1980 FUE Grafts | Dr. Shapiro & Dr. Josephitis (SMG) | Round 2 (Nov 13, 2023)

[hybonix]

Background Information

• I decided to go for Round 2 with both Dr. Shapiro & Dr. Josephitis at Shapiro Medical Group (SMG)
• To be honest, I could have waited several more years before I got another transplant as I was very happy with my current hair
• However, I decided to pull the trigger for a second procedure for the following reasons:
  • There were a couple of weaker areas in my hairline where I thought I could pack in more grafts
  • One temple point looked softer and wanted to just beef it up a smidgen with more hairs
  • I wanted to potentially lower the hairline if at all possible with SMG
• I worked with Matt Zupan, the patient coordinator at SMG to book both Dr. Shapiro & Dr. Josephitis:
  • After 3 reschedules (2 were due to me contracting COVID), we finally got the procedure done on Monday, November 13th, 2023
• I want to give another shout-out to @aaron1234 for coaching me through the whole process and recommending I go to SMG/Ron Shapiro
  • I also want to give kudos to @Melvin- Admin for his words of encouragement and advice throughout my first transplant

Medication

• I am currently on oral Finasteride daily (1.25mg) and oral Minoxidil (2.5mg)
• I also use Nizoral shampoo 3 times a week

Check Out My First Transplant With SMG Below

Pre-Surgery

• The front receptionist (Pamela) took my lunch order for the day
• Pictures of my hair were taken by Pamela (front, top, sides, and back) to show the before photos
• Pamela then took me to see Dr. Shapiro for the planning phase of my surgery

Note: It was fun seeing Pamela get excited and make the comment that I had hair now! In fact, the entire SMG team was relishing in the fact that I had a head full of hair and were super happy for me

Planning

• I met with Dr. Shapiro on the morning of my surgery to go over the game plan. Shapiro looked at me and said, "I think your case is pretty straightforward." He already talked to Matt Zupan and knew this was a case of adding more density and providing a fuller look
• Dr. Shapiro still asked me what I would like to do for my hair design in light of the above. I mentioned my desire to get more volume and potentially lower the hairline. Shapiro let me know that if they added more density to my frontal third, it would give the appearance of a lower hairline as you would not be able to see through it as easily
• Additionally, I brought up my temple points in which he said that I had such light-colored hair that it looked softer on one side, but he agreed to pack in more grafts on that side to make it match my other temple
• He drew on the hairline and mapped out the site with his pen. Shapiro lowered the upper corners of my hairline and also slightly lowered the very front by just a hair or two (no pun intended)

Surgery

• The Techs Prepped Me For Surgery
  • I was given Valium to relax
  • My head was numbed and ensured that I was ready to go for the procedure
  • The techs are always amazing:
    • They were sparking conversations with me and trying to learn more about me as a person
    • They made sure I was comfortable with blankets, had entertainment on the TV, and was ready with water/refreshments
    • They made me feel comfortable and you can tell they care about their jobs with SMG. It's always nice to see happy people in any line of work
• Dr. Shapiro Made the Incisions
  • Shapiro worked diligently and made incisions all over my frontal third
  • You can tell that Shapiro is passionate and every punch he made was done with purpose:
    • He would take pauses, assess the overall area, and then continue with the procedure
  • Shapiro also cut my hair as the procedure unfolded which was to show where I already had hair:
    • This would help him not transect other grafts and ensure he was filling in the gaps appropriately
  • Shapiro also worked well with the techs and would ask them to double-check the hairline/area just to triple check everything looked good
  • The whole operation was smooth and it's always nice to see everyone work harmoniously together
• My Head was "Shaved"
  • After the incisions were made, I was sent back to get my haircut
  • I was asked if I wanted to leave hair on top, but I said "Buzz cut it all."
• Dr. Josephitis Made the Extractions
  • The techs numbed the back of my head
  • Dr. Joe began making the extractions and also took his time to ensure a quality job was being done
  • We took a break for lunch. After lunch, another Valium was given to me per my request. Sh** feels good! 🫠
  • Dr. Joe continued and finished the extractions
  • The techs were constantly taking the grafts from Dr. Joe and storing them in Petri dishes to be counted
    • After counts were done, I noticed that some of the dishes were placed in the fridge
    • The staff let take a picture of the dishes and get a closer look
  • Once again, the team operated as a unit, like a well-oiled machine
• The Grafts Were Implanted
  • The techs placed/implanted the grafts in my head. I had 2 or 3 technicians constantly implanting grafts
  • Dr Shapiro would come in and check in on the techs to ensure things were going well
  • Once the implantation was done, Dr. Shapiro made several more punches to finalize and fill in any areas he needed
    • SMG left roughly 100 - 200 leftover grafts to ensure they could adjust/modify my hair as needed.
    • This process helps lock in final look for my transplant
• After Photos Taken
  • Dr. Shapiro and Pamela took photos of me after the transplant was completed
• Pain
  • This was the first time I had any discomfort with a hair transplant procedure. My head was definitely more sensitive and they had to numb it more than before
  • During certain parts, I could feel an extraction which prompted me to tell Dr. Joe immediately. More numbing was provided after
    • This also happened during the final incisions Shapiro made to finalize my look.
  • I asked why I felt pain and Shapiro said this was due to my scar tissue from the last procedure. He said it's not uncommon for this to happen, but to just keep letting the team know if I need more numbing

