Thanks, Mickey. I would expect the dreaded shockloss to bum me out for a while. You know who seems to take a lot of care planting into native hair - Dr. Wesley. My impression of him is he's a pretty conservative, careful and methodical doc. He might be a good person to consider for implanting into native hair. He also does FUE and uses punches as small as 0.75mm.

I definitely plan to take monthly photos to document growth.

z

Thanks for your input, HARIRI.

Thanks, MAGNUMpi.

Honestly, I think those points listed probably can't be found dominantly in North America. I am sure there are some, but not many doctors here would be willing to do it that way. Dr's have given mixed responses regarding fue. Some say they can match their fut with fue or near it. Some say the yield is just not good. The opinions are all over the place. I think it is up to us patients to carefully analyze everything ourselves and take everything into consideration.

My own opinion is that FUE CAN match or be near FUT yield today, but couple of years ago, it was probably unlikely. This is probably due to specific strategies each individual doctor employs. Now with so much trial and error I guess doctors are realizing somethings may work while some things may not.

Regarding Manual Punch
I originally thought my doctor would use manual on me as I thought that is how FUE was by the time I got to his clinic. I did have a list of clinics initially and a good portion did use manual punch. Now, I have heard of Dr. Rahal using manual fue by others telling me he has and that some of those guys have posted on the forums and they have had great yield supposedly due to manual fue. Some guys went even as far to tell me some of the results I seen of his fue prior to my surgery were done through manual punch. I talked to him about that but he said "that's not true". So, I guess he has been using motorized for a while and maybe recently acquired the first Artas machine in Canada according to a recent tv interview. I am very anxious to see the results based on extractions from Artas.

As far as Dr. Feller, I read he uses his own motorized tool, but will do manual under certain circumstances. I have read various posts from a patient of his regarding manual extraction after having it extracted from his Feller Punch. The doctor has written on forums about the FUE yield in general being less and his waiver or disclaimer supposadely mentions that as well if you decide to get FUE. Even well respected Spex, says fue will leave you wanting and has mentioned there is a yield issue in general with it on the forums in the past.

However, as a self-researching consumer, I respectfully differ from that opinion based on what I have seen on multiple forums and talking with people that have gone through FUE. I have seen doctors adequately match FUE especially through the manual extraction method under a slow process. It may be time consuming and less profitable considering some doctors overseas would only extract 700 grafts a day manually as well as possibly plant it themselves. But that wouldn't be much different from anyone doing a 5000 graft strip procedure on a single patient in one day, making the incisions, and having techs implant.

Realistically, I think in the end, the real issue is labor hours worked and the amount of time it took to complete a job on ONE patient. The manual process not only takes time, but may take days on one patient if it is a large session. The motorized extraction allows faster extraction and in one day. Another issue here is, not many clinics in North America can afford to have a single patient in a series of 2 or 3 days back to back with limited grafts causing less $$$. I notice clinics try to get in at least one, two, or three patients per day and MOVE onto the next new clients the next day. It will greatly hamper profitability more than it would yield, lol. I just learned that Dr. Feriduni even went from motorized back to manual punch. Maybe he sees something or realized it did not deliver in a couple of his patients.

As for Dr. Shapiro, I am not too sure of what exact specific tool or method they use for FUE. In my eyes, they seem to openly showcase FUE without any mention of yield issues and it seems like they do both procedures equally. I think Janna might better explain their method and philosophy when it comes to FUE. She seems to be very educated on nearly all topics and answers every question or gets the answer to almost every question someone throws at her.


So, back to those points listed earlier, there are probably a handful of surgeons that would make that list. There were talks about Dr. Lorenzo and how good he is with his FUE. I too believe he knows what he is doing with FUE, however, I would not put him as having the type of refined dense hairline I would look for based on my analysis of all of his posted cases. He seems to be really good with ultimate FUE coverage without utilizing body hairs. So, he can pretty much cover you behind the hairline to the back granted you have the type of ammo he needs to get the work done. I would not put him up there in the hairline density department until I see more of his "high density" marketed hairlines ranging from 60cm2 to 80cm2 grown out and combed back clearly showcasing it. He seems to be really good at doing extensively bald cases with his FUE method.

