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My Journey - Consultations with Surgeons: Ahmed, Arocha, Bisanga, Bosley, De Freitas, Ilea, Laorwong, McGrath, Muresanu, Pittella, Zarev and more


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I'm diving deep into the consultation phase.  Still researching a ton, but also moving forward with consultations.

So far I've contacted Ahmed, Arocha, Bisanga, Bosley, De Freitas, Ilea, Laorwong, McGrath, Miln, Muresanu, Pittella, Zarev and one more I don't remember (not on the recommended list, and not an option).

I've had in-person consults with some, and I plan to have in-person consults with more.  I travel a fair amount, so will likely knock out several consultations in one sweep each time I'm in a region.  Did that in Texas while spending some time there (Arocha, Bosley, Ilea, McGrath, and the one I can't remember right now).  Don't worry, my sights are set beyond those).  

I've provided answers to stock questions and sent in photos to Ahmad, Bisanga, De Freitas, Laorwong, Miln, Muresanu, and Pittella.

I've contacted Zarev but heard nothing back yet.

Dr. Laorwong was super fast in response to my answers and photos.  I'll post his reply in the next post on this thread.

Dr. Arocha gave some feedback and I'll post that later (don't have time now).  And I'll do the same for McGrath, Bosley, and Ilea at some point, even though I've definitely not going with Bosley or Ilea, and very likely not McGrath.

Attached are some photos.  They're not great, but they give you an idea.

My goal is to have as much coverage as possible. For a guy who has significant loss (several drs have said I'm a Norwood 5 or on my way), I want to do everything I can.  I see the miracle results of Zarev, Pittella, Ahmad, and others (and I've seen some great results from Laorwong, Miln, and Bisanga), and it makes me not want to settle.  I don't understand it, but it seems like some drs can do so much more than others-- not only in terms of quality but also in terms of quantity.

 

NOTES

donor hair:

:Dr. Arocha told me that my lower donor area is weak and that would limit ability to due FUE and limit the number of FUE grafts he could take.  No other Dr. had said this (which frustrates me if some knew but didn't tell me). Others all said my donor was good and didn’t get more specific.  Thus, Arocha recommended an FUT.  When I pushed for maximum coverage, he said he could do a combo FUT, FUE (next day), and also FUE from beard/neck.  I'll say more when I write about Arocha, but my point is, he said my mid-donor hair is fine, but my lower donor area is weak and he wouldn't take from there.  I mention this because that may limit what's possible for me.  Was very discouraged to hear that, but I'd rather face facts than not know them.

 

Meds:

i am on both oral finasteride and oral minoxidil. 

I have been on oral finasteride for several years.

i was on topical minoxidil for a few years, but I recently switched to oral minoxidil (only within the last few weeks).


Beard:

My beard is very strong,

 

 

I'm going to keep posting here in this thread, updating as I hear from each surgeon.  Would love any feedback, wisdom, and insight you have.

 

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DR LAORWONG

 

Dr Laorwong was incredibly quick to respond after I sent in answers to questions and submitted photos and video.

 

Here was his/office response:

image.png.f4702661ac20378c028ab91286a5a80d.png

4,000-4,300 grafts

 

Assessment and Graft Requirements

Given the extent of your extensive hair loss, you may require two sessions for complete coverage. Here’s the breakdown:

- Session 1 : 4,000-4300 grafts for the frontal hairline to mid-scalp area.
- Session 2 (one year later): 1500 grafts for the remaining bald spots and frontal touch up if needed.

The maximum recommended grafts per session, if your donor area is adequate, is 4,000-4,500 to avoid overharvesting.

Procedure Details

- Anesthesia: The procedure will be performed under local anesthetics and oral sedatives.

- FUE Techniques and Costs:
  1. Donor and recipient shaved FUE: Requires shaving the entire head, at 80 Baht per graft.
  

Included in the Price

1. One free PRP injection (for 1,000 grafts or more).
2. Post-op medications (antibiotics, painkillers, sleeping pills).
3. Wound care, hair washing, and low-level laser therapy (LLLT) for 5 consecutive days. LLLT promotes healing, increases blood supply, reduces swelling and discomfort, and prevents scarring.
4. The Trivellini system is used for FUE.

