PupDaddy

NewHare,

I've had a consultation with each of the following New York docs who are recommended or coalition physicians here. Based on their body of work, reputations, and my consultations, I think you wouldn't go wrong with any of them for the kind of work you're looking for:

Dr. True

Dr. Dorin (True's partner)

Dr. Wesley

Dr. Feller

I haven't met Drs. Bernstein or Beehner but lefty and esrec both give Dr. Bernstein high marks. I think it's fair to say that Drs. Bernstein and Beehner both in the more cautious/conservative camp when it comes to graft counts per session, which might suit you well. Definitely look at the portfolios of patient results for each of these docs, here and on their web sites, as each has a bit different approach and aesthetic.

I would readily trust any of these NY docs with repair of old plug work, either via punching out the plug grafts and dissecting them and repurposing them or via camouflaging them with new follicular units, or both.

Good luck!

Thanks very much for posting that, Dr. Lindsey. I think it gives us realistic expectations for strip scars when FUSS is performed by skilled surgeons who (a) don't take too wide a strip for the patient's scalp laxity and (b) take the time and care to perform an expert trichophytic closure.

As you note, even this doesn't guarantee a perfect, virtually invisible strip scar in every case, but the odds of getting a poor one are slim (4/120 = less than 4%). Good to know.

It should be plain by this point that this clinic is little more than an FUE mill, with minimal surgeon involvement with the procedure and technicians creating recipient site incisions, including for frontal hairline and temporal work.

I know of NO REPUTABLE HT SURGEON that delegates to technicians or nurses the critical surgical task of cutting graft recipient incisions, regardless of the tool used (blades, needles, or implanter pens). Certainly no other coalition or recommended surgeon on this forum does so that I am aware of. This is the heart, soul, and artistry of hair restoration surgery.

The fact that this doctor seemingly can't be bothered to carry out even this critical surgical task himself is, IMO, per se disqualifying. Add in the other disturbing clinical practices and online practices described in this thread and in the other related thread, not to mention the unprecedentedly numerous patient reports of poor practices and poor results, and it seems clear that this is not the sort of surgeon and clinic that should be vouched for and recommended by a patient-oriented surgical hair restoration site.

I'm not buying what cenkoa01 is selling. If anything, he's making this doctor and his clinic seem shadier.

Dr. Made nearly 65 percent of his recipient area over two days.

I've read enough. The admission of Dr. Doganay's own representative that Dr. Doganay allowed a non-physician to wield the choi implanter pen to do more than a third of the recipient site creations (and, by necessity, graft implantations) for paleo's case, is damning. Also, the doctor's rep does not dispute paleo's charge that this non-physician even created recipient sites for at least part of the patient's frontal temporal work.

The rep says that Dr. Doganay no longer does extractions since he "got famous" -- thanks in no small measure, I would surmise, to the promotional activities of the clinic and its visibility on this very forum. Apparently, the doctor is now too famous and too busy to actually perform hair transplantation. He has relegated all the FUE extraction work to technicians and now it seems he can't even be bothered to carry out the most critical aspect of hair transplantation in terms of artistic, cosmetic, and natural result -- the creation of the recipient sites for the transplanted grafts.

IMO, this forum ought not recommend initially, or continue to recommend ANY hair transplant physician that allows ANY non-physician to create recipient sites for a hair transplant. Whether blades, needles, or implanter pens are used, and whether the grafts were harvested by strip or by FUE, a line that should not be crossed, IMO, is having non-physicians create recipient sites, i.e. performing hair transplantation surgery. That is the work of the surgeon, the person who's name is on the door and whose work is the basis of recommendation here and the basis for members and visitors to choose the surgeon for their hair restoration surgery. Once even that surgical task is relegated to non-physicians for the sake of expediency and upping the head count, the work is no longer the surgeon's -- it is the work of anonymous, replaceable-without-notice technicians and other non-physician employees performing surgical cosmetic procedures.

I also tend to give more credence to paleo's account of the other issues he raises because his account seems more plausible in the context of what we know.

Perhaps Dr. Doganay has become a victim of his own early success, but it seems clear that his has become a technician/nurse-led hair transplantation practice and FUE hair mill, or at least is well on its way there.

The only thing that I was not really happy about (and put me in a bit of a worrying state) is when I noticed that the doctor actually left the room for a consultation with another client, leaving the head nurse alone performing the implant.

