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

[wprevil]

9 hours ago, consequence said:

5 months:

Overall it looks good on the right, still thin on the left. It seems like most of the hairs have grown, just immature caliber. Even feeling them, they're more "silky" like baby hairs -- they will hopefully coarsen up. Hopefully left follows the right, but if not will consider a minor touch up.  

 

To be perfectly honest, the front scalp looks very good! Theres no question theres more hair than you had preop. Its been 5 months so far. Just give it a month or 2 and you'll see a better change. But it still looks good. Wish I can see it styled though.

You got to stop freaking out man. Youre making me nervous. Youre fine!

Quote

Google's ITA matrix and Skiplagged to see what's out there, then Cheapoair, Momondo and Kayak for specific tickets.

I will look into these and thanks dude.

[Rawkerboi]

Right on track, the left side will fill up in coming months, still seven more month's to go lot of maturity left

[consequence]

15 hours ago, wprevil said:

You got to stop freaking out man. Youre making me nervous. Youre fine!

Thanks bro 😎

[Youth_Again]

looking great mate, temples look very full already. The party is about to start. It will improve weekly from there, I am so excited to get to that point 😎

Edited October 20, 2023 by Youth_Again

[consequence]

On 10/20/2023 at 2:19 PM, Youth_Again said:

looking great mate, temples look very full already. The party is about to start. It will improve weekly from there, I am so excited to get to that point 😎

Thanks brother. I'm having some difficulty being complacent with the left frontal hairline being a bit whispy. I'm going to look at Couto's other cases at the 5 month mark and then at a year to see if I'm on track, or if people that were thin at this stage just generally stayed thin at the end.

The actionable purpose behind this would be to have an idea as to whether I should start trying other things like laser helmets/PRP to thicken the shaft caliber or if I should just lay and pray. So little is known about these add-ons, but I suspect there is a window of opportunity with their use (ie. they may have more impact within the first year when the follicle is first establishing blood supply, etc. as opposed to afterwards).

There's also uncertainty about differences in the PRP protocol used at Couto's clinic vs ones near me. It has been difficult to get the full details of their PRP protocol via e-mail and to have a local MD follow the same approach -- ie. activated vs non-activated, leukocyte depleted or enriched, centrifuge rate, how many injections and how far apart (as far as distance). The consistency with PRP use across different centers is basicallly non-existent. So many variables and so little is known.

I will probably give the clinic a call later this week to touch base after seeing where I stand relative to his other patient posted cases.

[Youth_Again]

2 minutes ago, consequence said:

Thanks brother. I'm having some difficulty being complacent with the left frontal hairline being a bit whispy. I'm going to look at Couto's other cases at the 5 month mark and then at a year to see if I'm on track, or if people that were thin at this stage just generally stayed thin at the end.

The actionable purpose behind this would be to have an idea as to whether I should start trying other things like laser helmets/PRP to thicken the shaft caliber or if I should just lay and pray. So little is known about these add-ons, but I suspect there is a window of opportunity with their use (ie. they may have more impact within the first year when the follicle is first establishing blood supply, etc. as opposed to afterwards).

There's also uncertainty about differences in the PRP protocol used at Couto's clinic vs ones near me. It has been difficult to get the full details of their PRP protocol via e-mail and to have a local MD follow the same approach -- ie. activated vs non-activated, leukocyte depleted or enriched, centrifuge rate, how many injections and how far apart (as far as distance). The consistency with PRP use across different centers is basicallly non-existent. So many variables and so little is known.

I will probably give the clinic a call later this week to touch base after seeing where I stand relative to his other patient posted cases.

Pls keep us updated, the PRP treatment is so tricky. I think I won’t even do it, I wasn’t able to get a clear understanding of the method he is using tbh 

[Melvin- Admin]

On 10/19/2023 at 12:58 PM, consequence said:

5 months:

Overall it looks good on the right, still thin on the left. It seems like most of the hairs have grown, just immature caliber. Even feeling them, they're more "silky" like baby hairs -- they will hopefully coarsen up. Hopefully left follows the right, but if not will consider a minor touch up.  

  

Google's ITA matrix and Skiplagged to see what's out there, then Cheapoair, Momondo and Kayak for specific tickets.

Looking good 👏🏼

[EvansLawrence]

Looking great for tje 5 months

you dont need to worry at all at this point. Give it 2 more motnhs 👍

[hairman4321]

12 hours ago, consequence said:

Thanks brother. I'm having some difficulty being complacent with the left frontal hairline being a bit whispy. I'm going to look at Couto's other cases at the 5 month mark and then at a year to see if I'm on track, or if people that were thin at this stage just generally stayed thin at the end.

