Eugenix (Drs. Das/Somesh/Vinita) | 11,102 grafts | NW 6/7 | 28 yrs old | 2022/2023/2024

[asterix0]

If I were you, I would consider getting on a DHT blocker either topical or oral to protect your transplanted hair. You have weaknesses in your donor area unfortunately that indicate your recipient may thin over time. 

[hairman22]

18 hours ago, general-etwan said:

Respectfully disagree. Do you understand the extent and difficulty of what my situation was? I knew and agreed to our first HT covering the entire top, hairline to upper crown, knowing the lateral ridge and lower crown areas would continue thinning and would need to be addressed somehow, some way in the future. What would your planning have been? I didn’t hear any alternative. To rip away 9,000 grafts in one procedure, massacre donor area, and implant all over an area that would have then suffered shock loss? That can't be done. And I don't have that donor. The most important areas to get hair first are the top, midscalp to front hairline.

I don't need 4,000 more grafts. That might be your opinion but you're not me so you don't get to decide what my goals are. If we can get 2,000-3,000 (which I think we can with beard hair used again if necessary) redistributed to lateral ridge areas, that is going to make a massive improvement of overall uniformity.

My situation has already improved tremendously thanks to the job the team at Eugenix did the first time. 

I could never afford that.

Im really glad your happy.

Humps should have been covered in that 1st surgery

Imo you have to go for top top doctors once you reach high nw level or if like in my own case plan for worst case scenario once a diffuse thinner.

With your level you need 10k grafts. 

Eugenix should anaylse your donor and beard first and plan what is possible instead of leaving the humps way too thin.

The lower Eugenix packages im seeing too many similar issues lack of planning on the humps.

 

Good luck on your 2nd procedure i think you will get a decent enough result but could be better if the planning was correct

 

Edited June 2, 2023 by hairman22

[GeneralNorwood]

13 minutes ago, hairman22 said:

The lower Eugenix packages im seeing too many similar issues lack of planning on the humps.

Dr Arika told me "just slick hair back like our other patients do". Problem solved 🤣

Dr Das just skips lateral humps if somebody has recession there. She said that she doesn't want to take risk and harm existing hair there. But i don't understand this argument, since she will implant hair there in 2nd HT anyway. 

So is this delibarate attempt, to lure somebody in to 2nd HT asap? I don't know, but it looks shady. 

She should be more informative about this "hidden" plan of hers, that she is skipping humps and explain that she can do it only in 2nd HT. But she should talk about this before 1st HT, not after when you see huge disconnection between front and sides. 

Edited June 2, 2023 by GeneralNorwood

[MAL87]

I have nothing even remotely negative to say about general-etwan's previous or upcoming surgeries, but maybe there's a sort of lesson to be learned that part of the initial plan is to ensure these lateral humps are covered in the first go-around. 

I'm heading to Eugenix next month as a NW5 approaching NW6 and I'm going to be sure to mention that there need to be no disconnects there. 

[Stewie]

I believe transplanting close to existing hair can damage it also, so I wonder if this is a purpose decision on their part not to go to close in the first sitting and then do a second sitting to make it better? and also I guess with a lot of patients this one included, it does not look like the baldness has stabilised and so that also probably plays in the hands of safety for the first pass and then assess where you are at for a second pass? myself personally have had 3 surgeries now, ball ache I know but it seemed like the most sensible route to limit any problems from what I understood. Plus them not putting more grafts in only means you pay them less, so if they wanted to be reckless they could just go crazy moving tons of hair, but then there would be a backlash when things go bad because of that and over harvesting etc?!

[general-etwan]

18 hours ago, Gatsby said:

I promise you that you will care about your hair at 50. Trust me on this. 👍

Never said I wouldn't care, just that it will be less than at 28. Guaranteed

9 hours ago, GeneralNorwood said:

 

Dr. Muresanu speaks in this video about importance of balance between frontal and lateral hair. 

As you already now, this lower crown area can be managed with decent fadecut. Though i understand that visiting barber very often is not comfortable option. 

Melvin didn't adress lower crown in his last HT and his final result is great. He is contemplating one more HT in this area, because he is addicted to HT's 😅, nevertheles, how you look like in the back has the least importance from all sides. The most important is frontal look, then sides and top.

Therefore i would seriously think about completely skipping in 2nd HT this area between to red curved lines that you drew on the back (lower crown). You can ask Melvin about this, because he was standing before similar choice. 

But my thinking is - why waste precious graft in the back area, the least important area, when there areas with high priority to work on? You can always go back to this area later, you are young, you have time

That is indeed a great explanation by Dr. Muresanu. Very clear, very informative. Unfortunately as he stated exactly, it's a difficult decision whether or not to do temple reconstruction in patients with severe hair loss with side hair that may continue to regress.

You say here to consider skipping the lower rear crown region entirely but don't provide any alternative. If you'd like to be clearer, where are you saying to do the work if not doing any work there at all? The problem is still there is a severe contrast between the lower back of the head (thick, dense hair) and right above it (severely thinned, light hair). Even if just a few hundred are placed in the lower rear crown area, it will help a lot with visual redistribution and will not leave such a severe line of hair characteristic change. I agree most of focus should go to side lateral ridges and front. Yes.

9 hours ago, asterix0 said:

If I were you, I would consider getting on a DHT blocker either topical or oral to protect your transplanted hair. You have weaknesses in your donor area unfortunately that indicate your recipient may thin over time. 

I have been using pyrilutamide since the beginning of this year in addition to finasteride. Seemed to have been giving positive results. Stopped because of this upcoming procedure. What's left? Pretty much just dutasteride. Everything else is unproven experimental.

[general-etwan]

9 hours ago, hairman22 said:

Im really glad your happy.

Humps should have been covered in that 1st surgery

Imo you have to go for top top doctors once you reach high nw level or if like in my own case plan for worst case scenario once a diffuse thinner.

With your level you need 10k grafts. 

Eugenix should anaylse your donor and beard first and plan what is possible instead of leaving the humps way too thin.

The lower Eugenix packages im seeing too many similar issues lack of planning on the humps.

Good luck on your 2nd procedure i think you will get a decent enough result but could be better if the planning was correct

I have to say I don't recall ever seeing that large of an area done on a patient before all at once. If you can find me an example, I'd be very impressed with the work. Would you have done the area outlined in red all in one giant procedure?

That would have taken an outrageous number of grafts, would have taken 4 or 5 days, and density would have been lower and unacceptable. Also, the lateral ridge areas were still covered with some hair and transplanting into hairy areas isn't usually advocated for because it could do damage to native hair there. Medication is almost always recommended a solid try first. 

At the time of this picture, I was only on finasteride for 7-8 months, and it can take 10-12 months to sometimes see progress from finasteride in those areas of thinning hair. So our agreed plan was to wait and see if I'd get any regrowth or strengthening. If so, then transplanted hair to that area wouldn't be ultimately necessary. 

5300 grafts is a lot for one procedure. The consensus is usually play it safe and don't let doctors jump the gun with too many grafts too quickly and massacre your donor area. You can always have more procedures.

The only alternative that actually would have been feasible is this:

Is that what you would have endorsed? This makes more sense.

That would have required even more grafts still, probably 6,000+ and we didn't want to take any more than 4,000 from scalp donor. And at the time, I probably wouldn't have liked the idea or agreed to it.

I highly, highly doubt I have 10,000 grafts available for use.

9 hours ago, GeneralNorwood said:

Dr Arika told me "just slick hair back like our other patients do". Problem solved 🤣

Dr Das just skips lateral humps if somebody has recession there. She said that she doesn't want to take risk and harm existing hair there. But i don't understand this argument, since she will implant hair there in 2nd HT anyway. 

So is this delibarate attempt, to lure somebody in to 2nd HT asap? I don't know, but it looks shady. 

She should be more informative about this "hidden" plan of hers, that she is skipping humps and explain that she can do it only in 2nd HT. But she should talk about this before 1st HT, not after when you see huge disconnection between front and sides. 

Slicking back is a realistic strategy for extremely high Norwoods and middle-aged to older men who have traditionally done that anyway.

The reason to not implant entire lateral ridges on a first procedure is because medication may improve the area, and at that time we were still waiting to see if I would get satisfactory improvement from medication + topicals. In my case, anyway. And, 4,000 was a ton of grafts to be taking from my scalp donor on first-observation and first-procedure, so it wouldn't have been proper to jump the gun so much from the start.

I disagree completely that there's anything shady about it. We pay for grafts. I'm not paying any more depending on if the lateral ridges were addressed 1st or 2nd. Hair = hair in the end. And I haven't lost any hair due to damage that I otherwise would have kept. Nothing "luring" about it at all. And Eugenix didn't initially want to schedule me this early for a 2nd procedure. I essentially made them because I feel confident enough to keep the ball rolling and want to get it done now.

Dr. Das and I spoke ALL about this before my first procedure. Let me make that VERY clear. Not sure where this idea of it being "hidden" or "secret" comes from.

Edited June 3, 2023 by general-etwan

[general-etwan]

7 hours ago, MAL87 said:

I have nothing even remotely negative to say about general-etwan's previous or upcoming surgeries, but maybe there's a sort of lesson to be learned that part of the initial plan is to ensure these lateral humps are covered in the first go-around. 

I'm heading to Eugenix next month as a NW5 approaching NW6 and I'm going to be sure to mention that there need to be no disconnects there. 

I disagree that it's as easy as saying that. Without knowing the area of coverage needed, density desired, and number of donor grafts available, it's impossible to say whether it is proper to implant in lateral ridges immediately or not. It's not wise to implant heavily into an area of still-native-growing hair, especially when medication + topicals need more time to see if they are going to improve the area or not. If they are, then you definitely shouldn't be implanting into that area so soon.

Bald areas should always be addressed first, and thinning areas second, in my opinion.

Edited June 3, 2023 by general-etwan

[general-etwan]

4 hours ago, Stewie said:

I believe transplanting close to existing hair can damage it also, so I wonder if this is a purpose decision on their part not to go to close in the first sitting and then do a second sitting to make it better? and also I guess with a lot of patients this one included, it does not look like the baldness has stabilised and so that also probably plays in the hands of safety for the first pass and then assess where you are at for a second pass? myself personally have had 3 surgeries now, ball ache I know but it seemed like the most sensible route to limit any problems from what I understood. Plus them not putting more grafts in only means you pay them less, so if they wanted to be reckless they could just go crazy moving tons of hair, but then there would be a backlash when things go bad because of that and over harvesting etc?!

Exactly. Better to be conservative and leave areas being "treated" by medication a chance to respond to that medication for a good while first. As a doctor, you don't want to be transplanting into areas that could naturally strengthen from medication and topical treatment. You can always address more areas in future procedures, but you only have a limited number of grafts to work with that first go because you want to make sure you don't over-harvest the scalp donor area.

[GeneralNorwood]

5 hours ago, general-etwan said:

Even if just a few hundred are placed in the lower rear crown area, it will help a lot with visual redistribution and will not leave such a severe line of hair characteristic change. I agree most of focus should go to side lateral ridges and front. Yes.

I am just saying that if you really must do some implantation there, don't use more then 300+ grafts. Ask doctors what is their opinion on this, because if you insist on implanting hair in the back, they will  do it just to please you.

 

4 hours ago, general-etwan said:

Dr. Das and I spoke ALL about this before my first procedure. Let me make that VERY clear. Not sure where this idea of it being "hidden" or "secret" comes from.

Well, i was speaking about my experience. If you spoke about this before  first procedure, it's ok. I had talk like this only after 1st procedure and Eugenix tried to gaslight me that my lateral humps had worsened since 1st procedure. During my HT i was already more then a year on finasteride, so there wasn't hope for further improving on medication. 

And i am not the only one who was surprised about neglecting lateral humps after 1st procedure from Eugenix. There is @DeltaV for example. 

 

Edited June 3, 2023 by GeneralNorwood

[jackofall]

Hi @general-etwan - I am planning to visit Eugenix around August 2023. I know the pain of the anesthetic injections expecially the first 3-4 shots. How much pain did you experience on the scalp and beard area with anesthesia injections? how long did the entire procedure take in hours on a day? Did Dr Das oversee your entire surgery apart from performing slits? How good were the techs who did rest of the work as it matters on them a lot how they treated the donor areas without damaging much.

