bismarck

On 7/23/2018 at 10:20 PM, JeanLDD said:

I never denied that FUE the vast majority of the time will result in greater donor depletion and scarring magnitude, the difference is that you with small manual punch work you don't end up with the 1/10-20 who have significantly worse results due to bad scarring for whatever reason

The FUE risk is having poor yield and a chewed out ratty appearing donor area with widespread fibrosis and poor outcome/low yield. With FUT its a bad scar. The amount of scar tissue will be significantly less with strip because of geometry -- a single line leaves less collagen behind than thousands of circles. 

"I can't remember exact details but Keser and Vories have had FUE test cases with close to 100% yield, including Keser implanting at 70 FU/cm2."

This is a common assertion, but I really don't care what doctors claim unless they publish their data in peer reviewed journals (not cherry picked cases on their websites). I do trust the opinion of Konior more, as he seems to surpass those two with his patient posted FUE results, but there is no way to be certain. For the European doctors, there is a financial interest to promote FUE because they can have their techs do the surgery and make more money that way. The techs usually do not make much, but having to support the extra staff evens out the numbers to a degree. In America, FUT is less labor intensive, while FUE is very physically demanding. They charge more to accommodate for this so finances are usually not the issue, it's the labor.

Don't kid yourself Jean -- it's not that people that agree with you are open minded and unbiased and those that disagree have financial motives. There are risks and benefits with both procedures. Until surgeons man up and publish their data, the discussion comes down to opinion and cognitive dissonance.

Think about how insane the people that deny global warming sound -- it's hard for a man to understand change if his income depends on his remaining the same. Certainly this applies to FUT, but of course it also applies to FUE. Everyone, EVERYONE has financial interest and bias. As Louis said, you have to pick your poison.

On 6/20/2018 at 8:03 AM, JeanLDD said:

Constant issues with those having very bad shockloss around the scar also, rendering the donor management case a moot point.

This has been discussed extensively on these forums.

Greater donor depletion with FUE and lower yields are generally recognized issue. I have heard this stated to me in person by both Konior and Cooley, who both have a strong track record with both procedures. The limited studies comparing the two that I've seen are also uniform about this point (unless there's been a new study I haven't read). 

Those are essentially the only reasons anyone would do FUT over FUE (outside of cost). I have my procedure scheduled in a few months with a surgeon who is comfortable with both and am still constantly going back and forth about the issue. I'm a Norwood 3/early v at 38 ears and have been on Avodart for the last 5 years. I anticipate greater loss down the line, especially if I discontinue Avodart when for having children, and am not sure if I should 'burn the ships', as it were.

Ultimately, there is no clear cut answer until after the fact, and even then there is uncertainty.

OP: I feel your pain. If you could let us know who the surgeon was it would be deeply appreciated.

It sounds like you are not going back to the surgeon -- please let us know who did your procedure.

Reddy is extremely difficult to consult with if you are out of country. His secretary e-mail responses are pretty useless -- basically just boiler plate templates with your name inserted. His prices are also high, and don't justify the mixed results I've seen coming from his clinic. This experience may be different for domestic patients.

 

The other three (Bis, Feri, Lor) you mentioned have strong yields and are good for conservative hairlines.

Who else have you consulted with? There are some really excellent surgeons out there who focus more on revisions, which can be trickier.

PHD,

 

I appreciate your point about needing more transparency in the industry.

 

Although review sites like Amazon or Yelp have internal filters and algorithms to filter out disingenuous reviews, to an extent cases are at least manually vetted here (ie. when Doganay had an unusual number of cases submitted from patient accounts in a short time period, the moderators looked into it).

 

Still, the point is certainly there that we have no way to reach complete transparency as the internet currently stands. Even tracing IP addresses and browser cookies can have you running around in circles.

 

I'm not sure what there is to be done about it, beyond being vigilant about the potential for duplicity when large quantities of money are on the line. Overall, though, I don't really share Feller's perception of smoking guns behind every grassy knoll, and still think it could just be coincidence, or reflect varying levels of online awareness in different markets.

I've noticed this too, it is a little funny. Clinic submitted cases do seem to be more evenly distributed geographically than patient cases on the site.

