Michael Vories, MD

Nathaniel- Thanks for your input. I think it is admirable that you are learning as much as possible about the process before you proceed. However, I believe that far too much emphasis is placed on the term "NeoGraft." I do use a NeoGraft machine to assist me with extractions (I also have a CIT punch in case I need to perform manual extractions). Since I have joined this network of physicians, I have maintained that this machine is a surgical instrument and should be used only by physicians or physician extenders that are licensed in their state to perform the extraction phase of the procedure. This leads me to the question of where does the controversy exist? If it exists within the context of unlicensed technicians performing the procedure under "supervision" of physicians without training or experience in hair surgery, then I believe most people would agree that practice should be avoided. If the controversy exists within the context that the NeoGraft machine has some inherent flaw (such as risk of desiccation of grafts), then I would argue that when appropriately used, this risk is minimized and must be weighed against the risk of tethering of grafts when extracted by forceps. I hope this begins to answer your questions. Please never feel poorly about demanding transparency, it is the oxygen the whole field (not just hair surgery) requires. Mike Vories, MD

Here is an update on a 5125 graft FUE procedure performed over the course of four consecutive days in September of 2012. He is about 9 months out now, and I think these photos give a nice overview of the gradual nature of transplanted hair growth.

I agree. While I was watching all the manual punches in use, I also wonder about how could these surgeons keep us this fine motor work. But then a good friend of mine is a concert pianist, and she can play as well at 65 as she could at 45. I think often these fine motor skills are one of the last things a person loses as they age.

I thought is was outstanding. I am used to a motorized system, and part of that is my worry about obtaining tendonitis of some sort in my wrist with manuel extractions. Dr. Feriduni (and especially his assistant) used an extremely sharp CIT punch which required no twisting, just insertion. In fact, it resembled the action physicians use to make recipient sites. Very fast and very impressive.

I know the program. I chose to be in the Feriduni group. Can't be in two places at the same time.

Exactly. I chose to be with Feriduni's group, mostly because he was using a "no twist" technique with the CIT punch, so I missed out on the other procedure. Can't be in two places at the same time!

I can only imagine imagine that one step implies the grafts are scored and extracted at the same time (By the way- this is how NeoGraft extraction works). I am not really sure how much this differs from the way most manual FUE grafts are extracted, in which 25-50 grafts are scored, then extracted. Other than speed, I'm not sure what benefits this gives the surgeon or the patient.

I really can't comment on this procedure. I was with Dr. Feriduni's group during that time. I did see the graft morphology and the grafts looked clean.

Recently Ellis Instruments, which is well known in the HRT industry, has picked up the Hans Implanter for US distribution. Hopefully more FUE clinics will be looking at obtaining them.

I think the use of the Implanter pens is regional. In Asia, specifically South Korea, virtually all transplants use Implanter pens for placement. In the US, there is a long history of delegating placement of grafts to surgical assistants. This has a proven record of consistent results with FUT grafts, but fragile FUE grafts can be easily over manipulated with manual placement. Implanter pens, in which the dermal papilla is not touched by human hands, give better growth rates in my clinic. Of course this means the physician has to place the grafts, and this can be a real problem for physicians who do not wish to place their own grafts. It also limits the procedure to one patient per day per provider.

How would someone quantify something like this? I was impressed by all of the surgeons performing extractions. The speed was incredible for manual extractions, but the technology behind the ARTAS robot was fascinating. All of the grafts were placed using the Hans Lion Implanters, and I believe the use of these Implanters with the relatively fragile FUE grafts was the highlight of the conference. The HRT community focuses so much on just one aspect of the procedure, and I believe there will be a renewed focus in the near future on placing grafts. The extracting was great, but the Implanters, in my opinion, stole the show.

I have been to many HRT conferences, and this was the best. Totally focused on FUE, 10 surgeries were performed in 3 days. Hats off to Drs. Lorenzo and Ginzberg for putting this together.

FUE hair transplant 2050 grafts to the hairline and frontal forelock. Before photos, immediate after, and 2 week follow-up photos.