Now, again, based on those main points, I'd say there is a doctor in Turkey that has a strong eye towards facial framing and hairline densities. However, he does not take larger norwood cases for FUE. That is Dr. Keser. He does I think one patient a day averaging 700 grafts a day in one area of the scalp before moving onto another area of the scalp the next day with a max of I believe around 2500 grafts or so for the entire session (even if it lasts 3-4 days). He does it manually but his results speak for themselves I guess as FUE is his sole specialty and he has been doing it for a long time. I think he was the first FUE surgeon in Turkey if I am not mistaken.

Then comes another doctor that is actually is just one of the partners of Milena based on what I saw on her website. I learned of this partnership by going to Milena's website when she was first mentioned. After Spex advertised her, the link to that doctor's website from her website is not really active anymore. It is just an inactive logo. The company is Asmed and the doctor is Dr. Koray Erdogan. I actually knew about this company for a few years as I initially eyed them too. He actually specializes in FUE and does a fairly good job. However, his approach is just like what you are mentioning. I have seen a lot of cases where he does one procedure and then the patient grows and has a partial result but then he completes it later and nails it. It's like a two step approach.

Dr. Keser used to be 3 euros but due to popularity he went up to 3.5 euros per graft. He actually is one of the more expensive surgeons in Turkey. Dr. Erdogan is actually much less than that. This is basically due to the typical wages in Turkey and the clients they mostly deal with. Dr. Keser has more international clients and once was going to be recommended here on this forum but the issue with "donor safe zone" made it a concern. My own non-expert analytical opinion tells me that the donor safe zone is subjective. It's universal but there are reasons where it may not be based on how the baldness of your family members are as they age. For example, in my family, they have hair above the donor safe zone area and no one on my moms side is bald. The markings of the "universal safe zone" are not how they are on diagrams/photos/models as I would assume them to be based on my paternal family members scalps. They have really thick hairs above that area as well as below the donor safe zone. If I were to have aggressive balding or an unsafe donor area, then by this age I would imagine my donor safe zone limitation would have been detected.

Anyway, I thought I'd add my two cents and answer your question. I hope it helps.

__________________
Dr. Rahal FUE 3016 Grafts
My Hair Loss Website

Sean,

Thanks a ton for all that insight! I really appreciate it.

I'm afraid you're right - I'd probably have to leave North America to find an FUE doc that meets all (or most) of the criteria.

What do you think of Dr. Bisanga? He's been practicing FUE for quite a while; I think I read around 8 years. I was always impressed with Dr. Bisanga's well spread out extraction patterns. I know he uses a manual punch; uses 0.75mm - 0.9mm punches; accepts international patients; extracts grafts himself (although I think his techs extract most of them); and, has consistently good results.

What do you think of his hairline designs and density? Do you think they are natural? Do you think he approaches the 60fu/cm2 range?

I anticipate continuing to consult numerous of the best FUE docs about my two-procedure plan and their approaches. Hopefully, I'll be able to choose the best doc for me sooner than later.

By the way, motorized FUE extraction is not necessarily a deal-breaker for me. As you know, many patients have had great results with that extraction method. The potential problems with motorized extraction may be somewhat mitigated by having two smaller sessions instead of one big one. Fatigue is fatigue regardless of the extraction method.

z

Zen, no prob man. I think Dr. Bisanga does fairly decent work. His hairlines are decent and I think he is good with coverage. I have read in various posts nowadays on the forums that he would push fut on patients that need a lot of grafts in which he feels they have no adequate density. http://www.hairrestorationnetwork.co...r-bisanga.html . So, if you do decide that route, just make sure your deposit is refundable if strip is the option that is recommended just in case.

