Dr. David Josephitis (SMG) | 2,309 grafts | 35 years old | Dec. 20 / 21, 2022

[needmyhairback]

15 hours ago, stephcurry30 said:

OP Why did your surgeon make the incisions the day before? This makes no sense to me. 

 

I remember reading a Patient of Dr Bhloxman not too long ago who made pre made slits the same day and the Dr mentioned that the slits closed up extremely fast and the grafts might have not survived because of it.

 

I have bene on this forum for 7+ years and have yet to see a single surgeon who has done this? What's the purpose of this? Is this the possibility as to why your surgery didn't succeed? 

I have read several cases from SMG and looks like they make incisions the day before for large cases, above 2000 grafts I guess. Don't know how that impacts the outcome.

[Balding Bad]

16 hours ago, stephcurry30 said:

OP Why did your surgeon make the incisions the day before? This makes no sense to me. 

 

I remember reading a Patient of Dr Bhloxman not too long ago who made pre made slits the same day and the Dr mentioned that the slits closed up extremely fast and the grafts might have not survived because of it.

 

I have bene on this forum for 7+ years and have yet to see a single surgeon who has done this? What's the purpose of this? Is this the possibility as to why your surgery didn't succeed? 

As @needmyhairback has correctly stated, SMG prefers to break up the procedure into 2 days if the graft amount exceeds a certain amount, which I believe is 2,000. The first day is dedicated for the incision making process and the second day is dedicated for the extraction/implantation process.

As far as I'm aware, this is how SMG has always done it. In terms of this method negatively impacting the final outcome, that is not something I've heard or seen before.

Edited June 22, 2023 by Balding Bad

[Balding Bad]

JULY 2, 2023 UPDATE (STARTING FIN AGAIN!)

A minor update. Just wanted to flag that today I started Fin again. I was initially planning on halfing my pill and taking 0.5 mg twice a week, but decided I'll quarter it instead and take it 4x a week.

I don't actually have a pill cutter, so the "quarters" are approximate at best and I'm sure I'm losing the exact quantity/potency in the splitting process. I'll be monitoring for negative sides again (which were watery semen and anxiety/depression)...hoping for none, but only time will tell...

Edited July 2, 2023 by Balding Bad

[needmyhairback]

Any noticeable improvement yet? Do you plan to contact the clinic? At this point they can only tell you to wait until 12 months

[Balding Bad]

6 minutes ago, needmyhairback said:

Any noticeable improvement yet? Do you plan to contact the clinic? At this point they can only tell you to wait until 12 months

I'll wait until the 7 month update to make any type of assessments in terms of "improvements." I also plan on contacting SMG at that point to get their evaluation on my progress as per their recommendation in their literature.

[davidjosepha]

Hey man, thanks for commenting on my thread about my transplant with Dr. Joe. I saw this thread yesterday while looking at Josephitis threads before I posted my own. I wanted to provide some feedback then but I was having trouble figuring out what exactly to say. After I saw your comment on my thread though, I figure I'll give it another shot. I apologize if some of this sounds harsh, but I think it's something you could benefit from hearing. Take from it what you will.

I understand your disappointment and anxiety around the results, I imagine I will be feeling something similar over the next year as I wait for mine to grow in. But I really think you're jumping to conclusions and possibly have unrealistic expectations, and after reading your fin thread, you seem to have done the same with meds.

You were basically bald at your hairline in your 12/21 and 1/22 updates, and by 5/22 you had a noticeable improvement, but from month 2 on you'd say you were disappointed with the lack of progress each update. You reported on May 1 no sexual side effects whatsoever, including no watery semen, then on May 15 you had a single bad orgasm and you stopped entirely, then retroactively decided you'd actually been depressed and anxious for an entire month and it must be related to fin, not the 'challenging life events' you mentioned, and reported feeling better immediately after stopping fin -- less than a week later -- which is not how hormones work. You started again two months later, mid July, at an even less regular frequency, and in August, a month later, you complained about your hairline thinning rapidly again -- which, of course it was! You were going through a shed. That's what happens when you start taking finasteride. You were on it 5 and a half months, not nearly long enough to grow healthy hairs, stopped for 2 months, and then you seemed to think you were picking back up where you left off, but you weren't; you were starting over. And a month after starting back on finasteride only twice a week, you scheduled your hair transplant, describing your results with fin as 'lackluster'. No, they weren't! You were getting great results for only 5 months on fin, you just stopped too soon, and when you scheduled the hair transplant, you were going through a shed! By October you were starting to see significant growth again, but then you stopped, and 2 months later started up again at just one pill a week, and seem to have stopped again another 2 months after that. You haven't gone on a finasteride journey, you've been going on a finasteride treadmill. Of course it didn't do anything for your hairline, you never were on it long enough to give it a chance to.

