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I Have a Hair Transplant: What FUE Actually Looks Like From the Other Side of the Chair

Black and white editorial photograph for FUE hair transplant commentary by Dr. Frank Agullo, MD, FACS.

Hair consultations are different from the rest of my practice. Nobody walks in with a wish photo of a celebrity. They bring a photo of themselves, from a few years ago, and they want that hairline back without anyone knowing.

A patient came in recently, 37, never had any treatment before. He brought a picture of his own face. I am publishing the exchange nearly as it happened, identifiers removed, because these are the same questions I get every time.

My exam note from that day: bilateral temporal recession points with loss of hairline definition. Plan would be to graft these two areas with as many follicles as possible. 2,500 to 3,000 follicles and may need a repeat procedure.

Me: “Okay, so I do see that you have the temporal recession areas on both sides, and the front is also thinning out a little bit. And I got your wish picture, which creates a very tight straight hairline. So there is a lot of area we have to fill in to create that. But it is definitely doable. It looks like you have good donor hair.

“So there’s two ways of doing it. Are you familiar with the strip and the FUE?”

Him: No, I kind of read it a little bit. Any recommendation of which one would be better?

Me: “Sure. I see that on the back you like to wear it short.”

Him: Yeah, usually from the sides it can’t be that long. Usually I had it like kind of a high fade.

Strip Versus FUE

Me: “Right. So when people wear the hair short on the back, that’s where we get the hair from. So those are the follicles that we use to fill in the front. So one way to take them from the back is doing the FUE, which is the one by one, the neograft. We take them one by one, it heals in, and you don’t see any scars. The other one is doing a strip where I actually cut like a sliver of hair follicles or scalp, but it does leave a scar. So if you wear your hair short, you would see that long scar.

“So in your case, probably the best is gonna be the FUE, which is the one by one, so you don’t have any scars, and we transfer those from the back and we put them in the front one by one, so it looks very natural. I have a hair transplant, so it really looks very natural, and of course, you can do everything normal afterwards, so you can do sports, swimming, you can dye your hair, everything’s back to normal.”

Him: For the haircut you gotta be like a little bit meticulous with that area?

Me: “No, after everything’s healed, everything’s back to normal. There’s zero special care.”

Follicle Count and the Day Itself

Me: “The main thing here is filling in that area. It’s a pretty big area. With the FUE, we can do maximum twenty-five hundred, sometimes twenty-eight hundred follicles. The procedure takes about six to eight hours. We give you a little bit of sedation through an IV so you’ll be comfortable, you’ll sleep through most of it. And then you need about a week for everything to heal and set in.

“After a week, you’re back to normal. You can do normal activity, exercise, running, jumping, swimming, everything back to normal. For this procedure, we do have to shave the hair down all the way to be able to get the hairs one by one. We could spare the top, we could do just the sides if you want to keep the top, or we do the whole thing, whichever is better for you.”

Why Your Hair Type Matters

Me: “So the idea is obviously to fill in as much as we can and get the tightest hairline possible. It is possible you may need another treatment later to make it even fuller, more dense. I think with the first treatment we can get pretty close to what you want, but we may need to add density later. Your hair is good because it’s coarse and it’s a little bit curly, so that covers a lot more than fine hair. So I think we’re gonna get a really nice result for you.”

Timing Around Travel

Him: Does it matter whether I do it before or after?

Me: “No, it really doesn’t matter, it just depends on your timing. You gotta keep in mind your haircut, but the hair grows really quick so you really just need a week where you’re here, and that’s all you need, whether it’s before or after, whichever works better for you, and my coordinator can help you find the right dates.”

The Timeline Nobody Wants to Hear

Me: “Yeah, we can do it after, no problem, as well. There’s no rush. Remember the hair does take four to six months to start growing. So at six months we’re only like fifty percent of the results. At a full year, year and a half is when we have a hundred percent of all the hairs are growing. The graft take is very high, usually ninety-nine percent. We do use PRP, which means we draw a little bit of your blood and get the platelets, and we inject that into the area so that the hairs grow faster with the growth factors, and we get that really high take.”

Him: I was actually completely bald, so for me, it made a huge difference to have hair again.

Me: “Exactly. Psychologically, it really gives you more self-esteem and you feel better. So it is a procedure I highly recommend. There’s really no pain afterwards, it’s easy recovery. You may get a little swollen around your eyes for two or three days but it is, I think, one of the ones where everybody’s happy.”

