Recommendations for my situation (2nd HT)

[aykay7]

Hello all,

I have been lurking on here for quite some time, and now masking up the courage to make a post because I know how helpful and supportive the community here is.

Basically I am looking to get a 2nd HT, and need everyones advice and input as to which doctor/clinic they think would be the best for my situation.

Some background: I am a 32 year old, Caucasian Middle-eastern. I did one FUE HT in Feb 2019 with 2,750 grafts in Turkey. Never took any medication (finasteride/minoxidil, etc) as I have heard of the side effects. I would rather stay away unless really really recommended.

I am semi-pleased with my current hair, mainly because of the thinning in the top frontal area, some over harvesting to the back left side, and I believe wrong direction of implanted grafts. I am looking to have more density to the top. This time I am prepared to pay more and go bigger, as I plan for this to be the last HT I do. Budget I would say is up to 6 euros/graft. Not sure how many grafts I would need? But

I am considering the below and highly appreciate anyone who can better guide and advise me. Definitely open to others as well.

• Dr. Juan Couto - I just heard back and no availability through end of 2024, so I guess not really an option.  
• Dr. Rafael de Freitas - I have heard great things
• Dr. Munib Ahmad FUEGENIX - Also heard great things, not sure about his price and overall feedback
• Dr. Espinosa Custodio - really impressive results and hairlines on the instagram page and website
• I was considering some places in Turkey (Erdogan, HLC, HOI) but I've decided to stay very far away from there this time around

These are just the top ones I've read about, but open to consider others if you can recommend. Europe is easy for me, I'm planning to move to Canada by the end of the year so open to recommendations in the NA region as well. I would like to get it done before the end of the year so I suppose appointment availability is also something to factor in.

Please let me know what doctor/clinic you think is best for my situation? How many grafts do you think I need? Any other doctors/clinics you can recommend are much appreciated! (I am including some pictures of me taken today)

Thank you in advance!

[A_4_Archan]

Your donor seems sparse and thinned out from some angels....so its good that this time you are going to pick a better surgeon so can preserve your donor well...if you will not be on medication than there is chance you would continue to loose ground and again in maybe after 3-4 years evrythn will be same...its not that evryone will have side effects from meds...very few % of people faces side effects so you can just give it a try and suppose if you can't tolerate it than you can anytime stop it...its not that you are going to get any permanent side effects ...now about the doctor i would say if your budget is 5-6 euros than you can choose some of the best in the business and there will always be a long waiting list when it comes to the best surgeons but the wait will be worthy my friend ...imo you should consult the following doctors

Dr zarev - around 5 euros(best when it comes to extraction)

Dr munib ahmad - charges per surgery and not per graft (best when it comes to natural result)

Dr pittela - 4 euros per graft(good with high nw cases and showing very good results this days)

De freitas - 3.5 euros per graft(one of the best hairline designer and great value for money imo) 

Dr bisanga - 5 euros per graft (very well experienced ,straight forward ethical guy)

Dr couto - 4/5 euros per graft ( the sensation)

Prices might be changed so you can check that out with particular doctor himself...you can consult all of them and even check out their results and see whom you like the most...but keep calm and don't rush out ...

Edited April 18, 2023 by A_4_Archan

[DeltaV]

I suggest for your 2nd HT that you do not look anywhere until a consult with Dr. Munib. You can select a 30 mins video consult from his website Fuegenix, it will be money well spent. 

[Rafael Manelli]

All the names listed here are good.
 

If you narrowed down your priorities such as where you live, how much you’re looking to spend, we could perhaps narrow it down more.

[aykay7]

Thank you all for your reply, very much appreciated.

To further clarify, I am mainly looking to add more density to the top of my head (not sure how many grafts that would take?). I do not to lower my hairline.

Couto - is my #1 but unfortunately full until end of 2024.

Rafael de Freitas - filled in the online form and waiting to hear back.

Dr. Munib Ahmad - filled in the online form and waiting to hear back.

Dr. Zarev - filled in the online form and waiting to hear back.

I'm not sure how many grafts I would need, maybe 1,000? Overall I'm looking to spend no more than 5k euros. Europe preferred with flexibility for North America/Canada by end of the year. I would like to have the transplant done before end of this year.

I will be looking into the other doctors mentioned above ^ appreciate any other advice and input in the meantime.

Thanks once again!

