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

[Rawkerboi]

Right on track, you still have six more months left and i am pretty sure the density will fill up

[duchaine]

On 11/9/2023 at 9:01 AM, 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.

Microneedeling: depth and frequency please
do you use something on the scalp after MN?

[mxnprettynice]

1 hour ago, duchaine said:

Microneedeling: depth and frequency please
do you use something on the scalp after MN?

I use a 1.5mm needle for microneedling once a week. Immediately after microneedling, I will spray minoxidil and then wear a hat because of a study suggesting that most of the minoxidil evaporates from the skin before it can be absorbed topically.

[duchaine]

10 hours ago, mxnprettynice said:

I use a 1.5mm needle for microneedling once a week. Immediately after microneedling, I will spray minoxidil and then wear a hat because of a study suggesting that most of the minoxidil evaporates from the skin before it can be absorbed topically.

don'y you think it will be absorbed by the hat?

[duchaine]

On 10/31/2023 at 8:57 PM, consequence said:

•  

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. 

 

The nflamatory component of PRP and its effects on hair growth (ie: does it stimulate hair growth or does it increase hair loss?)  appears to be a very interesting topic.
The question is  similar for muscle growth and protein synthesis in general.
inflammation are crucial for protein syntesis but are catabolic as well. So, should we avoid inflammation?
As some researches pointed out, age should play a crucial.
For older people, that have high inflammation naturally, reducing inflammation increases protein synthesis while the opposite is true for younger people, that have low inflammations.
I'm not aware of researches comparing the effects of PRP on young and old people but I would not be surprised if they are totally different.

[mxnprettynice]

3 hours ago, duchaine said:

don'y you think it will be absorbed by the hat?

Not if the hair is long enough and there is a layer of hair between the hat. It definitely dries out on scalp much slower 

[Der3k7]

8 hours ago, mxnprettynice said:

Not if the hair is long enough and there is a layer of hair between the hat. It definitely dries out on scalp much slower 

Can you link the study that talks about this?

[consequence]

1 hour ago, Der3k7 said:

Can you link the study that talks about this?

I'm not sure which studies @mxnprettynice was referring to but these are a few that popped up after a quick google:

• Minoxidil application study 1 
• Minoxidil application study 2
• Minoxidil application study 3
• Minoxidil with microneedling study

I think the idea is that once the minoxidil crystallizes its "thermodynamic activity" decreases. That being said, ethanol is also caustic and I'm not sure as to the effect of having alcohol sitting on your follicles for a longer time period -- these studies are in vitro, not in humans, so there's no way to know whether they affect hair growth positively or negatively. Minoxidil dilates blood vessels by working as a free radical (nitrous oxide, which has an unpaired electron).

In a one year time span, 5% is more effective than 2% and microneedling with minoxidil seems to have an effect. Here's an odd quote from that 4th study:

Quote

Our study showed that the combination of microneedling and topical minoxidil treatment was superior compared to topical minoxidil alone with regard to increase in the hair count and patient satisfaction, although the response achieved was not cosmetically significant.

I don't know that there's a study looking at usage with @mxnprettynice's protocol of using a hat specifically, though presumably one that's waterproof would allow the minoxidil to stick around longer:

Also @duchaine makes an excellent point. PRP, minoxidil or pretty much any hormonal/non-hormonal treatment for hair will have different effects depending on age because they all, to one degree or another, use inflammation as a tool. Inflammation has profoundly different effects across the lifespan because the follicles themselves are physically different and respond differently. Give anabolic steroids to someone in their 70s and they will experience much more aggressive hairloss than someone in their 20s, for example.

But @Der3k7 you had a rhinoplasty while you were still recovering from FUE, and this would be a massive potential source of telogen effluvium/inflammatory stress, both from the surgery and the general anesthesia. Did you see any impact on hair growth?

If not then you have your answer.