 

For patient submitted cases, perhaps it reflects a shift in volume for the surgery to those countries or a change in the user demographics of this site.

 

For clinic submitted cases, I'd imaging that the well known clinics that are not submitting cases may shift away from internet marketing once their patient intake becomes more established (ie. perhaps once business is flush, it's easier to work with local patients).

As a great deal of the extraction is technical, it would not surprise me if some techs were better than the surgeons.

 

It is probably a more common scenario that the surgeon is more accomplished, but the great thing about the democratization of medicine that the internet affords is it allows us to find exceptions to the averages.

 

It is inevitable that, at times, someone with talented hands might discover their niche later in life, or not have the opportunity to go to medical school but develop a passion for the art.

 

I am thinking, in particular, of certain techs commonly mentioned on the forums from Belgium and Turkey.

 

We should recognize those clinics with extraordinary techs, just as we recognize the clinics with extraordinary surgeons.

With all the controversy that seems to surround nearly every post regarding the Maral clinic it just dawned on me.

 

The idea of the technicians being listed underneath the surgeons that "proctor" the surgeries is a good one, particularly for clinics that allow technologists to do extractions/implantations.

 

Also, it would be helpful to detail which parts of the procedure were performed by the tech, and which were done by the surgeon, and which were done by both in conjunction.

 

The closer we are to 100% transparency with hair restoration surgery, the closer we'll be to understanding how to target problem areas and consistently reproduce excellence.

But what if the hair follicles aren't splayed? It seems that you're taking one particular presentation and generalizing it.

 

 

I am not stating this as a generalization. I wonder if it may have been a factor in the FUE cases with poor donor sites that I have seen. What percentage of the population has atypical follicular paths, and whether this varies with age, ethnicity or Norwood is unknown, as far as I can tell (beyond the anecdotal data of individual surgeons).

 

As for yield, could you post Wesley's data, I don't recall it and google search runs dry.

 

Wesley's data is in his ISHRS talk on his website (the one hosted on vimeo).

I disagree, there are substantial gaps between the follicular units. I find it hard to believe that fibrotic healing would harm another follicle, but I can see how it would make extraction difficult.

 

The second part of your statement refers to a different topic, so no comment there.

 

When hair follicles splay out under the skin in different directions, there's no way you're getting all of them with an FUE. Adjacent follicles get damaged.

 

For example, imagine the a follicular grouping that looks like this (the lower image):

 

 

How is a punch under the skin not going to damage at least one, if not two of the follicles when trying to get that triplet? Adjacent follicles will be damaged with circular FUE extractions that would have been preserved with strip.

 

Beyond individual follicles, follicular units can be spaced more closely as well. For my own case in particular. Perhaps this is more true for people with denser hair, less diffuse thinning, or certain ethnicities.

 

As an aside, one of the advantages of FUT is the greater amount of supportive tissue, such as the subcutaneous fat that comes with the follicle. This adipose tissue does not come with FUE grafts, however, if it is truly necessary, then why do skeletonized FUE grafts grow? If it was crucial, shouldn't there be a significant shortfalls in implanted yield? But while FUE has a lower survival rate, it is not that huge. In Lorenzo's method, they're tweezed out with a forceps and squeezed through an implanter pen tip, and they look very thin, and are injected hard into the scalp.Yet they grow.

 

Yes, the weakened follicles of FUE grow, but not as consistently. You know Wesley's data as well as I do on this point. We can talk about Lorenzo all we want, but until he publishes his numbers, his pictures are only his best case scenarios. I need to see patients in person or see published data. Otherwise, we are lost in this neverending broscience quagmire.

So, I agree that thousands of holes creates a lot of scar tissue (so does a long cut, even if closed) but how do you know the scar tissue damages the adjacent follicle?

 

This is a concept I first heard from Dr. U, but it makes intuitive sense to me. The procedure is blind, you are trying to isolate a specific follicular grouping. Follicles cross paths, can turn unexpectedly under the skin, etc. I saw it for my own hair under high mag when I had my Fox test.

