Review Excerpt: About 200 temple punchouts from Dr. David Josephitis of Shapiro Medical Group. Repair to transplant by Dr. John Diep. 10 days out. And, did Exsomes regenerate my hair and prevent scarring?

[HairRun]

My main procedure was done by Dr Ron Shapiro and I'll post a full review about it as soon as some more growth gets in, but the punchouts are already looking good so I'm posting this part right now. 

Close up the original temple implants by Dr John Diep can be found here

 

The main procedure was performed by Dr Ron Shapiro, and the punchouts were performed by Dr. David Josephitis. Originally they didn't think they'll have time to do the punchouts and may do them at a later date, but Dr. David Josephitis was able to come in and do the punch outs which was awesome. He said he got about 100 on each side, and that he used the smallest punch to extract them. 

Another thing was that I had a wide scar from my previous surgery as you can see from the thread, and the original thinking was that it would also be excised at a later date but they were able to do it this procedure too, which was super appreciated. 

For the first procedure they asked me if I went back to get my sutures removed. I told him that they dissolved on their own. Dr Shapiro said that the dissolvable ones tend to cause inflammation. 

It seems that I was a complicated case due to the way my first surgery was handled. Dr Shapiro also said that my first strip was extracted too high. It seems that he was taking a lot into consideration, so I am super glad I went with someone who had a ton of experience. 

Scarring was my major concern about the punchouts. I scar pretty easily, something I always noticed. One time I got a scratch on my face and went to a dermatologist to prevent any scarring, but she said it shouldn't scar even though I told her I scar easily. The scratch resulted in a scar and she was surprised that it did. Though I've learned that I don't have certain particularly bad scarring characteristics, from my consult with Dr Timothy Carmen he said he didn't see any hypertrophic scarring from my first procedure, and Dr Shapiro said from the wide scar at the back of my head that I didn't have Keloid scaring (I think, not sure if I'm remembering the correct term for each).

Having dark or white dots, or pits was by biggest concern regarding the punchouts. I think I can rest easy now as you can see from the pics. 

I was lazy about taking pictures post-op. I wish I had taken more now because I'm curious about how the healing evolved day-by-day but oh well. 

Post-op or very close to post op

I have to say, when I first saw myself post OP, it was super haunting lol. It was like looking into a dystopian future. Bloody, and I'm a little squeamish at seeing my own blood. I was super old looking cuz the middle part was a replenishment (I still have hair there that was shaved off) so at that moment it just looked like a super thinned scalp, a version of myself that I've been trying to avoid for over a decade .And there was a bunch of the holes from the punchouts at my temples, which at the time I was afraid of would turn into a bunch of polkadot scars. I also have never seen myself bald before, I've never even had my hair short before. My first procedure was with my hair still long, uncut procedure, so going from never seeing myself with even my hair short to that was super shocking lol. 

The day after the procedure, I went back the next morning for a wash, and they said that I'm a fast healer, which was cool to hear. 

A bit post OP

10 days post OP

I'm pretty happy, from even a close distance it seems that the skin at the punchout area is nearly exactly the same as the rest of my skin. It's when you get in really close that you can kinda see some differences, but it's still only 10 days post OP. Visible scarring was a big concern regarding relocating the grafts, so now I can rest pretty easy. 

I've seen other graft removals where the changes to the skin is still visible a while post OP, and I have a tendency to scar, so I think the results speak to the quality of the surgeon. 

Finally, I opted for using exomes at my surgery. I am wondering if it helped prevent scars, and maybe regenerated some hairs. I'm not sure, but that seems to be the consensus to similar healing characteristics observed in the verteporfin trials thread. 

 

As you can see from the thread, the new finer hairs and lack of scars post OP have people concluding that it works, and that it induced some regeneration. I seem to have similar characteristics as you can see from the 10 days post op pics. You can see finer hairs emerging. Before, as far as I can tell, the there were only blunter, thicker hairs implanted into my temples. And there seems to be quite a few post op. Did exomes regenerate my hair ? 

