hairweare

Having finished med school more than several years ago followed by a career in which I worked extensively side by side with techs as well as being a veteran of 5 HT procedures, I have no dog in this fight but I will provide another common sense example that I think most lay people can relate to.

Let say you book a procedure at a well known clinic in Kazakhstan based on your extensive research were you have studied dozens of pictorial case reports and read first hand accounts from patients on various HT fora. You have met with Dr. B and were impressed with his demeanor and professionalism. The clinic is spotless, modern and everyone is wearing a cleanly pressed white lab coat. There are 3 other cases scheduled besides yours and two tech will be performing your extractions as Dr. B shuttles between the 4 OR suites. Of the 8 tech working that day who among them has had the most experience particularly with your caucasian curly hair? Which technician was a recent hire and still on their 6 month probation period? Were you aware that the head technician D. called in sick yesterday and was replaced by T.? Of the 8 technicians who has the lowest transection rate? who has the highest? Consider the batting line up of the World Champion SF Giants. All are professional major leaguers but hitters 1-8 all had different batting averages. Is it therefore logical to believe that all 8 technician working at Dr. B's clinic have identical transection rates and skills?

Dr. K was being totally honest that the reason doctors do multiple same day procedures and rely on techs is purely financial. There is no benefit whatsoever to the patient. A procedure with Dr. Reyes in Belgium who limits his extractions to 1500 a day or the work Dr. Lorenzo produced in Manchester is about as transparent as one can get in this industry. When looking at those results and consulting with those doctors or ones with similar practices, a patient has the best chance of getting precisely what he is paying for and having his expectations met. Yes, even a shortstop with a batting average of .230 can hit a game winning home run, but what are the odds?

Take it also from a non-medical perspective. If you were doing business with a company at this level of expenditure, would you prefer dealing directly with the owner of the business or with his employees?

Your donor region is incredibly dense for your age and NW class. You are quite fortunate but I do not think that this type of success and crown coverage would be typical or expected for similar NW6 patients.

Sean, realistically and practically that is not the role of the Network. Since it is primarily a marketing network for physicians and a free information source for patients, in order to maintain it's value for both parties, the moderators should "moderate" these cases and disinvite any physician whose work does not meet the quality standards previously set forth.

In order for HRN to maintain credibility for it's recommended doctors as well as the site itself, the moderators must get involved in a case such as this one, contact the physician involved and request that he post a explanatory response.

Other than the one photo from the back on 12/08/14 are there others that show the late results of your 5/14 repair procedure?

Not doubting your story Britboy but do you intend on posting any pictures showing your current progress? Yours was a complicated repair case and it would be illustrative to many here to see how you made out.

Are you presently employed? How about boss appreciation day where you volunteer to work for free. I am sure that you would gain massive respect from management especially if you could convince all of your co workers to join in.

Sure, if you could identify them by name and direct me to specific videos demonstrating their skill and work, I would consider the recommendation.

It is always important to keep in mind that the utilization of techs and performing procedures on multiple patients during the day can be very advantageous and rewarding....to the doctor but not the patient. Unfortunately whether the clinic is transparent or not does not change this fact. As with everything else in life if pays for the buyer to be aware.

sorry for duplicate post

Basically he is saying that due to skin laxity i.e, redundancy, removing the excess skin will have little effect on density. This may be the case for a primary relatively small FUT case but after the second or third strip, or following an initial megasession, density is clearly reduced to the extent that laxity or redundancy can not counterbalance.

Bismarck there is nothing wrong with your theory and I doubt that there will be any meaningful published study on the matter any time soon. That said I put my faith in Lorenzo based upon his voluminous posted results and on the basis of the first 1800 FU procedure my yield has surpassed my expectations and qualitatively superseded the results of my previous 1200 strip procedure. Even though he eschews FOX testing his yields have consistently been high. Mick at Farjo commented about his passion for his work and I would concur and add that this passion borders on arrogance but his results speak for itself. If my 6 week old 1900 crown grafts grow as well as the previous 1800 frontal ones I will be a very happy guy.