Bedside Manner

• I was asking Shapiro and the techs questions throughout the entire process. Shapiro answered them immediately and was enthusiastic about each answer
  • Dr. Joe was also very cordial and answered my questions while he was doing the extractions
• I would also talk to the techs throughout the procedure and engage with them multiple times regarding the surgery or random small talk
• Dr. Joe & the techs constantly reminded me to let them know if I felt any pain or discomfort. This was to ensure I was 100% relaxed for the surgery
• Everyone involved was super attentive. It was the most relaxed and professional medical environment I have ever seen

Shapiro Medical Group Review

• What can I say? Shapiro Medical Group ROCKS
• I love this group and I admire Dr. Shapiro for his passion for this line of work. Dr. Joe is also amazing and makes me feel super comfortable
• The office and surgical area are super clean
• Bedside manners are great, and their ability to work well as a team is fantastic
• Everyone's attitude is friendly and professional
• Everyone involved are absolute super stars, and I cannot recommend SMG enough
• Rating A++

BEFORE PHOTOS - HARSH LIGHT

From this photo, the hairline is a little weak and you can see through it:

AFTER PHOTOS - TRANSPLANT

PETRI DISH WITH GRAFTS

CROWN - BEFORE AND AFTER MEDICATION

The doctor noticed that my crown filled in on its own with only medication, no transplant! This was a nice surprise.

VIDEO OF INCISIONS AND EXTRACTIONS COMING SOON

SLIDE DECK OF HAIR TRANSPLANT (CLICK HERE FOR MORE PHOTOS)

• The above shows more photos of Surgery Day, Day 1 (post-surgery), Day 2, and Day 7
• I have pictures of Days 3 - 6 as well if you would like to see them
• I will add more as time progresses

Edited November 21, 2023 by hybonix

[Gatsby]

Excellent write up @hybonix. Also your point about medication filling in your crown is a great example of why medication should be the first port of call. I look forward to following your updates!

[aaron1234]

Considering that you have already one FUE already, I'm impressed with the density of your donor area (the pre-op pic of the back of your head).  Looks like you'll have plenty to work with down the road should you need it.  Of course, the work SMG did for you on round #2 looks great per usual.  Another 2k grafts upfront is going to be a significant bump in density.  Be patient, you know the drill

[Hair4Days]

Thanks for the great write up! Congratulations on your second procedure.
 

Since you’ve taken 5300 grafts so far, did the team mention how many grafts you have left for future surgeries? 

[parsia]

Thank you for your write up , I've followed your post before and I also had surgery with DR.Ron and Dr.Joe and I'm at 3months.

Can you please share how many total hairs you had in your 1980 grafts ? Was it above 4000 hairs?

 

[stephcurry30]

looking forward to seeing this home run result and progress

[ReturnIOfTheHairline]

Excellent write up, look forward to the progress!

[hybonix]

2 Week Update (11.27.23)

• Most of the scabs have come off except for a couple of little stragglers
• Things are looking good and soon all the hair will shed
• Weird note, but I did not sleep very well for the first 10 days after my transplant. I still had pain in the back of my head which finally subsided on Day 11/12
  • Dr. Shapiro looked at pictures of my donor and said everything was healing nicely
  • He recommended ibuprofen to reduce swelling to see if that helped

On 11/22/2023 at 5:27 AM, Hair4Days said:

Since you’ve taken 5300 grafts so far, did the team mention how many grafts you have left for future surgeries? 

