nathaniel

Very nice - soft and natural.

SymbolicHair,

 

I remember your post from another thread:

 

http://www.hairrestorationnetwork.com/eve/170596-fue-neograft-12-days-ago-post2354012.html#post2354012

 

I thought it was a bit strange at the time as I had never heard of Dr. Fitzpatrick, but you claimed to have been researching hair transplants for more than 5 years so I didn't think anything more of it. However, if rifle444 tells you, "stay away from this guy, please," then at the very least you should stop and reconsider your choice of doctors.

 

I just googled his website with the key words "Dr. Fitzpatrick hair transplant", and I must say his >5< hair transplant photos are pretty damn pathetic. Only 1 photo per patient??? Only from above??? Where are the hair line photos? The lighting in "Hair Transplant Case 5" is completely different in the before and after photo. Either that or the patient dyed his hair darker in the second photo. Actually, it's hard to see that there's any difference in hair coverage between the two photos - did a hair transplant even occur? The same goes for the other 4 cases! Where are the immediate post-op photos? What is the time line between the before and after photos? Even stranger, none of the photos are marked "before" or "after"!!! It just looks to me like the hair has been combed a little differently for the second photo in each patient case!!! Where are the graft breakdowns: # of grafts extracted per patient; number of grafts implanted per patient; breakdown of implanted grafts by 1, 2, 3, or 4 hair units; dispersion pattern across the scalp of grafts by hair units (ex. 1's in the front, 2's in the mid-region, 3's and 4s in the crown)?

 

I have no doubt that the printed brochures handed to you were very slick. I have the impression that Neograft has a very slick marketing department that works with individual doctors and creates the whole sales package for them - I don't know, but that is just the impression I'm getting. It would be lovely if Neograft would come on this network and face questions from members of the Hair Restoration Network forums - if for no other reason than to clear up misperceptions about the Neograft machine and it's business model. Maybe it's a great machine! But I have seen a lot of people on HRN speak negatively of their experience with Neograft, from poorly trained techs to doctors who are not involved at all in the hair transplant procedure. The Sean Rima video clip of Dr. Hall's practice was quite shocking as the doctor did not seem to be involved even in the drawing of the hairline.

 

Well, I don't want to cast unjustifiable aspersions on Dr. Fitzpatrick. Perhaps he is a great hair transplant surgeon, and rifle444 is an anomaly. Nonetheless, Dr. Fitzpatrick is marketing himself as a hair transplant surgeon, and as such he must be willing to allow others to scrutinize his qualifications, techniques, and results without taking offense. Please extend a personal invitation from me to Dr. Fitzpatrick to discuss in this forum his philosophies, methodologies, techniques, and results in regards to the hair surgeries he is performing - really, I personally learn so much simply by speaking to patients and doctors on this forum about all aspects of hair transplants.

 

I should also like to point out that his youtube video on hair transplants and Neograft do not show him or any of his staff actually performing a single hair transplant. Also, from the video it appears he uses the Neograft for both extraction and implantation - as it has been designed to do. However, in the same "fue-neograft-12-days-ago" link above, in which the Sean Rima/Dr. Hall/AZ case video is referenced, Future_HT_Doc (Blake) makes the comment:

"While I'm speculating a bit, I assume the graft placement in the AZ case was completed with the NeoGraft machine itself."

The photos on Dr. Hall's website are as pathetic as Dr. Fitzpatrik's; personally I'm still waiting to hear back from Blake as to why he surmises that Sean Rima's implants were completed with Neograft rather than the Hans Implanter that Dr. Vories uses or other implantation tools used by other doctors -- hint, hint, Blake ^^ . My own speculation is that Blake feels physicians and techs without adequate training and experience in hair implantation techniques can nonetheless easily use the Neograft implanter much like a nail gun to simply "point and shoot" - and by extension so could my neighborhood handyman. Of course, I am just speculating momentarily and don't want to put words into Blake's mouth as I am sure he will respond as he is very good about answering questions and addressing concerns.

 

At any rate, if Dr. Fitzpatrick is worth his salt, he shouldn't have any problems with you at least postponing your procedure while you double check his qualifications and address concerns that have been raised in this forum. And if it costs you a deposit, better that than your head...

