NW4/5? | FUT 3412 Grafts | Dr. Zufelt | December 2021

[Rex99]

I’d like to share my experience report of my HT so far and get feedback on the progress I’ve seen to date. Pardon the verbosity, feel free to skip to the pictures and provide feedback.    

 

About me: 40 years old with family history of NW6 on both sides. I was pleasantly surprised that I made it through my 30s without going full NW6. My hairline receded pretty early and developed a bald spot (so NW4) but it wasn’t until 2020-2021 that I began noticing rapid hair loss and the dreaded horseshoe emerging (NW5). I didn’t know hair loss prevention was really a thing until I researched in November of 2021.

 

Medication: I got on fin 1mg/daily November of 2021 with no perceivable side effects so far. \o/ I have avoided min based on my surgeon’s recommendation (he said it’s effectiveness lasts for ~15 years so he recommends waiting to use it until later in life when you need it more).

 

Goals

I have lived with a high hairline for a while and it never bothered me enough to research solutions. The emerging NW6 scared me though so I wanted to slow / stop that as much as I could. Restoring a hairline seemed like a bonus but I wanted it to be conservative and mature. I wanted to do the surgery locally in Salt Lake City (SLC) due to logistics. Cost was not a big factor for me but I did want to have the surgery soon. I also wanted to go as big as I could so as to reduce the number of surgeries. I did not learn about Ultra Refined Follicular Unit Grafting until more recently on this site… had I learned about it before it would have been a goal of mine. 

 

Decision on surgeon and surgery

I only consulted with local surgeons in SLC. In hindsight I wish I had found this site sooner and done some remote ones but somehow I did not find this site during my research phase which was, granted, short but intense. Nearly all of the “surgeons” in the SLC area seemed like jokers. They were plastic surgeons who did HTs on the side with a NeoGraft device. I seemed to know more about HTs after a weekend of research than they did. (This video from Dr. Gary Linkov about the different types of surgeons really resonated with my experience!) The only legitimate surgeon I found in the area was Dr. Zufelt. He has a lot of experience doing FUT and FUE. Similar to all members of the Shapiro group, Dr. Zufelt is a Fellow of the ISHR. This external validation and my conversations with him about realistic expectations and trade offs made me feel comfortable moving forward with him. He also had some pictures of results and they weren’t all cherry picked as his best results so I felt like he was an honest guy overall and wanted to help people similar to how his own HTs had improved his life. 

 

Aside from him, his staff was friendly and could answer a lot of my questions as well. His office is kinda odd. It used to be a group home and seemed low budget (prefab housing) especially compared to the high end offices of the joker plastic surgeons. The juxtaposition of office quality and surgeon skill was interesting as they seemed to be negatively correlated! Surgeon skill and quality >> office quality.

 

After discussing with Dr. Zufelt I decided to go with a FUT given my advanced hair loss and the high likelihood for multiple HTs particularly given my family history. Zufelt cited, and shared with me, the research (done by Shapiro I believe) on FUTs + FUEs combinations providing the highest graft yield and so this approach, starting with a FUT, seemed like the best long term approach. I, of course, don’t like the FUT scar and have some regret about it but at the time my thinking was that HTs are one-way doors regardless and with FUT I would be able to maximize the benefit given the research above. (Yes, I saw the recent video and thread about the debate here; very interesting!). If I had got on medication sooner and had been more proactive perhaps I could have gotten away with a FUE. 

 

Surgery cost and details

On December 17, 2021 I had the FUT surgery. He had estimated 3k grafts but given my goals of going big he said he would try to do as much as possible while being safe. I had a good dense donor area (100cm2 I believe)  and so he was able to get 3,412 grafts. He had quoted $3.50/graft and did 100 of the extra grafts above that quote for free. Included in the cost of the operation was also a PRP at the time of the operation (he includes this for free since previous patients saw much better results with them). I also have the option to have him do free SMP sessions at month 8 if I want to hide the scar more. Along with some post op care package that I opted in for, the total operation was just under $12k.

 

Surgery report:

Dr. Zufelt only does one patient per day these days. I like the fact that he was focussed and not distracted with other patients. He met with me to discuss my goals, drew the hair line and got to work. We agreed to:

• a conservative new hair line with the temples only getting 20cm2 coverage

•  My “horseshoe” area was at about 40cm2 and so the goal was to take that to 60cm2 so that it wouldn't’ appear to be thinning.

•  I asked him to use additional grafts to focus on the crown which he ended up doing. 

 

He and his assistant removed the strip and technicians went to work with microscopes preparing the grafts while he started carefully doing all of the punctures (is that the right term?) himself. We had lunch after which two technicians implanted the grafts. I did not think to ask if he was going to be doing the implants. It seems pretty common for even the best surgeons to have technicians do this portion. I wish I had asked about the technicians training and experience but I did not do that beforehand and, well, the valium was not conducive to critical thinking. My sense is that they had worked for him for a while but I don’t think they were trained nurses (aside from the one who helped with the surgery). He was in the other room while they worked and would check in periodically.

