2770 FUT (NW3.5, hairline, temporal points) with Dr Pathomvanich (Dr Path) - DHT Clinic, Bangkok, Thailand (Videos)

[_lshy]

Hey all, Australian here.

I've been looking to get a hair transplant surgery for a long time. COVID struck just as I was getting serious about it so a saga of booking local surgeons, cancelling, denial, frustration and ultimately waiting for the borders to open.

Well, they're open and I booked the first flight to Thailand to see Dr Pathomvanich at the DHT clinic.

As I write this I am a few hours post op and very happy with my experience so far. The clinic was very clean and presentable. The staff were super friendly, really helpful and kept me at ease. There are certainly cheaper clinics, but Dr Path has a legendary reputation with many awards and endorsements on this forums from surgeons like Dr Bloxam.

Looking through his previous cases, I see that his work is definitely on the top end but as you can imagine, I will be second guessing myself right until the results start showing. Again though, Dr Path is calm, confident and his staff are all so reassuring - it puts my mind at ease to know I am in good hands.

My Stats and Objectives

I wanted to restore my hairline as that's primarily the area most affected by my hair loss. I have some thinning on the crown but it's pretty minor cosmetically when compared to the my receding temporal points and high peaks.

Gallery of my hair before surgery

I've been on Dutasteride for 3 years, Finasteride 2 years prior to that. This has halted my hair loss - I don't think I saw much regrowth but no loss is a win unto itself.

Why Dr Path?

I was looking at a lot of surgeons. I was considering going to NYC to see Dr Bloxam. Perhaps Canada for H&W and some suggested clinics out in Spain or HLC in Turkey.

Thailand is close to me in Australia and I imagine I will need multiple surgeries over the course of my life so somewhere close to home is valuable to me so Thailand made sense given there were reputable surgeons there.

I was picking between Dr Laorwong and Dr Path. I feel both are great choices but my gut was telling me to go with Dr Path because he came across as compassionate, he listened and answered my endless questions and he would cite clinical studies / research which is something I value greatly.

Dr Laorwong has more activity, but his reviews are from his clinic and less candid reviews. That's not inherently bad but when Dr Path has pages of unscripted reviews, it adds a lot to picking him.

Everything Dr Path said corroborated my independent findings digging through medical journals and when there was something he was unsure of he would be up front and tell me there is no research on what I am asking.

He has a "no nonsense" approach which I respect. I asked him about PRP during surgery and he explained that there aren't any clinic studies to show it has a benefit in hair restoration surgery but it isn't likely to hurt - which I agreed with. He didn't try to sell me by throwing in extras, all he did was demonstrate through communication that he knew what he was doing and I liked the cut of his jib.

Dr Laorwong results are great though and to my knowledge they use similar techniques - but I had to pick one.

Travel Prep

So. Many. COVID. Tests.

Booking the Thai pass was mental, got approved in 7 days. 

I had to get an HIV and Hep-C test for the surgery, which I sorted in Australia.

Other than that I booked 8 days. Fly to Bangkok on the 4th of December, fly back to Sydney on the 12th December.

Surgery on the 7th December so that's 2 days to buy gifts for friends, surgery then 4 days post op in Bangkok.

Surgical Planning / Pre-Op (Day 0)

I arrived at the DHT Clinic at 8:45am.

I loved the clinic. It was very modern, well lit, clean and professional. The staff were all very friendly and super accommodating. There were no dumb questions and they were not rushing me for anything. I really really appreciated the customer service there and the life and joy the staff put into their work.

I filled out some forms, we did a rapid antigen test for COVID (I had a PCR test done 3 days prior), and after that I got dressed:

At that point I was shuttled into a room where there was a nurse who would take my before photos, then wash my hair.

People have mentioned that in the before/after photos of Dr Path's other patients, he will often have the before photos with wet hair and the after as dry. I get it now. I was instructed to wash my hair with antibacterial shampoo the night before and the morning of the surgery. My hair looked pretty wiry as a result and it was impossible to style. The goal of their photos were to part the hair so that the recession could be adequately observed.

They didn't drench my hair, they just sprayed it two or three times with a small bottle and it didn't change the appearance of my hair significantly. Just needed to do that so they could show the extent of my NW 😆

After my hair was washed, Dr Path walked in and encouraged me to draw what hairline I wanted in the mirror.