Doctor's Role

- Hairline design and preparation: The doctor draws the hairline and prepares the area.
- Donor area:The doctor administers local anesthesia (nerve block), makes excisions, and the grafts are extracted by a technician.
- Recipient area: The doctor administers local anesthesia (nerve block), makes pre-made incisions, and places 10-30% of the grafts. The rest are placed by assistants.

Post-Op Care
- Day 1: Surgery.
- Day 2: Afternoon follow-up, wound care, hair wash, LLLT.
- Days 3-6: Daily hair wash and LLLT.
- Day 6: Morning session if you have an afternoon flight.
Each post-op session lasts 45-60 minutes. 
You are responsible for arranging your accommodation and transportation.

Optional Add-Ons for Enhanced Results

1. Rigenera Activa Cell Therapy: Promotes hair growth. Available at a 50% discount (37,500 THB, approximately $1,040 USD).
https://absolutehairclinic.com/en/autologous-micrografting-technology-rigenera-activa-with-hair-transplant/

2. Hyperbaric Oxygen Therapy (HBOT): Increases oxygenation, prevents necrosis, and improves graft survival. This is recommended for smoker, diabetic, dense packing.
   - 1 treatment: 4,000 Baht
   - 3 treatments: 10,000 Baht (approximately $300 USD)
  https://absolutehairclinic.com/en/hbot-hyperbaric-oxygen-therapy-2/


Scheduling and Deposit

Appointments for 2024 are fully booked unless a cancellation occurs. 
Dr. Kongkiat Laorwong’s available dates for 2025 are:

- January: 7a, 15a, 31a
- February: 5a, 8a, 12a, 17a, 
- March: 9a, 13a, 14a, 16a, 20a, 21a, 22a, 25a, 27a, 29, 30a, 31a
- April:1, 2, 4, 6-8, 10-12, 17, 18, 19, 22, 23, 25, 26, 28, 30

Appointments marked with "a" are for afternoon sessions and are suitable for procedures involving less than 2,000 grafts.

To secure your appointment, please make a deposit of 35,000 Baht via the WISE App.

We look forward to assisting you with your hair restoration journey.

 

QUESTIONS:

 

Anybiody have insight/feedback about what Dr Laorwong proposes here?

 

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3 hours ago, mr_peanutbutter said:

you didnt mention if you are on meds or an intending to start meds

 

how is your beard?

Ah, thanks for pointing that out @mr_peanutbutter.

 

i am on both oral finasteride and oral minoxidil. 
 

I have been on oral finasteride for several years.

 

i was on topical minoxidil for a few years, but I recently switched to oral minoxidil (only within the last few weeks).

 

My beard is very strong, (I’ve never had trouble growing a beard (well, with the exception of elementary school… it didn’t come in so good  then 😁).    Just curious how beard hair would look on the scalp (I know they only use it strategically in certain areas, but some surgeons seem to use it more readily and others only as a last resort).  I’m also curious what my beard would look like after.  Maybe only take it from the neck where I shave it anyway?  I’m not sure  

 

lemme know if there are more questions  

 

 

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3 hours ago, asterix0 said:

I think Dr Laorwong laid out a sensible plan with realistic graft numbers. The reason why he recommended 2 surgeries is because you really can't do the 5000+ grafts you will eventually need in one session, it is too risky.

Makes total sense.  

@asterix0, any thoughts on the "Optional Add-Ons for Enhanced Results"?

Optional Add-Ons for Enhanced Results

1. Rigenera Activa Cell Therapy: Promotes hair growth. Available at a 50% discount (37,500 THB, approximately $1,040 USD).
https://absolutehairclinic.com/en/autologous-micrografting-technology-rigenera-activa-with-hair-transplant/

2. Hyperbaric Oxygen Therapy (HBOT): Increases oxygenation, prevents necrosis, and improves graft survival. This is recommended for smoker, diabetic, dense packing.
   - 1 treatment: 4,000 Baht
   - 3 treatments: 10,000 Baht (approximately $300 USD)
  https://absolutehairclinic.com/en/hbot-hyperbaric-oxygen-therapy-2/

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3 hours ago, UKLad81 said:

Curious to know what Dr Sever at Hattingen said…you look like an ideal candidate for one oh his famous FUTs. 

Hattingen responded to my initial inquiry, but I just sent in patient info/history and photos last night, so haven't heard back from them yet.  Talking with them to schedule both online and in-person consultations.

