nathaniel

mattj,

Did Dr. Rahal's patient try finasteride/propecia before surgery? The transplanted hairline looks very natural, but honestly it didn't look bad before - I don't see where it was lowered that much, just thickened up. Could not finasteride/propecia have done alot to improve the hairline without surgery?

I think Dr. Konior's hairlines look great and very natural - however, they also look like politician hairlines - they all make me think of Mitt Romney. I don't have dark, coarse hair; and I don't want to look like a politician!

That being said, Patriot34's comments about a hairline that "ages" with you is of concern to me. I love the look of Feriduni's hairlines, but I wonder how these individuals will look in 10 - 20 years.

Mickey85, have you commented before about Shapiro Medical Group's hairlines or FUE?

If this link gets removed by the moderators, the youtube title is "FUE hair transplant, hairline example by Dr Paul Shapiro of Shapiro Medical Group"

Ok......at this point in my life I want a hairline that looks like Michael Tintiuc....not very practical for long term hair loss, perhaps, but for a couple of years at least it would be fun

Larapixie: MICHAEL TINTIUC - CASTING CALL / MAY 2010

Thank you, Dr. Vories, for responding again to my questions. The thought of undergoing hair surgery is, to be perfectly honest, rather scary to say the least.

My point is that the main function of the negative pressure is to grab the grafts, and then I can drag them out. This is really no different than with manual extraction, in which inverted forceps pull the grafts out.

I think I see a difference between what my previous perception of the Neograft suction function was and the way you are currently describing it. Previously I had the impression that the suction component of the Neograft essentially "vacuumed up" quite forcefully the graft with no physical assistance from the operator; however, now as I read your response I understand that the operator, with the assistance of suction, is still responsible for carefully dragging the graft out - this in turn allows you to "feel" if a graft has been transected. That is quite a difference in perception, and I appreciate your clarification.

I do not believe that minimal depth incisions allow for dense packing anymore or less than other methods, just that there is less transection (in my hands) with minimal depth incisions.

I think I previously misunderstood you when referring to punch size - I assumed you were talking about the diameter of the punch, hence the question pertaining to punch size and single, double, triple, etc. grafts. Now, however, I think you are referring to depth when referring to punch size. Therefore, permit me to copy and paste from my previous posting as I think I was confusing the meaning of "punch size"

The punch size determines the upper third of the graft, but not the bottom two thirds

the size of the punch should not determine the ability to densely pack, since the bottom two thirds of the graft is not determined by the size of the punch

With this in mind, I would like to rephrase a couple of questions from my previous post.

1) Does the size/diameter of the the punched out graft relate to whether a follicular unit is a single, double, triple, etc.?

2) Do you target singles, doubles, triples BEFORE punching them out? Or do you first harvest grafts without thought to singles, doubles, triples and only AFTER harvesting the grafts sort them as singles, doubles, triples, etc. If sorting after harvesting is this done with a microscope or simply by visually "eyeballing" the grafts?

3) How do you correctly identify follicular units as singles, doubles, triples, etc., when some extracted grafts will be in the dormant phase?

Thank you again for replying.

- Nathaniel

Someone needs to say it...Nathaniel your a real pain in the ass i'm sure Dr. Vories has better things to do then answer your 1000 questions a day. Quit bothering the poor man.

Hi, aWidowsPeek -

Thanks for your input. If you are not interested in this thread I would suggest not following it.

For clarification, Dr. Vories is not the only physician of whom i have asked questions regarding hair restoration techniques. He is, however, one of the few physicians who lives within a reasonable driving distance of where I live. He is also the only HRN recommended physician who uses Neograft - of which I and others on this forum have some concerns; nonetheless I am trying to be objective about Neograft and learn as much as possible. I also have concerns about other techniques, from ARTAS to strip, and as such I continue to post questions in various threads in an effort to become more educated.

I should add that there are several other physicians within driving distance with whom I have also communicated. This is not to say that distance will govern my final decision in selecting a physician to treat my hair loss; however I cannot say that distance is not a consideration.

