Ali Emre Karadeniz

Dear Members, I would like to give some details about this difficult case of Pianist's. The grafts previously placed at the hairline at another clinic were so much badly placed and given a wrong angle (they were actually directed backwards) that I decided that there was no choice but removing them all. Unfortunately there were quite a lot of these grafts and I had to do many punctures at the hairline bringing the hairline about 1,5 cms back. Normally, I prefer not to bring it back more than a cm so that the punctured area at the hairline is not too deep, but here there was no choice. If the angles were not so bad I could have elected to leave the grafts that are within the transplanted area. I will hope the extraction sites heal well without significant scarring. For this aim, I used the smallest possible punch that was provided; a 0.6 mm punch. I did not try to get these grafts out intact, because that would have required a punch size of at least 0.8 mm and this would cause too large punch holes at the hairline. I estimated that I did 1500-2000 punctures to remove as many grafts as possible of which less than half were usable. I believe I was able to take out 80% of the previous grafts. The remaining couldn't have been removed either because the grafts were much wider than the 0.6 mm punch or there were grafts too close to each other. So I am planning another revision at the hairline to take out the remaining grafts in a couple of months. After graft removal with FUE, I took the left half of the strip. It took me some time to decide if I should excise the whole scar or leave the tails, as the tails at the sides are out of the normal route of the strip. I see a lot of these straight strips with the tails hitting the ear instead of going high up the temporal area. When I see this, I am left with the decision of taking the whole scar out but getting a low graft number, or going high on sides to get a good number of grafts but leave double scars at the tail. I decided to go up because I knew I needed those grafts. I can always do a scar revision at the tails later or do FUE grafting on the scars. On the second day, I decided to change the plan a little bit which explains the asymmetric excision at the donor area. After getting 2400 grafts from the FUE extraction plus left half of the strip on the first day, I decided that I should not go for a high number and cover the whole crown. I thought that the frontal part would surely need more grafts later, due to the empty extraction sites, so I should leave some of the grafts at the right side for a later session. I explained Pianist my concerns and we agreed to leave a part of the strip for the next session. So I took out the remaining scar, including the tail on the right. A double layer closure was performed using tricopytic. So in the next session I will take the right side of the strip and do a revision to the scar on the left corner. I know the plan sounds a bit unusual. Here are some graft numbers: FUE: 1:200, 2:600, 3:75...Total:875 FUT: 1:257, 2:1413, 3:317...Total:1987 TOTAL: 1:457, 2:2013, 3:392...Total: 2862 P.S.: I noticed the incredible beard donor and mentioned it to Pianist. However that will be my choice on a future 3rd session after I am done with FUT and scalp FUE. I will be happy to answer any technical questions you have. Regards, Dr. Ali Emre Karadeniz

Dear Tony, The decision to start with 3500 grafts FUT and by a very experienced surgeon was excellent. Even if you had no growth from this point - which is unlikely - , I believe you are in very good shape. The density is pretty good. Starting with FUT has left you with an excellent donor area for the future. Depending on skin elasticity, you could have another FUT or decide to have a large session of FUE to fill in the rest of the area. I believe very much in sound surgical treatment plants as much as good surgical technique and you look like a good example. Congratulations. Dr. Ali Emre Karadeniz

Here are the possibilities I would consider listed in the order of preference. 1. No hair transplant, just finasteride and observe. 2. 2200-2400 grafts densely packed at the hairline. 3. 2200-2400 grafts to the hairline and 500 grafts to the vertex. So if I had this hair, although I am a hair surgeon, I would prefer not to have a hair transplant at this stage. I have to add that, if I had a very limited budget like less than 3000 Euros, I would rather give the money to charity than having a hair transplant

