Dr Couto | 1700 grafts | Sept 2022 | Crown | Confused

[WhereIsMyMind]

it is obviously shock loss. There's no way in hell Couto overharvested such a small area with 1700 grafts. Not even a chance.

[15thaccount]

1 hour ago, WhereIsMyMind said:

it is obviously shock loss. There's no way in hell Couto overharvested such a small area with 1700 grafts. Not even a chance.

Couto doesn’t do the extractions it’s assistant does btw. Although he been doing it for 6 years.  That something people need to know 

[WhereIsMyMind]

I meant the same thing. I don't think any top surgeon should do extractions to be honest. You want him as fresh as possible for incisions and placements which is the actual 80% matter for cosmetic result.

What I mean is that 1700 graft spread out over a big area of scalp, is literally impossible to cause a bald patch, basic math tells you not even 1 in 10 hairs have been extracted from the area

[15thaccount]

2 minutes ago, WhereIsMyMind said:

I meant the same thing. I don't think any top surgeon should do extractions to be honest. You want him as fresh as possible for incisions and placements which is the actual 80% matter for cosmetic result.

What I mean is that 1700 graft spread out over a big area of scalp, is literally impossible to cause a bald patch, basic math tells you not even 1 in 10 hairs have been extracted from the area

See this is the thing , I think the  two main things that define define a good hair transplant .  That is graft survival and donor quality . extractions are fundamental and require good manual dexterity which trained Doctors tend to have over techs . The extraction process and the way they are handled is the main factor in them surviving . Look at bisanga, albeit I think kostis helps him now but he a doctor too who does all the extractions ,  never see one poor yield from him. Freitas who uses techs. I’ve seen poor yield on some Patients on the Spanish forum . Pinto, villa and Ferreira all do extractions and always produce high yield 

[WhereIsMyMind]

The extraction is a purely mechanical thing, if the person who extracts the graft, never transects or hurts it and has 99%+ hitrate (easy to check in plain sight or microscope), why would it matter? What if doing extractions means he will half-ass the incisions (which actually define the cosmetic result) because he is so tired from doing a repetitive mechanical thing?

There is no art in extracting graft, you either damaged it or you didnt.

Actually survival rate is more determined by how long graft is out of your body, and techs help reduce this time. So thats a nice counter-argument too.

Edited December 19, 2022 by WhereIsMyMind

[PizzaWolf]

3 hours ago, 15thaccount said:

See this is the thing , I think the  two main things that define define a good hair transplant .  That is graft survival and donor quality . extractions are fundamental and require good manual dexterity which trained Doctors tend to have over techs . The extraction process and the way they are handled is the main factor in them surviving . Look at bisanga, albeit I think kostis helps him now but he a doctor too who does all the extractions ,  never see one poor yield from him. Freitas who uses techs. I’ve seen poor yield on some Patients on the Spanish forum . Pinto, villa and Ferreira all do extractions and always produce high yield 

Dr. Ximena Villa does zero extractions. She does the implantation on two patients per day, her techs do all the extractions. The fact that you didn't know this speaks to how irrelevant this tech/doctor argument ultimately is in determining consistent results. Every single one of the doctors you've mentioned have produced poor yields, because ALL doctors occasionally do.

[DrMunibAhmad]

10 hours ago, WhereIsMyMind said:

The extraction is a purely mechanical thing, if the person who extracts the graft, never transects or hurts it and has 99%+ hitrate (easy to check in plain sight or microscope), why would it matter? What if doing extractions means he will half-ass the incisions (which actually define the cosmetic result) because he is so tired from doing a repetitive mechanical thing?

There is no art in extracting graft, you either damaged it or you didnt.

Actually survival rate is more determined by how long graft is out of your body, and techs help reduce this time. So thats a nice counter-argument too.

Sorry my friend but I don’t totally agree on this. Choosing and selecting the perfect hairs while extracting to place for example for the hairline, is a part of the artwork. 

Imo many hairlines even made with singles look pluggy or artificial, because many surgeons use triples which have been cut to singles  That doesn’t happen when you select the right singles.  

 

 

Edited December 19, 2022 by DrMunibAhmad

[WhereIsMyMind]

I get your point, but when a tech extracts hairs that are going in the hairline they automatically search for the weakest hairs, and surely the surgeon lets them know to do it, so I see it as a mechanical thing still.