 

- Nathaniel

I don't describe our clinic as "fully implemented ultra refined follicular unit grafting" because I don't know what it means.

 

Well I'm glad I'm not the only one who hasn't figured out what that means...

 

Does the resultant tissue "bubble" prevent or limit high density packing? It seems like (to a non-medical person like me just looking at the pictures) that the tissue "bubble" would prevent the grafts from being placed closely together; in contrast, the tiny sagittal slits seem like they can be placed very close to one another - just from looking at pictures, again I know nothing about medical techniques. Regardless, I'm still curious why you choose to use the implanter pens rather than blades - with the understanding that every doctor has his/her preference of tools.

What the kitten said - nice hairline!

Thank you, Burned, for sharing your story. I wish there was a single thread or gallery where people could see bad hair transplant results by doctors all in one place. It is difficult sifting through all these various threads and trying to remember all the doctors' names and cases of hair transplants gone wrong.

Hi Dr. Vories,

 

Is the "bubble look" at each graft implant recipient site because of the Hans Implanter? I've noticed in photos of surgeons who use the sagittal and coronal slits that there does not appear to be any of the above "bubbling" (for example, Dr. Bijan Feriduni's image below):

 

Forum By and for Hair Loss Patients - Pat - Publisher of this Community's Album: Photos from Pat's Visit to Visit to Dr. Bijan Feriduni clinic in Hasselt, Belgium - Picture

 

Also, why do you choose to use the Hans implanter pen? The below comments by Bill and by Blake

(Future_HT_Doc) caused me some concern:

 

Bill writes in his link: What is the “Stick and Place” Technique in a Hair Transplant | Hair Loss Q & A

 

I believe that the stick and place technique can yield excellent results when performed by well trained and supervised medical technicians. However, I found both the incisions made by the 19 gauge needles and the grafts to be a bit larger than what I typically see at leading hair restoration clinics who have fully implemented ultra refined follicular unit grafting.

 

And Blake responded to one of my inquires:

 

A 19 gauge needle would probably make a (roughly) 1.1 - 1.2 mm site in the recipient scalp. Many think this is too large, even for the 3-4 hair follicular unit grafts - which are normally 1.0 mm in diameter.

 

Would you describe your clinic as a clinic that has "fully implemented ultra refined follicular unit grafting"?

 

On a different note in reference to your above patient, you write:

 

At the time of his procedure (Sept 2012) are maximum procedure per day was 1500 grafts...We currently are able to perform 3000 grafts per day

 

What has changed at your clinic to enable you to double your productivity?

 

Thank you for responding!

 

Nathaniel

I'M BACK! Can I get a "Whoop! Whoop!"

 

Blake:

 

While I'm speculating a bit, I assume the graft placement in the AZ case was completed with the NeoGraft machine itself (and not a Lion Implanter - as it was with Dr. Vories).

 

Speculation is great - it's the foundation of the scientific method, yes? What have you observed about the Neograft machine or company's methodology that leads you to hypothesize that graft placement was completed with the NeoGraft machine?

 

A 19 gauge needle would probably make a (roughly) 1.1 - 1.2 mm site in the recipient scalp. Many think this is too large, even for the 3-4 hair follicular unit grafts - which are normally 1.0 mm in diameter.

 

Ok, so you meant 18 gauge needle, but even so, why do people consider the Hans Implanter too large regardless of which needle is being used? The recent recommendation of Dr. Lorenzo was met with complete and overwhelming approval, with accolades such as "The best FUE surgeon in the world" (think that was Dr. Feller, actually). By the way, how many needle options are there, and to clarify, the largest FUG possible is 3-4?

 

Finally to return to PupDaddy's concern:

 

Because if, as your surgeon advised, the tech or nurse is doing the "placement" of the grafts in the recipient sites, and the clinic uses implanter pens for FUE, then the nurse or tech is also necessarily creating the recipient sites

 

What are your thoughts on techs/assistants creating the recipient sites?

Dr. Feller states:

 

After that it's FUE time for me.

I'll do a separate video on that.

 

I am very interested in that video, Dr. Feller. Personally, I won't consider strip, but then I don't think I'll ever reach a Norwood 3 or higher, so I understand others who do go this route.

