1 Doctor Suggests Multiple Surgeries With Less Grafts, & Another Suggests 1 Surgery With More Grafts | HairLossTalk Forums

1 Doctor Suggests Multiple Surgeries With Less Grafts, & Another Suggests 1 Surgery With More Grafts

Discussion in 'Hair Transplants Information - General Discussions' started by Shad, Apr 28, 2018.

  1. Shad

    Shad New Member My Regimen

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    Hi HairLossTalk,
    Hope all's well. My name is Shad, 32yrs old from NY. Hair loss that runs in the family. I'm leaning towards FUT because of better yield and price. I shared pictures of my loss.

    I've been doing a lot of reading and now have a question regarding conflicting approaches from 2 doctors. Unless you guys prefer I mention doctor names, I kept names out of my post. This is more about an informed decision anyways. Based on what I read online and impressions from consultation, both docs seem great. Just their approach on surgery was different.

    The short story:
    The 1st doctor I saw recommended an surgery of 1200 grafts, and mentioned I should be committed to come back 6 months later for a 2nd surgery. This approach is essentially more surgeries and less grafts. The 2nd doctor I saw recommended one surgery of about 2300-2600 grafts. I think he mentioned I'd only need 1 surgery. His approach is less surgery and more grafts. Which approach do you think is right for me, as well as the typical patient? Prices were somewhat similar.

    The longer story:
    I asked both doctors about the opposing approaches. The 1st doctor essentially said:
    "I thought you had indicated to me that you were leaning toward an FUE procedure. Given your donor density and height of donor region, one (you) is more limited to the total numbers of high quality grafts harvested via FUE that is equal to a strip harvest. I could harvest more in quantity, but the quality will likely diminish.
    Secondly, I designed this to give you the most positive change with the least potential shocking. If you are now leaning towards strip procedure, I could harvest 2000 grafts and place them into the top and back bridge as well as the succinct location I had allocated the 1200 grafts for originally. Here is the draw back - you will likely loose 30-70 percent of the native hair in the region receiving the grafts of which a percentage may not regrow (permanent shocking). Further, even if you were to do a 2000-2300 graft treatment you will most likely STILL want or require a second touch up treatment because we are treating a region that still has native hair that is going to continue to fall."

    I then asked if he recommended FUT with 1200 or 2200 grafts as his primary recommendation. He said: "You can do either FUT or FUE if you choose to do 1200 grafts. If you choose to accept a larger region of shocking in the recipient region, I can reach about 2000 grafts but only with FUT not FUE. I recommended 1200 grafts as a minimal approach to your beginning thinning pattern but you can do either."

    The 2nd doctor essentially said:
    "This (1st doctor) implies that hairs that would be vulnerable to shock loss will no longer be present 6 months later? I disagree with the 2-step process, rather than traumatizing the scalp twice, it's better for patients to have the benefit from a full session and minimize any risk of shock loss by optimizing the solution in which the grafts are stored. The PRP/ACell/ATP/Hypothermosol combination is used to keep graft survival rate as high as possible, and for pre-existing hair preservation. Harvesting more in quantity doesn't necessarily mean the quality would likely diminish. It's simply not true if the optimal graft holding solutions are used. There is not a difference in graft survival between a 1200 and 2500 graft session. Those assumptions are outdated and only would apply to storing grafts in saline at room temperature (hopefully, no office does that anymore). I also disagree with the rates of permanent damage. That is simply a question of technique and attention to detail. The same reason that we do not require patients to shave their hair in the recipient area - it's a matter of performing the procedure slowly and carefully, rather than performing multiple surgeries in a single day."
     

    Attached Files:

  2. IdealForehead

    IdealForehead Senior Member My Regimen

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    What meds are you on and for how long? If you're just on minoxidil and nizoral you're shooting yourself in the foot. You could probably grow back a great head of hair no surgery needed.
     
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  3. JeanLucBB

    JeanLucBB Senior Member My Regimen

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    The second surgeon is correct. Sounds like dr cooley
     
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  4. Shad

    Shad New Member My Regimen

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    Thank you JeanLucBB. No, not Dr. Cooley.

    IdealForehead, I didn't think I should get detailed on the past, but thank you for asking and I will. The short story is I'm leaning towards surgery after trying alternative solutions for years. I will give a longer history tonight when I get home from work.
     
