Taking the Plunge... Finally - Circa 1500 Grafts with Dr. Juan Couto @ Fuexpert

[Diff-thinner]

On 4/30/2024 at 5:07 PM, Bizkid said:

Thanks for the feedback. I need to get something similar done. I contacted them this week and they told me they’re pretty much closed for appointments until 2025 just to even book an appointment. Don’t mind waiting just want to make sure a date is set.

All I can say is, yes the wait is long, but I guess we’ll find out in this thread eventually if it was worth it 

Edited May 1 by Diff-thinner

[4Godot]

On 4/29/2024 at 4:01 PM, Diff-thinner said:

I was very surprised with the cut, all day I wanted to get home to see what the donor looked like, I’m not sure what your thoughts are on how visible it is but I asked for the same cut I get every time and from my eyes it looks hardly noticeable and maybe even with some smp would be undetectable. 
 

 

 

Thanks again for the info. Honestly the donor looks amazing to me, I've seen that area look more irritated and inflamed post fade just from barbers razors and so on! Personally I'd sacrifice quite a lot in the aesthetics of the donor area were it a choice between that and density/shaping of recipient area, but looks like you don't have to make that call anytime soon.

 

I've seen many other instances where, once you look for it, you can definitely see a thinned out donor area, but I'd say this is undetectable to all intents and purposes in your case. 

[Diff-thinner]

I totally agree with you, especially if you wear your hair above a grade 2, it would be undetectable, I did make a point about the donor though because of the fact that I do like a skin fade so I’m quite happy with the way it turned out. Try to preserve your donor because it is the supply of all things you will need in the future 

[Diff-thinner]

I Just wanted to update regarding two things. 

1. Vertex hair loss seems to have actually gotten better since the HT, with regrowth. 
2. I don't think I have experienced any shock loss in the donor, which if i'm honest was my biggest worry when undertaking the process.

I will be reaching month two next week, really dying to see results but am trying to be realistic all the same
 

 

 

 

 

 

 

 

 

 

 

 

Edited May 6 by Diff-thinner

[Shishatskiy]

I heard that Dr. Couto requires taking finasteride before the transplant. Tell me, is this requirement still in place? Or you can have surgery with a doctor without taking finasteride.

[Shishatskiy]

I heard that Dr. Couto requires taking finasteride before the transplant. Tell me, is this requirement still in place? Or you can have surgery with a doctor without taking finasteride.

[Diff-thinner]

It really is on a case by case basis, I think if your hairloss is not severe and if he has to implant between hairs, Fin  is a must, but if your hairloss has already progressed and is predictable, he may not require it. He has unmedicated cases on his youtube, but as always to slow progression and make sure the transplant lasts he will likely ask you to medicate. But i cant speak for him, I can only speak for my situation  

[hairyelswhere]

On 5/6/2024 at 11:37 AM, Diff-thinner said:

I Just wanted to update regarding two things. 

1. Vertex hair loss seems to have actually gotten better since the HT, with regrowth. 
2. I don't think I have experienced any shock loss in the donor, which if i'm honest was my biggest worry when undertaking the process.

I will be reaching month two next week, really dying to see results but am trying to be realistic all the same
 

 

 

 

 

 

 

 

 

 

 

 

Hi Diff how is the hair transplant going. I'm sure it would be coming out good. I will be seeing Dr cuoto next month my hairline is like yours but I'm getting above 2500 grafts

[hairyelswhere]

On 3/23/2024 at 1:58 PM, Diff-thinner said:

Lets start from the beginning... because its a very good place to start. I have seen many questions regarding Couto, How to get a consultation, waiting lists and the rest. So I would like to detail my experience from the very start in the ultimate aim of providing more information for prospective candidates. I do genuinely believe this is a wholistic treatment, not only encompassing simply hair, but rather it encompasses an element of identity, confidence, and the manner in which you will eventually seek to live your life. From future hair cuts, to style to everything else. Certainly, in this brief preface, a decline in how well I presented my self, could have been traced linearly and in correlation with the decline of my hair, and ability to style it in the way I wanted, which eventually had repercussive effects on everything else mentioned. 

Additionally, I wanted to make this detailed, for those who want all information possible, because this forum, has provided such an invaluable service to me, and the way people respond, advise and give care and attention, makes giving back not only a duty but a pleasure. 
 