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8 minutes ago, CautiousResearcher said:

Makes total sense.  

@asterix0, any thoughts on the "Optional Add-Ons for Enhanced Results"?

Optional Add-Ons for Enhanced Results

1. Rigenera Activa Cell Therapy: Promotes hair growth. Available at a 50% discount (37,500 THB, approximately $1,040 USD).
https://absolutehairclinic.com/en/autologous-micrografting-technology-rigenera-activa-with-hair-transplant/

2. Hyperbaric Oxygen Therapy (HBOT): Increases oxygenation, prevents necrosis, and improves graft survival. This is recommended for smoker, diabetic, dense packing.
   - 1 treatment: 4,000 Baht
   - 3 treatments: 10,000 Baht (approximately $300 USD)
  https://absolutehairclinic.com/en/hbot-hyperbaric-oxygen-therapy-2/

I don't think any of these are worth it.

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I would forget about the add ons. How old are you now @CautiousResearcher? Do you feel that finasteride has stabilized your hair loss? You could use beard to augment your donor if your surgeon/s feel that your donor is weak. However ensure it's a surgeon who excels in the art of using beard hair. Also an FUT/FUE combo also makes sense. Take your time in doing your research and I wish you all the best!

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6 hours ago, CautiousResearcher said:

@mr_peanutbutter, thanks for the video.  I'm gonna watch again and respond with some thoughts/questions, but gotta get ready for a meeitng right now.  But in the meantime, what's "op"?

OP = original poster, is the person who started a discussion thread haha ! 👍

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1 hour ago, Gatsby said:

I would forget about the add ons. How old are you now @CautiousResearcher? Do you feel that finasteride has stabilized your hair loss? You could use beard to augment your donor if your surgeon/s feel that your donor is weak. However ensure it's a surgeon who excels in the art of using beard hair. Also an FUT/FUE combo also makes sense. Take your time in doing your research and I wish you all the best!

Thanks for the insight and advice, @Gatsby!  Helpful. 
 

I’m early 40’s.

Always hard for me to answer about stabilizing.  I think I still am seeing more thinning at the front, but (maybe) the crown is stabilized?  Not trying to be evasive, just hard for me to tell. 
 

also, just sent a video of my donor area to Dr Laorwong at his request and he said that my donor is good.  I know that’s not the same as an in-person consult, but that was nice to hear. Eager to hear from others to get third, fourth, and fifth opinions. 
 

thanks for the tips about beard transplant, FUT/FUE, and avoiding the add-ons.

 

grateful man!
 

 

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Just received the following email from Dr. Muresanu of Hattingen Hair:

Good morning,

 

thank you for your pictures!

 

I see a lot of “miniaturisation” over the entire top of the scalp that extends  into the Vertex (“Crown”).

This is usually a sign that the hair loss will continue and you are basically advanced Norwood 5 pattern, therefore we need to think how we can use the donor area to its maximum potential.

Ideally we would transplant the entire top of the scalp with a large session. The surface area that needs to be covered is large and will require a large number of grafts (at least 4-5000).

 

  • For such large cases the FUT method can usually deliver the necessary numbers in one session, whilst leaving sufficient reserves (via FUE) for further sessions in case you want more density in the crown.

 

  • FUE may  also be feasible but may require at least 2 sessions and the acceptance of an open or very lightly covered crown.

 I am attaching some instructions on how you can measure the size of the area yourself.

The redistribution strategy will prioritise the frontal half where we would transplant with high density with a conservatively designed hairline. Going backwards the midscalp will also get good coverage with medium density.

The posterior part (the crown) will get only light coverage and density as it is a large area. As mentioned above a second session may be needed if your goal is density in the crown as well.

To summarise the goal after the first session would be to recreate a pattern as if you had started losing hair from the back to the front, with a lightly covered crown and good coverage and density towards the front.

Let me know how you want to proceed.

 

 Warm Regards from Switzerland

Dr.Sever Muresanu

 

 

(Also, I am scheduled for an online video consult with him this week; and we are working to schedule an in-person consult for some time this summer given that both he and I are traveling extensively)

 

Would love to hear everyone's thoughts on Dr. Muresanu's email... and also on what he proposes vs what Dr. Laorwong proposes.