For FUE, I think what Dr. Bisanga did for his consultant was pretty good considering the fella was completely bald, however, I have never seen that result grown out. He mixed and matched hairs and gave him a look he is comfortable with. Another doc I compare him to, in my own opinion is, Dr. Umar. Dr. Umar I think is better in facial framing and good with coverage for large cases.

For Dr. Bisanga, I think:
-He is good with density and probably can achieve the desired density of 60cm2 (I think most docs can nail that number easily especially with our hairtypes)

-His hairlines do look ok, but it varies with grafts used and patient goals. I like a couple of his hairlines, while some I have had mixed feelings with.

-I have seen multiple step approaches on some of his patients though depending on what level of baldness they were.

Keep looking at tons of results man. Analyze them till you are certain. Look at the facial framing, look at the design structure, look at the yield, look at the angulation, look at the even distribution in terms of hair density and design, make note of the type of hair and the numbers planted, and so forth as well as recipient hair counts. It is very important to take all these things into consideration and more when you are analyzing.

I agree with you fatigue is fatigue in the hands of the professional. If they are doing 700 grafts manually a day or 4000 grafts motorized a day, in the end, the amount of hours spent working will cause that strain. That's why I think it is best to get estimates asking if a procedure would take a specific doctor 5 hours or 7 hours or 12 hours per day and so forth based on your estimated graft counts beforehand.

Remember, the hairline is the most important aspect of a hair transplant. Without it, everything else is tainted. Look through tons of hairlines for FUE.

__________________
Dr. Rahal FUE 3016 Grafts
My Hair Loss Website

Great contribution Sean. You are indeed a solid FUE fan and believer. So based on your sharp observations and followings. In your personal opinion, Who do you think are the top 3 FUE surgeons in order?

__________________
Hairline Repair + Scar Revision via BHT FUE with Dr. Feriduni on July 3, 2013
Scar Tricopigmentation with Dr. Koray Erdogan on May 3, 2013
2500 FUT (Hairline Repair) with Dr. Rahal on July 26, 2011
My Hair Treatments:
1- Alpecin Double Effect Shampoo (Daily)
2- Keratene Alphactive Retard Capsules (Once a day)
3- MOPC world Minoxidil 10% + Azelaic Acid 5% (Once a day)
My Rahal HT thread http://www.hairrestorationnetwork.co...ne-repair.html

Thanks again for your thoughtful input, Sean. When you say you have "mixed feelings," what are you referring to exactly? Density? Naturalness of design? Could you elaborate a little more on that?

I'm a fan of Rahal's hairlines (like most of us on the forum). I think he's a very talented surgeon, but the issues I have are: 1) he uses a motorized tool, 2) I don't think he goes down to 0.75mm punches (like Bisanga), 3) He hasn't been practicing FUE for all that long, 4) I haven't seen many examples of his FUE extraction patterns; does he spread them out well?

I'm more concerned with numbers 1, 3 & 4; less with #2, because he uses 0.8mm punches when appropriate, and that's pretty close. Even if I split my procedure up into two relatively small procedures for safety reasons, I wonder how much not using a manual punch will contribute to the final outcome. If you had it to do over, would you have opted for a manual punch?

SMG is also an FUE consideration, but the same concerns I have for Rahal, I have for them.

Feller is a strong consideration. He's been practicing FUE for a long time. He dense-packs where needed. His hairlines are very nice. As a bonus, he's close to where I live. The downsides are he's quite expensive; he doesn't use a manual punch (although I wonder if he'd do so if requested...); I don't think he goes down to 0.75mm punches (like Bisanga); and (most of all), I'm not a big fan of his extraction patterns. I feel they are not spread out enough (like Bisanga) and sometimes result in a geometric pattern which is discernible as slightly thinner than the surrounding hair. An example is found in this thread:

http://www.hairrestorationnetwork.co...r-patient.html

The yield and hairline design are extraordinary in the above case, but the extraction pattern is a little troubling. If you compare immediate post-op donor (which is in post #1 entitled "Just after FUE") with donor two years post-op (which is in post #17, fourth pic from the bottom), then you can see the rectangular outline of the extraction pattern. If Feller had spread those extractions further down and further forward above the ears the way Bisanga does (which is more difficult to do), then I suspect there would be no discernible pattern.

