NW3VKY

FUT performed on a 40 year old Caucasian male with:

 

- NW Class V-VI

- Donor density of 110 FU/cm2

- Hair diameter of > 85 microns

 

Treatment plan:

Follicular Unit Transplantation with 4000-5000 follicular units to restore the hair line, temporal peaks and mid head and crown area.

 

Performed procedure (February 23, 2009):

A Follicular Unit Strip Transplantation with 4460 FU

* 1680 single hair FU

* 2040 double hair FU

* 740 triple hair FU

 

Donor closing in 1mm lower edge Trichophytic Closure Technique (double layer suture);

A combination of parallel (single units) and perpendicular incisions (double and triple units) in custom-sized blades technique (~Cutting Edge blades of 0.7mm – 1.1mm).

 

This patient decided to step over to a hair restoration surgery after wearing a full hair piece for many years.The patient‘s aim was a high density Follicular unit Transplantation (HD FUT) to obtain a “similar” density to his hair piece. Unfortunately full coverage was not possible even with a high flexibility of the donor area and over average density of 110 FU/cm2. So he decided to wear a smaller hair piece after 1st procedure to cover up the non-treated areas. After he saw the result of the first procedure he decided to go for a second procedure to cover the crown area as well.

 

Treatment plan :

2nd procedure with 3500-4000 FU to add more density to the hair line and restore the crown area

 

Performed procedure (July 12, 2010):

A Follicular Unit Strip Transplantation with 3969 FU

* 990 single hair FU

* 1728 double hair FU

* 841 triple hair FU

* 610 four hair FU

 

Donor closing in 1mm lower edge Trichophytic Closure Technique (double layer suture);

A combination of parallel (single units) and perpendicular incisions (double, triple and four hair units) in custom-sized blades technique (~Cutting Edge blades of 0.7mm – 1.1mm).

 

Dr. B. Feriduni

Any updated pics on this case ?

I hope your right Can't Decide. "Buyer's remorse" is definitely the term, you nailed it. I should clarify, my hair loss might be more towards a Norwood 3, I've recessed on the sides quite a bit, but not much thinning on the vertex. Anywho, all I have to go on is what I've found online, which mostly has profiles where the patient is pleased with their recipient area, and dreading the time when it will fall out.

 

6, 9, 12 months. This is a long time to wait for indication of results. I realize the hair falls out before it grows back in months down the line. I guess I was just hoping for a "glimpse" of the final product, in my first few weeks post op.

PICS or it didn't happen

I would like to share this presentation of Dr. Bisanga "Hair Transplant Technique FUE/ FUT Compete or Complete"

 

(promotional video removed)

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.

The company known as Atlantis 2000, International has a company policy set up that they will not participate in Propaganda and created attempts to extort their company by less honorable people and their competition writing lies, but I will. I have seen stuff like what I have read on these blog sites fall out of planes from our enemies when we were fighting in the war. You may also run my ip address to see that I am a real past patient and stop with the horrible false accusations that I have read here on these so called blogs. Hair transplant doctors have the hardest jobs there are in the surgical field. They are dealing with young and old men that are mad at the world that someone has taken away their youth by means of losing their hair. They get mad at anyone; also including their wife’s and blame the hair transplant medical people when it is not thick enough in one session when they only get small amounts of hair on their first surgery. The human beings, male or female have over one hundred thousand hairs on the top of their heads. Then when bald men can only afford a couple thousand grafts, they get mad at all of the doctors that their hair is not as thick as Elvis's or Brad Pits was after only one time, even though they have all been told this verbally and this is stated in writing on all of their paperwork. My paperwork claims that when you are bald you will need more than one session throughout your lifetime. This kind of uneducated thinking and immature false stories show in the smear attempts, false statements made, fake pictures posted and false opinions of moles that are the work of evil angry men which will always show also in their private lives as well. I am a corporate attorney that has had five hair transplants in the past thirty plus years. I have been to three of Atlantis 2000, International's offices over that time period of my life when I was loosing my hair. Atlantis 2000, International does not pay the huge advertising budgets that other hair companies pay. Nor do they have grand marble tables and marble polished floors that other hair companies pay for in their overhead. All smart businessmen out there understand about the high overhead cost. They also pay a yearly lease on a Medical Suite in the Medical III Building adjacent to the Hospital just like other doctors do in business. Atlantis also has all the Medical Doctors licenses posted on their wall as every other doctor does also. I started thirty-years ago when Atlantis's prices were twelve dollars per graft/unit. They lowered their overhead little by little on their building and then the price dropped down to eight dollars per graft/unit on my second density surgery. When I did my third time years later after I had lost more hair due to growing older Atlantis made it even more affordable to becoming the first three dollar graft/unit I saw advertised at that time. After two sessions with their competition I did my third, forth and fifth procedure with Atlantis and they looked remarkable. That is why their competition tries to smear them as any large well known companies that do other things in this world know this as well. As I aged and lost more of my original hair that I was hoping to keep, I have done all my density sessions as they are called with Atlantis also. The uneducated men that think they will have hair as thick as Elvis or Brad Pit after only one time, this just will never happen as all of us older hair transplant patients all know this by now. If the uneducated guys want to blame someone out there they will have to blame their parents and grandparents before they were born.