 

[A_4_Archan]

If you can than please upload one head down pic so evryone can see the middle scalp properly ..imo you will need around 1500 grafts to dense pack your existing hairline till mid scalp..if you budget is around 5k euros than dr munib ahmad will be out of list as he is charging around 15k dollars minimum for a surgery ...though you can confirm this directly with him...imo de freitas will fit into your budget and he is an excellent surgeon to consider in that budget ...

[TheGreatPretender]

53 minutes ago, A_4_Archan said:

If you can than please upload one head down pic so evryone can see the middle scalp properly ..imo you will need around 1500 grafts to dense pack your existing hairline till mid scalp..if you budget is around 5k euros than dr munib ahmad will be out of list as he is charging around 15k dollars minimum for a surgery ...though you can confirm this directly with him...imo de freitas will fit into your budget and he is an excellent surgeon to consider in that budget ...

I feel the same as I was undecided between my big 3 choices. Since my norwood is a little bit highly diffused (NW5A) I felt like De Freitas was the best option moving forward, he also seems to be able to cover a lot of ground with lesser grafts contrary to many doctors and from what I have heard he aint afraid to go out of his way and do extra grafts to make the patient happy if feasible. I also need the hairline to be reconstructed and he is the best there is in my case alongside the fact that he presents himself well in treating patients with similar hairtypes such as my own. 

That being told there is no shame in waiting a little bit and analyising your options, chose the doctor that you feel mostly comfortable with and go ahead. I know from experience that the choice of the doctor is the hardest since there are lots of them to chose from the big names mentioned here, at some point you will need to go with your gut.

Good luck. 

[A_4_Archan]

6 minutes ago, TheGreatPretender said:

I feel the same as I was undecided between my big 3 choices. Since my norwood is a little bit highly diffused (NW5A) I felt like De Freitas was the best option moving forward, he also seems to be able to cover a lot of ground with lesser grafts contrary to many doctors and from what I have heard he aint afraid to go out of his way and do extra grafts to make the patient happy if feasible. I also need the hairline to be reconstructed and he is the best there is in my case alongside the fact that he presents himself well in treating patients with similar hairtypes such as my own. 

That being told there is no shame in waiting a little bit and analyising your options, chose the doctor that you feel mostly comfortable with and go ahead. I know from experience that the choice of the doctor is the hardest since there are lots of them to chose from the big names mentioned here, at some point you will need to go with your gut.

Good luck. 

True...in high norwood cases there are options like zarev ,pittela and eugenix ...but the op has to fix his hairline and in that case i would put my weight on de freitas than any other surgeon cause of his hairline skills....still he may check out other options..one more option is dr pekiner who is doing good hairline work...

[TheGreatPretender]

4 minutes ago, A_4_Archan said:

True...in high norwood cases there are options like zarev ,pittela and eugenix ...but the op has to fix his hairline and in that case i would put my weight on de freitas than any other surgeon cause of his hairline skills....still he may check out other options..one more option is dr pekiner who is doing good hairline work...

Agreed, those three are a good batch for people with zero to no hair around those areas I think. In Op's case he only needs to get a bit of the front fixed. I think he is likely to respond well regardless of his choice. 

I have seen some exceptional results from De Freitas in diffuse thinners though, some of them mind boggling if you just go and look around the spanish forums. 

[aykay7]

2 hours ago, A_4_Archan said:

If you can than please upload one head down pic so evryone can see the middle scalp properly ..imo you will need around 1500 grafts to dense pack your existing hairline till mid scalp..if you budget is around 5k euros than dr munib ahmad will be out of list as he is charging around 15k dollars minimum for a surgery ...though you can confirm this directly with him...imo de freitas will fit into your budget and he is an excellent surgeon to consider in that budget ...

Here we are, adding more pictures below. Let me know what you think, still 1,500 grafts?

Open to any more feedback/observations

[aykay7]

1 hour ago, TheGreatPretender said:

I feel the same as I was undecided between my big 3 choices. Since my norwood is a little bit highly diffused (NW5A) I felt like De Freitas was the best option moving forward, he also seems to be able to cover a lot of ground with lesser grafts contrary to many doctors and from what I have heard he aint afraid to go out of his way and do extra grafts to make the patient happy if feasible. I also need the hairline to be reconstructed and he is the best there is in my case alongside the fact that he presents himself well in treating patients with similar hairtypes such as my own. 

That being told there is no shame in waiting a little bit and analyising your options, chose the doctor that you feel mostly comfortable with and go ahead. I know from experience that the choice of the doctor is the hardest since there are lots of them to chose from the big names mentioned here, at some point you will need to go with your gut.

Good luck. 

