the B spot

Looking good E-money! You deserve it buddy!!!!!!

Hmmm --- Hi Sj--your right in that sort of middle ground--either FUE or strip would be fine, imho. Your comment about worrying about the scar should lean you toward FUE, but again your really left with either choice. It looks as if 1600-1800 grafts would do the trick---your pattern of loss dictates that we work around and enhance your forelock---then go back from the forelock into the thin middle section for some density. It looks as if there is a little crown thinning so we would want to be a little careful with the grafts used. I know the temptation would be to do more, but you still have quite a bit of hair--we need to get those thin/bald sections filled--recreate a bit of the hairline/temples--then go back toward the crown right in the middle. Touching the very front of the forelock would have to be determined in person--but would be no problem if the doctor felt it was necessary. Obviously, this is just an estimate--you would need to send your pics in for Dr. Ron to have a look for his approach to meet your wants and needs. Take Care, Jason

I don't work for a clinic that needs to "hype" or rush our results on the net--we talk about it, we develop a patient base, we formulate a realistic expectations, we talk about what we are doing with posters and at some point Dr. Ron will give his opinion and we will post our results/findings. I'll admit, I got a little over excited initially, but Dr. Ron and Matt calmed me down--let me know that we will take our time, then present our findings. FUE into the scar is #1 Low density passes--likely to need at least 2 passes. #2-not guaranteed--so many factors like scar vascularity--but still a solid option because it has minimal impact on available donor. #3--not necessarily the best option initially. We charge 1500.00 for FUE into the scar--I think that is the lowest cost for scar repair by far in the industry. The same as Dr. Ron charges for a strip scar repair. Additionally, would you have me rush 1-2 successful patients on the net--declare the procedure an overwhelming success??? I, and many others have grown tired of clinics rushing procedures/tools/"the latest and greatest new thing" only to be faced with the reality that for some it works, for others it doesn't and for many it's just OK. Look at how long it took for Dr. Feller to produce a real piece of equipment? When we have 10-15 patients grown out and we can establish a successful cross-section of patient results I will put them out there. FUE into the scar does work--but it is process and not without risk and will likely need at least 2 passes to achieve results. We have a guy coming over from the UK who has 175 2-3mm white dots all over the back of his head--we are doing fue into those dots to see if we can get this patient back to being able to buzz down to a #2-3 guard --which may take 2 sessions or 3. FUE is his only real option. My point is, each situation is different--for each patient the risks to gain have to be considered. For some that means a strip scar resection and low tension closure. For others that is FUE into the scar. Take Care, Jason

Hunky-- please send your information to my email directly at jason@shapiromedical.com I will make sure you are contacted shortly. Take Care, Jason

I believe someone tried to promote this as donor farming--and met with colossal failure. great idea, over-hyped and under delivered. Did I mention it was expensive? Not saying there is not a future or some benefit in the hands of the right clinics, but if small punches are used and the donor is properly managed, white dot scarring is minimized and is less of an issue--- when your using giant punches 1.1-1.3mm white dots will be an issue. Take Care, Jason

Did you call up Dr. Feller and ask him if he could help you out? The worst that happens is he says no. You never will know unless you ask. These are tough economic times and I know many clinics have responded to those in need of a break. It never hurts to ask for a stand-by or even just a simple break on the cost. I work with people all the time to find the right fit within a budget --which includes expensive airfare, etc....obviously this is a business, but never be afraid to ask for some help---most people come in plunk down a credit card or cash and never really bother with the cost--for others it is huge issue. Take Care, Jason

the Hoff is a hair GOD Spex is right--obviously as we age, things change--but overall there should really be no real difference, imho. Jason

