Absolute Hair Clinic | Dr. Kongkiat Laorwong | FUE 4128 | 45M | NW6 | October 2023

[rja]

17 hours ago, Hairwolf said:

This is shaping up well mate. Your donor is a bit wavy which will help with illusion of density. Will be interested to see this one in 3 months !

Hope so, man!

[TakeAction]

@rja any updates?

[Berba11]

30 minutes ago, TakeAction said:

@rja any updates?

+1

[rja]

Hi guys,

I intended to update once a month but was travelling last month and ended up not having time to do it. Apologies.

Today marks the 11th month for my first HT and 5.5 months for the second one. I've attached photos to show mostly the first one although there is one photo that shows the second as well (top view).

Overall, I have hair compared to where I started from. But to be honest, I'm a little disappointed with the first HT outcomes. Yes, I still have a full month to reach the 1-year mark, but I don't believe that at this stage things will change - drastically or otherwise.

I have had 4k grafts put in for each one of my HTs. Disconsidering the second one, which is very early to judge at this stage, I would have expected a denser result. The difference between my front left and right sides is especially noticeable to me. The left is much less dense - hopefully, this is also visible in the photos below.

I've asked Laorwong about it and he even examined me in person last month and he agreed a "top-up" is probably in order here, so I'm confident it's not my imagination.

I've taken photos with natural light this morning and with wet hair yesterday. The wet hair I think shows well how little density I have as well as the difference in density between the sides.

I am convinced I'll need to go for the third one, although I don't intend to do that in 2025, or at least not for at least a year from now, to allow the crown to also reach its full potential.

Very keen to hear your thoughts about my current status and any advice you might have.

Cheers!

 

Photos with natural light and dry hair:

 

Photos with wet hair:

 

Photo of crown. Note, I'm standing with my back towards the outside so that there'll be more light on the crown. So the front is the top of the photo.

 

[Berba11]

3 hours ago, rja said:

Very keen to hear your thoughts about my current status and any advice you might have.

 

I think it’s looking pretty good, but would agree that a little density too-up into weaker parts of the frontal third would be a nice enhancement. You said that Dr L thought he could get another 1,000 scalp grafts so I think you’ve got more than enough in the bank to build upon the work already done at the front. 
 

Crown looks like it’s starting to move which is good. 
 

I think you’ve gotten yourself into a great position. You’ve covered the entire scalp over two surgeries and still have scalp & beard donor reserves to call upon to give any weaker areas a boost down the line. It’s an ideal NW6/7 strategy. I know there’s a temptation to have wanted to drain the donor bank account sooner and try to nail everything in two goes rather than maybe need a third down the line but I think in 99% of cases it’s better to not go too gung-ho and always have that possibility to assess and redress later. 

[Gatsby]

Yes it’s looking very soft and natural. I would wait until the second procedure hits 12 months before considering a final third touch up surgery. One option might be to utilize beard grafts in the mid section to strengthen its appearance and to use less scalp grafts by doing so @rja. It’s only a thought. 

[rja]

1 hour ago, Berba11 said:

I think it’s looking pretty good, but would agree that a little density too-up into weaker parts of the frontal third would be a nice enhancement. You said that Dr L thought he could get another 1,000 scalp grafts so I think you’ve got more than enough in the bank to build upon the work already done at the front. 

Thanks. I know I can get another 1000 or so from my donor but I would prefer to use just beard hair next time. I feel like my donor is quite depleted and I would prefer to have less beard so I need to shave less hehe

1 hour ago, Berba11 said:

Crown looks like it’s starting to move which is good. 

Thanks

1 hour ago, Berba11 said:

I think you’ve gotten yourself into a great position. You’ve covered the entire scalp over two surgeries and still have scalp & beard donor reserves to call upon to give any weaker areas a boost down the line. It’s an ideal NW6/7 strategy. I know there’s a temptation to have wanted to drain the donor bank account sooner and try to nail everything in two goes rather than maybe need a third down the line but I think in 99% of cases it’s better to not go too gung-ho and always have that possibility to assess and redress later. 

I guess for me, the thought of a third surgery is unpleasant since I want to wear my hair long and every time you go through surgery, you need to shave it - it takes a very long time to grow . Unlike the 2nd HT where he left the first hairs from the first one untouched, now I'll need to fill in between (now) existing hairs and I'm not sure if the Dr will do it without shaving.

