Blake Bloxham

Dr Vories, We initially thought someone would have tried this approach along the way. But we searched the literature and found nothing. Did you publish your findings somewhere? The scarring actually surprised us. I wasn't expecting it to heal as well as it did. Wonder what differed?

KO, The removal of the mFUE grafts is similar, but they differ from mini strips. Dr Feller actually tried the mini strip approach before, and wasn't happy with the scarring. With mFUE, the punch itself makes it different than harvesting strips, and we've been very pleased with the scarring.

Yonex, It's difficult to quantify how "big" the tools are for two reasons: 1. we have played around with many slightly different sizes to optimize the number and quantity of the grafts we get with each punch and will still probably use slightly different ones depending on the patient -- like traditional FUE; 2. the punch is elliptical, not round and trying to figure out the surface area is messy -- and I've tried. Haha. I was initially concerned about scarring as well, but it really hasn't panned out that way. The moth eaten appearance is caused in FUE because so many grafts are taken with nothing left in their place besides a circular scar. With mFUE, you need a fraction of the grafts and the scars are closed. This doesn't mean scarring won't occur, but it won't be in the "moth eaten" appearance as long as the individuals sites are closed correctly.

Introducing: mFUE What is modified FUE (mFUE)? mFUE is a new approach to the follicular unit extraction (FUE) technique. The goal of the procedure is to create FUT-level results with FUE-level scarring. This means the growth and quality of strip surgery (FUT or FUSS), but without the linear "strip" scar. Why create a new approach to FUE? The FUE technique continues growing in popularity. Patients clearly want FUE. Whether it's the less invasive nature or the lack of the linear scar, hair loss sufferers have spoken! There are serious limitations to the technique, however, and growth and quality of FUE hair is still not on par with strip. But why is this? The best evidence we have available may offer an explanation: *The "blind" approach to FUE graft harvesting creates transection rates as high as 32%. *The small punches and pulling of grafts during delivery severly "skeletonizes,” or removes the protective tissue layer surrounding follicular unit grafts. According to studies, the growth rate of skeletonized FUE grafts is between 48-68.7%. This means only 1/2 to 2/3rd of all these "skeletonized" FUE grafts grow. *This same analysis shows that grafts extracted with an appropriate amount of supportive tissue grow 45% better than skeletonized FUE grafts (Reference). So what does this tell us? FUE is becoming very popular, but it may be less efficient and produce more variable results. Hair loss patients only have a finite number of available follicular unit grafts, and each one of these grafts must be optimized and used wisely. We do not believe the FUE techniques available today utilize these precious grafts properly, and wanted to find a way to overcome these issues and deliver the results patients deserve with the minimal scarring they want. From this, we created mFUE. How is mFUE performed? Here is a step-by-step breakdown of the mFUE approach. It highlights the differences between traditional and modified FUE, and explains why we like this method. Please note: all procedural images are taken from experiments with a porcine model. They are not from real patients. Ink is used to make the skin scoring more visible. These may not completely reflect the way these aspects of the procedure look on a real patient. STEP 1: A custom elliptical ("football shaped") punch slightly larger than a traditional FUE punch is used to superficially score (cut) the donor region The superficial depth decreases transection and the gentle rocking motion of the punch decreases the torsion and rotation injury associated with the twisting of a traditional FUE punch. The larger size of the tool also ensures that the follicular unit grafts in the center of the punch have a 0% risk of transection. The ability to move and position the mFUE tool creates very minimal transection rates along the border of the punch as well (equivalent to strip transection rates – roughly 1.59%). STEP 2: The physician then grasps the corner of the mFUE graft with forceps, lifts it gently, and uses a needle or blade to dissect it from the donor region. This allows for gentle removal of the donor follicles without skeletonization of the grafts, injury to the crucial base (bulb) of the follicles from pulling the grafts,"splaying" of the follicles (which significantly complicates graft placement), or ripping/tearing of the follicular units. This also ensures that 100% of the grafts scored are successfully removed - 100% "attempts made to grafts successfully extracted ratio." STEP 3: The mFUE graft is then handed to a technician who dissects it microscopically into perfect follicular unit grafts. This ensures all grafts are ideally shaped for placement and contain the correct amount of supportive surrounding tissue. This significantly decreases the greastest threat to FUE grafts: dehydration. it also creates grafts that look