Some advice on finasteride: first, buy a pill splitter. They're like $5, and you've spent literally a year and a half cycling on and off finasteride because you keep using 1 mg doses but at steadily less regular intervals, which is the worst way to do it both for results and for avoiding side effects. It's a much better idea to, for example, take 0.25 mg daily than to take 1 mg every four days. The latter is more likely to result in yo-yoing of your hormones. Second, yes, watery semen is an 'adverse' side effect, but it doesn't actually matter for anything other than getting a woman pregnant or painting her face, and it's subsided every time you've stopped, so you know it's fixable within a couple months by quitting finasteride. With that knowledge to comfort you, just stick it out for 6 months after you first notice watery semen. It will most likely resolve on its own. But if after 6 months it doesn't, and you really care that much about your semen consistency, go ahead, drop finasteride entirely. But starting and stopping repeatedly is not going to fix the watery semen issue, and it's not going to fix your hair.

Back to the transplant. You say you expected better results because of your native hair:

On 6/20/2023 at 10:45 AM, Balding Bad said:

I was never expecting a "wall of hair," but I definitely expected it to look much better than how it currently is.

It will! Once it is done growing in! Why are you looking at your results at the halfway point and deciding they're not what you expected? Of course they're not, because they're not the full results yet.

On 6/20/2023 at 10:45 AM, Balding Bad said:

And when you consider I still had some minor but decent coverage of native hairs, it should have turned out better visually

But you don't have any native hair there! Or, barely any. You've been off finasteride for months, any hairs you had there at the time of the surgery were shaved off or fell out due to shock loss, and you're back to where you started in Dec 2021, which is this:

For practical purposes, that area is bald. Sure, there are a few hairs, but in terms of the density following the surgery, those hairs add approximately nothing. The reason for this is that you refused to stay on finasteride consistently because of your fixation with your sperm's texture. If you had stayed on finasteride for the full year like it was suggested you do, you might have had something there to work with. But right now, there's next to nothing, and you need to have reasonable expectations about what is possible with a single surgery when filling in completely bald areas. There is a limit to the density of follicles that can be placed in a single surgery without compromising the survivability rate of those follicles, and SMG is ethical in a way that many clinics are not; they will not waste your limited supply of follicles by packing them too tightly and having a third of them not survive. If you want to take a bald area and get a density that is completely indistinguishable from a natural, non-balding hairline, even under bright lights and while wet, you most likely need multiple surgeries.

If you get on finasteride and stay on it for a year, based on how successful the 5 months you were on it was, it's likely that you will get some enough growth in that area to make a noticeable impact on the density of your hairline. But if you refuse to do that, you need to have reasonable expectations about what the results will look like, and I can pretty much guarantee you were briefed on all this, because 1) Matt Zupan made it extremely clear in his stock-presentation, which he gave me in 2022 only a few months off from when you met with him; 2) Dr. Josephitis brought it up as well prior to surgery; and 3) it was also stated explicitly in the forms I was required to sign before they could start the surgery. The goal is to have hair that looks natural under normal social conditions. Expecting a single surgery, even of just one area, that isn't at all noticeable when wet and under a bright light is just not realistic.

But lastly, and most importantly, you are doing the same thing you did with finasteride -- ignoring the stated timeline and doomsaying about how the whole thing is failed and worthless. You are at month 6. As you quoted from the SMG info, you are only 50-60% of the way there. Look at this picture in insanely direct bathroom lighting:

Do you see more skin or more hair there? Because when I look at it, I'd say around the hairline, 2/3s of what I see is dark brown hairs, and 1/3 is scalp peeking through. So if this is only 50% of the way to the final result, wouldn't you expect the scalp to be entirely, or almost entirely concealed by the time the whole thing is finished?

