Lotsofhair

haha funny aaron! Good one. NW1 : excluded (i guess everybody would agree right?) NW2 : IMO excluded due to lack of density NW3 : yes, which is just fine when you're 60-70... but it seems like even as a young man he had a very high hairline and his corners and temple points (!) were already gone. NW4 : possibly, because he does do a comb over (not in the classic sense : left to right or right to left, but from front to bottom). Which works really well for him as he has still a somewhat strong front. At first I thought you were going to address Obama's hair status... and I was thinking : what? Obama is a strong NW1-1.5! Lucky him.

Thank you Blake! Very helpful. Here's a picture to help "envision" : Thus the Hasson and Wong scar is exemplary of an excellent scar I believe... while I'm afraid I cannot say exactly the same for the other patient. The lower part of the sides are bound to get weaker (in the hypothesis of a NW7) and I don't think a scar should ever reach them... but should go higher up (again see HnW patient).

Dear fellow patients and doctors, I do not understand where exactly the donor area is eg. where the area that contains permanent hairs is located. Now please don't say at the back of the head, because that I got. Ok, here's a picture which is supposed to show where the safe area is (from Unger textbook, which may or not be outdated, I do not know) : In other words : between and above/up until the ears. But from this picture the sides seem to be excluded and hence do not constitute a safe area. Now, what puzzles me is the many amounts of (real life) pictures of patients with scars that extent up to the temple points and go very high up : the following picture not being close to the most extreme cases of very long scars I've seen... So in other words : do the hairs on the sides also qualify as permanent ? As permanent as those in the back ? Thank you very much for clarifying what exactly constitutes the safe donor area and where the permanent hairs on the head are located. Actually wait, I found exactly the patient I had in mind when writing this, as I would wish for exactly the same scar (he is a Hasson and Wong patient, so maybe Jotronic could help me) but I'm not sure whether those hairs high up on the sides are permanent or not... In any case, I admire this patient's case. Still I'm looking for confirmation or clarification on the topic.

Thank you Spanker I appreciate it. I agree these are all excellent doctors. Looking at pics is also very helpful in making a decision. I think I'll be fine. My decision for a H.T. is made. I'll ask a few more questions that are bothering me, but I'm very relaxed. Things will be fine.

Spanker, in all honesty, I am simply trying to educate myself on these matters. I sincerely apologize to you if my questions have caused you any offense. Different techniques have their own advantages and disadvantages and I believe that there is nothing wrong with having a discussion, on the very contrary. Nevertheless, and in any case, I apologize to you.

Thank you so much Janna! So if I understood right SMG does not proceed very differently than other clinics insofar as 80percent+ of their incisions are pre-made and then stick and place is only used for final touch up. I hope I stand correct. The website for some reason had lead me to believe otherwise. I am very glad to have started this thread. I have learned lots, hopefully others have as well.

You are correct. I meant "placing" the grafts not making the incisions for them. This was also my reading. The fact that he places most of the grafts himself is indeed impressive. ps : have corrected my typo

Oh sorry! God. I misread indeed. Actually in this case, Dr. Feriduni, who is a world-class surgeon, does it like other world-class surgeons : incisions = Dr. ; placing = tech team (and not incision + placing = Dr.) But, just to get back to the point : the issue was less whether doctors did the incisions themselves (they all do it seems) but whether those that practice stick and place as a main technique - and I believe SMG is among them ? (his has yet to be confirmed) - also put the grafts in themselves. The issue of grafts popping out "stands". Is it over-played? I don't know.

- misunderstanding (see below) -

Thank you. I was absolutely not sure, so I don't want to misguide anyone. Would still be good to have the final word of a doc. "Also, Lotsofhair, I don't know of any docs recommended on this site who don't make all the recipient incisions themselves, regardless whether the incisions are pre-made en mass or stick & place is being done. To the best of my knowledge, all the HTN Coalition and recommend docs make all the recipient incisions for the hair transplant, be it FUT or FUE." This would be re-assuring if true. I don't know if it applies to all. On Dr. Konior's profile it says that he makes "most" of the grafts insertions himself, which is impressive... WOuld have to be confirmed. Same for SMG and other clinics (Simmons?) Correct me if I'm wrong again, but I think that one has to realize that in stick and place, the Dr. does twice the amount of work : incision - as he goes - and then graft placement (vs. only incision in pre-prepared incisions by Dr., graft insertion by tech team)... Hence why, the doctor actually doesn't actually make ALL graft insertions hence recipient sites himself. If Dr. R. and P. Shapiro or Dr. Konior could guarantee they are 100 per cent hands in their use of stick and place, this would be phenomenal. If they are not - or do leave this question open - I think it would give grounds, not for concerns, but consideration or reflexion at least on part of the patient. Also the issue of grafts "popping out" due to increased blood flow (vs. premade insertions made 1-2 hours prior) in freshly created insertion sites - as happens in stick and place - stands. I fail to see the advantage (FOR THE PATIENT and his expected growth) of stick and place, apart from final touch ups (the latter makes a lot of sense)