 

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Just received the following email from Ian (consultant) with Dr. Bisanga of BHR:

Thank you for your emails yesterday and for providing your photographs and relative information. 
 
As a clinic, we offer photo assessment and in person consultation. To be able to provide accurate recommendations and to be able to inform patients of their status, graft availability, what can be achieved and their overall quality of candidacy, one key factor is their donor area. Donor density, hair groupings and surface area. These are measurements and data that can only be attained in person.
 
I have discussed your case with Dr Bisanga.
 
Your photos suggest that you are experiencing a NW5 pattern.
Your lateral humps(sides) appear to have retained some height which means less surface area on top that has experienced loss.
 
Your photos would appear to show a weakness and drop in density in your nape (please see attached image). This is referred to as retrograde alopecia. It is common, but it does limit areas of the donor and requires assessment to understand stability and extent of miniaturisation and would mean that the doctor would focus on other more stable and stronger areas within your donor.
 
It would appear that despite loss from hairline to crown, some native hair is present throughout these areas and hopefully you will respond well to oral minoxidil as you have recently changed from topical.
 
As you have requested an in person consultation, Dr. Bisanga would agree that this would be the most appropriate next step to allow a thorough evaluation.
 
This will allow the doctor to attain data such as donor density, hair groupings, levels of miniaturisation throughout the scalp, stabilisation and to evaluate the scalp for any inflammation, which then allows the doctor to confirm candidacy and propose an appropriate approach.
 
Each persons donor area is unique to them. Their donor density, follicular grouping (how many hairs in a follicle 1/2/3/4), any miniaturisation and the calibre of their hair. It is a persons donor that will influence how many grafts can be extracted from that area safely, without showing visible signs of extraction and to ensure optimal healing, allowing further extraction in subsequent procedures.
 
Patients with average or below donor density/areas of retrograde are generally able to safely provide around 3500 grafts from their donor area, in one procedure. If your donor would allow more then more can be harvested. The priority is a well managed donor.
 
To provide an idea of graft requirements, depending on hairline design and placement, a frontal third restoration may require roughly around 3000 grafts and a frontal half pushing back into your mid scalp around 4000 grafts. 
 
In cases such as your own where a high graft count is necessary, body hair such as beard and chest hair can also potentially be considered if compatible. 
Beard hair is a very reliable source of donor hair and due to its thicker calibre, is very effective blended with scalp hair to add the visuals density in the mid scalp/crown area. For patients with thinner hair calibre, thicker beard may not always be the most appropriate and so this would be discussed with the doctor.
 
(email continued with details about scheduling)
 
 
Love to hear any comments, insights, wisdom from the community on what Ian of BHR wrote.
 
 

Bisanga showing retrograde alopecia at nape of neck 2024-07-02.png

Bisanga showing high humps and narrow balding 2024-07-02.png

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52 minutes ago, CautiousResearcher said:

Just received the following email from Dr. Muresanu of Hattingen Hair:

Good morning,

 

thank you for your pictures!

 

I see a lot of “miniaturisation” over the entire top of the scalp that extends  into the Vertex (“Crown”).

This is usually a sign that the hair loss will continue and you are basically advanced Norwood 5 pattern, therefore we need to think how we can use the donor area to its maximum potential.

Ideally we would transplant the entire top of the scalp with a large session. The surface area that needs to be covered is large and will require a large number of grafts (at least 4-5000).

 

  • For such large cases the FUT method can usually deliver the necessary numbers in one session, whilst leaving sufficient reserves (via FUE) for further sessions in case you want more density in the crown.

 

  • FUE may  also be feasible but may require at least 2 sessions and the acceptance of an open or very lightly covered crown.

 I am attaching some instructions on how you can measure the size of the area yourself.

The redistribution strategy will prioritise the frontal half where we would transplant with high density with a conservatively designed hairline. Going backwards the midscalp will also get good coverage with medium density.

The posterior part (the crown) will get only light coverage and density as it is a large area. As mentioned above a second session may be needed if your goal is density in the crown as well.

To summarise the goal after the first session would be to recreate a pattern as if you had started losing hair from the back to the front, with a lightly covered crown and good coverage and density towards the front.

Let me know how you want to proceed.