 

Doing something blind, or by "feel" in general, will cause a more unpredictable outcome then actually seeing the course of the follicle beneath the skin. This is my reasoning as to the reason for the more moth eaten appearance I have noticed with some FUE over FUT cases, particularly with the older techniques.

 

There is no peer reviewed, double blinded study on the post operative appearance of FUE vs FUT of which I am aware.

 

Really a great discussion. Appreciate everyone's contributions. Unfortunately may remain a thought experiment until the surgeries, and the data, age further.

I cannot figure out what KO is trying to say here.

 

I cannot remember the last time I have encountered such bad writing, even by a foreigner.

 

There is certainly a reduction in hair density with every FUE hair plucked out, but this reduction in density is from losing the hair and has nothing to do with the scar left behind. If you double the diameter of the FUE scar, you do not change hair density.

 

I have to disagree. Statistically the chances of you hitting an adjacent follicle are higher when you're going into the skin several thousand times as opposed to entirely removing the strip.

 

Doubling the diameter of the FUE scar will unequivocally impact density more. The extreme example of this are the old hacky punch jobs from decades ago.

 

Also, although the idea that KO is putting out there is a tricky concept, he makes an excellent point about scar tissue contracture. I think it highlights how many variables there are at play beyond simply looking at the cm2 of skin tissue removed and number of follicles. I see no problem with his English.

So what if more tissue is "violated"? More important is how the donor area looks.

There is no debate about which scar looks more obvious in a bad outcome. I am speaking to the point that more grafts are wasted with blind FUE extraction.

 

If you go on the numbers that have been recorded, FUT always outperforms FUE. Until we have more updated double blinded assessments this is all we have. It's a waste of time to stand too strongly in one camp or the other. Pictures and video are not blinded in-person assessments.

 

Every time you violate the skin you create scar tissue. The blind technique and greater quantitative violation of FUE results in more scar tissue being left behind. This results in more potential damage to surrounding follicles, especially with the blind technique. This theory is backed up by pictures that I've seen, but this my opinion.

 

People with a lot more training than the laymen in this thread have different opinions about the merits and risks of one over the other, so it is obviously not a clear cut debate until formalized research is done.

 

But think about it -- do the math. pi*r^2 * the length of the cylinder * several thousand follicles. And compare that to a line.

 

KO, I was referring to the donor zone density being affected differently by the two procedures, not the recipient.

 

How the grafts are implanted has no bearing on how depleted the donor is.

 

Furthermore, the nape of the neck shouldn't be rising substantially in strip due to the laxity.

I have noticed a few surgeons say the nape doesn't move due to elasticity, but I think this may only be an assumption. Has this ever been objectively assessed? Where is the data? I've actually gone pretty extensively into the papers publishing the original technique, and could find no mention of this. No one is taking pictures of the height of the neckline because no one cares. But skin under tension stretches. This would apply to scalp with hair on it, but I don't see why it wouldn't also apply to the skin of the neck.

 

I like that people on here question assumptions made, but lets actually get to the end of questioning before we accept something as implicit fact.

 

Density is visibily depleted less because the spacing between the follicles increases by less than the diameter of the holes punched. However, the argument coming from strip clinics was that density is unchanged, which is untrue. You can see why some, like Scar5 are skeptical.

I can see why it would seem to be just a numbers issue. But to ignore the effect of the extraction method on transecting surrounding follicles and stem cells is vastly oversimplifying the comparison.

 

The risk of a linear scar is something to consider, but as far as density of the donor region -- the objective results are the only thing that should convince any of us. Seeing the patient in a double blinded clinical setting, from a distance and with grafts counts, that's the only data I'll take seriously. Not a broscience laden debate on an internet forum based on low resolution jpg's taken with iPhones. Just too many variables and vested interests from patients and providers to take the images too seriously.

 

It is unlikely that meaningful surgical research will ever emerge from a comparison of online pictures. I believe the theory I explained about increased scar tissue and blind technique leading to a greater transection of surrounding follicles is sound, and to me appears supported by patient submitted cases. But really, what is it based on?

 

Let's stop pretending we know anything with certainty. This is all just opinion and the equivalent of medical 'talk punditry,' until the procedures age enough to have meaningful numbers behind them.