The actionable purpose behind this would be to have an idea as to whether I should start trying other things like laser helmets/PRP to thicken the shaft caliber or if I should just lay and pray. So little is known about these add-ons, but I suspect there is a window of opportunity with their use (ie. they may have more impact within the first year when the follicle is first establishing blood supply, etc. as opposed to afterwards).

There's also uncertainty about differences in the PRP protocol used at Couto's clinic vs ones near me. It has been difficult to get the full details of their PRP protocol via e-mail and to have a local MD follow the same approach -- ie. activated vs non-activated, leukocyte depleted or enriched, centrifuge rate, how many injections and how far apart (as far as distance). The consistency with PRP use across different centers is basicallly non-existent. So many variables and so little is known.

I will probably give the clinic a call later this week to touch base after seeing where I stand relative to his other patient posted cases.

lay and pray, don't want to mess it up and you've got a long time to do until its final form - its looking pretty good already.

[EvansLawrence]

On 10/23/2023 at 8:56 PM, consequence said:

Thanks brother. I'm having some difficulty being complacent with the left frontal hairline being a bit whispy. I'm going to look at Couto's other cases at the 5 month mark and then at a year to see if I'm on track, or if people that were thin at this stage just generally stayed thin at the end.

The actionable purpose behind this would be to have an idea as to whether I should start trying other things like laser helmets/PRP to thicken the shaft caliber or if I should just lay and pray. So little is known about these add-ons, but I suspect there is a window of opportunity with their use (ie. they may have more impact within the first year when the follicle is first establishing blood supply, etc. as opposed to afterwards).

There's also uncertainty about differences in the PRP protocol used at Couto's clinic vs ones near me. It has been difficult to get the full details of their PRP protocol via e-mail and to have a local MD follow the same approach -- ie. activated vs non-activated, leukocyte depleted or enriched, centrifuge rate, how many injections and how far apart (as far as distance). The consistency with PRP use across different centers is basicallly non-existent. So many variables and so little is known.

I will probably give the clinic a call later this week to touch base after seeing where I stand relative to his other patient posted cases.

I had a 20min call with Couto himself 2 months before my surgery where He recommend me strongly to do PRP since I had a repair surgery going on. Apparently PRP changes from one clinic to the other. They have a special machine for the plasma that probably other clinics dont have or they have others. I didnt feel the urge by his side of just trying to sell me PRP sessions. He said that although they are always recommended, in repair cases much more. He even was honest and told me that if I can only do one to be that one the month before, in order to prepair the scap tissue that can be tight and hard from a previous procedure. And that later PRP can make shorter the shock loss.

If u are paraoid about it, then go for a PRP. Won't hurt and you can feel relaxed about knowing you are doing good your part. 

BTW yes I have seen cases from Couto where they are super at the 6 month mark but others that are not there yet. If in 2 months u are still like this then u can write them an email. But im sure it will all be ok.

[consequence]

•  

On 10/25/2023 at 3:18 AM, EvansLawrence said:

I had a 20min call with Couto himself 2 months before my surgery where He recommend me strongly to do PRP since I had a repair surgery going on. Apparently PRP changes from one clinic to the other. They have a special machine for the plasma that probably other clinics dont have or they have others. I didnt feel the urge by his side of just trying to sell me PRP sessions. He said that although they are always recommended, in repair cases much more. He even was honest and told me that if I can only do one to be that one the month before, in order to prepair the scap tissue that can be tight and hard from a previous procedure. And that later PRP can make shorter the shock loss.

If u are paraoid about it, then go for a PRP. Won't hurt and you can feel relaxed about knowing you are doing good your part. 

BTW yes I have seen cases from Couto where they are super at the 6 month mark but others that are not there yet. If in 2 months u are still like this then u can write them an email. But im sure it will all be ok.

Thanks for sharing your perspective. In how many injections does Dr. Couto usually give the PRP? Does he do microneedling at the same time? 

Couto varies a bit with whom he recommends PRP depending on their medical history. For 2nd surgeries like yours it seems he really seems to favor it, possibly because scar tissue can impede blood supply and cause caliber/thickness issues. 

I spent a good amount of time comparing his cases between here and recuperar, and it seems in general his patients that get PRP have slightly better outcomes than those that don't. A limit of this comparison was that sometimes people may just forget to mention that they got it. Not the most "scientific review" but it subjectively felt like there was a consistent effect.