I think the likelier explanation is that the blunter hairs made it really hard to see the finer hairs in the mirror and closeup photos, and those hairs were in the telogen phrase pre-op, but I've been taking a ton of supplements including biotin, and collagen post OP, so may have induced a bunch of hair growth spurts all at once. Thoughts? 

 

update, month 0.5 . 

I don't think it's possible to detect if punchouts were done in that area.

 

 

Only 0.5 month in, and I think there's already no point in updating it further. I'm not even sure if there's any artifacts from the punchouts. If there's any, it's really hard to get it on camera. I just love looking at my temples these days. No more weird grafts, and there's no scarring, just smooth skin there. 

Edited September 18, 2022 by HairRun

[BaldReaper]

Amazing post, thank you very much

[HappyMan2021]

FOLLOWING. I may need to get 50-100ish badly angled temple grafts punched out myself. 

Shapiro/Josephitis is on my radar.

Fairly busy today but I might send you a DM at some point this week @HairRun

[HairRun]

update, month 0.5 . 

I don't think it's possible to detect if punchouts were done in that area.

 

 

 

 

 

 

Only 0.5 month in, and I think there's already no point in updating it further. I'm not even sure if there's any artifacts from the punchouts. If there's any, it's really hard to get it on camera. I just love looking at my temples these days. No more weird grafts, and there's no scarring, just smooth skin there. 

 

 

 

 

 

 

Edited September 17, 2022 by HairRun

[AlexMeister21]

That healed very well. I might have to consider Shapiro as well to fix my mess ups from Diep. Did they say anything about how the scar may have impacted your donor?

[HairRun]

3 hours ago, AlexMeister21 said:

That healed very well. I might have to consider Shapiro as well to fix my mess ups from Diep. Did they say anything about how the scar may have impacted your donor?

He didn't say anything about this, but I have seen another post there a top level doctor said it may have been impacted by damaging the grafts next to the scar. The doctor was from Europe. I tried getting a consult with him but they said they were only accepting in person consults. 

[A Fue Good Men]

It’s a shame that we are continuously seeing sub par work from a recommended surgeon. I think it’s time we reconsider membership for doctors that are not performing at the level that’s expected from this forum.

 

On the flip side, it looks like Shapiro has done some great work at removing the misangled grafts. Barely any scarring noticeable. That’s a testament to their skills and high quality surgical tools.

 

hope you get to where you want to be soon  @HairRun

[RTC]

Most Diep results I see are garbage. He should be removed.

[HairRun]

Another update, I realize there are some times when the skin of the punchout area looks different from the rest, like when I'm out of the shower. But it doesn't seem to correlate to where the punchout holes were. I am realizing that it may be from the first surgery, and may be due to the particular technique used. I couldn't see what was happening for both, but it felt like Dr Shapiro did each of the incisions individually. My procedure with Dr Diep was a long time ago and again, I'm only going by what I felt so I'm not sure if my interpretations are correct, but it felt like he was using a tool with multiple points on it to create many incisions at the same time. 

Another thing was during the debrief, Dr Shapiro said that rubbing with friction could dislodge the grafts. It seemed that with Dr Shapiro the grafts were more secured than with Dr Diep because at the end of the procedure with Dr Diep I dropped something and when I picked it, suddenly him and the two techs got startled and told me not to do that or it could mess up the grafts. 

So I feel like there were definitely differences in the techniques used. 

[Gatsby]

On 9/17/2022 at 6:43 PM, HairRun said:

update, month 0.5 . 

I don't think it's possible to detect if punchouts were done in that area.

 

 

 

 

 

 

Only 0.5 month in, and I think there's already no point in updating it further. I'm not even sure if there's any artifacts from the punchouts. If there's any, it's really hard to get it on camera. I just love looking at my temples these days. No more weird grafts, and there's no scarring, just smooth skin there. 

 

 

 

 

 

 

Zero scarring my friend! 👌

[HairRun]

A recent amazing realization I just had is that I could probably do a beard transplant. I have a really fast and dense beard, that I'm not really into. In my early 20s I used to shave it 2x a day, then got too lazy. So I may be a really good beard transplant candidate. The only issue is that I thought I scarred really easily, and if I'm clean shaved, it might show up. So, it was kinda frustrating to have something on my face that I'm not into and not able to relocate. But, with the results of the FUE, now it's like having maybe 2000-3000 extra grafts in my pocket. My temple skin is more delicate than my jaw skin, so I guess a lot could be taken out without scarring. 