Take a look at this guy who also had surgery with SMG. Left picture is month 5, right is month 11. Look how frizzy and sparse his hair is at month 5 compared to 11? Sure, you're a month later along than he was at the time, but his hair at month 6 is only a bit better than month 5 -- still nowhere near as full or solid as when he finished. And everyone's timeline will be slightly different.

It's going to be all right. Your hair is going to continue to improve for another 6 months. You don't need to fret so much about what it looks like at any given moment. And it doesn't need to look perfect even when it's fully grown in. It will look great, but if you're focusing on how it's not perfect because some of your scalp is visible when someone dumps a bucket of water on your head then shines a spotlight on it, even 'great' will feel like a complete failure. If you really want your hair to be denser, there's one thing you can do besides a second surgery, and that's to get back on finasteride and stay on it. Cycling on and off finasteride doesn't result in any actual progress. If you get on it today, even 0.25 mg a day, and stay on it for the next 12 months, in 6 months your hair transplant will be fully grown in, but even after that happens, you'll have another 6 months of progress to look forward to after that as the finasteride begins to show real results with your native hairs.

[Balding Bad]

Hey @davidjosepha, appreciate you taking the time to chime in on my thread with a very lengthy reply! No worries on "harshness" of your tone, all fine by me as I much prefer brutal honesty over sugarcoating.

To address some of the things you mentioned, as far as my Finasteride thread goes, it's been a couple of years so my recollection of it is a bit rusty, however what I do recall is that my temperament and expectations during my time (trial) on Finasteride was cautiously optimistic. I was never as dour or negative as you proclaim that I was. Perhaps you just read it differently in your head, but my updates were never rooted in the supposed negativity that's purported or implied in your accounts. My hope was that Fin would help regrow hair in my frontal third, but if not, at the very least stabilize and prevent any future hair loss.

My regimen of titrating the Fin dosage is one that is commonly practiced. Browse through the forums and you'll see plenty of examples of other people implementing dosages at similar amounts and intervals as me. Granted, no two people are the same, so obviously we all must adhere to a regiment that makes sense for our own unique bodies. Taking 3mg per week is not unheard of and, in fact, it's actually championed by doctors like Dr. Russell Knudsen and Dr Vikram Jayaprakash. Always better to be safe than sorry.

Also, in regards to the negative side effect of watery semen, your callous dismissal of that side effect is entirely your prerogative, however, to me, it's not worth the risk. You claim that I should have ignored it and powered through Fin for another 6 more months in hopes the side effect would eventually subside. That's completely okay if that's something YOU'RE willing to do, however my risk appetite is clearly not as tolerable as yours, especially when you consider it can potentially become permanent. Granted, this is on an anecdotal basis, however the likelihood of that happening is still very much possible.

Moreover, it's heavily implied from your post that I only took issue with the watery semen due to the visual change in its consistency, as if it's only a mere cosmetic inconvenience that I'm concerned about. The change in consistency is absolutely indicative of a decline in the semen quality. No one in their right mind would shrug that off and hope for the best. As someone who hopes to have kids one day, to prioritize a head of hair at the expense of one's manhood / future posterity is outrageously negligent.

Anyways, not sure if you saw my latest post, but I'm actually back on Fin, 0.25mg every other day for 1 mg per week. I'm gonna see how I fair with that dosage. If the watery semen rears its ugly head again, I may have to throw in the towel with oral Fin completely and opt for topical Fin instead.

In terms of my HT progress, I agree that I need to be more patient and let it play out...but that being said, the current  trajectory definitely seems to be lagging, especially when compared to most folks, who are typically further along (visually) at this point in the game. Other people who have chimed in and opined on this thread seem to agree as well. So it's clearly not just me who thinks the progress is underwhelming...because objectively it is.

Anyways, appreciate you chiming in and I look forward to seeing how your journey panes out.

