1700 FUE with Couto on 5/29/23 - My Amazing, Remarkable, Not Bad, Very Good Day in Madrid

[consequence]

Hello friends, wanted to summarize my recent FUE procedure with the esteemed Dr. Couto in appreciation for the incredible help I've gotten from this forum over the years.

I'm now 10 days post op from my trip to Madrid. I began looking into transplantation ~10 years ago and always loved Dr. Couto's temple points, I think he's one of the best in the world when it comes to imitating mother nature.

Medical history: 

Age: 47, non smoker, no other medical issues
Dutasteride 0.5 mg/day for 10 years
Ketoconazole shampoo 3-5 x/week for 17 years
Minoxidil 5 mg/day for the last 6 months.
2 past PRP sessions, not recently
Intermittent laser helmet use over the years

Logistics of the trip:

I flew to Madrid on a non stop 11 hour flight from the United States with Iberia Airlines.

My packing list included:

• A wedge pillow from Amazon in addition to my neck pillow, vacuum sealed in original packing (so it would fit in my suitcase) for sleeping after surgery:

\

• Neck pillow which was crucial in allowing me to stay on my back when sleeping and avoid rubbing my temples against the pillow in case I accidentally turned.
• ZIppered hoodies to wear after surgery as I didn't want to deal with buttons post-op.
• A lot of sterile normal saline wound wash so I wouldn't have to use tap water after surgery for the recipient. Probably unnecessary but I wanted to reduce the risk of infection.
• Melatonin to help with rest after surgery as I am not a back sleeper. Recuperation is crucial and having something to knock me out was much more necessary than I anticipated.
• Surgical caps for going out, though I really didn't end up using these and my neck pillow was sufficient to allow me to avoid contact with the airplane headrest on the flight back. I also only left the hotel once in the first 7 days after the procedure (other than for my return flight).

- My hotel was La Gran Hotel Ingles, based on its reviews across different travel websites. (I stayed at an AirBnB when I had visited a few years prior for my consultation, but despite having great reviews it was a little dirty so I opted for a hotel on this stay.) It was a nice stay, clean and quiet despite being in the center of downtown.

- If you want to be extra careful, you can ask the maid service for new sheets each day, or if in an apartment you can wash your sheets yourself to reduce risk of infection. I came across this suggestion on some random website and thought it was interesting, though probably a bit cumbersome to do on your own after surgery.

Initial consultation:

-I sent him these pics at my initial e-mail consultation for the design I wanted, Julius Caesar headband courtesy of my mom:

- He generally agreed that this was feasible and quoted me 1400 grafts, though he ended up putting in 1700. This is the design he impromptu drew on the spot in his office at my initial consult. He is the best in the world at temple points in my opinion ("entradas" in Spanish) with Konior being a close second:

 

- The office is located in what looks like a really nice area of downtown Madrid in a ground floor corner office. Be careful of banging your head on the hanging lights over the reception desk after the procedure, they are literally RIGHT at transplant level.

- There wasn't much difficulty in getting to and from using Uber. Another popular ride app in Spain is called "Bolt" and sometimes is faster/cheaper depending on time of day.

- Dr. Couto is exceptionally charismatic and has a "larger than life" personality. I remember at my initial consultation I had just walked in the front door of the clinic and he was coming out of an operating suite. I think he could tell I was a bit nervous and he walked up to me right in the waiting room and gave me a quick but very detailed assessment before he went back inside to continue his surgery. My actual appointment was an hour later where he elaborated further on what he said, but it was really remarkable to see him do this off the cuff. I felt like he was an older brother trying to help me through high school when I met him. Very comforting and confident.

- He reminded me a great deal of a somewhat more ebullient version of Dr. Konior. You can tell he holds himself up to an extremely high standard and takes a lot of pride in his work, but also just generally a cool dude. Also not that it's important but he's a good looking fella, looks a bit like Ricky Martin.