What would you prefer, that your grafts are out of your body for 4 hours because doctor is "selecting the best grafts" and then he has to make incisions after all that work, or that 1 or 2 techs extract your grafts in 1 hour and the grafts stay out of the body only for 1 hour, and then the doctor does the incisions fresh. I would personally choose the 2cnd (if there is a guarantee that the tech team is properly trained). I dont see much art in this repetitive process so I think it makes sense many top surgeons have ended up with this schedule.

Edited December 19, 2022 by WhereIsMyMind

[DrMunibAhmad]

One of the problems is that you can’t tell looking at a graft if it is miniaturised or a soft single if you don’t know where you took it from. 

I get your point. But i stil like to do everything myself. The time out of body of every graft is less ten 4 hours. 

[Prof101]

he only extracted from the sides, which was surprising to me, because the back is much thicker and the sides weren't the thickest (but were NOT see through, coverage was perfectly normal). 

So you guys think this is shock loss? If so, how long should I wait for it to grow back 

I would also be surprised if such a top surgeon over-extracted, but for now I have a weird situation, both uncommon, and is hard to tell which is which. I have not seen many cases of shock loss in donor on here, nor have I see over extraction by top docs. 

 

worried 

 

[mister_25]

15 minutes ago, Prof101 said:

he only extracted from the sides, which was surprising to me, because the back is much thicker and the sides weren't the thickest (but were NOT see through, coverage was perfectly normal). 

So you guys think this is shock loss? If so, how long should I wait for it to grow back 

I would also be surprised if such a top surgeon over-extracted, but for now I have a weird situation, both uncommon, and is hard to tell which is which. I have not seen many cases of shock loss in donor on here, nor have I see over extraction by top docs. 

 

worried 

 

I asked my clinic about a spot on my donor that I believed was shock loss and asked when it would resolve itself the reply I got was “any hair that sheds after surgery will start to regrow in 3-5 months”

I do believe it looks like very severe shock loss. Couto is a top doctor and judging by how many grafts you got extracted and counting on Coutos skills this isn’t overharvesting. 
Melvin posted a video recently on shock loss and over harvesting. It might be a informative watch for you.

I will say that I’ve never seen a case of permanent shock loss in the donor, only in the recipient sites with weak native hairs on diffuse thinning cases. Wishing you the best

[NikosHair]

40 minutes ago, Prof101 said:

he only extracted from the sides

Looking at your post-op pic he appears to have carried on the extractions to the back. It looks like the central area at the back is has been left. As you say you're predisposed to a NW6 which characterised by the crown continuing to descend into that central region. He also observed the back had been overharvested in your previous procedure. Scarring is visible.

The extraction pattern does not look like an error based on information provided.

Do you have post-op photos of the side? Ideally the clinics photos.

[Prof101]

Here is the side pot op. I was really surprised how high they went, since apparently I am heading to NW6, to me it seems that area close to the top does not qualify as donor

 

Comments appreciated 

 

[A Fue Good Men]

Curious to know the punch size used

[HappyMan2021]

On 9/27/2022 at 7:31 AM, Prof101 said:

At every since consultation I have made in the last 2 years  (Hasson, Mohebi, Mwamba, Couto)

 

On 9/27/2022 at 7:31 AM, Prof101 said:

I saw these doctors in person

to clarify, so you literally flew to Canada, Belgium, Spain, and LA to see all these docs in person? This seems like a massive investment just for consults.

 

Also, sorry you are in this situation. It's very depressing when someone seemingly does all the research, makes all the right decisions, chooses an elite doctor, and things still go sideways. 

Edited December 20, 2022 by HappyMan2021

[Prof101]

20 minutes ago, HappyMan2021 said:

 

to clarify, so you literally flew to Canada, Belgium, Spain, and LA to see all these docs in person? This seems like a massive investment just for consults.

 

Also, sorry you are in this situation. It's very depressing when someone seemingly does all the research, makes all the right decisions, chooses an elite doctor, and things still go sideways. 

Yep, I flew to all these. I did all the research I can, reading this forum and even spanish forum (re Couto). I even asked a few local docs if they are willing to do a test surgery on me to see whether I am a good responder (i.e. no issues with my follicles or scalp). Both said this is unnecessary in that in this day and age everyone is a good responder (i.e., follicles grow). 

I wish I insisted on this. But otherwise as you can see did all I can/ 

My next trip is to Bulgaria to see Dr. Zarev.  

[Prof101]

Also I wanted to ask people here on the forum: 

Anyone knows a reputable doc in the US who does body to scalp? I am really interested in a test procedure to see how that pans out. To make sure that my beard and body heal without marks, and whether that hair grows. 

I think if I ever want to get good coverage, I have eventually to do fit farming. 