[Murat-kz]

On 5/31/2023 at 7:46 AM, general-etwan said:

 

Dustin Johnson hair doesn't look cool. Why did you provide his example again? I hope you do not want to look like him

Edited June 3, 2023 by Murat-kz

[Murat-kz]

On 6/1/2023 at 7:47 AM, general-etwan said:

Another pic just from today in somewhat natural lighting. 

general-etwan will you tell me if it was the original plan to use 5 000 grafts in the first surgery to concentrate on the front part and to leave the back part (and lower sides) open like this to cover it in the second surgery? If it stays the same even after a year it is not good. If you did not plan the second operation at all then I would say it was not good planning. They had to cover these parts during the first operation

 

 

Edited June 3, 2023 by Murat-kz

[asterix0]

@general-etwan There is no reason to stop finasteride prior to your procedure, or after. You can (and I believe should) continuously use it, unless you experience side effects. 

[GeneralNorwood]

9 minutes ago, asterix0 said:

@general-etwan There is no reason to stop finasteride prior to your procedure, or after. You can (and I believe should) continuously use it, unless you experience side effects. 

He didn't stop finasteride. He stopped using minoxidil and pyrilutamide

[general-etwan]

On 6/3/2023 at 11:16 AM, jackofall said:

Hi @general-etwan - I am planning to visit Eugenix around August 2023. I know the pain of the anesthetic injections expecially the first 3-4 shots. How much pain did you experience on the scalp and beard area with anesthesia injections? how long did the entire procedure take in hours on a day? Did Dr Das oversee your entire surgery apart from performing slits? How good were the techs who did rest of the work as it matters on them a lot how they treated the donor areas without damaging much.

I experienced a lot of pain all over the scalp, and specifically on the chin areas of the beard. I put up with a lot though and didn't want to make the team stop working all the time to inject more anesthetic, so I toughed a lot of it out, but they still had to keep giving me quite a bit more and more. Many clinics will say HTs are completely painless. Ha! When working on such a large area, and given that the local anesthetic only works for a limited time before gradually wearing off, there's going to be pain involved. But it's something you push through if you really want this.

My HT took 6-8 hours each day, with some breaks and lunch thrown in there too. Dr. Das drew up the plan, performed all of the incisions, and then kept coming back every 30-60 minutes to evaluate all the progress and make sure next section was going to go as expected. Techs were excellent. As you can see in all my images, the angles and direction of all the graft placement is top notch. Zero problems with any of that.

[general-etwan]

On 6/3/2023 at 1:39 PM, Murat-kz said:

Dustin Johnson hair doesn't look cool. Why did you provide his example again? I hope you do not want to look like him

Ha! As I stated, because he has a very similar hair loss pattern situation to my current status. Temples slightly receded, but hair in tact on top enough to not be called "bald." That's a huge point. 

Dustin Johnson is probably way cooler than you. He's seen as a good-looking guy and is not seen as a bald or even balding guy at all. That's why it's a good reference to make to my situation. To get back to something close to this would be excellent:

Edited June 5, 2023 by general-etwan

[jackofall]

I have had done it twice and experienced the same although every clinic says they have some not so painful injections.  It wears off quickly for me too and having 2 days of procedure is scaring me

[general-etwan]

On 6/3/2023 at 1:53 PM, Murat-kz said:

general-etwan will you tell me if it was the original plan to use 5 000 grafts in the first surgery to concentrate on the front part and to leave the back part (and lower sides) open like this to cover it in the second surgery? If it stays the same even after a year it is not good. If you did not plan the second operation at all then I would say it was not good planning. They had to cover these parts during the first operation

Yes, because they did not want to risk taking more scalp donor in the first procedure, as my scalp donor isn't great. 4,000 + 1,300 beard was seen as a big extraction, and the area we covered was the maximum area we could cover with that amount of grafts in one procedure. I still had hair on the lateral ridges and lower crown, albeit thinned. But still there. And there is the potential for medication + topicals to improve that area enough to make it work decently. And as you can see with a fade haircut, it looks quite good. And from the front, the thinned ridges aren't super noticeable.