- Here is a montage of the initial surgical pictures. I don't have the pictures from the clinic yet; this was the best I could do in my sedated valium'd up state. I can send Dr. Couto's pics when I get them:

- Day 1 he did half of the left side and midline (60% or so) and day 2 he did the remaining 40% on the right. I noted that he had placed the widow's peak/frontal forelock slightly asymmetrically and he explained that he did this because he found that most natural widow's peaks were not symmetrical. He even added that he had kept the right temple point slightly larger than the right for the same reason. I was resistant to this at first, but have since spent some time looking through Google images and realized he was spot on.

- It was raining a good amount after surgery and one of the surgical techs, Paola I believe, allowed me to take her umbrella even though it meant she would go home in the rain. Don't be a dope like me, plan for weather.

- Esteban, who's been there 10-15 years I believe, was the one that did the extractions. I had seen him mentioned in a lot of posts on the various forums so I was glad it was him. Super chill with a good sense of humor.

- I wasn't very good at staying still during the extraction -- it was a little painful and I was restless. Day 2 was easier but I'm just kind of a physically anxious person. I got scolded by Esteban (as I should have been) for moving too much, and I kept getting paranoid that if I fell asleep my head would jerk but I did my best.

- The extraction was the toughest part of the procedure (other than the swelling on day 3 post op) and even then it wasn't that bad. Be mentally prepared for this. The implantation was much easier to deal with, probably in part because Dr. Couto was so personable during the procedure -- like literally at one point we were all jamming to Queen and singing along to Bohemian Rhapsody as he put together my hairline.

- Here are images of my head after the first day and again at day 3. My donor site was pristine by day 3 though unfortunately I had severe facial swelling at the same time (I tried to crop the blur so you could see. My vision was about 60% impaired which made it extremely nerve racking to avoid hitting my head on things):

-Incidentally, I know it seems obvious when you read "don't hit your head on anything after surgery" but when your vision is impaired from the swelling and you're groggy from anesthesia you need to be careful. These have been the 4 horsemen of my post transplant obstacle course (the third image is a reading light on the airplane head rest that was just begging to stab me in the donor during my return flight):

- This is a little odd but the way I avoided them was literally by putting my arm or hand in front of my head any time I went through a door or sat down on a seat. Literally like I raise my right arm up before entering my car and let that touch the door frame first, then I would slowly lean into the car:

  I am trying to take care of these grafts like they're my children!

- The original hairline was flawless. At 1 week post op and I've noticed some "gaps" appear in the hairline on the left:

- This worried me initially, but it looks much better after 85% of scab removal today:

- There's no way to tell whether this is significant until a year so I'll just try not to think about it too much until things evolve down the line. 

- Regarding post op instructions, they told me to apply a baby shampoo/aqueous mixture in a 1:5 ratio on day 10 (they gave me a special bottle of shampoo), let it sit for a few minutes and then gently but firmly work off the scabs like how Melvin showed us in his post transplant care video.

- I am currently day 10 post op on the left and day 9 on the right. So far things looks fuecking amazing and I pray to the Hair Gods that the final hairline follows suit.

- Physical activity recommendations that I intend to follow are as follows:

1. Week 1: no exercise.
2. Week 2: light activity as long as it doesn't raise my heart rate/blood pressure.
3. Weeks 3-4: light exercise is okay but no weight lifting or high intensity cardio.
4. > Week 4: Weight lifting and cardio okay.

- For the first week I was pretty strict about staying inside and avoiding physical activity as instructed. Luggage was tricky to deal with at the airport because of this (had to wait for porters or ask other travellers to help me) but I didn't want to pop any grafts. Also ended up getting detained at immigration on the way back for a few hours, which really sucked. The agent told me it was random selection, but I'm not sure if my head cover and post op appearance had something to do with it.