Edited November 11, 2023 by consequence

[Der3k7]

16 minutes ago, consequence said:

I'm not sure which studies @mxnprettynice was referring to but these are a few that popped up after a quick google:

• Minoxidil application study 1 
• Minoxidil application study 2
• Minoxidil application study 3
• Minoxidil with microneedling study

I think the idea is that once the minoxidil crystallizes its "thermodynamic activity" decreases. That being said, ethanol is also caustic and I'm not sure as to the effect of having alcohol sitting on your follicles for a longer time period -- these studies are in vitro, not in humans, so there's no way to know whether they affect hair growth positively or negatively. Minoxidil dilates blood vessels by working as a free radical (nitrous oxide, which has an unpaired electron).

In a one year time span, 5% is more effective than 2% and microneedling with minoxidil seems to have an effect. Here's an odd quote from that 4th study:

I don't know that there's a study looking at usage with @mxnprettynice's protocol of using a hat specifically, though presumably one that's waterproof would allow the minoxidil to stick around longer:

Also @duchaine makes an excellent point. PRP, minoxidil or pretty much any hormonal/non-hormonal treatment for hair will have different effects depending on age because they all, to one degree or another, use inflammation as a tool. Inflammation has profoundly different effects across the lifespan because the follicles themselves are physically different and respond differently. Give anabolic steroids to someone in their 70s and they will experience much more aggressive hairloss than someone in their 20s, for example.

But @Der3k7 you had a rhinoplasty while you were still recovering from FUE, and this would be a massive potential source of telogen effluvium/inflammatory stress, both from the surgery and the general anesthesia. Did you see any impact on hair growth?

If not then you have your answer.

No my nose job was a full year after my ASMED hair transplant my results were already subpar with low yield 

[Der3k7]

21 minutes ago, consequence said:

I'm not sure which studies @mxnprettynice was referring to but these are a few that popped up after a quick google:

• Minoxidil application study 1 
• Minoxidil application study 2
• Minoxidil application study 3
• Minoxidil with microneedling study

I think the idea is that once the minoxidil crystallizes its "thermodynamic activity" decreases. That being said, ethanol is also caustic and I'm not sure as to the effect of having alcohol sitting on your follicles for a longer time period -- these studies are in vitro, not in humans, so there's no way to know whether they affect hair growth positively or negatively. Minoxidil dilates blood vessels by working as a free radical (nitrous oxide, which has an unpaired electron).

In a one year time span, 5% is more effective than 2% and microneedling with minoxidil seems to have an effect. Here's an odd quote from that 4th study:

I don't know that there's a study looking at usage with @mxnprettynice's protocol of using a hat specifically, though presumably one that's waterproof would allow the minoxidil to stick around longer:

Also @duchaine makes an excellent point. PRP, minoxidil or pretty much any hormonal/non-hormonal treatment for hair will have different effects depending on age because they all, to one degree or another, use inflammation as a tool. Inflammation has profoundly different effects across the lifespan because the follicles themselves are physically different and respond differently. Give anabolic steroids to someone in their 70s and they will experience much more aggressive hairloss than someone in their 20s, for example.

But @Der3k7 you had a rhinoplasty while you were still recovering from FUE, and this would be a massive potential source of telogen effluvium/inflammatory stress, both from the surgery and the general anesthesia. Did you see any impact on hair growth?

If not then you have your answer.

Also, based on reading the abstract it says evaporation of the water and alcohol is critical to the absorption of the minoxidil. I believe the drug designers want the water and alcohol to evaporate and leave behind minoxidil crystals on the scalp based on what I read in the abstract. The studies abstracts seem like they’re all the same study on quick glance 

[consequence]

13 minutes ago, Der3k7 said:

Also, based on reading the abstract it says evaporation of the water and alcohol is critical to the absorption of the minoxidil. I believe the drug designers want the water and alcohol to evaporate and leave behind minoxidil crystals on the scalp based on what I read in the abstract. The studies abstracts seem like they’re all the same study on quick glance 

The first two are the same, just the first link is the full paper. You want to avoid crystallization because it reduces scalp penetration. This is a quote from the study:

Quote

When the concentration is pushed up to a level where prompt crystallization is unavoidable, the delivery of drugs can be markedly depressed relative to a supersaturated system even though the concentration is high.

