PupDaddy

Wow. You’d almost think that the naysayers and personal attackers here are personally invested in FUE clinics or something. Are some of your loved ones FUE? Listen, if FUE were perfect, then FUE clinics would consistently turn out cases indistinguishable from strip. That hasn’t been the case to date. Personally speaking, I can nearly always tell when the work was FUE versus when it was strip. On visual inspection, the best strip work still holds a significant edge over the best FUE work in terms of yield/density and the quality/characteristics of the matured transplanted hair. The differences can be even more pronounced when viewed in person, at least for the cases I’ve seen. FUE outcomes have improved since the days of its infancy, but as the limited available clinical research confirms, the blind punching with tiny punches it requires and the skelotanized grafts it yields remain obstacles to consistent, strip-level yield and strip-quality matured transplanted hair characteristics — yes, even when implanter pens are used (no offense to Dr. Vories or to any other FUE doc). So how about we withhold judgment on mFUE and dispense with casting aspersions on these docs’ integrity for giving us a peek at a nascent approach they are experimenting with? They are in the early stages of testing a harvesting method that could, conceivably, marry the best of the strip and FUE worlds. Good for them, good for us. Innovation breeds innovation. If it doesn’t pan out, que sera. What’s your beef?

Gorgeous, refined, natural work, especially given the patient's high contrast between hair color and skin tone. Patient was well served in this instance by taking a conservative approach and not closing temples but instead filling in and densifying his natural pattern. Looks great on him.

Really nice work by Dr. Arocha! And not easy to achieve this degree of frontal hairline naturalness for a patient with such high contrast between hair color and skin tone.

Looking forward to seeing the matured result for this one. Dr. Wesley executes some of the most interesting and unique frontal hairline recipient designs for a natural, non-transplanted look.

Very very interesting stuff, Drs. Bloxham and Lindsey. Microscopically dissected fu’s from dispersed “micro strips.” Cool! And very creative. Assuming that the quality of the grafts, transection rate, and quality of grown-out hairs generated by mFUE harvesting prove to be essentially equivalent to that of strip (I see no reason in principle why they wouldn’t), I suppose what we’ll all be interested to see is donor scarring for substantial sized cases. I wonder, on average, how many of these dispersed elliptically punched/scored “micro strips” need to be taken for a 1,500 graft transplant, a 2,500 graft transplant, a 3,000-4,500 transplant, etc., how long each tiny straight scar would be, and how the donor area will look after recovering from a large session(s). For what it’s worth, a while back I had about 70 old 90’s mini-grafts punched out from my frontal recipient area and repurposed by a top coalition doc, with the goal of leaving me with a near virgin frontal third to work with for a future restoration. Fairly large punches had to be used to score each of these big multi-hair grafts, and each of the 70 extraction sites were then sutured closed, forming 70 short, thin, linear closed wounds — which I imagine are similar to closed mFUE extraction sites. I was told to expect faint, short white lines as scars. They healed and scarred beautifully. Even with my frontal third shaved slick with a razor, the scarring is all but invisible. If this sort of scarring is comparable to the donor scarring that could be expected from mFUE, I think patients would be at least as happy with it as they would be with the round punctate scarring of traditional FUE, but with strip-level yield and strip-quality matured hair characteristics (if all pans out with mFUE). I had the same question as David about surgical glue as the go-to method for closing the mFUE excision sites, since this would seem to offer such an easy post-op for the patient. Dr. Lindsey answered it from his perspective and provided some interesting first-hand information. Sounds like he’ll go with suturing them, Dr. Feller will staple them, and . . . Dr. Bloxham? Anyway, I am eager to see some full-fledged mFUE restorations. Congrats to Drs. Feller, Bloxham, and Lindsey for trying something different for the benefit of hair loss sufferers. What with proven strip, better FUE protocols and outcomes, pyloscopy in development, and now mFUE, these are heady times (pun intended) for hair transplantation.

Dr. Arocha continues to impress, both with his FUE work and his strip work.

Wow. Beautiful, beautiful, natural, undetectable work. Perfect.

Despite this patient having had an unfavorable FUE/Fox test, his cosmetic result turned out great -- especially considering the relatively small number of grafts transplanted and his fine hair caliber. He looks miles better than before. He should be thrilled. Good job, Dr. K!

Fantastic work. Gorgeous result.

This is beautiful work given the limited donor graft numbers. You gave this patient an excellent cosmetic improvement using scant resources. Nicely done. Was the issue poor laxity? Poor donor density? Both?

I tend to agree with what others have said: An impressive achievement technically, but the patient might have been better served not trying to achieve coverage on top and front with beard hair and instead just fill in his scar via FUE and then shave down. Cosmetically, I think the patient might try some pomade or other product to minimize the Brillo appearance of the transplanted beard hair.

One of the best ht's posted here, ever!

I'm not sure that forum rules allow me to. Moderators?

Beautiful work! Especially good considering this patient's less than stellar donor and hair characteristics.