I would like to add that I believe that there are a quite a few people who appreciate the question-answer format of the HRN forum whereby even casual readers can sit back and learn from other people's questions and responses; and I believe that the questions not only contribute to that process but, as in this particular thread with Dr. Vories, allow the physician to demonstrate his/her knowledge and ability in the field of hair restoration.

In the end, however, no one else is paying for my treatment or subjecting their physical being to surgery on my behalf, and so I make no apologies for my due diligence.

Sincerely,

Nathaniel

Generally, the size of the extraction punch determines the size of the graft, but this can be misleading with the NeoGraft machine.

So the punch size determines the upper third of the graft, but not the bottom two thirds. This is important in that the size of the punch should not determine the ability to densely pack, since the bottom two thirds of the graft is not determined by the size of the punch.

 

Hope this answers these questions!

Actually, I'm even more confused...

Let me paraphrase what I think I am understanding you to say, but please correct me if I'm mistaken:

1) The Neograft only punches out the upper 1/3 of the graft; the bottom 2/3 of the graft is dragged out - with the assistance of vacuum suction? Does the physician physically pull on the graft in any way to drag out the bottom 2/3?

2)

The punch size determines the upper third of the graft, but not the bottom two thirds

3)

the size of the punch should not determine the ability to densely pack, since the bottom two thirds of the graft is not determined by the size of the punch

3) Does the size of the the punched out graft - whether upper 1/3 or bottom 2/3 - relate to whether a follicular unit is a single, double, triple, etc., and is it the upper 1/3 or bottom 2/3 that determines this? Or do you only sort out singles, doubles, triples, etc., after harvesting the grafts and, if so, is this done with a microscope or simply by visually "eyeballing" the grafts?

4) How do you correctly identify follicular units as singles, doubles, triples, etc., when some extracted grafts will be in the dormant phase?

5) Lastly - can you or other physicians tell immediately when a graft has been transected at the moment of transection - especially if you are using some type of automated FUE? I just read this thread on Dr. Bisanga's ability to respond to the "feel" of grafts during the extraction process:

http://www.hairrestorationnetwork.com/eve/140154-new-hair-transplant-instrument-dr-harris-revolutionizes-fue-3.html

Thank you for replying!

Amazing post on Dr. Bisanga's technique. I hope Prez is doing well.

We have no exact cut-off point to differentiate between ultra refined and standard follicular unit grafting. However, there is an obvious aesthetic difference when viewing postoperative photos from surgeons who consistently use smaller cutting instruments versus those who don't. Those who use slighlty larger tools or create "chubby grafts" (grafts with more surrounding tisue) tend to lack the ability to dense pack follicular units as closely together and have to make slighlty larger incisions. Often times, more than one procedure is necessary in a given area to create the kind of density a patient wants.

Bill,

1) For clarification, it is the tool used that creates "chubby" grafts - yes or no?

2) If yes, do Hans Implanter Pens create "chubby" grafts? I'm assuming the answer is "no" based on Dr. Vories statement:

the use of implanter pens is not a barrier to high density grafting

3) It's quite confusing, actually. I thought blades and pen needles were used to create the recipient incision site - not the graft. Grafts are either prepared under microscopic dissection or at the time of extraction in the case of FUE...?

We specifically target single hair grafts for hairline and temporal point work

 

Dr. Vories,

1) Can you explain how you "target" single hair grafts for hairline and temporal point work?

2) Do you mean you use only singles in the hairline and temporal point work, or do you merely aim to include singles with doubles, triples, or quadruples in the hairline and temporal point work?

3) If you use only singles in the hairline and temporal point work, how far back do you go before you transition to doubles, triples, or quadruples? For example, would you use a quadruple 3 millimeters behind the hairline as in the case of a Norwood 1 or only in the vertex as in the case of a Norwood 5?

Recently I've been intrigued by how the degree of hair loss may govern the distribution of 1's, 2's, 3's, 4's, etc. across the scalp. For example, I initially found the diagram on Shapiro Medical Group to be very illuminating; later, however, I realized that the same diagram had limited application for a Norwood 1 or 2 patient.

Thank you!

- Nathaniel

Chillboy's scar alone is enough for me to NEVER recommend Dr. Madhu to any of my family, closest friends, distant associates, total strangers, or my worst enemy's dog "Fido" - and Fido's been dead and buried now for 3 years.

