FUE DHT with 3622 grafts Eugenix

[fualopecia]

Ten years on from my first post here! How time flies. It's strange to reflect on how scared I was of hair loss. With the help of everyone else's posts, threads and comments, finasteride/minoxidil and glorious Toppik my outlook has changed significantly. 

I'm now 35 and think it's time to organise my first hair transplant. I've attached some recent photos to demonstrate where my hair situation is at the moment.

History

I started losing hair in my early 20's. I got onto Minoxidil 5% topical daily when I was 23 and started finasteride 1.25mg daily from age 25. It feels like i've lost a lot more hair over the last ten years but I'm grateful for the medications I've been on and that I've had no side effects. My vertex loss has expanded a lot and my frontal hairline and temporal points have receded.  Thanks to toppik, I've be able to successfully conceal most of it. I'm now at the point where I'd like to improve my frontal hairline to frame my face (something concealer can't do by itself). It's getting harder to cover the crown and I don't like the shape of my face with my current hairline and disappearing temporal points.

Medical History

I'm generally pretty healthy and try to eat a balanced predominantly plant based diet during the week. I don't smoke but I drink about 1-2 standard drinks apx 3 nights a week. No other medications/supplements etc. I do have a tendency to scar (hypertrophic scars). Even though I've never had any surgery before, I've got scars from accidental cuts and sport injuries.

Current Medications

Finasteride 1.25mg daily (it is cheaper to get the 5mg tablets and cut them in 4). I was slack for a few years where I was probably only taking it once a week.

Minoxidil 5% topical (1-2x week). I don't like the topical application and have asked a few HT surgeons their thoughts on oral minoxidil - particularly in terms of timing around 

Ketoconazole shampoo 1-2/week

Transplant Surgeons

I'm based in Australia but am willing to travel anywhere for the right surgeon. Whilst I generally think you get what you pay for, I don't have unlimited pockets and am able to spend apx 15- 20K AUD for the first transplant. Given some of the amazing results from places like Turkey, India and Thailand that are within my budget I've sought advice from Ozlem Bolcer in Turkey, Eugenix in India and Dr Path in Thailand. Very open to any other recommendations however as I want to get this first decision right.

Current advice

Eugenix (India - preferably Arika, Pradeep or Priyadarshani):  They have said I am Norwood 3V and suggested 2500-2700 grafts to the front and 1500-1700 to the crown with 3000-3200 scalp grafts and 1000-1400 from the beard. We have a phone call coming up and I've asked if a video call is possible.

Dr Path (Thailand): He has said between 2300 to 2700grafts to the hairline and that he thinks a bell shape hairline will suit me better than a straight hairline. He thinks the crown will be about 2000 grafts. He suggested a mix between FUT/FUE but given my propensity to scar (which he didn't comment on, so I've followed up), I'd prefer FUE if possible which would cost 118baht/graft(!).

Dr Bicer (Turkey): Still waiting for her response. 

Expectations

I'm trying to be realistic and not expecting any miracles. I know this may be one of other HT's in the future. It's a marathon and not a race but given I spend most days thinking about my hair and hairloss, I think I am prepared to move toward thinking about the HT daily instead. I certainly don't want to give up and just shave my head. I'm not expecting a teenagers low hairline, I just want an improvement on what I have currently and to be able to better frame my face. That is my main priority. I don't mind if I still need to use hair concealers and take medications indefinitely. I don't expect high density in my crown, and would even be happy leaving it as it is if I could get a great frontal hairline. A few grafts in the crown for concealer fibres to work on would be great though.

I'm reading lots of threads on here every day and trying to do my research but the best decision I think I can make would be picking a high quality surgeon and team.

Next steps

Once I get a better idea of what the surgeons and teams are like, I would like to do a video consultation for them to get a better idea of my hair. I've asked them all their thoughts on oral minoxidil and duasteride. 

Would love to hear from this forum about what else I could be doing or any other clinics that I should reach out to.

[fualopecia]

I've added some wet hair pics if they help at all.

[fualopecia]

A couple of pics from 2012!!