Congrats, Nishant! You hair looks excellent. As your surgeon noted, the vertex and crown are less efficient areas to transplant than the front. I think your doctor did you proud. Many FUE docs don't believe in taking more than 2,500 grafts per transplant, whether in one day or on multiple days. Others disagree. Your surgeon is in the first camp, so strip made sense for you, especially with the length you keep your hair. Grafts taken outside the safe zone risk being more susceptible to the effects of DHT over time, i.e. miniaturization or "death." Maximum number of safely harvestable FUE grafts from within the safe zone is a case-by-case determination, but some FUE docs say between 5,000 and 6,000 as a rule of thumb. Thanks for sharing.

johnny2000, PLEASE DON'T BE DISHEARTENED! Your situation is not disastrous or irreparable. Keep in mind that members here are extremely well educated on FUE and hair restoration, and notice far more than the average person. We are a very picky bunch that spend way too much time looking at hair restorations. FUE scarring will be visible on anyone with a shaved head, and is usually detectable at a zero guard. Even without further intervention, the back of your head should look fine at even a 1 guard, or at most a 2 guard. This is not to say that your clinic shouldn't explain why the grafts were taken as low as they were or why they apparently weren't taken from a larger area -- but you'll be fine!! If your results aren't up to par, you look to have plenty of donor available to shore things up. So don't dismay. Okay?

Strange. It looks like an artificially restricted donor area, and over-harvesting within that area.

Fair question. My working theory is that implanter pens, as a tool for recipient site creation and graft placement, fall somewhat short of custom cut blades (or the types of needles used by Maras, Diep, and Rahal) and forceps placement -- in terms of best achievable cosmetic result for surgical hairline restoration. For example, I wonder whether Rahal's or Konior's hairline work, or that of other top docs known for their hairline work, would suffer if they were required to use implanter pens and were given plenty of time and opportunity to adapt to them? I recall Janna of SMG mentioning that they tried but rejected implanter pens, although I'm not sure what the circumstances were. It would be interesting to hear from docs and clinics here that have experience with both, or at least knowledge of both.

I hear what you're saying, and I agree that hair characteristics play a huge role in the outcome, as does transplanting at a density equal to the average density of the surrounding hair, but time after time I see hairline restorations executed with implanter pens that yield hair but look transplanted--at least compared to the "best" hairline work (in quotes because best is a subjective conclusion). Take a look sometime at immediate post-op pics of hairline restorations executed by top surgeons using implanter pens vs. immediate post-op pics of hairline restorations executed by top surgeons using slits and forceps placement. There's quite a contrast, which I think is reflected in the matured results. I could be completely wrong, of course. Here's another, related observation and question: Several top docs don't use implanter pens but use needles (rather than custom cut blades) to make their recipient sites. I believe that Rahal, Diep, and Maras fall into this group. My understanding is that the needles they use are somewhat flattish at the point, which makes possible a type of lateral slit-making by orienting the needle that way. (Please correct me if I'm mistaken.) Maras says he uses needles as small as 21 gauge for single hair grafts and uses 20 gauge needles for multiple follicle fu's. Diep says he uses 20 gauge needles to make his recipient incisions. I couldn't find what Rahal uses. Question: Are the needles used by these docs different in characteristics, design, size, shape, function, etc. than the needles of the implanter pens? I think they must be, because when comparing the immediate post-op photos of these docs' work with immediate post-op photos of the implanter pen docs' work, I detect similar differences as I do when comparing immediate post-op custom cut blade work to implanter pen work. Thoughts and info?

Jackpot, Abedogg! Great save and turnaround to a somewhat odd start. You now have an enviable head of hair.

Beautiful FUE work, Janna! Good use of donor, with plenty still in the bank, and refined hairline work as always. Always interesting to see how even a modest advancement of a receded hairline shaves years of a guy's appearance.

Purely subjectively, enhanced with hubris. With that caveat . . . To my eye, the hairline work of the notable docs using these pens doesn’t quite reach the level of naturalness and refinement of the best hairline work out there, be it via strip or FUE. It seems that the round holes created by these pens don’t allow for the density of packing, fine angulation and direction control, ultra fine micro-irregularity, and precise layering effects achievable with tiny flat slit incisions, mostly oriented laterally (aka the lateral slit technique). Implanter pens have been around for quite awhile, but only a tiny handful of top ht docs have adopted them, and the ones that have are FUE-only docs. In this sense I think they have become something of a niche tool, more an accommodation to the particular challenges of FUE than a superior tool for creating recipient incisions that yield more cosmetically appealing results. I think that the higher rates of graft survival claimed by the FUE docs using these pens come at a price, or at least with a compromise. I’m not saying that Lorenzo’s and Doganay’s hairline work is bad, not by any means, just that it isn’t quite so natural, undetectable, and refined as my favorite FUE and strip hairline work—and the common denominator appears to be the use of implanter pens. Others may, and likely do disagree.

Two very nice examples of what you're talking about come to mind, performed by Dr. John Diep, who is recommend here. I have pm'd you video links.

Thanks, guys. Really good info.

Ah. Thanks, Sy! Dr. Vories pretty well answered my question in the thread you linked to. He says that only the upper third of the FUE graft is gripped with the forceps when loading the graft into the implanter pen, thus avoiding gripping the graft by its dermal papilla as apparently is necessary for traditional manual implantation. I still think that better cosmetic refinement is achieved using custom cut blades and manual placement, especially for hairline restoration, but I now better understand the argument for implanter pens reducing the risk of critically traumatizing delicate FUE grafts during implantation. Interesting stuff.