The patients that got it usually did so with Couto himself at his clinic, which means they were more often Spanish and had thicker darker hair to begin with. His older cases (like before ~2018) don't ever seem to mention PRP, so I think maybe his clinic started offering it around 2020. There were only one or two cases of his that I could find where an international patient was getting it with a local MD instead of going back to Couto.

The reason the specific clinic giving the PRP is important is there are a lot of protocol variations because there are no "best practices" for hair growth yet. For example, one of the things Dr. Couto emphasized to me was that his machine employed a very gradual increase in the blood centrifuge rate over time, not an abrupt increase to maximum speed all at once. The clinics near me don't have the same PRP equipment and their devices seemed to abruptly accelerate to maximum speed, though I'm going to ask to observe the centrifuge next time I go in.

I would imagine the more gradual incease in spin rate causes less physical trauma to the blood sample, and presumably less blood sample activation/inflammation. If trauma makes cells burst, for example, they're going to release all sorts of inflammatory debris. The infamous "shock loss" or telogen effluvium. So when you say "It can't hurt." part of me says, "Can we really say that?" 😇

The question clinical trials would answer is whether, in the post-surgical setting:

1. PRP's growth factors rescue and strengthen borderline follicles or
2. Its inflammatory component (ie. physical trauma, incomplete effectiveness of white blood cell removal by centrifuge, etc.) inhibits growth and damages follicles.

My guess is when done correctly it is the former, even after surgery. The only time I think it is definitely pointless to get it is at the time of surgery itself, because the actual operation is a several-fold more potent version of endogenous PRP than plasma injections ever could be, so it would be redundant.

There are other variables as well. If the clinic uses single needles with evenly spaced injections or numerous mini-injections, the distribution and depth of trauma would vary. Usually the depth of the roller needles is supposed to be too superficial to directly contact the root, which may not be the case with needle injections. On the other hand, some inflammation is needed for growth (which is the reason microneedling is theorized to work). Some places also use Acell or stem cells to augment the PRP, though there's really no evidence either of these have an effect. There's no evidence they don't work either, but that's a slippery slope of a thought process. 

Also, in the US, PRP is usually offered at private practice beauty clinics, either in surgical or dermatological type settings. From what I've seen, usually the supervising physician farms out their actual injection work for these to their NP or PA. This can make it near impossible to discuss theory or protocol modifications directly with the MD (ie. to make them closer to those of FUExpert). And even if you can talk with them, they're unlikely to know as much about hair as Dr. Couto. My hunch is they're usually just following the directions that came with the PRP kit. These are are unlikely to be as well thought out as what they're doing at FUExpert, and may be more designed for facial PRP (about which there is more research, but skin is very different than hair).

At the end of the day, I'm leaning strongly towards getting a few rounds because my follicle survival percentage seems decent but the caliber is low. I think I could go back to Couto, but I'm hesitant to take a 22-hour round trip flight to Spain every 3-6 months. My neurosis wonders if the stress of the flight would increase the WBCs in the PRP sample. 🙃 Also it's a lot of effort for something that could potentially not even matter. Who knows though, maybe. I'll send a message to the clinic and take it from there. 

 

Edited October 31, 2023 by consequence

[consequence]

Here are my 6 month pics (24 weeks).

Edit: Actually a little over 5 months, I did my dates wrong. 

The right hairline and temples are essentially complete and indistinguishable from my native hair, super happy about those parts.

The left hairline is still a bit pluggy, maybe an 8/10. I've been looking at other results at the 6 month mark and then seeing how they ended up at a year to see if I'm on track or if I need to try something like PRP or get on Viagra/Cialis. 🍆

Edited November 9, 2023 by consequence
corrected date from surgery

[Gatsby]

I think for six months it's looking excellent. Allow for another six months for any new growth and thickening to progress. Thanks for sharing @consequence. 👌

[consequence]

1 hour ago, Gatsby said:

I think for six months it's looking excellent. Allow for another six months for any new growth and thickening to progress. Thanks for sharing @consequence. 👌

Thanks @Gatsby you are a pillar of the transplant community, appreciate your positive attitude. I know this is small change compared to all that you've gone through. 🙃

[mxnprettynice]

Looks good @consequence! some transplants gain density by month seven, so there's potential for even more fullness in the coming months. You might consider trying microneedling with a derma pen. This could potentially revive follicles that are dormant. I began using one at a depth of 1.5mm weekly, starting in the month 2. I was surprised by results within 20 days. Combining topical minoxidil with oral minoxidil can be a good approach as well, especially now if you've started microneedling. This dual therapy has been effective for many people I've seen.

