Second procedure with dr. Couto of Fuexpert

[Zinedine]

On 2/15/2023 at 7:51 PM, stockholmare said:

@BaldingEye@TorontoMan unfortunately I do not have pre second surgery pics that clearly show the situation: this is because I wore my hair forward in a way that would conceal the situation after my first procedure.

Overall I am feeling well, trying not to think about it and waiting for the shedding and ugly duckling phase to start (saw several shafts today during the shower)

I am slightly concerned as I still feel some pain in the recipient/donor, but I figure it it fairly normal at 3 weeks post op.

Does anyone know if it is ok to go for (non-challenging) walks within the first 24/48 hours after surgery? I did so to increase blood circulation, but now I question my decision.

How is that pain going... 3 weeks is still early and I guess it all depends on the case, some barely mention that and others like you have it for months... how is it now? How is all looking? Donor? 

And about the walks, I never read anything about them not being a good thing, I would say they are even good and will help you relax.

[consequence]

I agree with Melvin here. It's a little frustrating, to be honest, to see how aggressive and critical the forum can be sometimes.

You established a new "line in the sand". Your density wasn't perfect, but looking at the pre-op I don't think it was a yield issue. From my armchair perspective Couto implanted you less dense to start with:

That doesn't look like 35% to me, closer to 80% - but really who the f can tell from 2 dimensional jpgs on a forum.

My hunch is he thought you had a fibrotic scalp with limited blood supply and wanted to ensure graft survival. I'd be curious what your hairline looked like without high magnification and with a non spiked hairstyle.

Also, not to nitpick, but you started oral minoxidil a month after the procedure, when most of the immediate healing and engraftment was completed.

If folks could spend some time on the Spanish forums they'd realize that not every case Couto publishes looks like a home run (he's at about 90%). What really stands out, though, is his sense of accountability and ownership of his results. And to that end, I've never once seen a bad outcome of a revision with him.

I suspect you're going to come out of this looking like a rock star. Please keep us updated.

 

[OliverAtom]

On 3/8/2023 at 7:38 PM, consequence said:

I agree with Melvin here. It's a little frustrating, to be honest, to see how aggressive and critical the forum can be sometimes.

You established a new "line in the sand". Your density wasn't perfect, but looking at the pre-op I don't think it was a yield issue. From my armchair perspective Couto implanted you less dense to start with:

That doesn't look like 35% to me, closer to 80% - but really who the f can tell from 2 dimensional jpgs on a forum.

My hunch is he thought you had a fibrotic scalp with limited blood supply and wanted to ensure graft survival. I'd be curious what your hairline looked like without high magnification and with a non spiked hairstyle.

Also, not to nitpick, but you started oral minoxidil a month after the procedure, when most of the immediate healing and engraftment was completed.

If folks could spend some time on the Spanish forums they'd realize that not every case Couto publishes looks like a home run (he's at about 90%). What really stands out, though, is his sense of accountability and ownership of his results. And to that end, I've never once seen a bad outcome of a revision with him.

I suspect you're going to come out of this looking like a rock star. Please keep us updated.

 

Totally agree with you. I also think that Dr Couto played safe thinking @stockholmare had a fibrotic scalp with limited blood supply and wanted to ensure graft survival. Dr Couto will also try to benefit his patients. We also see this when he is always using a lot fewer grafts than other clinics and still gets better results.

Some people just get in here and comment, I think being jealous or sent by another clinic. It is a total pity. 

And I think the same, this will become a beautiful result ☺️

[stockholmare]

Hello everyone,

Sorry for the latency, I have been very busty with work and family.

Today marks 10 weeks after my second procedure. Everything feels fine, I must say the pain and recovery time was way less vs the first procedure (number of grafts was also roughly 25%, so kind of expected).

My temples/ hairline were the weak spots and at the moment I have not noticed any early growth/baby hair.

Hopefully that will start soon, as I am now well into the 3rd month.

keeping my fingers crossed 🤞

All the best

[consequence]

You are coming along. Please keep us updated and be patient. Try not to look at it every day and if you figure out how share the secret 🙂

[BaldingEye]

Hello @stockholmare looking as it should for 10 weeks. So many things will happen from now on.

How is your donor looking?

[Henry]

On 4/5/2023 at 4:12 AM, stockholmare said:

Hello everyone,

Sorry for the latency, I have been very busty with work and family.