Sorry GQ--I did not see this thread. At SMG FUE is 6.00 per graft with a 500.00 travel discount. (If the session does go 3 days, we do knock off an additional 200.00 to cover the additional stay) The idea behind this is we have many, many patients who need hairlines of 2000 grafts or less---at 6.00 per graft patients who are candidates for or simply want FUE for hairlines/frontal density---we want patients to be able to choose based on what THEY feel is best--without finances being the biggest determining factor. A 1800 graft hairline via strip would cost 9000.00- 900.00 travel discount = 8200.00 1800 FUE hairline = 10,800.00-500.00 = 10,300.00 So about a 2000.00 dollar difference, which we feel is about the right difference in price given the difference in extraction and the 2-3 days it takes for the procedure. The maximum amount of FUE grafts we extract is 1000---regardless if a patient is the easiest patient of all time and we could get 2000 in 4-5hours. Dr. Shapiro is interested in perfection only and in his opinion, taking 2-3 days to design a hairline using all FUE extracted grafts is good thing, not a negative. Additionally, we only do 1 FUE patient per week at this time. I would say we are about 3 months away from being able to present any hairline patients---I have gotten several emails asking for pics---I would be happy to provide them, but I simply do not have them. When we 1st started to do FUE our 1st patients were repair patients who inquired as to our procedures and we repaired them at a reduced rate---however, while their growth is fine, they have declined the share their results with the public. We just finished a young man from New Zealand who ended up getting about 1800 grafts who we are excited about as he has said he will share his pics, send us updates, etc... Again, people are choosing SMG based on trust, Dr. Shapiro's commitment to excellence and perfection. We have a smaller patient base. We are not making outrageous claims of expanded donor or any claims that fly in face of reason. We are doing FUE in what we feel is a laid back, non-rushed, highly detailed manner that will provide our patients with the same excellent results they demand. Dr. Shapiro would never offer a procedure that did not maintain the same level of excellence he has displayed over 15+ years. For those that want results now and an additional measure of comfort, I cannot help other than to tell you Dr. Feller, Dr. Bisanga, Dr. Harris, and Dr. Wolf all offer FUE and have shown excellent results and possess impeccable reputations. I welcome dialogue, questions, etc... or inquiries-- We work with those interested in coming to SMG--please feel free to contact me (as many of you already have ) or simply ask a question as GQ has. Take Care, Jason

You might try a drive up to Dr. Gabel's in Oregon or a drive to Dr. Alexander in Arizona. Last I checked both of these doctor's fees were extremely reasonable and they both do excellent work. Cheers, Jason

Dr. Cooley is excellent and has demonstrated his work for many years. Anyone choosing him will be in good hands. As far as the "lateral slit vs needles" it really boils down to the skill of the physician---a great physician can use laterals/saggittal grafts and some doctors can use needles---my preference is custom cut blades--- I know Dr. Cooley uses both needles and blades--depends on the patient. As far as Dr. Konior--he is a great doc and a great guy. It is nice to see him get the credit he is due as a premier HT doc---the man loves hair As far as TC's comment, Dr. Konior himself would likely tell you it is all about proper planning and strategic placement. We all too often forget the art of hair transplantation is to achieve a cosmetically acceptable appearance with a MINIMUM # of grafts---all with an eye toward the future. Take Care, Jason

Oh, Ok Bill--- I did not see the surgeon listed. I hope this gets sorted. Take Care, Jason

Dr. Gencheff--are you saying you performed Aaron's surgery? I did not see him mention his doctor on this thread. Thank You, Jason

Yeah, I think it is tragic when people like Aaron do not fully understand what getting HT #1 signs you up for........more hair transplants. There is nothing wrong with getting a HT---but there is something wrong when a clinic misrepresents coverage or fails to acknowledge the warning signs of patients who have unrealistic expectations. I have guys get really upset at me for telling them they are not candidates. Then they go find a clinic willing to take the cash. Hair transplants is a HUGE commitment both financially, time wise and emotionally. This is why younger guys are generally not good candidates because it is just so difficult to understand the lifelong commitment in your 20's Anyway, all good points--tough to deal with this situation other than to add density to the front and hold out for propecia to continue to work. Take Care, Jason

Hi aaron, I would say that from your pics you probably have achieved most of what 2100 grafts had to offer, in addition to possibly losing some existing native hair in the transplanted region. The overall shape of the hairline looks appropriate, albeit less dense than you had hoped/expected/were led to believe. I want to point out some positives: ---Your hair looks good grown out, you still have quite a bit of native hair and you seem to be responding well to propecia. At this point in time, you should likely wait until the 14-15 month mark like PGP stated to get a true read on your results---generally speaking you may be a slow grower, but everything that will eventually show up will have broken the skin by 10 months---- so give it a little more time to mature. I want to encourage you and let you know that your situation is not terrible---I know you feel misled and are unhappy with your results, but I want to focus on what can be done to help you out going forward. In your situation a minimum # of grafts can be used to add density in the hairline---I would not touch the crown again for a bit. I would encourage you to share your doctor with Pat and Bill so they can help you as well. Take Care, Jason