- For food, groceries, medical supplies delivered to your hotel room or apartment, they use an app in Spain called "Glovo" that offers same- or next-day delivery. I used this to order bags of frozen peas to keep the swelling down after surgery. Also if you get a chance while in Madrid, try Tierra Burrito. Some of the best Mexican food I've had in my life, especially helpful if you have any nausea post procedure but want to have some basic nutrition in your stomach. Uber eats also works in Spain, though it is slightly more expensive and you can't do the non-food stuff. The downtown area of Madrid, especially around my hotel, was one of the most vivrant walking communities I've ever seen in my life, reminded me of Rome or Paris. Didn't get to experience it much, but I will be returning for sure.

- I've heard some docs like Feller say you can travel the day after surgery. This might be okay for a one day procedure and short flights, but I didn't want to travel with open wounds and draining lidocaine/blood into a gauze wrap while on the plane during my 11 hour transatlantic.

-My facial swelling was fairly severe on days 2/3 and I've heard the altitude of a flight can make it much worse, so you really have to watch your window of opportunity for travel.  Once my face ballooned up like a rubber water bottle I wasn't able to get around for a few days. Even flying back on day 6/7 was a little tricky, though much better than it would have been earlier in the week.  I took 2 weeks off from work, though I think today (days 10 on left and 9 on right) I would have no issue returning. Still, better safe than sorry!

Sooooo that's my summary thus far. Kind of experiencing that weird cocktail of hope and fear that probably everyone who's had surgery here understands. There are moments where I just stand in front of the mirror and think "please, please grow!" as if I'm talking to a house plant, but otherwise doing pretty well. Occasional throbbing along the hairline but pain has been fairly manageable with nothing beyond the regular Tylenol they gave me.

This community is a really special and unique place on the interwebs; thank you all a thousand times over for sharing your advice and personal experiences! Any feedback is sincerely appreciated and I will do my best to keep you guys updated.

Edited June 8, 2023 by consequence

[duckling]

i dont if the hairband was better or the pictographical explanations 😄 . jk

quite a big writeup and pretty detailed and interesting one. 

now coming to work, the widow's peak with the new temples makes the hairline look aggressive. 

you have choosen a great surgeon so you can relax until the 1 year mark when the final result for hairline will be complete. good luck for results. Happy growing !

[Big Rome]

you have gone to one of the best doctors in the business, loving the hairline and temple design 🔥🔥🔥

[consequence]

Thank you guys. One thing to add --

When I sprayed the moisturizer spray given to me by the clinic after surgery, I made sure to use my right hand to do the right side and left hand to do the left side. This allowed for a more symmetric distribution, particularly at the temple points.

[Spring15]

Good luck Caesar! Julius! 

[RobertoDeNiro]

What an incredible Thread you have created. I loved the piece "enemies after a hair transplant". 

Reading through I could see my self in your eyes. Couto is a LEGEND. The way he treats his patients and the passion he has for Hair Transplants is something everyone should experience when they go into a Hair Clinic. 

Good luck!

[Youth_Again]

On 6/8/2023 at 8:56 AM, consequence said:

Hello friends, wanted to summarize my recent FUE procedure with the esteemed Dr. Couto in appreciation for the incredible help I've gotten from this forum over the years.

I'm now 10 days post op from my trip to Madrid. I began looking into transplantation ~10 years ago and always loved Dr. Couto's temple points, I think he's one of the best in the world when it comes to imitating mother nature.

Medical history: 

Age: 47, non smoker, no other medical issues
Dutasteride 0.5 mg/day for 10 years
Ketoconazole shampoo 3-5 x/week for 17 years
Minoxidil 5 mg/day for the last 6 months.
2 past PRP sessions, not recently
Intermittent laser helmet use over the years

Logistics of the trip:

I flew to Madrid on a non stop 11 hour flight from the United States with Iberia Airlines.