Since

suggestions are always welcomed

I find it very disconcerting that the Hair Restoration Network would continue to recommend a doctor to the rest of the world that no well versed member of this site would ever recommend to anyone - especially after such a horrid result. Even if Chillboy's results were a fluke, there should be an immediate cessation of the Hair Restoration Network's unrestrained recommendation for Dr. Madhu's clinic (or any recommended clinic with such unacceptable outcomes) pending investigation. Notice I did not say that such clinics should be immediately dismissed completely without due process - just that HRN's recommendation should include a disclaimer related to any investigation pending the outcome. A disclaimer as such is far more considerate than when, for example, one of Boeing's new 737 Dreamliner airplanes has a small fire and all Boeing 737 airplanes around the world are completely grounded pending not only investigation but also a fix for whatever caused the problem.

Moreover, there REALLY needs to be an independent gallery of all doctor/clinic results listed alphabetically by doctor/clinic to which both doctors and patients can post results. Currently the only such pictorial galleries are under doctors' profile pages which naturally are going to include only images of a doctor's best patient outcomes. In contrast, visitors to HRN seeking evidence of poor to even average patient outcomes for any particular doctor must sift through numerous, often lengthy and frequently indirectly related threads to find such postings (assuming such postings exist). The current structure enabling doctors/clinics to post their best results in one place under the doctors'/clinics' name while in contrast providing patients only the opportunity to post outcomes in unrelated, solitary threads or personal blogs (often outdated for someone doing a current search) does not provide the general viewing public sufficiently equal opportunity to review all available information on a particular doctor/clinic.

The goal of any good resource provider is to make all available information easily accessible in its entirety. Imagine, Blake, if you had to study for your medical exams by searching through threads...

If that is a picture of his thumb, then it doesn't look too long... especially for 2500 grafts.

I am looking forward to seeing the results. You are very fortunate indeed to have such a good outcome on the scar.

If that is a picture of his thumb, then it doesn't look too long... especially for 2500 grafts.

I am looking forward to seeing the results. You are very fortunate indeed to have such a good outcome on the scar.

The scar is virtually not noticeable. I mean - I wouldn't normally see it - but when you point it out, I can make out a little "something" ....but just barely. How large was the strip that was removed? Can you feel the scar when you run your fingers over it?

Otherwise, looks very promising - I look forward to seeing your final hairline and scar results. What was the difference in price between the FUT and FUE procedure w/ Dr. Cooley?

Doug Monty,

I know there is a lot to respond to in this thread. And some of the statements made here have led to additional questions on my part, but I will refrain from asking them at the moment to give you a chance to reply to what has already been posted.

With that in mind, can you please respond to my initial questions?

Alternatively, if the comments and questions in this thread are too time consuming for you to respond on your personal time, could you please have an official representative from Neograft reply on "company time"?

To be honest, and I don't mean any disrespect towards you, I would really like to have an "official" Noegrarft representative at least contributing to this thread for the purpose of transparency - though I certainly appreciate your input even in a non-official capacity and welcome greatly your participation even alongside an "official" representative.

Thanks!

Nathaniel

Perhaps a new thread should be created to discuss the FUE/FIT opinions being expressed here? Either way, I agree with Blake and a few others on keeping the tone respectful - even though we all have experienced difficult emotional trauma resulting from our own hair loss histories - ultimately using loaded terminology such as "stupid" and "liar" does not contribute positively to objective and lucid discussions with regards to hair transplants.

That being said, I did follow one of Mickey's (a self avowed FUE proponent) link in this thread and it appears to me that Mickey acknowledges that depending on the situation FUT is a better option than FUE:

http://www.hairrestorationnetwork.com/eve/169896-practical-theoretical-fue.html

FUE has many glaring advantages over FUT which would be more evident but I don't think it can supersede FUT just yet in terms of total hairs/grafts achievable. Sure you could go past 50% extraction on the donor, but I think it would be left cosmetically barren in most cases. Part of the reason people want FUE is to avoid the linear scar and other complications(visual and other) on the donor of FUT so going past 50% via FUE would in a way be reverting back to the unacceptable donor result that lead people away from FUT in the first place.