***Update: In fairness, I asked Spex about this case, and he thinks the extraction pattern was at the request of the patient, and because the patient had extraordinary donor density, Dr. Feller felt like it was safe. I also concede that the lighting in the pic I reference was very unflattering, and at different angles the donor looks much better. Spex went on to say that Dr. Feller will work with the patient to spread out the extraction pattern (he did so with Spex himself). So, before committing to him, I will make sure that Dr. Feller is cool with approaching my extraction pattern similar to how Dr. Bisanga tends to - as spread out and non-geometric as possible.

But I digress. I'm having an awfully hard time narrowing down my choices for FUE. All the surgeons have their strengths and weaknesses. I wish I could take the best from all of them and put them into one doc! lol

Bisanga seems to cover all the bases, but I'd love to know more about why you think his hairlines are not quite up to par. Also, any thoughts on Feriduni?

Thanks,

z

You aren't wrong about Feller's extraction zones being a bit too condensed. Also, he is not a fan of FUE on large cases at all. Anything regarding more than a hairline tweak or above 1,000 grafts, he most likely would prefer to go FUT. There was a case where a patient went to Feller for FUE(through the motorized method) and was disappointed with the results. On the 2nd procedure it was done with a manual punch and was improved but still not to a satisfactory level. He then went to Dr. Rahal. He has posted his 4 months post op but nothing after. Here is the thread:

http://www.hairrestorationnetwork.co...-2012-a-4.html

Feller has done some outstanding FUE work though and that was the only case I have seen where the results were not satisfactory. Dr. Rahal has some average cases, as do H&W, Shapiro etc. I'm sure you could ask Feller if he could spread the extractions out some more.

For me and FUE. Dr. Lorenzo is the only Doctor I would consider. He is FUE exclusive and has 100's of results done via clear video.

I can see what Sean means about Bisanga's hairlines, whether it be via FUT or FUE. They certainly do not have the aesthetic appeal that Dr. Rahal or that other unethical Doctor who has the same name as the Italian fashion designer do. Even in Dr. Rahal's more mature cases, the hairlines accentuate their features and frame the patient's face perfectly. The latest Rahal FUE result posted by Matt showcases this. I think Rahal even has Lorenzo beat on actual hairline design. Feller comes in a close second because he actually lets some patients design their own hairlines and then he tweaks it a tad.

__________________
Links:

Revamped Advantages/Disadvantages of FUE. Myths dispelled. Educate yourself

Everything FUE. Manual, motorized, ARTAS, NeoGraft, physician details and more

FUE Norwood 1-6 examples

Hair Transplant Basics. Must read. Constantly updated. Content loaded.

Mickey85,

My strategy is to do two FUE procedures (8 months apart) to equal approximately 2000 grafts. First would address thinness in forelock (I'd estimate 400 - 600 grafts). If that's a success, then second would be to build out my hairline laterally (I'd estimate 1400 - 1600 grafts).

With that strategy, Feller may be a good doc to consider, because they are both relatively small procedures. However, that doesn't negate my concerns about his extraction patterns. And, I have seen that thread before which influenced me to strongly consider Rahal instead. But then, we have Sean's yield issue which concerns me. Having said that, both Feller and Rahal have outstanding FUE results (especially Feller since he's been doing it longer). I guess FUE is just more risky, period. Even in the best hands.

Does Lorenzo accept international patients? Doesn't he use the choi implanter which seems to concern many people? What are his extraction patterns like? What size punches does he use? How would you describe his hairlines? Clearly, you're a fan, but if you had to point out concerns you have with Lorenzo's work or methods, what would they be?

Thanks,

z