My packing list included:

• A wedge pillow from Amazon in addition to my neck pillow, vacuum sealed in original packing (so it would fit in my suitcase) for sleeping after surgery:

\

• Neck pillow which was crucial in allowing me to stay on my back when sleeping and avoid rubbing my temples against the pillow in case I accidentally turned.
• ZIppered hoodies to wear after surgery as I didn't want to deal with buttons post-op.
• A lot of sterile normal saline wound wash so I wouldn't have to use tap water after surgery for the recipient. Probably unnecessary but I wanted to reduce the risk of infection.
• Melatonin to help with rest after surgery as I am not a back sleeper. Recuperation is crucial and having something to knock me out was much more necessary than I anticipated.
• Surgical caps for going out, though I really didn't end up using these and my neck pillow was sufficient to allow me to avoid contact with the airplane headrest on the flight back. I also only left the hotel once in the first 7 days after the procedure (other than for my return flight).

- My hotel was La Gran Hotel Ingles, based on its reviews across different travel websites. (I stayed at an AirBnB when I had visited a few years prior for my consultation, but despite having great reviews it was a little dirty so I opted for a hotel on this stay.) It was a nice stay, clean and quiet despite being in the center of downtown.

- If you want to be extra careful, you can ask the maid service for new sheets each day, or if in an apartment you can wash your sheets yourself to reduce risk of infection. I came across this suggestion on some random website and thought it was interesting, though probably a bit cumbersome to do on your own after surgery.

Initial consultation:

-I sent him these pics at my initial e-mail consultation for the design I wanted, Julius Caesar headband courtesy of my mom:

- He generally agreed that this was feasible and quoted me 1400 grafts, though he ended up putting in 1700. This is the design he impromptu drew on the spot in his office at my initial consult. He is the best in the world at temple points in my opinion ("entradas" in Spanish) with Konior being a close second:

 

- The office is located in what looks like a really nice area of downtown Madrid in a ground floor corner office. Be careful of banging your head on the hanging lights over the reception desk after the procedure, they are literally RIGHT at transplant level.

- There wasn't much difficulty in getting to and from using Uber. Another popular ride app in Spain is called "Bolt" and sometimes is faster/cheaper depending on time of day.

- Dr. Couto is exceptionally charismatic and has a "larger than life" personality. I remember at my initial consultation I had just walked in the front door of the clinic and he was coming out of an operating suite. I think he could tell I was a bit nervous and he walked up to me right in the waiting room and gave me a quick but very detailed assessment before he went back inside to continue his surgery. My actual appointment was an hour later where he elaborated further on what he said, but it was really remarkable to see him do this off the cuff. I felt like he was an older brother trying to help me through high school when I met him. Very comforting and confident.

- He reminded me a great deal of a somewhat more ebullient version of Dr. Konior. You can tell he holds himself up to an extremely high standard and takes a lot of pride in his work, but also just generally a cool dude. Also not that it's important but he's a good looking fella, looks a bit like Ricky Martin.

- Here is a montage of the initial surgical pictures. I don't have the pictures from the clinic yet; this was the best I could do in my sedated valium'd up state. I can send Dr. Couto's pics when I get them:

- Day 1 he did half of the left side and midline (60% or so) and day 2 he did the remaining 40% on the right. I noted that he had placed the widow's peak/frontal forelock slightly asymmetrically and he explained that he did this because he found that most natural widow's peaks were not symmetrical. He even added that he had kept the right temple point slightly larger than the right for the same reason. I was resistant to this at first, but have since spent some time looking through Google images and realized he was spot on.

- It was raining a good amount after surgery and one of the surgical techs, Paola I believe, allowed me to take her umbrella even though it meant she would go home in the rain. Don't be a dope like me, plan for weather.

- Esteban, who's been there 10-15 years I believe, was the one that did the extractions. I had seen him mentioned in a lot of posts on the various forums so I was glad it was him. Super chill with a good sense of humor.

- I wasn't very good at staying still during the extraction -- it was a little painful and I was restless. Day 2 was easier but I'm just kind of a physically anxious person. I got scolded by Esteban (as I should have been) for moving too much, and I kept getting paranoid that if I fell asleep my head would jerk but I did my best.

- The extraction was the toughest part of the procedure (other than the swelling on day 3 post op) and even then it wasn't that bad. Be mentally prepared for this. The implantation was much easier to deal with, probably in part because Dr. Couto was so personable during the procedure -- like literally at one point we were all jamming to Queen and singing along to Bohemian Rhapsody as he put together my hairline.