 

He removed the sutures on day 7 and has periodic check-up appointments with me. Dr. Zufelt is quite accessible and answers emails, texts, and phone calls. He is quite personable and so I have no complaints about this aspect of the HT. Whether or not I can recommend him will depend on the results in 12-18 months and I am curious what you all think.

 

Pictures!

 

New hairline lines prior to surgery (I can’t remember if we went with the top or bottom). Check out that immense forehead!

Day 8

He said I didn’t need to shave the recipient area (or the donor area aside from the strip which was covered by the remaining hair easily). As a result you can’t easily see in the photos the grafts he placed on the top of the head where the majority were used.

Day 14

The scabs have mostly given way to the graphs so you can see the new hairline before the shed began. The immense forehead is now merely a massive forehead.

 

Month 2 - the dreaded shed

My hair certainly looked much worse than before the surgery. I started using hair fibers for the first time as a stop gap until future growth. This was all pretty depressing even though I had been warned about it.

 

Month 4 - some growth, not much

 

Month 6 - meh, what do you think?

 

It is probably the lighting but the crown looks worse than month 4 IMO:

The hairline so far:

Right side:

Left side:

 

Overall I am underwhelmed at the progress so far and had expected better results by month 6.   The right temple looks better than the left. Both are patchy but the right is much more filled out. In terms of other areas I don’t notice too much change. I understand that as you move up the head it takes longer to see growth (with the crown taking the longest) so I wasn’t expecting to see much growth there yet. Part of my disappointment in the result so far stems from seeing much better results at month 6 on the forums here. I think I am overly focussing on the temples though and I should be realistic that with the 20cm2 target it is going to not be amazing like other HTs who were able to go all in on the temples (mine will be thinning at best but with combing it over I don’t think it will matter). I’m hoping that I am a late grower and that over the next two months it really starts to develop. That said, I’d like honest feedback from this group on the progress so far. 

 

My biggest concern is how patchy the right side is. There were two techs and I worry that I may be seeing tech bias here (the one on the right was less skilled than the one on the left?). Is it normal to have an asymmetric response? I realize that I should probably just relax and let it play out since I can’t do anything about it but I can’t help but wonder. Thanks in advance for the honest feedback. 

Edited June 24, 2022 by Rex99
bolding

[Gatsby]

39 minutes ago, Rex99 said:

I have avoided min based on my surgeon’s recommendation (he said it’s effectiveness lasts for ~15 years so he recommends waiting to use it until later in life when you need it more).

To be honest I don't understand the logic in this? Minoxidil and Finasteride are preventative measures and are the first line option for MPB before surgery should be considered. I'm not a doctor but I have never heard of this in 37 years. Unfortunately hair loss and hair restoration is all about patience. At six months you have regained your hairline and more density will keep coming in. Also it's great that you are taking finasteride and able to tolerate it! I wouldn't touch the scar before 12 months as it is still changing during the first 12 months as it continues to heal. I have many scars (and I've had SMP) and you risk the ink bleeding if you have SMP performed on young scar tissue. If you have good laxity and choose FUT for your second surgery then there is really not much point in having SMP there. The hairline grafts are singles and look soft and natural. Wishing you all the best and thanks for sharing!

[Rex99]

Thanks for the feedback and advice around the SMP!

Let me try explaining the logic again... His advice was given under the context that I had already decided to get a HT. Given that, if I were to get on Minoxidil now then at around age 65 the effectiveness would start to wane and may halt altogether. Assuming my hair will be in worse shape at age 65 and I plan on living for an additional 15+ years (I do 😉) then by holding off on using it I keep that modality as an option versus using it now. The reasoning made sense to me and I was curious about the quality of results without the Minoxidil overhead so I decided to at least start that approach. 

Edited June 24, 2022 by Rex99
Typo

[Rex99]

 

23 minutes ago, Gatsby said:

If you have good laxity and choose FUT for your second surgery then there is really not much point in having SMP there.

Good point. I do have good laxity and so I am still a good candidate for FUT. I'll probably do another one athough FUE is appealing to avoid the recovery aspects of the FUT scar. The only reason why I would do the SMP would be to allow for shorter haircuts. As of month 5 I couldn't go below a number 5 (4 in some places). I'm hoping that gets better as the scar heals because I would be disappointed if I couldn't do a 3 (I'd like the option to do a fade with a 2 as well).

[Gatsby]

I have scars in my donor (both from strip and repair) and I have had SMP for them. 👍

[SMS]

Rex99,

Thanks for posting.  I read your write up with a lot of interest.  I am in SLC as well, am in a similar situation, and wondered how you were progressing and if you chose to do a second procedure?