 

 Warm Regards from Switzerland

Dr.Sever Muresanu

 

 

(Also, I am scheduled for an online video consult with him this week; and we are working to schedule an in-person consult for some time this summer given that both he and I are traveling extensively)

 

Would love to hear everyone's thoughts on Dr. Muresanu's email... and also on what he proposes vs what Dr. Laorwong proposes.

 

This is a fairly accurate assessment and I would’ve expected a similar response from Dr Sever. I definitely agree that you will need at least 5000 grafts for decent coverage. Frontal density, decreasing as you go back seems the norm mate. It all depends on the method of surgery. If you are comfortable with FUT then Sever and his clinic are probably one of the best in the business especially for those that are high norwoods. He’s an excellent doctor and says it how it is - of course with the patient in mind.

If it helps, I’ve been to him in Dec and had a FUT with him and I’m pleased with how things are going. He’s been regularly checking in since the HT. See how you feel when you speak to him in both in person / skype and then see how you go from there. But to summarise you’d be making a very wise choice with Hattingen. 

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2 minutes ago, UKLad81 said:

This is a fairly accurate assessment and I would’ve expected a similar response from Dr Sever. I definitely agree that you will need at least 5000 grafts for decent coverage. Frontal density, decreasing as you go back seems the norm mate. It all depends on the method of surgery. If you are comfortable with FUT then Sever and his clinic are probably one of the best in the business especially for those that are high norwoods. He’s an excellent doctor and says it how it is - of course with the patient in mind.

If it helps, I’ve been to him in Dec and had a FUT with him and I’m pleased with how things are going. He’s been regularly checking in since the HT. See how you feel when you speak to him in both in person / skype and then see how you go from there. But to summarise you’d be making a very wise choice with Hattingen. 

@UKLad81, really helpful to hear from someone with first-hand experience.  Thanks for sharing that!  I need to go look at your profile.  

I will say, one of the things I've really wrestled with is the FUT vs FUE choice.  I know both have their advantages (and that people debate even that quite often on HRN!).  I'm open to the possibility of FUT but I also am hesitant in part because I may want to wear the hair in my donor area pretty short at some point.  

But what you say about your experience with Hattingen is very confirming (and matches my conversations with him already).  I'm eager to have the online consult this week-- and hopefully an in-person one in a month or two depending on his travel schedule and mine.

Thanks for offering your feedback mate!

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3 minutes ago, CautiousResearcher said:

@UKLad81, really helpful to hear from someone with first-hand experience.  Thanks for sharing that!  I need to go look at your profile.  

I will say, one of the things I've really wrestled with is the FUT vs FUE choice.  I know both have their advantages (and that people debate even that quite often on HRN!).  I'm open to the possibility of FUT but I also am hesitant in part because I may want to wear the hair in my donor area pretty short at some point.  

But what you say about your experience with Hattingen is very confirming (and matches my conversations with him already).  I'm eager to have the online consult this week-- and hopefully an in-person one in a month or two depending on his travel schedule and mine.

Thanks for offering your feedback mate!

If you do go with FUT (and I’m sure Sever will say the same later this week), you can always go and get some FUE in to the scar to make it less visible. But it’s a fair concern and something you will need to decide eventually. All the best with your consult with him and tell him “the Indian guy from UK says Hi - the one that recommended all the Indian restaurants whilst he was here ;-)”

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3 hours ago, CautiousResearcher said:

@UKLad81, really helpful to hear from someone with first-hand experience.  Thanks for sharing that!  I need to go look at your profile.  

I will say, one of the things I've really wrestled with is the FUT vs FUE choice.  I know both have their advantages (and that people debate even that quite often on HRN!).  I'm open to the possibility of FUT but I also am hesitant in part because I may want to wear the hair in my donor area pretty short at some point.  

But what you say about your experience with Hattingen is very confirming (and matches my conversations with him already).  I'm eager to have the online consult this week-- and hopefully an in-person one in a month or two depending on his travel schedule and mine.

Thanks for offering your feedback mate!

The harvesting area in an FUT procedure is on the higher side of the donor, above the oxcipital notch.  That is, you can keep the hair just long enough to cover the scar and do a gradual fade under it.  This would allow for you to harvest the best quality hair you have and still have the option to wear a high and tight haircut.  

Edited by LaserCaps

Patient Consultant for Dr. Arocha at Arocha Hair Restoration. 