like this: and not this STEP 4: The small (millimeters) defect left behind by the elliptical punch is then closed by primary intention. In other words, it is closed with surgical material. This can be done three different ways: either by staples, which are removed after approximately 10 days (this is the method Dr Feller and I have mainly experimented with); by sutures, which are removed after 10 days as well (this is the method Dr Lindsey prefers); or by a third option: closure with TissueSeal (histoacryl) -- a clear tissue adhesive that requires no suture or staples, no removal, and naturally holds tension equivalent to sutures for the first 7-10 days. The adhesive also serves as an anti-biotic agent, a water-proofing agent, and naturally falls away after the 10 day mark. This option is designed for those who want the traditional FUE post-operative experience or want to return to "normal life" sooner. Here are examples of each closure technique and a comparison to a traditional FUE post-extraction donor region. Please note: Because the mFUE technique requires a fewer number of extractions, the number of staples or sutures used to close wounds in the donor area is approximately equivalent to the number of staples or sutures required to close a strip wound. STEP 5: The microscopically dissected grafts are then placed in the physician-made recipient sites (the same way they are placed during traditional FUE or FUT/strip surgery) What does the donor region scarring look like? Our original goal was to create a procedure with strip-level results without a linear strip scar. Initially, we weren't sure the mFUE scarring would be comparable to the minimal scarring created by traditional FUE. Throughout our clinical testing, however, we were pleasantly surprised with the healed scars. According to most dermatology texts, the size of the wound we create with the mFUE punch is small enough to not require closure by primary intention (sutures, staples, or tissue adhesive). We wanted the best scars possible, however, so we decided to spend the time to close the wounds. Clearly, this made a huge difference. To quote Dr Lindsey, the scarring can be "impeccable!" After viewing the results, I feel this technique exceeded our initial goal of creating strip results without a strip scar, and actually allowed us to achieve “strip results with FUE-level scarring.” Here is an example from Dr Lindsey: "This patient prefers to buzz his sides short, and has had no problem shaving down to the 2 guard he used before surgery." Here is a shot of his donor region. Note how the patient has a thinner donor region in general. If you look in the area near his crown, where no mFUE grafts were taken, you'll see it is less dense than we would like. Even with this lower density, the mFUE scars are still, essentially, undetectable. Here are a few more angles (sides of the scalp): Here is Dr Lindsey showing an mFUE scar up-close. Frankly, I still have a difficult time seeing it. I zoomed in 100% and think I found it here: What are the benefits/advantages of mFUE? *Strip-quality grafts and strip-level growth yields. This means 98% growth, no skeletonization, no harsh extraction injuries, and no grafts scored with failed delivery. *Strip quality hair. None of the "wiry" or "kinky" hair we sometimes see from traditional FUE – which is caused by damage to internal root sheath or distortion of the internal follicle. *FUE-level scarring. No linear scar! Diffuse, very cosmetically acceptable scarring in the donor region like we see in traditional FUE. This allows patients to "buzz" their sides short. *Hundreds of follicular unit grafts (FUGs) from only a few cuts ("insults") to the scalp. We can extract approximately 100 FUGs with only 5-6 mFUE punches. *Less "insults" to the scalp means MUCH less of the subcutaneous FUE scarring – which theoretically can make extraction more difficult and decrease yield during future hair transplant procedures. *Less punches means a significantly smaller number of scars too. *Ability to undergo larger sessions in a single pass without compromising extraction techniques. *All manual tools and techniques. Nothing is motorized or automated. *All extraction is done by the hair transplant surgeon. *Easier to use for a "hidden" FUE approach -- because only a limited number of small spots need to be shaved for extraction. *Significantly decreased graft "out of body time" compared to traditional FUE procedures of similar size (meaning even less dehydration). Clearly, we are very excited about this new approach! It took nearly two years to conceive and test, and we -- Dr Feller, Dr Lindsey, and I -- are very excited to finally make the announcement. We are currently offering mFUE sessions up to 1,500 grafts at Feller and Bloxham. I'll let Dr Lindsey expound on his current practices. We are limiting the session sizes temporarily to make sure everything meets our expectations as we move from clinical testing to offering the procedure on a large scale. Eventually, we will start offering larger sessions. This is just our “teaser announcement.” Please stay tuned for more examples of donor scarring and mFUE “before and after” results. Thank you for taking the time to view the post. I look forward to comments and questions!

