Nadimi, Konior, or Shapiro? 1k - 1.5k FUE Second Surgery Hype!

[hybonix]

Hello everyone! After my huge success with SMG, I am looking to book a second HT surgery to fill in my hairline and lower/straighten it if possible. I am looking to undergo a 1000 or 1500 graft FUE in 2022 or 2023. I am not sure if it's wise to rush into another surgery as my first transplant was in October of 2020 (Age 27) and you can see my thread in my signature. I would like to ask the forums if there are any gotchas or things I should think about with booking a second surgery only a year or two after my first.

Additionally, my top surgeon choices are as followed:

1. Dr. Shapiro
2. Konior
3. Nadimi

Since this is a tune-up appointment, I am curious if there are any other great surgeons who can maximize yield out of a low number of grafts. It appears Konior and Nadimi are masters at this, but curious if anyone else has any suggestions. I thought about Hasson, but H&W are more of a big volume clinic and not one for refinement based on my research. So, they are off my list.

What do you guys think? Is it dumb to schedule another appointment so quickly? Any things I should be careful of (shock loss, donor depletion, age, finasteride/minoxidil losing effectiveness causing more hairloss, etc.)? I will be 29/30 for this second surgery as well.

Edited November 19, 2021 by hybonix

[Melvin- Admin]

After a successful surgery with Shapiro, why wouldn't you return?

[hybonix]

27 minutes ago, Melvin- Moderator said:

After a successful surgery with Shapiro, why wouldn't you return?

They are my first choice, but I know how excellent Konior and Nadimi are, so it's tempting to try another surgeon as well. I have always wanted to go to Chicago as well so it would be kind of a mini vacation for me.

[Melvin- Admin]

44 minutes ago, hybonix said:

They are my first choice, but I know how excellent Konior and Nadimi are, so it's tempting to try another surgeon as well. I have always wanted to go to Chicago as well so it would be kind of a mini vacation for me.

I think Konior is one of the very best, so you wouldn't go wrong with him or Nadimi, but I also believe that Shapiro is excellent, and in fact, Dr. Konior has referenced his study, so there is mutual respect. I always think, 'if it ain't broke, don't fix it.' But that's just me. I think Shapiro really did amazing work on you. 

[SLA]

I always err on the cautious side. You are VERY young and could lose a significant amount more hair, possibly even if on Finasteride...or perhaps you develop side effects down the road or a study comes out talking about long term detriments of finasteride or god forbid you get a medical condition in which you can't take finasteride, etc...who knows as a lot can happen.

We all have limited donor hair. If it is me, I would carefully assess with a top HT doctor to learn what my donor potential is and plan from there. Last thing you want to end up with is a front heavy full head of hair with nothing in the midscalp/crown and no resources to fill in.

I think your results look phenomenal!

[Melvin- Admin]

12 minutes ago, SLA said:

I always err on the cautious side. You are VERY young and could lose a significant amount more hair, possibly even if on Finasteride...or perhaps you develop side effects down the road or a study comes out talking about long term detriments of finasteride or god forbid you get a medical condition in which you can't take finasteride, etc...who knows as a lot can happen.

We all have limited donor hair. If it is me, I would carefully assess with a top HT doctor to learn what my donor potential is and plan from there. Last thing you want to end up with is a front heavy full head of hair with nothing in the midscalp/crown and no resources to fill in.

I think your results look phenomenal!

Good points.

[BDK081522]

A word of caution here. You're still relatively young and received a fantastic result from SMG. It's a hairline that will look great for the rest of your life. The design works because it matches a matured hairline with eroded temple points. If you decide to go lower it may start to look a bit unnatural if you didn't address the temple points. To my eye, a key giveaway of a transplant is a lower hairline with receded points. That just doesn't occur in nature. If you lose your temple points it's inherent that you have recession in the hairline. So, if you did lower the hairline, even a cm or so, you would want to recreate your temple points with this restoration. Now you're looking at around 2,000 or more grafts and may still lack the density you desire. It's a slippery slope so just be careful. As you're well aware your donor is a finite resource so sometimes accepting what you've already been given is the most appropriate choice. 

[HappyMan2021]

You had a phenomenal result the 1st go around and seriously look like a new person, congrats. I don't understand why you don't want to go back to Shapiro......

Also who wants to be a tourist after having hair surgery. Besides feeling like sh*t, your scalp will look very odd. True you could wear a hat, but I wouldn't wear a hat until 10 days post op at least. Plus all the walking around, getting in and out of cabs, all the activity heightens your risk of bumping your head (even very slightly) which can cause graft dislodgement for the 1st 10 days.