- Here are images of my head after the first day and again at day 3. My donor site was pristine by day 3 though unfortunately I had severe facial swelling at the same time (I tried to crop the blur so you could see. My vision was about 60% impaired which made it extremely nerve racking to avoid hitting my head on things):

-Incidentally, I know it seems obvious when you read "don't hit your head on anything after surgery" but when your vision is impaired from the swelling and you're groggy from anesthesia you need to be careful. These have been the 4 horsemen of my post transplant obstacle course (the third image is a reading light on the airplane head rest that was just begging to stab me in the donor during my return flight):

- This is a little odd but the way I avoided them was literally by putting my arm or hand in front of my head any time I went through a door or sat down on a seat. Literally like I raise my right arm up before entering my car and let that touch the door frame first, then I would slowly lean into the car:

  I am trying to take care of these grafts like they're my children!

- The original hairline was flawless. At 1 week post op and I've noticed some "gaps" appear in the hairline on the left:

- This worried me initially, but it looks much better after 85% of scab removal today:

- There's no way to tell whether this is significant until a year so I'll just try not to think about it too much until things evolve down the line. 

- Regarding post op instructions, they told me to apply a baby shampoo/aqueous mixture in a 1:5 ratio on day 10 (they gave me a special bottle of shampoo), let it sit for a few minutes and then gently but firmly work off the scabs like how Melvin showed us in his post transplant care video.

- I am currently day 10 post op on the left and day 9 on the right. So far things looks fuecking amazing and I pray to the Hair Gods that the final hairline follows suit.

- Physical activity recommendations that I intend to follow are as follows:

1. Week 1: no exercise.
2. Week 2: light activity as long as it doesn't raise my heart rate/blood pressure.
3. Weeks 3-4: light exercise is okay but no weight lifting or high intensity cardio.
4. > Week 4: Weight lifting and cardio okay.

- For the first week I was pretty strict about staying inside and avoiding physical activity as instructed. Luggage was tricky to deal with at the airport because of this (had to wait for porters or ask other travellers to help me) but I didn't want to pop any grafts. Also ended up getting detained at immigration on the way back for a few hours, which really sucked. The agent told me it was random selection, but I'm not sure if my head cover and post op appearance had something to do with it.

- For food, groceries, medical supplies delivered to your hotel room or apartment, they use an app in Spain called "Glovo" that offers same- or next-day delivery. I used this to order bags of frozen peas to keep the swelling down after surgery. Also if you get a chance while in Madrid, try Tierra Burrito. Some of the best Mexican food I've had in my life, especially helpful if you have any nausea post procedure but want to have some basic nutrition in your stomach. Uber eats also works in Spain, though it is slightly more expensive and you can't do the non-food stuff. The downtown area of Madrid, especially around my hotel, was one of the most vivrant walking communities I've ever seen in my life, reminded me of Rome or Paris. Didn't get to experience it much, but I will be returning for sure.

- I've heard some docs like Feller say you can travel the day after surgery. This might be okay for a one day procedure and short flights, but I didn't want to travel with open wounds and draining lidocaine/blood into a gauze wrap while on the plane during my 11 hour transatlantic.

-My facial swelling was fairly severe on days 2/3 and I've heard the altitude of a flight can make it much worse, so you really have to watch your window of opportunity for travel.  Once my face ballooned up like a rubber water bottle I wasn't able to get around for a few days. Even flying back on day 6/7 was a little tricky, though much better than it would have been earlier in the week.  I took 2 weeks off from work, though I think today (days 10 on left and 9 on right) I would have no issue returning. Still, better safe than sorry!

Sooooo that's my summary thus far. Kind of experiencing that weird cocktail of hope and fear that probably everyone who's had surgery here understands. There are moments where I just stand in front of the mirror and think "please, please grow!" as if I'm talking to a house plant, but otherwise doing pretty well. Occasional throbbing along the hairline but pain has been fairly manageable with nothing beyond the regular Tylenol they gave me.

