PupDaddy

P.S. Dr. Yaman, I was intrigued by the description of your FUE protocol in your profile: using a micromotor (motorized handheld punch) set at low speed rather than high speed to minimize heating and breakage of the follicles during extraction, and extracting and implanting in 1,000 FU increments to decrease out-of-body time of the transplanted follicles.

Ditto what others have said: This is an excellent cosmetic outcome for this fellow, especially considering the amount of real estate there was to cover. I'm particularly impressed by the appealing facial framing Dr. Yaman achieved for this patient with the design of the hairline. Well done!

Really beautiful FUE work, Dr. Panine. Very refined hairline. Do you do the extractions yourself? What tool and punch size(s) were used for the extractions?

How does permanent SMP work out as the patient ages? As the pigment of the patient's native buzzed down hair gradually lightens, then goes to gray, then to white, won't it look odd that he maintains a large frontal island of perpetually dark "follicles?"

Sean, Per recedingboy's suggestion, Dr. Diep might actually be a very good fit for you. He is all about facial framing. He does all the FUE extractions himself, using a non-motorized punch of his own design. Like Rahal, he makes the recipient slits using beveled surgical needles. You can check out his work on his YouTube channel where he has posted dozens of impressive before-after video FUE results, and often discusses his philosophy and approach to facial framing through cosmetically appealing hairline placement, hairline shape, and temple/sides advancement where appropriate, based on the patient's face shape, ethnicity, etc. Might be worth a consult. He does both Skype consultations and in-person consultations in his Los Gatos, CA office. Good luck with the completion of your ht journey.

Looking great, yeahwrite! Can't believe how quickly you're growing in. Must be great to have that facial framing back. Going forward, would love to see some hairline shots with your hair combed/brushed/lifted back. Would also be interested to know what tool(s) and punch size(s) Dr. K used to extract your grafts, per houtex's question. Thanks for keeping us updated. Much appreciated. Continue growing well!

Worthy of a bump, Spanker. Dr. K is an artist.

Good catch, mav! Thanks for the correction.

I agree. A home run result here by Dr. Diep. This fellow must be ecstatic. I continue to be impressed with Dr. Diep's hairline design, placement, and execution. Also impressive is the consistently good FUE yield this doc appears to achieve. This is likely at least partially attributable to him doing all the extractions himself, using a non-motorized manual punch of his own design (the "Diep Extractor") with a .9 millimeter diameter punch, which is slightly larger than that the FUE punches in popular use by some clinics (e.g., .75mm-8.5mm) and which might contribute to the extraction of healthier, more robust grafts. Whether the punctate scarring is more noticeable using this slightly larger punch size is hard to determine from the post op donor photos I've seen. Anyway, terrific result!

What others have said. Lovely, refined work and a life-changing yet natural and appropriate transformation for a gentleman whose donor density and hair caliber seem to have diminished, somewhat, with age, as would be expected. I especially like his hairstyle and his look in his first "after" photo. Terrific.

Really lovely work and cosmetic result, and kudos to Dr. Maras for long-sighted donor management and plan. I've mentioned this before, but I don't see this level of hairline refinement and naturalness from docs using implanter pens.

Wow. Beautiful. This is the largest single-session FUT of Dr. Wesley's I recall seeing. Looks like this fellow styles his hair with Vitalis or Brylcreem, so I imagine it looks even denser au naturale. Nice!

Looking good, David! I really like the hairline advancement on you, as well as its design. Looks like Dr. Bhatti did you proud. Wishing you continued good growth.

This fellow is looking great, Dr. Keller! Love that natural, refined hairline.

Great work, Dr. Lindsey! This fellow looks SO much better transplanted than he did with his hair piece. As you say, good catch by Davis91 of your good decision to angle the transplanted hair a bit more vertically than usual to better match the growth angle of the patient's native hair. Looks right on him.

Borromeo, I would echo what Sean and Garageland said: You could use a touch-up of the hairline work, but don’t rush it. Let your scalp and your psyche heal a bit. You sound like maybe you’re a little panicked, or at least frantic. Don’t be. Overall you have a great head of hair, and although your hairline can and will look even better with a touch-up, it isn’t urgent. Take your time and consult with a number of Coalition or Recommended docs. And if, right now, you can’t afford the work you decide you really want, from the doc you want, then wait until you can afford it — or ask the doc about financing options. You made some mistakes, but not disastrous ones. Those mistakes aren’t irreparable IF you do your research this time and don’t rush yourself or let yourself feel pressured to schedule another surgery right away. Take a breath. Good luck!

NY10013, The ARTAS is no longer all that new. It has been tried by some of the world's top ht docs and their clinics, including, for example, Rahal and Shapiro Medical Group. Both have abandoned it in favor of manual FUE extraction, using either standard punches or hand-held motorized punches. As Mickey85 noted, a good percentage of the surprisingly few photographically published ARTAS-assisted FUE results have been subpar compared to what is achievable with good manual FUE extraction and a talented, experienced ht doc creating hand-made graft recipient incisions. The ARTAS is heavily marketed to plastic surgeons and dermatologists as an "easy" way to add hair transplantation to their menu of offered procedures. One of the New York docs you mentioned would arguably fall into this category. FYI, two of the most experienced ht docs in New York City that perform a good amount of FUE -- Dr. Wesley and Dr. Dorin -- both do manual extraction of the grafts using hand-held motorized punches. Both these docs are recommended here and both have published numerous examples of their FUE work here. There is much healthy debate as to the "best" tool for safely extracting viable grafts via FUE: some docs advocate sharp tip punches, others advocate dull tip punches, others claim equivalent viability using one of several variations of motorized punches, some having sharp tips and other having dull tips, and some docs have developed their own custom designed punches or hand-held motorized punches and devices for FUE extraction. What I don't think you'll now find is any serous debate, at least among top FUE docs, that an ARTAS is a better or even equivalent tool for viable FUE graft extraction as a manual (hand-held) punch of whatever variety in competent, experienced hands. Please do your research before deciding on a hair transplant doc, FUE or otherwise. A poor result from a hair transplant can have long-lasting negative consequences and can squander thousands of your precious, finite supply of donor follicles. Find a number of docs who are well reviewed, have published lots of well documented before-after photographic examples of their work (with the tools and techniques used for each case specified), and whose work appeals to you. Then schedule virtual or in-person consultations with each of them. And don't let your geographical location be the deciding factor or even a limiting factor. Many men fly thousands of miles to get worked on by the doc that their research and consults reveal to be the best fit for them.That doc could end up being in your backyard, but if he or she isn't, then (to quote Jay Mohr quoting Christopher Walken), "there are airplanes." Good luck!

