PupDaddy

Gorgeous! Dr. Paul’s hairline work is on my personal (very) short list of tops in the world.

I personally love this result. It makes a terrific cosmetic difference for this patient without being overdone.The distribution of the 2750 harvested grafts as between hairline, top, and temple peaks and points is just right, and there looks to be near 100% yield. I think he should leave things just as they are unless and until he experiences significant additional loss. Obsessively looking at HT photos as we do, I think sometimes we get used to a certain “look” from today’s mega-mega sessions that isn’t necessarily desirable for everyone -- almost like walking around the Upper East Side of New York or Rodeo Drive in Los Angeles and seeing all the women and men who’ve obviously had work done that looks right to them, their surgeons who are considered tops in their field, and people who travel in their circles. Sometimes less is more. Well done, doc.

I personally love this result. It makes a terrific cosmetic difference for this patient without being overdone.The distribution of the 2750 harvested grafts as between hairline, top, and temple peaks and points is just right, and there looks to be near 100% yield. I think he should leave things just as they are unless and until he experiences significant additional loss. Obsessively looking at HT photos as we do, I think sometimes we get used to a certain “look” from today’s mega-mega sessions that isn’t necessarily desirable for everyone -- almost like walking around the Upper East Side of New York or Rodeo Drive in Los Angeles and seeing all the women and men who’ve obviously had work done that looks right to them, their surgeons who are considered tops in their field, and people who travel in their circles. Sometimes less is more. Well done, doc.

Beautiful result, Matt! Congrats. Did you do scalp laxity exercises prior to your procedure? If so, when did you start, which exercises, how many times per day, etc? Thanks!

I don’t think that Dr. Lorenzo does 4k+ FUE procedures, consistently or otherwise. Last time I perused the results on his site, the cases with big numbers were the result of two procedures, separated by at least 8 months.

Oy. It appears that what your doctor did was use relatively large punches to extract small clumps of hair and flesh akin to the old “mini-grafts” rather than using small punches (1 mm or less) to extract naturally growing follicular units of comprised, variously, of 1, 2, and 3 hairs. Then he implanted these grafts widely spaced and also improperly implanted them along the anterior border. What he did was only remotely related to FUE insofar as he extracted the grafts from your donor with punches. Fortunately, your situation looks to be repairable, provided you find a top-notch ht surgeon adept at true FUE and repairing poor transplants. Research the list of recommended and Coalition surgeons on this site. They might well need to punch out some of the larger grafts that were placed at the anterior borders, either in an initial separate procedure or in conjunction with an overall repair transplant. Judging from your photos, you probably will need upwards of 2,000 true follicular unit grafts for a satisfactory result. Good luck!

Dr. Gabel trained in hair transplantation with Dr. Konior, which is one of several reasons that he produces the excellent results he does and is considered by those in the know to be among the best of the best. Happy growing, Superman1!

Congrats on your FUE with Dr. Rahal! The work looks beautiful, as does your donor area. Wishing you 100% yield! Quick question: Did Dr. Rahal do all the punching of those 3015 grafts?

Also, have you personally consulted with both these docs and/or with any others? How many grafts have the docs you've consulted with estimated you would need in total to complete your restoration? I think you might be confusing "yield" (the percentage of transplanted grafts that grow) with transplanted density (number of grafts per square centimeter that are transplanted). From what I've seen of Dr. Dorin's work, he achieves as much yield from the grafts he transplants as anyone. He just happens to be in the camp of ht docs who avoid super dense packing in a single session due to risk of insufficient blood supply that could compromise yield and squander grafts, preferring instead to transplant at slightly lesser density and then bolstering density, if necessary, with a second procedure after the blood supply in the recipient area has recovered and can support a new crop of transplanted grafts amongst the previously transplanted grafts. Other ht docs are comfortable with a more aggressive initial packing. Both approaches are valid and both have benefits and detriments, but you should understand the difference going in. That said, given your relatively low Norwood number, it could well be that docs from either "camp" could satisfy your objectives in a single session. You should ask the docs you consult how many grafts they would propose to transplant, at what density (grafts per square centimeter) they would propose to transplant, and how many sessions they would require to complete your restoration. That way you can meaningful compare your options. As Mickey85 said, if after these consultation you haven't found a surgeon who meets all your criteria, then by all means keep looking and continue consulting -- and don't limit your search to New York if you can't find the right patient-doctor "fit" for you.

