Michael Vories, MD

My state, South Carolina, gave me problems getting a licensed Physicians Assistant (whom had completed medical school and passed all licensing exams) to expand her scope of practice to extract grafts. There is no way a state medical board will allow un-licensed techs perform this work. Each extraction is a medical decision in terms of depth, angle, and the concentration of extractions. This is a time limited issue and any patient whom has had unlicensed technicians extract grafts should report those physicians to their medical board by filing a simple complaint. Problem solved.

A few responses to my latest posts have referenced my use of the NeoGraft machine. I wanted to take just a few minutes to address my use of NeoGraft. As many of people on this site know, NeoGraft is the American name of the Medicamat machine, which was developed in France with the lofty goal of making FUE extractions faster and with less transection. In Europe an un-licensed technician cannot use this machine, and it was not developed for this purpose. The machine is a surgical tool, to be used by surgeons. That said, in my hands it accomplishes it's goal of increasing extraction speed and minimizing transection. This is the reason I use it daily. I do understand the backlash against the use of the machine by un-licensed technicians under the "supervision" of physicians with little or no background in hair surgery. However, for a physician such as myself, who has performed hair restoration surgery for the past decade, I do not believe that the misuse of the machine by other physicians should prevent my proper use of the machine.

I wish I did. He wore his hair very short from the time we saw him for consultation until his procedure.

Here are the consultation before photos where his hair is a little longer.

Here are the before photos for this thread.

Here are the before photos for this thread.

Here are the before/after photos from the original 1500 graft FUT procedure we performed on this patient in 2007.

This is a 2000 graft FUE case for a 55 year old male who wished to advance his hairline. Shown are before photos, immediate after photos, and 2 week follow-up photos. Patient understands the likelihood of telegen effluvium. A good take home point for my staff is the importance of using Hans implanters for these FUE procedures. The delicate morphology of FUE grafts resulted in poor growth when we were hand placing FUE grafts several years ago. In our clinic patients like this did not experience the initial growth at the two week mark with hand placement. Because implanter pens do not traumatize the dermal papilla, we have experienced much better permanent growth since beginning their use. As in performing FUE extractions, using implanter pens does require a trained physician to do the work, and limits the clinic to performing one procedure per day per provider.

Attached is a 4 month follow-up of a 3000 graft FUE case performed in our Charlotte clinic. Before photos, Immediate after photos, and 4 month follow up photos are included. Even though this patient is likely to experience more growth in the coming months, he understands the likelihood of a second procedure to increase density.

These are good points. This was this patient's second procedure with us, the first being a 1500 graft FUT procedure 5 years ago. He was very pleased with the coverage (I can post before/afters tomorrow when I am back in the office) of his first procedure, and just wanted more coverage in his vertex. As I am sure most on this site already know, salt and pepper hair goes a lot further with coverage, so with a total graft count of 3000 grafts he should be pleased with the outcome.

Submitted is a photo tour of my clinic in Charleston, South Carollna. We perform one FUE surgery per day. First, my staff- which is myself and my surgical technician, Vickie Lesesnse. (I have a second surgical technician- Kathleen Hegarty, in our Charlotte office). Between the two of us we can transplant up to 3000 FUE grafts in one day. Procedures larger than this require two subsequent days. Mike Frame, my clinic manager, took the photos. This case is a 1500 graft FUE case on a 60 year old make with stable hair loss, with grafts weighted towards the vertex. We set up extractions with Vickie on my left side. We use the NeoGraft machine for extractions, for reasons I will supply in a separate thread. I perform all extractions. In this case, since there is a lot of gray hair, we first dye the hair to prevent color bias. Extractions are performed with a 0.9 mm punch. This is a large punch for us, but for salt and pepper hair we get fewer transections than with the 0.8 mm punch we normally use. Grafts are collated by Vickie, and placed in numbered wet petri dishes once they are lined up for placement. We extract at a typical rate of 600 to 700 grafts per hour, and extraction for this case began at 9 AM, and ended at 11 AM. After a short break, we began placing at 11:30 AM. For placing I move Vickie to my right, since I am right handed. She loads the graft into the Hans implanter, and I use a stick and place motion to place the grafts. We do not use pre-made incision sites, and I place all of my grafts once I have mapped out my grafting area. One of the problems with stick and place is the potential for painting yourself in a corner, so during the placement of the grafts I am constantly assessing where I am and how many grafts I have left. We place about the same speed as we extract, so 300 grafts were placed before a short lunch, and the remaining 1200 grafts were placed between 1 and 3 PM, with the patient discharged at 3 PM. Most cases for us are in the 2000-3000 graft range, so this was a welcome short day.