Let me follow up with Dr. Shapiro to see how many grafts I have left. I will get back to you on that.

On 11/21/2023 at 8:19 PM, aaron1234 said:

Considering that you have already one FUE already, I'm impressed with the density of your donor area (the pre-op pic of the back of your head).  Looks like you'll have plenty to work with down the road should you need it.

Regarding overall density, here are some pictures. The back picture is 50 hairs per mm² which is the back of my head after the first transplant. The side picture is 89 hairs per mm² which was taken before the second transplant. I believe Dr. Shapiro said you want at least 50 hairs per mm², so with that, I am not 100% sure how many grafts I have left:

Edited November 29, 2023 by hybonix

[Steeeve]

Really looking forward to this journey!! Congrats and happy growing!!

[Steeeve]

Also, your donor looks amazing for already having 3k+ already reallocated!!

[Melvin- Admin]

Probably one of the best and most detailed write-ups on the forum 🙏

[parsia]

21 hours ago, hybonix said:

2 Week Update (11.27.23)

• Most of the scabs have come off except for a couple of little stragglers
• Things are looking good and soon all the hair will shed
• Weird note, but I did not sleep very well for the first 10 days after my transplant. I still had pain in the back of my head which finally subsided on Day 11/12
  • Dr. Shapiro looked at pictures of my donor and said everything was healing nicely
  • He recommended ibuprofen to reduce swelling to see if that helped

Let me follow up with Dr. Shapiro to see how many grafts I have left. I will get back to you on that.

Regarding overall density, here are some pictures. The back picture is 50 hairs per mm² which is the back of my head after the first transplant. The side picture is 89 hairs per mm² which was taken before the transplant/harvested grafts. I believe Dr. Shapiro said you want at least 50 hairs per mm², so with that, I am not 100% sure how many grafts I have left:

Just like to do some revision here that  these are grafts not hairs , I believe the software that Dr.Shapiro using wrongly label them as Hairs , but you can

see some of them are 2's . 

when I had surgery with Dr.Shapiro , I've got same " Hairs " in microscopic picture , But it needs to be revise as Grafts . 

Also I do believe both of them has been taken before your 2nd surgery , If " Back " and " Side " was correctly named in pictures , Looks like the back

doesn't have much left to harvest ( Since it is 50 ) but sides are still high number and have graft to harvest ( 89 ) .  

Also in your first surgery ( On your thread ) when you post microscopic picture , I'm very positive It was wrongly counted on software by clinic , Occipital

area marked as high density and temporal area marked as low density and they were both marked as 64 FU/CM2 , Which is a impossible.

because 64 is either should consider as  low density or high density , It can't be both , Second is I did actual counting and in your Occipital area you had

more than 100 grafts before first surgery ( Which is consider as high density ) and in your temporal area you had 64 ( Which is consider as low density ) . 

These errors was out of your control though. 

Edited November 29, 2023 by parsia

[hybonix]

8 minutes ago, parsia said:

Just like to do some revision here that  these are grafts not hairs , I believe the software that Dr.Shapiro using wrongly label them as Hairs , but you can see some of them are 2's . 

when I had surgery with Dr.Shapiro , I've got same " Hairs " in microscopic picture , But it needs to be revise as Grafts . 

Also I do believe both of them has been taken before your 2nd surgery , If " Back " and " Side " was correctly named in pictures , Looks like the back doesn't have much left to harvest ( Since it is 50 ) but sides are still high number and have graft to harvest ( 89 ) .  

Thank you for the correction. Yes, you are correct that these were both taken before my 2nd transplant, which I noted in my previous response as well. However, I wasn't super clear on that, and I have modified my original statement.

Edited November 29, 2023 by hybonix

[parsia]

13 minutes ago, hybonix said:

Thank you for the correction. Yes, you are correct that these were both taken before my 2nd transplant, which I noted in my previous response as well. However, I wasn't super clear on that, and I have modified my original statement.

No Problem , I just updated my post about your first surgery microscopic number as well. 

I honestly still not sure the back and side has been labeled correctly on 2nd surgery , I believe you had 89 in your back and 50 on side.

So basically based on correction of mistakes of number  from your 1st surgery you went from 100ish to 89 After your first surgery on back and you also

went from 64 to 50 on your side.

They are both making  sense now  from mathematical and surgical prespective.

I have been into these microscopic pictures with Dr.Shapiro and I kind of know how to figure these mistakes . 