This community is a really special and unique place on the interwebs; thank you all a thousand times over for sharing your advice and personal experiences! Any feedback is sincerely appreciated and I will do my best to keep you guys updated.

I am so happy to read your post, we actually met on June 1st, I was there for my first consultation and got offered to go on september 2023 due to a last minute consultation. I actually asked the clinic if you were willing to share your details so I could talk to you regarding the long flight, since we are both based on the west coast.

Glad to see you are doing better and your face is not super swollen like it was that one day. 

[consequence]

A couple additional things I wanted to note or ideas I came across.

• A few sites recommended not using a cloth towel to dry your hair, but paper ones. This makes sense as cloth towels usually have bacteria on them even if they look and smell fine. I think even safer would be to just let your hair air dry -- it's a buzz cut and shouldn't take more than a few minutes. Why expose your scalp to yet another foreign object.
• Avoiding certain foods before and after surgery, in particular green tea/jasmine, spices (not just cayenne but things like turmeric, ginger, cloves, etc), caffeine/stimulants, nicotine, alcohol and marijuana (even if taken in capsule or edible form). Many of these have complicated anti-inflammatory and blood thinning effects. This might seem like a good thing until you realize that not all inflammation is bad -- a little bit is needed to stimulate follicles to start growing after surgery. Too much inflammation, of course, and you kill the graft or cause shock loss. It's a balancing act. Dr. Lindsey's site probably said it best: avoid foreign cuisine and just eat bland American food, at least up until your surgery.
• Be very careful with chewing because your temporalis muscle can contract with too forceful of a bite and pop a graft out. On day 2 I was eating a semi-ripe apple and as I bit in I felt something loosen on the left of my hairline. Literally had a mini existential crises. Don't be dumb like me, eat softer foods and soups for the first week or two. 

           

• Cracking after surgery. This explains what might have occurred at the mid aspect of my left hairline above (the red arrows). This explanation is from Dr. Feriduni:

          

"When the scalp is very dry or dehydrated after the surgery, ‘cracked lines’ could occur in the recipient area. This phenomenon appears when the scalp returns to its normal condition. It is almost comparable to the cracks in the desert. You could use a moisturizing body lotion to hydrate the scalp (for example The Postoperative Serum from Dr. Feriduni Hair Clinic or a regular lotion)."

This is likely what occurred with my scalp. Doing my best to keep it moist.

• It's a good idea to design a tin foil cover over your head to avoid radiation to your follicles: 
• The reason for this is the dermal papillae is so sensitive after transplantation that any radiation could impact your follic-   ..no just kidding. It's pretty easy to overthink recovery but it's also pretty easy to get lazy about it. There's a sweet spot but it really requires a healthy sense of perspective. Don't be part of the tin foil hat crowd.

There are a few other points that come to my mind while I'm out and about so I reserve the right to come back and edit this post down the line. Still I thought these might be helpful for others with similar questions. This site and you guys have been a real blessing, thank you all so much for the company on this bizarre roller coaster of recovery.

Edited June 11, 2023 by consequence

[CharlesBarkley]

Thanks a lot for your detailed explanation.

Your design looks phenomenal. 

 

[Rawkerboi]

That's a really nice detailed experience. 

But Man i am in love with your Julius Caesar headband. 

 

Edited June 13, 2023 by Rawkerboi

[consequence]

Here are some updates from Weeks 2 and 3:

Just at week 3 today and have noticed a gap starting to appear on the left. Not sure if this is early shedding or follicles that didn't survive.

It seems a little early for shedding, no?

I'm assuming this will probably be a gap that I will try to address later. Just thinking about what I could have done to contribute to this -- who knows. Just praying it's early shedding (not sure how common that is at week 3) and that this all works out.

What an emotional rollercoaster this whole process has been.