Project much, Seth?

What the others have said. 300 more grafts would likely just be a further waste, and I personally would consult with a couple of coalition or recommended surgeons here before deciding to let your surgeon have a second go at you. I might even go so far as to say you would want to look into having some of those temple grafts and lowest hairline grafts removed (in other words, redo the shape and location of the hairline), either in conjunction with a second transplant session or in advance of it. There are several approaches to removing grafts that a top notch ht surgeon could discuss with you (e.g. punching them out and re-transplanting them elsewhere, electrolysis, etc.). Good luck!

PLEASE keep us photographically updated of your progress! We are eager to see more of Dr. Konior's FUE work. The hairline design and post-op photo look great, as is always the case with Dr. K.

Lovely work as usual from Dr. Ron. Very nice cosmetic improvement! SMG's FUE work impresses more and more.

Interesting. Three FUE procedures. I totally understand that you don't want to be recognized by prying lurkers, but if you can figure out how to mask any identifying features in your before-after photos I think a lot of people here would be interested to see your case -- especially since you ultimately received what characterized as a great result. Your call, of course. Can I ask what your starting Norwood level was and the number of grafts transplanted with each of the 3 procedures? Can you tell us the doc(s ) that performed your procedures? How did you or your doc(s) go about measuring the grown-in yield of your 3 FUEs? How is your donor area now? I'm not offended that you advocate FUE over FUT or that you hold the practices and work of certain docs in higher or lower regard than others. I have no dog in this race. I have some personal favorite docs based on their published results, just as there are some docs whose work doesn't impress or appeal to me as much. Some do primarily FUE, others do primarily FUT, some do good amounts of both. It's just that you seemed remarkably pro FUE and anti FUT (and the docs that offer it) for someone whose thread about his own FUE case indicated a less than satisfactory outcome. Sounds like your two subsequent procedures left you a happy camper. Good!! I do think that the best FUT work still holds a significant edge in consistent yield/density over the best FUE work on visual comparison and that the limited clinical data is consistent with this, and explains why this would be so. But there is some fine FUE work being turned out today that I personally would be happy with as a patient. In fact, as someone no longer in his twenties (or thirties, or . . . ), and whose Norwood level took decades to reach its present IVA and seems fairly stable, I now would likely be an excellent candidate for a large FUE restoration -- unlike, in my opinion, higher Norwood 20-somethings who run a significant risk of prematurely using up their safely extractable donor supply by flying to Turkey for the FUE mega sessions being marketed to them.

Weren't you on this very forum fretting about the poor result you got from your FUE transplant? At 15 months post FUE surgery you started a thread to ask whether you could expect any further growth or thickening of the transplanted hair because you still had a "large, thin area" behind your hairline that had been transplanted: http://www.hairrestorationnetwork.com/eve/173108-15-months-post-fue-will-i-get-more-growth.html#post2372711 I'm not trying to bust your chops, but it seems odd that you would so enthusiastically promote FUE and so vociferously malign FUT and FUT docs/clinics when you seem to have experienced first hand the challenges associated with FUE yield and matured density/hair quality. Did you experience a sudden turnaround of your situation after the 15-month mark? (I hope so!) Did you go for a repair or touch-up, as you indicated you might? Could you please post before and after photos of your FUE transplant surgery/surgeries so we can assess your FUE results? Thanks!

Hi Alex, First, lovely FUE work, as we've come to expect from Dr. Maras. Second, can you please expand on this statement from your original post: "Some doctors or clinics, offer FUE procedures of 4000 – 5000 grafts in one session. This increases substantially the risk of donor depletion and FUE scarring and many times not allowing any additional FUE procedures." What do you see as the main challenges/problems with mega FUE sessions ("session" meaning one hair restoration surgery, whether preformed in a single day or over multiple days)? Why, in your experience and opinion, do sessions of, say, > 3,000 FUE (a) substantially increase the risk of donor depletion, and why do they (b) substantially increase the risk of FUE scarring that could prohibit future additional FUE sessions? As to "a" (increased risk of donor depletion), is it because yield will likely be poorer with such large sessions, resulting in wastage of hundreds if not thousands of donor grafts? If so, why is it that yield likely will be poorer with mega sessions? Other reason(s)? As to "b" (increased risk of donor scarring that could interfere with or prohibit addition FUE extractions in the future), is that because such large sessions result in subcutaneous scarring to adjacent or nearby un-extracted follicular units? Other reason(s)? Thanks in advance for your response.

Really, really nice result. Gorgeous work. Excellent use of grafts. Appropriate hairline for the patient.