While I am an advocate for FUE in certain cases, I have just seen so many good FUT cases (usually large ones) that seem to result in a much better yield (1978Matt's rock star results included) while also preserving donor.

 

 

This has been my observation as well. The gap has narrowed, but as long as FUE is blind, it is unlikely to completely catch up, even when comparing the best in each field.

 

The only two solutions to the blind technique (ie. to 'see' the follicle, avoid transection and have consistently 'bulbar' or 'chubby' grafts) are either:

 

1) the subgaleal approach (piloscopy) advocated by Wesley or

 

2) development of an assisted anterograde extraction technique

 

For the latter, something analogous to the so-called "intelligent scalpel", or "iKnife" based on mass spectrometry comes to mind. Instead perhaps based on high resolution ultrasound, tactile information such as soft tissue resistance/density of follicle versus surrounding connective tissue/fat, high resolution digital images, CAD, immunofluorescent staining by having the patient eat something leading up to the surgery, or something else entirely.

 

The second thought is obviously more speculation and just to throw a few crazy nonsensical ideas out there into the ether.

 

The former is supposed to be clinically available in a few months, but I have noticed researchers can underestimate the time from 'bench to bedside' (ie. being too optimistic about their passion, trying encouraging investors/venture capitalists). I would not be surprised if the turnaround was more like 5-10 years.

 

While intriguing, there is a great deal that could go wrong. For example, what if the micro-cameras that he uses cause too much scalp trauma and we have to wait for smaller devices to develop? Or what if the reason for the higher survival is that the trials only involve a few follicles, and that the yield drops off sharply at higher numbers? (operator fatigue is a well known phenomenon; although the video makes it look like the surgeon is a Star Wars fighter shooting the Death star, the degree of fatigue for a newly developed surgical technique is hard to predict).

 

Still, even if Wesley doesn't show up with the answer, his mindset and thought process are extremely important. If he doesn't solve the FUE blind spot, someone else will soon enough.

 

Although this thread is a tired old discussion, and one of countless others like it on the forum, comparing posts over time gives one an interesting opportunity. Although I don't believe FUE is quite at strip yet, the discussion about this same point has certainly evolved. It reminds me of an old debate I used to see on film forums about digital versus film for recording movies. Liability vs product is always going to be the issue, but hopefully not for much longer.

 

There is no compensation. The virgin zone is thinned. Sure, your empty forehead gets some hairs, but the back stretches and thins, albeit in a nicer and more natural lie of hair than FUE, but then hen its the strip scar lottery means the hair must be strategically cut to cover it.

 

I do not believe FUE and FUT to be consistently different in terms of how natural they look when implanted, but that wasn't my point. I was referring to donor zone density. When harvested, the pattern of hair in the donor zone with strip is usually denser than the pattern in which they are implanted, so you have greater real estate coverage per follicle (ie. I've heard the other Dr. K cite 50%).

 

When individual units are extracted, the gain in coverage would not be as great because the original follicular units are not immediately adjacent (ie. 'tiny holes' appear post FUE --> thousands of tiny circles have more circumference than one long curved line --> more tissue is violated with FUE than with strip --> more scar tissue forms --> the 'dead zone' of donor scalp without follicles is greater).

 

That is to say, while donor real estate and grafts harvested are the same, we can't only look at what we remove, we have to look at what we leave behind. And in this case it's scar tissue. When more skin is violated, it implicitly follows that there is more scar, and thus more loss of density.

 

This is only a theoretical discussion until a group of surgeons actually do the relatively simple experiment of actually counting donor density in a controlled and blinded setting (ie. similar to what Wesley, Atlanta doc, and others have already done in other scenarios). I am not sure that this study is perceived as being profitable enough to actually fund, but I expect it will show up at some point. I wouldn't be surprised if the data has already been recorded but not published.

 

So to respond to the OP with the talent for baited thread titles, people are choosing the procedure that's right for them. We are rarely dealing with black or white in hair restoration, but rather many shades of grey.

There is one issue that Dr. K has not explained much or any.

