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

[Prof101]

On 5/26/2023 at 12:23 AM, mustang said:

It does not but you definitely need another 500-600 grafts to blend it in with surrounding hair.

I think Dutasteride Mesotherapy would suit you well. You will be getting the growth factors plus dermarolling and localized 5AR suppression much higher than with Finasteride which people continue to take using Mesotherapy.

I had over harvesting with Couto on my right side (they went quite high as well). It was extremely obvious and it was only a 1200 surgery and had it repaired with 200 BHT. Not it's not noticeable.

You still have 1.500-2000 grafts on your donor if managed properly and BHT would certainly help you.

Couto is awesome but he does use a big punch and

Out of my 15 surgeries it was by far (and probably the only) the most painful post op one. My donor hurt for a month.

 

Did you mean to say (when referring to your BHT) as : Now it is not noticeable? Or you indeed meant, "not" meaning that your BHT did not turn out as subtle as you wished? 

 

Also when you say I need to blend it with the surrounding hair, I understand what you mean, and to me it looks visible in the picture I took with my head back and facing the sun. But does it look the case in the other pictures? I do not mind critique at all, as it is hard for me to be objective. Yesterday the ppictures I uploaded were taken in bright light, as you can see my shirt is overexposed. I attached two more, one with combined hair. 

I actually thought the problem was no longer the crown but the front which is now looking odd when I com my hair I think

 

 

 

 

 

 

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

[hairman22]

On 4/15/2023 at 3:10 AM, Prof101 said:

it's in june 

Good luck with it

Im confident he can do something for you

He has some incredible cases genuine nw7s in their 50s 60s thin donor who recovered. 

Once you had a transplant he will really try to find a way to get you a good look not perfect but good

 

[Prof101]

Regarding Duta mesotherapy, for a second I got excited reading on one page that it is side effect free, then I see on another website. (bauman medical) saying this: 

 

 

What are the Possible Side Effects of Dutasteride Mesotherapy?

Aside from the temporary numbness or soreness from the treatment, systemic effects from 5AR inhibitors include mild and temporary decrease of libido (sex drive) or mild, temporary erectile dysfunction. For those who experience side effects from Dutasteride Mesotherapy, it may take weeks to months for these side effects to resolve.
While there are some reports that Dutasteride Mesotherapy may have fewer side effects than oral finasteride or oral dutasteride, you should discuss any previous sensitivities to 5AR medications with your doctor.

 

Disappointing. 

[Prof101]

And this is before and after facing direct sunlight (opened shades facing window) 

 

 

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

[mister_25]

Its definitely a big improvement. I believe the magic will happen on your second procedure as it will give you a more balanced and uniform density across the scalp.

[Prof101]

OK I did not know it is that bad. 

I was going to meet a woman in a few weeks for a trip. If it is that obvious what should I do? You think a hair cut will make it less obvious? 

 

[Benz]

I advise keeping your hair long, with no haircut, until you meet Dr Zarev.
Keeping your hair long gives more information about the coverage/hair structure, which is essential.
If you feel insecure about your hair and have a meeting with that woman before meeting Dr Zarev, you can use some premium concealers to decrease the balding effect.
I hope this helps you take care.


 

[Escanor]

3 hours ago, Prof101 said:

Regarding Duta mesotherapy, for a second I got excited reading on one page that it is side effect free, then I see on another website. (bauman medical) saying this: 

 

 

What are the Possible Side Effects of Dutasteride Mesotherapy?

Aside from the temporary numbness or soreness from the treatment, systemic effects from 5AR inhibitors include mild and temporary decrease of libido (sex drive) or mild, temporary erectile dysfunction. For those who experience side effects from Dutasteride Mesotherapy, it may take weeks to months for these side effects to resolve.
While there are some reports that Dutasteride Mesotherapy may have fewer side effects than oral finasteride or oral dutasteride, you should discuss any previous sensitivities to 5AR medications with your doctor.

 

Disappointing. 

Hello,

First of all, thank you for presenting your case. In a few months I have an appointment with doctor couto and it is important to see cases in which there are some problems.

I have information about dutasteride mesotherapy. I have been punctured 4 times in a period of a year and a half.

The first was done by an inexperienced doctor. It was very painful. I had no side effects and no great improvement either.