 

There is a 10,000 graft FUE result and to me, it does not look convincing at all. The patient was basically a NW7 and the result after several operations was average at best. Maybe the patient was happy with the result but I certainly would not be. And that is not a flaw of the surgeon as he is one of the best FUE surgeons in the world, but a limitation of hair transplantation and particularly FUE. In most cases there just is not enough donor hair to cover a NW6 or 7 with enough coverage and density... Even with FUT the surgeons have to compromise with an unnaturally high hairline and spare crown density.

 

All in all I like that you have embraced FUE and I do see this trend continuing but I do not see FUE transcending FUT in terms of total graft/hair quantity. Maybe sporadically but not consistently. Just my opinion for what it is worth.

Oh, I wish we had created a separate thread for this "FUE/Strip" discussion....That being said, I will create two posts: The first post to address specifically questions regarding this photograph of Lorenzo's work; the second post to jump into this hurricane of "FUE/Strip"...

Mick,

Exceptional result.

1) Beginning in September will Dr. Lorenzo operate exclusively out of your clinic in...London is it? Or will he travel back and forth between London and Spain doing hair transplants in both locations? I ask this because on the whole London is much more expensive than Spain.

2) What will be the cost of FUE w/ Dr. Lorenzo at your clinic in the UK? How does the cost differ from Dr. Lorenzo's procedures performed in Spain?

3) Will you offer travel discounts to patients based on distance travelled?

4) It has been stated that the coarseness and dark color of many Spanish patients' hair have contributed to the successful outcome visually of Dr. Lorenzo's work. My hair is sandy blonde/light brown and relatively fine (at least to me, I'm no hair expert). My hair is even lighter and finer on my temples. How do you take thicker, darker, coarser hair from the "safe zones" of FUE and match it convincingly to the lighter, finer hair along the temples in people whose hair is not dark and coarse?

5) Recently I met with a highly respected coalition doctor in the USA who performs both FUE and Strip. He is known for hairline design. He was very clear that he could not achieve visually the same results with FUE as he could with Strip. Remember - I am focusing on visual results - not graph yield or transections (I'm assuming his FUE procedures yield a comparative number/percentage of healthy grafts as his strip procedures do). Specifically this doctor stated that strip offered him a broader spectrum of subtle graft variations to construct a fine hairline than does FUE. I know this last statement will probably bring a wave of responses, but I do ask that responders minimize language that might trigger inflamed, nonobjective, off-topic emotional responses. Mick, your thoughts (as well as thoughts from Dr. Lorenzo) would be greatly appreciated. I would like to add that the coalition doctor I spoke with felt that even the BEST hairlines he had viewed by even the most acclaimed European FUE doctors did not match up in quality to the BEST hairlines he has viewed resulting from strip.

Ok.....let the fireworks begin....

Oh, one last thing, Mick, like Spanker I cannot afford a $56000 hair transplant - or even one at half the price. I will say that I am "fortunate" in that the coalition doctor stated he could create a stellar hairline with only 1000 grafts from strip, so in that sense I don't see me approaching a $56000 hair transplant thank goodness....

Ok.....now to post #2, which will be short....not sure about the responses, however....

TL; DR - ok, thanks!

1) Othersyde, why did you go with strip rather than FUE?

2) Can you feel the first strip scar with your fingers?

Your first HT outcome looked excellent btw, but I do see what you mean about the lack of density in the front.

3) Did you anticipate that the front would be lacking in density and would require you to return for a second procedure to thicken it up? If so, why not just do it all at once and be done with it?

Thanks!

Nathaniel

Bill,

Again I have reviewed the criteria for physicians to obtain "Coalition" status.

Ultimately, those using smaller instruments, creating smaller grafts and transplanting higher densities while minimizing trauma to the scalp can be referred to as using ultra refined techniques.

Is this not all member physicians of the Hair Restoration Network, whether of "Recommended" or "Coalition" status?

Are there physicians of the Hair Restoration Network with only "Recommended" status who are performing hair surgery with larger "cutting instruments" of 1 mm or greater?