Unfortunately now that I've been on medication and topicals for over a year, those side ridge areas are not going to improve. I could simply try to maintain and get fade haircuts every week, but I do not want to. I am voluntarily saying I want to redistribute hair to the ridges now because I want those areas to have hair more consistent with the characteristics of the hair now above it and below it. 

You keep saying they "had" to cover these parts in the first procedure, but I haven't seen it done with anyone else. Then again, most guys have a higher up horseshoe ring, and their hair loss is more stabilized and therefore they don't have an area of visual thinning that extends down lower.

If they would have shaved down all my lateral ridges and implanted all over them in the first procedure, they either would have had to 1) take a giant risk with 2,000-3,000 more grafts from scalp donor, or 2) left the whole back of my head (crown) bare. You have to pick your poison somewhere, somehow.

In the end if we do the ridges now, I'm not paying any more than I would have otherwise, and we didn't permanently damage or lose any hair due to being too aggressive to start.

[general-etwan]

8 minutes ago, jackofall said:

I have had done it twice and experienced the same although every clinic says they have some not so painful injections.  It wears off quickly for me too and having 2 days of procedure is scaring me

Yeah but at the end of day it's just some physical pain on skin. You know it's going to go away and you're doing it for a reason. It's not like, you know, being psychologically dead in life or anything. Now that's something to be scared of.

[general-etwan]

Alright, well, with my personal interpretation just a few days out, I'm drawing up the following potential different strategies for how to best handle this:

1) Priority: fill lateral ridges, front to crown. Address lower crown with as few grafts as possible (not a priority).

 

 

2) (assuming some more grafts available for use than #1) Priority; fill lateral ridges, front to crown. Then fill lower crown with as much left as possible to decrease crown baldness.

 

3) (assuming some more grafts available for use than #1) Priority: fill lateral ridges, but also use some grafts to reconstruct temples. Leave lower crown very bare. I know many said forget about the temples because it's too much work, but then we also said forget about the crown too. It's my expectation that I will be choosing one or the other to at least address a little, after the lateral ridges are taken care of. So I may have to choose between temples or lower crown prioritization. Isn't crown a "black hole" for grafts, whereas temples don't require that many to look good? But I also would be self-conscious about having a big bald spot on lower crown and how that would look from behind. Not good.

However, SMP or fibers would never be an option for temples, whereas SMP or fibers could potentially be used in crown area. Right?

 

[GeneralNorwood]

7 hours ago, general-etwan said:

 

 

 

Coud you show picture like this from left profile? 

[Xanadu]

10 hours ago, general-etwan said:

I experienced a lot of pain all over the scalp, and specifically on the chin areas of the beard. I put up with a lot though and didn't want to make the team stop working all the time to inject more anesthetic, so I toughed a lot of it out, but they still had to keep giving me quite a bit more and more. Many clinics will say HTs are completely painless. Ha! When working on such a large area, and given that the local anesthetic only works for a limited time before gradually wearing off, there's going to be pain involved. But it's something you push through if you really want this.

My HT took 6-8 hours each day, with some breaks and lunch thrown in there too. Dr. Das drew up the plan, performed all of the incisions, and then kept coming back every 30-60 minutes to evaluate all the progress and make sure next section was going to go as expected. Techs were excellent. As you can see in all my images, the angles and direction of all the graft placement is top notch. Zero problems with any of that.

I went to Eugenics too, and I must say that I found the injections almost completely painless. Like a 3/10, and much less pain than for example going to the dentist

Edited June 5, 2023 by Xanadu
Changed from 2/10 to 3/10

[general-etwan]

5 hours ago, Xanadu said:

I went to Eugenics too, and I must say that I found the injections almost completely painless. Like a 3/10, and much less pain than for example going to the dentist

Oh yeah, I should clarify the actual injections weren't too bad at all. But the actual insertions of grafts was extremely painful as the anesthetic kept wearing off.

[ready4Hair]

19 minutes ago, general-etwan said:

Oh yeah, I should clarify the actual injections weren't too bad at all. But the actual insertions of grafts was extremely painful as the anesthetic kept wearing off.

Ugh. Hadn't heard of this. Don't they have a way to titrate or estimate the amount needed so this does not happen?