My consultations with Dr. Mwamba and Dr. Couto

[Prof101]

 

Background: I am 42, heading to NW6 or even NW7 but on meds and been +- stable for the last 5 years. In fact some improvement the last year after dermarolling and massaging. My problem is that I have LOW donor density. Most doctors (Feller, Mwamba, Hasson, Mohebi,..) estimated that my absolute max is 3.5-4K of grafts. On the lower range Hasson will not do more than 2.5-3K. 

Therefore I either need to think about FIT (harvesting beard hair in the donor area) OR a magician. Which is why I paid visit to Dr. Mwamba and Dr. Couto lately, respectively. 

 

Dr. Mwamba in 2022 (in person consultation) 

I have seen many surgeons in the US, and no one has spent any time measuring anything on my scalp except for Dr. Mohebi. Dr. Mwamba is most thorough on this level and I really appreciated it. He took his time with the scope to count my density in various areas, measure the potential progress and tally up the donor area. He found that I have nearly 9K of available donor hair and he is comfortable using 3K. 

He said he can restore the mature hairline and top with 3K. He is open to FIT in order to do a second procedure for the crown. Harvesting 2K more donor but replenishing the donor with beard hair, which is plentiful. 

For this to look good however we talked about me having to keep my hair short on the sides and back. As otherwise the beard hair would stick out the more we use of them. The more FIT I do, say I need 3K, the more I would be looking at having to wear an upper cut type of haircut. 

He is very nice and answered all questions. He said the office will type up the findings and send me that together with the recommendations. (I am nervous they have not been responding but hopefully they will soon). 

I asked him about scars. He said the FUE punches these days do not leave scars (which I believe because I have seen many cases on this forum without observable scars), and that applies to the beard as well he said. He said the beard is even better at healing than the scalp and it is very rare to see anything after.

The consultation is not free but very affordable and worth every penny. 

 

Dr. Couto in 2022 (in person consultation, free) 

 

I have long been impressed with Couto's results and I really feel lucky that I managed to get an in person consultation with him. He is known to have wait lines of 2 years + sometimes. Also there is an aura of mystery around him, similar to Zarev: unbelievable results online, but not many reviewers online. I think now I know why. 

He is about one of the nicest and down to earth doctors that I have seen and he spent a FULL HOUR with me. I really have no idea why he was so generous with his time. I ran out of questions and things to talk about, and he showed me around the office and so on. 

He began asking about medications and we talked for about 15 mins at least about the importance of making sure that I am taking my medications. 

He used the scope to look through the scalp, and also examined the skin itself. He did not do the type of counting that Dr. Mwamba did, but he did look closely at my donor area. 

I received one bad news after another: Low density (I knew), my FU have mostly 2s and not many 3s-4s (did not know), my hair is thin (the opinion has been split on this), my head is wide and needs more grafts for a good result, and I have high contrast.  But the worst news of all is that he said FUE leaves scars, as I will explain shortly. 

I asked him about how many grafts I have in total. He said he does not like to make such estimate like this. He said in the op room when they shave my head and start looking at extraction spots and so on he will get a better idea. Plus the availability will depend on how my hair will look after the transplant. So to his mind it is multi-factorial and I might have more than 3 K (he thinks most likely). 

So I was surprised when he said he is willing to take me and drew a hairline and showed me what he would do (same as Dr Mwamba's idea): Hairline and top, stop short at the crown. THEN wait a FULL YEAR, and go at the crown with whatever we have. He thinks most likely I will have some left for the crown (reiterating that I might have more than 3 K). 

To him FUE does leave scars. The reason is that he is  meticulous about making sure to have near 0% transection rate. So he wants to use the smallest punch (0.8mm I think), but not smaller to a point that it could cause transection. He wants the full follicle with the bulb (where the stem cells are). This issue is one of two issues that are giving me a pause. 

Unrelated but important: contrary to me prior belief, according to him I would be better off with a longer cut when harvesting is aggressive. I actually thought that those that adopt an upper cut after HT do it to hide any thinning in donor. Would appreciate thoughts on this.  

 

As for the before and afters and the website mystery: I have seen people on here wondering why he does not have his website up, and why he does not have many real cases on this forum. Some suggested (as they do in the case of Zarev as well) that he is very selective in the cases he shows, implying some subpar results or something like that. Well, I can happily report that he scrolled through HUNDREDS of cases in front of me, organized by day of surgery as part of his own in-house portfolio. He also scrolled through his offline website. I kept saying wow wow wow. "How did you manage to do this?", etc. I was really shocked by how good everything looked. He told me when they had the website up they will literally get 300 emails every day. I believe him. Not many surgeons willingly open their folders for you.