Also, Mickey, perhaps the clinic's maximum number of extractions per day and maximum total extractions per transplant would be a good fit for this thread?

Also, Mickey, perhaps the clinic's maximum number of extractions per day and maximum total extractions per transplant would be a good fit for this thread?

How about listing which doctors do the extractions themselves and which doctors delegate the extractions to their techs or nurses? I think it would be valuable to know who is wielding or operating the clinic's tool of choice for the FUE extractions -- the physician, or his techs. If this thread isn't the best place for that info (your call, Mickey85), then perhaps a separate thread could be started.

How about listing which doctors do the extractions themselves and which doctors delegate the extractions to their techs or nurses? I think it would be valuable to know who is wielding or operating the clinic's tool of choice for the FUE extractions -- the physician, or his techs. If this thread isn't the best place for that info (your call, Mickey85), then perhaps a separate thread could be started.

A proviso: Make sure that your chosen clinic does not use implanter pens, such as the Hans Implanter Pen or the Choi Implanter Pen. Why? Because if, as your surgeon advised, the tech or nurse is doing the "placement" of the grafts in the recipient sites, and the clinic uses implanter pens for FUE, then the nurse or tech is also necessarily creating the recipient sites -- because that is how these implanter pens work: the recipient hole is made with the implanter pen, which is loaded up with previously extracted grafts, and a graft is placed from the pen simultaneously with the cutting of the recipient hole. You will want to confirm that the clinic does not use implanter pens for FUE and that your surgeon will be creating/making all the recipient sites. I personally think that the transplant physician should at least place all of the frontal hairline grafts (as Dr. Konior and some other top docs do), but as others have said, it is not uncommon or unusual for reputable clinics to have their techs or nurses do all the graft placements.

Whatever extraction tool is used by a clinic, I also think it would be helpful to list those physicians who perform the follicular unit extractions themselves vs. those who delegate the task of extracting the follicular units to their technicians. The pros, cons, and legality by country, state, etc., of permitting techs to perform the extractions should also be discussed, perhaps with a link to a thread I recently started on this topic.

With FUE being practiced by more ht clinics, more often, and with large FUE sessions becoming more commonplace, I thought we might broach the subject of non-physician techs performing the all-important excisions (punches) and extractions (removals) of the follicular units from the patient’s donor rather than the ht surgeon doing them. An FUE patient of Dr. Feriduni’s recently reported here that Dr. F’s nurses/techs did all of the FUE excisions and extractions for his large (4,000+ grafts) FUE case, with Dr. F’s hands-on involvement being limited to administering the numbing shots and making the recipient incisions. His techs did all the graft excisions using manual, surgical punches, and they did all of the graft implantations into the recipient incisions. The patient wasn’t ragging on Dr. F at all and said he was very satisfied with how the surgery went. He only recently had the procedure done and is awaiting the results. I’ve read accounts of other FUE patients, including, as I recall, some of Dr. Rahal’s FUE patients, where the doctor’s techs did all or most of the follicular unit extractions, using either manual hand-held punches or motorized hand-held punches. I am interested to know people’s thoughts and opinions concerning this practice. On the one hand, it can be argued that techs have routinely been doing excisions of follicular units for years – from strips, during FUT transplants. On the other hand, the strip itself is excised and the wound sutured closed by the ht surgeon. And it can be argued that dissecting follicular units from a physician-excised strip under a microscope is a far different animal than directly puncturing a patient’s scalp thousands of times with a manual or motorized hand-held cutting device. Is the practice medically ethical? Even if so, given the technical challenges inherent in “blindly” excising and extracting hundreds or thousands of precious, finite grafts from the donor via FUE whilst avoiding transecting the follicular unit being excised or injuring surrounding follicular units, should we expect this task to be performed by our surgeon rather than by his non-physician assistants? Is this practice analogous to an ht doc relegating the excision of a donor strip in an FUT procedure to his non-physician assistants? Or is this practice simply necessary and inevitable as FUE session sizes increase? Are we paying for, and relying upon a surgeon’s skill and experience for this crucial part of the hair transplantation surgery? Or are we fine with this practice provided that the techs are well-trained and skilled? Which begs another question: On whom will these techs have “practiced” to achieve their expertise? How many patients’ grafts will they have transected or otherwise damaged on their way to achieving their skill level? What is the FUE surgeon's duty in terms of notifying prospective or actual patients and/or obtaining their consent that his techs will be doing all or some of the extractions? Must the surgeon advise the patient as to the number of procedures each tech that will be working on him has done? Or should techs simply be forbidden from doing FUE excisions on patients? If we are okay with our FUE surgeon having their non-physician techs cut into our heads with surgical punches hundreds or thousands of times, i.e., performing the first “half” of an FUE transplant, should we also be okay with our FUE surgeon having their techs make the recipient sites? If techs can be taught and relied upon to do FUE excisions and extractions, can they not be taught and relied upon to make the recipient sites? Many clinics already have their techs do all or most of the implantations into the recipient sites, so why not let the techs do the entire procedure and let the ht doc just oversee things? I am not being facetious. I am interested to find the boundaries here. Might it be that docs who continue do the FUE excisions themselves will make that known as a marketing advantage? Or might FUE docs start implementing a two-tiered pricing structure, charging the patient more if the patient elects to have the surgeon do the FUE excisions and extractions rather than his staff? The advent of robotic FUE extraction systems (e.g., ARTAS, Neograft) further fuels the issue. Should non-physician techs be allowed to execute the extractions using one of these machines? Is that different – or the same, or better, or worse -- that an ht doc’s non-physician techs performing the FUE excisions and extractions using hand-held manual punches or hand-held motorized punches? Your thoughts?