This is where I felt greedy, in that moment I could ask for a lower hairline and go crazy but I was taught by other people's experiences that conservative is best with hair transplants.

I went with the middle ground approach and placed the hairline at the bottom of the baby hairs on my middle hairline. The peaks would be brought down to reflect that and my temporal points reconstructed (even as I write this post op, I am having second thoughts that I went too far and brought it down too much. I am so worried it will end up too thin but I gotta stay positive)

Here is a gallery with the hairline design

They set up a laser measuring guide to ensure symmetry between the two sides, then broke it up with some irregularities.

We talked about FUT vs FUE vs FUT+FUE and I said I am happy with whatever has the best cosmetic result. I leaned towards FUT because I had read studies showing there was greater graft survival, more hairs can be harvested and eventually you can do a combination procedure to maximise donor area.

They used this clever gladwrap contraption they placed on my head to chart out the area to cover so they could calculate how many grafts would be required. I thought it was genius because I spent an hour trying to do the same things using a tape measure.

We planned 2600 grafts into the temple peaks and temporal points (side burns).

They gave me 20mg of diazepam as tablets (valium) and we walked into the operating theater. I don't use valium generally so I don't have a tolerance, but somehow I was awake through the whole thing but feeling a very drunk-link intoxication with less dizziness.

The Surgery

In summary; we entered the operating theater at 10:30 am and finished at around 7pm and I had 2770 grafts transplanted.

Strip Removal

The process was quite chill - I lay on my stomach on an adjustable chair that has a face hole (similar to a massage table).

Before each of the initial anesthetic injections were inserted, the nurse would let me know so I wasn't surprised. I wasn't expecting this but a nurse was massaging my legs to distract me from the injections.

I had read that the anesthetic injections hurt a lot but it turns out I felt nearly nothing. A prick every now and then but it was so mild that I laughed to myself at the apprehension I had over it. Felt like the apprehension was worse than the actual injection.

The strip was removed quickly, I only felt some light tugging but no pain at all.

I then got up for a bathroom break. Here's a photo of me post strip-removal.
You can clearly see exactly how many drugs I am on:

Gallery

I then went back into the theater for part two, the incisions.

Incisions

While Dr Path prepares the graft sites on my scalp, the strip is being processed by his technicians. They view the grafts under a microscope and sort them into the groupings. They even let me look at my own follicles on one of their microscopes which was kinda awesome. 

Dr Path premakes the graft sites using a depth control pen then his nurses will use a dilator to expand the site then insert the graft with tweezers.

Below you can see the incision site creation pen configured to be the correct depth for my graft. 

He then places a few test grafts to make sure everything is calibrated correctly.

Once everything is set and ready to go, Dr Path designs the hairline using the pen - creating all of the incisions for the grafts to be placed into.

From there the technicians get to work placing the grafts into the sites.

The operation began at 10:30 and ended at around 7pm, maybe 8pm. It was labour intensive work and the team at the DHT clinic are incredible.

We broke for lunch about 60% the way through and I got a local dish that I love. Fried pork mince with basil, was so damn good.

Immediately Post Op

Looking at myself in the mirror after the surgery was surreal. I was looking like one of the many heads I had seen online immediately post op.

Once everything was done, they gave me some anesthetic for the ride home (warning me it might hurt later on). I paid for the extra grafts. They gave me instructions on the medications, told me not to bump my head on the taxi door and I headed back to the hotel

The First Night (Day 0 Night)

I might be weird but I have had sunburns that hurt more than this. I rate the pain a 1 or a 2. I barely feel the donor area - feels kind of like a dull low droning of an ache. If I lie directly on it it lets me know that for sure but I figured out a way to suspend my donor area above my pillow without causing any discomfort.

I got my travel pillow, flipped it on its side and placed my donor area between the two cushion bits. 

I got maybe 4 or 5 hours sleep - not from pain but from worrying if I brought the hairline too low or if the results are going to look terrible 😆

Post Operative Care

I was invited back the next day for the nurses to wash my hair and show me how to do it. I asked if they wouldn't mind doing it for me for the rest of the week because I was nervous that I would mess it up in the hotel. They were happy for me to come back.

Honestly Dr Path and the staff at DHT clinic are extremely friendly. Everyone is laughing and smiling (though their masks). The clinic is very professional, I felt at ease the moment I walked in.

 

Edited December 18, 2021 by _lshy

[_lshy]

Day 1 (Post Op)

This morning I woke up after mildly disturbed sleep. Nearly no pain from the donor site, the best way I can describe it is that it feels like I have been wearing really tight headphones for a few hours and am at the starting point of developing a headache. The worst part is not being able to sleep on my side - but there are worse things 😆

I have been taking Paracetamol every now and then which probably takes the edge off a bit.

I went into the clinic today, the nurses washed my hair, took some photos and gave me a compression band. I'll be going in again tomorrow to get another wash

The Donor Area (scar)

Dr Path said my scalp was very elastic which increases the risk for a larger scar. I am hoping for a 2mm scar but that probably won't be the case.

The scar is long and narrow - going from ear to ear (I prefer this, leads to a less visible scar)

I look pretty much the same as I did yesterday but with less sleep and more swelling

 

[Britanium]

This is just amazing 🤩 such a superb detailed account of your experience! Probably the best I have seen. The work looks superb! Just love the hairline/temple design. You definitely made a much wiser choice in changing from your original choice of Dr 👍🏽

[_lshy]

Thanks @JC71, I'm glad you feel that way. Having known the difficulty of being on the other end, searching for a surgeon - I only hope my experience will help the next person make an informed decision

EDIT: My only other hope is that this all grows out perfectly 🤣

Edited December 8, 2021 by _lshy

[Britanium]

3 minutes ago, _lshy said:

Thanks @JC71, I'm glad you feel that way. Having known the difficulty of being on the other end, searching for a surgeon - I only hope my experience will help the next person make an informed decision

EDIT: My only other hope is that this all grows out perfectly 🤣

Yes growing out perfectly is number 1 😂

[Gatsby]

Incredible write up @_lshy! Very happy for you mate and that scar looks pencil thin. Now tell me the wait wasn’t worth it? 😉 Probably gave you more time to make a more educated and well researched decision. Enjoy your recovery in the land of 1,000 smiles. All the best and happy growing! 👌

[Melvin- Admin]

I’m glad you made the right choice 🙌🏼 Dr. Path is one of the best. Look forward to seeing your updates and subbed!

[_lshy]

Day 2

I am mostly having a hard time sleeping because I might be a bit jet lagged and I am used to sleeping on my side. I took some melatonin and got maybe 4 or 5 hours. I will have a bit of a sleep debt to pay off 😆.

I have minimal swelling which is great and I might be good to remove the compression bandage tomorrow.

In Other News

Looks like I might not be allowed entry back into Australia.

It seems Medicare (government body that tracks vaccine status) messed up my identity and I am apparently two people. It breaks their system to get my vaccine status via my passport number.

I spent an hour on the phone with them today and they told me verbatim "you've done everything correctly but the system is broken. We don't know what to do". We tried amending my records to increase the likelihood that the system will identify me the next time I try obtain my international vaccine certificate, but it takes 24 hours for the system to update so I will know tomorrow if I gotta plan for an indefinite stay.

I'm travelling on a New Zealand passport so worst case scenario, I have to wait for either Australia to open up for unvaccinated travellers or NZ to allow anybody in then travel to Australia via the travel bubble.

Haha, yikes

 

 

[Britanium]

Cool, new hair & now new life in Thailand 🤣All change 👍🏽

[Gatsby]

1 hour ago, _lshy said:

I'm travelling on a New Zealand passport so worst case scenario, I have to wait for either Australia to open up for unvaccinated travellers or NZ to allow anybody in then travel to Australia via the travel bubble.

_Ishy are you not vaccinated or is your 'new Medicare alias' unvaccinated?

[_lshy]

I am vaccinated but the name Medicare have for me is different to my name on my passport. When they try to link my passport to my medicare account they get an automated error saying that the passport doesn't match my identity. There is no manual override.

My current course of action is to try change my name in Medicare to better match my passport name - but there are lots of variables. My name is 29 characters long and contains 2 hyphens. I know Medicare set my first and middle names as initials rather than the full names, who knows what they did to the rest of it.

It also takes 24 hours for a name change in Medicare to set, so I might have to extend my stay and keep trying a different variation of my name each day until Medicare figures me out.

I'm probably going to change my name to something like "John Smith" when I get back to Sydney so this doesn't happen again 

Edited December 9, 2021 by _lshy

[_lshy]

All sorted, spent a few hours on the phone to the Australian COVID Vaccine Registrar and the issue was that I am a New Zealand citizen applying for proof of vaccine status from outside Australia.

When we are in the country we have a "permanently temporary" visa automatically assigned to us - but as soon as we leave we don't have any visa. My application for my proof of vaccination failed because I was applying for it from outside Australia, meaning Medicare's system was matching my passport with an Australian identity (me) that did not have a current visa.

Long story short, they granted me a manual exemption and I am all set to return on the 12th of December (2 days from now)

[Britanium]

1 minute ago, _lshy said:

All sorted, spent a few hours on the phone to the Australian COVID Vaccine Registrar and the issue was that I am a New Zealand citizen applying for proof of vaccine status from outside Australia.

When we are in the country we have a "permanently temporary" visa automatically assigned to us - but as soon as we leave we don't have any visa. My application for my proof of vaccination failed because I was applying for it from outside Australia, meaning Medicare's system was matching my passport with an Australian identity (me) that did not have a current visa.

Long story short, they granted me a manual exemption and I am all set to return on the 12th of December (2 days from now)

Anxiety level decreased ? 😉

[_lshy]

Haha, very much so. Honestly, I liked the idea of staying in Bangkok longer - but it's a little different when it's because you can't actually leave 😆

I'm going into the clinic in 45 minutes for a shampoo and checkup. My last shampoo and checkup is tomorrow then it's back to Sydney. Pretty excited to go back and stare at my hairline intensely in the mirror every day for the next 6 months 🤣

My stitches will be removed by my local GP 3 weeks after the surgery date. Dr Path wrote a letter for my GP with instructions on how to remove the stitches.

[Britanium]

6 months ? No it will be 12 months + of intense staring, willing it, taking pics of it and hopefully discussing it here on the forum 😉

[_lshy]

Day 3

Dr Path came in to inspect where I am at with my recovery and gives a nice rundown. I bought a bunch of oral Minoxidil which I will start using now (I had been avoiding topical Minoxidil because it's too much effort and it might kill my cat).

So now my medication stack is 1 x 0.5mg Dutasteride EOD and 1 x 5mg Minoxidil (oral) EOD.

After that they washed my hair and gave me a run down on how to do it myself when I am back in Sydney

I feel obligated to say I am not sponsored or anything, just making these videos because I want to give back to this forum for helping me get here 

Edited December 10, 2021 by _lshy

[Britanium]

Excellent stuff @_lshy 👍🏽

[_lshy]

Day 4

Last day in Bangkok today! Went to the clinic for my last shampoo session and said bye to everyone.

Loved my experience, thrilled with everything so far - can't wait to see these grafts start growing!

The clinic left me a momento to remember the clinic by 

Will continue to update this over the coming months with my progress

[_lshy]

We removed my compression bandage today and I noticed my donor site is starting to swell, get a bit sore and hot. It's about a 3/10 pain score maybe.

Significantly less painful than plucking a hair but I certainly feel it more than I did in the first few days.

My flight back to Sydney is in 12 hours. I still cannot believe this happened.

 

 

[Britanium]

Safe journey back 🙏

[Melvin- Admin]

7 hours ago, _lshy said:

We removed my compression bandage today and I noticed my donor site is starting to swell, get a bit sore and hot. It's about a 3/10 pain score maybe.

Significantly less painful than plucking a hair but I certainly feel it more than I did in the first few days.

My flight back to Sydney is in 12 hours. I still cannot believe this happened.

 

 

So happy for you man, where did you get your sleep pillow? 

[_lshy]

I got it at one of the shops after customs at Sydney airport. It cost around a billion dollars (actually $45), along with a $15 bottle of water 😅

Edited December 11, 2021 by _lshy

[Sammy]

It looks great mate, can you share how much did it cost? And why did you use FUT instead of FUE method 

[_lshy]

Day 6

Back in Sydney today, shampooed my hair after the flight home. It was pretty bizarre being 1 of maybe 15 people on a boeing 777, but I got an entire row to myself and got to fully lie down the whole ride over.

What's absolutely crazy is I met a stranger in his 70s on the same flight, got chatting and he had actually had several surgeries from Dr Path in the past and was considering another!

Looking at the stubble now, I can really appreciate how well considered the placement of the graft directions are. The density along the hairline is higher than the back and it's obvious that they are single grafts. According to Dr Path I yielded mostly doubles which I believe is not great, not terrible. I can't tell yet but I feel like my temporal points will have a lower density than I want, but we'll see where things land in a year.

Quote

It looks great mate, can you share how much did it cost?

Thanks mate. It was around 10k AUD (7k USD) for 2770 grafts via FUT ($3.6/graft) and another 3k AUD for the flights, hotel and souvenirs (also an unforgettable trip to an incredible city, I am already planning my non-HT return).

Quote

And why did you use FUT instead of FUE method 

There are several reasons, mostly it's about my long term play. I expect to need multiple surgeries so I had to consider total graft yield for future procedures as well as graft quality (and related graft survival) as I don't want to be wasting grafts and I want the result to be dense and natural. 

Generally, with FUT is considered a more consistent way to ensure high quality grafts [2], though with a competent surgeon it's certainly possible to get high graft quality and related graft survival from FUE [1] (I believe Dr Path is capable of this).

With FUT, the strip is removed and dissected into follicular units under a microscope. The contents of the strip are easily visible and the strip isn't moving. Where with FUE the surgeon extracts the follicular unit from the scalp directly and attempts to achieve the same (or ideally better) graft quality as that attainable via strip dissection.

Some studies show higher survival rates with FUT when compared to FUE in a clinical setting [3], though other show similar results [1]. Looking at the after transplant buzz cut, I certainly couldn't afford to lose 20% of the transplanted grafts.

The issue with FUE is that it leaves more room for error and surgeons need to be more careful with how the grafts are handled outside of the body. A graft left outside the body for 6 hours reduces its survival rate to 86% [4] and requires surgeons to take additional precautions with their storage (like closer temperature management or enriched storage solutions). FUT grafts have a lot more tissue on them, so they are more resilient to being outside the body for longer.

Lastly graft yield is greater with FUT. I am almost expecting to need another surgery in 1.5 years to touch up the hairline and achieve the best cosmetic outcome I can. Though I am also taking Dutasteride (and now oral Minoxidil), I expect I will be throwing in a few grafts into my mid forelock and possibly crown.

Though the extraction method is only half the battle. There are considerations on the other side to enhance survival - implanter pens ve pre-made slits, needle size, etc. Those factors are surgeon specific though and unrelated to how they get the grafts (i.e. FUT vs FUE).

I normally wear a mid fade and the scar is above where I normally start my fade. Additionally, SMP (or even a makeup pencil) is enough to make the scar practically invisible. People who go have more aggressive fades might need to consider FUE more or FUT + SMP

Ultimately, I am a guy who suffers from balding - I don't have the expectation that I can do a surgical procedure and look untouched. I also don't mind sharing with people that I got it done so I am not embarrassed by the scar.

Everyone is different but for my value set, it's a fair compromise to increase the chances of the best possible cosmetic outcome.

References: 

1. FUT vs. FUE Graft Survival: A Side-by-Side Study of 3 Patients
2. A Morphologic Classification of Follicular Unit Excision (FUE) Grafts
3. FUE vs. FUT-MD: Study of 1,780 Follicles in Four Patients
4. Review of Factors Affecting the Growth and Survival of Follicular Grafts

Edited December 13, 2021 by _lshy

[_lshy]

Day 11

The grafted hairs are in place, looking like a buzz cut. I have noticed the redness is reducing and if all of these end up growing, I think I'll be really happy with the result.

Looking at the buzz cut grafts, I know they will shed but in the back of my mind I know that 1 in 20 patients have their hair grow right away and I can't help but hold onto that hope 😆

I didn't have any scabs which I think is because I had hair washing done at the clinic. There was lots of crusting though - which I softened in the shower and shampooed off 

Buuut on day 9 I was feeling confident as the hairs are all in place and everything feels pretty settled so I started having hot showers again - washing my scalp with hot water and baby shampoo. Did this on day 10 as well. I just found out that hot water is still not good until the end of the second week so I am a little concerned I compromised my results.

Honestly, overall I haven't been too careful. Days 1 - 3 I sprayed saline solution every hour, sometimes every 2 hours, a bit of sight seeing on day 4, yeah now showering with hot water. I'm a sucker for impulse and now I'm looking at the buzz cut and wondering if I cut my potential graft survival in half.

I guess we will see but my god do these days move at a crawl

Gallery Link

Edited December 24, 2021 by _lshy