the economic uncertainty recently I admit the SMP option sounds appealing to see how my hair holds up over the next few years in case I need to reallocate the donor that I have left.  But I will probably need another HT eventually.  What do you guys think?  I hope to thicken it up, allowing me to wear it a bit shorter with some more robustness to wind.

Edited May 10, 2022 by Lightmare

[Britanium]

I have been reading back through the thread from the beginning, early on I was talking about a second pass. I’m going to say don’t go back to the same clinic for round 2, it’s clear they are under quoted the amount of grafts needed the first time, and imo they are doing it again now. I would be looking at some of the forums recommended list and they other clinics/Drs we normally mention.

Hair Transplants are very rarely “One and done” but this should have more grafts from the beginning, I just think they wanted to hook you to come back for more. 

[rob7331]

You've got a seriously fantastic recorded patient case here - lots of detail, especially with the microscope stuff. I'll be honest that's pretty out of my depth and beyond what I would normally monitor in a hair transplant situation. But kudos for it.

I'll say this however - your yield was excellent, especially when looking at the pre and post op. With a good haircut and some styling I feel you could actually be 'complete' where you are, in the sense of the general public not noticing anything out of the ordinary. But I'll admit the pull to get another HT to 'finish it off' can be enticing. Depending on your donor, I think it's completely feasible to knock it out in one go - reinforcing the front and sprinkling throughout the mid scalp, with a bit left for the crown. I'll leave that up the excellent clinics you've no doubt consulted with.

Regarding SMP, I know very little about it and am not sure I would personally go for it in a situation like yours where you are 80% there. I understand it's worked wonders for others however.

[John1991]

My opinion is that they should've quoted 3000+ grafts (give or take) for the frontal third and then filled in the crown after allocating the grafts in a way that would better frame your face.  For the number of grafts they used and the area they placed them in, this isn't bad, but it's their job to appropriately assess the number of grafts you need to have a more cosmetically significant result in the first place (without another procedure).  I would second what J.A.C. says and advise you not to go back to this clinic.   

Edited May 10, 2022 by John1991

[mafpe]

i'm not sure about your HT survival rate because it looks like theres alot to be filled.

there's two factor that comes to my attention.
1. 2580 graft for quite a big area. it's expected that the hairline is see through due to the lacking density, but that is because you guys are hoping for finas to kick in.
2. your crown area, i'm happy for your crown since i don't see any transplant there, but it did thicken up nicely, meaning finas worked for you, so good decision on both your doc and yourself.

actually im on the contrary to JAC/john's opinion this time, because there was a posibility that finas could helped your hairline to be denser than it is now, and that was the hope why you guys did so little. this worked for your crown. 1500 seems like a low number but you did have 2500 before this, so in total you are putting 4k in your frontal area. granted, it won't be dense enough probably, but it should be okay, given that hair transplant are almost never dense enough unless you give it a second pass, although if you only do 1500, it would only look appropriately dense, (won't look as good as most 2nd pass density fix though).

great thread btw! it's really nice to see the research you did on your own going, plus the microscopic photos!

[Lightmare]

Thanks everyone for your honest feedback.  This is great!  It seems that overall the density was too low, and the planning was on the ultra-conservative/hope fin would help side (it kinda did), but with the right styling this looks pretty good as-is.  I agree with all of the above.  

I am probably not going to return to the same clinic as the density was too low and the price was higher than I'd like to pay again, I mostly wanted to get their assessment in terms of the success of the growth/yield.  I am relieved to hear yield was good as I had some worries about scalp conditions midway through, but those have been all but answered.  If / when I do another surgery it will be with a top clinic recommended on here (I keep seeing amazing results out of Eugenix and there are many others) to finish this off.  

The other thing I'd like some advice on is whether SMP to thicken up my scalp and crown is really a viable option for me at this point given where my hair is now.  If anyone can offer some advice on this that'd be great.  Thinking long term, it might help augment my results without burning through more donor hair, in case my hair loss speeds up somehow (though I plan to take oral fin/min forever).  Additionally is hard to take a week+ off all of my household duties for a transplant+travel+recovery with a world class doctor (in addition to planning all the covid / blood work etc and spending more money) at this point.  The ugly duckling phase also haunts me but I know I'll have to faced it again someday 😄). The timing of something like this is really crucial as I'm super busy with a 3 year old and both my spouse and I have demanding jobs.  Last year I had a perfect opening and I took it to get this HT done, but it was with a local doctor so no need to do the international travel / planning.  That was before I found this forum too - you guys all rock!!

So I'd like to see if SMP would help my situation. If it won't help my situation, or if the cons outweigh to pros, I could live with what I have for a while and save up / plan for my next HT when I can take time off.  I have seen a few folks on here ( @hairthere @EvoXOhio ) that have some experience in combining SMP + HT that I'd love to hear from given my situation, but any advice on that would be most most welcome. 

Edited May 10, 2022 by Lightmare

[Britanium]

Glad to hear you’re considering some of the best clinics if you decide on round 2 👍🏽 @Gatsbyis another person with SMP experience..