Mahmood--- I would not comment on this thread, other than to say that I think you already answered your own question. Dr, DeVroye is very respected and does great work... you should certainly feel comfortable choosing him. Good Luck! Jason

If you do more than 30-40 with your diffuse thinning, your going to experience a ton of shockloss. I would be wary of anyone telling you a density of 60 is OK when you have thinning throughout the entire male pattern at 23. Your not even a HT candidate, quite honestly. You need to wait a few more years.

To add to what Spex has already written, for clinics that properly manage the donor, use smaller instruments, and space out extractions properly, buzzing down to a #2 or even a #1 is possible ---it depends on how much you take from the donor---at some point, even if the entire donor is visibly un-scarred-- the gaps left by over harvesting will be noticeable. Spex is right though, until you get into the chair, no one know what you will yield or of you will be easy or difficult until they start extracting. This is not to put you off FUE-- you should consider FUE always until it is not an option and the reason it is not an option is apparent and explained to you. If you post a pic or two, I am sure we can help you out further. Take Care, Jason

bllorayne--the first thing we need to do is get that virgin scalp of yours laid! Seriously, though, if you could post some pics or send them to me at jason@shapiromedical.com I can give you an idea of what your looking at for possible grafts look at a couple of different approaches as far as placement/method/short/long term etc.... At 27, your likely a candidate for getting a HT---depending on your expectations, current level of loss, family history and response to meds....you have a great regimen and have for 2 years, so Yes, it is likely a solid time to start actively planning to go forward. There are a lot of factors to be considered, but this is a great start. Take Care, Jason

I would say the average person who has removed his allotment of strip tissue, regardless of the amount of grafts obtained, should generally have roughly 1-2K of grafts available via FUE simply due to the fact that there will still be a "donor region" untouched to extract from. (ie. a patient is stripped out at 7107 grafts, but still has a donor region that looks the same as before the strip surgery, minus strip tissue, this donor region can be harvested from to yield additional grafts)--this patient would have yielded average strip graft numbers, BUT, by expanding the donor region through FUE may gain another 1000-2000 grafts possibly raising his total to 9000 grafts--where in years past, he would have been through after his last strip session. Whether or not a clinic should extract them is another matter and specific to each patient. Take Care, Jason

Doug, this thread is about Dr. Feller's motorized FUE extraction tool. You should start your own thread and try to explain the merits of your equipment/process. Jason

TC---this is a great question(s) First, I think for a majority of clinics seeking to maximize available donor via fue--the % of extraction is 25 to 30% maximum. Additionally, the surface area of the donor area is not reduced like with strip, leaving the surface area of the donor to be covered with less hair. When we do "hair math" it is always the average patient who has a density of 80-85 fu's cm/2 That generally leaves a patient with 23-24 fu's to be taken per sq cm in an irregular pattern. Which generally corresponds to about 4500-5500 grafts available by using only fue. Of course, there are some patients who can do more, but just as well, there are some patients who have less. It is generally held that to maximize a patients donor both strip and FUE must be used in tandem--whereas using either strip or fue will reduce the amount of available grafts. To answer your question directly, if a patient uses his 6000 available strip grafts---he should have roughly 1000-2000 grafts available by expanding into the untouched areas and taking a measured extraction over the entire donor region. This is simply a best estimate since again, patients may have more or less depending on their situation. Once a clinic measures your donor density and takes into consideration your age, current level of loss, family history and response to meds, a more factual approach can be taken. For most patients the 50% extraction rule is not an option---it is next to impossible to remove 50% in an irregular pattern over the entire donor region and not leave gaps or thicker/thinner spots in the donor region----- the issue with FUE is that if you approach it with the idea to take a large # of grafts, say 5000---your taking a chance on the condition of the donor post-op. The better approach, (but albeit less instant gratification), is to take 2500-3000 grafts, let it grow in, observe the coverage, re-map the donor region and proceed accordingly. We think there is a threshold for every patient that may occur at 4000 in some, and say 6000 in others, where the donor looks pristine and untouched, but by taking just a little more the donor becomes ragged or moth-eaten and is obviously very noticeably thinner/gapped when grown out. When you factor in the potential for white dots and that eliminates shaving down to a #2--forcing patients to maintain a higher buzz cut, then the actual benefit of fue is retarded. I have actually seen this happen--it is not pretty and presents a real challenge to repair because we have try and thin the donor to match because a noticeable difference exists from the back of the head and the sides. Again, FUE is tremendous and offers an excellent opportunity to approach baldness--but it has limitations and is not a "cure-all" ---if anything a patient wishing to attempt restoration wholly via FUE must be planned out well in advance and likely in increments that are smaller than our normal strip sessions. Like anything else, seeking to move quickly or over-exaggerating the benefits of a procedure result in higher risk and potential greater harm to the patient--something that must be avoided at all costs. Sorry for the long answer..I hope this is what you were looking for. Take Care, Jason