Fact one for the record: Dr. Calhan does all the surgical parts of all the procedures just like other doctors do at other companies that I have used and the rest of their medical staff

Color me confused ??? :confused:

Follicle transection rates depend on the patient characteristics as well as the inner diameter of the punch. Among the field's most experienced practitioners of FUE, transection rates range from 2% to 8.5% for the 1-mm punch and from 3% to 10% using the 0.75-mm punch. A 1-mm punch can exact an average graft of 2.5 hairs/graft, while a 0.75-mm punch yields approximately 2.1 hairs per graft. I think most of us on this forum agree, however, that punches of 1mm or larger can result in visually unacceptable donor area scarring.

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 ?

My understanding is the thickness of the graft, the amount of tissue where the stem cells live, etc., is important for yield. It follows that the smaller the punch, the thinner the graft. Does this concern anyone?

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 ?

Guys (and Gals)

 

Ive been speaking to a UK clinic about having FUE. Before I went for a consultation I asked them:

 

- What is the price per follicle transferred?

 

and seperately

 

- How much would it cost for 1000 transfered follicle's?

 

The answer I got both times was the same... 2 pounds per follicle, but you need to see us for a consultation... so I went for a consultation!

 

The doctor in question said I would need between 1000 to 1200 follicle's for what I wanted to do, giving me around 2500 to 3000 hairs as the end result.

 

As I understand, multiple hairs may grow from 1 follicle (Please correct me if Im wrong with this?)

 

So, In my head, doing the maths... that would be:

 

2 pounds x 1000 follicle's = 2,000 pounds

2 pounds x 1200 follicle's = 2,400 pounds

 

for the work (assumedly with a bit of extra cost for medication etc). So I was expecting tops something about the 3,000 pound mark.

 

So... blow me... the cost I got for the work (and no there are NO complication with the work.. Im told its very very straight forward with me).... was 6,500 pounds.

 

Now.. that doesnt even exactly work out to 2 pounds x 3000 (hairs rather than follicle's) = 6,000 pounds and so the cost they have given me works out about 5.40p per follicle.

 

So Im looking at, what I think is a 4,000 pounds descrepency here... yes I am going to go back and check it.

 

However, I was wondering, from peoples expericence and price quotes,

 

- does this sound "right" for the UK on a per follicle basis?

- And/Or Does anyone know if places are charging per hair, rather than per follicle?

- Anyone else any experiences of "London" prices for 1000 to 1200 follicle's where theyve had work performed in the last year?

 

Basically.. am I nuts to go back to them and say "how does this price match up, when Ive been told about 2 pounds".

 

Any answers or thoughts much appreciated!

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.

Dear

 

I believe if Bill and Blake invite tissue engineers, biotechnologist and other doctors who are working on stem cell hair multiplication or cellular regeneration.

There could be an international break through into cellular hair regeneration. I am providing through my clinic in Mumbai is stem cell hair multiplication from my regenerative lab. Since Aderans did its phase one safety trial in UK under its parent company Intercytix. This safety approval in UK was carried forward to phase two trials which is presently being conducted in the USA. Similarly Aderans and histogen phase one clinical trial for safety efficacy from US FDA. And these safety efficacy documents are accepted by Indian regulatory authorities. So we are absolutely ethical and legal with a special consent form with our in-house regenerative lab to offer hair multiplication to our patients. Only thing is we have to be careful about percentage success claim. Propecia and minoxidil were able to increase to increase hair density by 13 hairs per sq cm. This was the criteria by US FDA to clear their claim of their role in hair re-growth. Aderans, histogen and Dr. Nigam are waiting may be 2 years from now to get the claim approval. All 3 of us may differ little bit in their laboratory processing approach. Aderans and Dr. Nigam use autologous stem cell and serum free growth factors. Both of us do not plan to come up with a product. Hence our stem cell is not labelled as a drug. While histogen is coming up with stem cell hair based product called HSC. Histogen is most probably into allogenic stem cell. Since we are going to offer process under monitoring of doctors and GMP certified lab, the regulation for us will be much lighter and cure friendly especially after the clearance of safety. That is how we could become the first stem cell hair multiplication clinic in the world in 2012 in Mumbai. Of course it’s still a long way to increase the success rate further. The moment histogen gets WNT protein safety approval; my process is complete only legally i am waiting to offer the same through my clinic. Next year July- August I'll be publishing my papers.

 

Regards,

Dr. Nigam.

Fascinating - thanks for positng.

well, i'm a hard line republican social conservative, so i think that stem cell research is immoral and wrong, and a sick thing to do to fetuses. that's how i used to think until i read your post. now i think they should do it, and give me back my hair.

 

i'm just kidding though, i've never been against scr

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.

I had an FUE operation on 1st June and here we are just over 6 months later and I only have about 15-20% growth. I am very disappointed and not very optimistic about it improving. I would have thought that after 6 months one should expect to see about 50% growth? I have been in touch with my Surgeon (whom I don't want to mention at this stage) who has told me that it is still early days yet and more will grow, however, I am not convinced as I look identical to what I did before the op.

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 !