From your link: Coalition of Independent Hair Restoration Physicians - Membership Standards

While many surgeons now perform standard follicular unit grafting, only a minority have risen to the challenge of using very tiny incisions and grafts to achieve ultra refined results.

This is where I get confused. How is "Standard follicular unit grafting" different from "Ultra Refined Unit Grafting"? And which "Recommended" physicians of the Hair Restoration Network only do "Standard follicular unit grafting" - (meaning using larger cutting instruments of 1 mm or greater I presume)?

Thanks! Nathaniel

I think a hair transplant is potentially far more dangerous than any temporary side effects from Finasteride.

My understanding is that none of the side effects of Finasteride are permanent, and the temporary side effects are not very dangerous. Finasteride has a very short half life in the body I believe (24 hours???) - though I am no medical professional.

I really think you should consult with your primary care physician about Finasteride - and even a hair transplant - before you go all out on a permanent procedure that may have permanently horrible results. I have never heard anything good about Bosely, btw...

Hi, Raymond,

Looks like everything is progressing nicely.

Why did you decide to go strip rather than FUE? And how is your scar in the back doing?

Thanks!

- Nathaniel

Very nice, Dr. Doganay.

This was FUE, yes?

Replace the word "blades" with cutting instruments. Implanter pens include a cutting instrument and as long as they are small and refined (typically ranging from .6mm to 1.0mm depending on the size of the follicular unit), the technique can be considered "ultra refined".

Thank you for clarifying! Though I have looked at pictures of the Hans Implanter, I tend to visualize the "cutting instrument" as a needle (whether rightly or wrongly), and in my mind a needle is not a blade. So, yes, the terminology was a source of significant confusion.

- Nathaniel

Using implanter pens does not prevent dense packing. Using the stick and place method of placing grafts, it has been shown that grafts can be placed as high as 80 grafts/cm2. This degree of density should be used with caution, and donor/ recipient ratios should be respected.

Thank you for replying, Dr. Vories.

1) If 80 grafts/cm2 is the upper limit for dense packing and then only when used with caution, what is the typical grafts/cm2 that can be implanted safely with pens when dense packing?

Also, please feel free to chime in on my questions to Bill in the previous post.

Finally, earlier in this thread I asked that you clarify if you break grafts down by hair numbers for the patient and also how you disperse 1, 2, and 3 unit grafts and possibly 4 of larger grafts in the scalp. Could you please provide a description? Recently Dr. Feriduni described for me how he dispersed such grafts in the scalp, and I found it very interesting. Here are my original questions on the topic, slightly edited for flow in reposting:

3) Do you keep track of graft breakdowns, and if so would you please include in your posted examples?

4) Similarly, can you illustrate how you distribute these grafts throughout the scalp (for example, in Mickey85's post diagraming FU placement only 1s are used in the front of the scalp - is that your approach as well?). A similar example of graft distribution is on Shapiro Medical Group's website, and i find it interesting that Dr. Wesley seems not to have used any grafts larger than 3's, whereas Shapiro's diagram includes grafts as large as 4's.

5) Speaking of which, what is the largest graft size you implant?

Dr. Feriduni recently replied in another post to similar questions I posed, and I found his reply very interesting with regards to how he distributed different graft sizes across the scalp. He also clarified for me that he only uses pens for eyebrows and only uses blades on the scalp.

Thank you for taking time to answer my questions!

- Nathaniel

"Ultra refined" follicular unit grafting refers to smaller blades, incisions and grafts, providing physicians and their staff the ability to densely pack grafts closer together while minimizing trauma to the scalp.

Bill, I read this page previously, but it still leaves me a bit confused to be honest. Dr. Vories states that with implanter pens grafts can be placed as high as 80 grafts/cm2 - when appropriate. But you specifically state that "Ultra refined" follicular unit grafting refers to smaller BLADES.

1) Can you please clarify? Also, Dr. Vories has stated that pens protect grafts better than forceps during implanting, yet again your statement suggests that smaller BLADES cause less trauma to the scalp.

2) Do pens protect grafts better than forceps during implantation but at the cost of greater trauma to the scalp?

3) Can one achieve "Coalition status" using pens?

