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.

WOW....most of us are trying to grow hair on our heads and people really care about implants for their eyebrows ? Only in Redondo Beach or Beverly Hills. The trend used to be thinner eyebrows and less bushy eyebrows, now the bushy ones are in style ? I don't get it. To each their own, I guess. Did anyone catch the cost ? $6-8K ! For about 100 grafts by my calculations. So, about $80/FUE graft.......

I have spent some time researching multiple Drs including Bosley, MHR and many NeoGraft offices/clinicians. Currently, I have not yet had a transplant yet. I am looking to make a decision soon. However, I can tell you what I have learned and why he states the more density. Maybe I have more to learn and am naive. But, it makes sense to me. I have also spoken with 8 of his referrals, several of whom were similar to my pattern loss. I can tell you that no office has been as transparent and open with their procedures and how they do things, as they have been. I do think it is a somewhat legitimate claim because he, as he and his staff explained to me, unlike many surgeons and transplant centers, doesn't chop up naturally occurring follicle units into singles just for the sake of a "graft". His contention is that many transplant centers and the industry will take many of those 2, 3 and 4 hair units and make them singles, which obviously reduces your density in the crown/bridge/vertex areas. This keeps patients coming back for multiple procedures because they never get the density on a single procedure and why many patients have 3 to 4 procedures on average. So, in essence, many unscrupulous clinics will make what should be 1000 grafts into 2500 grafts, rather than focusing on keeping the units, fatty tissue, nerves, together and focusing on density. So, many of his grafts in the crown/vertex areas may be 4-7 hairs (maybe two 2 units and 1 3 unit) and he leaves them together as they grow naturally, thus having more density. I have seen the results with many patients on his website, in person and over the phone. He is getting consistently dense results. For his pricing, he tiers it bases on #hairs and approximate cm of tissue to excise - ranging from 15 cm (2000-3000 hairs), 25 cm(3500-4300), 30cm(4500-5500) and 35 cm (5500-8000) - with the # of hairs depending upon your own density. I guess that ranges from 100-200 hair/cm sq ? So, I guess it will vary in the yield, depending upon the patient. The only thing that concerned me about this tiering is that it does not seem too scientific to understand the yield you may need since every patient has a different density in the donor area. For instance, I may only be 150 hr/cm sq would only give me 4500 hair or about 2250 follicle units (avg). Where, someone with 200, it may give them 6000 hairs. Therefore, I think they should do some type of densitometer or something to get a better idea since that is the way he prices. I am considering other options and alternatives, but I have to say that I have been very impressed with this office, the staff, website and the results. Don't dismiss his density claims out of hand. I think it is somewhat marketing, but also he seems to be changing the way the hair industry markets "grafts" and not true # of hairs, so that there is not as much deception with regard to splicing up follicle units and the patient continually getting on a treadmill of multiple repeat cases.

I have been looking at Dr Vories' practice and his surgery centers recently. He does NeoGraft exclusively now. I know there is a lot of stigma attached to NeoGraft and I have read all the negative comments by the esteemed Drs on this site, as well as some experts. I would be glad to copy in his site address here, for you all to look at it and give me some feedback, but I did not want to violate any "promotion" criteria. I am just a prospective patient and just want some honest feedback. Pros: Dr Vories and NeoGraft * FUE procedure - no linear scar * quicker recovery * cost is about the same as FUT- $4/graft * within driving distance * Dr extracts and places all grafts (many NeoGraft offices, only technician does both) * Medical Dr and he focuses on hair surgery only * Hair transplants for 10 yrs * Have spoken to many of his patients and they are very complimentary and satisfied * Carolina Hair Surgery says on his site that he offers - 85% survival guaranteed (need to clarify how measured) * I have seen about 25 videos on YouTube of his work - seems credible * Have seen 2 patients in person and looked at the work and seen before and after - one was crown very similar to mine and the restoration of the crown was very good Cons: NeoGraft and this office (from what I have learned on this site and my research) * Hypopigmentation and many small 1mm dot scars - although not as detectable on short hair cut * More collateral damage to grafts due to dessication and transection, less yield * Dr only uses .8mm punch - which can not easily extract a 3 or 4 follicle unit - less density * Have surfaced my concern of density and he states he does capture some 3 and 4 units with .8mm in Caucasions (seems dubious since avg 2 unit is .78mm and I think 3 unit diameter at bulb is about .86) - again, maybe with fine hair like have and being Caucasion, that is feasible * Torsional stress can lead more failure and graft viability * Suction can cause graft viability and dessication issues * Could be less "density" and larger grafts than I may get from traditional FUT * Since my area is the crown, I am just concerned that I can not get enough density from 1 and 2 unit grafts So, there it is. I am still considering both FUE and FUT, need about 2000 grafts in Vertex - I am a NW Type 3V.

What did you ever decide to do about Dr Vories. I have consulted with him, as well. He used to do FUT and for last 3 years has done NeoGraft exclusively. I know he limits his practice to hair surgery and I have spoken to quite a few of his patients.

Most NeoGraft offices are charging about $4-$6/graft, from the ones I have checked with - looks like Bauman is charging about $12/graft. Exhorbitant !