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PupDaddy

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Hair Loss Overview

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  1. Dr. Dorin of True & Dorin does some of the finest temple work I've seen.
  2. Just as clarifying info to Zizou88's post, my understanding is that Dr. Konior is assisted in PG (placing grafts) by (at least) his lead technician. In other words, he is "involved" in that stage of the FUE procedure as well but his technician(s) also place(s) grafts in the recipient sites (which he makes). At least that is my understanding.
  3. Looks to me like different technicians implanted the left and right sides of your hairline and/or that the quality of the grafts differed as between the two sides. I think you could use a small session touchup of the left side of your frontal hairline. Otherwise, your transplant looks great.
  4. Gasthoerer, I dont' contend that one type of Category A tool is superior to another type of Category A tool (I wouldn't know), or that Category B tools are "superior" to Category A tools or vice versa. Category A tools and Category B tools have different purposes--apples and oranges. I'm only saying that I favor the use of Category B tools for insertion of grafts into premade recipient sites over forceps-only insertion of grafts into premade recipient sites. If Dr. De Frietas uses true implanter pens for his hairline work that could help explain why he isn't on my personal "tops" list of hairline docs, although I admit I haven't studied a lot of his recent work. Timely and interesting topic.
  5. We should make a distinction between (a) implanter tools that both cut the recipient site and implant the graft into that site, versus (b) implanter tools for inserting grafts into recipient sites that have already been made using a custom cut blade or needle. The critical distinction is that Category A tools are used by the surgeon (or technician at some clinics) to simultaneously make a recipient incision and plunge a graft into it, whereas Category B tools are used by technicians only to seat grants into recipient sites that the surgeon has already made. Category A tools include Choi and Lions type pens, as used by Lorenzo, Vories, and others. Category B tools include Erdogan's KEEP tool and Yaman's implantation tool. Category B tools essentially hold the walls of the pre-made recipient site open and form a channel for grafts to be fed through. Forceps are used in conjunction with the KEEP tool (a Category B tool), but only after the graft has been loaded through the side of the tool’s hollow tube using a sort of swiping-rotational movement off the back of the hand and only to then finish seating the graft into the recipient site. Yaman's implantation tool, also a Category B tool, is similar. It looks like a Category A implanter pen but the point of the hollow needle is blunted and isn’t used to cut a recipient site. Instead of using forceps to guide the graft the remaining way down the hollow metal tube into the recipient site, the technician uses the tool’s plunger to perform this task. Both these tools purport to reduce trauma to grafts that can result from gripping them at the "meat" between forceps and "cramming" them into tiny recipient sites--trauma that can be exacerbated by fatigue and by recipient sites starting to close up after some time. Some ht docs have employed a combination of Category A and B tools for FUE transplants, favoring blade or needle-made recipient sites for hairline work that are then filled using Category B tools (e.g. KEEP, Yaman) and using Category A tools to both make recipient sites and seat grafts behind the hairline zone. MY SUBJECTIVE, PERSONAL VIEW: I strongly favor ht surgeons and their teams using Category B type tools to reduce graft trauma during the implantation process. I am solidly against the use of Category A type tools for hairline and temple work. Based on viewing hundreds if not thousands of photos and videos, I don't see the consistent cosmetic refinement of hairline work and frontal temple work performed by the top surgeons using Category A type implanter pens (yes, I include Dr. Lorenzo and his spawn) that is achieved by top surgeons who make recipient sites using custom blades or needles. I personally think that graft survival and growth rates of FUE will be significantly enhanced, as will their consistency, by the widespread adoption of Category B implantation tools in the hands of well-trained technicians, everything else being equal. Excellent topic, Squidward! I hope you'll forgive my pontification.
  6. Thank you for that clarification, Dr. Yaman. We are seeing real progress in FUE protocol and cosmetic results with the advent of newer, well thought-out motorized systems with better control and better designed punches, as well as graft embedding tools such as yours and Dr. Erdogan's. Keep up the good work!
  7. Dr. Yaman, Am I correct that your new implanter device is for seating/embedding FUE grafts into PRE-MADE recipient site incisions? In other words, whereas traditional implanter pens (Choi, Lions, etc.) are designed both to cut a recipient incision and implant a graft into that incision, your tool is used only for the second part of the process, i.e. to seat/implant a graft in a recipient site that the surgeon has already made using a custom cut blade or needle? In that sense, this tool is used similarly to Dr. Erdogan's KEEP embedder, for example, yes? It is a tool used by the tranplant surgeon's technicians NOT to make recipient incisions but rather to seat FUE grafts into the doctor-made recipient incisions with less trauma to these delicate grafts that can occur with techs using only forceps to "push" or "cram" a graft into a recipient incision. Is that right? I personally haven't seen the same degree of hairline work refinement from docs and clinics using traditional implanter pens, but I see FUE graft embedding tools like yours and Dr. Erdogan's (if I am understanding your tool correctly) as an important advancement in FUE protocol.
  8. Trix, I think you might be asking why some surgeons DRAW hairlines with squiggles whereas others do not. It seems just to be a matter of personal preference. Just because a particular surgeon doesn't DRAW squiggles (micro and macro irregularities) along the planned hairline doesn't mean that the surgeon won't MAKE them when he makes the graft incisions. Some ht surgeons choose to pre-draw the irregularities and more or less follow them, some don't, choosing to do things a bit more free-style/free-hand. That said, some ht surgeons generally seem to favor a lesser DEGREE of irregularity along the hairline than others, and vice versa. (For example, I would put Dr. Erdogan in the first camp.) Other docs routinely employ a pattern of tiny "spokes" or "triangles" extending from the hairline at regular intervals. Others favor more irregular zigs and zags and of varying length. Others still pretty much follow the line but insert randomized single hair "softeners" along it. This really is where the artistry of creating and transplanting a hairline comes in and is why you can often tell one doc's work from another's once you get to know their style. But whether or not the surgeon DRAWS the macro and micro irregularities into the pre-op hairLINE doesn't seem to indicate anything one way or the other from what I have observed.
  9. I recall Dr. Konior posting a case here of a patient who wanted just a new hairline transplanted in front of his hair system. I don't recall whether any work was needed or done to the patient's temples or temple points, though.
  10. Ingenious! Looks to combine the benefits of forceps placement into custom blade/needle recipient sites with the benefits of pen implanters, without the shortcomings of either method.
  11. dude85, Precisely as Spanker just said: DO NO RETURN TO THAT DOCTOR. He inexplicably populated your temples and frontal hairline with 2 and 3-hair grafts, which is a huge no-no. Go see a top hairline doc (e.g., Dr. Konior, Dr. Gabel, Dr. Diep, Dr. Cooley, Dr. Shapiro, etc.) to assess your situation. Like Spanker said, there are several possible approaches to fixing this: (a) camouflaging the pluggy work by transplanting lots of newly-exctracted 1-hair grafts in front of, and between the 2 and 3-hair grafts, (b) punching out some or all of the 2 and 3-hair grafts and replacing them either with newly-extracted 1-hair grafts or with single hair grafts created by dissecting the punched out multi-hair grafts into 1-hair grafts, © electrolysis to "kill" the 2 and 3-hair grafts (as an alternative to punching them out and repurposing them) followed by transplantation of newly-harvested single-hair grafts, or (d) some combination of the above. Get thee to an elite hair restoration surgeon with an impeccable record for hairline work and hairline repair work.
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