No clinic that I am aware of promotes the fact that techs play a leading or substantial ancillary role in their procedures and some webpages are in fact either inaccurate or misleading. The physician who I consulted with for all three of my strip procedures did not inform me that on the day of surgery one of his associates whom I knew nothing about would be doing the procedure in his absence. Lack of transparency has been and unfortunately continues to be an issue that remains widespread within the industry.

It is a simple concept of HT relating to supply and demand that the recipient zone can never achieve the same density as the donor zone. The higher the NW class and the more grafts required due to greater surface area to be covered the more this unfortunate equation applies. Sure this gentlemen could cut his sides shorter to lessen the effect but men of this age group often prefer hair of more equal or proportional length, and cutting the top shorter negates the "layering" effect that creates the perception of more fullness.

It is common sense that a donor zone which has been evenly and diffusely thinned by FUE extraction will have less contrast with the obligatory thinness of a larger recipient area. This concept really shouldn't be that difficult to understand. Study some of Lorenzo's higher NW cases if you need to see evidence of this effect.

HT is a very lucrative and competitive business. I have made it clear to anyone bothering to read my comments carefully that I spare no criticism for any physician who places his commercial interests blatantly ahead of that of his patients. I am a veteran of both strip and FUE as well as a physician myself, to call me a shill or to question my contributions as being anything other than generous and objectively helpful is quite absurd.

Kesser does manual extraction and works with two techs. He states that he is involved in the entire procedure on his website but the tech's exact role is not specifically detailed. He is a trained plastic surgeon with more than 12 yrs experience doing exclusively FUE. Personally I did not wish to go to Turkey or India but I would certainly consider Kesser if I did.

Unfortunately, I believe that market opportunity and unavoidable debilitating wear and tear of one's hands renders tech assisted procedures inevitable. Either make arrangements prior to booking that assure you know who is doing what and be willing to pay more for it, or find an up and coming doc in Europe or the East who does it all by himself. I am surprised that De Reys does not get more attention on this forum. He is experienced and patient oriented but does not seem to have succumbed to market opportunities which surely would enhance his income. Umar in the US I believe is also mostly hands on, skilled and experienced but his rates have increased substantially over the past few years putting him out of reach for many here.

Blake, I am still not convinced that this is a true limiting issue. Granted Lorenzo is not one lacking in confidence, but he convinced me to opt for two smaller sessions at a minimum of 4 months apart rather than perform a single procedure over 2 days even though the number of grafts extracted would be the same. Prior to the second procedure he demonstrated to me under the microscope that there was no visible white dots or scarring to be seen. The extraction process essentially went along the same as the first although only 1400 as opposed to the earlier 1500 were extracted. Prior to the procedure both Dr. Umar and Lorenzo predicted that there were 2500 grafts left for harvest so I still ended up with 400 more than expected. 6 weeks following the second procedure my donor area has recovered and looks no different than it did after the first procedure within the same time frame.

He commented to me that at his clinic he does all of the "tougher extractions" cases. As you know scalp characteristics are quite variable and some virgin cases can be more challenging that 2nd or 3rd FUE ones, so I do not think that it is fair to generalize that a first FUE case always renders subsequent ones more difficult. I am sure that the experience, skill and confidence of the surgeon plays a important role in determining what is considered a "challenging" case. For a tech who approaches every case in the same way or a surgeon with only a few hundred case experience, this may indeed be a limitation of FUE.

I can't fault the result but as can be readily seen in photo #19 despite the pt's excellent hair characteristics, the density contrast between the non androgenic affected zones and the recipient area is quite apparent. This is not the fault of the surgeon but rather a inherent limitation of the strip technique. Compared to a high NW Lorenzo case with a similar number of grafts, I believe the blending of densities between these zones is generally much less noticeable.

I have had a total of 9300 grafts over 5 procedures and other than the donor area was never shaved. I asked Dr. Lorenzo why not in my case and his succinct reply was that it was not necessary. Figuring out hair angulation on the human scalp is not rocket science and using loupes and an implanter pen I seriously doubt that he was too concerned about transecting native hairs.