 

Also curious who you would choose as your FUE surgeon. ^^

It is not a "one size fits all" device. It comes with a variety of different sized needles for different sized grafts. What's more, the graft selection process is where the surgeon would select specific grafts based upon needs. He/she would then load one graft at a time into an appropriate sized needle and implant it in the scalp. Small needles with single hair grafts would be used in the hairline; slightly larger needles with 2-3 hair grafts (FUGs) would be used in the frontal/mid scalp; and the large (for lack of a better term) needles with 3-4 hair FUGs would be used where appropriate.

 

Thank you Blake - and Bill - for clarifying how the Hans Implanter works; Bill, I look forward to reading the new link on implantation devices.

 

But this evening I'm a bit sleepy after a long day out and about in the hot, summer sun; so everyone gets a temporary reprise from my endless questioning!

 

But rest assured, I will return to this thread and after reading through everything more thoroughly, I will no doubt have more questions to pose. Until then, sweet dreams everyone!

Why would your derm turn you down? Who is your derm?

Every week nowadays, and yesterday was a fine example, I see a patient who presents for repair of automated FUE.

 

For clarification, Dr. Lindsey, there are only two automated FUE machines currently in use in the hair transplant field, Neograft and ARTAS, correct? Are these new breed of patients former Neograft or ARTAS patients? Or a combination of both, and if so, what percentage?

 

Yesterday's guy was typical of this new breed of patient. He saw a flyer or ad for an automated FUE marketed by a general plastic surgeon or facial plastic surgeon office, went to them thinking that they do hair routinely, and then find that after meeting with the plastic surgeon for a few minutes on the day of surgery, that some "non-employee technicians" (I'm quoting the patient) do their case...Often times, and I brought yesterdays consulting patient in to the procedure room to meet our patient on whom we were working yesterday(for comparison), the consulting patient has what appears to be 300-500 grafts scattered along the hairline. Surrounding these grafts are lots of miniturized hairs that almost certainly will go soon, and the donor area has what appears to be 1000 or so 1.5mm punch scars.

 

So you're saying that out of 1000 or so FUE automated punches, only 300-500 survived intact enough to make it into the hairline? Are the miniaturized hairs also implanted hairs, or are they native hairs; and why will the almost certainly go soon?

 

Thank you, Dr. Lindsey!

Hi, Dr. Vories,

 

Like every other person on Hair Restoration Network I am dealing with hair loss issues. I have been reading as a "guest" for some time and recently created a profile so I could ask specific questions.

 

Your name has come up recently with regards to Neograft, and after reading more and more about Neograft I have been left, to be perfectly honest, quite shocked with the practices and results associated with Neograft. I have also read where you maintain that in properly trained hands Neograft yields excellent results.

 

As such I am glad that you are active in these forums because I don't want to judge Neograft or the doctors associated with Neograft without hearing from them - and unfortunately thus far none have responded to some of my concerns, though I've only posted those concerns recently.

 

Without taking away from the pictures posted in this thread of the 5125 FUE graft, would you mind responding to some of the questions and concerns I've raised in the following thread:

 

FUE with NeoGraft 12 Days Ago... - Page 4 - Forum By and for Hair Loss Patients

 

I am both a very inquisitive and highly analytical person, and I hope you do not take offense at my very pointed style of inquiry; at the same time I believe I am also very fair minded and willing to listen to more than one view point. Even so, my primary goal is simply to obtain the best treatment for my hair loss, and to that end I make no apologies about being direct. That being said I believe the transparency of this forum will aid all members, both patients and health care providers, obtain better outcomes in the field of hair loss treatment and, as such, I would appreciate your direct input.

 

Thank you!

Dr. Lindsey, Blake writes about the 19 gauge needle in the Hans Implanter Pen:

 

A 19 gauge needle would probably make a (roughly) 1.1 - 1.2 mm site in the recipient scalp. Many think this is too large, even for the 3-4 hair follicular unit grafts - which are normally 1.0 mm in diameter.

 

This statement is bothersome to me.

 

I'm curious to know what is the size(s) of the needle(s)/blade(s) you use at the recipient site? I'm still a little confused on the "Coalition doctors" who use "smaller blades" at the recipient site - it almost seems like that is a requirement for Coalition status. In your opinion, is it possible to achieve "Coalition" status with a 19 gauge needle? Are there any doctors out there who have achieved "Coalition" status with a 19 gauge needle? And would 1.1 - 1.2 mm cuts along the front of the hairline yield "natural" and unnoticeable results?