Cialis/Viagra can be particularly beneficial in the early stages of a hair transplant. In my case, I used it since I didn't want to give up nicotine vaping.

Edited November 6, 2023 by mxnprettynice

[Der3k7]

On 11/5/2023 at 11:14 PM, mxnprettynice said:

Looks good @consequence! some transplants gain density by month seven, so there's potential for even more fullness in the coming months. You might consider trying microneedling with a derma pen. This could potentially revive follicles that are dormant. I began using one at a depth of 1.5mm weekly, starting in the month 2. I was surprised by results within 20 days. Combining topical minoxidil with oral minoxidil can be a good approach as well, especially now if you've started microneedling. This dual therapy has been effective for many people I've seen.

Cialis/Viagra can be particularly beneficial in the early stages of a hair transplant. In my case, I used it since I didn't want to give up nicotine vaping.

Wait why are you guys talking about taking viagra or cialis after a hair transplant in the beginning? Are you guys saying this because of increasing blood flow improve graft survival? 

[Samson1]

18 minutes ago, Der3k7 said:

Wait why are you guys talking about taking viagra or cialis after a hair transplant in the beginning? Are you guys saying this because of increasing blood flow improve graft survival? 

I know that's what Dr Thiago Leal recommended for the FUE3300 case

[Youth_Again]

From my understanding you did your surgery on May 29th, so you are not even at 6 months yet. It's looking really good, should see improvements weekly now.

[consequence]

On 11/7/2023 at 12:56 PM, Der3k7 said:

Wait why are you guys talking about taking viagra or cialis after a hair transplant in the beginning? Are you guys saying this because of increasing blood flow improve graft survival? 

There have been a few studies as of late suggesting that it improves blood flow to the hair follicle (dermal papillae), but they are extremely preliminary -- the one I linked is only in vitro and animal models, and humans are not small furry rodents.

Dr. Leal in Brazil apparently recommends its use in his high density patients. I haven't looked too much at his patient submitted cases, but the one thread I saw that mentioned the Viagra was a high density packing and Leal hit it out of the park.

I think a lot of people will be on the combination soon as finasteride/dutasteride can cause ED anyways, so it's a nice synergy.

Edited November 9, 2023 by consequence

[consequence]

8 hours ago, Youth_Again said:

From my understanding you did your surgery on May 29th, so you are not even at 6 months yet. It's looking really good, should see improvements weekly now.

That's a fair point. 😬 I'm at 24 weeks which is 6 "Februaries" but 11/29 would be my actual 6 months.

[consequence]

On 11/5/2023 at 10:14 PM, mxnprettynice said:

You might consider trying microneedling with a derma pen. This could potentially revive follicles that are dormant. I began using one at a depth of 1.5mm weekly, starting in the month 2. I was surprised by results within 20 days.

Do you have a pen that you recommend in particular? Something like this one?

I tried minoxidil foam in the past but gave it up because it was too messy and sticky, and it gave me facial swelling/red eyes. I may give it another go though, who knows. Oral minox has been a game changer for me.

Thanks for the suggestions!

[Der3k7]

4 hours ago, consequence said:

Do you have a pen that you recommend in particular? Something like this one?

I tried minoxidil foam in the past but gave it up because it was too messy and sticky, and it gave me facial swelling/red eyes. I may give it another go though, who knows. Oral minox has been a game changer for me.

Thanks for the suggestions!

I really like the minoxidil dropper it allows me to get the end of the dropper right up against the scalp between hairs and I’m able to do it in a way that my hair stays mostly dry and then I comb it after and all the liquid is on the scalp and my hair is still dry and combed and styled as usual I do this in the morning and then apply xyon dutasteride at night 

[mxnprettynice]

Yes, @consequence adding microneedeling will revive dormant hair follicles. I'm quite confident you'll get a new growth phase. Typically, it takes about 2-3 months to get results from microneedling, so patience is key. I've included my progress photos after adding microneedling to my minoxidil and finasteride.

[consequence]

8 hours ago, mxnprettynice said:

Yes, @consequence adding microneedeling will revive dormant hair follicles. I'm quite confident you'll get a new growth phase. Typically, it takes about 2-3 months to get results from microneedling, so patience is key. I've included my progress photos after adding microneedling to my minoxidil and finasteride.

Wow, was that on transplanted hair? Which specific pen did you use?

[EvansLawrence]

Ok!

looking on track.

Since I see you are a perfectionist one just like me I would recommend you to contact Fuexpert and do a PRP with them in their clinic so it accelerates the recovery and u can be more relaxed about it hehe.

But looks good.