Dear members, I would like the community to think deeper about allowing technicians do operations under supervision. At first sight it may sound okay and we may think results should be the deciding factor. However, I see three main problems with this approach. First, results are evaluated through photos at online forums. Photos can be photoshopped, combed and styled to look better, certain angles can be preferred to make it look nicer or bad and dark photos can be deliberately presented to give as little information as possible. For example, there is a patient viewing session at annual ISHRS meetings where reputable surgeons show their live patients. We frequently see that the results are not as impressive as we would expect from previous knowledge about those surgeons. Second, it takes one year to get a result. There is plenty of time to manoeuvre and let followers forget about a patients thread. Third, patients with a low budget choose these technician clinics because they think that otherwise they have no chance of getting their hair restored and they may be right. These patients seem to rigorously defend their clinics not because they believe that they will get an excellent result, but because they believe that they deserve the opportunity to have a hair transplant just like other wealthy patients; I also agree with them. In addition, when they are treated well by the staff they will be so satisfied that any criticism to the clinic will be taken as an offence to them. However, inevitably future hair transplant candidates are mislead. For all these reasons we actually get the information that we are allowed to get. On the other hand, I think that opinions supported on this forum should have scientific and legal bases, not practical bases. Of course when there are many posts about the results of a surgeon, the community is able to get a feel for how good the quality is, but there is enough gray area for followers to be mislead if we don't have clear medical and legal borders. Lastly, I think that the main quality of this network is the recommendation system of surgeons. The acceptance of supervised technicians doing surgery will sooner or later defeat this system. Technicians who show good results will eventually be candidates for recommendation. I apologise to all if I sound a bit arrogant and want to say that this is not my intention at all. It is just that this is a topic I have been thinking about for a long time and the recent progress in the market worries me as a physician. Best regards, Dr. Ali Emre Karadeniz

I roughly agree with this rule. However there are two points that I would like to add. The first one is that growth at the frontal area is faster than at the crown. I think the above chart is closer to the speed of the frontal part and the crown follows on average 3 months later. The second point is mentioning the 'slow growers', who I didn't believe much until recently. I still think that some patients who eventually have low growth are called slow growers by clinics who don't want to admit failure. Usually when I don't see about 60-70% growth at 6 months I assume that I am in trouble. However I have had a couple of patients who reported close to no growth at 6 months and 70-80% growth at 9 months. I am not sure if these should be called slow growers as the definition is actually meant for patients with a constant delay to actually see most growth between 9-18 months. The patients I mention have a frighteningly low growth in the first 6 months and actually catch up at around 9 months. I thought it would be useful to mention these variations in growth.

Dr hairweare (sorry, but you haven't mentioned your name), I too prefer instruments that give me the most tactile response as a surgeon who does microsurgical vessel anastomosis, but I don't agree that the manual punch gives me this. On the contrary, the need to use hand force for drilling into the skin when using a manual punch prevents me form getting a perfect feel for the angle and depth. As you know, in microsurgical procedures there should not be significant force in the hand for the maximum sensitivity and accuracy of the movements. I believe that the hand work to rotate the punch thousands of times is a waste of energy. The second thing is that the force to penetrate the skin with a manual punch causes a depression at the skin surface, altering the natural direction of the follicle and making it more difficult to control the angle. The third thing is that when the fingers rotate the punch holder, there is an oscillating movement with every rotation being at a slightly different angle to the skin, whereas when the motor rotates the punch the hand can stabilise the hand-piece so that all rotations are kept at the same angle. And fourth, when doing high graft numbers, fatigue while using the manual punch can cause the accuracy to deteriorate at later stages of the procedure. For all these reasons I also disagree with people who claim that the transection rate with the manual punch should be lower; I think it could be higher. Once the sharp edge of the punch touches the side of a follicle, it inevitably will cause a transection, no matter if the punch is manual or motorised. The angle should theoretically be the deciding factor in transections. All of these of course should be proven by studies. I don't criticise manual punch users but I will not surrender to claims that are derived from marketing strategies and accept the inferiority of the motorised punch, until I see convincing data. Regards, Dr. Ali Emre Karadeniz

Dear PupDaddy, I was just warned by the moderator not to post results until I am considered for recommendation. I didn't know that doctors were not allowed to post results if they are not recommended, so I will respect the rules and wait for Bill to have a look at my patient results that I sent him. I have immediately after photos showing the incisions but I will not post anymore until I am allowed to. Regards, Dr. Ali Emre Karadeniz