Getting a Consultation. 

My advice here is be persistent, bordering annoying. I had emailed around my birthday looking for a consultation, and had a reply initially to do an online one, sending pictures of the state of my hair, when a reply was received it was decided that due to the thickness of my donor hair and the state of my recipient hair, that an in person consultation would be better, but that because bookings were closed I would have to wait until the new year  to even attempt getting a consultation. This was in early 2022. So ... I waited, my gut intuition, was that this was the guy. Around October I emailed in confirming the date and time that the consultations would open in January because as soon as they opened I wanted to be the first one on the phone. January came and I had already drafted an email to them, and sent it immediately on the opening of consultations, and then proceeded to call them, to make sure they would open my email. It worked.  I had got the consult .... In January... 2024. Doing my calculations, I was told that surgery would be booked for 2025, by which time I would be nearing 30, and really wanted to enter my 30's with a hairline and framed face. Oh well I said, if you want what you want, you must bide your time and wait. 

 

 

The consultation. 

It was great, but honestly not what I had expected. Dr Couto, I would describe as the 'DON', Cool, Calm, Confident. Filled with an air of self belief, that only results from success, the kind that makes you know what you are capable of. Rather than being in the hands of a surgeon, I would describe him more as an artist, sitting in front of him you get the sense that he is already designing your hair when your sitting there. He discussed my hair characteristics, and the fact that each hair was very thick, which he prefaced that he doesn't usually describe even in his videos, this i thought was great, but actually turned out it is not. This is for two reasons, one is blood supply, the thicker the hair, the more blood is needed and the more that hairs compete for blood supply, this placing more hairs densely packing it risks a lower yield. Second is the problem with the hairline, a hairline requires soft hairs, that makes the progression natural, and so having thick hair is great for behind the hairline, but not so great for arguably the part that everyone notices at first. He thus recommended 1,100 grafts initially and we were done at that. He jokingly told me to go and 'prepare for a fight' with the receptionist who does the booking so that we can get everything booked. 

I went downstairs preparing my monologue. I did my best, and telling her 'come on its only 1.1k grafts'. she looked at me and said, your best hope is a cancellation, but usually its a wait and see. I made sure she knew my name and that in the hopes that if someone did cancel, I would be thought of. 


About a week later, I got a cancellation March 19th, best believe I booked that date straight away. 




The surgery 

On the day, we did basically a second consult, a redraw of the hairline and me and Dr Couto, were surprised with the results of the topical finasteride I was using, it had yielded growth, and made him more confident to implant between hairs, the hairline he draw he said was perfect, the word perfect was used quite a few times, and I would say I am very happy with it, I dont know what norwood I would be now, any advice from you guys would be appreciated. 

Esteban does the extractions, dont worry, he has been trained by Dr. Couto and as you will see from my donor, im actually very happy, to the point at the beginning with photos I was quite astounded at how good the extractions were. 

Since it was a hairline surgery, Dr Couto does almost everything, he left only 200-300 grafts in the mid scalp to be done by the other surgeon. but everything from the site holes to the implantation was done by Dr Couto. Halfway through the surgery an about turn was made, the 1100 grafts were considered not to be enough... Why? well because of my hair characteristics once again. Because of my family history, the Dr wanted to be very conservative with my donor zone, and so while the density is 'superior' what was really bad was the graft count, mainly triples, hardly and 4 or 5 grafts, maybe only 60 for use in the safe donor zone, meaning that while there are loads of grafts available, the singular graft count was lower, meaning more grafts were needed. I cant lie, I was a little disappointed... but apparently this is typical of my genetic origin higher density, average FU's. So we had to do a second extraction of around 300 grafts, taking me to close to 1500. We started at around 10am and finished around 6:30 PM. The doctor checked like three or four times, every time I would leave the room he would call me back, take another look, and just stare and say 'perfect'. You guys can decide from the pictures. Finally we did the hightech PRP.

After care

They give you a little bag, with moisturising spray, a plastic spray bottle, shampoo and an after care manual. The spray is to be used every 30 mins, to keep the recipient site moist, and thats all basically.

The wash, 

I went in two days later for the wash, got my hair washed and was told all the after care needed regarding shampooing and that on day ten to make sure that all scabs were taken off. 