 

Thank you, Dr. Lindsey, for your participation in these forums.

Thanks, Blake! I look forward to it!

OMG, Dr. Lindsey! That FUE Revision patient on your HRN profile looked horrible before you assisted him!

 

Hair Restoration Social Network - Hair Loss and Transplant Photos

 

At what point does such butchery constitute medical malpractice or legal action?? If I was that guy I'd be suing like He11 the clinic that did that to me!!!

 

I can't understand how a plastic surgery clinic or other doctor would allow such horrific work to be performed in their office!! Are the doctors being duped by these automated FUE companies as much as the patients???

Thank you for your input, Dr. Lindsey!

Looks totally natural!

Thank you, Blake, for clarification between the Neograft implanting tool and the Hans Implanter used by Dr. Vories. However, I must say, based on what you have written, TygerD's experience, and another link here on the HRN by hair70 I've just found, my confidence in Dr. Vories and/or the Neograft machine is waning fast (which is unfortunate as I live not too far away in Georgia and was considering options within driving distance).

 

You state:

 

A 19 gauge needle would probably make a (roughly) 1.1 - 1.2 mm site in the recipient scalp. Many think this is too large, even for the 3-4 hair follicular unit grafts - which are normally 1.0 mm in diameter.

 

Why would Dr. Vories use a device which makes such large incision sites that many in the medical field consider to be too large? Did you ask him this as part of his "recommended status" vetting process? If so, what was his reasoning?

 

PupDaddy writes in a thread by "Welcome" (http://www.hairrestorationnetwork.com/eve/170349-dr-vs-nurse-placing-grafts-after-extraction-2.html)

 

Make sure that your chosen clinic does not use implanter pens, such as the Hans Implanter Pen or the Choi Implanter Pen. Why? Because if, as your surgeon advised, the tech or nurse is doing the "placement" of the grafts in the recipient sites, and the clinic uses implanter pens for FUE, then the nurse or tech is also necessarily creating the recipient sites -- because that is how these implanter pens work: the recipient hole is made with the implanter pen, which is loaded up with previously extracted grafts, and a graft is placed from the pen simultaneously with the cutting of the recipient hole. You will want to confirm that the clinic does not use implanter pens for FUE and that your surgeon will be creating/making all the recipient sites.

 

I personally think that the transplant physician should at least place all of the frontal hairline grafts (as Dr. Konior and some other top docs do), but as others have said, it is not uncommon or unusual for reputable clinics to have their techs or nurses do all the graft placements.

 

How can a surgeon/tech "select" the appropriate graft for a recipient site if a bunch of grafts are randomly "loaded up" in the pen?!? Now it seems clear to me why the pen makes such large incisions - because it's a "one size fits all" plug (what other reason can there be?).

 

I am particularly bothered that the initial discussion between Dr. Vories and Tyger was locked - I mean, I understand that Bill felt that nothing more could be gained by letting that discussion continue in the open forum, but I quite disagree. The issues here are 1) technique(s) used for harvesting; 2) technique(s) used for implanting; 3) qualifications of the person(s) doing the procedure(s); 4) Full disclosure of all the aforementioned well in advance of the procedure by the supervising physician to the patient. As a potential hair transplant patient, I want to understand why the Neograft procedures undergone by TygerD and hair70 - at two separate clinics at opposite ends of the country - had similarly very poor patient outcomes. And I do mean similarly - weird angles, large graft sizes, large gaps/poor density, a lack of singles in the hair line - and this despite the fact that Dr. Vories is supposed to be a "hair transplant specialist" unlike North Valley Plastic Surgery in Arizona. Specialist or not, it really seems like Neograft is running the whole show and, worse, they aren't in any way qualified to do so. Is this why Dr. Vories is now doing the implanting of hair solely by himself now? Did he realize too late that Neograft was sending him totally unqualified technicians?

 

Many people in TygerD's thread asked questions to which I would like to hear answers - questions about technique, not about "graft survival" (which Dr. Vories keeps focusing on). I mean, I get that sometimes in medical treatments things "don't go right" or "don't go as planned"; however, if the fundamental approach/technique is not appropriately planned from the beginning, how can the outcome be even remotely satisfactory?