Beautiful work! To address the crown issue ... There is a reason why HT surgeons call the crown "the black hole." It takes a LOT of grafts to rebuild it adequately, and it's always expanding in a circular manner. This runs the risk of creating an unnatural "island" of hair, which makes surgeons nervous as well. Usually, these grafts are better suited for more visible areas of the scalp. However, and like Dr F said, this patient seems like a good candidate, and the results are excellent.

Delancy, I do agree with limiting the number of grafts via FUE in one session. FUE yield is more variable as it is, and the 5,000 graft cases in one day make me a tad nervous. However, I think it's worth noting that "6 months to a year" may be a bit of an underestimation when it comes to these "wow" FUE transformation timelines. If you look at a lot of the big results, from guys like Dr L, for example, you'll see this taking 3-5 sessions. I'm a believer in waiting 12 months between sessions. I think most other surgeons are as well. This means the transformation can take upwards of 5 years, not an extra 6 months. While I agree that our society is FAR too fixed on instant gratification and results now, most guys wait decades before deciding to finally restore their hair and likely don't want to wait another 1/2 decade for the results. I also wish this was clearer in some of the FUE videos. Also, a quick comment about yield: we can argue the theoretical benefits of FUE v strip until we're blue in the face, but I stand by the fact that graft-per-graft growth, strip will always have better growth yield. In the study I've shared from Dr Wesley, he shows that skeletonized grafts grow about 30-40% less than grafts with appropriate supporting tissue. Even if in worst strip extraction, all of the grafts that don't lay on the outer rim of the strip will -- assuming good microscopic dissection -- have nice supporting tissue and stand the best chance of surviving and growing. This simply isn't true for FUE. Even in the best of hands, the grafts will be skeletonized. This is the very nature of the method, in fact. Now, does this "guarantee" a good result? No. You could have techs that don't dissect correctly, place poorly, you could have a surgeon that doesn't make incision sites correctly, etc, and the results could stink. And there will always be the benefit of the lack of linear scar with FUE. However, arguing about growth yield is kind of a moot point. The basic principles behind the procedure and the data we have backs this. It's one of the strip "pros" that is essentially a fact; just like the lack of a linear scar is an FUE "pro" that is a pretty indisputable fact.

Weare, Isn't PMA only 4.5 months or so out? When I reviewed his thread, the most recent image I saw was the back of his results while he was showcasing the crown work. I also seriously disagree with the FUSS results comments. Come on man!?? Really? Haha. But like I said before, I think we've reached a standstill here. Also, just to clarify a few points: I champion for patients to undergo the right procedure for their goals. If that's FUE, then great! Second, Dr L charges $9.32 for the first thousand grafts, but he manages to do plenty of FUE -- and my point here is that I'm going to be doing a lot via our new method in the future, and not just strip. Third, I'm confused ... I think I'm the only person in the thread who has actually performed both procedures. Why will no one take my word that the taxing comments are being exaggerated. I know you've called him a 'robot' and said he possesses magic skills, but Dr L isn't the only one who can remove grafts manually without getting 'crippling arthritis.' Lol. Again, I think objectivity has gone out the window here and no matter how points are being presented, we're running in circles. I really do like you gents, and we really are on the same team here. We have slight differences of opinion, but I don't want to the discussion to create a negative vibe on the boards. Also, weare, I want to see some more pics of the results! If I offended anyone, my bad! I apologize. Best of luck.