Edited July 7, 2023 by Balding Bad

[needmyhairback]

I hope there has been improvement?

[Balding Bad]

1 hour ago, needmyhairback said:

I hope there has been improvement?

I can't honestly say there has been, but you be the judge. I'll be posting an update momentarily.

[Balding Bad]

JULY 22, 2023 UPDATE (213 DAYS POST-OP [7 MONTHS])

I've been a bit busy, henceforth why I'm 3 days late with my scheduled update, but as the age old saying goes: better late than never! Hopefully same goes for my hair growth because, in my opinion, there hasn't been much meaningful growth since my last update. In fact, in certain images it looks like things have regressed rather than progressed!

At 7 months, we're past the halfway point, but can't say I feel like I'm over the hill. There's still a lot of ground to cover in my opinion. My sentiment is still the same as last month's, so I won't rehash it since it'd just be repetitive. Although, I do have to say, I really can't believe that 7 months later I'm still rocking a hat whenever I go out. And on the days I am forced to style my hair, it blows my mind that I'm still utilizing my styling tactic to cover the frontal thinning...it's just very aggravating when I think about it.

In my month 5 (May) update, I had indicated I had some annoying folliculitis occurring at the nape of my neck. For whatever reason, this month it's decided to flare up again and it's actually gotten worse with more popping up. As of this writing, the situation has improved slightly with the size of the cysts decreasing, but they are still very much present. The only reason they aren't visible in my photos is because I still haven't gotten a haircut yet, so they are essentially covered at the moment.

At slightly over 3 months now, this continues to be the longest I've gone without a haircut.

I'm still on Fin at 4x a week at .25mg dosage for a total of 1mg per week. I've only been on this regiment for just under a month, still too soon to notice any benefits and/or potential negative sides rearing its ugly head.

I haven't reached out to SMG yet to get their take on my progress, but I will be doing that within the coming days. I'm quite curious to hear what they have to say.

My month 7 rating still remains 3 out of 10.

In terms of the photos, I've kept the same format from last month, which is:

1.) wet hair

2.) wet hair - dimmer lighting

3.) dry hair

4.) dry hair - dimmer lighting

Anyways, looking forward to seeing what the community thinks of my progress at the 7 month mark. Thanks!

WET HAIR

 

Edited July 23, 2023 by Balding Bad

[Balding Bad]

WET HAIR - DIMMER LIGHTING

Light is pretty much my sworn enemy right now. See last photo...

Edited July 23, 2023 by Balding Bad

[Balding Bad]

DRY HAIR

[Balding Bad]

DRY HAIR - DIMMER LIGHTING

[needmyhairback]

Thanks for the update. I agree this is disappointing for month 7. I understand the frustration when you still have to use styling tricks to cover your baldness, but to stay positive I think now it takes much less effort to cover your baldness than before the procedure, doesn't it?

Don't lose your hope yet. It can still improve in the coming months. I am curious what the clinic would say other than please wait for the 1 year result.

Edited July 23, 2023 by needmyhairback

[Balding Bad]

54 minutes ago, needmyhairback said:

Thanks for the update. I agree this is disappointing for month 7. I understand the frustration when you still have to use styling tricks to cover your baldness, but to stay positive I think now it takes much less effort to cover your baldness than before the procedure, doesn't it?

Don't lose your hope yet. It can still improve in the coming months. I am curious what the clinic would say other than please wait for the 1 year result.

Appreciate the positive spin, but the irony is that styling my hair actually takes the same amount of time, if not slightly longer now, since the frontal hairs are very wiry and do not blend well when I comb my hair forward, so now I have to futz with the front to make it seem convincingly "normal."

Yes, I'm curious to see what SMG says beyond the canned response of wait for the full year. I think, barring a miracle, the current trajectory indicates the final year's result will likely be lackluster, with none of my original issues remedied (thinning, see through, continuation of styling tactic to conceal balding). 

[mrmane85]

I'm sorry to hear this, this must be a  really frustrating time for you. 

Please keep us updated on what the Dr says when you next speak. 

[Henry]

I think if you trim your hairs on the side, you'll have a much better, much fuller looking head of hair. Just a suggestion.