 

Ignoring "graft survival" (or lack thereof), let's focus on the initial technique(s) that are most likely to lead to optimal outcomes. Below are questions/comments that were asked/made by more than one person in TygerD's thread regarding density, angles, graft sizes, lack of singles in the hairline, etc.

 

(http://www.hairrestorationnetwork.com/eve/170309-should-i-have-wait-year-receive-my-refund-5.html)

 

Tom Cruise writes:

 

What is going on with that graft placement? It doesn't look right. Doesn't look right at all.

 

GNX1 writes:

 

sorry to hear bro. thats some of the worst FUE work ive seen in quite some time. I wud just define that as early plug work.

 

I would not go back there if THEY were paying me!

 

hairthere writes:

 

What I don't understand is how a good result could have been expected after viewing the patient immediate post-op. The graft placement looks extremely poor in terms of the density, angles, and design. What exact density were those grafts placed at?

 

doesnt even look like there are any singles up front.

 

And as for North Valley Plastic Surgery in Arizona, Spanker states in hair70's thread about hair70's experience with NeoGraft (http://www.hairrestorationnetwork.com/eve/167928-fue-transplant-care-neograft.html):

 

Man, I have seen worse, but that looks pretty bad. Not something you are going to be thrilled about in the end. Low density and it looks like pretty large grafts. Some big gaps.

 

And hair70's pictures, like TygerD's, look AWFUL!!! And hair70's writes how similar his experience was to TygerD's:

 

You are absolutely correct about NEOGRAFT machine and its intended purposes.

 

They are putting these machines in the hands of technicians to perform hair transplant procedures who undergo some sort of training and mentoring program before they are on their own.

 

One could argue the technician has more experience than the plastic surgeon or office doc who wants to provide this service in his practice also.

 

This is still surgery in my opinion and technicians should not be allowed to perform surgery. . .especially unsupervised in my case.

 

During my procedure, even the nurse? took the machine and practiced on me while the solo techician was counting. . .soo unprofessional!

 

When scheduling, they had to call some sort of central dispatcher to find a technician that was available for my surgery date. First it was one person scheduled who I tried to research and then she had family issues last minute soo they sent someone else. . .

 

Doesn't sound promising huh? I was stupid and impatient and should've done more research especially on THIS FORUM.

 

My procedure was over 8 months ago at NVPS in AZ.

 

8 month result attached. . . .less than 100 hairs out of a supposed 1000 FUE implants and most pointing at un natural angles to my hairline. . .it is worst then being bald in recipient area. . .I hoped no more hairs showed up actually!

 

I am sure the transplant gurus will refine extraction techniques in the future whether automated or not but it is going to be almost impossible to teach the artistry of natural hairline creation depending on age, race, facial characteristics, etc, etc. . .

 

Some people are just naturally going to be better than others.

 

For those of you who are looking to get a transplant procedure. . .take it from me after loosing thousands of dollars and even more in sleep, frustration, anxiety, etc, etc. . .don't go to an office that does FUE "on the side" like North Valley Plastic Surgery in AZ who calls a NEOGRAFT dispatch center to send out a "trained" technician to do your transplant.

 

That may work well for getting your car towed when it breaks down but not for your hair surgery!

 

 

 

I also have read your comments, Blake, expressing your own thoughts, opinions, and concerns in these threads - and they are good comments. But I would like to hear more from the doctors who were responsible for performing/supervising these hair transplants. What technique(s)/method(s) did they use and why? And also I would like to hear from Neograft representatives themselves - what is their public response to the concerns expressed repeatedly in various threads on HRN, particularly with regards to charges of "aggressive marketing" and "unqualified techs" performing aspects of hair transplanting for which they are not qualified. I mean, even in the Neograft video when the hairs are being implanted, there seems to be NO CONSIDERATION AT ALL to angle, depth, or graft size while implanting - it literally looks like "shoot and plug" - at least that's what it looks like to me, but admittedly I do not work in the medical field, which is why Neograft needs to explain clearly the technique for implanting hairs demonstrated in that video. Otherwise, man oh man.....based on what I've seen and read, I will not be considering clinics using Neograft for my hair restoration needs!