  5. Shad

    Shad New Member My Regimen

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    I think to best answer that, I should give my history. My history may be a separate topic in itself from my original question, but I was thinking I should just include the history here instead of making a new thread.

    History:
    I'm 32 now. Hair loss seems to run in my family but I also think balding was accelerated due to treatment my prior urologist gave me around age 25. He suggested I take DHEA and then clomid for ED and low testosterone, because a good weight/diet/exercise/PDE5 inhibitor pills didn't help much. 1-2 months after taking those, I started to notice hair loss and estrogen was high, so I told him I wanted to stop DHEA/Clomid as it didn’t help anyways.

    About 2 years ago, I found an experienced doctor with ED in young patients. The new doctor put me on HCG, testosterone replacement therapy, anastrozole and calcium d glucarate (both which help decrease estrogen caused by increasing testosterone). This seems to be more effective for my symptoms. I still have symptoms some days, but it's better.

    Before starting the new treatment, I thought I might get additional hair loss as it's a side effect of testosterone. So I started applying rogaine one-two times a day, lipogaine once a day (product with minoxidil and natural DHT blockers), and Nizoral 3x a week (ketoconazole) for about a year. The doctor also offered a Minoxidil/AzelaicAcid/2%Ketoconazole/Latanoprost solution. I didn't use that longer than 2 months because it made my hair feel and look dry. I don't know if it was one of those ingredients or if some alcohol was in it. Ever since applying these topicals, the good news is I haven’t noticed any increased hair loss from testosterone use, but the bad news is no new regrowth. Within the past few months, I started tapering off of Rogaine, Lipogaine, and Nizoral to see how low I can go without noticeable hairloss. I now take all of them only once a week. I tapered off for a few reasons. I didn't see regrowth. I felt like I was taking too many meds/chemicals/hormones between my ED and hair loss regimen. What I had to use daily began to feel inconvenient. Plus, it sucks to know I’d have to apply products daily long term. I know surgery is expensive, but buying products for years can add up too, right?

    Below are the only prescription/treatments I’m taking now. My testosterone doctor did not recommend finasteride for patients with ED, as he mentioned some patients with ED symptoms who took finasteride were difficult to treat. He said if I wanted to, only topical finasteride can be explored. Given that I still have ED somedays, I think I'll just stay away from finasteride topical or not.

    Current prescriptions/treatments:
    Rogaine/Lipogaine (once a week now, will increase use temporarily to daily 2 weeks before surgery)
    Ketoconazole shampoo (once a week now, will increase use temporarily to daily 2 weeks before surgery)
    HCG (500iu twice a week)
    Testosterone cypionate (30cc of 200mg/mL twice a week)
    CMP testosterone 10% cream (one click a day to raise low DHT to normal range)
    Anastrozole (twice a week)
    Calcium D Glucarate (twice a day)
    Occasional use of PDE5 inhibitor and popular foods/supplements that benefit ED, inflammation, or cholesterol (greens, beans, tadalafil, beet powder, arginine, pycnogenol, turmeric, psylium husk, etc)
     
    #5 Shad, Apr 29, 2018
    Last edited: Apr 29, 2018
  6. IdealForehead

    IdealForehead Senior Member My Regimen

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    You are playing a dangerous game shad. Was your testosterone truly low before you got on testosterone replacement? Did you ever try to get it up naturally?

    You should talk to @Afro_Vacancy. he was able to get his ed treated without adding more androgens. Adding androgens is always a bad idea if you're balding. Anastrazole will also potentially accelerate hair loss.
     
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  7. Shad

    Shad New Member My Regimen

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    IdealForehead, I'll talk to @Afro_Vacancy. Thanks for caring. I know what you mean. Some guys look for a quick fix but that's not the case. Low T around 200, no more than 300 if lucky. It's embarrassing to think back on it but I'll share. Maybe my story will help some other young man with ED.

    I was into natural fitness and diet alot. Healthy weight BMI. One of the main reasons is because of ED. I tried the natural route for over a decade! Looking back on it, I realize that may have been too long. Missed out on my 20s with my parents wondering what's wrong. I figured it's unusual for young men to have ED, so one day, it'll just go away if I just keep focusing on diet/training. ED made me feel like I couldn't get into a relationship, so I just spent my 20s absorbing myself into career/diet/exercise/family.

