I just got a hair transplant in Bangkok with Dr. Ratchathorn Panchaprateep of Absolute Hair Clinic couple of days back. It was a very cool experience and wanted to share it with my blog readers. I got 6715 FUT/FUE grafts in a single day and my doctor said this was the most she had ever done in a day.
I also combined it with a mini vacation with my family and it was definitely nice to experience the tropical weather and escape the -35c Polar Vertex sweeping Canada.
My Hair Loss
I started losing hair rapidly at Age 22 mostly due to stress induced Telogen Effluvium, but that sped up the onset of genetic Androgenetic Alopecia that I had the genes for. I tried topical Minoxidil, but all that did was put the breaks on for a few years, until I slowly lost ground in Norwood 6 on Norwood Hamilton scale that I was pre-disposed to over time.
It is a very distressing situation for a young guy to be losing hair, but there isn’t much you can do. I tried the only drug that can help, Finasteride but I unfortunately got the whole bevy of side effects that are associated with the drug, including sexual dysfunction so had to stop using it. I got away with buzzing my hair for many years and I was happy with that, but it was harder to pull off more hair I lost.
I was looking into transplants for a very long time and just waiting to pull the trigger. Hair transplantation is nothing but putting hair from areas less prone to balding like sides of head(or even beard) in cosmetically important areas of the scalp like the front. The problem with this is that it doesn’t stop your natural genetic process of balding so longer you wait, better it is from planning and knowing what you are working with. It is important to do your research and know the consequences before jumping into surgery, because it is very difficult to undo a bad job. Now at nearly 28, it felt like the right time to get a hair transplant.
Contrary to what people think, I decided to get the procedure done because I wanted to think less about my hair.
Why Dr Ratchathorn and Thailand
Hair transplantation is a very specialized and niche field. There are maybe 20 hair transplant doctors in the world that are worth going to. It is not just about moving follicles, but they need to placed in an artistic fashion which both looks natural and covers as much scalp as possible. You need to plan for future loss and manage the “donor” resources so that you have enough in the bank if hair loss progresses. I did not want to restrict myself to one region, but look for the best in the world within my budget. These are the reasons I chose Dr. Ratchathorn.
- She offered the FUT technique – FUT technique takes a “strip” from back of the back of the head and is a better technique for people who may need more grafts down the line, like me. We decided on FUT/FUE combo procedure 4500-5000 initially and then around 2000 grafts using FUE/beard later
- She does not implant in rows
- Her angulation, artistry and refinement in hairline is excellent
- She was willing to experiment with Verteporfin – a YAP inhibitor that could potentially help with donor healing and regeneration
- Was very responsive over WhatsApp, email and answered any queries I had promptly. I felt that she really cared about my case
- Liked her planning of overall case and was realistic with amount of grafts I needed
- Fits my budget for the amount of grafts I needed to move – I paid 80 baht/graft for FUT and 90 baht/graft for FUE
I spoke to and consulted with over 40 world class hair class surgeons before settling and booking with Dr. Ratchathorn.
Pre-op consultation plan
I met with Dr Ratchathorn the previous day before surgery at 7 PM. We went over the plan, which was 4500-5000 FUT/FUE combo for the next day and 2000 odd FUE/beard at a later date. My balding area was judged to be at 188 cm2 and she wanted to fill it in with 35 FU/cm2 of density, higher in the more consmetically important front and lower in the back. So total graft requirement would be around 188×35=6580.
This of course won’t give me perfect hair, but it would give an acceptable result, while preserving precious donor reserves for later. The crown is known as the “black hole” of grafts and it needs a lot of grafts to fill in. It can also expand so it is best left sparse and I can work with fibers in there. We also decided to go above the current hairline at my request. This way I will naturally recede into a higher, age appropriate hairline as I age. Every cm you lower the hairline by, it needs atleast 1000 more grafts. And I really need to keep these in the bank.
She told me that I have around 7000-8000 lifetime grafts. We also did a HIV test and I made a deposit for roughly half the amount with a combination of Wise and Credit Cards.
Medications I take
We went over medical therapy, because it is important to slow down the genetic process. She expressed that 5AR blocker like Finasteride would be important for me, but if I can’t take it then I would need to look at alternative treatments including LLLT, PRP, stem cell and Dutasteride Mesotherapy. I’m looking into these. This is what I currently take:
- Oral Minoxidil 5mg/day
- Custom LLLT helmet with 5mW 650nm lasers – 3x/week
- 2% Ketocanazole Shampoo with Saw Palmetto, essential oils Hair Covet brand – Everyday
- Collegen supplement with Biotin, Vitamin D, Keratin
Operation Day
After using the anti-septic shampoo twice the night prior and on the day of surgery and eating a hearty breakfast, I was at the clinic at 8AM. My vitals were checked, I changed into the surgery gown and then Dr. Ratchathorn met me and drew up the hairline. We went 0.5-1cm above the current hairline and added bit of natural recession in at my request. The current hairline should offer some softness while it slowly recedes away. This was an idea I got from Dr. Muresanu of Hattingen Hair and should end up saving 500-1000 grafts.
After this, the nurse went over what I would like for lunch and gave me some pills including pain killers and anti-biotics, sedatives. I was then put on the operation theater and injected anesthesia, which I knew would be the most painful part of the procedure, but it wasn’t too bad at all. Maybe 3 or 4 out of 10. I had much more pain at the dentist. They also massaged my feet and used a vibrating device to distract my nerves to make it feel easier.