I keep thinking about those patients who went to Pitella, for example ... and got it all done in one go... I ended up not going to him, for various reasons, and Dr Laorwong is a good surgeon, but I can't help thinking what-if ...

 

[rja]

55 minutes ago, Gatsby said:

Yes it’s looking very soft and natural. I would wait until the second procedure hits 12 months before considering a final third touch up surgery. One option might be to utilize beard grafts in the mid section to strengthen its appearance and to use less scalp grafts by doing so @rja. It’s only a thought. 

Yeah, I intend to do exactly that. I won't go to surgery before at least the end of 2025 - I want to give the crown at least a year to grow, if not more.

I also want to utilise if possible ONLY beard grafts and as many as possible - if I can find someone that can harvest in the thousands and implant those without shaving my hair - I'd go for it.

 

[Berba11]

31 minutes ago, rja said:

Thanks. I know I can get another 1000 or so from my donor but I would prefer to use just beard hair next time. I feel like my donor is quite depleted and I would prefer to have less beard so I need to shave less hehe

Thanks

I guess for me, the thought of a third surgery is unpleasant since I want to wear my hair long and every time you go through surgery, you need to shave it - it takes a very long time to grow . Unlike the 2nd HT where he left the first hairs from the first one untouched, now I'll need to fill in between (now) existing hairs and I'm not sure if the Dr will do it without shaving.

I keep thinking about those patients who went to Pitella, for example ... and got it all done in one go... I ended up not going to him, for various reasons, and Dr Laorwong is a good surgeon, but I can't help thinking what-if ...

 

You don't want to be putting beard hair into the frontal third or anywhere close to the hairline. Beard is best used in the midscalp and crown as the thicker texture will blend better further back and away from the finer hairs near the front. Also for styling purposes you want your hair to behave in a uniform way hence it's better to have only scalp hair in the frontal third.

It's worth asking if Dr L would do a no-shave procedure, though personally I think it's best to shave down and give the surgeon as much access as possible for the best result.

Pittella (and Zarev) are outliers. Most NW6 & 7's will need three sessions: two to establish coverage and then a third for fine tuning and maximising available donor. Pittella's approach is higher risk, high reward in terms of the sheer number of grafts being moved in one go. I know that's annoying but when you consider how many years you have ahead of you to enjoy your full looking head of hair, that 12 months or so of re-growing the hair post-op really isn't so long!

[4chanhrn]

I think 1000 odd grafts in front will densify things a lot. If you want to use more beard to densify midscalp/crown, you can look into a BHT specialist for 3rd op like Mwamba or Pittella once everything grows out. Laorwong has done very good job of getting 9000 from that donor and giving you very good results, but he isn't a BHT specialist.

Edited September 18 by 4chanhrn

[Hairwolf]

On 9/19/2024 at 5:30 AM, 4chanhrn said:

I think 1000 odd grafts in front will densify things a lot. If you want to use more beard to densify midscalp/crown, you can look into a BHT specialist for 3rd op like Mwamba or Pittella once everything grows out. Laorwong has done very good job of getting 9000 from that donor and giving you very good results, but he isn't a BHT specialist.

I would echo the other comments here. Bearing in mind your starting position- that you had a very large area to cover, this looks really good. You were always going to need a 3rd op for density. The frontal third does need another touch up, and another 1000 FU should do it and yes you have the BH in reserve also.
 

Totally get the frustration with the wait. I am almost 2 and a half months post 2nd op and still shaving it down; however,  as others have said, it’s a marathon not a sprint. 
 

The crown indeed still has time so yeah sitting tight is the right idea.

[rja]

12 minutes ago, Hairwolf said:

I would echo the other comments here. Bearing in mind your starting position- that you had a very large area to cover, this looks really good. You were always going to need a 3rd op for density. The frontal third does need another touch up, and another 1000 FU should do it and yes you have the BH in reserve also.

Thanks @Hairwolf. I think I did not realise a third HT was part of the plan - at least not consciously - and now, the realisation that it is necessary if I want to be satisfied with the final results fuels my disappointment.

On top of that, I thought Dr L would have used beard hair in the 2nd HT so I would have had a higher scalp reserve now to gain more density or to keep my donor less patchy in general, and he ended up not doing that for some reason.