I don't know if lateral slit can be combined with "stick and place" and I get the impression that these are two mutually exclusive procedures where you have either "stick and place" WITHOUT lateral slit or pre-parared incisions WITH lateral slit... this is where the insight of a Dr. Konior or a Dr. Shapiro would be informative. I will quote some very interesting ideas (clearly in disfavor of stick and place) from another thread. Note that these are written by patients, not doctors : "When I think of the difference the main one would be that you always read about how the healing process in the slit acts as a glue to hold the graft in place. It would seem that a slit that has started, however slightly, this process is at an advantage against graft popping over a freshly made slit that is exuding blood. It also seems that stick and place is messier because of the continual bleeding which could also lead to more graft popping with less chance of seeing it quickly. Another benefit of the doctor making slits is the repetitiveness would seem to help with consistent angulation. The only benefit I see of stick and place is as a time saver for the doctor." "I think the distinction is that in stick and place, the techs (not the doc) are making the majority of incisions right before they place the grafts. The alternative is for the doc to make all the incisions by himself, and then have them filled by techs over the coming hours. Do you trust the techs to control design, transection, and angulation?"

Stick and place, stick and place. Apart from that, would you like to share any additional informations with us StaggerLee123 pertaining to the subject of stick and place (see I'm getting the hang of it )? I'll answer some of my questions : a mixture of pre-made incesions (95 per cent of recipient sties) "stick and place" (5 per cent give or take) is used where stick and place only fulfills the purpose of final "touch ups" to the hairline. So, I really would like to know if the doctors mentioned in this thread conceive of "stick and place" in the aforementioned way or actually use "stick and place" for 100 per cent of the job. And if so, why, considering the disadvantages often described by other doctors who prefer lateral slit.

Thank you Spanker. Dr. Konior definitely uses/used stick and place (a quick search for patients shows this), he furthermore uses/used both of a mixture of both at least (I conclude this from one of his repair cases on this forum where he explicitly stated to have used a mixture... would be interesting to know the philosophy behind that). In any case some of his results are simply extraordinary. Which makes the question of his use of the technique all the more interesting. It would be interesting to have a real debate going. Some of the top surgeons seem to be big proponents of lateral slit and expressly reject "stick and place" as an inferior method with lots of disadvantages while other doctors describe it as gentle and th(eir) preferred method... mmm.

Hello everybody, Some doctors feel that the "stick & place" technique is inferior (to lateral slit technique or pre-prepared incisions). 1 - Therefore I was surprised to read that Shapiro Medical Group seems to be a proponent of this technique and still use it today on their patients and describe it as "gentle"? ( I'm assuming all this from reading their website : Maximizing Survival . Maybe the website is outdated? If yes, please let me know ) 2 - Which leads me to ask : what other top doctors use or defend this technique? Thank you all, you've been so helpful to me so far!

Cant decide. Thank you! However, I should add that a Dr. mentioned that what happens is (understandably) there is less graft tissue around dissected grafts... this might be a factor to consider.

Hello everybody, Let's say I want to have a 2000 grafts ht. My donor will probably (I'm throwing figures) give 1400 1 hair grafts, 500 2 hair grafts, 100 3 hair grafts. What if I wanted to use all of this for the hair line only (where it is advisable to use only 1 hair grafts in my understanding) : would the hair transplant surgeon dissect the 2 hair grafts into 1 hair grafts? And in any case, are there any drawbacks to doing this (not natural, harming grafts, lower survival) ? Or just things to take into considerations. Thanks : )

Dear all, I wish (as most people I assume) for a dense, very dense hair transplant. However, when does a hair transplant density reach a point where too tightly packed grafts actually hamper graft growth and survival ; a point when - paradoxically - more becomes less ? Things to take into account are, I think : - blood supply - oxygen (please feel free to list more or elaborate) Naturally, hairs grow at a rate of anything between 80 and 110 grafts per cm2 I think (correct me if I'm wrong)? So why can't hair transplants achieve the same without risking grafts from not growing? So what limit do doctors agree on then? I see some clinic listing 70 (hair clinic 1) or 75 (hair clinic 2) g/cm2. I've read an interesting post where a coalition doctor explained that he would watch for too much bleeding during graft implementation as this is a sign for project or potential necrosis and thus decrease the planned density as he would go on. I did not understand the medical reasoning behind this. Would also be interesting to know on a side note. Thanks! ps : also I'm confused whether people mean 80-100 GRAFTS per cm2 or 80 HAIRS per cm2 when talking about natural density.