 

Just to be clear: I do not work in the medical field, for a competing hair clinic, marketing firm or anything to do with hair transplants. I know my post is very long - but I've been reading other members' threads for sometime now, first as an unregistered "guest" and now as a registered member so that I could finally post specific questions about things that remain unclear to me.

 

And I like your comments and posts, Blake, and certainly don't want to seem like I'm coming at you!

 

But you were the last person to respond to my queries, and I was that annoying kid in high school who always asked way too many questions, and now I'm here!

 

As always, thanks for providing this forum!

Thank you, Bill, they've been great reads!

 

I'm curious about the Hans Implanter as described in Dr. Vories' link from the Neograft page. Is the Hans Implanter the implanter used on the Neograft in the Neograft video in Mickey85's FUE thread? Does the Neograft video show "Stick and Place" with the Hans Implanter?

 

 

Also, speaking of "Stick and Place," I wonder if you could clarify/expound on what you wrote below at this link: What is the “Stick and Place” Technique in a Hair Transplant | Hair Loss Q & A

 

I believe that the stick and place technique can yield excellent results when performed by well trained and supervised medical technicians. However, I found both the incisions made by the 19 gauge needles and the grafts to be a bit larger than what I typically see at leading hair restoration clinics who have fully implemented ultra refined follicular unit grafting.

 

How big is a 19 gauge needle??? And how much bigger are the grafts? And what does "fully implemented ultra refined follicular unit grafting" mean? It sounds like you are describing a technique or method. Is the "Coalition of Independent Hair Restoration Physicians" using a completely different technique - an ascribed method - from Recommended Doctors on the Hair Restoration Network? Or have they just demonstrated a higher level of innate artistry and mastery of skill?

 

Thanks again for this forum!

Thank you Blake and Tyger for your responses.

 

Tyger I am sorry for your poor outcome. I've read your history and threads. Do you feel your poor outcomes are a result of the Neograft machine itself or poor technique on the part of the doctor and his techs/assistants? Or a combination of both?

 

Personally, I've seen some impressive NeoGraft results from Dr. Vories. However, I personally believe this is because Dr. Vories is a dedicated FUE expert, not because he uses a certain tool.

 

Blake, when you say "personally" do you mean you've met in person former hair transplant patients of Dr. Vories/Neograft and examined the results? Or do you mean based on the pictures of his work posted on this site, it is your "personal" opinion that his NeoGraft results are "impressive"?

 

I've found Mickey's link on manual and motorized punches very informative - though not sure if it has helped me to actually come to any definitive conclusions! One thing, though, is the Artas system much newer than Neograft? How long have the two systems been around?

Nathaniel,

 

I'm fairly certain he uses a motorized punch designed by Dr. Alan Feller. To my knowledge, the only recommended physician who uses the NeoGraft machine is Dr. Michael Vories.

 

 

Future_HT_Doc,

 

Thanks for the clarification, but what is the difference in the way the neograft and the motorized punch designed by Dr. Feller operate? Does the motorized punch have a higher successful extraction rate? I mean....again.....is Lorenzo's claim that he hasn't seen any great hair transplants because of the tool used to extract the hairs, or the skill of the person implanting the extracted hairs?

 

Also, Future_HT-Doc, maybe you could clarify, GreatPelo writes:

 

"bet about 80%+ are not hair transplant specialists who are adding it as one more service and don't even partake much during the procedure....letting techs do all the work..including harvesting, site creation, etc...."

 

Of course, GreatPelo says "BET"...so he's just surmising, but as a non-medical person I'm confused - I thought doctors had to do residencies in fields for a number of years before they could practice in it. I mean, can a GP/Family doctor just decide that he's going to do brain surgeries to make more money and then start offering his services in this field the next day?? I know that's kind of a silly illustration, but I had assumed that doctors had to be extensively trained in a particular field before the could work in that area....????

Up to now I have never seen a great NEOGRAFT result only average at best. None of the world top FUE doctors use it which is enough for me.

 

Lorenzo, Is that because of the extraction process is flawed? Or because the techs don't have the skill to create the incision sites and transplant the hairs? I mean....if the techs are the skilled ones, shouldn't they know how to do it properly?

Dr. Lindsey,

 

Do you use the Neograft machine?