I am not a medical professional and my comments should not be taken as medical advice. All opinions and views shared are my own. 

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2 hours ago, CautiousResearcher said:

Just received the following email from Dr. Muresanu of Hattingen Hair:

Good morning,

 

thank you for your pictures!

 

I see a lot of “miniaturisation” over the entire top of the scalp that extends  into the Vertex (“Crown”).

This is usually a sign that the hair loss will continue and you are basically advanced Norwood 5 pattern, therefore we need to think how we can use the donor area to its maximum potential.

Ideally we would transplant the entire top of the scalp with a large session. The surface area that needs to be covered is large and will require a large number of grafts (at least 4-5000).

 

  • For such large cases the FUT method can usually deliver the necessary numbers in one session, whilst leaving sufficient reserves (via FUE) for further sessions in case you want more density in the crown.

 

  • FUE may  also be feasible but may require at least 2 sessions and the acceptance of an open or very lightly covered crown.

 I am attaching some instructions on how you can measure the size of the area yourself.

The redistribution strategy will prioritise the frontal half where we would transplant with high density with a conservatively designed hairline. Going backwards the midscalp will also get good coverage with medium density.

The posterior part (the crown) will get only light coverage and density as it is a large area. As mentioned above a second session may be needed if your goal is density in the crown as well.

To summarise the goal after the first session would be to recreate a pattern as if you had started losing hair from the back to the front, with a lightly covered crown and good coverage and density towards the front.

Let me know how you want to proceed.

 

 Warm Regards from Switzerland

Dr.Sever Muresanu

 

 

(Also, I am scheduled for an online video consult with him this week; and we are working to schedule an in-person consult for some time this summer given that both he and I are traveling extensively)

 

Would love to hear everyone's thoughts on Dr. Muresanu's email... and also on what he proposes vs what Dr. Laorwong proposes.

 

It's refreshing to read true statements such as the miniaturization you're dealing with.  This does bring up a point.  

Most believe we're born with 100,000 hairs.  We'll have lost half of that number by the time we're teenagers and still don't realize there's any hair loss.  If on the average people have 6-8K grafts, with an average of 2.2 hairs per graft, you're talking 17K+ hairs to do the job of 50k.  An illusion of density to say the least.  Thus, whatever hair you can enhance/improve, will only help to add to the overall density when it's all said and done.  Considering the fact you're dealing with retrograde, why not approach this medical modalities first?  If you end up reversing the miniaturization and improve the retrograde - you'll be far more than just a marginal candidate.  

With regards to numbers, I often see 4K, 5K, 6K recommended.  If the most that can typically be harvested is 2000-2500 grafts, how do you get from this to thousands and thousands of grafts?  You could do FUT and FUE at the same time, (2 day procedure), you could over-harvest or split grafts.

There are a few concerns with FUE and the retrograde you're dealing with.  If anything is harvested from that area, it's likely those grafts will eventually be lost.  So this brings me back to the non surgical options. 

Could you take all your donor and put it up top?  Sure, why not?  But, is that the goal?  (Ask the size of the punch being used.  If you end up with circular type scars throughout when done, you'll then be dealing with more issues).

The segment removed during an FUT procedure will be divided and separated under a microscope.  Follicular units can come with 1-5 hairs per follicle. You could take a 5-hair follicle and split into 5) 1-hair follicles.  Yes, you would obtain the numbers but not the density.  If you put 1-hair grafts throughout, this would yield a diffused and unnatural look.  (Oh, and are they pricing by the hair and not grafts?  That would make more sense.  2500 grafts would be approx 5500 hairs). 

The instrumentation used during FUE is very small.  This allows for micro-scars which will not be detectable to the naked eye, particularly if the punch is smaller than .9mm.  If the instrumentation is so small, so will the graft.  Less substance and less hair per follicle.  The only way to obtain greater numbers of grafts is through over-harvesting.

I urge you to take a conservative approach.  This, eventually, will help you achieve your goals.  (Putting a small number of grafts, in the overall scheme of things, over a large area will only lead to a very thin result and the need to do more procedures in the ensuing years). 

 

 

Patient Consultant for Dr. Arocha at Arocha Hair Restoration. 

I am not a medical professional and my comments should not be taken as medical advice. All opinions and views shared are my own. 

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