 

now I sit here, waiting, and hoping that another home run has been hit. Because it is my first time, I am a little apprehensive about certain things, but im trying to be very careful. 

this is a long winded description but I wanted to be detailed and if anyone has any questions do let me know id be happy to answer. In any case here are the photos, let me know what you think. 

Over and Out 

Diff

 

 

You said surgery started at 10 am was that a bit late in your opinion or is that normal with Dr Cuoto.

For my surgery next month I have been advised to attend at 1pm surely that is late to start surgery I'm booked in for 3 days 

[Diff-thinner]

Hi mate, 
 

10 hours ago, hairyelswhere said:

Hi Diff how is the hair transplant going. I'm sure it would be coming out good. I will be seeing Dr cuoto next month my hairline is like yours but I'm getting above 2500 grafts

So far its too early to tell tbh, im only coming up to month 2 next sunday, so hopefully growing phase will start in month three I believe. I was only one day for 1475, if yours is a similar case how comes you have so many grafts quoted, whats your hair characteristics ? 

 

 

10 hours ago, hairyelswhere said:

You said surgery started at 10 am was that a bit late in your opinion or is that normal with Dr Cuoto.

For my surgery next month I have been advised to attend at 1pm surely that is late to start surgery I'm booked in for 3 days 

Couto is a machine, the day I was there the surgery finished at like 8PM and he was still working another case after finishing mine. Honestly I think on weekdays its all he does! 

He will most likely do like 730 grafts a day for you if its 2500, which means that you need three half days rather than full days if you get me. 

[hairyelswhere]

6 hours ago, Diff-thinner said:

Hi mate, 
 

So far its too early to tell tbh, im only coming up to month 2 next sunday, so hopefully growing phase will start in month three I believe. I was only one day for 1475, if yours is a similar case how comes you have so many grafts quoted, whats your hair characteristics ? 

 

 

Couto is a machine, the day I was there the surgery finished at like 8PM and he was still working another case after finishing mine. Honestly I think on weekdays its all he does! 

He will most likely do like 730 grafts a day for you if its 2500, which means that you need three half days rather than full days if you get me. 

I will be doing the temples too. My first day starts at 1pm. I do not know why my mine is about 2700 maybe my hair line and recession is worse but when I look at your photos it looks like my head. I'm from the Mediterranean region and been on finasteride for about 6 months the meds don't work for me. Are you in London by any chance?

[Diff-thinner]

2 minutes ago, hairyelswhere said:

I will be doing the temples too. My first day starts at 1pm. I do not know why my mine is about 2700 maybe my hair line and recession is worse but when I look at your photos it looks like my head. I'm from the Mediterranean region and been on finasteride for about 6 months the meds don't work for me. Are you in London by any chance?

I’m Mediterranean/ North African, so we have v thick hair normally, which is why I’m surprised at the graft quote, but yes I didn’t have to do temples, I’m in the uk.  

[hairyelswhere]

4 minutes ago, Diff-thinner said:

I’m Mediterranean/ North African, so we have v thick hair normally, which is why I’m surprised at the graft quote, but yes I didn’t have to do temples, I’m in the uk.  

Your donor area is very very good no scars at all. I was not planning to do temples however when ever I have seen a hair transplant without temples it looks obvious so I changed my mind in consultation and added it on. Other surgeons I have seen have given me very inconsistent graft numbers anywhere from 1200 to 5500

[Diff-thinner]

1 minute ago, hairyelswhere said:

Your donor area is very very good no scars at all. I was not planning to do temples however when ever I have seen a hair transplant without temples it looks obvious so I changed my mind in consultation and added it on. Other surgeons I have seen have given me very inconsistent graft numbers anywhere from 1200 to 5500

Yeah quite surprised and happy with the donor to be quite honest. That quoting is very weird, but if you’ve had a consult with couto he will do another one on the day and give you his final feelings on graft count 

[hairyelswhere]

Did you wear a hat after your transplant surely wearing a hat might move the grafts. I am being asked to bring a hat but don't know what type and if any use

[Diff-thinner]

5 hours ago, hairyelswhere said:

Did you wear a hat after your transplant surely wearing a hat might move the grafts. I am being asked to bring a hat but don't know what type and if any use

Yes I did, literally on the way home. I bought a snapback the day before, there is a way to put it on, that doesnt disturb the grafts. 