So my theory as to why we do not have many reviews on him is that most of his patients are from Spain/Portugal and nearby countries, that they usually would not come to english speaking forums and that they are sufficiently happy and don't feel the need to look elsewhere. I cannot say however whether he makes people sign wavers (I am merely mentioning it because a couple of docs in the US do it). 

He then went and introduced me to someone who is on a checkup 6-months post op visit (from spain). Unreal ... as his pictures. But it is true that people in Spain tend to have denser donor areas. So that also explains why there is less drama about HT here. If you got the money you go to Couto or Lorenzo and be done with it. 

In terms of methods, what separate him from the rest is that he does not do more than roughly 1K per patient a day. He only has 2 patients every day, 1K in morning and 1K in afternoon. He explained to me that he wants the grafts to spend the least amount of time outside the body. Also the less trauma to the donor in one day the better. 

 

The wait is very long (Waiting to hear back on dates). But I do not mind that.

 

My main issues are this now:

- All previous docs saw a max of 3K and therefore did not see the crown as being remotely possible without body hair. It seems (if he is honest) he tends to disagree. While he did not promise how much there will be left he said "you have more than 3K" and he wants to wait and see how much we can use. Normally I would be suspicious but for someone who has an excess demand, I don't think he is trying to win me over. I am a difficult case, while he only has to turn on his website for a month to book a full year.  

- Second, I am someone who, if medications fail one day, might end up NW7 in worst case scenario. So the issue with FUE leaving scars (dotted points) is problematic for me. I am assuming that beard to donor grafting (in case I decide to shave it off one day) would completely resolve this issue of scar visibility? I am not too familiar with the tattoo business either. 

So the allure of Dr. Couto is not only his natural results but his Zarev-like magic. Perhaps his super efficiency with grafts usage and survival rate will make a meaningful impact on overall outcome... 

Alternatively I can go with Dr Mwamba and not worry about the scars and work with someone who is ready to replenish the donor area as we go along. 

But Dr. Couto does some magic similar to Zarev and it is really hard to turn down that opportunity. 

Thoughts MUCH appreciated and I hope that me review was helpful as there is a lot of interest in him, with few sources. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited May 3, 2022 by Prof101

[Britanium]

Would you please be kind enough to reduce the text size ? Thanks 😊 

[SLA]

Sounds like you did your research! While both surgeons are world class, I would want to see from both surgeons photos of similar cases to yours and how they turned out.

I would also consider @Eugenix Hair Sciences Eugenix and @Dr. Felipe PittellaDr. Felipe Pittella who have both shown evidence of success with very challenging cases.

This Eugenix case was done on singer Anup Jalota with only 3k scalp grafts and 4k beard grafts. He was a NW6/7. The other thread show the miracle Dr. Pittella pulled off with an NW7 with 'poor' donor in which he intentionally over harvested to provide homogenized density throughout the scalp.

 

 

 

[Britanium]

@Prof101Thanks for reducing the text size 👍🏽 That’s some very impressive ground work you have put in ! I also happen to agree that @Eugenix Hair Sciences+ @Dr. Felipe PittellaAs well as @DrTBarghouthi + Dr Bisanga could also be considered. A couple of things you mentioned… Yes it’s long been my belief that patients are much more likely going to post in their own language/particular countries forums (if at al) I’m a member of a Italian forum, but prefer to post here. And yes it’s not just FUT that will leave a scar, FUE although working with mostly small punches will still leave you with thousands of small white dots ! The only scarring which is particularly difficult to notice is when Beard grafts are taken from under the chin. 

[DrTBarghouthi]

Great research and write up. Can you be kind enough to post more photos of your donor and the areas you are concerned about?

[Prof101]

Thank you for the responses. 

I hope you understand that after seeing world class surgeons - but clearly not all , I am at a point where I would benefit most from comments about the questions/thoughts I raised rather than suggestions of new clinics. I reached a capacity limit for new consultations 

I attached a picture of the donor area. It is deceptively plentiful. No matter how much it lacks of density, my hair characteristics are such that my donor area looks good. It is far from see through. 

The sides are poor though, I admit. I don't have a picture of them (that is discrete enough), but the sides won't handle more than 20% of loss and my surgeons know that. 

Thank you!

 

 

Edited April 29, 2022 by Prof101

[Prof101]

Here you can see what lies underneath what appears to be a a solid donor area .... is a not so solid one.

