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olmert

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Everything posted by olmert

  1. I thought the density will never get better than after 18 months post op. Because of different timing of different grafts, you can get denser by year 3?
  2. Sean, after the fda approves something for one use, docs are allowed to use it for anything. It is called off label and happens with just about everything fda approved. It costs too much to get fda approval for everything. Scar5, if fut stretches up the neck and this leaves the donor region more dense looking, then this is a good reason to get fut instead of fue. Who needs neck hair? I don't believe fut raises the neck much. I have heard 90% of the stretching is within 1 inch of the scar.
  3. Yes, at least in the part of the surgery that ARTAS does. This has nothing to do with whether the average result is better, but speaks to the disaster rate. If LASIK's disaster rate is 1 in 10,000, then Hasson's is probably higher. I don't know if he has done 10,000 transplants yet. It is because disasters caused by human error is more common than disasters caused by computer error, which mostly derives from checksums. This rule even applies to work by formerly university affiliated physicians, including those who exaggerate their predictive powers in ways the medical community call inconsistent with their teachings. And while Spanker is reminded of that commercial, I am reminded of when Bill refused to add Dr. Bhatti to the recommended list of doctors here, and suggested the reason was other doctors said Dr. Bhatti is irresponsibly making wrongful and exaggerated claims about FUE that is inconsistent with the medical evidence. (Bhatti only does FUE.) I don't know whether Dr. Bhatti is formerly university affiliated, but it appears Dr. Bhatti recently stopped exaggerating and thus was added to the recommended list.
  4. Well, that explains it. Perhaps a currently university based physician would point out when he is relying upon mere anecdotal evidence, and further that the medical community regards relying upon anecdotal evidence as substantially less reliable than relying upon a study.
  5. Does Hairweave have any citation for his belief that what I say about robotic surgery or new devices is incorrect? Or for that matter does he have any citation for his belief that opthamologists get lasik less often than non-opthamologists? KO, what I say is not based upon belief. It is like when economists were arguing with geologists a couple years ago. The geologists vouched that they know the science and we are about to run out of oil. The economists said every time someone claims scarcity, the price goes up and the scarcity stops. And lo and behold the economists turned out right. Fracking got better and doubled oil reserves.
  6. Hairweare, LASIK is not risk free. With millions of LASIK’s performed, you will find disasters, but you won’t find a higher incidence than with the equivalent procedure that is not computer assisted. They probably have computer assisted heart surgery that does not always work, but is still safer than the non-computer assisted version. Future Hair doc, it is just a matter of time before technology commoditizes every field. Much of law work is now done by software, and the end result is you need fancy lawyers for less and less of your work. The question is not if, but when. (Even in the short term, you will see incremental commoditization, which is really all ARTAS is, since there is other work besides hair plucking. Spanker asks the wrong questions. I don’t know the answers to them. I am not an ARTAS engineer. But I do know something about regulation and lawsuits. I do know that traffic lights go dark all the time, yet no traffic light has ever flashed green for all traffic.The lawsuits and regulators do not allow technology that has a greater chance to go awry than the alternative without the new technology. This does not mean that all new technology is better. The average result might be worse with the new technology. But the chances of disasters happening are always less with new technology. New technology abides the maxim first do no wrong. There is a reason no one has ever gone blind from LASIK. Telling me you had a bad result is no evidence at all, unless you are comparing the rate of bad results between LASIK and the old technology. The FDA has cleared a number of hair lasers, which is not from testing that they reduce hair loss, but from testing that they never cause disasters. And I don’t mean to say ARTAS results are better, at least not yet. But you won’t get a disaster from it, and you are more likely to get a disaster from Hasson and Wong, or any other fancy or non-fancy doc slipping up. In other words, the disaster rate from the human hands will always be greater than any newly approved technology, or the new technology will not get approved. This is not blind faith. This is proven human history.
  7. The thing is I don't really know enough to be able to look at before and after pics and say definitively that one job was better than another. I've seen a lot of results that look pretty much the same to me. I wish there were someone here who is like a hobbiest at this and has a firm opinion that Madhu is better than Radha or the opposite. Of course, someone like that probably would not post to express his preference because he won't want to make an enemy of the other doc. Maybe he could just email me. I wouldn't tell anyone.
  8. Spanker and Future HT Doc don’t understand the difference between computer failure and computer check sum failure. Computer failure is common. A credit card does not get accepted. A red light is broke and turns dark. Computer check sum failure is when person A swipes a credit card and person B gets charged. Or when the traffic light gives a green light to the cars in all directions. This is a one in a billion chance because the computer knows when the check sum fails, and turns off. A million things have to go wrong in sync for a check sum failure. Perfect storms are rare. A human stealing your credit card even because of bad computer security is not a computer check sum failure. No one, by the way, is going to hack ARTAS to screw up transplants. Terrorists have other targets. The LASIK comparison is equally flawed. No one has ever gone blind from LASIK. There may be a 1 in 10,000 incidence of some visual loss. There are also known risks such as the halo effect. This has nothing to do with introducing the computer element, as done with LASIK. You need to compare the LASIK side effect rate to the rate at which these bad results occur in comparable surgeries that are not computer assisted, perhaps PRK. Google “PRK.” When I got PRK in one eye and LASIK in the other eye, Dr. Manche at Stanford told me the incidence of bad results is equal for both tactics. Even assuming that computers will never improve upon the results of the best doctors (which is extremely unlikely in the long term), computers will bring the patient cost down and top doctor salary down. There are two components to what the top doctors charge. 1) Average doctor charge, and 2) Fancy doc premium. The fancy docs don’t pick their prices randomly and certainly not exclusively based upon their own expenses. They look at the market and charge the most they can. At the end of the day, they are economic entities in a free market and not working for a dime less than they can get away with. I will pick simplified numbers. Say the average doc charges $9K for a HT, and the average fancy doc charges $20K. $11K is the fancy doc premium. $9K reflects actual expenses plus the average doc wage. Future HT Doc says "it is difficult to see how [ARTAS] will drive costs down.” He cites the cost of ARTAS. But $300K is pennies when spread over thousands of surgeries (or actually $100 per surgery). ARTAS could get competitors, which will limit how much they can charge. The bigger charge of the fancy docs is the fancy doc premium. This goes down the more a hair transplant is closer to a commodity, that is to say the less distinguished the fancy doc process is from the average doc, or the more all docs are using ARTAS. The price of the fancy docs will depend much more on how much they can distinguish themselves than upon their actual expenses, including ARTAS. So if ARTAS becomes the gold standard, fancy docs will charge less. Patient wins a lot. Average doc wins a little. Fancy doc loses a lot. In my equation, the world as a whole becomes a better place, even if the fancy docs lose part of their premium.
  9. I've already had one FUT with a cheap doc who is recommended here. It looks good to me, so I am not convinced the expensive docs recommended here are worth the extra money.
  10. Fear of computer failure is irrational. When was the last time you swiped your credit card and was charged the wrong amount? If that happens, it was because of the human that inputed the number. In short, you are safer with the computer than you are with the chance of human error. These computers have so many check sums, which in short are mathematical verifications of a million things, and if everything is not perfect, will not continue. You would need the perfect storm, one chance in a billion, to screw up. So plenty of times the credit card does not work. This happens when the check sums fail. But ARTAS will know to shut itself off when this happens, not to keep transecting. Computers also do most of the work for LASIK surgery, and I don't think the computers have ever botched that, not even once. There haven't yet been a billion LASIK surgeries.
  11. Surprisingly Radha, even though she is a relatively new doctor and much newer than Madhu, charges more. She charges $1 per FUT graft, while Madhu charges 50 Indian ruppees or about 77 cents a graft. My surgery would cost about $600 more with Radha. If there were substantial evidence Radha was better I would go with her. But I have heard good things about both, so I don't know what to do, and am starting to figure that without any other data point to go by, I might as well go with the cheaper one. I know with Western doctors $600 would be considered chump change, but without any other good data point, it has to count as something. I think Madhu just has a cheaper set up, with more tech's and assistant doc's, so he can do a lot more surgeries and keep the price low.
  12. Future Hair Doc is forgetting the maxim that it is very hard to convince someone he is wrong when his livelihood depends upon him being right. There is an inherent bias. To make money in a field, it helps that the field not be a commodity. The more hair transplantation is commoditized, the more tools like ARTAS make the difference between doctors less, the less doctors will make. There are doctors that laser the top layer off your facial skin off, which makes you look a couple years younger. And you don't get much different a result depending on the doctor. So doctors cannot distinguish themselves or charge more than the average doctor. If ARTAS becomes the new gold standard, the top HT docs will be offering a product less distinguished form the worst HT docs. The premium they charge will go down. So while Joe Tillman laments the day of commoditization, when you will find a HT doc on yelp, such a day will bring prices down for the patient, to the detriment of the top docs.
  13. Joe Tillman writes: "If the patient wants the most grafts at once and has an advanced pattern of balding, doesn't ever want to shave and understands the risk then he'll choose strip." This is a vey confusing statement. Why does Joe add in the words "at once," which hedges the declaration? Doesn't Joe believe that you can remove the words "at once" and the statement remains true. This is to say, doesn't Joe believe believe whether you want more grafts at once or want more grafts after all surgeries, you cannot do FUE? KO writes “While I agree that FUT does not deplete density visibly due to the reasons JoeTillman explained, the line coming from clinics and posters in the past was that density would be unchanged after a strip, and that is the reason that many on the forums get irritated.” Are you referring to Joe Tillman’s explanation for why the same number of grafts taken by FUT will not make the donor area as bald as would if taken by FUE. This explanation, Joe said, is hard to visualize, but relates to new skin forming to fill in the holes caused by the FUT stretch. It is certainly hard to visualize because at least ostensibly the hair would seem to cover whatever happens to the skin. Are you saying you disagree with this explanation and further do not believe that hair taken via FUT reduces donor density less than if taken via FUE, and further someone seeking to maximize total lifetime grafts transplanted cannot do it with FUE alone, without FUT? (You are likely aware Spanker, Joe Tillman, and some others have argued otherwise.
  14. False. Except for 1% of men, you can always use more hair.
  15. OK, so you are saying that there is a difference between technical density (hairs per square inch) and visible hair density. You say after FUT (as opposed to FUE) there might be the same number of hairs per square inch in the donor area, but there will appear to be more. And you say new skin plugging in holes caused by the FUT stretch is what raises the visible hair density, without raising technical hair density. It is a difficult for me to visualize how skin plugging in holes raises visible density.
  16. Let me phrase it this way to try to understand. Assume a 2.5 inch wide donor FUT region. Assume 10,000 hair follicles evenly spread in it. Therefore hair density is 4,000 hairs/inch = 10,000 hairs / 2.5 inches. Assume FUT cuts out the middle half inch and takes 2,000 hairs, leaving 8,000 hairs behind. Assume the remaining 2 inches stretches out to cover the missing half inch. The donor region now has density of 8,000 hairs / 2.5 inches = 3200 hairs / inch If you FUE, instead, and take 2,000 hairs out, you end up with the same 8,000 hairs / 2.5 inches = 3200 hairs / inch. Now, Joe Tillman says that over time the stretched out post-FUT skin breeds new skin to fill in the holes caused by the stretching. He says that this new skin raises the hair density. But, it seems, the equation does not change. There remains 8,000 hairs / 2.5 inches = 3200 hairs / inch. Adding skin to fill in holes over time does not change this. So how is this reasoning not more 1 + 1 = 3 ? I can't make sense of it. It appears KO can't either.
  17. I share KO's confusion. It sounds to me like more 1 + 1 = 3. Joe Tillman says that new skin fills the gaps in the stretched skin. But the new skin does not bring new hair with it, or change the surface area, which is determined by the skull. Density = hair grafts / surface area of scalp. New skin filing in gaps will not increase the hair grafts. It will not reduce the skull surface area. Therefore, it will not increase hair density.
  18. I think tightness largely depends upon the patient's low laxity. I have tightness after just one FUT of 2100 grafts.
  19. Here is the problem. I've heard good reviews about Radha too. So I wouldn't know who to pick, if choosing between the two. I have no idea if there is a particular set of facts that would be specific to a patient that would influence the choice.
  20. When I spoke to Madhu's office, I got the impression a whole team of doctors split up the work and do more than one person per day. They said Madhu's wife and at least one other doctor does some of it. They said Madhu does the important parts. Dr. Radha Palakurthi does everything on her own. It is a small office. She has done fewer surgeries than Madhu, but a lot of her before and after pics look good.
  21. Yes, there is. I am a math guy. And having read all the reasonings given, I can say these reasonings are based upon misunderstandings of math, which is a very common phenomenon. One thing I can tell you is that, if your claim is true, it is not for any of the reasons given Dr. Karadeniz might be a great surgeon, but he is not a mathematician. And his reasoning makes very clear that he does not understand the math here. For most everything in surgery, higher math will not help and a fourth grade understanding is all that is advantageous. In short, you can believe that in some circumstances 1 + 1 = 3 and be the best surgeon in the world. And Spanker’s reasoning is the same 1 + 1 = 3. It is very common in the world for people smart in some areas to have a mathematical blind spot. Most of the world doesn’t understand the mathematics behind why raising tariffs makes a country poorer, when the tariffs give more tax money taken in part from foreigners. And here too a group consisting of FUT believers gives reason after reason for why the FUT/FUE combo gives more grafts. And each reason given is another form of 1 + 1 = 3. And I do suspect, if the claim were true, someone would have a reasoning to give that is not based upon mathematical misunderstanding.
