PupDaddy

Hi smiledoctor80, Would you mind telling us which surgeon did your FUE with the ARTAS, how many grafts, etc.? We are very interested to know about it and your progress. Thanks!

Congrats! You chose a fantastic ht surgeon. Based on the layout in your photo, those 2,300 grafts should do you wonders. Here's to easy healing and great growth.

Ha! From the title of the post, I thought at first we were going to see befores and afters of two strip surgeries performed on Dr. Ron and two strip surgeries performed onDr. Paul. LOL. Terrific work as usual from SMG. Excellent coverage and density from relatively small number of grafts in the first procedure; nice bulk up from the second procedure -- and natural, as usual.

I am not so dismissive of new technology, especially one that has been cleared by the FDA, developed in collaboration with experienced FUE surgeons, and purchased by some of the top names in the business. There have already been numerous "guinea pigs" during the clinical trials, and considering that ARTAS is now being used by Drs. Bernstein, Harris, Rahal, and others for their FUE cases, we should start seeing more and more patient results. As we know, there are three primary challenges with FUE transplants, especially large session FUE transplants: (1) punching around the follicular units without transecting or otherwise damaging them, and doing so repeatedly, thousands of times, being dead center each time and precisely matching the angle of growth, (2) separating the follicular unit from the dermis and subcutaneous fat to enable extraction of the FU without undue torsion, yanking, or other forces that can damage it, and again, doing so repeatedly, thousands of times in a session, and (3) getting "chubby" FU's rather than "lean" FU's -- again, thousands of them so that the FU's that are transplanted will not only survive but mature well and flourish as well as FU's extracted via strip. ARTAS purports to address each of these challenges by perfectly, repetitively, and quickly (making possible mega FUE sessions) excising and separating for extraction healthy, robust follicular units that should yield growth percentages and hair maturity rivaling strip transplants -- something that even the most careful and gifted FUE surgeons using manual punches or hand-held motorized punches have yet to consistently achieve. So I, for one, am optimistic about ARTAS as a game-changing tool for FUE, especially for large cases. I am especially interested to see results (including the appearance of the donor) of the first wave of Rahal patients whose FUE transplants are done with the assistance of the robot and whether his large ARTAS-assisted FUE cases consistently yield results as good as his large FUT cases.

Skin is elastic. The perimeter of a 1 mm hole that is cut into the scalp can momentarily be stretched outward. Based on Dr. Bernstein's description and the ARTAS videos, I would surmise that the 1 mm, sharp punch nests inside the 1.3 mm duller punch (the 1.3 mm dull punch is kind of a "sheath" around the 1 mm sharp punch) and that both can extend and retract independently. The 1 mm punch extends, i.e., emerges from within the outer punch, to cut the hole and hold it open momentarily for the 1.3 mm dull punch to slide over the inner punch into the hole. The minutely larger outer punch, having a rounded/tapered outer surface edge, slightly stretches the hole to accommodate it but doesn't cut the hole larger. The sharp inner 1 mm punch then retracts, leaving the duller 1.3 mm punch to extend farther forward into the hole to separate the "root" of the FU from the dermis and subcutaneous fat, and then retract, allowing the hole to snap back to its original size. Or so I would surmise. When you watch the ARTAS videos, you see that all of this happens in an instant. I doubt that the reputable docs who have adopted and/or helped develop the ARTAS (Harris, Bernstein, Rahal, etc.) would lie about the cutting punch size or use the thing on patients if unacceptably large holes were created -- something that would be evident as soon as the patient's donor area heals.

According to Dr. Robert Bernstein on his site, the ARTAS currently uses "a sharp 1 mm punch" to cut through the upper part of the skin (epidermis and upper dermis), "immediately followed by "a duller, 1.3 mm punch" to "separate the deeper part of the follicular unit from the remainder of the dermis and subcutaneous fat." So the surface punch is 1 mm, which seems an acceptable size in terms of punctate scarring -- maybe not quite so good as the smallest manual punches, but small enough. Plus, I would think you would get a greater number of 2 and 3-hair FU's using a 1 mm surface punch. I spent a couple of hours yesterday watching the various ARTAS videos on YouTube and reading about it on Dr. Bernstein's site. I have to say, it is very, very impressive. Precisely replicating perfect depth and perfect ANGLE of follicular unit scoring, over and over, quickly and efficiently, with computerized mapping to make the most efficient use of the donor, and without the fatigue of manual or hand-held motorized punches, looks to be a game-changer. And according to Dr. Bernstein, who was one of the first adopters, ARTAS beats the transection rate of manual extraction or hand-held motorized extraction -- especially for large sessions -- hands down: “A follicular unit is about a half a millimeter and you have a one millimeter circle that has to go dead center over it to punch this out. So when you’re doing it by eye and you’re doing thousands of them over time you’re missing them over time it’s not exactly precise. The robot is dead center each time and follows the angle of the hair." * * * "There’s always damage to the follicles when you’re doing it [manually] because you’re doing it by hand through these very tiny incisions and so the yield is going to be less and so with a robot if you try to get out 100 follicles you’ll get very close to 100 follicles.” I'm really interested to see yield and density from some of the top docs using ARTAS compared to their FUT or manual/hand-held motorized FUE results, and I'm especially interested to see 3,000+ single-day FUE cases from these docs now that ARTAS should make this more practical and repeatable.