Another patient of this clinic (the first being paleo) reporting that technicians are creating recipient sites and implanting grafts (simultaneously, using implanter pens) while the surgeon is AWOL. Not good.

It also now appears that Dr. Doganay no longer does any extractions himself and leaves that task entirely up to his techs/nurses as well.

Yikes, paleo. If technicians are wielding implanter pens and using them on patients' scalps, then Dr. Doganay's clinic has indeed become a technician clinic where technicians perform hair restoration surgery. Many budget FUE clinics in his country reportedly have adopted this model (although some try to disguise it) but this is the first I've heard that Dr. Doganay has gone down this path. If your report is accurate, it sounds like Dr. Doganay only personally worked on part of your frontal hairline and let his technicians perform the rest of the transplant surgery, from scoring and extracting the grafts from your donor to creating the recipient sites and seating the grafts for the remainder of your recipient area, including even some or all of the temple work (which I consider to be part of the hairline).

FUE2014, if what paleo reports is accurate then techs are necessarily creating recipient sites too because that's how implanter pens work. We've read about other budget, technician FUE clinics in that country letting technicians do the site creation with needles or blades or drills followed by forceps placement/seating of the grafts into those sites. This is the first I've heard of an FUE clinic letting technicians perform these surgical tasks with implanter pens, but that's really beside the point. In my opinion, technicians shouldn't be creating recipient sites in patients' scalps regardless of the tools used, and certainly not at the clinic of a doctor that is recommended here.

Very, very concerning.

yes, both days young nurses did the extraction and Dr Doganay only partially did the implantation. For most parts of the operation he wasn't even there.

paleo,

Dr. Doganay says he uses implanter pens to simultaneously create (cut, punch) a graft recipient site (hole, channel) and seat a graft in it. It would be highly irregular if someone other than the surgeon did any graft implantations at a clinic where implanter pens are used. That would mean that a non-physician was performing the cosmetically all-important surgical task of creating the graft recipient sites. Are you sure that his techs or nurses were implanting some or most of your grafts? Using implanter pens? If so, this would be very, very concerning.

Thank you for clarifying your FUE protocol, Dr. Diep. I was relieved to see you confirm that you personally punch (score, excise) each and every FUE graft, a critical task that many if not most clinics offering FUE have relegated to technicians.

I have no problem with technicians plucking the previously scored grafts from their sites. Nor do I have a problem with technicians placing/implanting the grafts into the recipient sites made by the surgeon. These seem responsible, efficient, non-surgical uses of technician labor for FUE procedures and both are standard protocol even at the increasingly rare clinics where the ht doc personally scores/punches the grafts.

One question: You used the word "drill" as well as the word "punch." Do you still sometimes use a motorized punch? Is that what you meant by "drill?" I thought you only used manual, non-motorized punches.

I would hope that the aftercare situation that HTsoon described was an anomaly. In my opinion, patients really need to see their surgeon after the procedure is completed, even if just for a couple of minutes to have the surgeon inspect the implantations, assure the patient that all is well, and make sure they understand and are comfortable with immediate aftercare. Patients also need to be able to get in touch with their surgeon post op if they have serious questions or concerns, at least via email, and the clinic's staff should be well versed and organized for follow up with each patient post op to make sure the patient is compliant with post op care and to answer "routine" (although nothing is routine to a ht patient) questions.

Thank you for participating in this discussion.

Agree with what everyone's said. One of the best SMP cases I've seen. I don't know that I could differentiate this one from the real thing. Well done!

I don't know which other of Dr. Rahal's patients you're comparing yourself to just 4.5 months post op, but it looks to me that things are going great and you should have a tremendous cosmetic improvement (you already have) when all is said and done. Maybe check back with us with new photos at nine to ten months post op? And then 1 year post op? My guess is that compared to your pre op, your cosmetic situation will be strikingly better by then.

Your hair characteristics appear good for ht (thick caliber, somewhat course, with wave), and already you've had significant growth. You went with a reliable and proven harvesting method (FUT/strip) and one of the top docs and clinics in the world. Keep in mind that throughout the next eight to ten months, not only will new transplanted hairs be popping through but other transplanted hair will have gone through additional growth cycles and will be maturing and improving in quality.