  22. I find it extraordinary that Spanker still misunderstands that an FUT/FUE can take more grafts than a series of FUT's. It doesn't matter what density the patient starts out with. In the mind boggling example he gives first he says the FUT takes 43% of the grafts from the donor region. Then he says you can have FUE take an additional 30%. Meanwhile he says if you skip the FUT, and do only FUE, you can only take at most 40% of the hair. How exactly can you only take 40% with an FUE, while you ca take 43% with FUT (and then even an additional 30% with FUE). Then he says it depends on how much density the donor originally has. No it doesn't. No matter what original density, it makes no difference how you take hair out, whether by FUE or FUT. Regardless, you can take the same amount out. And you will not get more grafts from and FUT/FUE combo rather than a series of FUE's. To sum up, 1 FUE and 1 more FUE will give you two grafts. 1 FUT plus 1 FUE will give the same two grafts. One plus one will not equal 3. And Dr. Karadeniz's math is no better. His bunching up (or excess) skin theory makes no sense. If an inch wide strip of hair containing 500 follicles is bunched up so that it is only 1/2 and inch wide, then the hair will be twice as dense. It will look twice as dense. Stretching it out to one inch wide will return it to half as dense. Again, one plus one will not equal three.
  23. Spanker, explain to me your logic in assuming you can do 30% FUE harvesting after the FUT, and keep the same donor density that you would keep if you did 40% FUE without FUT. In the strictly FUE case, and in the combo FUE/FUT case, the surface area of the donor region is the exact same afterward. So the ultimate density of the donor region is exactly proportionate to however many grafts you took out, no matter by FUE or FUT. To put it another way, you would have to take much less than 30% FUE after the strip to keep the same donor density than you would for 40% FUE without strip. By taking the 6K grafts from FUT and stretching the skin, you essentially already did an FUE of 6K/14K = 43%. Afterward the area has only 57% of what it started with. If you then do FUE and take out another 30% of the remaining 57%, then you only have 40% ( = 70% X 57%) of the density you started with. So in sum you are saying the combo is the equivalent of doing an FUE that removes 60%, and any pure FUE would probably only remove 40%. Therefore you get more by doing the combo. This is more 1 + 1 = 3.
  24. Spanker, but you aren’t giving any reason, or you are giving a reason I can’t see. Are you saying it is so because of the higher transection rate for FUE, and saying FUE docs who claim only 2% higher transection rates with FUE are wrong? Perhaps you say the combination will get more grafts because FUT takes the grafts from the entire strip instead of cherry picking with FUE. This seems illogical reasoning. After the strip is taken the neighboring skin gets stretched out, so is essentially cherry picked too. My example shows this is faulty logic. Assume you start out with a donor region of 2.5 inches that contains 10,000 grafts. You have two options. Option 1. Cut with FUT a half inch strip in the middle, which gives 2000 grafts. Allow the remaining 2 inches to stretch out to cover the missing half inch. Now the donor region remains 2.5 inches, but only 8000 grafts cover it. Option 2. Cherry pick with FUE 2000 grafts throughout the entire 2.5 inch region. Now the donor region remains 2.5 inches, with 8000 grafts covering it. Dr.Karadeniz at least gives a reason. He says when you stretch skin out through FUT the skin gets stretched but the hair somehow doesn’t get any thinner. He says the FUT donor region gets no less dense with hair because it started out bunched up and relieving the bunch up means the donor region gets no thinner even though you took away hairs. This reasoning makes no sense to me and KO, but at least Dr.Karadeniz gives some reason, instead of declaring it self evident. 1978Matt gives a reason. He says the transection rate is higher with FUE, while Mickey85 says the transection rate is barely higher. The extent of your reason is “it is just a fact.” Are you saying people have tried both ways in the past, and the people doing FUE/FUT ended up with more grafts, while no one knows why?
  25. 1. As to 1978matt’s points, I must first thank him for not saying "1+1=3.” But at this day and age, 1) can’t you go to a mega FUE guy, like Dr. Bhatii and get 5000 FUE’s in one session? And moreover is the transection rate really reduced by a whopping 50% by the fifth FUE? ; 2) Furthermore, don’t a lot of doctors say their FUE transection rate are just 2% worse their FUT transection rate: a 10% transection rate sounds fine to me, while a 50% transection rate sounds so bad that I would not get the surgery. 2. drkaradeniz’s point is very hard to understand. KO argues that it is false, that it is 1 + 1 = 3. According to KO, say you took a strip of hair 2 inches wide with 3,000 hair follicles. Say you then compressed it and bunched it up, so that instead of covering 2 inches, it now covers one inch. Now you have 3,000 follicles per inch, instead of 3,000 follicle per two inches. KO says that the hair will look twice as dense after the bunching. drkaradeniz says that no, the hair will not look more dense because bunching skin together does not cause the appearance of denser hair. If this is really true, this is a very hard concept to follow. Does drkaradeniz means it is true? Is drkaradeniz instead saying the very believable claim that the hair is so dense in the FUT donor region that you can never perceive the reduced density that comes from taking the first 4,000 follicles? This, I have heard before: with very dense hair, the human eye cannot notice a small reduction in density, so while harvesting hair reduces density, it will not be noticed.
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