 

[Der3k7]

Oh I see, hmm

[consequence]

On 10/31/2023 at 12:57 PM, consequence said:

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?" 😇

 

These are the variables that vary with different PRP techniques. I think we owe it to ourselves to try and establish a standard in hair restoration, though it will probably be a decade or two before we reach a consensus (ie. head to head placebo controlled and double blinded trials)

It would make sense for different kit manufacturers to conduct these tests as the blood comes from the patient themselves, so all the major cost would be machine use time. Would not be a difficult study. And whichever manufacturer did it first and most conscientiously would have a dramatic uptick in sales that would more than justify the labor cost. Get it together transplant industry.

[consequence]

I thought there weren't studies on PRP with FUE but I found something -- this is a peer reviewed study on PRP with FUE showing good effect. They used the "Y Cell Bio PRP kit".

Particularly interesting was the faster growth/thickness and shorter catagen phase after surgery (ie. the infamous "ugly duckling phase" we talk about, also called the "desert" on the Spanish forums). Pretty hard to get past the numbers:

It seemed like it moved things forward about 3 months and helped save borderline follicles.

Non PRP:

PRP:

This was with a particular surgeon and a particular kit, larger studies need to be done.

--

And below is an interesting comparison of different PRP systems that seems to suggest Emcyte as the most effective as far as platelet concentrations:

However, the optimum dose of PRP for hair growth is unknown. Too much and you could actually kill the follicle instead of helping it grow.

Quote

Of the 33 systems and protocols we analyzed, only 11 met the definition of PRP as defined by Marx et al as having a minimum platelet concentration of 1 000 000 platelets/µL. Additionally, Marx et al and others have stated that platelets in PRP should be concentrated to at least five times that of baseline to be efficacious2 —only 10 of the 33 systems and protocols reviewed met this definition. Lastly, 3 of the 33 systems and protocols reviewed even resulted in a final PRP product with a platelet count less than that of whole blood, with a PRP platelet factor increase of 0.737 with Biotechnology Institute PRGF-Endoret,24 0.65 with Curasan AG24 and 0.52 with Selphyl. Of the systems analyzed, Emcyte GenesisCS had the highest platelet concentration tested at 1643±421×103 /µL.30 The lowest platelet concentration was 88×103 /µL with Selphyl.29 This variable range highlights the importance of system selection and protocol adherence.

However, an optimal platelet concentration for PRP has yet to be identified. More is not necessarily better as too high of a platelet concentration can be detrimental to the healing process....a lower PRP platelet concentration (2 000 000/µL) exerted positive effects, while the higher PRP platelet count (5 000 000/µL) was harmful to healing.

So basically who knows. I asked Dr. Couto which kit he uses to see if someone nearby has the same one, but haven't heard back.

Edited November 14, 2023 by consequence

[consequence]

My actual 6 months (180 days):

 

Still having density issues at the center/left hairline that haven't changed, and even the right looks a little sparse from the side.

From looking at (several) cases similar to mine on the forums it seems about 30% are behind me at this month and 30% are ahead, with about 40% being just where I am.

For the people who are at my level, it seems most of them stayed about the same through the end. So yes I've got 6-12 more months for caliber but I'm not holding my breath at this point. Time will tell, but my hunch is that it's unlikely.

The good news is I can style my hair a little and disguise it, at least from the front:

Hair combed from left to right:

 

More chaotic neutral:

 

I've been looking into microneedling that @mxnprettynice suggested though I know others have debated about its benefits. The Dr. Pen that seems popular on Amazon is appealing, but according to that 700+ page thread on Hair Loss Talk, the Derminator may be best. This is from a comment there:

Quote

Just be careful with the Dr.Pen as they are actually just re purposed permanent make-up pens and have the potential to cause micro tearing which can cause permanent damage to your skin. Most people agree that the Derminator is the best but it's a bit more expensive.

Here's a video from the Derminator manufacturer that goes into more detail:

And an image from their website:

Wish they had done it with something that acted more like scalp soft tissue (ie. a banana or half boiled potato) but the demonstration is compelling. It suggests that some pens have more motion in the translational x-axis as opposed to a straight z-axis puncture like you see in the second row.

Still, I wish they had the Derminator on Amazon so I could see some user reviews. The pen's inventor himself has kind of weak diffuse thinning in that video which makes me wonder from whom I'm taking advice.