If my correction is right ( Which I believe it is ) You still have more hair in back to harvest and on your side you don't have much left. 

Edited November 29, 2023 by parsia

[hybonix]

VIDEO OF PROCEDURE (INCISCIONS & EXTRACTIONS)

HAIRLINE DESIGN

[gs1207]

Any reason for choosing the hybrid approach of Dr Shapiro doing the incisions for placement while Dr Joe performed the extractions? Curious if one is preferred? 
 

I understand Dr Shapiro is more experienced, but was that a decision you made? I have a procedure scheduled with Dr Joe for next year but I don’t believe Dr Shapiro will be involved, so curious to hear your thoughts. Thanks, and good luck with your results! 

[BurnieBurns]

3 hours ago, gs1207 said:

Any reason for choosing the hybrid approach of Dr Shapiro doing the incisions for placement while Dr Joe performed the extractions? Curious if one is preferred? 
 

I understand Dr Shapiro is more experienced, but was that a decision you made? I have a procedure scheduled with Dr Joe for next year but I don’t believe Dr Shapiro will be involved, so curious to hear your thoughts. Thanks, and good luck with your results! 

Dr. Joe does all the FUE extractions at the clinic, regardless of whether it's his or Dr. Shapiro's case. 

[hybonix]

On 12/4/2023 at 8:32 PM, gs1207 said:

Any reason for choosing the hybrid approach of Dr Shapiro doing the incisions for placement while Dr Joe performed the extractions? Curious if one is preferred? 

I got lucky with scheduling Shapiro as he tends to be always booked, and Matt helped out a little since I was a returning patient. Shapiro also did my first procedure, so it was nice for continuity purposes. Dr. Joe is an excellent FUE surgeon as well.

On 12/4/2023 at 11:51 PM, BurnieBurns said:

Dr. Joe does all the FUE extractions at the clinic, regardless of whether it's his or Dr. Shapiro's case. 

That is correct and also is why he teams up with Shapiro on these surgeries.

[hybonix]

1 Month Update (12.14.23)

• I am in the ugly duckling phase and all transplanted hairs have shed
• I am wearing hats as my hair is super patchy and I look like a dog with mange. lol
• Word of advice, do not pick any scabs from the harvested grafts as I picked one and it bled more than expected -- not fun.
• Things going well, not too much to report

Edited December 14, 2023 by hybonix

[Cooper48]

Looks like you are right on track.  Will get worse before getting better so just hang in there. 

[duchaine]

Congratulations!
Great HT and great report!
Can you show the numbers for the temporal hairline? Thank you!

[hybonix]

On 11/24/2023 at 10:54 PM, parsia said:

Thank you for your write up , I've followed your post before and I also had surgery with DR.Ron and Dr.Joe and I'm at 3months.

Can you please share how many total hairs you had in your 1980 grafts ? Was it above 4000 hairs?

 

Here are the final counts:

• 1s - 633
• 2s - 1176
• 3s - 171

Total Hairs: 3498 hairs

[parsia]

10 minutes ago, hybonix said:

 

Here are the final counts:

• 1s - 633
• 2s - 1176
• 3s - 171

Total Hairs: 3498 hairs

Thank you very much for that , I appreciate it.

So your average is roughly 1.76 hair per graft , Based on what I calculated  In your first surgery it was 2.02 hair per graft , So you basically get less hair per graft in 2nd surgery compare to the 1st one.

Its normal because hair per grafts are varies and also depends on the goal of surgeon they can harvest more from side than back ( Especially when they want to address hairline )Generally as you know density is more in back of donor compare to sides , I believe you still have reasonable amount of  donor left in back of your donor in a case if you want to use them for midscalp or crown in the future.

Best luck.

[hybonix]

2 Month Update (1.13.24)

• New hairs are starting to sprout
• Not much difference except my hairline looks weak right now
• Old transplanted hairs from my 1st procedure are growing back. I hope next month I can style it again.
• I am growing a beard as well. It turns out the oral minoxidil helped grow facial hair! It's still a little patchy though (I never could get much facial hair before meds). I am derma rolling my face 2 - 3 times a week to see if that helps grow more hair
  • @aaron1234 You asked if oral minox helped with beard gains -- the answer is, yes.

 

[aaron1234]

Just another few weeks and the fun begins.  Looks like a little shock loss behind your ear.  That'll come back too.  Hang in there!