Thank you so much for your advice. The general consensus does seem to be leaning towards De Freitas, and I have been very impressed with him. Anyway I just uploaded more pics above and open to any more feedback. Thanks again!

[aykay7]

1 hour ago, A_4_Archan said:

True...in high norwood cases there are options like zarev ,pittela and eugenix ...but the op has to fix his hairline and in that case i would put my weight on de freitas than any other surgeon cause of his hairline skills....still he may check out other options..one more option is dr pekiner who is doing good hairline work...

Thanks for your advice. Yes I definitely think the focus needs to be on my hairline and needs a dense packing. Also more density through to the mid-scalp. I also uploaded more pics.

[A_4_Archan]

Thanks for the pics..imo minimum of 1500 is needed ...i would say if your budget allows you should go with dr munib ahmad...and if your budget don't than dr de freitas would be perfect..see its like better skilled doctors uses less grafts comparatively still they are able to create an illusion of density ...thts what makes them special and you will pay what you saved with other cheap ones...still thts just my opinion and you can do ur survey and take suggestions from other members ....take your time and i wish you all the best...and i would repeat the same thing one more time that widout meds its always tough to hold on to those grafts..

[TheGreatPretender]

4 minutes ago, aykay7 said:

Thanks for your advice. Yes I definitely think the focus needs to be on my hairline and needs a dense packing. Also more density through to the mid-scalp. I also uploaded more pics.

Honestly you look better then me so chances are you will get a very good result with a good doctor. De Freitas defo seems like a good option in your scenario, your density is also very good and you arent in a high level of norwood yet. 

I also agree with Archan, 1500 would be minimal, maybe you can max it up to 2000? but surely somewhere within this range.

Edited April 18, 2023 by TheGreatPretender

[duckling]

Getting zarev will take lot of time. Surgery date may be received for year 2025. So you can strike him out if you don't want to wait for him.

[aykay7]

Great, thanks for all your input.

I think it's important to note that due to the over-harvesting in my 1st HT, I should be be looking for manual punch extraction rather than motorized?

Does that make sense? Would that be the better option for me?

[A_4_Archan]

10 minutes ago, aykay7 said:

Great, thanks for all your input.

I think it's important to note that due to the over-harvesting in my 1st HT, I should be be looking for manual punch extraction rather than motorized?

Does that make sense? Would that be the better option for me?

Hands matter more than tools my friend ...its not that a motorised punch results in over harvesting of donor...over harvesting is not the fault of punch but its the fault of hands using it..even with manual punch over harvesting can happen if the hands using them aren't experienced ..so don't worry about that...still if you want to explore options than you can check out dr pekiner who is using manual punch and his results are also good..

[aykay7]

Hello all, just wanted to write an update.

I requested a consultation from Erdogan/Asmed and HOI, just to see what they say out of curiosity. (I have decided no way I'm going back to Turkey this time around)

HOI - I sent the pictures via WhatsApp and they answered within 2 minutes quoting me 3500-4000 grafts at 6,000USD. It was their main WhatsApp number and the quotation was done within 1 minute of me sending the pictures, so I doubt a doctor actually saw, assessed, and quoted that.

Erdogan/Asmed - I sent the pictures and they say Mr. Erdogan has evaluated and says "the surgery should consist of 5,000 grafts"

 

I definitely didn't expect to be quoted that much 😮 I was thinking I'd need 1,000-,1,500 grafts max just to increase the density. What do you guys think?

I really hope they're just gauging the grafts to increase costs 😔

[A_4_Archan]

If you just want to increase density of whole scalp than ofcourse you will need more..somewhr around 3k but if you want just hairline density and a bit towards midscalp than 1500-1700 would be fine...

[Pubichair]

Sorry to say bro, but your density is crap at the moment. In order to get a decent result you need a good doc and a lot of grafts.

Mig you just want a fuller hairline 1500 will do. But to cover the whole scalp 3k would seem to be the absolute minimum imho. 
 

Next to that. Munib from Fuegenix could fix you up. But it’s out of your budget. But think well. You don’t want to mess up a second surgery and lose more donor hair/time. So sometimes it might be better so save up some more money and get a proper repair surgeon. 
 

forget about graft counts, only think about the quality of the surgeon and the results he’s had so far. 
 

its a lot of money, effort, time and hair you spent, so chose carefully. 

[Rafael Manelli]

A lot of people say that ASMED tend to quote higher graft numbers.

On 4/20/2023 at 9:49 AM, aykay7 said:

Hello all, just wanted to write an update.