And regarding PRP, Dr. Couto's kit is from an Italian manufacturer that I've not been able to find in the US. I sent them a message on their website to see if I could purchase the machine for myself but haven't heard back. If they don't follow up, I am going to go with Emcyte as that has the highest and most consistent concentrations of platelets/growth factors according to the study I linked above. Who knows if this means they get better results. Studies that have compared PRP with saline wounding suggest that the majority of the benefit is the wounding itself, so.. whatever.

More than anything, I just don't want to go through a second procedure -- the first was such a painful rollercoaster. Not being able to dye my hair has isolated me from the dating scene for the last 6 months and I don't want to go through that again. Still, surgery may be the only option after a year and perhaps it's not as bad the second time around, but I'm trying less extreme solutions first. Second procedures can also fail or not provide improvement too.

Alrighty then, onwards and upwards.

 

[BaldReaper]

23 minutes ago, consequence said:

My actual 6 months (180 days):

 

Still having density issues at the center/left hairline that haven't changed, and even the right looks a little sparse from the side.

From looking at (several) cases similar to mine on the forums it seems about 30% are behind me at this month and 30% are ahead, with about 40% being just where I am.

For the people who are at my level, it seems most of them stayed about the same through the end. So yes I've got 6-12 more months for caliber but I'm not holding my breath at this point. Time will tell, but my hunch is that it's unlikely.

The good news is I can style my hair a little and disguise it, at least from the front:

Hair combed from left to right:

 

More chaotic neutral:

 

I've been looking into microneedling that @mxnprettynice suggested though I know others have debated about its benefits. The Dr. Pen that seems popular on Amazon is appealing, but according to that 700+ page thread on Hair Loss Talk, the Derminator may be best. This is from a comment there:

Here's a video from the Derminator manufacturer that goes into more detail:

And an image from their website:

Wish they had done it with something that acted more like scalp soft tissue (ie. a banana or half boiled potato) but the demonstration is compelling. It suggests that some pens have more motion in the translational x-axis as opposed to a straight z-axis puncture like you see in the second row.

Still, I wish they had the Derminator on Amazon so I could see some user reviews. The pen's inventor himself has kind of weak diffuse thinning in that video which makes me wonder from whom I'm taking advice.

And regarding PRP, Dr. Couto's kit is from an Italian manufacturer that I've not been able to find in the US. I sent them a message on their website to see if I could purchase the machine for myself but haven't heard back. If they don't follow up, I am going to go with Emcyte as that has the highest and most consistent concentrations of platelets/growth factors according to the study I linked above. Who knows if this means they get better results. Studies that have compared PRP with saline wounding suggest that the majority of the benefit is the wounding itself, so.. whatever.

More than anything, I just don't want to go through a second procedure -- the first was such a painful rollercoaster. Not being able to dye my hair has isolated me from the dating scene for the last 6 months and I don't want to go through that again. Still, surgery may be the only option after a year and perhaps it's not as bad the second time around, but I'm trying less extreme solutions first. Second procedures can also fail or not provide improvement too.

Alrighty then, onwards and upwards.

 

Your hair looks good for sure, you also expose it with very transparent photos in contrast to what most people in this forum do in their presentations.

I would personally expect something better from Couto but its still early to say anything for sure, give it 2 more months.

[consequence]

1 hour ago, consequence said:

Wish they had done it with something that acted more like scalp soft tissue (ie. a banana or half boiled potato) but the demonstration is compelling. It suggests that some pens have more motion in the translational x-axis as opposed to a straight z-axis puncture like you see in the second row.

[Melvin- Admin]

@consequence

Your hair is coming in nicely!

[Kacan]

 

On 11/23/2023 at 10:34 PM, consequence said:

My actual 6 months (180 days):

 

Still having density issues at the center/left hairline that haven't changed, and even the right looks a little sparse from the side.

From looking at (several) cases similar to mine on the forums it seems about 30% are behind me at this month and 30% are ahead, with about 40% being just where I am.

For the people who are at my level, it seems most of them stayed about the same through the end. So yes I've got 6-12 more months for caliber but I'm not holding my breath at this point. Time will tell, but my hunch is that it's unlikely.