Hey Tex, The reason is can be risky to ht a young patient is not because the grafts might not grow (they don't grow better as you get older) but, rather, because a young patient's baldness pattern might not be developed sufficiently to know what they will be facing in middle age and later in terms of hair loss. That is why using up lots of donor at a young age and/or doing an aggressive frontal restoration on a young patient can be risky. Anyway, I hope you get some better growth and density in the next couple of months, and if not, your doctor has said that he stands behind his work and will take care of you. Best of luck!

Hi s2k, It sounds like you and your doctor, in devising a plan for your first ht, have taken into account your anticipated future hair loss and the fact that you will not be taking finasteride. So I think you are set and should be fine. A target of 3,000 grafts is large but not massive, so it sounds like your doctor is making sure you will have plenty of grafts left in the bank for future procedures should you need them. So even if you were to lose some or all of your currently native hair in the frontal half over the coming years, your doctor would be able to fill in amongst the DHT-resistent transplanted hairs with additional DHT-resistent transplanted hair to prevent things from being "see through." And if you do progress to a VI down the road, there should still be enough donor left for okay coverage in that event. Can I ask: What is your present Norwood level? Are you completely bald in the hairline zone? Do I understand correctly that you have some remaining native hair in your mid-scalp area but everything in front of that will be transplanted hair? If you are able to post a couple of photos, some of the vets or docs here might be able to give you some better reassurance about your plan, but it does sound as though your doc is well aware of your concerns and has planned things conservatively with a view towards the future, but also with a large enough session initially to provide you with a nice cosmetic change.

Hi KGV, If you go to the home page and put your cursor on the "Consult A Physician" box and then click on "Find a Physician" from the drop down menu, you can navigate to maps where you can find hair transplant physicians recommended by this site, by state. You can then visit the web sites of the physicians you are interested in and search this site for results of their work posted by them and and their patients, reviews, etc. Some will even give you a preliminary evaluation via virtual consultation. There are a number of excellent physicians recommended by this site in the states you mentioned. Many here will advise you, however, that locale should not be your primary concern when choosing a hair transplant surgeon. Rather, you should choose the very best surgeon you can wherever they might be, whose work is consistently of a quality that appeals to you and impresses you, and who is able to deliver excellent hair restorations for patients similar to you in terms of hair loss pattern and hair characteristics, and who you feel comfortable trusting your restoration to after meeting the surgeon for an in-person consultation. You will also want to consider how many grafts you are told you will need for a satisfactory restoration, whether the physician would perform the restoration in one session or in multiple sessions, and whether the physician would perform the restoration via FUE or FUT -- all of which are factors to consider. Good luck!

This is a fantastic result! Really, stunning. And how great for this fellow that he was able to mask things with his native hair while the transplanted grafts grew in. I've thought for some time now that Dr. Paul had established himself as the equal of any ht doc out there for similar sized cases, including his famous brother. This case further confirms it.

Wow, Janna! I can only imagine what emotional pain and daily hassle that scar had caused this fellow for the better part of a decade. This fellow's life had to have been transformed by Dr. Ron's efforts. Thank you for sharing this case.

Ah! I wasn't aware of that. Would you mind sending me a private message for my own, confidential use, letting me know what concerns were not addressed?

Dr. Keser's work has been discussed, shown, and linked quite a bit on other hair restoration forums (a poster on one of those forums compiled a list of links to Dr. K's results a while back), his clinic posts on one of those forums, and videos posted by some of his patients are also publicly available. I agree that this pick for top 5 is something of a wild card and "conditional," as I said, but the work of his I've seen is beautiful and extremely impressive. He performs multi-day FUE sessions, taking a maximum of 700 grafts per day. I do hope that his clinic and patients start posting here more.

Great work on a dark-haired hairline, and fantastic density! A perfect marriage of great donor hair and a great surgeon.

Sorry for the confusing syntax, Mickey. I was saying that some of Dr. L's hairlines aren't quite as dense as I'd like to see but, more so, some of them aren't quite as naturally irregular or as refined as I'd like to see. Not to say they aren't good -- they are, only that I've seen some hairline work from other ht docs that, generally speaking, I prefer. But I'm not slogging Dr. Lorenzo at all. I would seriously consider him for an FUE restoration, which is saying something because at this point, there are only a small handful of FUE docs I would personally consider.

secondtime, Man alive! You look fantastic now. Dr. Umar did you proud. I haven't followed your thread or progress. I just saw the thread today and compared your before pics to your most recent update pic. Personally, I would leave things just as they are and keep your hair at the length it is in your most recent pic, i.e., slightly longer than in some of your earlier pics. It looks very appealing and utterly natural this way. I don't think you need or necessarily even want more density because the appearance of just the slightest amount of thinning in those spots (and I do mean "slightest") is completely age appropriate currently and for the future and contributes to the naturalness of your great head of hair. Congrats.