Dear Sean, The problem with trying to compare results with manual vs. motorised FUE we inevitably compare apples and oranges. The compared groups are not homogenous. 99% of patients want more grafts and more coverage in a single session. These patients will usually be less educated than the other 1% and will usually go to much cheaper FUE clinics who provide motorised FUE done by technicians. So this group of patients are operated by a much lower average quality of surgeons. On the other hand, the 1% who understand how delicate the FUE procedure is, will go to much more expensive and high quality clinics who provide either manual or motorised FUE. These patients will ask for less number of grafts per session for the reasons you mentioned. The manual FUE surgeons will not be forced to do a dangerously high number of grafts per session and will take a safe number having the luxury of taking care of each graft. This is why I think we will be comparing apples and oranges. If the patient asks a motorised FUE surgeon for 1500-2000 good grafts, I believe those grafts will be at the same quality with manual FUE grafts and the results would be the same. As a motorised FUE surgeon, I would like to one day do an FUE procedure half and half with an experienced manual FUE surgeon and have the grafts evaluated by an objective team for graft quality to clarify this issue. I hope to arrange in a future workshop. I would be willing to give up on my technique if the manual FUE happens to come on top. In the end we are scientists and not fans of a sports club; what is better for patients should be preferred by all of us. Regards, Dr. Ali Emre Karadeniz

27 year old patient. 2701 grafts FUE : 600 singles, 1161 doubles and 940 triples. (0.8 mm motorised sharp punch) Dense packing using coronal incisions with custom made Cutting Edge surgical blades 0.6, 0.8 and 1.0 mm. Results 6 months postop.

I believe this question is not relevant to what I have been trying to say in this thread. Ofcourse there must be many technicians who do their jobs quite well. The main point is that they should be doing ONLY the procedures they are trained and licensed to do. I was trying to explain what can go wrong if technicians are allowed to do procedures that they are not trained to do. Even if there may be some technicians that could do the doctors job as well, if you allow technicians do these procedures then we can never be sure if the patient is one of the lucky ones who have found this talented technician or is heading a disaster. Every patient deserves the trained and licensed skill of a physician with a very good chance of getting an excellent result and the chance of being properly treated in the rare incidence if things go wrong; they don't deserve a gamble.

Dear Bismarck, As I mentioned earlier, I was hoping to end this thread unless the patient shows up, but since your question is related to the topic I feel responsible to answer it and probably what I am ready to say now is going to reopen the topic for a long time. Unfortunately this procedure was done 3 years ago at a company I don't currently work, which means I don't remember details of the procedure and I have no access to operational data. However taking another look at my limited records that I was able to keep despite all efforts of the company to prevent it, I found a crucial note that I put in the report that might explain the problem. I have taken a note that the placement was very difficult. This is a note that I put usually when there is severe popping of the grafts during placement. I also saw that the grafts were of excellent quality with 600 singles 1000 doubles and 1000 triples for a total of 2600 grafts. I have seen a few times before that severe popping has led to poor yield. It is probably the damage to the grafts by multiple insertions and drying that causes the poor yield. This problem is usually unpredictable before surgery and I don't think there is a perfect solution to it. I now tend to let my assistants try inserting a couple of grafts after I do 50-100 incisions to check for popping and accurate slit size. If I see significant popping I inform the patient and advice him to accept that I don't densely pack and distribute the grafts a little to ensure safety of the extracted grafts. If severe popping occurs after all the incisions are done, doing more incisions and skipping some incisions to protect the grafts is probably the lesser evil. I hope this is useful information for those who are following the thread. I assume it is a rare thing to see a surgeon trying to figure out what went wrong in his own procedure and discuss it openly in a forum. I was advised by friends not to actively take part in discussions on the forum, for the obvious reason of being vulnerable to attacks by people who have destructive intentions while using a nickname, although I am overly enthusiastic about what I do and can't keep myself out of discussions. I hope I will not regret it. I also encourage my recent patients to share their experiences on the forum and am willing to share some of them myself when the patient and the moderator of this forum allows me to. I believe that any surgeon who trusts himself in his surgical skills, should share not only the excellent results he gets over a long period of time, but some challenging cases that the result is not yet evident, letting the public see the progression of his average results rather than only his best. Obviously there will be some average or somewhat unsatisfactory results presented but the educated community has enough material and experience to judge how those results add up to. Regards, Dr. Ali Emre Karadeniz P.S. Please call me Dr. Emre