Also as others have said, you are naturally a NW7 really bad balding. I hope you can acheive your goal NW 1 look, but you need to anticipate future hairloss and graft count. Most of the NW 6/NW 7 patients I see on here become NW 2 or N3 in the best case. 

Edited November 20, 2021 by SadMan2021

[hybonix]

On 11/20/2021 at 11:56 AM, SadMan2021 said:

You had a phenomenal result the 1st go around and seriously look like a new person, congrats. I don't understand why you don't want to go back to Shapiro......

I have decided to go with SMG for my next procedure as they did amazing work for me. 

On 11/19/2021 at 4:59 PM, BDK081522 said:

A word of caution here. You're still relatively young and received a fantastic result from SMG. It's a hairline that will look great for the rest of your life. The design works because it matches a matured hairline with eroded temple points. If you decide to go lower it may start to look a bit unnatural if you didn't address the temple points. To my eye, a key giveaway of a transplant is a lower hairline with receded points. That just doesn't occur in nature. If you lose your temple points it's inherent that you have recession in the hairline. So, if you did lower the hairline, even a cm or so, you would want to recreate your temple points with this restoration. Now you're looking at around 2,000 or more grafts and may still lack the density you desire. It's a slippery slope so just be careful. As you're well aware your donor is a finite resource so sometimes accepting what you've already been given is the most appropriate choice. 

I consulted with SMG and they said the same exact thing. Do not lower the hairline, but add more density to it so that when I get older, the hairline still fits a maturing man and a lot of people go wrong by going low and the transplant does not age well. I wanted to go lower, but with my hair loss, it's best to keep it a little higher. Thank you for the solid advice.

On 11/19/2021 at 3:22 PM, Melvin- Moderator said:

I think Konior is one of the very best, so you wouldn't go wrong with him or Nadimi, but I also believe that Shapiro is excellent, and in fact, Dr. Konior has referenced his study, so there is mutual respect. I always think, 'if it ain't broke, don't fix it.' But that's just me. I think Shapiro really did amazing work on you. 

^ I agree. I actually contacted Konior and this was his response to me on the situation:

Such a class act doctor!!! 

NEXT STEPS:

• SMG suggested  1000 - 1500 FUE grafts  to add more density to the hairline and pack in more grafts in the center as well. They do not want to lower the hairline but fill it in more as Matt told me that low hairline transplants do not age well if I lose more hair.
• I may be scheduling this surgery for August or November of 2022. I may push it to 2023 as well.

[BDK081522]

That's a great decision! SMG is top notch and I'm glad you're sticking with them. They have presented a very wise strategy and you'll be happy in the long run. 

[Britanium]

Great choice ! They will just make your excellent result even better 🤩

[Ryan Rap]

Class act response by Konior. Also I checked your previous result and agree, the hairline will age well. Just increase density and if you do lower it, just do it ever so slightly as not to use up too many grafts needed elsewhere. Best of luck! 

Edited November 24, 2021 by Ryan Rap

[hybonix]

Thanks for all the feedback once again. Should I shoot for 1500 or 2000 grafts? If I did 2000, my total donor supply used would be 5322 giving me roughly another 1 - 2k grafts left in the tank. I really want to lower my hairline just a smidgen and beef it up as well.

[SLA]

17 hours ago, hybonix said:

Thanks for all the feedback once again. Should I shoot for 1500 or 2000 grafts? If I did 2000, my total donor supply used would be 5322 giving me roughly another 1 - 2k grafts left in the tank. I really want to lower my hairline just a smidgen and beef it up as well

I saw your result @hybonixand it looks excellent. Seems as if you have a case of hair greed- I get it :)...especially as a young man.

If you will only have 1-2k grafts left in the tank after this upcoming procedure, I personally would not do anything.

I can't recall your age exactly, but I think you are in your late 20s or early 30s, so you could potentially lose A LOT more hair. I didn't start losing hair until around 32 (I am now 48) and I am nearly a NW6.

Finasteride may hold you for sure, but....it may not. They only implanted into your frontal 3rd and sounds as if you are planning to keep this procedure relegated to the same region (lowering the hairline), so in essence, you will have a maximum of 2k grafts left should the mid-scalp and crown go which is a minimal for those areas. Of course, you could be a candidate to use beard hair, mixed in should those regions go, but it is not as reliable as scalp hair.

Just my 2 cents as a 48 year old with some life experience....think hard about the future :).