[NARMAK]

Hi OP, i think Eugenix are certainly a solid option and @Gatsbywoulf be best placed as an Australian to advise you there having travelled to them.

For your hair loss, taking 1mg (sorta) Finasteride daily is good but you could switch to Dutasteride now if you feel you haven't really had side affects as it's even stronger and may help you blocking even more DHT. Also, your Minoxodil application if 1-2x a week is correct. That's woefully inadequate when the dosage is usually 2x a day. You need to increase that and if you combine it with Microneedling once a week at 1mm to 1.5mm with a derma pen, you should see a great increase too in areas hopefully. 

You have got diffuse thinning it seems through the scalp and that usually makes you a tougher candidate too which is why imo getting a solid regimen together can be more important long term. However it does seem that your frontal hairline doesn't look bad in terms of framing so if they maintain that, hopefully it will help to smartly spread your grafts out however, you unfortunately appear to have a sub par beard in terms of density etc. to be used as a donor area. So this makes medication and positive responses even more important alongside a conservative hairline. 

[Melvin- Admin]

You have some great names. I see your crown looks like it has concealer or is this your natural hair, it looks oddly thick in the middle

[HappyMan2021]

Out of the names you mentioned, I think Eugenix is the best shot. You should also consider some of the elite European and NA docs. Yes, traveling from Aus will be a massive pain, but it could be worth it. 

 

[fualopecia]

13 hours ago, NARMAK said:

Hi OP, i think Eugenix are certainly a solid option and @Gatsbywoulf be best placed as an Australian to advise you there having travelled to them.

For your hair loss, taking 1mg (sorta) Finasteride daily is good but you could switch to Dutasteride now if you feel you haven't really had side affects as it's even stronger and may help you blocking even more DHT. Also, your Minoxodil application if 1-2x a week is correct. That's woefully inadequate when the dosage is usually 2x a day. You need to increase that and if you combine it with Microneedling once a week at 1mm to 1.5mm with a derma pen, you should see a great increase too in areas hopefully. 

You have got diffuse thinning it seems through the scalp and that usually makes you a tougher candidate too which is why imo getting a solid regimen together can be more important long term. However it does seem that your frontal hairline doesn't look bad in terms of framing so if they maintain that, hopefully it will help to smartly spread your grafts out however, you unfortunately appear to have a sub par beard in terms of density etc. to be used as a donor area. So this makes medication and positive responses even more important alongside a conservative hairline. 

Hey Narmak.

Thanks for the response. I might make the switch to dutasteride asap and see if I tolerate that. Being more diligent with my finasteride i've noticed some improvement already. I struggle with the minoxidal topically and if can't do it twice a day wonder if the oral form might be better- i'll ask the surgeons too.

Thanks for the tip about microneedling, that sounds great. I'll look up some posts to see how it's done.

In terms of the beard hair, I certainly don't have dense beard hair - have plenty in other parts though. I was surprised Eugenix want to take 1500 grafts from my beard. Given my propensity of scarring, I'd really rather avoid doing the beard grafts in my first HT- until I can see what the scarring looks like on my scalp.

[fualopecia]

5 hours ago, Melvin- Moderator said:

You have some great names. I see your crown looks like it has concealer or is this your natural hair, it looks oddly thick in the middle

Thanks Melvin. Long time admirer of your HT journey! Some residual concealer that didn't wash out. Do you micro-needle too?

[fualopecia]

4 hours ago, HappyMan2021 said:

Out of the names you mentioned, I think Eugenix is the best shot. You should also consider some of the elite European and NA docs. Yes, traveling from Aus will be a massive pain, but it could be worth it. 

 

Thanks Happy Man. Would people like Basinga and Hassan and Wong be the type of elite docs you're talking about? I'd definitely consider consultations with them just worried that they may be double the price of Eugenix - which may be worth it but may be something I can't afford.

[Melvin- Admin]

4 minutes ago, fualopecia said:

Thanks Melvin. Long time admirer of your HT journey! Some residual concealer that didn't wash out. Do you micro-needle too?