Edited June 20, 2023 by consequence

[consequence]

Also, Dr. Couto recommends PRP at 1 month, then every 3 months after treatment. Have any of you tried this?

[Will_the_way]

3 hours ago, consequence said:

Just praying it's early shedding (not sure how common that is at week 3)

Shedding is absolutely normal at this point. I shed almost all the hair by the end of week 3.  Don’t stress yourself out lol

[consequence]

Here I am at 4 weeks post surgery - shedding has progressed though it seems the temples have held on a little more and the left side is looking less patchy than the right. Good times. 

[Giddylot]

The hairline looks great, but the transplanted area does not look dense enough for the most important area, which is the front.

 

Lets see the result.

[consequence]

16 hours ago, Giddylot said:

The hairline looks great, but the transplanted area does not look dense enough for the most important area, which is the front.

I've seen this comment on other cases of his recently and it has been on my mind as well. That being said, here's my head (top) next to another case of his (below):

Taking into account the differences in picture resolution, I think the density looks pretty similar. This is how that case turned out:

In my opinion a very pleasant result, though I am cherry picking a bit. Here is @Ramsey's recent procedure with Couto that he recently posted:

   And his comment:

On 6/17/2023 at 11:00 AM, Ramsey said:

Could the density be more? Sure! Can I go back and add more density? Sure. At 54 years old I am still thrilled at the result. 

Now we can compare to another surgeon that's known for dense packing:

Much denser packing but probably with a similar end result, especially when viewed from above. What Couto does is transplant the frontal line more densely but then spaces out behind, presumably to avoid graft loss or necrosis from overdense packing, and to stretch out coverage. The frontal line needs the most density, but it is also usually the oldest place of recession and so has been fibrotic for longer.

Remember the blood supply of the scalp:

   

z

 

Too little density and you get corn rows. Too much and you risk necrosis. It's a balancing act.

This illusion has seemed to work well for him in the past, particularly with darker haired patients, as long as the frontal line grows -- what another surgeon has referred to as the "illusion of coverage". Also part of the apparent spacing is from increased photo resolution, as historically most people on here don't post pics from so close and with high resolution.

Perhaps also because he uses PRP during the recovery period I think hair caliber contributes to this illusion, though certainly I know there are people here that think PRP doesn't make much of a difference. Platelet reduced fibrin (PRF) seems to be the new contender in this aspect of recovery, though almost nothing is known about either in post op recovery medical literature just yet.

For me, the main reason I came to Couto was his temple points. Hopefully the density will be sufficient, but if not that can be readdressed with a minor procedure down the line.

But yes, certainly in my vulnerable post op state any ambiguous or critical commentary is more than enough to send me down a spiral of analyzing pics across the forums. But beyond adding PRP to my recovery and taking care of my health not much else to do but wait patiently and pray to the Hair Gods.

Edited June 29, 2023 by consequence

[RobertoDeNiro]

@consequence Your post is amazing. I am enjoying and learning a lot about hair with you as I did with Dr Couto. He is a true master designing the best possible HT for his patients. True passion.

You are looking great at 4 weeks. 

[disTressedHairline]

Best surgeon in the world. How did you get an appointment with him? I can't even get a consultation . . . 

[consequence]

16 hours ago, disTressedHairline said:

Best surgeon in the world. How did you get an appointment with him? I can't even get a consultation . . . 

It took a long time, this is true. But I was willing to be patient because a year or two here and there meant nothing when compared to the permanence of a transplant. 

Part of what makes Couto so good is how much care he takes with each individual patient, as opposed to these Bosley-type Hair Mills that scalp patients by the score like they're reenacting Little Bighorn.

Good things come to those who wait.

Edited July 3, 2023 by consequence

[Kacan]

I know that Dr. Couto has an assistant for the implantation part. Did you see him, or Couto did the whole part?

[cloudyhaze]

@consequencehow did you go about scab removal? My doctor's office instructions were that it's ok to massage head with shampoo/water right after the 3rd day, while I see other doctors recommend to not touch the scabs and let it fall out on it's own. I'm currently 10 days post op and just been sticking to dumping water/shampoo mixture on head, and not touching it at all.