You look great, S2! Looks like you got good yield from those 2,800 grafts and that Dr. Eser did an outstanding job with the layout. Congrats!

Flawless! What a hairline (not that you had a poor one before, but this is model-actor material). Very happy for you, Spanker.

Dr. Feriduni didn't do the extractions. His nurses/techs did them. Tooktheplunge says that Dr. Feriduni has 6 nurses/techs who extract the grafts from the donor. (I assume by "extract," taketheplunge means punching out/excising each follicular unit and removing it from the donor scalp.) According to taketheplunge, the nurses/techs, working in rotating teams of two to minimize fatigue, extracted 3,000 grafts initially and then an additional 259 grafts. Dr. Feriduni's direct, hands-on involvement apparently was confined to administering the numbing shots and making the recipient sites -- unless I am misunderstanding something. Wishing tooktheplunge fast, high-yield growth! Thank you for sharing your adventure. Please keep us posted of your progress.

Is it blasphemous of me to say that I've actually come to slightly prefer Dr. Paul's hairline work to that of his more famous brother? There, I've said it!

Modenese, First off, you look great. Congrats! When were the first three photos (the ones with you wearing the cool jacket and holding your camera) taken in relation to the 6-month photo in the time-line grouping? I ask because your hair appears significantly longer and denser up top and in front than it does in 6-month photo in the time-line set. Maybe just a different angle? Thanks for sharing!

According to the thread's title, this was an FUT, not an FUE. But I agree, this looks to be a terrific result by Dr. Bisanga.

Congratulations, fritz. Happy growing. For what it's worth, I think you made an excellent decision to have a final pass done to your hairline. Looking back at your 13-month second ht photos, the contrast and demarcation between your transplanted hair and native hair was detectable (not just to that young girl ). Dr. Dorin seems to consistently achieve some of the most refined, natural hairlines around, so I predict you will be a happy man, indeed. Good luck to you, and please keep us posted!

Here is a link to the thread that Mickey85 started and mentioned in his response: http://www.hairrestorationnetwork.com/eve/169281-ultimate-manual-versus-motorized-fue-thread.html. It is not a comprehensive list (yet), but as you will see from reading it, some FUE docs prefer manual punches for doing the excisions, others prefer commercially available motorized punches such as Dr. Harris' SAFE that you mentioned, others prefer the ARTAS computerized robotic system, and others still have devised their own manual or motorized punches. A number of the docs contributing to or referenced in the thread explain what they see as the benefits of the extraction tool(s) they use for FUE. And, as you will learn, not all hand-held motorized punches are created equal. As others have advised, your best bet is to thoroughly review the body of work of FUE physicians and let their results, rather than the tool they use to excise the follicles, be your guide. A number of top, world class docs experienced with FUE are recommended on this site and post plenty of cases here and on their web sites, so that is an excellent place to start your research. Incredibly good and incredibly poor FUE results have been obtained by docs using all sorts of extraction tools. It's more about the skill, artistry, and experience of the doc and his team than it is about the particular tool that is used to execute the excisions. Good luck!

Looking great for just 6 months! Those 3968 fu's have already made a tremendous cosmetic difference. Congrats.