Today marks 10 weeks after my second procedure. Everything feels fine, I must say the pain and recovery time was way less vs the first procedure (number of grafts was also roughly 25%, so kind of expected).

My temples/ hairline were the weak spots and at the moment I have not noticed any early growth/baby hair.

Hopefully that will start soon, as I am now well into the 3rd month.

keeping my fingers crossed 🤞

All the best

I wouldn't mind some busty work too if i say so myself. Anyway goodluck with this journey, i hope everything works well for you.  

[consequence]

On 11/20/2022 at 2:10 PM, stockholmare said:

I did a PRP session 1.5 months after the procedure: could an unexperienced nurse damage the grafts during a PRP session?

Who recommended that you do this after surgery? I have seen some clinics trying it, but so little is known about PRP, particularly in a post-operative setting when the dermal papillae are so fresh, I'm not sure this was a good idea. Looking through Pubmed, there aren't many randomized trials about this (of the two I found, one was done intra-operatively and had some benefit and in another it was used for cicatricial alopecia and there was no benefit). At this point it's basically the wild west.

I would be inclined to say that if the majority of Couto's patients don't do PRP around surgery (which I believe is the case) and the majority get good results, just stay in the middle of the pack and don't try anything too crazy.

Reminds me of that other poster from India on here who was trying crazy nonsense like standing on his head for an hour every day after surgery to "improve blood flow" and and ended up having a subpar result. Sometimes less is more.

Also, did you do PRP 1 month prior to the procedure this time as you planned?

Edited April 9, 2023 by consequence
added pubmed

[stockholmare]

On 4/9/2023 at 12:26 PM, consequence said:

Who recommended that you do this after surgery? I have seen some clinics trying it, but so little is known about PRP, particularly in a post-operative setting when the dermal papillae are so fresh, I'm not sure this was a good idea. Looking through Pubmed, there aren't many randomized trials about this (of the two I found, one was done intra-operatively and had some benefit and in another it was used for cicatricial alopecia and there was no benefit). At this point it's basically the wild west.

I would be inclined to say that if the majority of Couto's patients don't do PRP around surgery (which I believe is the case) and the majority get good results, just stay in the middle of the pack and don't try anything too crazy.

Reminds me of that other poster from India on here who was trying crazy nonsense like standing on his head for an hour every day after surgery to "improve blood flow" and and ended up having a subpar result. Sometimes less is more.

Also, did you do PRP 1 month prior to the procedure this time as you planned?

The doc suggested I did a PRP the first time, when I asked him if that could have had an impact he said that it is unlikely given I did so after 1.5 months, but it is impossible to know because he did not perform it (I went to a clinic closer to home).

I did do a PRP treatment 3 weeks prior to the surgery this time, suggested by the Doc as a "preparation session" that would have all the growth factors activated for the grafts to have higher survival chances.

[stockholmare]

On 4/8/2023 at 12:27 AM, BaldingEye said:

Hello @stockholmare looking as it should for 10 weeks. So many things will happen from now on.

How is your donor looking?

thanks so much, I really hope so! The donor is looking better now and keeping my hair slightly longer helps concealing: if I went for a number 1-2 buzz cut scars would be quite visible, but I think that's normal and expected

[iamspanish]

Hi @stockholmare, I am very sorry about the whole process as the first operation had a rather poor result. I'm sure you'll be much better now.

I wanted to ask you two questions:

• Did Couto do the entire insertion process for you? Or did an assistant that he is training participate?
• What kind of hair thickness did he tell you you had? I see some pretty big punch.

Regards

[Spring15]

Can we  get an update pal?

[Escanor]

On 5/15/2023 at 11:40 AM, iamspanish said:

Hi @stockholmare, I am very sorry about the whole process as the first operation had a rather poor result. I'm sure you'll be much better now.

I wanted to ask you two questions:

• Did Couto do the entire insertion process for you? Or did an assistant that he is training participate?
• What kind of hair thickness did he tell you you had? I see some pretty big punch.

Regards

Yeah, some people in the Hispanic community are attributing the bad result of the first operation to the fact that the insertion (or part of it) was done by an apprentice doctor and not by Couto.

It would be nice if the OP can confirm it for us.

[iamspanish]

27 minutes ago, Escanor said:

Yeah, some people in the Hispanic community are attributing the bad result of the first operation to the fact that the insertion (or part of it) was done by an apprentice doctor and not by Couto.

It would be nice if the OP can confirm it for us.