Honestly, Bill, I don't mean to be disrespectful in any way, but it almost seems - again, I am relatively new in these forums - that "Coalition status" is more dependent upon the use of small blades rather than actual consistently stellar outcomes, regardless of the tool used. Maybe I'm misinterpreting the word "Blades", but I've been sifting through the threads of these forums for awhile now, and the title "Coalition Doctor" is still unclear to me. Perhaps your page can be tweaked for clarification if I (and presumably others) have misunderstood it?

Finally, I understand that both "Recommended" doctors and "Coalition" doctors pay a fee to be included in these forums as a "Recommended" or "Coalition" doctor - and I understand why, that's fine; I also understand that merely paying a fee does not automatically result in a title of "Recommended" or "Coalition" status and that physicians have to meet certain criteria - all good as well.

4) Is the financial cost to doctors for the title "Coalition doctor" greater than the financial cost for "Recommended doctor"? Or do doctors pay the same fees regardless of their status as a "Coalition Doctor" or "Recommended Doctor"?

Thanks!

- Nathaniel

Don't know exactly what TL;DR means, but the porn industry has made millions of off such pictures...

westham1975,

Do not rush into a HT without doing more research not only on this doc, but also other docs - each doc has a different approach and those differences can yield significantly different results.

Train travel in the UK and especially Europe is so fantastic (at least compared to the USA) that there is NO REASON AT ALL for you not to travel to the continent and meet with several different doctors before you have a procedure. Make it a vacation/research trip. Travel to Belgium and meet with Dr. Feriduni, Dr. Bisanga, and several other doctors in the region, then on the way back stop in Brugges for a couple of days and eat lots of Belgium chocolate!!! It's summer - take a vacation for God's sake!!!

DO NOT UNDER ANY CIRCUMSTANCES SIMPLY GO WITH THE LOCAL DOC BECAUSE HE'S "CONVENIENT" - WRONG!!!!!

Nick is trying to tell you - research other docs.

The reality is if you are having problems finding negative or positive feedback on a clinic or surgeon you should cross them off you list.

Everything Greatjob has stated is spot on the money, but especially the part about a lack any feedback - screams "Danger!"

I have met with 2 HT docs at this point - one a recommended surgeon on this site and another a coalition surgeon on this site. I still have questions about technique, procedure, and even integrity. One doc recommends FUE, the other Strip. Who is correct? Each was very adamant about their approach. I would GREATLY like to move forward and get on with my life. However, the key to moving on with my life is to hedge my bets now BEFORE a procedure (because there is no guarantee!), so that I minimize delaying my life by trying to go back for repair later on after a messed up first procedure.

Mmmmm......Belgian chocolate.....

"Ultra refined" follicular unit grafting refers to smaller blades, incisions and grafts, providing physicians and their staff the ability to densely pack grafts closer together while minimizing trauma to the scalp.

Thank you for clarification, Bill. But does this mean that pens cause more trauma to the scalp while simultaneously preventing dense packing?

One of the questions I am waiting to hear back from Dr. Vories about is if the "bubbles" prevent dense packing.

With your level of loss my first advice would be to save your money and shave your head, because the chances of achieving your goals are not great. However with your comment "4 years wait is a bit too much" I would say you should definitely not undergo a hair transplant. Very few people achieve their goals with one procedure, and very few people with your level of loss achieve their goals with 2 or 3 procedures, so if you are not willing to spend a significant amount of money and invest years of time you should definitely not head down the hair transplant route, as you will more than likely end up back on this forum telling tales of disappointment.

I concur completely with Greatjob. You will not be happy with the results, and you will suffer MORE emotionally and psychologically than currently.

On a side note, Seth, one thing I find interesting is how we all tend to perceive our own hair loss as "the end of the world"; yet ironically I frequently look at other men whose hair loss is more advanced than mine and think that it looks natural, appropriate, and even distinguished or cool depending on the person - whether it be Bruce Willis or Ghandi.

Again, I know it's not what you want to hear, but it's not the end of the world -- I honestly believe you will be happier if you accept your hair loss rather than try and change it through physically and emotionally torturous, endless, costly procedures.

Sincerely,

Nathaniel