You had less than 3,600 grafts transplanted into a rather large area, less than five months ago. Keep in mind also that it isn't at all unusual that an ht patient wants or requires a touch-up session after their first ht has grown in and matured. There may be areas that can use some densifying or tweaking. You'll know more in the coming months but as I said, for this VERY EARLY stage you are showing excellent growth. Try to not drive yourself crazy comparing your still very early growth and maturation to that of other patients (early, spectacular growth is the exception, not the rule) and certainly not to patients whose transplanted hair has had time to fully grow in and mature.

Good luck!

Bill and David should clarify with Dr. Diep whether he personally performs all the scorings and extractions of grafts in his FUE cases himself or if his techs do some or all of them. He claims to personally do all the extractions himself using a manual punch of his own design, and he touts this -- the surgeon, with intimate knowledge of anatomy and physiology, personally "pulling each hair root" (as he puts it) -- as something that sets him apart from other clinics that offer FUE hair restoration.

His techs would be expected to participate in the extraction process by collecting, sorting, and inspecting the grafts as the doctor scores and extracts them, so it wouldn't be out of the norm for one or more techs to be right there by his side during the extraction process and working on the patient's donor. If any of them are actually scoring or extracting grafts, however, that is counter to what Dr. Diep claims and is information that potential patients should know. Bill and David, could you please clarify this with Dr. Diep?

At every clinic recommended here, techs routinely do all or most of the implantations, be it an FUT case or an FUE case. Implantation of grafts into recipient sites made by the surgeon is one of the primary jobs of an ht tech, the others being to dissect strips into follicular units for strip cases and to collect, sort, inspect, and store grafts harvested via FUE. So it wouldn't concern me if Dr. Diep uses his technicians for these tasks. The one exception, of course, is where implantation is performed using implanter pens. Techs should never be doing graft implantations in that case, only the surgeon.

If Dr. Diep is routinely double-booking in-person consultations and rushing potential patients through them, that is both poor form and poor practice. The in-person consult is crucial to providing information, answering questions, formulating a long-term strategy for a patient's restoration, allaying concerns, and generally providing a patient with informed consent. It should be more than a rushed intake (sign them up) or marketing ploy.

The doctor not at least checking in with the patient following a ht before the patient leaves the clinic is discouraging and can indicate a lack of interest in the patient or his after care. I hope that isn't the case.

It sounds as though aftercare might be disorganized at this clinic and that the patient's access to the doctor's direct advice and input following surgery could be lacking. Again, I hope this is not the case.

I would urge Bill and David to raise these issues with Dr. Diep, see what he says, and, if appropriate, ask that he formulate a plan to address them.

Really good cosmetic improvement, especially for only 2,500 grafts and the amount of area covered. (The patient's wavy hair didn't hurt either.) Dr. Diep continues to produce impressive results.

In one of his recently posted YouTube videos (I don’t think I’m allowed to link to it), Dr. John Diep says that grafts harvested by strip “will grow five to ten percent better” than grafts harvested by FUE.

Dr. Diep’s quantification is notable because he offers and regularly performs both methods of extraction and considers himself an FUE specialist. Dr. Diep performs all the extractions for his FUE cases himself using a manual (non-motorized) punch and tool of his own design.

As far as I’m aware, Dr. Diep is the only HRN recommended surgeon other than Drs. Feller and Lindsey and maybe Dr. Ron Shapiro to have publicly quantified the expected growth differential between these two harvesting methods in his practice.

In the mentioned video, Dr. Diep says that both extraction methods produce “excellent results” but that FUT/strip will grow “five to ten percent better.” He goes on to say that FUE is well suited to cases of mild to moderate hair loss whereas FUT/strip is advantageous for cases of advanced hair loss where very large numbers of grafts must be harvested.

More grist for the FUT vs. FUE mill, I suppose.

Damn, Matt -- you look like a movie star! Beautiful work here by Dr. Konior, and apparently solid growth of the 2075 FUE grafts that were transplanted.

Also good to see less conservative hairstyles on Konior patients like our two Matts (1978Matt and matt3480). Someone once commented here that Dr. Konior gives patients "politicians" hair, but I think that's more a function of his Chicago-centric clientele's styling choices. There's nothing Mitt Romney about matt3480's hair.