One nice touch that they were playing nice music in the OT all the time. I enjoyed that and I think it was soothing for everyone
FUT strip and FUE excisions
After this, the FUT strip was taken from the back of my head. I barely noticed it. We took out 50 cm2 of strip from back of my head and the estimate was that we would get around 3200 FUs from it. So we started with 1800 off FUE excisions to make up the difference. There was a brief hiccup where there was power outage in the OT. Important things were still functional, but it wasn’t ideal so they moved me to an another room. I nearly tripped because I was sedated, but thankfully no harm was done. Dr. Ratchathorn told me this has never happened before since it was a commercial area.
Dr. Ratchathorn did most of the excisions, other than a few which were done by what I think was a tech. Not completely sure, but it felt that way. Regardless she was present throughout. The worst part of the extraction process was my neck, which was really sore from laying head down.
After that, it was time for a quick snack around 2 PM, quick pee break and I was back on the OT table in the initial room that I had started.
Incisions and Implantations
Then it was time to implant the grafts. We started with PRP and Regenera Activa STEM treatment, which was injected into my head. Meanwhile the staff was working to dissect the FUT grafts. Dr. Ratchathorn then started making the incisions to place the grafts. I was watching her from the convenient reflection on the glass in front of me. It was really cool to watch her do it. She was really attentive with the artistry.
Then the implantation started. It was like a conveyer belt with 2 technicians implanting the grafts. The grafts would be loaded, passed onto the technician, implanted and passed back to be loaded again. It was like a well oiled machine and the techs implanted them like butter. I roughly noticed that each technician put 1 graft in every 5 seconds or so, but it still took forever simply because of the sheer number of grafts. Dr. Ratchathorn was present throughout and was closely monitoring everything, other than briefly stepping out for what I presume was consultations and checking up on other patients. I think she put in the crucial grafts as well.
She told me the actual number of grafts that we managed to get were closer to 6715 because I had exceptional scalp laxity for strip. The estimate of 3200 FUs for the 50 cm2 strip was completely off and it actually yielded 4824 FUs, meaning I had exceptional occipital area density of 97 FUs/cm2 from where the strip was taken. You can really see how FUT maths for high norwoods with the right characteristics. What would have been a poor FUE donor barely giving 4000-5000 FUE grafts prone to minitiarisation, could possibly give over 9000 with FUT/FUE combo. Not to mention that you could tap into the beard for even more grafts.
Around 9PM we were done with front/mid and Dr. Ratchathorn told me she would finish off the back as well and that I would not have to come back for an another procedure. I had another brief pee break, more snacks and it was again back to making slits and implanting grafts. The crown was left sparse and only put in enough grafts that were absolutely necessary. I dozed off after this and it was midnight by the time we finished everything.
There were a total of 20 techs working on me, including the ones dissecting grafts. They were all very professional and I felt really sorry for them for the amount of thankless, tireless work they had to go through so I promised them that I would be sending them a cake on my birthday which was in a few days 😃
Verteporfin
The only thing that was remaining was injecting the Verteporfin that I had bought along. Verteporfin is a YAP inhibitor, which can prevent scaring of wounds and hence help regenerate donor area and follicles. This is very much an experimental thing and there are few doctors running trials on it, which Dr. Ratchathorn agreed to. I only had bought along with me 60mg of it, so we went with 0.4mg/ml of concentration in DMSO, alongwith numbing agent so that it doesn’t cause pain if it washes away the anesthetic. She said she would have preferred to have had more of it, but it is what it is. The whole process was smooth and I had zero pain after it was injected at the very end after we finished off the implantations.
After everything was done, I enjoyed my well earned dinner – Thai chicken curry and rice with egg and then finished off rest of the payments. Because we went way over the graft count that we had initially planned for, I had trouble making payments because my cards would get declined over and over. I finally used my Mother’s Credit Card to make some of the balance up and pay off everything. It was 1AM by the time we finished everything.
Recovery Protocol
The toughest part of recovery from a hair transplant is sleeping upright with a travel pillow so that you don’t damage the grafts. Every day, I goto the clinic for Hyper Baric Oxygen Treatment(HBOT), where I am exposed to high pressure pure oxygen. My wound is then cleaned up, the doctor examines me and we have a brief chat about how things are going. Dr. Ratchathorn really cares about her patients and goes the extra mile to make sure everything is right. On the first couple of days, some grafts had popped and she put them back in. She said this was simply patient physiology, where some people have tougher skin. We did not do LLLT and I was asked to avoid the sun because the injected Verteporfin is known to cause burns when exposed to the sun.
Other than the antibiotics, pain killers, predinosone given by the clinic, I am also taking Oral Minoxidil 5mg, Tadalafil 5mg, Sildenafil 25mg and L-Arginine 1g for Vasodilation to improve blood flow to the massive number of grafts. I was told half the FUT stutures should come off at day 7 and rest at 10-14 day mark, just before I leave Bangkok. I’m staying at an Airbnb close by to the clinic and that turned out to be a very good decision.
Picture Gallery
The clinic said they would send me pictures at day 5, but I was too impatient and had the nurse take a few at day 2. I’ve attached pictures from all angles as a slideshow below.
I can’t say enough good things about Dr. Ratchathorn and the entire team at Absolute Hair Clinic. She is deeply caring, very informative, a real expert, personable and gives max attention to your case. She really goes the extra mile for her patients. The staff are fantastic and really make you feel cared for.
Threads where I’m updating progress
Hair transplants can take upto a year or more to fully grow. I’ll update progress here, but I am also updating my progress here:
- Hair Restoration Network Forum – Thread
- Reddit – Initial post
- Hair Loss Conquerors Facebook Group – Initial post