I wouldn't really jump to any conclusions yet though sir. It does look pretty thin now but 5 months is still a lot of incoming hair growth, I've been watching time lapse videos of hair growth from people without hair transplants and let me tell you, the difference on the thickness and volume of their hair for any period of 5 months is amazing.

So even if there wasn't any new hairs sprouting for you at this point, those hairs that you already grown could still have a chance of thickening and blending in better with your native hair.

If it didn't improve though, i really think finding a hairstyle that's thinner on the sides and longer on top, would be your best course of action. 

 

[Spring15]

With a name so epic I expected more from this doctor. Disappointing slightly. I think with a second session to add density would give a great result - maybe not with Josephitis though 

[Melvin- Admin]

It’s still early, hopefully you’re a slow grower. Have you been in contact with your surgeon?

[Balding Bad]

On 7/25/2023 at 2:12 AM, Henry said:

I think if you trim your hairs on the side, you'll have a much better, much fuller looking head of hair. Just a suggestion.

I wouldn't really jump to any conclusions yet though sir. It does look pretty thin now but 5 months is still a lot of incoming hair growth, I've been watching time lapse videos of hair growth from people without hair transplants and let me tell you, the difference on the thickness and volume of their hair for any period of 5 months is amazing.

So even if there wasn't any new hairs sprouting for you at this point, those hairs that you already grown could still have a chance of thickening and blending in better with your native hair.

If it didn't improve though, i really think finding a hairstyle that's thinner on the sides and longer on top, would be your best course of action. 

 

 

Appreciate the suggestion and it's something I also considered. However, my original plan was to grow out all of my hair since longer hair (slicked back) has always been something I've wanted to rock. What I didn't take into account was the HT not being successful/yielding poor results. So with fuller, denser looking sides, that obviously exacerbates the sparseness/thinness of my frontal hair.

I'm still partially hopeful the transplanted hairs thicken/more follicles pop up and improve the visual/illusion of density. That's why I haven't gotten a haircut yet, but, yeah, if there continues to be no signs of meaningful improvement in my frontal hairline then I'll likely shorten the sides to improve the overall aesthetics. 😐

Edited July 27, 2023 by Balding Bad

[Balding Bad]

On 7/25/2023 at 8:07 AM, Spring15 said:

With a name so epic I expected more from this doctor. Disappointing slightly. I think with a second session to add density would give a great result - maybe not with Josephitis though 

Haha, appreciate the humor. Although I must disagree with "Disappointing slightly." It's more than slightly, I'd say "majorly" would be more accurate...to me at least.

Yes, that's my thought as well for a potential 2nd op. It's a shame, but it is what it is.

Edited July 26, 2023 by Balding Bad

[Balding Bad]

8 hours ago, Melvin- Moderator said:

It’s still early, hopefully you’re a slow grower. Have you been in contact with your surgeon?

Same here. 🤞

I reached out on Monday and was supposed to have a call scheduled with Dr. Joe this Friday, however he needed to reschedule/postpone it due to an upcoming HT conference he will be speaking/presenting at. So hopefully I can lock him down in mid-August and get his assessment then.

[Melvin- Admin]

16 hours ago, Balding Bad said:

Same here. 🤞

I reached out on Monday and was supposed to have a call scheduled with Dr. Joe this Friday, however he needed to reschedule/postpone it due to an upcoming HT conference he will be speaking/presenting at. So hopefully I can lock him down in mid-August and get his assessment then.

Good, best to keep communication with your surgeon, let him know your feelings. Two things can be true at the same time. You can be disappointed with the growth at this time, and growth can still happen in the next few months.

[hybonix]

Wow, I am sorry for the lackluster results. The team is correct in saying to wait the full year, but by month 7/8, we should see a good foundation of what is to come. However, the wiry/kinky hair will go away. Mine was like that and it took 13 - 14 months for things to get better. By the second year, the wiry hair was much better, so do not fret there.

Please let us know what Shapiro and Dr Joe respond with.

[Balding Bad]

AUGUST 18, 2023 UPDATE (240 DAYS POST-OP [8 MONTHS])

Greetings all. I'm a day late with my post, but made sure to snap these photos yesterday to accurately reflect 240 days/8 months post-op.