Dear Members, I understand the criticisms and questions asked here, especially considering that I am not a well known doctor on this community. But what do those members criticising me expect me to do? I believe there were only three things I could do: be honest, share an explanation with the public and offer the patient a repair. There are a few B&A videos that I uploaded on youtube so anyone can have a look at them. The link is Ali Emre Karadeniz - YouTube. I tried to present a result about 2 weeks ago but the thread was removed by the moderator the next day. I suppose non recommended doctors are not allowed to present results. I also sent a couple of samples to Bill a week ago and am waiting for his feedback. I would like the members to respect that I do not want to present my cases and discuss myself on this thread. Since I have shared all I know about this story I am not planning to say anymore unless the patient shows up. I am open to all discussions on relevant threads, including presenting my cases, answering questions on threads that my patients have opened and any other topic on hair surgery. Regards, Dr. Ali Emre Karadeniz

Dear TheOtherSide and members, I have become a member of this network very recently and have discovered this thread. As I am being active on the forum and hoping to be a coalition surgeon in the near future, I feel responsible and obliged to post an explanation to the unfortunate story of TheOtherSide, even at the cost of bringing this inactive thread to the front. Although I have been a very active hair surgeon in the last 4 years by performing about 1000 procedures, my hair restoration history isn't very long. It all started when I began working at Transmed in November 2010. I left Transmed in August 2013 to start my own business in January 2014. Considering the first 3 months for me was mostly observation and joining operations to do parts of it for the purpose of training. I had 6-8 months experience when I operated on TheOtherSide in September 2011. As employees of Transmed, we were 4 plastic surgeons at that time. We never knew how patients were booked in for an operation. There would be two groups of patients; patients who came to be operated at Transmed and patients who came to be operated by Dr. Melike. The patients in the first group were randomly assigned to doctors. There would be a few possibilities for patients who came in for Dr. M. If the plan was to do FUT then Dr. M would usually do it. If the plan was FUE, then the patient would be assigned to one of the plastic surgeons as Dr. M did not do FUE. In this case there would be two other options. Either Dr. M would do the recipient site incisions or the plastic surgeon would do it. The decision would be given by Dr. M. In TheOtherSide's case, the patient was assigned to me for both the graft extraction and recipient site incisions. Ofcourse I did not know that he came just for Dr.M. Even if I did, it would not be my decision. So I did the procedure. 9-10 months postop the CRM told me that the patient had low growth and asked my opinion. We were not able to find the cause but I told them that we should offer a free repair. The CRM told me that the free repair offer was refused by the patient and he wanted his money back. This time I advised them to give the patient his money back, but this was refused by Dr. M. There was nothing I could personally do about it. TheOtherSide's story is an unlucky one. He not only had a bad result, which happens to many patients in the world, but he also felt he was betrayed. So he lost his trust in the clinic, rightly refusing the free repair. I don't know how his final situation is and if he had a repair procedure by another surgeon. I would like to let TheOtherSide and all the community to know that, although there wasn't much I could do about this at the time and I did not have direct financial interest in his procedure, I am ready to offer him all kinds of support including a free repair if he wishes to contact me. Best regards, Dr. Ali Emre Karadeniz

