NW3VKY

Any updated pics on this case ?

PICS or it didn't happen

I looked it up on YouTube and it appears that he advocates using a 1.0 mm punch, as .75 or .8 mm is too small for 4 unit FU. Also, he advocates combining FUE and FUT, as necessary for max yield.

Color me confused ??? :confused:

So, for density, in the crown area, generally speaking, would you go with a .9 mm to try and get as many 2, 3 and 4 units and still minimize the scar ? Assuming, caucasion with medium density ?

Yes, it does me. Even if you extract a 2 unit, and the bulb is not transected, have very little fatty tissue around the graft seems like it could, at a minimum cause for greater delay in taking root at the implanted site. Maybe this is why we see it take longer periods, 6-8 months with FUE, v. 4-6 months with FUT, for follicles to start growing ?

I am no expert. But, from my research, we mostly all have just 1 hair per follicle. Now, there are "follicular units" which are grouped together and many Drs try and keep them as 1 graft, but you can not be sure. The best thing is to be up front with the Dr if he is doing FUT, and ask if he keeps the follicular units together or cuts them up a lot giving you more "grafts". Clearly, if you have a lot of units cut up into singles just to give a "graft" or "follicle count" - you will not get the density you want or the value in your transplant. Hair counts are the most important, regardless of how it is spliced and diced. If you are doing FUT and a Dr tells you that it is $3/follicle (about 2 Pounds ?) that means you are really paying about $4 Pounds ($6/graft) most likely - since the average graft is about 2 follicles (or a 2 follicle follicular unit) - assuming they don't splice them up. Bottom line is, my understanding is that "follicle" = 1 hair. A "follicular unit" can be a grouping of 1, 2, 3 or 4 follicles together, but they all have a separate bulb or root. The average person has about 15% 1 hair, 50% 2 hair units, 35% 3 hair units, and about 10% 4 hair units. There is an anomaly whereby, some follicles mutate to a conjoined follicle with 2, 3 or 4 hair coming out of one follicle, but that is not common, very rare. It is called pili multigemini. So, bottom line is - "1 follicle" = 1 hair "1 follicular unit" = can by 1, 2, 3 or 4 hair follicles grouped together but with separate and distinct follicles per hair. I am new to this, but someone please correct me if I am giving incorrect info here. I am still learning.

Would like to hear some responses on this from surgeons or educated key opinion leaders on this topic. Thanks

What is the inner diameter of the Hans Implanter device that Lorenzo uses ? I would think it would have to be at least 1.2mm to accommodate up to 1mm punched grafts/donor sites. Is the Hans Implanter a good device to use for placement ? It seems that it would be very sensitive and easy to transect the bulb on placement as the clinician tries to extrude the root into the placement site all at one time. Plus, it seems like it would be difficult for handling by the assistants to keep from "over-handling" the grafts putting them into the implanter one by one.

So, I have a question. Is it common for FUT surgeons to dice up natuarally occuring follicular units so they have more "grafts" ? I know sometimes, there may be a reason, such as providing 1 unit grafts for hairline reconstruction and temple points. But, if the crown is being restored, wouldn't it benefit the patient and be more ethical to leave them anatomically as they come grouped ? I have just heard that some surgeons will split up 2,3 and 4 units to singles just so they can have more "grafts". So, in other words, one patient having surgery with a reputable Dr may have 2000 grafts consisting of 250 1 hair = 250 1000 2 hair = 2000 750 3 hair = 2250 250 4 hair = 1000 Total hairs = 5500 hairs Or, with a less reputable Dr - or maybe this is common in the industry - 2000 grafts, cut down: 1250 1 hair - 1250 500 2 hair - 1000 250 3 hair - 750 Total hair = 3000 hairs So, as you can see, what is important is ascertaining the number of hairs and not the number of grafts, per se. So, how do we go about doing that ? What is the protocol you can ask of the Dr

I have been researching FUE for some time, the different techniques, punch sizes, inner diameter, outer diameter, what is feasible to harvest larger follicle units, etc. The one main question I have......what is the generally accepted size punch for a caucasion male, with medium caliper hair in donor area. I am a NW 3V and most of my need is in the vertex. I have about 50 cm sq which needs to be restored - of area - about 7 cm x 7 cm. So, obviously, I want the most density possible and don't necessarily want a bunch of 1 units. I know it depends on how closely they are packed, as well. My question is, if the clinician is taking 2,3 and 4 units for my crown, doing FUE, what would be the minimum punch size that they would need to use ? My research tells me that since a 1 unit avg about .46mm (at bulb); a 2 unit is .78; a 3 unit is about .86 and a 4 unit is .94mm, the clinician would need to use a 1mm punch to effectively get the larger 3 and 4 units. I know these are averages and that mine may be smaller. So, when I see some of the experts like Lorenzo (who appears to us a .75mm on most cases), Feller and others who use .8mm most of the time, it makes me think that either they are transecting the larger 3 and 4 units or maybe they are not going down to the bulb root, but simply going down over the shaft, breaking the dermal layer and pulling it out, without damaging the root of the larger units. I would just like your opinion on the feasibility of the .8mm punch in extracting larger units.

Some clinicians have explained to me that they use an 18 guage needle where others have told me they use a small blade. I guess I could see the advantage of using a needle would be that you have a site which is created more compact and can hold the graft better, more securely. However, the cons, as told me other clinicians is that it may blanch the graft bulb or cause it to pop out if not correct size. The advantage explained to me for the small slits were that it simply spreads the dermis and does not take away tissue or possible transecting or harming adjacent native roots. I am curious what most top clinicans do.

Fascinating - thanks for positng.

I know you are kidding around but actually, stem cells can be derived from our own bodies now. Fetuses are not necessary, for the record.

To the OP, just curious and to be fair, do you have any possible contraindications that could be contributing to the result, such as diabetes, smoking, excessive alcohol ? I have heard that those things can affect the success rate, as well.