    The cause is not clear but I have clues:
    -As a boy, I had a lot of eczema. I wish my parents weren't so quick to use steroid creams and were knowledgeable on diet, but it's not their fault. Many doctors prescribe steroid creams too easily. It's possible that effected my hormones long-term. My parents have diabetes/high cholesterol. So they weren't always giving the best foods to us. Their time was spent making sure we had a roof over our heads. They're cultural too and learning about diet just wasn't in their culture. I started learning to eat better in my mid 20s.

    -I do have some moderate pains that never went away probably from sports/heavy lifting (Core, leg, neck region all on the left side. Diagnosed with L5-S1 disc herniation and mild spinal stenosis). Inflammation/pain can contribute to ED. Wished I was smart enough to not play so aggressively or lift so heavy, but then you read conflicting advice that lifting heavy is great for increasing testosterone. It can be confusing.

    -I think I have higher cholesterol genetically, or maybe whatever inflammation I have is leading to the higher cholesterol. I eat much healthier than obese people and some of them have better cholesterol numbers than me.

    -Arteriogenic dysfunction was found in a penis ultrasound. To do the ultrasound, trimix is injected into the penis to cause an erection. The doctor was surprised when I didn't get any erection from the usual dose. So he increased it. He said most people with arteriogenic dysfunction are born with it or get it from injury. At that time, I had low T but this doctor didn't know much about how to handle low T in young men. So he just suggested more Trimix and sent me on my way. It didn't work well enough and the thought of having to inject my penis long-term sucked. Some urologists aren't good for treating ED in young men and unfortunately, those are the doctors I think many young men first see. I was lost for awhile until I started researching for countless hours on doctors who successfully treat ED in young men. Testosterone helped somewhat in my case. Any help was welcoming at this point.

    I think I may have got off topic from my original question, but hopefully my story helps. Hair loss is no where near as important as ED is to me, but if it's treatable and convenient to do so, then I'd like to. Topicals didn't work to my satisfaction for the reasons mentioned in my prior post, so I'm leaning towards seeing Dr. Carlos Wesley soon for hair surgery.
     
    #7 Shad, Apr 29, 2018
    Last edited: Apr 29, 2018
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  8. Afro_Vacancy

    Afro_Vacancy Senior Member My Regimen

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    What dose of trimix did you use?

    Have you been tested for atherosclerosis?
     
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  9. Shad

    Shad New Member My Regimen

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    @Afro_Vacancy Thanks for reaching out. I was going to reach out soon.

    I can't remember the dose. I'll get back to you on that by either digging up some papers to find the dose. I never actually asked the 2 urologists, primary doctor, and my testosterone doctor to specifically test me for atherosclerosis. I just told them my ED story. Perhaps I should. Based on what I'm reading on how to test for atherosclerosis, it seems they've run some of common tests done for it. Tests that have been ran were blood tests, EKG, penis and testicle ultrasound. I suppose I'll bring it up next time I see my primary.
     
  10. Afro_Vacancy

    Afro_Vacancy Senior Member My Regimen

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    Get a serum measurement of prolactin as well if it's available.
     
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  11. Shad

    Shad New Member My Regimen

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    @Afro_Vacancy Low end of the normal range for Prolactin. Numbers for last 2 times it was tested:
    6.2 ng/ml a few months ago
    4.6 ng/ml 2 years ago when new to TRT treatment

    Whether I had/have significant atherosclerosis or not, from what I've read, I think I'm treating it right lifestyle wise. I've attached my most recent bloodwork from my TRT doctor (Dr. Justin Saya). The cholesterol numbers are the best they ever have been but to do it, I took it upon myself to mostly eat a low fat vegan diet for 3-5 months. I wanted to test if it improved ED and cholesterol, and it did. Total Cholesterol 160mg/dl, LDL 90, with ED symptoms improved. The problem was it's hard to maintain this diet long-term, especially socially. So I've recently changed that to include healthy poly/monounsaturated fats and small amounts of meat/dairy. The ED seems only slightly worse which I'm ok with. I'll see how the #s are in my next lab work.