 

 

I don't understand why so many people have a difficult time understanding the density issue. You have to realize the amount of real estate lost with a strip is compensated for because the extracted grafts are implanted in a less dense pattern than from where they are harvesting.

 

That, combined with the nape of the neck rising, seem to me the reasons strip impacts real estate density far less than FUE.

 

Dr. K: I find it very interesting that you've 'never had a strip patient run out of follicles'. This may reflect a very fortunate patient population, a miscommunication, or perhaps was made for effect. I could easily refer you to dozens of cases on this site alone of strip patients that have 'run out' of follicles.

 

Also Dr. K, could I ask what percentage of your practice is FUE vs FUT?

4000-5000 grafts FUE procedures are performed to give an excellent result, but finishing off the donor area completely. There is just not enough time for those patients to get older, find about their donor area, complain about their surgeons decision and damage the surgeons reputation. There is not enough time and memory of patients to refute this mistake of the surgeons and the surgeons will surely get away with it.

 

Interesting. What about the point that overdoing strip can cause scars that would prevent you from being able to do FUE in the future?

 

I do not think it is unreasonable to assume that overdoing either FUE or FUT prevents you from getting the complementary procedure.

 

- Too sparse a scalp from FUE, the strip scar will show, not a candidate for FUT anymore.

 

- Too big a strip scar, can't afford to lose density, not a candidate for FUE anymore.

 

Is there a way to predict the category for which you're at more risk? If you have pencil thin scars, perhaps the most overall yield is from strip first. But if you have great donor density, perhaps the best best yield is from FUE first. Although this would also help with strip scars.

 

It does not seem unreasonable to think that scalp laxity, which appears more important for future strip procedures, would decrease with repeat procedures. Whether this is impacted more by FUE or FUT is an important point to consider.

Who did your procedure?

Could you please post a before/after pic of your entire hairline with your eyebrows included so we can get a better idea of the overall improvement/lowering? And overall yield?

Dr Lorenzo should probably charge moire considering his reputation and the extent of his involvement in the procedure. I wonder who would be cheaper between him and Konier for 3000 grafts FUE?

 

Konior quoted me $17.5k for 2000 grafts with FUE, so it appears they are comparable.

This thread makes me feel bad for Dr. Wong.

I appreciate your kind words KO, I am fortunate to have a more mild case. Still, I have seen Konior and other reputable surgeons work on guys with my level of hair loss, so I know it is not uncommonly done.

 

In consultation, Bisanga, Lorenzo and Feriduni suggested essentially reinforcement of my current hairline, while Mwamba and Erdogan agreed with minor work similar to that of Konior. I know there is a range of opinion when it comes to hair restoration and patient age, just as there is a range of approach with any surgical procedure.

 

I understand it is a cost:benefits issue, and everyone has a different opinion of how much money they want to put in the market.

 

I am comfortable with surgery because of the freeze Dutasteride put on my frontal and vertex loss (ie. there is a strong chance I can maintain a low hairline for the next 15 years). If I were to have exceptional recession behind the transplanted hairs later, I would have further work done or consider a hairpiece, but overall I favor a more assertive approach.

 

I unfortunately have to admit the cynical truth that in most professions and most relationships, hair matters. I certainly feel I get a different response from people when I go out without Dermmatch and Toppik than when my head is painted.

 

If I was to be honest, I think probably the more deciding factor for Konior's deferral was that my excessive questioning gave him the impression of my being a high maintenance patient, or even lacking confidence in him as a surgeon, which was not my intent. It has always been my nature to question extensively, and I can easily see how that can become tiresome.

 

Still, he was patient and considerate with me throughout. At one point he said something along the lines of "There is no way we have to transplant hair with FUE and truly have the same yield as strip."

 

To which I replied "Until piloscopy emerges."

 

He asked me why I thought this; I mentioned the video from Dr. Wesley's site about 'chubby' and 'skinny' follicles.

 

Konior then told me, "You're living in a fantasy land."

 

Which I thought was a fairly honest answer. Piloscopy is years if not decades away, and could very well go the way of hair doubling, stem cell transplantation, RU, etc. It would be silly to hang our hopes on something that is still in clinical trials. It may ultimately be an amazing surgical technique, but even in a good scenario, it could take quite a bit more time than expected. Konior is warm and personable, and also exceptionally blunt -- three attributes of a great physician.