FUE procedure 2200 grafts into frontal forelock and hairline. Patient had previous FUT procedure and was unhappy with hairline. Unable to obtain before FUT photos, but included are before FUE photos, immediate after, and 2 week "preview" photos.

"Preview" results of a 2020 graft FUE case. Photos before procedure, immediate after, and 2 week follow-up. Patient has elected to begin finasteride to see how it would affect the vertex.

I have made attempts to contact this patient, and if things are as they appear, to make good on what seems to be a substandard surgery outcome. Thanks for everyone's input.

During the time I had a PA it was explained, both during the consult and in writing, that both myself and the PA would be doing the work. Presently, I do all the extracting and placing on all patients, and have done so since November 2012.

To clarify- we did perform two procedures on the day in question. Both myself and my PA switched off on cases in both extraction and placement. My suspicion is that there was a too high transection rate when my PA was extracting (Not her fault- the surgical techs are responsible for graft inspection) and that resulted in unilateral poor graft survival. Tyger and I have worked out an agreement to put this issue to bed.

I wanted to take the opportunity to respond to recent posts. Our clinic performed a 1200 graft procedure on an African American patient in August of 2012. This patient has stated that he posted photos of his results at 9 months post-op. I believe these photos are accurate and show poor graft survival on his right hairline and frontal forelock, with acceptable growth on his left hairline and frontal forelock. The procedure was performed by my Physician Assistant (not an unlicensed technician), and I personally supervised the procedure while I was performing a second procedure that was occurring that day. While I agree with posts that describe the result as poor and not representative of a recommended clinic on this forum, I would like to reassure this online community that this is not the result we see consistently in my clinic. In November of last year, my PA left our clinic due to family health concerns, and since her departure, I have extracted and placed all grafts for all of our surgical patients. I do use surgical technicians to count and collate grafts during extraction, and to load the Hans Implanter pens for graft placement. I also perform all administration of local anesthesia for patients. I would like to make clear that myself, Michael Vories, MD takes full responsibility for all outcomes, good or bad, that occurs in my clinic. Regarding the recent posts- I believe the poor result is not due to poor hairline design or graft density. We perform many African American surgeries, and densities that would be unacceptable in Caucasian patients do well with African American patients, who normally have a lower absolute hair density. (Unger 5th Edition). I do not believe the result is due to poor hair exit angle- African American patients have a random acute exit angle, with hair follicles that vary from relatively straight to a sharp C or even an S curl. See the below video for a recent example of another African American patient. The above shows another African American patient one month after surgery. Note that some of the transplanted hair has already shed. I believe TygerD's result is due to poor graft survival. I also believe that poor graft survival is most often a result of a breakdown during the intra-operative period. Transection, desiccation, and placing trauma are all well-known reasons for poor graft survival, and I believe one or all of these occurred during this case. That is unacceptable for our clinic regardless of who is performing the procedure. However, we have seen results like this before, and there is no reason to believe we will never see results like this in the future. The best human hands (and I suppose robotic hands) and human minds can do is reduce these known factors as much as possible, and by doing so obtaining a typical result that is good to excellent. That is the goal for my clinic and myself, and I look forward to posting results that continue to prove myself to this forum. Dr. Vories

Because this patient has decided to express his situation in this public forum I am compelled to respond. At the six month mark this patient was satisfied with growth on the left side, and not the right. Unfortunately HRT is not perfect in every case, and when we see unilateral growth like this we take responsibility (even though this could have occurred with poor post-op care). By giving the patient the opportunity to re-graft at no charge, or refund at the one year period. It is apparent that he wants his refund now, and his using this forum to expedite this refund. I do understand his desire to get this repaired as soon as possible, but I stand my policy of waiting until the year mark.

I have a hairline video I can post tomorrow of this case.

The last video should include the graft count of 4225 grafts.

Dense packing of the hairline and frontal forelock in a two day FUE session. See photos and the hair transplant video below:

Here are some hairline close-ups of a previous post to show dense packing. For details of the case please see previous post.

Spanker- I agree with you. Hopefully I have erased all names of patients who have had their photos cropped. (Patients whom I show their full face have given name permission as well). I have gone through the photos, but if I have missed any please let me know so I can have names erased. As a new poster, this was my error.