I think Dr. Feller and Dr. Mohebi here were right, I have a certain level of waviness of thickness that are underestimated. And they hide the poor numbers. 

 

[GHTJourneya]

You mentioned world class doctors, you clearly did some research.

I highly doubt you only have 3K before it looks depleted, typically 4K is the low-end of the spectrum. Regardless, why don't you use 4K and simply do scalp micropigmentation on your donor area, and keep your haircut relatively short, or more like a medium/high fade? This way you can get more grafts and cover the depleted areas. 

Anyways, I would prioritise the frontal part (+temples) and the rest could be covered with body or beard hair, as you said, or even a partial hair system. I had my HT done by Dr. De Freitas. Excellent work as well, really high standards as to donor area/density. Most people have a density around 2-2.5 hairs/graft, so it's absolutely normal that you have more 2s than 3s, like the rest of us. 

I think HT doctors are always parsimonious, they won't tell you that you're an amazing candidate because they don't want you to have unrealistic expectations. It might turn out better than what you think. Best of luck

[Nw7HPE]

5 hours ago, Prof101 said:

Here you can see what lies underneath what appears to be a a solid donor area .... is a not so solid one.

I think Dr. Feller and Dr. Mohebi here were right, I have a certain level of waviness of thickness that are underestimated. And they hide the poor numbers. 

 

Your donor seems pretty strong 

[Nw7HPE]

Thank you for your informative and detailed post , those are some of the top doctors in the industry and I would be comfortable with going to either one . 

You are going to have a great hair transplant . 

[shadowcast]

Regarding scars, I think it's pretty well-established that whether or not you'll have any visible will also partly depend on your skin. So I don't know that going to Couto guarantees visible donor scars/going to Mwamba guarantees no visible donor scars.

I went to Lorenzo, I believe his techs use at least an 0.8mm punch, sometimes up to 0.9mm. I believe I have 0 visible scarring. I'm looking at photos of my donor now from 10 days post-op and the work is almost undetectable.

Also, Lorenzo told me the thing about Spanish people having great donors is bullshit.

Edited April 30, 2022 by shadowcast

[mrmane85]

Personally I would go with Couto if given the opportunity. 

He seems to be the Spanish version of Konior in that he is able to maximise the result/appearance of each graft used and has so many home run results on the Spanish forums. 

But this is just my opinion and it's not based on any real experience, more a gut feeling. 

[Prof101]

30 minutes ago, mrmane85 said:

Personally I would go with Couto if given the opportunity. 

He seems to be the Spanish version of Konior in that he is able to maximise the result/appearance of each graft used and has so many home run results on the Spanish forums. 

But this is just my opinion and it's not based on any real experience, more a gut feeling. 

Thanks. do you have a link to these Spanish forum? 

[OliverAtom]

On 4/30/2022 at 1:29 AM, Prof101 said:

Here you can see what lies underneath what appears to be a a solid donor area .... is a not so solid one.

I think Dr. Feller and Dr. Mohebi here were right, I have a certain level of waviness of thickness that are underestimated. And they hide the poor numbers. 

 

 

Wow, thanks a lot for such a detailed introduction. So much great information about both Dr Mwamba and Dr Couto.

Now it´s up to you to decide. Both doctors have a great reputation and they are a complete warranty. In my opinion, Dr Couto is the best of the moment and if you have the chance to do it with him I wouldnt think it for a minute.

About Spanish Forums, the most famous is: "foro. recuperar el pelo .com"  There you will find lots of cases from not just Dr Couto but also other Spanish and international clinics. 

Did you get a reply from Dr Mwamba clinic? 

Thanks for sharing your experience 😉 

 

 

[Prof101]

Yes, Mwamba responded with the plan. A nice long write-up. 

He estimates I have 45 FU/cm2 in donor area (although this is lower bound, he found some areas up to 60). He calls it below average but to me it sounds like it is VERY LOW!!

Which is why I am really surprised that Couto thinks he can do more than 3K with me. (3K in front and more for crown later...)

But My plan is to go to Couto, and if donor area looks depleted then go to Mwamba for FIT. 

I think the last thing that a hair surgeon want is a depleted donor area, as this becomes a major reputation concern ... "do no harm"

So Couto must know what he is doing, being a top doc with impeccable reputation apparently. 

 

Edited May 3, 2022 by Prof101

[Melvin- Admin]

Be careful believing that any doctor is performing magic. There’s no doubt Cuoto is skilled, but at the end of the day. A surgeon is only as good as the donor and scalp they have to work with. No one has a magic wand to produce more hair. I think you have done some good research. Usually, you should have a good feeling of who would meet your goals after the in person consultation.