A few days ago I contacted the clinic and they told me that the insertion is done 100% by Dr. Couto, but the extraction is done by the person who is training. Which seems a little weird to me, I thought that the extraction was done by the specialized nurses.

[Escanor]

7 hours ago, iamspanish said:

A few days ago I contacted the clinic and they told me that the insertion is done 100% by Dr. Couto, but the extraction is done by the person who is training. Which seems a little weird to me, I thought that the extraction was done by the specialized nurses.

Yes, it's been a while since Dr. Couto doesn't do the extractions himself. But that has not affected his results, the one who does  it's already a high quality professional.

The issue its the insertion. Some people say that they have an apprentice to lighten the waiting list, but if the clinic has told you no then we'll have to believe them.

[iamspanish]

11 minutes ago, Escanor said:

Yes, it's been a while since Dr. Couto doesn't do the extractions himself. But that has not affected his results, the one who does  it's already a high quality professional.

The issue its the insertion. Some people say that they have an apprentice to lighten the waiting list, but if the clinic has told you no then we'll have to believe them.

yep! Please @stockholmare don't stop responding, believe it or not, it is very helpful to others

[Melvin- Admin]

He’s probably got amazing hair now, and forgot all about us 😅

[Maballack]

On 2/7/2023 at 2:19 PM, Rafael Manelli said:

It grew better at the hairline for some reason. I’ve seen this many times. I wish I knew why.

I noticed the same on first 2 lines grew better than the rest and the worst been crown.

My theory is that these first line were implanted first and the crown was implanted last, these grafts were out from the solution was more time, keep in mind that grafts can survive for some minutes out of the solution.

The other risks is solutions are not created equal some have atp, some are just saline water so the grafts will die pretty quickly there.

I am going to another surgery, that's why I would like to know why having poor growth.

 

Thanks

[stockholmare]

Hello All,

not much to share at the moment. i am almost 4 months in and very few grafts have sprouted, mostly on the right side, while left is showing almost no signs of growth.

I am posting pics later, but there will be no visible change vs the pre-op.

I am trying to be confident that this time i will get a good result.

To some of the comments: the doc did all the implantation himself, while extractions were performed by the same tech who di them in my first procedure, so not an apprentice for sure.

I honestly felt very well taken care of and, as I said before, the Doc goes really above and beyond to to his job: I perceived he was not doing it for the money (he absolutely does not need it) but because he cares about his patients and his reputation above all else.

I may not be happy after the second procedure and a bad respondent to HT in general, but in all honesty I would still recommend Dr. Couto to anyone who asks me: capable, trustworthy and integer professional.

[iamspanish]

Thank you @stockholmare for your response! I look forward to seeing your results, all the support and calm you need from my side. You are going to have great hair by Christmas!

[Escanor]

On 5/19/2023 at 3:53 PM, stockholmare said:

Hello All,

not much to share at the moment. i am almost 4 months in and very few grafts have sprouted, mostly on the right side, while left is showing almost no signs of growth.

I am posting pics later, but there will be no visible change vs the pre-op.

I am trying to be confident that this time i will get a good result.

To some of the comments: the doc did all the implantation himself, while extractions were performed by the same tech who di them in my first procedure, so not an apprentice for sure.

I honestly felt very well taken care of and, as I said before, the Doc goes really above and beyond to to his job: I perceived he was not doing it for the money (he absolutely does not need it) but because he cares about his patients and his reputation above all else.

I may not be happy after the second procedure and a bad respondent to HT in general, but in all honesty I would still recommend Dr. Couto to anyone who asks me: capable, trustworthy and integer professional.

Thanks for the info. Im going to see Doctor Couto on January of 2024 and im very excited to see how he works. 

[consequence]

Thank you for the update.

Are you taking minoxidil and finasteride still and at what dose? Have you considered 2% ketoconazole?

 

[Z--]

Wishing you great growth brother. 

[stockholmare]

On 5/22/2023 at 12:49 AM, consequence said:

Thank you for the update.

Are you taking minoxidil and finasteride still and at what dose? Have you considered 2% ketoconazole?

 

5mg Oral minox as instructed by the doc and finasteride 

[stockholmare]

On 5/21/2023 at 7:32 PM, Escanor said:

Thanks for the info. Im going to see Doctor Couto on January of 2024 and im very excited to see how he works. 

I am sure you will be satisfied. I probably am a bad responder to HT, but the doc is a very good professional (and man)