Dear members, I think that the grafts should be extracted by a physician. Although I am feeling more and more lonely everyday about this. There was a recent message at the ISHRS website called 'Consumer Alert'. I thought it was announced to declare that technicians should not do this, but to my surprise a Turkish colleague pointed out that 'Licensed Technicians' were aloud to do it. I couldn't help but thinking that the old generation of hair surgeons are trying to find a solution to the overwhelming FUE era, and are now coming up with two options: Buy the robot or allow technicians!! There are a few important things that the person who extracts the grafts needs to consider, and you really need the physicians eye to take care about them. Please note that this eye has to be open throughout the procedure to readjust during the course of the operation; a supervising eye can not provide this. These are; 1. Extracting mainly from the permanent zone and entering the transition zone just for feathering purposes. 2. Not extracting from areas that might look depleted like temporal areas and neck. 3. Choosing proper instruments including the punch size depending on tissue character. 4. Doing a proper FUE test and if transection rates appear high offer FUT or cancel operation and give money back!: I believe this is very important. 5. Controlling penetrations per area and keeping equal distance between punches to avoid moth-eaten appearances. 6. Controlling angle and depth of punch and rotation speed to keep transection rate low. 7. Choosing the optimal graft number for both the patients recipient needs and the donor capacity. There may be even more to add to this list. Can anybody say that a technician can take care of all these factors? About the incisions: In Turkey the incisions are also performed by the technicians, which I also think is unacceptable. You will see that none of the large hair clinics even have the Cutting Edge blade cutter and the surgical blades. They just cut ordinary razor blades with scissors. They have no idea about preparing blades to the depth and width of the patients grafts. They have never heard of coronal or sagittal incisions. They don2t know at what density they are doing their incisions. And so on... Regards.

Dear Members and Future HT Candidates, I am writing this short overview about how things work in Turkey hoping that it will be useful for future candidates. As a relatively new member to the forum I am seeing a lot of wild discussions going on at multiple threads about HT in Turkey. I will try and give objective information, avoiding being for or against any clinics in Turkey as I am a Turkish plastic surgeon and hair surgeon myself. It is estimated that there are about 500 hair transplant teams or clinics in Turkey; therefore this country has been one of the main centres in the world for hair surgery and attracting many patients around the globe. The two main characteristics of hair surgery are that the prices are very cheap and surgical teams solely consist of technicians and staff from various backgrounds such as nurses, ambulance paramedics, anaesthesiology technicians, cardiovascular surgery pump technicians, car mechanists, secretaries and even housewives! Hair transplants are not perceived as surgical procedures by this nation and are treated like going for a hair cut. A Turkish billionaire who drives a 1 million Euro car will hope to have a HT for 1000 Euros! There are around 10 medical doctors in Turkey that actually do parts of the surgery such as graft harvesting and recipient site incisions. The remaining 490 teams do not have a doctor that is a part of the operation. Not surprisingly FUE is the only technique used by these teams. They quickly teach each other how to drill down the patients scalp to extract grafts and the teams multiply in number rapidly. To my knowledge there are only 4 clinics left in Turkey that are able to do FUT. Despite being a huge HT country, there are about 30-40 technicians in Turkey that know how to prepare grafts from a skin strip. There are 4-5 technicians that are trained to do slivering; that is less than the number of hair surgeons! The financial balance between the two techniques are altered and it is 3-4 times more expensive for a Turkish clinic to be able to offer FUT, compared to FUE. Under these circumstances, is it a good idea to go for a HT in Turkey? I think it is as long as you know what you are buying. What do you buy when you go for a HT in one of the technicians FUE clinics and who should go for it? This is what you are going to get: Technicians will aggressively drill down through your scalp for about 5000-6000 times. You can usually see this if you look at immediate postop photos of the donor area. The transection rate is going to be 50-70%, which means you will get 2000-4000 grafts that are severely transected. These grafts will be placed but will show growth less than expected. About 2000 grafts will have disappeared due to total transection. Since partially transected grafts grow some hair, there will be significant improvement despite the wasted grafts. Since these technicians have a very primitive knowledge of recipient site incisions, it will usually look unnatural, or at least too widely spread. The major problem will be at the donor area. When a Turkish technicians operates on your donor area, the donor is mostly finished. Most patients will have significant moth-eaten appearances at the donor area. Patients who have a very strong donor might still not show signs of weakness and permit another session of FUE, but that will be it. There is no hope of doing 3 or 4 procedures. I usually do only FUT if I know a Turkish technician has operated on a patient. I have tried many times to do FUE after a technician and failed to get anything. Now is this acceptable for a patient? It can be if the patient just wants some hair on his head and feels that he has no hope of getting a proper one in his life time. If the above scenario doesn't suit you, is there a better option in Turkey? Certainly; the 10 doctors in Turkey including the 2 recommended surgeons on this network can provide excellent HT procedures for a much cheaper price than their counterparts in Europe and USA. The only difficulty is to find them, because they typically are much smaller companies than the large technicians clinics who do 10-20 procedures a day. These boutique clinics have a hard time surviving in the market due to the wide unlicensed competition with very low prices. Doing these procedures for even double the price of the technicians doesn't make it a very profitable business, considering that they can do only 1 patient a day. They don't have much of an advertising budget. Agents usually prefer to work with technicians to get more customers and make more profit. So only the patients can find these boutique clinics. I think this is enough information on summarising this topic. I once again want to emphasise that I do not want to be involved in any competition with other clinics and have no intentions of advertising my own. I hope it will serve as a guidance to future patients. Regards, Dr. Ali Emre Karadeniz