There is no other practical way to utilize a manual punch on anything but a nub so shaving of the donor area for FUE is essential and not discretionary.

20 yrs later after a total of 5600 grafts/ 3 strip procedures I revisited NHI to discuss options to deal with my newly but progressive NW 6/7 horseshoe pattern which had reappeared. The docs there looked at my scar and remaining donor region and estimated 800 remaining grafts at best by strip with the chance of yet an even greater widening of the already visible occipital scar. Their advice was SMP which I immediately rejected as a consideration after watching a demonstration case there.

I then saw Dr. Umar who after looking with just a comb but no microscope felt that he could safely extract 2500 scalp hairs but would also need 2500 beard hairs to cover the thinned out crown. I had trouble with what appeared to me as an approach that was too aggressive and chose to research FUE in greater detail before deciding what to do. Ultimately I went with Dr. Lorenzo who advised two small sessions with predominately scalp hair. Using a microscope he estimated that a total of 2500 scalp grafts could be obtained but felt it wiser to start with 1500 and see how the donor zone recovered. 8 month later he was able to extract another 1400 scalp FUs and augmented the crown work with another 500 single beard FUs. (300 were used earlier to address the scar)

6 weeks after the second procedure my donor area has recovered sufficiently to obtain a clipper cut. My barber informs me that the area looks no different than before and suffice is to say does not suffer from a moth eaten appearance. In my own view, the difference in density between donor and recipient is not as obvious as it was before and overall gives the illusion of a middle aged guy with still a decent head of hair.

Again, I don't believe that the above patient even at 26 should have any other concern but to enjoy his newly styled hair. He has avoided the occipital scar and has plenty of donor hair remaining to address any future progression. If I were to start my journey all over again, I would have opted for FUE but only with sessions limited to 3000 over 2 days and done exclusively by surgeons or possibly a specific trusted tech with known experience and results.

Congratulations on a truly stellar result. Those new to the forum may find it hard to appreciate how challenging your situation was being a NW-6/7 repair case. The work that Lorenzo was doing in Manchester has set the gold standard for what can be achieved with FUE and should end the debate in regard to high transection rates, excessive scar tissue, decreased viability etc., attributed to FUE. Your case provides proof positive that in experienced hands, with stringent quality control and conservative split procedure protocols, what otherwise would be considered impossible can be achieved with the proper technique and plan.

My case was similar but not nearly as challenging as yours. I am now 6 week s/p the second procedure where a composite total of 2900 scalp grafts and 800 beard grafts were placed from front to crown including a single ear to ear old strip scar 8 months apart. I am hoping that my end result will also be similar to yours and have more reasons now to be optimistic.

Based on it's pharmacokinetics, 1mg QOD is very likely to be efficacious although as David points out has not been clinically tested. Since enzyme inhibition is permanent, unless the body is manufacturing new 5 alpha reductase faster than it is being inhibited, DHT levels will decrease. As with any other drug prescribed, the lowest effective dose should always be favored but again in this situation, lowering it from 1mg/day is empiric and not scientifically proven.

Many of the reported side effects are confounded by similar psychosomatic complaints. It will take more time and honest scientific inquiry to ultimately shed more light on this important issue.

The donor area does not seem to be depleted and it appears that the Dr's pre-op assessment of 7000 total grafts was a conservative one. Light hair with minimal scalp contrast bodes well and should he continue to thin it is likely that it may be diffuse and look quite good at a shorter length. Great result!

I can say both intuitively and subjectively based on my two procedures in skilled hands, this is not a factor and certainly not worse a destructive exercise than a scalpel blade cutting through tissue in creation of both the strip and recipient sites. FUE yield relies on more than one factor and I doubt transection rates or ischemic issues have that much negative affect on the techniques that Lorenzo has devised up until this point. My personal opinion is that tech participation and longer ischemic times obligated by multiple patients without adding a third implanting physician is pushing the envelope and I am anxious to see what affect on yield if any this will have in the coming months.