    Last year, I was on the paleo diet. My bloodwork from that was not great. Maybe the highest I've ever seen it. Total Cholesterol of 288 and LDL at 191, but HDL at a nice 86. ED was still severe, so I decided paleo was not my solution. There's so much conflicting diet advice out there. The takeaway is maybe because different diets work for different people so test it if you're willing, or take a balanced approach if you won't test it. These results indicate I probably do well with less meat/dairy/fats and more veggies/fruit
     

    Attached Files:

    #11 Shad, Apr 29, 2018
    Last edited: Apr 29, 2018
  12. Afro_Vacancy

    Afro_Vacancy Senior Member My Regimen

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    I'll be trying a diet like that in the next 8 weeks, beginning tomorrow.
     
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  13. Murkey Thumb

    Murkey Thumb Experienced Member My Regimen

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    Not sure 2-3k grafts would be enough for your hair loss. I would be looking at 4-5k grafts as you are defuse front & mid scalp. You could fly to Turkey and get that done by FUE in a single session and it would still be cheaper than 2k grafts in the States.
     
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  14. Pequod

    Pequod Established Member

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    1200 grafts is laughable, you need at least 3500 with 5000 looking even better. Your donor area looks good, go get some other opinions and skip those two,
     
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  15. Shad

    Shad New Member My Regimen

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    @Murkey Thumb @Pequod Thanks for the advice. That is news to me. I spent a good deal of focusing my time looking for good hair loss doctors in or near New York. I figured I'd at least visit 2, which I did to compare. I read a lot of good things about Dr. Carlos Wesley who is one of the doctors I saw. He suggested the 2300-2600 grafts for FUT, with PRP (platelet rich plasma hair restoration). Now I'm considering to get one more opinion.

    My thought on this is that 2300-2600 grafts may look good after a year, but since I'm 32 with genetic hair loss, I may need surgery again in a couple years right? So I should probably get more grafts done now instead of doing multiple surgeries? Is there any flaw in this thinking?
     
    #15 Shad, May 1, 2018
    Last edited: May 1, 2018
  16. Murkey Thumb

    Murkey Thumb Experienced Member My Regimen

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    No you are on the right lines you don't want too many transplants as it is not a good experience. Get as much done as you can with the first one but leave enough donor for a further one later down the line 5-10 years. Trouble is with a lot of these surgeon is that they are very conservative in their approach plus its extra bucks for them later. I am not a fan of FUT especially when you can easily get the same results from FUE without the scar. If you can take the time off work head over to Turkey or Spain.
     
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  17. mattj

    mattj Established Member

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    You have what appears to be a fairly strong frontal area, which will mean you require fewer grafts; although it's uncertain how long that hair will remain. Your crown looks good. You're lucky that your loss is forward of the crown.

    I see absolutely no merit in undergoing two surgeries for such a small number as 1200 grafts. It's true that harvesting too many grafts in one go can be harmful, but in most cases it's safe to aim for figures of 2500 or perhaps more. This refers to FUE, which I take it is what you want. Much higher numbers are possible with FUT.

    So it's fair to say that I agree with the second doctor But I will say that a man with your degree of hairloss would need more than 2500 grafts to cover the entire balding area. If you're set on FUE then you would need a second procedure, unless you are happy with a result that focuses on the front third and leaves the rearward area untouched. And many patients are happy with that sort of approach and it does look natural.

    In summary, I agree with most of what the second doctor said, but if you want to achieve more than just a strong hairline and frontal zones then a second surgery will be necessary.
     
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  18. DoctorHouse

    DoctorHouse Senior Member

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    I agree with Matt. I would not do a first time surgery for less than 1500 grafts. Not even worth the hassle. Your loss is going to require at least 2600 grafts that can be achieved in one day by most FUE doctors at this point.
     
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  19. Shad

    Shad New Member My Regimen

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    Thank you guys. I'm going with the 2nd doctor. I'm scheduled for FUT of 2300-2600 grafts with Dr Wesley in about a month. I'll ask his thoughts on going slightly higher with the grafts. From reading the responses, I get the feeling I should go for slightly more.

    I prefer FUT over FUE because I don't mind having longer hair, it's cheaper, and better yield.
     
  20. Murkey Thumb

    Murkey Thumb Experienced Member My Regimen

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    Good luck Shad!
     

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