Exactly! I don't recommend doing that very often but the trend is that patients want more grafts per session than they used to be in the past. Sometimes I will do the combo in 2 days, but patients can prefer this than having the 2 procedures 1 year apart. Another small point is when H&W do 5000 FUT they prepare mostly singles and doubles. Their hair per graft rate is usually 2 or below, giving less than 10000 hairs. When I do a combo I tell the assistants to prepare 3s and 4s mostly, knowing that there will be enough 1s and 2s coming from FUE. This 3000 FUT is equivalent to 4000 FUT with a slim graft cutting style. The average hair per graft rate of the combo mixture is over 2, usually giving about 10000-12000 hairs.

Dear Blake, Now I understand why you don't see the point of the combo. There is no such combination as 1500 FUT+500 FUE; this of course would be very silly. As you mentioned, you could just increase the strip a bit and get the 2000 easily, there is no question. There were some presenters who did like 2800 FUT+500 FUE; I also think in this scenario it is not worth doing FUE for just 500 grafts; I would rather leave it at 2800. The point of the combo is when we want to go for the maximum - which I don't think we should do very often. Here is an example: Lets say with the maximum strip with some tension we can get 3700 grafts and we would like to have 5000 to do the job. In this case I take a 3000 FUT that is close to the maximum, but avoiding the tension that the extra 700 would have caused, for a more comfortable postop healing and a better scar. Then I do a 2000 FUE. So we have 3000 FUT+2000 FUE to get 5000. In my opinion this is an alternative to doing a 3000 FUT now and another 2000 FUT next year. Another example is when the patient has a couple of procedures before: Lets say he has had 1 FUT and 1 FUE or 2 FUT's before. He has a bad scar done by a nonprofessional and left with little donor that with only one technique there are too few grafts (like 1000) to do anything. In this case I do a combo to get a more significant number like 2000 and usually improve the previous scar. I could give some examples with photos, but I guess I will have to wait for Bill to answer and process my application to be recommended here. I did try to post a patient result before but it was removed the next day so I assume only recommended doctors can do that. Regards.

Dear Blake, Unfortunately I don't understand your point. Lets assume FUT has slightly better yield than FUE. When we do FUT+FUE we will get FUT grafts with very good yield and FUE grafts with slightly worse yield. I hope you don't assume that the yield of FUT will be decreased by adding FUE at the same time as this is not relevant. So what is the problem? I am not saying that FUT+FUE is better than doing two separate FUT's, on the contrary probably the latter is better. But we should not be comparing a technique that is aimed at getting more grafts in a single procedure with two separate procedures. I am introducing FUT+FUE only if we want a graft number more than a usual amount in a single procedure. It respects the value of FUT and takes advantage of the extra grafts FUE is giving without damaging the potential of FUT. I hope I am able to explain my point better. The excellent Italian surgeon and my friend Dr. Marcio Crisostomo presented his talk at the same panel about his approach with FUT+FUE. He also has this very good idea of preserving an area above or below the strip design for a future FUT+FUE. He leaves a strip of area without doing FUE for the future. I believe we have 2 good FUT's and 2 good FUE's in one patient at our disposal. We can only have the 2 FUT's if we start with FUT. If we start with FUE then we kill some of the potential grafts of FUT. I am saying that doing FUT+FUE is just a way of providing more grafts in a single sitting without causing the mentioned problem. I think it should be used only if necessary in some specific situations. Regards.