In my next procedure, I'm gonna see what's possible with filling in my fut scars with them and see what the healing and yield is is like. If it's good, I may go nuts for a more youthful density and hairline. 

Edited September 19, 2022 by HairRun

[FUT4000]

I might have missed it in your write up but what was the reason they decided to punch out your temples and give you a higher hairline with larger forehead versus filling in your temples? 

[follically challenged]

On 9/19/2022 at 4:50 AM, HairRun said:

My procedure with Dr Diep was a long time ago and again, I'm only going by what I felt so I'm not sure if my interpretations are correct, but it felt like he was using a tool with multiple points on it to create many incisions at the same time. 

Yikes. I'm all for efficiency but....such a tool sounds barbaric

[HairRun]

On 9/25/2022 at 8:15 AM, Corbyn said:

 

Are we talking about this Dr Diep???
 

If yes then I'm honestly I'm shocked cos Dr Diep was my to 5 doctors whose clips I would watch on youtube all the time. But since I'm from Southeast Asia I knew very earIy on that I would never be able to spend so much of money to head to States and afford his transplants. Whatever happened? Do you reckon is his skills or that the patients were unsuitable candidates for HTs in the first place??

Yes, that's the same doctor. I too was drawn to him by his extensive youtube channel. I have since learned to rely on the independent patient reviews, instead of their self published portfolio. If you search this doctors name on here, you'll find many had similar patients issues with their results to me. 

From what I gathered in my other consultations with both top hair transplant doctors or their trusted patient advocates, is that not the best technique was used in my procedure. One of which criticized his work on my transplant live on hair (I submitted my photos for the consultation) 

 

Somehow the hairline ended up lower than what we agreed upon during our consultation. The placement, angles, and resulting hairline design are the doctor's technique and I don't believe depend on my biology,. I also seemed to have a low yield, which some other patients of Dr Diep also experienced, it can not be ruled out that it might be my particular biology, which is one of the many reasons I picked Dr Shapiro, who I rated number 1 in the world for complicated cases. 

Other people who have had procedures with Diep have written more extensively on his techniques, so I recommend doing a search for his name on here. 

There are certainly cases where his work turns out very well. I would like to know what is causing these differences. 

If you are in South East Asia, I believe that there are doctors from Thailand on the recommended list. Have you checked them out yet? 

Edited October 1, 2022 by HairRun

[A Fue Good Men]

On 9/24/2022 at 7:06 AM, follically challenged said:

Yikes. I'm all for efficiency but....such a tool sounds barbaric

This might explain the “cornrow” effect we have been seeing, especially as of note recent

[FUT4000]

On 9/20/2022 at 11:02 AM, FUT4000 said:

I might have missed it in your write up but what was the reason they decided to punch out your temples and give you a higher hairline with larger forehead versus filling in your temples? 

bump. im really interested in the explanation on this

[HairRun]

On 9/20/2022 at 11:02 AM, FUT4000 said:

I might have missed it in your write up but what was the reason they decided to punch out your temples and give you a higher hairline with larger forehead versus filling in your temples? 

Sorry, I missed it the first time, but the angles and graft selection was too poor. They were larger, blunt hairs, and the angles were weird, so they would have been hard to blend in. But having them blended in is also a legit approach. The people I consulted with were split 2:1 of relocate vs blend in. I went with relocating them. 

I'll be re-filling those areas in a future procedure. 

[Festa]

Things are looking good, keep us updated.

[Tiger2050]

Diep needs to be removed for the recommended surgeons list. I know @Melvin- Moderator had a good result from Diep way back but people also have good results from Turkish hair mills if they are lucky. Diep has way too many repair cases on this forum, he’s a bad surgeon. 

Edited October 4, 2022 by Tiger2050

[BaldReaper]

any updates?

[hybonix]

Updates!?