Anyway, knowing that I will go through a third one in a year+, I just want to find a good surgeon who will use as much beard hair as possible (even if just on the top/crown area) and will be able to do so successfully unshaved.

I noticed my hair takes a very long time to grow at my age - I would prefer to not shave it if I can avoid it.

 

[4chanhrn]

On 9/22/2024 at 2:24 AM, rja said:

Thanks @Hairwolf. I think I did not realise a third HT was part of the plan - at least not consciously - and now, the realisation that it is necessary if I want to be satisfied with the final results fuels my disappointment.

On top of that, I thought Dr L would have used beard hair in the 2nd HT so I would have had a higher scalp reserve now to gain more density or to keep my donor less patchy in general, and he ended up not doing that for some reason.

Anyway, knowing that I will go through a third one in a year+, I just want to find a good surgeon who will use as much beard hair as possible (even if just on the top/crown area) and will be able to do so successfully unshaved.

I noticed my hair takes a very long time to grow at my age - I would prefer to not shave it if I can avoid it.

 

I don't think you NEED a 3rd HT. Given where you started from this is a very good final result if you want to stop here. A lot of people I've seen stop here, but may go back few years down the line to get that final touchup. Unless you are working with surgeons called Zarev or Pittella, this is simply the reality of restoring high NWs. The issue with getting everything done at once is that it's harder to manage the donor and if you have growth issues or want to fine tune things, it's just harder. Even top notch docs like Sethi usually need 3 goes to completely restore high NWs.

I think Laorwong prefers to use scalp hair because it's better, but also I'm not sure he's as experienced with it as others like Mwamba, Pittella or Sethi, who've worked with beard hair a lot more.  Laorwong also does no shave procedures(both in donor and recepient), but it's better to trim it down.

I'm following your case as I'm going with his partner with similar loss. I would be very happy if I ended up where you did.

[rja]

2 hours ago, 4chanhrn said:

I don't think you NEED a 3rd HT. Given where you started from this is a very good final result if you want to stop here. A lot of people I've seen stop here, but may go back few years down the line to get that final touchup. Unless you are working with surgeons called Zarev or Pittella, this is simply the reality of restoring high NWs. The issue with getting everything done at once is that it's harder to manage the donor and if you have growth issues or want to fine tune things, it's just harder. Even top notch docs like Sethi usually need 3 goes to completely restore high NWs.

I don't NEED a 3rd HT, but I'm looking at my result and while I'm not blind to the difference between where I started and where I am right now (and/or will be in about a year when the crown matures), I am very critical about the result and would have liked to see a better one. I had 4k grafts transplanted in each one of my HTs. I feel like it's either not enough or the survival rate was poor - since everyone always mentions how the frontal part is the most visible one in an HT (which makes sense), I am disappointed that mine looks very sparse - especially when comparing one side to the other.

I can appreciate donor management is a hard task and it seems Dr L did a good job with it, but I think had he used beard hair - even just 500 or 1k grafts - especially for the second HT, we could all agree it would have been better donor management overall. I even mentioned many times to him that I do not wear a beard and would be quite happy to have a beardless smooth face if possible so he's more than welcome to remove 100% of what's there is needed 

As for top-notch Drs needing a 3rd go - I have accepted that now that I realise what 8k grafts look like on a NW6/7 patient like me. I wish I had realised that at the beginning of my journey though, because perhaps my decision on which Dr to go with would have been different. Again, it is not because Dr L did a bad job - not at all - but because his way of doing things is perhaps more costly than the others. And costly not in monetary terms but in terms of the need to go through the process 3 times instead of just (most likely) once.

 

 

[rja]

2 hours ago, 4chanhrn said:

I think Laorwong prefers to use scalp hair because it's better, but also I'm not sure he's as experienced with it as others like Mwamba, Pittella or Sethi, who've worked with beard hair a lot more.  Laorwong also does no shave procedures(both in donor and recepient), but it's better to trim it down.

I believe he does have that preference, given how he handled the 2nd HT where I was certain beard hair was going to be used and it wasn't.

Not sure about the no-shave process with him. I haven't spoken to him about it. Hopefully, no-shave means no-shave/no-trim/no-touch.

[rja]

2 hours ago, 4chanhrn said:

I'm following your case as I'm going with his partner with similar loss. I would be very happy if I ended up where you did.

Thank you and good luck!