Hello Everyone! I just got back form the meeting and am trying pull myself together as all has been very tiring. The meeting was a mixture of old and new members with nice discussions all over the place. The FUT+FUE combo panel I was talking was convincing to most of the attendees and all the surgeons were well prepared for their talks. The point I was trying to make was that we should put all FUT vs. FUE discussions aside and take these as two complementary techniques for a long term, multistage hair restoration plan for patients. Especially when we foresee that the patient is going to need multiple sessions, we should avoid doing FUE first that would damage the excellent graft potential of FUT. FUT+FUE can be a good option to get very high number of grafts like 5000, while having the two advantages of utilising the skin laxity but not stretching the strip too much, thus preserving donor area aesthetics. Regards, Dr. Ali Emre Karadeniz

I totally agree with this summary of the current situation about manual vs. motorized FUE. I would like to add that, despite no scientific evidence has been documented showing an advantage for either method, the manual punch doctors have succeeded in marketing their technique better than the motorized. They have taken advantage of the manual method sounding more 'hand-made' than the motorized, thus creating the illusion that the grafts are handled with better care and with less damage. There might be an indirect truth in this, that the unauthorised technicians who do FUE all use powered devices, leading to hair transplant disasters not because of the instruments they are using but because of the lack of professionalism. I am eager to either participate in or to see scientific studies clarifying this topic in the near future.

The discussion that might start here deserves a thread on its own, probably under a main topic on surgical techniques, so I will keep it brief. Besides Maral Clinic has started to become annoyed which is something that I don't want to cause. We can discuss this later on at a more relevant thread. There are two main reasons for this: One has already been pointed out by PupDaddy. The point here is that, FUT preserves untouched donor for FUE but FUE destroys the FUT area which could give the best grafts of the donor area. The other reason is related to mechanics. The physical principles that each depend on are different. FUT takes advantage of skin laxity and then elasticity. FUE just reduces density. The techniques are actually not alternatives - which is the reason why I don't like FUT vs. FUE type of discussions very much - but complementary in getting the most out of the donor area. If we don't start with FUT, we loose the chance of taking some of the grafts via skin laxity, because we take lets say 30-50 % of the grafts from the skin excess instead of taking 100%.

Dear Matt, The high hairline examples from three respected surgeons are excellent! I also love your 4312 grafts FUT procedure. Regards.

Dear Members, I will be attending the ISHRS 22nd Annual Scientific Meeting In Malaysia, 7-12 October. I will be presenting two scientific papers named 'Evaluating Graft Quality in FUT+FUE Combined Procedures to Evaluate The Two Techniques.' and 'Protecting the Donor Area in FUE.' I will also be available at resting hours to do consultations and/or scientific discussions. Regards, Dr. Ali Emre Karadeniz

Well I guess I will have to step out of this after this post. I was warned not to post as a doctor due to this danger of being exposed to attacks by an unknown person while I am known. Why are you so angry? In the end it is just an opinion, never mind I am a doctor. Why should a high hairline defeat the purpose of a hair transplant? I think one of the worst results to end up with in hair restoration is a low hairline at middle-age and no donor to cover the balding area behind it. Practically no one has plenty of donor hair if they have started balding in their early twenties. I will not go into a FUT vs. FUE discussion at this level, but just to let you know, I do 80% FUE and 20%FUT due to patient preference.

I agree with other members. No need for a hair transplant, just use finasteride.