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Partial Shave FUE - 2340 Grafts - Dr Manish Mittal, London - 10/01/23

Speoj

Speoj

member
Hey all,

After thinking about getting a hair transplant for a few years, this week I finally got it done! I'm 29, starting receding when I was 16, I've been using minoxidil for 5 years and finasteride for 2 years. I did see some positive results with both, but it only helped to curb the diffuse thinning that started to set in when I was 24, they did help with thickness but didn't do much to improve my hairline. I tried derma rolling on the hairline for about a year but after seeing no results I stopped and started to think more about getting a HT.

I wanted to go for a partial shave FUE to address hairline recession, as mentioned in a previous post I have always styled my hair to cover my hairline, so wanted to go partial shaven to continue to cover the hairline through the ugly duckling phase. Over last summer and autumn I had consultations and conversations with a bunch of different surgeons and clinics. I was looking at going abroad for it initially, I liked the idea of going to either Cyprus or Belgium, waiting it out in a hotel for post op and coming back once the scabs were off. But whilst I was still weighing up my options in a consultation with Dr Manish Mittal (Dr Mani) he asked about how I respond to anaesthetic which led to me talking to him about my unilateral renal agenesis - I was born with one kidney, the other didn't develop, it's hereditary, and is usually passed down the male side of the family. For all terms and purposes I am 'healthy' but it does mean that my tolerance to things like alcohol and recreational drugs are lower that other peoples. And a few years ago from stress and overworking I had a scare where the one kidney had the symptoms of it failing and I had to get to hospital quick for them to do checks and put me on a drip until it flushed the kidney out. The A&E doctor at the time said that if I hadn't had gotten to them when I did it might have been more serious, that in future a similar episode might mean dialysis. So when it came to picking a surgeon for the HT, I then decided it would be best if I stayed in the UK so that if I did have a reaction to the anaesthetic, that at least I could get to a hospital quick where I could explain what was happening faster than if I was abroad.

I was chatting to some of Mani's patients on Reddit who were happy with their decision and from what I saw, I liked his hairline designs and he seemed to have a good track record with cases similar to mine - hairline restoration work and less full coverage diffuse thinning. I also liked that he only sees one patient a day, that he does the punches for the extractions to keep on top of donor management and does all of the incisions himself. So I pulled the trigger and we set a date.

In terms of wait time I think it is around 3-6 months. In the consultation in August he said realistically we'd be looking at February, but chatting to Rus his co-ordinator we managed to set a date in January which was my preference, being after Christmas when there's not much going on and was the most convenient time to take time off work. Before they would take me on as a patient though I had to get bloods done that showed kidney function, Mani said that if it came back as normal function he'd go ahead, but would have to decline if kidney function came back as abnormal. Did the tests, came back fine, and we were all set. And in terms of pricing, I was quoted between 2200-2400 grafts at £3 a graft. Which would include PRP and a 12 month supply of finasteride.

Chatting to Dr Mittal's co-ordinator, Rus in the run up to the consultation just put me at ease, like chatting to an old friend. I didn't get that kind of rapport chatting to other co-ordinators. And in the run up to the op and now post op, the communication has been great, quick responses over email, knows his stuff and sometimes it can even be difficult to get off the phone, we always seem to have a lot to talk about, which is the opposite of what I experienced chatting to other co-ordinators. So yeah, shout out to Russel.

On the day of the op I got to the clinic for 9am, I was nervous as anything, it was tipping it down and when it rains in London everything grinds to a halt. I was late, but so was Dr Mittal. The receptionist requested paperwork that I had sent over weeks ago. I resent it, she couldn't open it to print it off, I offered to resend it as a PDF but in the end completed parts of the paperwork by hand. Not a great start but understandable, just a miscommunication. If I had known they needed the paperwork printed off I could have printed it at home to save them time on the day.

But by 9:45 that was all dealt with and we designed the hairline. It's something that was discussed at length at the consultation, so we were quickly on the same page about my goals etc. Since my teens I have always had a windows peak hairline, that then receded, it would would have been unnatural and very noticeable if I opted for a straight hairline, instead I wanted to stay conservative, to have a mature hairline still just with less regression. Mani reaffirmed that the recession was quite deep so he'd shave back the hairline to reinforce and blend the native with the transplanted grafts.

I was concerned about the pain and how I would respond to the aesthetic, I was chatting to people days before on this and other forums who'd already had work done at different places who said the pain can be pretty bad so I felt like I was ready for the worst pain I'd ever felt. But when the anaesthetic was injected in it didn't feel that different to giving blood or donating plasma, just in your head. After 5 minutes or so, once it had set in I didn't really feel anything after that. Still in the room, still aware of what was happening and chatting still, just didn't feel any pain. At any point when I could start to feel something I would say so and Mani would inject more anaesthetic, which was a mix of lidocaine and adrenaline.

Mani used a motorised 0.85 punch to do the extractions, as one tech, Salma used a clicker to keep on top of the graft count whilst another tech, Edene, was at a microscope dividing the grafts into singles, doubles and multis. Dr Mittal said I had one of the best donors he'd seen in a while, with that majority of extracted grafts being multis; mostly triples, quads and even some fives. They had to split some of the multis up to make more singles. It felt a lot like being at the dentist, I couldn't feel the extractions but I could hear the sound of it if that makes sense.

