PupDaddy

Hi Loags, Thanks for the great writeup and progress reports of your procedure with Dr. Radha. Looks like you're coming along great! Continue to grow well and keep us posted.

Hi Loags, Thanks for the great writeup and progress reports of your procedure with Dr. Radha. Looks like you're coming along great! Continue to grow well and keep us posted.

Beautiful work on a major case, Dr. Diep.

Wow! I just looked back at your "before" pics, HR. This is going to be beautiful. It already is, but I think with another 3-5 months of maturing it will be off the hook. How's your scar looking? It was looking really good soon after the procedure.

Wow! I just looked back at your "before" pics, HR. This is going to be beautiful. It already is, but I think with another 3-5 months of maturing it will be off the hook.

There are a number of hand-held motorized punch systems currently being used for FUE, each differing in punch sharpness, wall thickness, oscillation feature, rotation speed, grabbing/pulling feature, and other aspects. In the U.S., for example, Drs. Harris and Umar each sell their own hand-held motorized punch systems to other ht docs. So it is difficult to generalize when talking about hand-held motorized punch systems. They have evolved along with FUE. A couple of early models fell out of favor for various reasons and are no longer in use. As more was learned about what works and what doesn't, other systems have taken their place in the market. To date, there are no studies establishing that hand-held motorized punch systems in general, or any specific motorized punch system presently on the market, cause more or less damage to hair follicles than do FUE extractions using manual punches -- due to heat or other reasons. Some docs/clinics using a motorized punch system get good FUE yield, some don't. Some docs/clinics using manual punches get good FUE yield, some don't. Ultimately, the extraction of viable grafts comes down to the experience and skill of the surgeon or tech using the tool, be it a motorized punch system or manual punches.

Dr. Beehner, This is beautiful hairline and frontal core work for a patient with challenging donor issues -- and an interesting approach involving FU's, double FU's, and even some FUE. Please update us on his progress from his most recent procedure. I seem to recall that you wrote a paper about the use of double or multiple FU's behind the hairline transition zone. I'm wondering how this approach achieves greater density when, presumably, these larger grafts can't be as densely packed as 2-hair and 3-hair single FU's. Also, would I be right in assuming that patients receiving double or multiple FU's with this combination approach can't carry off as short a haircut as patients with a "pure" FUT transplant because the larger grafts and space between them would become apparent? Last question (and then I'll shut up): Do you make slit recipient sites for these double or multiple FU's with blades, or do you make round recipient sites with punches -- and why?

What Spanker said. For an FUE crown session in the U.S., I would check out Dr. Wesley (New York), Dr. Diep (California), Shapiro Medical, which you already know (I actually prefer Dr. Paul's work), and Dr. Umar (California). If you ware willing to expand your travel to all of North America, also check out Dr. Rahal. Also, regarding "no shave" for FUE, some FUE clinics market this to mean a particular approach that is sort of a hybrid of strip and FUE. They buzz down or shave an ear-to-ear strip of hair and only extract grafts from that strip. If you grow your hair fairly long in the back prior to the procedure, the shaved down strip will be more or less covered while it grows back in. This approach will limit the number of FU's that can be extracted in a session because you are excluding a large portion of your donor area, and you don't want that strip of donor over harvested.

chrisdav makes an excellent point. You can never shave down to zero (slick), even with good FUE. Well, you can, but your head will look like a white polka dot festival. The practical difference between "good" FUE scarring and a "good" linear strip scar is a single blade length. With a good strip scar you can cut down to a 2 blade. With good FUE scarring, you can cut down to a 1 blade. That said, good FUE scarring is probably a bit more predictable from a good FUE surgeon (these days) than a good linear scar from from a good strip surgeon -- although there are some strip docs who seem always to achieve a paper thin scar.

Hey bismarck, I recall Spanker saying that Dr. Konior presently limits FUE sessions to 1,500 grafts per day. I don't know whether he does consecutive day FUE sessions, even if you were willing to pay for two surgical days. So if that's the case, how about go with Feriduni if you decide on FUE and with Konior if you decide on FUT?

hey, now

bismarck, Thank you for a fantastically interesting thread. I commend you for taking us through your ht decision-making. You are asking all the right questions of yourself for your long term satisfaction (tough to do!) without getting caught up in hype or dogma. I look forward to learning your decision and following your results. I think this thread will be a valuable resource for others in your shoes.

I have to say, I tend to agree with Matt and home on this one. There is something "clumpy" about the frontal work, as if this fellow is wearing a hairpiece. Maybe the haircut has something to do with it, but you can also pretty clearly see where the transplanted hair ends and the native hair begins. I think Matt's point was that too many 2-hair FU's might have been implanted too close to the very front. Maybe that, and as I have opined before, insufficient micro irregularity in this doctor's hairline work generally, keep it from looking utterly natural. Headon does have a point: FUE has progressed to a point where we can nitpick FUE work almost as much as we nitpick strip work -- but I don't see that as a bad thing. It would be great if some day soon we don't even need to ask whether it was FUE or strip but just nitpick away at the result regardless.