[Youth_Again]

Any update ?

[Melvin- Admin]

Would love an update 🙏

[consequence]

Here are some updates. I'm trying more magnified views for this period as a lot of the changes are subtle and difficult to see from a distance. Also taking pictures with my camera in "outwards facing" mode as selfie mode also seems to blur a lot of the fine detail and nuance.

11 weeks:

12 weeks:

From above at 12 weeks:

Frontal view further away, 12 weeks:

Oblique view at 12 weeks -- the pic below really shows the difference between the frontal line where Couto did denser packing and then the less dense area behind. Hairs have come in for the most part but they're still narrow caliber:

Funny that that one hair at the bottom that just took off on his own like Usain Bolt.

At this much magnification I know some people might say the density seems sparse, but this may not be the case when the hairs thicken up down the line (hopefully). As I discussed in my previous post above, I think there is a "critical threshold" we have to be cautious of with transplantation to reduce the risk of necrosis.

The left side is lagging behind the right and without quite the same yield just yet. There are a few open spots at 12 weeks but it's a work in progress:

If these don't fill up I may return to Madrid to "top off" the hairline in the future, but let's see what the next 9 months bring.

Not really sure why but it seems to me there was a significant jump between 11 and 12 weeks. I did make some changes to my supplement regimen during this period which I will post on at a later time, but it could also just be the random will of the Hair Gods.

In general I'm happy with how it's been coming along. My face is framed much better, and with my hair combed forward you really can't tell I've had any work.

As far as post op care, there don't seem to be many hard recommendations in the medical literature or my instruction packet, so I've just generally been trying to stay healthy:

• I cut out stimulants to large degree (Ritalin, caffeine, modafinil etc) as they are vasoconstrictors and impair sleep -- I want to make sure blood flow is as good as possible. To keep the garden "watered" if you will.
• Exercising, but not a crazy amount as it is a bit of a free radical inductant.
• Cleaned up my diet but not doing intermittent fasting until I hit the 1 year mark. Just want to keep my body in a comfortable "growth" environment, and dramatic weight loss is probably not part of that equation.
• Still keeping my weight healthy and avoiding high blood pressure is also important as hypertension also reduces peripheral blood flow.
• I did do PRP a month prior and a month after, but instead of directly into the operative bed I went a little above and wore an elastic headband for an hour or two afterwards to let gravity passively draw the injected solution in the operative bed and bathe the dermal papillae. I may do another session now at 3 months but still pondering.
• I adjusted my job which used to be overnight to evening hours and will be reducing my hours further just to rest more.

Basically just doing my best to make the follicles feel as welcome as possible in their new home. 🤗 I sometimes think back to that post about the dude who was asking if it was okay to snort cocaine before his hair transplant because he didn't want to "ruin his New Year's". 👀 Just amazed at the range of patients on this forum sometimes. 

To be honest I've been keeping away from the forums as viewing posts and getting criticism during recovery can be a bit stressful. Having good sleep and peace of mind are a huge part of healing I think -- perhaps because they impact growth hormone levels.

One thing that has become painfully clear in recovery is how lucky I am to have this forum. I tried researching for some other surgeries (one non cosmetic and the other cosmetic) and there is nothing like HRN on the entire planet for either of them. Realself, Yelp, Facebook, Reddit, nothing came close. Certainly no place is perfect but that's just the nature of the beast, especially with techniques in hair restoration being so new in the larger scale of things. We are really spoiled by this place (and its sister foreign language equivalents) and for that I am truly appreciative.

Song of the moment -- Mafro's "Alright". Cautiously optimistic and hopeful. To those of you in recovery I wish you best of luck! And a big thank you to everyone else for your advice and insights.

Edited September 4, 2023 by consequence

[consequence]

Also here are the pictures taken by the clinic themselves at the time of my surgery, as I never submitted those with my original post:

 

The crazy stuff we do for our hair, right? 😅