Singles: 413
Doubles: 725
Multis: 1119

After the extractions we broke for lunch, and after Mani did the incisions at the recipient area. He used a 1mm blade for the singles at the front of the hairline, they find that the singles just slot straight in that way, and then switched to a 1.25mm blade for the rest. He said for the quads and fives he nearly went up to a bigger blade but was reluctant because he wanted to keep trauma and scaring to a minimum. The anaesthetic meant that I didn't feel pain whilst he was doing the incisions, and Salma was back on the clicker keeping count of how many incisions he was up to whilst Edene continued organising the grafts. Mani created irregularities along the hairline to create a more natural look which we chatted about whilst he did them. Once the incisions were done and Dr Mittal was happy with the density for dense packing the grafts, they used a blue dye to more easily identify the incisions for implanting the grafts. Salma and Edene then implanted the grafts into the incisions, they started with singles in the hairline then worked back and I was free to watch some movies on Netflix. Once the majority of the grafts were in, Mani asked the techs to leave 30 or so singles until the end and he implanted these himself, creating additional irregularities along the hairline with the last remaining grafts. Every step of the way I got the impression that they take their time with everything, with an attitude of it's done when it's done which I admired. We were all finished at 7pm, they rinsed my hair, took the photos attached below and put a bandage over the donor area.

Mani then went over the after care procedure with me again, gave me a post op care goodie bag with baby shampoo, saline solution spray, a weeks worth of Clarithromycin, airplane pillow and some gauze pads. As mentioned in a previous post, some of this I had already picked up but it was very much appreciated. We then chatted on the sofas in the reception area until my partner arrived and he waited for us to get a taxi.

All in all a great experience, apologies for the essay, I'll be updating as the journey continues...

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Bigmac

Bigmac

Administrator
Staff member
Everything sounds like you had a good experience. Those 2340 grafts should provide a nice new hairline for you. It’s good that you waited and started meds. Curbing future loss is the best way to have a successful hair transplant.
Time to rest up and take it easy.
I’ll look forward to your updates.
All the best.
 
Speoj

Speoj

member
Thanks Bigmac for the words of encouragement, and sorry for not posting updates sooner. I didn't realise how much it would take it out of me the first few days, but it healed well.

The scabs finally all came off at day 12, still had some dryness at the recipient area so at day 14 I started to dab the hairline with aloe vera gel so it didn't get too itchy. Donor scabs were off by day 10, but still some redness and still pretty itchy. I started using aloe vera gel on the donor area after the scabs were off because it started to look a bit red from my scratching it because it was pretty itchy.

Here's photos from Day 14 post op. With the scabs off and going the non-shaven route I've been able to style my hair as usual to cover it.

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Speoj

Speoj

member
I'm now at 1 month post op.

The shedding started at around Week 3, I was pretty gutted about it starting so early as it was just before I went to visit family for the first time since the op (had a family bereavement, also why I haven't updated this in a while), everyone wanted to see it up close and they were all very supportive but it was a shame the ugly duckling phase started days before. I showed them all the Day 14 pictures and explained the shedding was part of the process.

I don't think these Day 30 pictures do justice to how red it looks lol. It looks sore but it feels fine, a lot less itchy than it has been, but now it's starting to shed it just looks quite pinky red underneath. The donor has been pretty itchy, from about Week 3 onwards I've been dabbing CeraVe moisturising lotion on the donor which helps with itchyness far more than aloe vera gel does. And the aloe vera clumps up when it dries in to shiny flakey glue like clumps. There has been some thinning at the crown which wasn't there before the op, it might be because I was off minoxidil for 14 days before then another 14 days after the op, so might have lost some ground on the crown or it might be a bit of shock loss. I've started minoxidil again at the crown, midsection and hairline so hoping it will speed things up.

Just the waiting game now, looking forward to it growing out but preparing myself for more shedding to come. Here's the Day 30 photos.

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Bigmac

Bigmac

Administrator
Staff member
Everything looks on track at 30 days. Redness can linger for quite some time.
 
Speoj

Speoj

member
Thanks Big Mac. Here is the 2 month update.

I've been growing the donor area out. Still very much in the ugly duckling stage. Still pretty red. The front of the forelock where it was shaved back and reinforced with more grafts is looking pretty thick, the native hair is bouncing back well and the new grafts around them are giving a good illusion of density at this stage which with any luck will continue to grow out and thicken up.

One thing I did notice at this stage was the very tips of the transplanted hairs look a fraction darker / thicker than the subsequent growth behind it. Which is really interesting. Because I know there are two camps of thought on this; transplanted hairs keep their original characteristics VS they adapt to their new position and adopt the characteristics of the hairs around them etc. My thoughts are in line with the first camp on this, that body hair for instance will always be body hair. To explain a bit better, in these photos you can see that the new transplanted hair have thicker tips for the first 1mm or so then they get slightly thinner after it continues to grow. Not sure whether this is to do with that or just part of the new hair cycle. It's not something I am concerned about, but thought I'd mention it because I found it interesting.
 

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Speoj

Speoj

member
Here's the 2.5 month update (11 weeks today).

The redness in the transplanted area is finally starting to fade. The right side is coming through a lot stronger (first image). The day of the op Dr Mani did mention the left was the weaker side and the natural regression was worse on that side anyway, so interesting to see the left side is still trailing along behind. Think this is fairly common for one side to develop faster than the other, seen it in other cases. I've parted the transplanted hair slightly on the left side to show the patches still yet to grow through.
 

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I

Im new here

member
I think the hairs you are seeing/have there are the grafts that didn’t shed.

The right side kept more grafts than the left so I wouldn’t say the left is lagging behind really. Your transplanted growth should begin anytime now really with sprouting hairs so they might both be at the same pace

You kept hold of quite a few grafts during the shedding phase
 
S

SadKing

member
Would love an update! Thanks for posting in such great detail.
 
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