Ahh ok makes sense. Looks like you haven’t lost much hair for the past decade. I do believe building a master plan is vital. I would work in sections. Hairline, midscalp, crown. You’re gonna wanna shave too, so the surgeons can really pack grafts where needed.

[DrTBarghouthi]

I came across this and believe that a more conservative approach is needed. I would focus on your frontal and midscalp as they seem to be diffusely thinning. As for the crown, I think the area around your parietal humps is what stands out and would give you good coverage once filled- especially on profile views. I would leave the mid lower crown for now as this saves some grafts. Your full crown would need a good number especially if you consider how it goes towards your midscalp. I think 4000 grafts for these areas will do well. I have taken the liberty of drawing on your photo- apologies for that. As you can see. I suggest leaving the lower mid crown as a smaller circle for now. Other areas including the sides, midscalp and front are ok to address. 

[fualopecia]

Hey everyone. Thanks for your comments and suggestions.

I've ended up chosing Dr Arika Bansal at Eugenix in Delhi given her experience, the initial consultation and most importantly the overwhelmingly positive reviews on here. Pre operatively she suggested commencing dutasteride 1mg on the weekends and continue finasteride during the weekdays. 

I'm sitting in my hotel room in Gurugram with several different feelings as I embark on the start of the transplant tonight! Fingers and toes crosses. Any tips welcome!

[mr_peanutbutter]

godspeed

[fualopecia]

Before starting this write up of my hair transplant, I just wanted to thank and acknowledge all the contributing members on this forum. The advice, information, shared experiences and feeling of not going through this alone has been instrumental.

Pre op

Planning 

After reaching out to Eugenix via Whatsapp last year, a member of the team replied asking for some basic health and hair loss questions as well as some photos. This information was reviewed by their doctors and was relayed back to me. They annotated some of my photos and included how many grafts they thought would be needed (see earlier post). 

Consultation

I requested a consultation with Dr Bansal who I had done the most research on and was able to have a quick consultation with her whilst she was between procedures. She seemed caring, knowledgable and safe. Of course nothing was guaranteed from the online assessment and I was aware that she would have to examine my hair in person before having a better idea of graft targets. She estimated 2700 grafts to my frontal area and temple points and suggested a second procedure for my crown down the track; all dependent on my donor density and what my hair/skin was like during the procedure. 

Cost

Eugenix have a number of packages which determines the cost per graft. I chose the super premium package with Dr Arika Bansal. This involved her planning the procedure, designing the hairline and performing the slits but no extracting or implanting. It also included accommodation for four nights and airport transfers. I had an early bird discount of 315INR per graft (not inclusive of an 18% tax). If I had my time again, I’m not sure it’s worth paying this much just for her just to design/plan and perform the slits as you get senior technicians doing all the implantation and extractions. If you can afford it and don’t have time to do much research on hairline design etc, then it can be a useful package as Dr Bansal is a gun- and you can sit back and be less involved. I would have liked a package where she did the crucial extractions and implantations too. I believe Dr Das- who is also getting some amazing results -is about 30% cheaper. 

Pre op bloods/instructions

Eugenix requested some basic blood tests which were easy to organise through my GP. I was required to pay a non-refundable deposit of 20,000 INR which I did through a credit card using a secure link they sent me when I was ready to lock in a date. I used the latitude 28 degrees credit card which doesn’t have any annual or international transaction fees. They also advised me that I would need to stop minoxidil 30 days before the procedure but could to continue finasteride and add dutasteride two times a week. They also request stopping alcohol and smoking for a week before and after the procedure.

 

Flights

I chose to travel business class with Air India. Qantas -who also do direct flights to Delhi from Melbourne -has had a bad wrap recently. Business was really nice. I think economy would be difficult due to some of the cultural differences between western and Indian culture around personal space; particularly when trying to protect your recipient areas on the way home. Some of the other advantages of business was that there is more privacy so you can spray you head with saline every couple hours, have space to get comfortable in a sleeping position that protects your head and having access to quicker check in and boarding so you don’t stick out as much on the way home with your surgical cap or fresh scars. 