Hi everybody, How many months is it best/safest to wait between 2 strip surgeries? I mean BOTH for the donor area and the recipient area (so as, in the latter case, to not hamper or kill growth, or cause schock loss and the like). Explanations along with the specific numbers would be greatly appreciated. Thank you so much : )

Thank you so much everybody for your insights! I should mention - from a patient perspective - that : 1. I do understand how the fee could put off some doctors (although the publicity generated from successful HTs displayed here probably outweigh this). I had not idea of how substantial it was. 2. I love the transparency here. Much respect to Bill for not escaping any details, including the financial ones. This inspires much confidence. I would tend to go with Dr. Fedurini, rather than Dr. Bisanga and the reason is precisely that in the very unlikely event the HT would not be successful, and in the even less likely event talks with the clinic would be disappointing, I would have a community to turn to and ask for accountability. However, I wonder how effective the pressure of this community on doctors can be. I've witnessed some threads in the past but I still have mixed feelings. Poor results, when they occur, tend to be attributed to the patient ("have you taken minoxidil/finasteride after the ht?", "poor characteristics" and the one i love : "idiosyncratic response") ; and the offer of having a second HT under the hands of the same doctor, with the same team, in the exact same clinic (for the probably same poor results) as a form of apology should seem like a downright crazy plan to every person blessed with minimum logical skills. Refunds in the event of obviously failed HTs should be the standard or norm. If 2000 grafts were extracted and only 500 grew, it's a problem. Which leads me to wonder just how many doctors ever do propose actual refunds to the patients they have failed.

Hello everybody! I'm still in the process of deciding on a doctor. In Europe, I am undecided between Fedurini (coalition member, which is pretty important for me since such a membership implies accountability for results) and Dr. Bisanga who seems to produce equally good results but is not even recommended on this site, hence not a coalition member either. How come? No afterthoughts, just a genuine (and genuinely naive question) from a patient looking for the best doctor possible, somebody to trust and feel safe with. Thanks so much!

Thank you Dr. Mejia your schema - aaaBBBaaa - was very hopeful! I do see exactly now what was meant by "removing completely the first scar". Very interesting!

Oh! I think I get it! Thank you StaggerLee123! I take it that when you say "the surgeon takes the donor from either side of the scar" you mean either slightly on top or bottom ; not left or right, making it longer. The scar actually gets larger (ie. 1 cm -> 2 cm)... Obviously this would lead to a more noticeable scare. But still only 1 which I suppose is better than 2! Very interesting. Here's an article on the subject : "There’s no doubt that one scar is the best for multiple hair transplants. However, subsequent sessions make the single scar wider depending on the width of the strip that is excised. A 1cm width strip will leave a minimal or invisible scar on average, whereas a wider strip will leave a bigger scar. The outcome of a single scar after two follicular unit transplant (FUT) procedures usually results in a donor scar that is wider than the original since the total width is doubled, more or less. Excising the scar from the first hair transplant is not easy since the hair follicles within the scar are not aligned in the same direction as normal hair follicles since they are embedded in scar tissue. Even with trichophytic closure, the hair follicles within the scar are in danger of transection. Careful dissection is very important to avoid damage to these follicles even though I use my open technique with the aid of skin hooks. I still have a hard time in some cases to try to dissect the follicles that are within the scar to avoid transection, since the hair direction of the follicle is distorted due to fibrosis. If we excise the strip and the scar is included at the center it would be much easier, in the same manner as if we avoided dissecting inside the scar. However, slivering a strip inside the scar is more difficult. When you encounter the scar, there is the potential for follicular transection. In my opinion, if the scar is invisible, why bother to incise the same scar causing more potential for follicular transection. If we make a second scar, we do not encounter the old scar and there will be less potential for transection. If the patient needs further sessions, the two scars can be incorporated into one. If the scar from the first hair transplant session is a little bit wider, I will use a single scar by excising the first scar and incorporating the scar inside the strip to prevent an even wider scar when it heals. I always discuss with my patients prior to surgery whether they would want a single scar or two scars. Whether to do one or two-scar strip is still a debate. However, the majority of hair restoration surgeons as well as patients will select a single scar, if possible. The majority of my patients still have a single scar after subsequent sessions. Dr. Damkerng Pathomvanich" Will a Second Hair Transplant Result in Two Donor Scars? | Hair Loss Q & A

Hello everybody, According to Bernstein Medical "with FUT, the first scar is completely removed in the next procedure. Even though the scar may be longer in the next session, with FUT, regardless of the number of procedures, the patient is left with only one scar" I cannot make sense of that. How is that even possible? I'm confused. I thought that 2 FUT = 2 scars (one on top of the other), 3 FUT = 3 scars, and so forth. Makes sense? Ok, I possibly get the "the scar may be longer in the next session" but what if the 1st session was already a mega session and the longest possible scar was already produced. Then what? The argument just confuses me. I'm interested what the doctor means exactly and how he would make such a goal possible on a purely physical basis. I've seen pictures of patients with exactly that : 2 or 3 scars in the back of their head and I assume that each scar is the product of a single HT. Please somebody help and shed some light on the issue. Thx so much! ---------------------- full post : "With each subsequent session, the scarring in FUE is additive • For example, if the first FUE session is 2,000 grafts, there will be 2,000 tiny round scars. With a second session of 2,000 grafts, there will be a total of 4,000 scars • In contrast, with FUT, the first scar is completely removed in the next procedure. Even though the scar may be longer in the next session, with FUT, regardless of the number of procedures, the patient is left with only one scar" Source : FUE vs. FUT Pros and Cons of FUE Hair Transplant vs Strip Harvesting | Bernstein Medical - Center for Hair Restoration

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