[SLA]

...and please know that I am not trying to rain on your parade :). Wishing you the best and encouraging you to keep the future in mind

[hybonix]

5 hours ago, SLA said:

If you will only have 1-2k grafts left in the tank after this upcoming procedure, I personally would not do anything.

I have only harvested 3,332 grafts thus far. If I use 1.5 - 2k more grafts, I will have utilized a total of 4,832 or 5,332 grafts. Average donor supply is 6 - 8k grafts. So, with that number in mind I would have roughly 2 - 3k grafts left to use.

5 hours ago, SLA said:

I can't recall your age exactly, but I think you are in your late 20s or early 30s, so you could potentially lose A LOT more hair. I didn't start losing hair until around 32 (I am now 48) and I am nearly a NW6.

Finasteride may hold you for sure, but....it may not. They only implanted into your frontal 3rd and sounds as if you are planning to keep this procedure relegated to the same region (lowering the hairline), so in essence, you will have a maximum of 2k grafts left should the mid-scalp and crown go which is a minimal for those areas. Of course, you could be a candidate to use beard hair, mixed in should those regions go, but it is not as reliable as scalp hair.

I started to lose my hair at 18 years old and when friends look at pictures of me back then, they can immediately see how thin I was. It got more aggressive as time went on and I was pretty much bald in front third by age 26/27 and my bangs failed to cover it. I am now 28 years old.

Finasteride and oral minoxidil has stabilized my hair and I believe caused some regrowth as my crown has filled in and the hair behind my frontal third is stronger than ever. However, with the above, is it still possible I will lose more as I get older?

Here is were I was before the procedure:

5 hours ago, SLA said:

...and please know that I am not trying to rain on your parade :). Wishing you the best and encouraging you to keep the future in mind

Absolutely understand. I want to be realistic and need to plan accordingly. I appreciate your guidance here.

Edited December 14, 2021 by hybonix

[SLA]

Hi @hybonix- While I hope finasteride and minoxidil will stabilize your hair forever and that there will be additional treatments and/or hair cloning in due time, however, it is a realistic possibility of still losing more hair down the road. I have heard different theories and anecdotes such as finasteride can halt further hairloss forever to it simply kicks the can down the road and can delay (perhaps even for decades) but not forever. Then other attest that finasteride held them steady for a period of time, say 5 years and then it began to lose some efficacy. The truth to all of this is dependent on the individual. So, YES, you can potentially lose more hair down the road. 

I just wouldn't want to see you invest in your frontal 3rd with no resources left for the rest.

As for average donor, are assuming you have the high end of the average donor or have you confirmed this to be true? If you haven't check with them, I would see what SMG thinks about your lifetime available grafts. Also, might be a good idea to address with them what I have been saying as they are the professionals.

Best of luck!

[hybonix]

@SLAThank you for the detailed follow-up. I am not trying to be greedy, but I do want to pack in the hairline a little bit more and add some to one temple point as those hairs did not grow as well as the other side. Maybe I should just shoot for a max of 1 - 1.5k grafts? I am meeting with SMG tomorrow as well and will report back with their advice.

[hybonix]

@SLA @Melvin- ModeratorI am booked for a second surgery on May 31st!!! We are shooting for 1300 - 1600 FUE Grafts depending on how my donor looks. I am super stoked and excited to be working with SMG again. I will be posting another thread tracking my progress for the second surgery. I may do a Youtube video as Melvin suggested, so that SMG has some live content as well.

[HappyMan2021]

@hybonix how far down will SMG bring the hairline? Like is the goal to bring you back to a perfect NW 1, or more realistic NW 2, NW 3, etc.?

[hybonix]

4 hours ago, SadMan2021 said:

@hybonix how far down will SMG bring the hairline? Like is the goal to bring you back to a perfect NW 1, or more realistic NW 2, NW 3, etc.?

We are looking to bring it to a NW 2/3 area. They are going to fill in the corners and pack in the hairline. Additionally, add a little more to the temples to complete the look. When I go in the office, we will have a better idea when they buzz my donor hair to see how many grafts we can use.

Edited December 17, 2021 by hybonix

[SLA]

Best of luck @hybonix!!!

[Melvin- Admin]

17 hours ago, hybonix said:

@SLA @Melvin- ModeratorI am booked for a second surgery on May 31st!!! We are shooting for 1300 - 1600 FUE Grafts depending on how my donor looks. I am super stoked and excited to be working with SMG again. I will be posting another thread tracking my progress for the second surgery. I may do a Youtube video as Melvin suggested, so that SMG has some live content as well.

That would be awesome man, I know Dr. Josephitis has a good YouTube channel.