 

Hotel

The concierge team organised my hotels and transport between the clinic, airport and hotel. I was given the option of the Hilton or the Courtyard (Marriot). The Courtyard seemed to be more modern and had better Google reviews. Both hotels are less than 15mins drive to the clinic (HIlton is closer). I chose to stay an extra day (five nights in total) as I wanted to reduce the risk to my immediate post op care by having to travel. The Indian food at the Courtyard was amazing and the staff were attentive. They were also accommodating of my needs around the procedure and brought my included breakfast to my room each morning. Their rooms have a sun/lounge chair that I found really useful for sleeping on day 0 and day 1 to protect my implanted crown/hairline and temples. I didn’t want to take any risks knowing how much I move in my sleep. Without an Indian number I was unable to create an account for Zomato (their Uber Eats) as it would have been convenient to order food to the hotel for a change. 

 

Airport

I had read about a lot of scams at the Delhi airport; particularly around money exchange and taxi’s. I was assured by the Eugenix concierge team that there was free wifi at the airport and my driver would contact me 1 hour prior to landing but also be waiting with a sign with the hotel name as you exit the main airport post baggage claim. Unfortunately the wifi in the airport required an Indian phone number to receive the one time code. I’ve subsequently read that you can ask a staff member at the airport to assist by giving you a code/token to access wifi. I’ve told Eugenix to look into it and provide future international travellers with the details. I also avoided getting any money out as everything I needed to pay for I could use my travel credit card. 

 

Day of Procedure

 

Arrival

The concierge team told me that a driver would pick me up at 8am on Saturday morning and told me to have a decent breakfast as well as not to wear any hair fibres in my hair and a button/zip up shirt that doesn’t need to go on over your head. On arrival you take off your shoes and wear a pair of their crocs around the clinic. I started with the nurse who did a blood pressure, oxygen sats and pulse rate check. She also did tiny test injections of two local anaesthetics on my arm to make sure I wasn’t allergic to them. Nb my date was changed by a day due to a flight cancelation for the surgeon but they went above and beyond to make sure everything was smooth and my schedule wasn’t hindered. 

 

Meds

Before starting, they encouraged me to take an anti-inflammatory (two different types; one to help with pain and one to help with tissue repair and reduce scaring), a probiotic, an antibiotic, an antacid and a one off small dose of an anti-anxiety medication called alprazolam (like a shorter acting valium). If you have any hesitations, I’d recommend speaking to one of the senior doctors as they can explain their rationale and help reassure you. 

 

Payment

I opted to bank transfer as this was the cheapest method. Eugenix charge a 1.5% surcharge on Visa and Mastercard. They asked me to make the bank transfer a week before the procedure. I negotiated to use "Wise" (a money transfer service) as they can process the transfers within a few hours and I wanted to see Eugenix in person before sending them such a large amount of money. I hadn’t used Wise before but it worked really well and their fees were cheaper than the banks. I’d suggest setting up the app/account before travelling and loading it up with money. It’s good to have extra in case they can take more grafts than expected and any surplus can be transferred back to your normal bank account free of charge. Because my procedure was changed to the weekend, my payment was made on a Saturday and didn’t clear until Monday but the team were understanding. 

 

Design
Firstly ‘professional’ photos were taken in a little alcove with the Eugenix backdrop (see below).

Dr Bansal- alongside a posse of nurses/techs and other doctors (as well as someone recording the session for “internal use only”) - then asked me about my expectations and desires. I told her that I wanted to focus on my frontal hairline and temple points to frame my face and not sink too many grafts into my crown but if everything went well a few grafts to the crown for my hair fibres to stick onto would be ideal. I’d watched all the videos they had on hair transplant expectations and hairline design so felt pretty informed already. She thought my donor area was very promising in terms of density and the hair not being too thin or too thick. This was pretty important given I don’t have a dense beard or body hair. She used an eye liner pencil to draw her proposed hairline and areas of implantation. Photos were then repeated and displayed on a screen. She told me the hairline could come down .5cm and we settled on a design we were both happy with. She said we would need between 3200 to 3500 grafts but I was happy with whatever she could safely take. After that I changed into Eugenix scrubs and then they shaved the donor and recipient areas (followed by more photos of course!). 