[NikosHair]

Thanks for providing the post op pic. I think objectively there is nothing to indicate the you have been overharvested. The photo shows an even distribution of extractions. Hopefully temporary shockloss. The contrast between skin tone and dark hair does not help the visuals. This is also visible in your beard. 

On a practical note, have you tried using a concealer? eg DermMatch. It's quick to apply and can be used on your beard.

 

 

 

Edited June 29, 2023 by Melvin- Moderator
Removed photos per member’s request

[BaldingEye]

On 12/19/2022 at 7:23 PM, Prof101 said:

he only extracted from the sides, which was surprising to me, because the back is much thicker and the sides weren't the thickest (but were NOT see through, coverage was perfectly normal). 

So you guys think this is shock loss? If so, how long should I wait for it to grow back 

I would also be surprised if such a top surgeon over-extracted, but for now I have a weird situation, both uncommon, and is hard to tell which is which. I have not seen many cases of shock loss in donor on here, nor have I see over extraction by top docs. 

 

worried 

 

Hello Prof,

Wow, you really did your homework. I had never heard of anyone doing such a "touristic" route flying to see all those Doctors. 

And yes, it totally looks like you are experiencing shock loss. Now, as you may know, it is time to be patient. 

About the extraction, as others have already noted, it looks completely normal and you do not have to worry. I know from my own experience that we tend to be nervous and we want everything to be great right away but, a hair transplant takes time and in your case, it´s not the easiest at all. 

You went and did it with the best doctor. I am pretty sure no other clinic was a better fit for you than Dr. Couto´s. 

My advice, be patient, sit down and relax. And post a lot of photos and updates for us to see your progress. 

[jjsrader]

22 hours ago, Prof101 said:

Also I wanted to ask people here on the forum: 

Anyone knows a reputable doc in the US who does body to scalp? I am really interested in a test procedure to see how that pans out. To make sure that my beard and body heal without marks, and whether that hair grows. 

I think if I ever want to get good coverage, I have eventually to do fit farming. 

Dr. Umar for sure.  He is S. California.

[Sitries1]

Well nobody can say you didn't do your research!  As others have said, It sounds as though there was a BIG mix up in communication here. It's really strange that the surgical plan/strategy was changed midway through the procedure! I can't imagine that this is a common thing! I mean if they are extracting grafts for the hairline then these would be grafts suitable for the hairline (lots of singles etc), so then to just whack them all into the crown doesn't seem a good well thought out approach!

I'm really surprised that considering he has such a solid reputation that Dr Couto doesn't perform the whole operation himself from start to finish. I think if he had of then this scenario would not have occurred. I had my HT with Dr Ferreira in Porto and I cannot imagine for a second that something like this would happen under his care - he is way too conciencous and plans everything to the last detail. 

Its easy for me to say i know but I would try not to stress anymore about this now becuase it will not change the situation. Stay calm and look at the positives. Dr Couto produces amazing results so your crown area should now be fixed.  You have dark hair so SMP can be fully utilised in the donor region so you can still harvest more hair for the hairline. 

 

[AB2000]

To the OP, like others have said this does have the appearance of shock loss, from which you should be able to recover.  From looking at the extraction dot pattern it doesn't appear to be a case of overharvesting.  The FUE dots seem spread out normally.

My advice if you are to pursue further surgery - go to a doctor who specializes in depleted donor cases.  Don't bother with a doc who does great work on patients who have a lot more hair than you do.  You'll probably want some beard used to maximize your result by preventing that "island" effect in your crown.

[mister_25]

Any update on your shock loss situation?

[Prof101]

To avoid depression and stress, I am currently not taking any pictures nor trying to check the recipient or donor area. Donor area still feels much thinner than before, but I am trying to give it some time before I start taking pictures. Even when I look at the mirror I see the thinness. I am really surprised that they extracted all the way to the gutter, which is making the gutter looks worse. I don't understand why they had to go that high! 

 

As you can see from the picture I posted, the density of punches is higher toward the top... weird.. 

 

[airporteffect]

2 hours ago, Prof101 said:

To avoid depression and stress, I am currently not taking any pictures nor trying to check the recipient or donor area. Donor area still feels much thinner than before, but I am trying to give it some time before I start taking pictures. Even when I look at the mirror I see the thinness. I am really surprised that they extracted all the way to the gutter, which is making the gutter looks worse. I don't understand why they had to go that high! 

 

As you can see from the picture I posted, the density of punches is higher toward the top... weird.. 

 

So sorry that you’re going through this. I’m rooting for you and have faith that all will turn out well. Stay strong 🤙🏻.