The good news is I can style my hair a little and disguise it, at least from the front:

Hair combed from left to right:

 

More chaotic neutral:

 

I've been looking into microneedling that @mxnprettynice suggested though I know others have debated about its benefits. The Dr. Pen that seems popular on Amazon is appealing, but according to that 700+ page thread on Hair Loss Talk, the Derminator may be best. This is from a comment there:

Here's a video from the Derminator manufacturer that goes into more detail:

And an image from their website:

Wish they had done it with something that acted more like scalp soft tissue (ie. a banana or half boiled potato) but the demonstration is compelling. It suggests that some pens have more motion in the translational x-axis as opposed to a straight z-axis puncture like you see in the second row.

Still, I wish they had the Derminator on Amazon so I could see some user reviews. The pen's inventor himself has kind of weak diffuse thinning in that video which makes me wonder from whom I'm taking advice.

And regarding PRP, Dr. Couto's kit is from an Italian manufacturer that I've not been able to find in the US. I sent them a message on their website to see if I could purchase the machine for myself but haven't heard back. If they don't follow up, I am going to go with Emcyte as that has the highest and most consistent concentrations of platelets/growth factors according to the study I linked above. Who knows if this means they get better results. Studies that have compared PRP with saline wounding suggest that the majority of the benefit is the wounding itself, so.. whatever.

More than anything, I just don't want to go through a second procedure -- the first was such a painful rollercoaster. Not being able to dye my hair has isolated me from the dating scene for the last 6 months and I don't want to go through that again. Still, surgery may be the only option after a year and perhaps it's not as bad the second time around, but I'm trying less extreme solutions first. Second procedures can also fail or not provide improvement too.

Alrighty then, onwards and upwards.

 

Could you please share what are the values of Hemoglobin, Hematocrit and RBC on your last blood test?

[hairman4321]

On 11/24/2023 at 4:34 AM, consequence said:

My actual 6 months (180 days):

 

Still having density issues at the center/left hairline that haven't changed, and even the right looks a little sparse from the side.

From looking at (several) cases similar to mine on the forums it seems about 30% are behind me at this month and 30% are ahead, with about 40% being just where I am.

For the people who are at my level, it seems most of them stayed about the same through the end. So yes I've got 6-12 more months for caliber but I'm not holding my breath at this point. Time will tell, but my hunch is that it's unlikely.

The good news is I can style my hair a little and disguise it, at least from the front:

Hair combed from left to right:

 

More chaotic neutral:

 

I've been looking into microneedling that @mxnprettynice suggested though I know others have debated about its benefits. The Dr. Pen that seems popular on Amazon is appealing, but according to that 700+ page thread on Hair Loss Talk, the Derminator may be best. This is from a comment there:

Here's a video from the Derminator manufacturer that goes into more detail:

And an image from their website:

Wish they had done it with something that acted more like scalp soft tissue (ie. a banana or half boiled potato) but the demonstration is compelling. It suggests that some pens have more motion in the translational x-axis as opposed to a straight z-axis puncture like you see in the second row.

Still, I wish they had the Derminator on Amazon so I could see some user reviews. The pen's inventor himself has kind of weak diffuse thinning in that video which makes me wonder from whom I'm taking advice.

And regarding PRP, Dr. Couto's kit is from an Italian manufacturer that I've not been able to find in the US. I sent them a message on their website to see if I could purchase the machine for myself but haven't heard back. If they don't follow up, I am going to go with Emcyte as that has the highest and most consistent concentrations of platelets/growth factors according to the study I linked above. Who knows if this means they get better results. Studies that have compared PRP with saline wounding suggest that the majority of the benefit is the wounding itself, so.. whatever.

More than anything, I just don't want to go through a second procedure -- the first was such a painful rollercoaster. Not being able to dye my hair has isolated me from the dating scene for the last 6 months and I don't want to go through that again. Still, surgery may be the only option after a year and perhaps it's not as bad the second time around, but I'm trying less extreme solutions first. Second procedures can also fail or not provide improvement too.

Alrighty then, onwards and upwards.