The takeaway

FUE if you wear your hair short, because there is no line to hide. Twenty-five hundred to twenty-eight hundred follicles in one session, six to eight hours under IV sedation, one week local. Then wait. Four to six months before anything grows, fifty percent at six months, the full result at a year to a year and a half. That last part is the whole job of the consult.

I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center.

Ready to Talk?

If your hairline has been bothering you and you want a straight answer about what FUE can and cannot do, let’s talk. Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com.

#StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

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Playboy Called About Penile Filler. The Story Is the Combination.

Greyscale cropped study of a man in a white t-shirt and jeans, one hand resting at his hip and groin, landscape orientation, for an editorial on men's aesthetic injectables

Playboy ran a piece on August 11 called The Penis Has Entered Its Filler Era. Rachel Khona wrote it, four of us were quoted, and the magazine had room for one line from me on rising demand.

Here is the version with the rest of it.

Four Complaints, One Name

“I see many men come in for male enhancement. Some are looking for increased girth, some want increased length, others are more concerned with treating erectile dysfunction, and a good number are interested in increasing libido and sexual drive. Today, we have many options that we can use to treat these patients, and these procedures have a very high satisfaction rate.”

Four motivations, not one. Sorting out which one a man actually walked in with is most of the work.

What Filler Does

“Any patient looking for increased girth of the penis is a good candidate for hyaluronic acid, or filler. Contraindications include any open wounds, skin irritation, and sometimes previous scarring from other procedures. I find most men are good candidates, as long as you have the right expectations, that is, there’s an improvement in girth and a slight improvement in length at rest.”

On duration:

“Most hyaluronic acid filler procedures will last at least a year, sometimes more. There are more permanent solutions, such as Lipoderma, which is a donor fat graft, or Bellafill.”

Candidacy here is almost never limited by anatomy. It is limited by expectation.

What the P-Shot Does

“The P-Shot is the injection of platelet-rich plasma into the corpora cavernosa and the tip of the penis. It will increase sensation and sexual arousal. It’s an infusion of growth factors into the penis. It can help with erectile dysfunction and increase libido and sensation.”

I have offered PRP in this area for over ten years. I describe the mechanism as proposed rather than proven, and I say the same thing to patients.

What Bocox Does

“Bocox is a term used for injections of botulinum toxin, Botox, Dysport, or Jeuveau, into the corpora cavernosa. It’s like a long-term Viagra or Cialis, which lasts between three and four months. It relaxes the smooth muscle of the cavernosal arteries, creating harder erections and a slight increase in length of about one centimeter, longer penis length at rest, and many men use it to treat flaccid erections.”

Why the Combination Is the Story

“Yes, it is important to note that in many men we combine all the procedures.”

Filler is volume. The P-Shot is biology. Bocox is hemodynamics. A man with three components to his complaint gets all three.

Which means three clocks running at once:

“The P-Shot is usually done once or twice per year, and Bocox is usually recommended every three to four months depending on how long it lasts on each individual.”

Filler sits at a year or more. Lay that out at the first visit or the patient discovers it piecemeal and feels like the goalposts moved.

Where the Risk Actually Lives

“These procedures are overall low risk, and the main risk comes from using non-FDA-approved substances, or injections by non-licensed providers. The main risks are infection, bumps and nodules, and bruising. All of these can be prevented by an experienced provider.”

I have made this same argument about at-home injectables, about jaw shapers, and about hand filler. The pattern does not change by anatomy. The treatment is rarely the danger. The syringe holder and the contents are.

Why Now

“The demand for both is up as men are more self-aware of the treatments and options available.”

Nothing changed technically. Awareness did, and Playboy running the piece at all is part of that shift rather than separate from it.

Frank Agullo, MD, FACS. Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, plastic surgery fellowship at Mayo Clinic, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine.

Consults at Southwest Plastic Surgery in El Paso. Call (915) 590-7900 or text 1-866-814-0038. Full list of male procedures on the practice site.

#StayBeautiful

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Fifty Hairs From the Back of My Head: YOU by Acorn and the End of the Exosome Hype Cycle

A vial of personalized YOU by Acorn secretome serum, made from the growth factors and proteins produced by the patient's own hair follicle mesenchymal stem cells, paired with microneedling, Morpheus8, or fractional laser for skin and microneedling for scalp rejuvenation. Reviewed by Dr. Frank Agullo, MD, FACS, double board-certified plastic surgeon in El Paso, Texas.