The work looks solid, and he's still got half a year of growth and maturation to go, but . . . This is one of those cases where I actually preferred his look before transplantation. It was handsome and suited him, but it isn't my head so who am I to say.

From the photos, it looks like every one of those 2553 grafts grew. Impressive! Joe -- Does Dr. Rahal use custom cut blades to make lateral slit recipient sites for his FUE cases?

What Matt said. Lateral slits (not possible with round needles) still offer the best looking hairline results, imo. I also agree with Matt's inclusion of Dr. Gabel on a list of top hairline docs to watch.

Bumping this one cuz it's such gorgeous work and seems to have flown under the radar. I'm loving Dr. Gabel's hairline work: ultra dense packing (61 FU/cm2 here!), perfect angulation, and just the right amount of micro and macro irregularity to avoid the blunt wall-of-hair look. Nice!

First, Joe, congratulations on your new position. Dr. Rahal is lucky to have you on his team, and vice versa. It’s good to know that the members of this forum will continue to hear from you on a regular basis. Regarding what you said above, given the current state of FUE technology and technique in the hands of a skilled physician such as Dr. Rahal, what in your view still would make strip the better option for a patient? In other words, what factors currently would lead you to recommend strip over FUE for a given patient? Thanks!

As of today, my vote would be for Dr. Diep. His FUE video gallery on his site is extensive and extremely impressive, including a good number of Asian patients. He does all of the extractions himself (a big plus in my book), manually, using tools and punches of his own design. I don’t know exactly what he charges, but from what I have read it is certainly competitive. I think Dr. Diep doesn’t get his due on this site for a couple of reasons: 1) He hasn’t posted as many results as other physicians (but if you visit his site he has rather extensive video and photo galleries of his body of work), and 2) He is a bit quirky, in kind of a charming way in my opinion. English is his second language, and whether the product of his culture or just his personality, he tends to present his posted and video results using adjectives like “amazing” and “fantastic,” which can be off-putting to some. In his video presentations, his offices don’t appear to be the slick operation of some of the more glamorous docs. He just seems to do things his own way. As Joe posts more of Dr. Rahal’s FUE work in the coming weeks and months and tells us more about Dr. Rahal's current FUE protocol, my vote could change. But as of now, Dr. Diep would get my FUE vote as between the two. I respectfully disagree with densedream’s suggestion. I personally find the body of Dr. Diep’s FUE work more cosmetically appealing than that of Dr. Lorenzo, especially with regard to the all important hairline work. Good luck!

Another lovely result by Dr. Paul!

I personally love the work of Dr. John Diep, who has two offices in California and is a recommended physician here. He does both FUT (strip) and FUE extraction, with an emphasis on FUE. Visit his web site and look through his large video gallery of results. Like most coalition and recommended physicians here, Dr. Diep will give you a free consultation. He is someone I personally would travel to for a transplant if I didn’t live in California, but since you live there and travel costs are an issue, all the better. Also check out the work of the other California based recommended physicians here and schedule consultations with them as well. Many transplant physicians can now do virtual consultations via photographs or Skype if distance or time off from work is an issue -- although an in-person consultation is ideal, both for the surgeon and for you in deciding who you want to trust your head and precious donor supply to. Good luck!

I’m with you on this one, KO.

I do wish Dr. Erdogan would build in a bit more macro and (especially) micro irregularity into his hairlines, though. They tend to appear a bit blunt and harsh for my liking. By using custom cut blades to make lateral, linear recipient incisions (lateral slit technique), Dr. E achieves a greater illusion of hairline density and more hairline refinement than some other prominent FUE docs who use hollow implanter needles that make tiny round holes. If Dr. E would add a bit more irregularity along the hairline perimeter for naturalness, his FUE work would be tops in my book.

That’s some very nice, densely packed hairline and temple work, Joe. I look forward to seeing more of Dr. Rahal’s FUE results. Questions about Dr. Rahal’s current FUE protocol: 1. What extraction tool is used? 2. Who executes the extractions? 3. What tool is used to make the recipient sites? 4. Does Dr. Rahal make all the recipient sites? 5. Who implants the grafts into the recipient sites? 6. For large FUE transplants that can’t be completed in a single day, does Dr. Rahal do consecutive day sessions, or does he stage two sessions a number of months apart? Thanks!

That’s some very nice, densely packed hairline and temple work, Joe. I look forward to seeing more of Dr. Rahal’s FUE results. Questions about Dr. Rahal’s current FUE protocol: 1. What extraction tool is used? 2. Who executes the extractions? 3. What tool is used to make the recipient sites? 4. Does Dr. Rahal make all the recipient sites? 5. Who implants the grafts into the recipient sites? 6. For large FUE transplants that can’t be completed in a single day, does Dr. Rahal do consecutive day sessions, or does he stage two sessions a number of months apart? Thanks!