 

give it a few more months and have some hope, lots of cases keep pulling through really strongly until month 8 that i've seen. 

re a second procedure: i've just been to Laorwong and had next to 0 swelling. There was a tiny bit the day after, and then the day after that near one of the temples, but by day 3/ 4 it was undetectable. it could be that your body just had a reaction to something, or it could be that the Drs all have different techniques to combat swelling. I had a head band and anti-swelling drugs for 5 days or so afterwards all provided by the clinic. Whatever it was, it was incredible. Your day 3 photo is really insane so i'd understand why you'd be put off a second. Do you know what happened or is it still a mystery? still, you could go for a 2nd procedure with a different doctor who's patients you've noted have little to no swelling. 

theres still the annoyance / dealing with wanting to hide from the world for 4 months after though; thats very understandable. 

[consequence]

7 hours ago, Kacan said:

 

Could you please share what are the values of Hemoglobin, Hematocrit and RBC on your last blood test?

They were within normal range. No anemia or polycythemia. Why do you ask?

[Kacan]

5 hours ago, consequence said:

They were within normal range. No anemia or polycythemia. Why do you ask?

Was it in the low valid limit? Do you have the values?

And by the way, do you think that your scalp didn’t accept some grafts, or not enough grafts were implemented on the left side?
 

[consequence]

38 minutes ago, Kacan said:

Was it in the low valid limit? Do you have the values?

And by the way, do you think that your scalp didn’t accept some grafts, or not enough grafts were implemented on the left side?
 

The grafts grew, just not thick in caliber. There is one spot on the left where there is gap and you can see a double behind, so I assume a single didn't grow in front of it because I couldn't imagine Couto would make such a rookie slip.

Never gotten this question before or seen it discussed, but below is my most recent CBC with diff. I'm smack dab in the middle for everything:

[consequence]

Some have suggested the density could be better. Here is my post op shot:

The density of graft placement does seem a little more spaced out on the left than the right. Perhaps Couto was trying to conserve grafts, I'm not sure.

This may have contributed to  to the more sparse appearance I'm seeing on the left now.

[consequence]

12 hours ago, hairman4321 said:

give it a few more months and have some hope, lots of cases keep pulling through really strongly until month 8 that i've seen. 

re a second procedure: i've just been to Laorwong and had next to 0 swelling. There was a tiny bit the day after, and then the day after that near one of the temples, but by day 3/ 4 it was undetectable. it could be that your body just had a reaction to something, or it could be that the Drs all have different techniques to combat swelling. I had a head band and anti-swelling drugs for 5 days or so afterwards all provided by the clinic. Whatever it was, it was incredible. Your day 3 photo is really insane so i'd understand why you'd be put off a second. Do you know what happened or is it still a mystery? still, you could go for a 2nd procedure with a different doctor who's patients you've noted have little to no swelling. 

theres still the annoyance / dealing with wanting to hide from the world for 4 months after though; thats very understandable. 

Thanks for the advice. Laorwong seems very strong, I'll review his patient submitted cases more carefully if I want to go back in for a second pass.

I really don't care about the swelling. I imagine it would be much better with a revision as it would be just a few grafts hopefully. Alot of the edema isn't actually "inflammation" it's literally fluid from the lidocaine used for anesthesia. Esteban may have used more with me because I kept feeling the extractions. The amount of lidocaine would presumably be much less the second time around.

My main annoyance/reason for hesitation at going back is the whole not being able to use hair dye afterwards. Some people say wait 1 month, other people say wait 12 months, no one really knows the answer. I've waited this time till 6 months though probably will dye it around month 8. It's just hard to convince myself to go through another procedure with the possibility that I may not get a significant improvements and so much of my life was disrupted by the restrictions afterwards. Also second passes seem to be less consistently successful than virgin scalps, at least from looking at the cases here.

Either way, pretty disappointed with my left side as it seems to have plateaued. Other cases like mine that level off around 6 months don't really seem to get much better. Every case I've found here that looks like mine from months 4-6 just kind of stays there.

If there's a miracle, great, but I don't think anythings going to change at this point.

Whatever. I did my best and went to a surgeon that seemed to have a decent track record, ultimately can't control what I can't control. That's just life.