My only reservation about Dr. Lorenzo's work is that some of his hairlines look, to me, a bit less refined, appealingly irregular, and/or dense than they might. Whether that is a product of design or of limitations of the Choi implanter pen, I don't know -- and others might very well disagree with my totally subjective observation. But no doubt about it: Dr. Lorenzo has posted more, thoroughly detailed, consistently good-to-great FUE results than anyone I know of, and I think he belongs on anyone's short list of FUE surgeons. Also, I have no problem with his and his technicians' speed and agility handling the grafts and loading them into the implanter pen. The proof is in the pudding, and from what I've seen with his many, many posted, video results, Dr. Lorenzo consistently achieves excellent yield with FUE.

Returning to the topic for a moment . . . . I am (conditionally) putting Dr. Muttalip Keser (Ankara, Turkey) on my list of Top 5 FUE surgeons worldwide. I say "conditionally" because his web site says that Turkish law prohibits the posting of patient photos on it, so the available photos and videos of his work are decentralized. But from what I've seen, Dr. Keser does fantastic FUE work.

Maybe the difference is that SMG's larger sessions are strip? I do remember Janna saying that SMG isn't noticing any difference in yield as between FUE and FUT, so maybe it's just that the FUT cases you are thinking of where higher density was achieved were due to more grafts being transplanted (a bigger session). Either that or maybe you've lost a contact lens, cd. But I agree with you: SMG's FUT and FUE work is consistently beautiful and my personal favorite among the groups that generally take a more conservative approach.

I disagree with you on this point, chrisdav. From what I see and comparing it to other SMG results, the yield achieved from the 2,000+ FUE grafts is the same as would have been achieved if the same number of grafts had been taken from this patient via strip. The relatively small graft count had to cover quite a bit of real estate (NW IIIA), so whether taken by FUE or FUT, they weren't going to give this patient a "mop" of hair -- which I think would have looked wrong on this patient anyway.

This fellow look absolutely great! SMG's FUE work is impeccable. Thank you for the update.

Hi Pipj83, I think BadBeat got it right. You look good with a shaved down head, much like a good friend of mine who has your same amount of hair loss (probably approaching a NW 6) and truly looks better than when he had hair in his college and graduate school days. I think if I were you, I would either leave things be or consider FUE but, as BadBeat said, with a view towards keeping your hair closely cropped with a 1 or 2 guard. It would suit you well and you would appear to have plenty of hair but be style-forward with the shaved down look.

No. beaverbuzz, Ultimately, it isn't for anyone but you to say whether you should or should not be happy with how your temple peaks are looking in the context of your hairline advancement. It is your head and face, after all. However, Janna articulated what others have observed: You have gotten a good amount of growth of the transplanted peaks hair, and the kinkiness of those hairs will subside over time as they go through a couple of growth cycles and mature, making them blend better with the temple hair behind it. If you decide in a few months that you still want to bulk them up some, Janna has said that Dr. Shapiro is happy to do it. Until then . . . . DUDE, YOU DON'T NEED TO WEAR A HAT! Sorry to shout. Please do not take offense, but might I ask whether you, like a lot of people (myself included), might have some OCD/perfectionism tendancies? I think it is fair to say that you have become fixated on your temple peaks. They might not yet look 100% like you ultimately want them, but they absolutely do not look unatural or call attention to themselves or negative attention to you in any way. I promise. You have an amazing head of hair and a handsome face of which your temple peaks are a tiny part of the whole – and those peaks, as is, look better than most guys’ out there (certainly better than mine) by themselves and, especially, in context with the rest of your hair, your face, your head, and the total YOU. I apologize if I am out of line or if I offended you, but it is actually painful to read that you feel compelled to wear a hat in public and social situations only because the transplanted hair of your newly-advanced temple peaks isn’t yet as dense and mature as you would like. I am not saying that your pain isn’t real; it obviously is. I am saying that it isn’t necessary or rational and truly hope you come to see that and start enjoying your new and improved hairline (including the front, temple corners, and temple peaks) and the additional cosmetic appeal it has given you. If you and Dr. Shapiro decide to tweak things a bit later on, fine, but I promise you are good to go -- hell, great to go -- right now. Want more assurance? I showed my girlfriend your after pics when your hair was grown out more. I gave her no background or anything, and just asked her what she thought about this fellow (you) and his hair. She said, “Wow, he looks great! Does everyone’s transplant turn out this well?”

This fellow looks great, Dr. Keller! Beautiful work.

Very, very nice, natural restoration. The patient's curly/wavy hair characteristics are really beneficial to this result as well. Nicely done!