 

OT

By the time I got into the operating theatre start the procedure it was about 0945hrs. The room was well air conditioned, there was a whiteboard with my name and vitals and a TV that they stream music from YouTube. You could definitely bring your own speaker and playlist if you wanted. 

The local anaesthetic administration was fine. It’s not comfortable but they go to a lot of effort to help reduce the pain by using a little vibrating device, very small insulin needles and even offer a squeeze ball or massage to distract you. I just focused on deep breathing/mindfulness. It’s only uncomfortable for a couple minutes. They didn’t do the whole scalp at once and just did an area at a time; splitting it up during the procedure. They also took some blood for PRP at this stage too. Dr Bansal came in and did the slits from the frontal area and then it was just getting to work extracting and implanting. 

It was a long day (0945 to 2230) of lying in various positions (back, front, side, sitting) while they did their thing. Your eyes are generally covered to protect them from the bright lights but there are constantly people asking you how you are and if you need a bathroom break. They changed teams of nurses and technicians during the day to avoid staff fatigue. Occasionally in a couple of spots I could feel a sharp scratch, but when I let them know, they just topped up the local anaesthetic in that area and it was fine. Lunch was also delicious - I had the vegetarian thali. Highly recommended but very filling so don’t feel pressured to finish it all - especially if you have to then go and lie on your stomach! They really work like a well oiled machine during the procedure. Lots of people come in and out during the day - many didn’t introduce themselves - especially some of the technicians and doctors. I could only tell them apart by the colour of their scrubs. Techs in maroon. Doctors blue. Some of the post care team were in green.

I was a little concerned by the amount of supervision by Dr Bansal as I had done the research and put my faith in her. I had no idea who was doing the extractions and implants. I ended up just trusting the process. Dr Sethi created a good youtube video outlining that regardless of what package you use or who does your procedure, the standards are all really high at Eugenix. Dr Bansal also checked in a couple more times after I expressed my concerns. 

There was only one other small procedure in the theatre next to me but for most of the day it was just me. 

My final graft total was 3622.

2616 into the frontal hairline, 1005 into the crown, 126 into right temple and 190 into left temple.  

After it was all done, I got a little massage, more photos, offers of food and very clear instructions on post op care before being dropped back off at the hotel just after midnight. (I was pretty happy it was so late so I could just sneak up to my room without being seen by people in the lobby). They sent me back with a Eugenix ‘goodie’ bag containing a Yogi book, medications, gauze, betadine, saline/spray bottlle, sterile surgical caps and presciptions/written instructions/medical certificates and medication instructions. I also bought a month supply of their hair multivitamin which was around 1000 INR. 

 

Post op 

After an average night sleep I woke up and set my phone timer to go off every hour to remind me to spray saline onto my recipient areas. There was ooze on the neck pillow which I was told to expect. I got an automated whatsapp text/email reinforcing care instructions and some instructional you tube videos. 

I've never taken so many tablets in my life! In addition to my finasteride/dutasteride mix, there are over 10 other tablets a day for the first 7 days. Because I had my temple points done, I was also told to avoid wearing a hat for 7 days and if I went outside/to the airport, that I would need to wear a sterile surgical hat. Very sexy. 

I returned to the clinic on day 1 for the donor site wash and then again on day 2 as Dr Bansal wanted to review me. She was happy and suggested that I increase my dutasteride to 3 times a week given the increase growth I’d had preop and the breakthrough loss I was getting with finasteride alone. 

As a bonus all of the liquids they gave me (betadine, ointments, small saline spray bottle) were all less than 100mls so I could take them onto the plane with me. 

 

I can’t believe it has finally happened. I look forward to sharing my progress each month for the next year (hopefully!). Now to the next stage; the ugly duckling phase. Eek. 

 

[fualopecia]

See new thread for updates

 

Edited April 4, 2023 by fualopecia