Fifty Hairs From the Back of My Head: YOU by Acorn and the End of the Exosome Hype Cycle

A few weeks ago I sat in a chair in my own clinic and let one of my team pluck fifty hairs out of the back of my head. Roots and all. Not a transplant. Not a vanity moment. A collection.

Those follicles went to Acorn Biolabs, a Canadian company that runs its lab in California. Forty-five days later a small box came back to me with twelve 2cc vials in it. Mine. Made by my own mesenchymal stem cells while they were stressed in culture for fifteen days. Not the cells themselves. The signal those cells produce when they are working.

A week after the box arrived I added two of those vials onto my own face during a Morpheus8 RF microneedling session in my MedSpa. Seven days later my wife looked at me across the kitchen and said, “What did you do? Your face looks better than it did a week ago.” That was not the Morpheus8 alone. That was the bottle with my name on it, delivered through the channels we had just opened.

What YOU by Acorn Actually Is

Acorn calls it YOU. The brand line is YOU for Skin and YOU for Hair. The technical word for what is inside the bottle is secretome.

A secretome is everything a stem cell secretes when it is in contact with a tissue that is asking for help. Not the cell itself. Not a soup of mystery exosomes. The signaling output. The growth factors, cytokines, proteins, collagens, and yes, the exosomes, in the proportions your own cells produce them.

Worth being precise about this, because patients keep getting it wrong. The bottle does not contain stem cells. The cells are banked separately by Acorn and stored as your property. The bottle contains everything those cells produced when the lab put them to work. Two different products from one collection.

The collection is the part patients always ask about first. Acorn is, by their own description, the first hair follicle stem cell platform of its kind. There are roughly 1,500 to 4,500 mesenchymal stem cells at the base of every one of your hair follicles. Pluck fifty of them from the back of your scalp, where the nerve density is forgiving, and the lab in California has more than enough cells to bank a quarter of them and put the other three quarters to work making your secretome.

The math the lab will tell you is straightforward. Roughly 34 times more concentrated than the best platelet-rich plasma you could draw on your best day. About 5 billion exosomes per vial. No preservatives. Stable refrigerated for 18 months. Pluck to first dose: about 45 days right now.

Where It Sits Next to PRP, PRF, and Exosomes

The regenerative aesthetics shelf is crowded and most of it is hype. Here is how I sort the actual contenders in 2026.

What it is Source Blood draw? Dose consistency Where it fits in 2026
PRP (platelet-rich plasma) Your own blood, single spin Yes Drops with age, varies day to day Reasonable for younger patients with healthy blood. Less predictable as you age.
PRF (platelet-rich fibrin) Your own blood, slower spin Yes A little steadier than PRP Good scaffold for under-eye and orthopedic work. Still less age-dependent than PRP, but not a step change.
Generic donor exosomes Cultured donor stem cell media, vialed and shipped No Manufacturer dependent. Often nothing but the empty carriers. I do not use these. An exosome rubbed on intact skin goes nowhere, and “five trillion exosomes” on a label tells you nothing about what is inside the carriers.
Recombinant pure PDGF (Ariessence) A single recombinant growth factor in HA No Identical dose every kit, single molecule Excellent post-microneedling topical when you want one specific signal at a controlled dose.
YOU by Acorn secretome Your own hair follicle mesenchymal stem cells, expanded and stressed in lab. The bottle is the secretome only, the cells are banked separately. No (one painless follicle pluck) The same biology your body made, concentrated Default when the patient wants the broadest, most personalized regenerative signal we currently know how to deliver, applied through microneedling, Morpheus8, or fractional laser channels.

The table is not exhaustive. But it captures the choices a patient is realistically being offered today.

Why the Exosome Conversation Is Finally Getting Honest

For two years patients have walked into consultations holding bottles of donor-derived exosomes someone sold them. I will say what most of my colleagues already think.

An exosome is a carrier. An empty Easter egg unless you know what is inside it. Most of the donor exosome bottles on the market in 2026 are sold without published assays of payload. Worse, exosome companies are supposed to filter everything but the exosomes out of the product. So even if there is a useful signal floating in the supernatant, it gets discarded before it ships.