[NARMAK]

27 minutes ago, Melvin- Moderator said:

Be careful believing that any doctor is performing magic. There’s no doubt Cuoto is skilled, but at the end of the day. A surgeon is only as good as the donor and scalp they have to work with. No one has a magic wand to produce more hair. I think you have done some good research. Usually, you should have a good feeling of who would meet your goals after the in person consultation.

I completely get what you mean but Dr Zarev almost gives the illusion he has a magic wand

[Prof101]

1 hour ago, Melvin- Moderator said:

Be careful believing that any doctor is performing magic. There’s no doubt Cuoto is skilled, but at the end of the day. A surgeon is only as good as the donor and scalp they have to work with. No one has a magic wand to produce more hair. I think you have done some good research. Usually, you should have a good feeling of who would meet your goals after the in person consultation.

Fully agree. I don't believe in miracles either. Which is why I had to pause and think of why Couto is more optimistic.

But my thinking is as follows. All doctors agree that I have 3K and that they would use it effectively for front/top. And that is Couto's plan in the first surgery.

Therefore his optimism about the possibility of a second surgery is currently immaterial however alluring. I will probably not go for Vertex unless I am convinced I have the supply. 

 

[Prof101]

What I don't understand however is how come my donor area has the appearance to be thick (I even get complements on it) if I have BOTH low density and thin hair. 

That part I never figured out. Only two docs told me my hair caliber (but not density) is good: Mohebi and Feller. 

[A Fue Good Men]

On 4/30/2022 at 5:17 AM, shadowcast said:

Regarding scars, I think it's pretty well-established that whether or not you'll have any visible will also partly depend on your skin. So I don't know that going to Couto guarantees visible donor scars/going to Mwamba guarantees no visible donor scars.

I went to Lorenzo, I believe his techs use at least an 0.8mm punch, sometimes up to 0.9mm. I believe I have 0 visible scarring. I'm looking at photos of my donor now from 10 days post-op and the work is almost undetectable.

Also, Lorenzo told me the thing about Spanish people having great donors is bullshit.

Spanish/Iberian folks, on average, have great donors. One of H&W’s showcase results is a Spanish norwood 6 that they restored in one session. Ive seen it with my own eyes when I was there a couple times.

 

Lorenzo runs a Spanish hair mill (4 patients a day, heavy tech involvement). He uses way more grafts than his peers so his opinion on donors doesn’t mean much to me.

[omarca]

Hi there my friend! I personally consulted with Mwamba and he also try to only harvest a max of 1000k per day. And also if you have to use body hair he uses let say for example 1000k one day from scalp, and the other day 1000K from beard...he does not mix body with scalp procedures in one day. ...so he is also very meticulous about this at least it is my impression! The consultation money... they give it back if you have the procedure with him.

hope this helps.

Also can you post photos from the top and front of head? thanks

[Zinedine]

 

On 5/3/2022 at 7:01 PM, Prof101 said:

Yes, Mwamba responded with the plan. A nice long write-up. 

He estimates I have 45 FU/cm2 in donor area (although this is lower bound, he found some areas up to 60). He calls it below average but to me it sounds like it is VERY LOW!!

Which is why I am really surprised that Couto thinks he can do more than 3K with me. (3K in front and more for crown later...)

But My plan is to go to Couto, and if donor area looks depleted then go to Mwamba for FIT. 

I think the last thing that a hair surgeon want is a depleted donor area, as this becomes a major reputation concern ... "do no harm"

So Couto must know what he is doing, being a top doc with impeccable reputation apparently. 

 

 

Great choice going with Dr Couto as he is said to be the best Hair Transplant surgeon today. Your result would be fantastic for sure. 

 

[mustang]

I had surgery with Couto and can highly recommend him. My density wasn't has great as other patients but results were overall good enough and he his a very nice guy.

One thing I will say, out of all the surgeons and surgeries Dr Couto's was the one that hurt the most BY FAR. Not during surgery but afterwards, I had severe pain in my donor area for almost a month so I am pretty sure he either uses a bigger punch or goes in deeper than other doctors, that might explain his great transection rates.

Again, I can only assume, I never had post op pain in 15 surgeries, only with him

[Big Rome]

how did you manage to get in touch with Dr Couto at FueExoertClinic? 

[Z--]

Couto is a magnificent choice. Seriously, he is top three in the world 100%, if not arguably the best.