[hairyelswhere]

50 minutes ago, Diff-thinner said:

Yes I did, literally on the way home. I bought a snapback the day before, there is a way to put it on, that doesnt disturb the grafts. 

You know in day 1 how long was the surgery, I go in next week. On the first day does he concentrate on towards the back or does he start with front hairline. If you had the choice would you do anything differently. Sorry for all the questions. 

[Diff-thinner]

52 minutes ago, hairyelswhere said:

You know in day 1 how long was the surgery, I go in next week. On the first day does he concentrate on towards the back or does he start with front hairline. If you had the choice would you do anything differently. Sorry for all the questions. 

Not at all, ask away... When I was in your position I was positively wanting to know everything :D. I only had my frontal third done, so they started with the hairline, Couto did like 80% then the last like 150 grafts were done by another DR. 

[chrisu]

Hey OP congrats on the procedure. looks like he did an excellent job with the design. I was intrigued with the statement below

"this is for two reasons, one is blood supply, the thicker the hair, the more blood is needed and the more that hairs compete for blood supply, this placing more hairs densely packing it risks a lower yield. Second is the problem with the hairline, a hairline requires soft hairs, that makes the progression natural, and so having thick hair is great for behind the hairline, but not so great for arguably the part that everyone notices at first."

Was he originally saying that he thought thick hair would be great but its not for hairline because of blood needed to supply the hair and dense packing causes lower yield? If that is the case then how did he dense pack your area, it looks clean

[chrisu]

For more experienced members, how important is the way the shafts stick out after the surgery. If you glance at OP, everything looks angled perfectly. Does it matter a lot if a few hair aren't perfect post-op?

[Diff-thinner]

16 minutes ago, chrisu said:

Hey OP congrats on the procedure. looks like he did an excellent job with the design. I was intrigued with the statement below

"this is for two reasons, one is blood supply, the thicker the hair, the more blood is needed and the more that hairs compete for blood supply, this placing more hairs densely packing it risks a lower yield. Second is the problem with the hairline, a hairline requires soft hairs, that makes the progression natural, and so having thick hair is great for behind the hairline, but not so great for arguably the part that everyone notices at first."

Was he originally saying that he thought thick hair would be great but its not for hairline because of blood needed to supply the hair and dense packing causes lower yield? If that is the case then how did he dense pack your area, it looks clean

No it was me actually, I thought having thick hair would make me a great candidate, but it turns out that in Coutos opinion, medium thickness, rather than coarse thick hair is better, because there is more to chose from for the hairline. Second, his worry with dense packing it, was the fact that graft survival is arguably more important than having loads of hair packed into a small area, because you can always add more later, and arguably having more hair survive when implanted, means that you also dont need to harvest the donor area for more grafts to have a similar impact. 

[Diff-thinner]

17 minutes ago, chrisu said:

For more experienced members, how important is the way the shafts stick out after the surgery. If you glance at OP, everything looks angled perfectly. Does it matter a lot if a few hair aren't perfect post-op?

Might have to tag team @Melvin- Admin in for this one ?

[chrisu]

6 minutes ago, Diff-thinner said:

No it was me actually, I thought having thick hair would make me a great candidate, but it turns out that in Coutos opinion, medium thickness, rather than coarse thick hair is better, because there is more to chose from for the hairline. Second, his worry with dense packing it, was the fact that graft survival is arguably more important than having loads of hair packed into a small area, because you can always add more later, and arguably having more hair survive when implanted, means that you also dont need to harvest the donor area for more grafts to have a similar impact. 

ah got it, thanks for clarifying. i wonder how the doctors assess what is the correct amount

i might have missed it but how much density did you receive per cm^2?

[Diff-thinner]

20 minutes ago, chrisu said:

ah got it, thanks for clarifying. i wonder how the doctors assess what is the correct amount

i might have missed it but how much density did you receive per cm^2?

Never found out tbh, if im frank I dont think it was measured

[hairyelswhere]

Hello mate, 

Had my first day in surgery. Are you able to talk to me in what's app. The extraction in donor area again 1st class the holes are barely visible. 

 

Edited Tuesday at 12:25 PM by hairyelswhere
I posted too soon after surgery