85% is not accurate for most cases. We normally see a greater survival rate than this, based on hairline hair counts. However, we have many patients who use tobacco (in any form), and for these patients graft survival does not seem to be as high. So we assume all patients smoke tobacco and make the 85% guarantee. I am having trouble downloading videos on this site- if you visit My FUE Hair Transplant there is a good video that a patient has posted that shows a close up of the donor area. Thanks!

This FUE case of 2500 grafts to the frontal forelock and hairline resulted in meeting the patient's goals of establishing a hairline and combing his hair back. The density in the hairline needs to be improved. The patient had side effects to finasteride but apples Rogaine Foam each night to the vertex. Currently trying to format this video- Please check back for video update.

Sorry for the confusion. Good hair caliber allows for lower than average recipient density to still give good coverage.

I just looked up that 8000 graft case. I did not see a hair count- but the results are incredible. How many hours did it take to place 8000 grafts? The thought of having to place that many grafts makes me dizzy. (I place all grafts myself)

Wow- I stand corrected. 15,000 follicles in a single session, FUE or FUT, is larger than anything I have heard of- and I have been doing specifically HRT for the past 10 years. I do agree that 10,000 grafts in a typical donor bank of a NW7 is unreasonable and would result in a depleted donor. As a general rule we do not cross the 50% barrier, and in most cases we don't come close to 50%. There is a separate discussion revolving around these big FUE cases. Factors that need to be included are the size of the punch, the depth of the extractions- which affect transections, and how this changes the growth of the donor area. This discussion revolves around the lack of enough large FUE cases to give patients assurance that the donor area will not be cosmetically depleted. As these cases are submitted on this forum or others, patients will become as comfortable accepting these cases as they have with large FUT cases.

I use the NeoGraft machine for extractions because of it's speed and short learning curve. I use the Hans implanters due their sustained sharpness, as does Dr. Lorenzo.

Why did our clinic switch exclusively to FUE? The advantages of FUE, compared to FUT, are easily discerned. The lack of a visible donor scar (with punches smaller than 1.0 mm) is the most common reason patients come to our office. But is the theoretical advantage of FUE that is the most exciting. Many clinics like to quote that FUE should delegated to small sessions only, and they can't move as much hair as FUT. This is simply not true. The real power behind FUE is the enormous flexibility over the size of cases. With the extraction devices we have now (which will only improve over time), we can extract between 0% and 100% of the donor bank. Our current understanding is the donor bank becomes noticeably thinner at 50% depletion, so theoretically this flexibility leads to the potential of large cases. We recently finished a 5125 graft session (over 11,000 hairs) in a patient, whom is documenting his experience in a blog. With the possibility of performing large cases with FUE, the last drawback was removed, and for this reason we stopped doing FUT cases. Many on this forum may not agree with our reasoning, but we simply felt the benefits of FUE outweighed FUT.

Given his relatively young age, there is a good possibility his vertex will expand and he will need further surgery. He is aware of this likelihood, and has the donor to accomplish this if needed.

I use the NeoGraft machine for extractions only. Please let me emphasize I use the machine, this is not a procedure that is delagble to assistants. I also use Hans hair implanters for placement of grafts, so I extract all of the tissue, and I implant all of the tissue. I do use an assistant to load the implanters.

3000 graft (5128 follicles) FUE case performed over a two day period. Before photos and Immediate After photos are submitted.

2500 graft (4125 follicles) FUE case performed in a single session to the hairline and frontal forelock. Before, Immediately After, and 6 month post-op photos are submitted. More hair growth is likely in the coming months.

1800 graft (2208 follicles) FUE session done in the hairline of this patient with traction alopecia. The curl of African American hair helps with filling in the hairline with relatively small number of grafts. Before photos and After photos at one year post-op are submitted. New photos will be issued on this post when patient identity can be concealed.

Two day FUE session of 3020 grafts (5912 follicles) placed in hairline, frontal forelock, mid-scalp, and vertex. Very good hair caliber helps with relatively low density. Before, four month post-op, and 12 month post-op photos are submitted.

Two day FUE session of 3412 grafts (rough count of 5400 follicles). Gray hair gives good result due to lack of skin-hair color contrast. Very difficult to get accurate hair counts due to hidden gray follicles. Before photos and After photos at one year are submitted.