YOU by Acorn flips that conversation. The product contains about 5 billion exosomes per vial. It also contains the proteins, the cytokines, the collagens, the growth factors that live alongside them in your own biology. Acorn measures and reports those concentrations. You are getting a controlled, characterized, autologous regenerative signal, not a black box.

That is the difference. And it is why this is the first stem-cell-derived treatment in the United States I have been willing to use on my own face.

What It Can and Cannot Do

I will never tell a patient we can turn back the biological clock. The founder of Acorn, Drew Taylor, says the same thing in the same words, and that is part of why I trust the company.

What we can do is meet your tissue with the youngest version of your own signaling that is still bankable. The first time a patient does a collection, the lab cryopreserves a quarter of the cells. Those cells will sit, frozen, at the age you were when you collected. Every subsequent secretome run draws from that same starting point. Five years from now, ten years from now, your secretome is still being made from the version of you that walked into the room today.

That is the actual longevity claim. Not “younger.” More like a savings account, in cells, that pays out signals every time you make a withdrawal.

How It Gets Delivered

YOU by Acorn is a topical applied through microchannels, not an injectable. The currently approved use is application after microneedling, Morpheus8 RF microneedling, or fractional laser resurfacing on the face, and microneedling on the scalp for hair. The procedure opens thousands of microchannels into the dermis. The secretome is reconstituted with the topical hyaluronic acid that ships with the kit, dropped onto the freshly channeled tissue, and microneedled or rolled in while the channels are still open. The window closes within hours. That is when the signal reaches the compartment that is asking for it.

For face protocols I typically reconstitute two of the 2cc vials per session. For scalp work I run YOU as a microneedled scalp treatment in series. Patients who already trust their PRF or PRP scalp regimen do not have to choose; we layer YOU into their existing schedule for one or two sessions and let them tell us what they prefer.

Who Is the Right Candidate

Anyone scheduled for microneedling, RF microneedling, Morpheus8, fractional laser resurfacing, a medium-depth peel, or a hair restoration protocol who wants the most personalized regenerative topical we currently have. Anyone who has been quietly buying donor exosomes and wants to stop. Anyone who has had inconsistent PRP results and suspects, correctly, that their blood quality is part of the variable. Anyone in their forties, fifties, sixties, even seventies whose PRP drop-off has been measurable to them.

Anyone planning to bank for a family. Acorn’s family plan is two adults and up to four kids on a single banking subscription. The cells are yours, stored as your property, retrievable at any time.

What I Have Done With Mine, Honestly

I treated myself first. That has always been my rule for anything new in the practice. I have been on GLP-1s for the past year, dropped about twenty pounds, and there is no question my skin would have lost more elasticity than it has if I had not been keeping up with my MedSpa protocol. So I scheduled a Morpheus8 session in my own clinic, microneedled two cc of YOU by Acorn into the freshly channeled tissue, and went home. One week later my wife noticed before I did. The Morpheus8 alone is good. The Morpheus8 with YOU was different.

I am telling you the personal experiment because you should know what your surgeon is willing to do to himself before he offers it to you.

Why Choose Dr. Agullo for Regenerative Aesthetics in El Paso?

Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. Fellow of the American College of Surgeons. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Affiliate Professor at the University of Texas at El Paso. Castle Connolly Top Doctor for thirteen consecutive years. Texas Super Doctors Hall of Fame, 2025. Aesthetic Everything Top Plastic Surgeon, 2026. The Acorn Secretome was named a 2026 NewBeauty Award winner and Acorn was on Fast Company’s list of Most Innovative Companies of 2026, and we are early adopters in West Texas.

We are a clinic and a MedSpa under one roof. Surgery on one side, regenerative aesthetics on the other, the same surgeon planning both. That is not a marketing line. That is the only way the next ten years of this category get done responsibly.

Ready to Talk?

If you are thinking about microneedling, hair restoration, a peel, or a Morpheus8 course, and you want to understand whether banking your stem cells now and running secretome through your protocol makes sense for your skin and your decade, the most useful forty-five minutes of your year is a consultation with the surgeon who would actually plan it. I will tell you whether YOU by Acorn is right for you, whether you are better off with PRP or recombinant pure PDGF for the procedure you are considering, and whether the procedure itself is the one you actually need.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful