RecedingTide

Gho and Nigam are full of s***!...There...Someone had to say it. Bring on the ban hammer.

Nice of Dr. Wesley to keep it real. The elephant in the room is of course propecia. I know for a fact that some doctors won't transplant a patient unless they're on it and I suspect that in many of these cases it has as much to do with maintaining the calibre of the transplanted hair and integrity of the donor as it does with stopping further native loss on top.

We're probably not supposed to post links so google Dr. Bernstein FUT undermining or something along those lines and he explains it well.

In a nutshell, it is possible to kind of shear the skin and most superficial layers away from the deeper layers so that they are almost separate in the region of the excision (well kind of, hard to explain without a diagram). While only putting in one layer of staples it is still possible with this method to close the donor in such a way that the deeper layers carry more of the tensile forces than the superficial layers because in the region of the closure they are not really a continuous layer.

So in effect you have the deep layers carrying the tension while the superficial layers and skin close pretty much with no tension ensuring a fine scar. You need to really know what you're doing with undermining but that's part of the reason Dr. Hasson maximises a patient's donor better than everyone else. He's really good at tapering the width of the strip to ensure uniform tension on closure and he knows how to undermine when required to keep the tensile forces deep in the scalp to ensure the the wound edges and skin heal properly and deliver a cosmetically acceptable scar.

I believe Hasson and Wong's whole donor closure technique is better than even other surgeon's who use staples. Joe has said that they take an hour and a half from start to finish, paying attention to the tension in every part of the patients scalp and accommodating the width of the strip accordingly. Who knows what other tricks they use that they keep to themselves.

They do extensive undermining as well. This is a big part of the 'secret'.

Dr. Hasson is the best in the world when it comes to strip excision and donor closure. He pretty much wrote the book on maximising strip extraction while providing a great cosmetic scar. As a result he can also extract more donor over multiple procedures. Look at London Lad post op after 11200 grafts.

As for Rahal he is quite good but it's in dense packing and yield where he excels. I've seen fine scars and stretched scars from him; no different than most other surgeons. Remember though that physiology is important when it comes to wound healing and also your laxity for minimal tension on closure.

Feriduni has very refined tricho closures and is up there on all fronts. He can do it all. Both himself and Hasson are big proponents of staples these days.

Rahal and Feriduni are the best for hairlines. Feller and Hasson can create the same standard of hairline but tend to be more conservative with donor usage.

The work was rubbish. I think he looks pretty good with the shaved head though. Then again I also think the remnants of the hairline and shadow the transplanted hair creates makes it look really good. I still think that since he's cut he could get 3000 from rahal or H&W no prob and could still buzz down and prob have a better scar. Or he could FUE the scar. He looks pretty good regardless though. Dude is yoked for mid 40s. The roids and HGH are working well. His jaw is significantly bigger than when he was a young man but it kind of suits his image. Rogan is the man.

Hmmm. In general I don't think FUE has the same yield as FUT but I agree with what others have said in this thread; I believe it is the case that 1400 was never going to be enough for your goals. Double that, 2800. would be more appropriate. Problem is 2800 is pushing what can be done reliably in 1 session of FUE.

Maybe the conservative approach of 1400 in the first session followed by another 1000-1400 in the next session will actually turn out better in the long run that if they went straight ahead and implanted 2800 in one go. Your donor has not been squandered. No worries on that front.

It's far from a disaster here. You'll be fine and I'm sure Rahal and co. will take good care of you. Stay positive. All the best.

I'd guess you could get a 3rd strip of 1500 Can't Decide. Then 1000 FUE. You're in a great situation.

Also have to keep in mind that if the back and sides thin, the transplanted hair(taken from the back and sides) will also thin...

This. So important to consider. Some men seem to keep a thick horseshoe whereas for some it just disintegrates.

I suppose 300-400 FUE into the scar would help as it is also kind of a skin graft which will break up the scar.

I think Rahal's clinic should stick to FUT. They're up there with H&W.

Ah yes, thank you the Harris SAFE motorised drill.

Not convinced by Rahal's FUE work. His strip results are amazing. His FUE with ARTAS work reminds me of Armani's results; hit and miss.

Surely Matt's FUE was manual? Anyone know?

*** Let me make a correction. Looking back at the first page it seems as if the extractions were done manually. Don't think FUE is matching FUT yet.

I sincerely hope you get this resolved and get the growth you're looking for if you decide to go with another procedure.

Like a few others said, it's going to depend on a variety of variables. However, in general terms, I've heard donor thinning is apparent after approximately 50% of the available grafts are extracted via FUE.

Bisanga will say closer to 30% but if 50% is the threshold it actually means 9000 FUE is possible for many but it's really hard to know. For sure cost is an issue but even still I haven't seen too many big restorations by FUE. Well I guess time and session size makes it much slower to restore big areas with FUE alone.

I would think the top guys with 0.9mm punches and smaller could go to 40% for most. Interesting discussion.

Well this kid is going to be even more depressed when/if he loses the hair behind the hairline and is walking around with a freakshow tuft. I'll have to look back at the first post but I hope this was FUE at least.

He could be norwood 6 by 25.

:eek: Damn that's an incredible result. Congrats. Rahal knocking it out of the park as usual.

Spex can go really short and look like he has a native head of hair. Testament to the work.

Some spectacular results here. You guys need to get these up on your site. The small results gallery on the site does not do you guys justice.

Insanely good and it looks like Dr. Rahal covered a nice sized area with less than 3000 grafts. Loads left in the tank for the future.

The ARTAS system is only a possible option. Dr Rahal still performs FUE using the handheld extraction tool.

 

I actually just posted a compilation of FUE results.

 

http://www.hairrestorationnetwork.com/eve/167798-dr-rahal-fue-compilation.html

That's good to hear Matt. I think the option of the handheld extraction tool is important because I'm not sold on the idea of the punch size of the ARTAS. I think it could be an issue for certain skin types. Big difference between a 1mm diameter punch and 0.75-0.8. Nice to have the option.

Really? I feel like his FUE work is always very solid. Any examples in particular you think don't meet his normal gold standard.

I wouldn't say always Blake. Regarding particular cases: Yes I feel there are a couple on the forums recently but I'd rather not go pointing them out. Rahal is a top guy so I know he'll sort them out. Of course on the flip side, Rahal hits some home runs too with FUE.

I don't think it's a stretch that planting at higher densities with FUE in one pass can affect the yield but hey that's the risk they take. I don't think even the top dogs are beyond criticism. I don't mean to single any doc out in particular, (happen to think the Rahal outfit is in the top 3 strip in the world) but rather than highlight an example, maybe it's better to say that even some of the top guys find the consistency with FUE is just not comparable to FUT. Even Feller will admit that.

Loads of docs have FUE cases that don't yield that well. My real concern is the big sessions, around 3000 say. Not sure if they're really in the best interest of the patient. I haven't seen too many of those that have worked out great. I've seen a few from Lorenzo and Feriduni. I know Lorenzo has done some massive cases (4000 even) but I guess that must have something to do with how he minimises time out of the body. Not sure though.

Suffice to say, FUE is a bit risky re yield even if you're going with the top tiers. I don't happen to think Rahal's consistency is up there with Bisanga, Feriduni and Lorenzo but imo he's the next tier (just an opinion of course). In all honesty, I believe there's only a handful of good of FUE docs.

Long story short, FUE is more hit and miss even with top docs.

Bisanga, Feriduni and Lorenzo are the FUE front runners imo. Feller of course is exceptional but he has reservations these days about FUE for anything beyond filling in some hairline recession. In North America, the Shapiro bros seem quite active in FUE and seem to be getting nice results.

As a great a strip surgeon as Rahal is, the FUE results seem to be a bit hit or miss. Perhaps with the hairline density he packs at, the skinnier more vulnerable FUE grafts don't yield as well sometimes. Just a thought. Incredible strip surgeon though.

Feriduni seems like a good choice for people that want to strip out and then get some more with FUE.

Any updates mate?

Fantastic result. Always appreciate the honesty. Incredible hairline. I'm jealous.

You dodged a bullet there with Ailesbury. Good stuff. If you're going with FUE then Bisanga and Feriduni are definitely the guys to go for in Europe. Lorenzo in Madrid too. Those 3 will not steer you wrong and have the results that you would expect given their reputations. Good luck and keep us updated.