Got my vote

I am completely behind FUE as an option, and my opinion is that it needs to be presented to the patient, regardless if a clinic offers it or not. I would hope clinics are doing this, regardless of bias toward the procedure. Like Bill said, strip has shown to be more consistent, which I agree with. Almost every patient can achieve excellent results via strip, with FUE that is not always the case. However, the fact is FUE approached properly is amazingly proficient. If the patient is candidate and the approach is well thought out--there is no reason not to choose FUE. Like anything else, FUE has been over-hyped and is currently being over-sold as "scarless" "for every patient" "increases the donor" etc.. In fact, using FUE alone may reduce the amount of available grafts, produce white dots and is not for every patient. But, with that said, there are patients that truly benefit from this procedure, and, there are patients who desire this approach regardless. I am a supporter of both strip and fue in the hands of top clinics. Those who rail against FUE as a non-option are uninformed. Those who use fear-mongering to rail against strip are wrong as well. I am happy to discuss the merits of FUE on another thread, for the original poster--the question is "Do I do strip or FUE" ---the only drawback to doing strip is #1--he has an amazing scar already #2 post-op discomfort The only drawback to fue is #1 slightly more cost #2 shaving the donor area below the existing scar to reach the grafts. Like I said earlier, the likely option is just to do a small strip session. But FUE represents another option to be considered as well. Take Care, Jason

For a session of this size a typical patient should experience no difference in yield ---for strip patients in the hands of a top clinic the yield should be near 99-100% ---FUE might be slightly lower, but it seems most yield issues result from the improper handling of the grafts vs extraction. When you have staff that is extremely experienced, caring, and detail orientated this should not be a problem. I think once you start talking about doing 2-3-4-5K of FUE per day, the yield/transection rate is logically going to go up---FUE grafts are unprotected, whereas strip grafts are encased in the strip/sliver and are less susceptible to damage. Once you force yourself and staff to hurry up or move faster to accommodate larger graft sessions, you keep the grafts outside the body longer (which will impact growth/yield) and the risk factor for damage increases. In our case, by keeping the sessions 700-1000 per day, no hurry, relaxed, we find we get the grafts and get them back in the body in a proper time-frame. This also is conducive to gently handling the more fragile grafts as well. The same applies to strip--in a top clinic doing 1000-1500-2000 grafts is not much of a challenge, but as you increase the session size, you increase the risk factors as well--clinics that are prepared and experienced minimize these risks and the results show accordingly. Again, if you approach FUE properly and use it properly, there should be little difference, unless a patient has some characteristic that makes them a poor candidate at the start. Take Care, Jason

Hi bananas-- because you have already undergone strip, unless you are adverse to the post-op discomfort, strip would be a solid choice. Additionally, the resulting scar will in all likelihood be as nice as before. However, buzzing down the lower portion of the donor to get 700-800 grafts would be a fairly easy surgery and not worrying about post-op staples or stretching of an already excellent scar is a benefit as well. In your case it simply comes down to choice--- for example at SMG your cost for 800 strip grafts would be 3600.00 For 800 FUE grafts your cost would be 4300.00 Your in a great position from a cost and procedure point of view... to choose whichever method you feel is best. The only downside of choosing a strip session is the post-op discomfort and you must limit your physical activity for a longer period of time to prevent any stretching. Take Care, Jason