Scar, I never said he "woke up" to the realities of FUE. He's performed the procedure for upwards of 12 years. He tried a lot of different things with it over the years, and came to these conclusions after lots of experience. This was good science and enough data to form a valid opinion. Also, what's wrong with discussing the actual results in the recipient region? Isn't this why patients undergo surgery? Also, didn't you say earlier in the thread that you had FUE at one of these places with the lax laws and you were disappointed with the results? KO, I said the taxing nature was being blown out of proportion before. Especially in the era of motorized tools. I used my first hand experience to back these statements, and was told I was wrong. Lol. At this point, gents, I think we're at a stalemate. I'm not sure the thread is really helping those researching FUE or strip procedures either. I stand by my points, but I'm going to only try and interject here when I think it's necessary. Thank you all for the discussion.

Keyser, If you look through that thread, you'll see that I asked the patient multiple times to message or email me. I tried to contact him privately as well. Never heard a peep. We can't investigate if the patient doesn't give us the information and consent to do so. Trust me, I would have loved to help this guy out. Also, this obviously isn't the standard for any type of hair transplant surgery. It's really not a reflection of any procedure; it's a very strange situation that I still don't understand because the patient didn't reply.

Joe, All of us "hair geeks" need to sit down and have a few brews one day. As a certified hair nerd myself, I LOVE talking to fellow enthusiasts! I also agree with your comment about Dr. K's ethics. I remember telling Bill this was one of the reasons I highly endorsed him when he was being considered for recommendation. Best of luck with the new arrangement. Seems like a good fit!

Congratulations! I think this will be an impressive transformation when it's all said and done.

Explanation about subcutaneous scarring with FUE -- for those interested: http://www.hairrestorationnetwork.com/eve/179288-fut-less-costly-compared-fue-can-i-choose-fut-post2430629.html#post2430629 Dr Feller has done many large FUE sessions in the past. He's back away from them for the reasons I've discussed before. It's not that he doesn't have the capacity to do them or that patients don't consult requesting big FUE sessions, he's just not satisfied with the results compared to his strip procedures. He thinks yields are too variable, doesn't like risking grafts -- as many of his patients are high NW cases, and doesn't think FUE yields the same hair characteristics -- all things I've discussed previously in the thread. KO, I do think you bring up an interesting point. I often consult with patients/exchange messages with members and read paragraphs about donor scarring without seeing a single comment about the recipient area/final appearance.

Lake, Still shooting for the end of this week. Likely Saturday or Sunday. I'm planning on releasing more details than I initially thought, so I'm putting together a more extensive presentation. Taking a bit longer. I also need a few pictures too.

KO, Completely agree on all points. Especially with the multiple pass comment. Many guys don't want to wait 3-5 years -- assuming you wait 12 months, which is pretty standard for maturation, between procedures -- for a full restoration. This isn't clear in many video results. Scar, Don't know what to say; all I can claim is my first hand experience, and, in the grand scheme of medical/surgical subspecilties, FUE is not all that taxing. I don't think I ever called it "a breeze," but I find myself MUCH less fatigued than I do after a 14 hour shift in an ED or on medicine wards or on other surgery services. Some of the comments about it leaving you an arthritic cripple are a bit of an exaggeration, in my opinion. This also doesn't take using motorized tools into consideration. All I can say is guys, especially in medicine, make life long careers out of things that are much more taxing.

Keyser, My bad! I meant to say "when he was in the UK," not "while he was in Europe." I'm going to make the annoucement this week as long as I get a few photographs I need. I have not invented a robot on the level you describe above. I fear SkyNet too much to ever do something like this : ) All jokes aside, I do think the new technique addresses a few of the FUE "problem areas" I talk about. I'm trying not to overhype it too much though. It's definitely been very reliable and impressive for us, and I think it's a great approach for a lot of patients, so I don't want it to seem like some marketing gimmic.

Weare, Don't a lot of the top guys in Europe charge similar prices to US guys? I thought Lorenzo was 6 pounds (9.32 US dollars) for the first couple thousand while he was in Europe? I think where we really see the price difference is Turkey. This is because of the technician-driven model. And, again, that discussion is a whole other beast! Have a good one, gents!

So many replies just in the time I went to bed! This thread is active, boys! Ontop, Yeah, that's all I've really been trying to say. Maybe I'm just too loud or verbose about it, er something! I think there are patients who are well suited for both procedures. Doctors should be aware of all the facts and properly consent the patients. KO, I agree. I think there are some legitimate areas where strip has the edge over FUE. Just like there are areas where FUE has the edge of strip -- IE cosmetic scarring in the donor region (in most cases). There are MANY doctors who could buy a machine, fire 90% of their staff tomorrow, charge twice as much, and essentially stay in business based on their prior street cred no matter what the results look like. Yet they don't. This is why I don't understand the "economics" argument as much. Though some say this argument is more about laws prohibiting techs extracting. But, you guys have gotten to know me over the years. I've put too much effort into this field to do the above. Also -- and, Jesus, this is probably going to add another 5 pages to the thread -- I agree with both your points: I still see more "wow" results from strip -- though there are a lot of EXCELLENT FUE results shared on the forums all the time; AND I do think there are textural differences to the hair that grows from FUE grafts versus strip grafts. The texture of our hair is determined by the width and orientation of the internal root sheath (IRS) of the follicle. If this becomes disoriented -- either via compression or traction injury, general damage to the lower third of the follicle, crush injury, etc -- the hair will grow differently. This is why I personally think the hair grows a little different during the first 8-9 months of any hair transplant -- follicles are settling and maturing. However, I've noticed it tends to stay a bit "kinkier" with FUE grafts. I think this is because of permanent changes to the follicles during the FUE process. Then again, maybe this is just me?? Scar, Glad you joined us again! 1/2) I would really hope doctors would be objectively objective -- for lack of a better term. Physicians shouldn't be salesmen. Period. It's their job to lay the facts out on the table without distortion. If patients generally want to know where they can get FUE for $2 a graft, and the doctor knows, they should tell them about it. I've done this many times in consultations. However, remember that doctors still must make recommendations to their patients too. If a doctor has explained the data -- not "feelings" -- behind FUE and strip, laid the options out at the table, and still says "I think you're better suited for strip and I recommend doing it with X number of grafts," then they've still been objective and fair. If they distort facts and offer something they know is sub-par based upon customs -- like you said above, then this is wrong. I guess this is why it's so important to work with trustworthy docs. 3/4) I do love FUE!! I promise! Haha. Look, being a hair transplant surgeon is an amazing job. I've been blessed to have the opportunity to work at the best hair transplant resource on the web and cut my teeth with some of the best in the business. Truly. I'm grateful, and I thank you all for the opportunity. Compared to some of the other types of surgery you can do today -- and Weare will back me up on this one -- the "fatigue" factor with FUE really isn't an issue. Try standing over an OR table working on a plastics case for 12 hours, or harvesting vessels with a vascular guy for hours on end. These cases, for me at least, are fatiguing. Yet guys make 40 year careers out of it. Frankly, I don't find myself feeling overly fatigued or taxed during FUE procedures any more than strip. I get to sit in a comfy chair, I don't have to wear layers of surgical garb or lead aprons (seriously), I get to actually talk to awesome patients while I work. Trust me, this is 10 billion times less fatiguing than any other surgical sub-specialty out there, not to mention 90% of other fields of medicine. Also, there are ways of making the tech model work in the US. Guys have done it for years. To be continued ...

Yeah, so I was confused about the vortex punch. I tried to ask Dr Vories in another thread, but I think he didn't go back and read it. I was confused as to whether or not it was just a sharpened punch you put into a handle -- like the versi handle, a motorized tool, etc -- or if it was an actual tool/device in and of itself? The only thing I find when I search "vortex FUE punch" is a motorized device. Maybe John Casper can clarify? Respek if he's doing all manual! That's the way I personally like it. Also, the quote I was talking about for Dr Vories was one where he was discussing his testing before actually doing the procedure. Some call this a "FOX" test. It's essentially just where you extract a few grafts to get a better idea of depth, angle, etc. Unless I've merged conversations in my head, he says unless he's getting 80% during this, he stops. This would mean if he got 81, 82% etc, he'd go forward. I don't think this convo was about the AA patients. Also, the yield, graft survival, and transection are all different things. Saying "85%" graft survival isn't the same as 85% growth technically. However, I feel like I'm putting words in Dr Vories mouth here, so I won't speculate. Weare, The "which gives more grafts" strip v FUE debate is about as eternal as this one! Haha. Frankly, I think you'll probably get the "most" grafts by "stripping out" and then going back and salvaging as much via FUE as possible. You can get a ton of grafts via straight FUE as well. But then this gets into defining the safe zone, taking more than 50% density, etc, and is another discussion for another day. Also, it's difficult to price strip procedures and FUE procedures the same, in my opinion, because people don't really do strip "price per graft" any longer. Most seem to charge by "session size" for strip and by graft for FUE. Don't really know why, but that just seems to be the trend.

Small FUE session combined with FUT?? Are you referring to our new FUE technique? The combined FUE/FUT thing has been done many times before. I've never really understood or supported this technique before. This isn't what we're doing here. Thanks for the kind words.

Looks like he got a good tan too!

Weare, Thanks for taking a look at the references! The ARTAS study is significant for the fact that it's a study sponsored by ARTAS that reported transection rates on that level. This study wasn't subjected to any sort of peer-reviewed critique, so the fact that the rates were still reported at this level is somewhat telling. I believe Dr Vories still uses the NeoGraft to score the grafts, but now delivers the grafts manually. I'm not sure if the average transection rates with NeoGraft are available somewhere, but that would give more of an answer. However, Dr Beehner and Dr Wesley -- to my knowledge -- both extract grafts manually. The data from Dr Wesley showing growth rates is from grafts extracted by "best practice" which, in my opinion as well, is manual tools. So this is much more of an "apples-to-apples" comparison. Again, if you do have anything tangible to review refuting these claims, I really would like to read it. Do I think the transection rates from a top FUE guy and top strip guy differ? Yeah, I still do. I was watching one of Dr Lorenzo's YouTube videos the other day -- and, of course, I can't find the specific one I'm talking about now -- and he quoted his transection rate for that particular surgery at 11%. I also remember Dr Vories saying he will stop the procedure or recommend a different approach if he's seeing greater than 20%. To me, this means anything near that ballpark but still under would be considered acceptable (15%, etc). Dr Feller uses nearly identical criteria during his initial testing before diving into a full-blown FUE procedure. Transection with strip is going to be 2%-ish. So, I think its different -- however, see below for how much this really matters. Keep in mind, however, that transection of grafts isn't the whole story. What's more important, and this was shown by Dr Shapiro in a portion of the Hair Transplantation text, is what happens to the grafts that are successfully extracted -- and, again, this doesn't take grafts that were scored but failed to be extracted into account. FUE grafts are stripped of a lot of the protective supporting material, especially near the hair bulb, and this leads to issues. It also does not touch on the delivery phase, which is where avulsion injury and tension damage is brought into the picture. This is where I think the true difference in yield lies. Now, Dr Vories says this can be overcome by using a Choi/Lion implanter. And this is definitely an interesting theory. And one I'd be interested in reading more about. However -- and I think you'll note the pattern here, this still comes down to personal experience and, to my knowledge, hasn't been studied objectively. Now, here's the important question .... Does this matter? Joe Tillman made a very interesting post essentially stating that the evidence was correct, but it's all much more moot when patients are seeing good results from FUE. Does it really matter if only 80% of the grafts grow if the results are good and the patient avoids a strip scar? Frankly, this is an important consideration and I think it's closer to the point you're making. However, I think this illustrates the difference between the physician's role and the patient's role. The patient's role is identifying their goals, discussing the options with ethical practitioners, and obtaining the best results possible. The physician's role, in my opinion, should be to focus on some of the academic minutiae we're discussing here and always strive to better what's available. Some of these recent back and forth conversations actually crack me up a bit, because I feel like I'm arguing against something I actually support. It's a bit maddening because I've always been a big supporter of FUE. Who wouldn't be? Over the years, however, my perspective changed from that of the patient/observer to that of the physician -- as we discussed above, and I found myself focusing more on these very fine details. Sometimes I think my academic evaluation of these details comes off as "anti-FUE" or "pro-strip," but this isn't the case. I see the potential FUE has and what it offers to hair loss sufferers, and I feel obligated to put it "through the ringer" in a sense, and really work on improving these small areas in order to offer the best procedure to patients. This is the same thing guys like Lorenzo, et cetera, did when they made changes to the protocol. I've been uber invested in this field for years now, and I really feel passionate about combing through each detail and coming up with the best solution in the end. Until we figure out a reliable method of donor regeneration, hair transplantation is a complicated chess game, that involves using a finite number of grafts to really make a big cosmetic difference. In this game, EACH one of those follicles matters. And I want to be able to say I've done my best to preserve and utilize each follicle to the extent of my abilities. In the end, I think this is what our new technique does. It's cool. However, it's a totally new approach and will likely draw a lot of questions and some controversy. I expect this won't be the last long forum post I write about it! Haha. However, I personally believe it's the best way to achieve what I outlined above. To steal a good phrase you used above, I think it combines the best aspects of the two techniques we have available and offers patients our "best practice." We will see what others think! To me, this is ethical and very important in the end.