The other three I did with Doctor Oscar Muñoz. We did it every 4 months and the doctor was quite honest with me, he explained that the improvement is barely noticeable and that his real usefulness is to speed up the effectiveness of the oral treatment.

Conclusions: in my case no side effects. But its effectiveness was low.

[Melvin- Admin]

Big improvement for sure, focus the second procedure on the outer edges. 

[AB2000]

4 hours ago, Prof101 said:

OK I did not know it is that bad. 

I was going to meet a woman in a few weeks for a trip. If it is that obvious what should I do? You think a hair cut will make it less obvious? 

 

Have you used Toppik before?

[Prof101]

it never worked for me... Also I don't like the idea of someone touching my hair and finding fibers on their hand... 

 

[Prof101]

What I am confused about, is that at the 5 months mark, I did not see problems with the edges, it looked like it was growing all the way back to the top of the crown 

or maybe I am missing something 

 

[mtb]

Trust in Dr Zarev. If there is something that can be done he is the one to do it. Best of luck in your meeting with him. I assume you’ll be impressed like the rest of us who have gone to him. 

[Prof101]

Hoping so. His work is super impressive, but I don't want to get my hopes up. I just don't have the grafts. If he is willing to work with BH then maybe there is some hope. 

[mrmane85]

On 4/14/2023 at 10:10 AM, Prof101 said:

I hope so man. But I do not see how I can get a repair without BHT involved.

Here is what Mwamba told me: 

"You have 9000 FU, of which 40% can be used for hair transplant (+/-1800
to 3000 grafts)."

Couto used 1800, for the crown, now I am left with 1200+, maybe 1500. 

But anyway this is the very reason I am going to Zarev with the hope he can find someone. 

My belly hair is as soft and as thick as my head hair... 

 

 

Dr Pittella would also be a good option to look at. Renowned for good results using bht. 

[mtb]

13 hours ago, Prof101 said:

Hoping so. His work is super impressive, but I don't want to get my hopes up. I just don't have the grafts. If he is willing to work with BH then maybe there is some hope. 

If there is any possibly way Zarev will know how to do it. He has some wild repair cases he will show you in your consultation. 

11 hours ago, mrmane85 said:

Dr Pittella would also be a good option to look at. Renowned for good results using bht. 

Agreed. My brother is having procedure with Pitella later this year. Excellent option. Pitella embraces beard hair while Zarev doesn’t like to do it. Dr Zarev will of totally necessary.  

[Prof101]

I see that he placed grafts homogeneously, spread evenly.. so I am not sure what went wrong. at some point it looked like it was growing strongly arond the swirl. Is it possible for transplanted hair to grow once (4 months post op) and then fall after? 

[shadowcast]

I have the same gap effect in my crown/against my sidewall (right side when photographed top down). This is actually normal. With the way shingling works, as hairs angle out and exit the swirl, they will naturally lie in a way that exposes the most scalp. Opposite is true as the swirl folds in and maximum shingling occurs - this area will look very dense, so much so that if you photograph yourself from behind (not top down), you will likely see a nice big hump of hair on that side. I originally thought I had poor growth on one side, but Dr. Bruno Pinto explained all this to me and even showed me on a scope how my growth was perfect.

I think what you are seeing is about right for 1,700 grafts, which is absolutely not close to enough to what you need in that crown.

Another thing, careful analyzing crown photographs too much. The crown is of course a spherical shape, so looking at 2D photographs will give you odd perspectives that don't relate to how things look in reality.

Edited May 28, 2023 by shadowcast

[Prof101]

I am trying to prepare what to say to Dr. Zarev. 

 

I am not aiming for perfect coverage, I do not have the grafts for that. I am now looking to claw my way back to have a naturally thinning hair. 

I wonder whether just taking care of the top/sides/ridges would make the crown look less unnatural? 

Thanks @shadowcast. While the points made by others regarding the edges being thinner is correct, I just wonder whether they are saying this from a coverage aspect of naturaleness aspect.  

 

I am trying to assess the naturalness of the results so as to know whether to wear a hat during next semester when I will be teaching a large class. 

 

 

 

 

 

[CharlesBarkley]

On 5/28/2023 at 3:24 AM, Prof101 said:

Hoping so. His work is super impressive, but I don't want to get my hopes up. I just don't have the grafts. If he is willing to work with BH then maybe there is some hope. 

Why you say you do not have the grafts? I am pretty sure he follows this Forum and he is following this thread as when he does a "Search" his names would pop-up in the results... 