Agree with all the positive comments, especially NoTakeBacks' analysis. Another gorgeous, natural, patient-specific case from the talented Dr. Cooley.

Thanks for posting that fascinating video, Dr. Lindsey. I'm starting to get a better idea now of the mFUE process. I look forward to seeing followups showing mFUE patient's fully-healed donor scarring following significant sized procedures. Based on your videos and my understanding of the technique, I see no reason not to expect the same consistent growth percentage of grafts harvested via mFUE as is achieved with grafts harvested via strip since both use visual, microscope-assisted dissection of the fu's from the excised tissue and both methods maintain the supportive tissue surrounding each fu graft. Correct?

I counted about 26 elliptical segments extracted that yielded the 1692 follicular unit grafts for this case. You seem to punch out the segments in "rows" to form sort of a broken horizontal line, is that right? How many "rows" of extracted segments did this case entail, if you recall?

Would you say that the benefits of mFUE scarring v. strip scarring come from (a) a pattern of broken/dotted "lines" of non-continguous short scars rather than a solid linear scar, and (b) less tension on the closures of these short, punched out elliptical sections versus the tension along the upper and lower edges of a solid linear strip wound?

custar,

It is apparent that you are just beginning your research into hair transplantation. There are numerous threads here with dozens if not hundreds of pages devoted to the FUT vs. FUE debate. PLEASE take your time, do your research, read everything you can about hair transplantation, including the differences between extraction of follicular units via FUT (strip) vs. extraction of follicular units via FUE.

Finally, PLEASE consider that you are contemplating COSMETIC SURGERY, not buying a pound of sugar or other interchangeable commodity. Forget about "fair and competitive" pricing and look for the surgeon(s) producing, to your eye, the very best, most consistent results (they should have a large folio of befores and afters). A lot of cosmetic surgeons do nose jobs and face lifts, for example, but I think you'll find that the ones who try to compete primarily on price are surgeons you'd rather avoid.

As a starting point, go through the numerous threads in the "Results Posted by Leading Hair Restoration Clinics," "Hair Restoration Results Posted by Patients," and "FUE (Follicular Unit Extraction)" sections of this forum, and visit the web sites of the surgeons/clinics that impress you, and schedule virtual or in-person consultations with them.

Be willing to travel to wherever that surgeon(s) you rate best for you might be located. Again, this is cosmetic surgery with life-long consequences you're contemplating. If right now you can't afford the work of the doctor(s) you rate the best, or if you can't arrange for financing of your procedure through your chosen clinic or through other avenues, then WAIT until you can afford it.

Good luck!

Terrific! Life-changing result. Looks totally natural, i.e. doesn't look transplanted.

You are so close, Pup. So close !

Is there a prize for being the closest? A virtual Chevy perhaps?

Okay -- one more tweak to my guess:

They aren't the same person? (Maybe they are even twins, and the photos got shuffled?)

In other words, there was a mix-up when compiling this patient's case photos? Both are "before" photos, taken months apart (note the longer hair in the photo on the left) that could be, and possibly were initially confused for before-after photos of work on the patient's frontal forelock?

This isn't a before-after presentation? It's two shots of the patient before he had work done? The photo on the right was taken at his consultation? The photo on the left was the day of surgery after he was marked but before it commenced?

For only five months on, you're looking great! Dr. Alexander designed a beautiful hairline for you.

Please update us as things progress.

Thanks for sharing your experience.

Hi Coppal,

Sorry, but I tend to agree with the guys cautioning against getting a HT, be it via FUE or FUT. KO noted the pertinent factors and reasons -- your extensive diffuse thinning (as opposed to front-to-back recession) at your young age being primary among them.

Something you might consider is getting some sessions of temporary SMP to reduce your dependency on fibers and concealers. If you choose not to get on fin, what's left of your native hair on top will likely miniaturize and depart faster, but it looks like it's likely to go either way. As it does, you could continue SMP and cut what you have left shorter, eventually buzzing down to a 0/1 but with SMP giving you the look of a hairline and buzzed down hair. I think it will make an appealing look for you.

I had the same experience with minoxidil as you. Can't use the stuff.

Good luck with whatever you decide!

most dedicated HT Surgeons eventually agreed that manual extraction is the best option for FUE and have since passed on motorized punches (including Dr. Feller and Bhatti).

Dr. Bhatti uses motorized punches.