CJ, John brings up a great point; one of the most important things to do after a procedure is make sure you're following your clinic's specific post-operative instructions to a T! Good luck on the upcoming procedure!

KO, Do you mean graft insertion or creating the incisions? I agree that creating the incisions is absolutely crucial. It's the most artistic part of the operation -- alongside design.

Weare, Again, I don't want it to seem like I don't like FUE or I'm anti-FUE. I like FUE! I like FUE a lot! I absolutely understand the pros of the less invasive nature and know patients want it. This is precisely why Dr Feller, Dr Lindsey, and I set out to work with the technique and remedy some of the issues I point out above.

Weare, I wouldn't call it a bias. To be honest, I think it's more of a necessary balance. Sometimes we get so caught up in these "before and after" results without reading the fine print, that big assumptions are made and then propagated. As far as the evidence is concerned, see this post here: http://www.hairrestorationnetwork.com/eve/178876-costs-fue-us-vs-europe-asia-post2428542.html#post2428542 It took me quite a while to find something with actual concrete data, and I'm so glad Dr Wesley and Dr Beehner took the time to do so. As you can tell, this is objective data. Utilizing images is subjective and anecdotal. This is the best evidence I've found so far. It shows better growth with strip. If you have any other concrete, objective numbers, please share them - because trust me, it's lacking! Thank you for bringing up the excellent example of CABG v angioplasty. This makes my point perfectly. Let me propose a series of questions here: You have three patients coming onto your cardiology service with the following diagnostic cath findings. Tell me which ones you would take for angioplasty with stent placing -- the less invasive technique, and which you would refer to CT surg for CABG ("bypass surgery"): 1) A patient with 70% stenosis of the LCA (left circumflex artery) 2) A patient with 90% stenosis of the L main 3) A diabetic patient with triple vessel disease Now, unless your institution does it differently, let me explain what the answers would be: 1) cath with stent, 2) CABG, 3) CABG. But cath is less invasive? You see commercials on TV telling you its 100% effective for patients with coronary artery disease. So why send the second two patients for open heart surgery? Because it is the right surgery for the right patient! You, as a cardiologist, evaluated all three of these patients, weighed the pros and cons of both surgeries, and recommended the surgery best suited for the individual patient. This is the exact same thing I'm saying. I understand you had a great experience with Dr Lorenzo. I understand it was MUCH better than your strip surgeries from a long time ago. And this is awesome! He's a wonderful surgeon. But honestly, I do think you're showing a bit of bias here as well. I've heard you make a few comments about Dr Lorenzo and FUE that were far more incredulous than those I've made discussing the two. My point is simple: provide informed consent and perform the right procedure on the right patient. Is this really that biased?