I requested a consultation from Erdogan/Asmed and HOI, just to see what they say out of curiosity. (I have decided no way I'm going back to Turkey this time around)

HOI - I sent the pictures via WhatsApp and they answered within 2 minutes quoting me 3500-4000 grafts at 6,000USD. It was their main WhatsApp number and the quotation was done within 1 minute of me sending the pictures, so I doubt a doctor actually saw, assessed, and quoted that.

Erdogan/Asmed - I sent the pictures and they say Mr. Erdogan has evaluated and says "the surgery should consist of 5,000 grafts"

 

I definitely didn't expect to be quoted that much 😮 I was thinking I'd need 1,000-,1,500 grafts max just to increase the density. What do you guys think?

I really hope they're just gauging the grafts to increase costs 😔

I would avoid HOI.

Your hair looks sparsest at the frontal tuft. The very front middle, where it needs the highest density, not the lowest. Then there seems to be a roughly triangular area of low density behind and especially to the left side. It’s not bald however. You maybe only need 50% more density there. To be conservative, you might need about 2000 grafts minimum. Your hair seems to have a good texture for coverage. Even just 200 grafts could make a huge difference to that frontal circle.

[aykay7]

On 4/24/2023 at 2:11 PM, Pubichair said:

Sorry to say bro, but your density is crap at the moment. In order to get a decent result you need a good doc and a lot of grafts.

Mig you just want a fuller hairline 1500 will do. But to cover the whole scalp 3k would seem to be the absolute minimum imho. 
 

Next to that. Munib from Fuegenix could fix you up. But it’s out of your budget. But think well. You don’t want to mess up a second surgery and lose more donor hair/time. So sometimes it might be better so save up some more money and get a proper repair surgeon. 
 

forget about graft counts, only think about the quality of the surgeon and the results he’s had so far. 
 

its a lot of money, effort, time and hair you spent, so chose carefully. 

Thanks for your honest opinion, I appreciate it. Agreed, my density is very poor. I'm not sure if it was due to poor density implantation on my transplant, or if it's because I simply kept losing hair. 

I also did not go on any meds, the side effects do not really seem worth it to me. So now I'm questioning whether I should even do a 2nd transplant if I still refuse to go on the meds.

Dr. Espinosa Custodio quoted me 2,200-2,400 grafts. HLC quoted me 2000-2500 grafts. Couto, Pinto, & Zarev full until end of 2024/25.

I am waiting on De Freitas's consultation.

It's not that I don't have the $$$ for Munib, but I am questioning of it is worth it to go so big and make that kind of investment, when I will probably not go on meds and may continue losing hair...

 

 

[aykay7]

On 4/24/2023 at 2:24 PM, Rafael Manelli said:

A lot of people say that ASMED tend to quote higher graft numbers.

I would avoid HOI.

Your hair looks sparsest at the frontal tuft. The very front middle, where it needs the highest density, not the lowest. Then there seems to be a roughly triangular area of low density behind and especially to the left side. It’s not bald however. You maybe only need 50% more density there. To be conservative, you might need about 2000 grafts minimum. Your hair seems to have a good texture for coverage. Even just 200 grafts could make a huge difference to that frontal circle.

Yea def avoiding the Turkish hair mills, although doesn't hurt to get their consult/opinion, out of sheer curiosity. 

Thanks for your opinion and feedback, and please see my above comment ^ with the latest consultation I have received. I have received more conservative and realistic quotes of 2k+ grafts. 

Currently questioning if I should even consider a 2nd HT if I do not plan on taking any meds. Bit of a mental game...

[Renegade]

On 4/26/2023 at 2:46 PM, aykay7 said:

Yea def avoiding the Turkish hair mills, although doesn't hurt to get their consult/opinion, out of sheer curiosity. 

Thanks for your opinion and feedback, and please see my above comment ^ with the latest consultation I have received. I have received more conservative and realistic quotes of 2k+ grafts. 

Currently questioning if I should even consider a 2nd HT if I do not plan on taking any meds. Bit of a mental game...

You'll have to be okay with the possibility of the hair in a few years  being the same or worse in density than now. 

If we would see pictures before your first HT one could maybe make a careful estimation how it could play out for you. 

[Sunset Dune]

Just out of curiosity has your hair (the front) always pushed up the way it’s styled in those pictures or did that occur after hair transplant? I’ve noticed lots of hair transplant patients have their hair styled up exposing the hairline and I’m wondering if that’s how transplanted hairs stand or if the patient intentionally styles it that way