So to start things off, I'll recap my call with Dr. Joe that occurred on Tuesday (08/15). I've got to hand it to Dr. Joe, who spent an entire hour speaking to me and during that time I never felt as though he was trying to rush the call or cut it short. His time and attention was fully dedicated to me and I feel that deserves some recognition and praise. That being said, I do feel like the convo was overall not super helpful or informative and felt like we were going in circles at times. He didn't really provide any insightful commentary or assessment on the photos I provided other than saying that it appears that I'm "on track" in terms of my progress. I was hoping he would provide some basic analysis regarding the areas that are clearly lacking, but he kept it very neutral, neither praising or being critical on the matter.

As I kept pressing about the lack of density and the overall thinness/sparseness of the hairline, he did state that it could be due to shock loss of the native hairs. I asked if the thinness could be due to poor yield with the grafts not taking, but he doesn't believe that to be the case. I asked if the current growth looks to be appropriate and reflective of 2,309 grafts and he concurred that it does. When I continued to press about how it looks very weak/see through at the 8 month mark, he did concede that he may have potentially been too conservative with the graft count and it's possible he should have placed more grafts, but cited his decision was based on me having very limited donor hairs and, therefore, didn't want to overharvest in the first procedure. I have an odd T shape on the back of my donor, where the hair in the T region looks a bit thinned out. This was flagged to Dr. Joe prior to the operation and he took that into account when extracting grafts.

Ultimately, Dr. Joe said he wanted to make sure to do right by me and offered to do a free touchup and/or discounted 2nd procedure. As of now, I'm unsure what the next path forward will be for me. I know I'm going to wait for the full 12 months and probably several months after to ensure the full results are achieved before making any decision.

Anyways, in terms of my progress for Month 8, I have to say I think there has been some notable improvements. I feel like my hair looks best when it's wet and combed. When I view it from a straight-on angle under favorable lighting conditions (low lighting) and from several feet away from the mirror, I actually think it looks great! But then when I go in closer for an inspection that illusion crumbles...and that frustrates me. It's akin to seeing a girl off in the distance that looks hot, but then as you get closer it becomes clear that she's mediocre at best. Good for afar but far from good. And I think that's the situation with my hair/progress so far. I think the reason my hair looks better when wet is cause it essentially thins out all the hairs on my entire head and, therefore, the frontal thinning doesn't appear as bad by comparison.

When my hair is dry that's when I think it looks the worst. It just looks super sparse and see through. There's no volume to the hair as one would expect when it's dry, like it should fluff up and give off an illusion of blending to make it look thicker...no such luck with my hair. Moreover, the spot in the front of my hairline that is visibly bald (circled in last month's photos) continues to show no signs of growth. I think the right side of my hairline looks pretty decent, but the center and left side is very sparse/see through and is very blatant when viewed from above.

Even though I think we are still running behind schedule and that the sparseness/lack of density is still an issue and I'm STILL resorting to my old styling tactics to conceal the frontal thinning, I do feel like there has been a marginal improvement over last month's.

So for Month 8, I'm gonna bump up the score from 3 out of 10 to 4 out of 10.

As of now, I still don't feel confident with my hair and I often rock a hat when I can. I hope the remaining 4-6 months of this journey will get me to a place I'll be happy with...I really, REALLY hope I can turn that corner, but I also do realize that another procedure is likely what it's gonna take to get me there... 🙃

Anyways, photos below for you all to assess. Would really love the community's feedback! The photos will follow the same format from last month's. Thanks!

P.S. I'm still on Fin at 4x a week at .25mg dosage for a total of 1mg per week. I've detected no negative sides as of yet. Also, I finally cut my hair on 08/12, which was a good decision since I'm finding it has made styling my hair more manageable and I'm no longer wasting up to 20 minutes to get the concealment styling right! 🙂

Lastly, I do want to flag that my folliculitis on the nape of my neck has been dying down. Not 100% resolved. If anything, it just seems dormant right now, like there's still light and minor bumps here and there but nothing crazy enflamed like last month.

WET HAIR

Edited August 19, 2023 by Balding Bad