Your crown is looking so much better now after this hair transplant. Dr Couto and his team did a great job indeed.
So you are now just past 8 months of your result right? That would mean you still have months ahead to get better since crowns take some more months than a normal hairline HT.

Could you share and show photos with other perspectives. Say the normal photos from the human view. Could you take frontal, back and side photos so that we can see how you look walking around in the streets? 
 

[OliverAtom]

On 5/29/2023 at 3:01 AM, Prof101 said:

I am trying to prepare what to say to Dr. Zarev. 

 

I am not aiming for perfect coverage, I do not have the grafts for that. I am now looking to claw my way back to have a naturally thinning hair. 

I wonder whether just taking care of the top/sides/ridges would make the crown look less unnatural? 

Thanks @shadowcast. While the points made by others regarding the edges being thinner is correct, I just wonder whether they are saying this from a coverage aspect of naturaleness aspect.  

 

I am trying to assess the naturalness of the results so as to know whether to wear a hat during next semester when I will be teaching a large class. 

 

 

 

 

 

 

That crown is looking superb @Prof101 quite an improvement there!

If I were you I would just go back with Dr Couto to finish the sides/ridges.

However, since you were traveling to Bulgaria... How was your consultation with Dr Zarev? How is he in person one on one? What was his assessment on your current HT evolution and your future possible HT with him? Could he do BHT? How many grafts he prospected to get from your donor? 

[Gasthoerer]

I am sorry for what happened.

For me personally, this is very poor planning from the clinic and in general unacceptable behavior. I would honestly visit a few other clinics and get their opinions and also take some time to reflect about the different options. 

One last shot might be everything you have left and you need to choose wisely where to put how many grafts. I would really like to see some better all around pics (maybe even with shorter hair on the sides). 

[duckling]

On 5/29/2023 at 6:31 AM, Prof101 said:

I am not aiming for perfect coverage, I do not have the grafts for that.

think he is the one who can defy these. I am not big fan of taking lot of hair way outside safe areas but he seems to be doing it and his patients have good results atleast for 1 year that we have seen. if the non dht resistant hair even last 10 year then i say the procedure is super worth it for higher norwood.

good luck for consultation. if you have good body hair then surely you wont worry about grafts.

[Gatsby]

I think Dr Zarev can give you an incredible result if you have a good scalp donor. 👌

[Prof101]

I promised everyone an update after my visit to Dr. Zarev. I will re-upload my pictures soon, which I took down momentarily. 

Dr Zarev has  a beautiful and fancy clinic. Spotless. Cleaner than a surgery room and fancier than a beverly hills clinic. I am happy for his success as he clearly deserves it. 

As for him, he is a kind person, energetic, friendly, and professional. Also he is *sharp*, super intelligent. You can tell. He explained to me a bit his technique, as how he manages to do more with less, technically, and it makes a lot of sense. However, I cannot claim I understood it fully, and I do not know how wide he wants to advertise it, so I will only keep it at that. 

The consultation was very long and very thorough, exceeding my expectations. Maybe his generosity had to do with me flying all the way for that only purpoe. He started showing me some of his results with people with thin donor. Impressive stuff. Some are even more impressive than what we have seen.  

He went on to take measurements, which again exceeded my expectations. You probably have seen a video of his mapping of the scalp. What I did not know was that in order to assess the density in each area he took many samples from each small area. He in fact showed me that in the same area I have a lot of variation in density. This took an hour. The most scientific mapping one can get/

Imagine the gap between him and the industry. It seems the industry standard is to look at your scalp, while his standard is to map your entire scalp based on density, hair thickness, etc. 

I was shocked when he told me I have at least 3,500 FUEs, and maybe up to 5K. Others estimated 1500. Having said this, we agreed that I am willing to have a thinner look than the standard HT. Not abnormally thin but something along the top of my head where the new HT is.  

He did not criticize Couto in any way. His is more classy than this. He understood that something went wrong and he is just trying to help. He said that based on the # of grafts Couto's output was very good, and natural. 

Anyway, if you want to see how A Zarev approach is different from the rest, you might want to check updates next year. 

Everyone is impressed with his post op n of the donor area, I wonder whether the recepient area stays as read as with other transplants. Makes a big difference work wise. If anyone knows anything about this let me know. O/W I could probably text him.