 

In any case, as can be seen on many of the other threads here, it is not rare to see surgeons who have done excellent work, but have neurotic or unstable patients complaining about fairly minor flaws with the hairline. No one likes dealing with prima donnas. Intended or not, my inquisitive approach may have portended this nature.

 

It was a great experience overall, and I am appreciative of the time they spent with me, but I will continue my search.

I traveled to Chicago recently to visit Dr. Konior after noting his considerable internet presence, numerous cases, and online videos, and pristine track record. First, we had an e-mail and then phone consultation, predominantly about my frontal hairline.

 

I spoke with him on the phone on a Saturday, and spent nearly 45 minutes discussing his philosophy of hair restoration. At that time, we considered both FUT and FUE, with his holding off on his final recommendation when seeing me in person. He then performed Fox testing for me, designed a potential hairline, and spoke to me about the possibility of our surgery.

 

I wanted to highlight a few things:

 

- Tom Ruiz is an incredible office manager and representative for the office. Walking into the office at 6:30 in the morning, he sat there politely and it was already clear he had been up for some time. He touched base with me 10 minutes prior to my appointment and helped me avoid getting lost with my confused Chicago taxi driver. Exceedingly good at his job, Tom reminds me of a young Alfred Pennyworth -- he's the secret behind Batman's success. His knowledge of the hair loss industry is profound, and he has a knack for delivering answers to its more controversial aspects in a balanced and honest manner.

 

- Konior'a surgical assistants, Feliche and Lisa, were quite nice. I did not interact with them as much as Konior, although they both seemed personable and conscientious when it came to scheduling issues and questions post operative management. It is clear Koynior runs a tight ship, and they match him in professionality.

 

- Dr. Konior himself is remarkable. At the highest level in terms of work ethic, integrity and affability. He spent 45 minutes with me for our 6:30 a.m. meeting, took time to answer my many questions, and even took time to sketch a potential hairline. I found out later that the time he made for me that morning would mean he left 45 minutes later in the evening. Although minor, this stood out as an example of his dedication to patient care.

 

- I tend to analyze things carefully, and he was patient with my various concerns and a straight shooter.

 

- I had recently shaved my head before meeting him (2 weeks prior), and my hair has since filled out and came in evenly after that. At the time, it gave my hair a more thinned out appearance. This led to him recommending only FUE for my procedure. Strangely, it has completely filled in since then, and regained its former density.

 

- As some of you know, I am still trying to weigh the benefits and risks of FUE and FUT in my mind. Ultimately, the question comes down to scarring versus yield. As Konior is known more his FUT work, I expected him to come down more on this side for my procedure. Rather, he carefully weighed the benefits and limitations of both.

 

He pointed out much of has been discussed on the forums. The scarring of an FUT was minimal, but a line would remain. Patients with diffuse thinning may work better for FUE for 2 reasons 1) the scar would be harder to conceal and 2) better follicles could be chosen for the frontal hairline.

 

- We discussed my opinions on hairstyle. I mentioned I was taking Dutasteride, and that the only way I would shave my bead is if I later decided to have a family and needed to discontinue Avodart for a short period. If I developed dramatically aggressive hair loss during that time, ie. the horseshoe' I may say, forget this and go to the skin.

 

I unfortunately have a strong family history of balding.

 

vs.

 

He looked better as an X-man.

 

To my surprise, Konior recommended only an FUE for my procedure due to his concern about my shaving my head in the future. As he is so strong with strip, it impressed me that he assessed my future concerns, and went with what I agree is the more appropriate surgery.

 

Tom was present during the interview and took extensive notes.

 

Konior then took me in and did a brief Fox testing on me, transplanting 10 units, which demonstrated most straight follicles with good density of mostly 2, 3 and 4 graft follicular grouping.

 

During his examination of my scalp and on microscopic view of the extracted follicles, Konior noted many shorter follicles, which I wonder if due to the uneven regrowth of my hair initially after shaving my head were the smaller hairs that have since grown out. He called me over from the exam chair prior to re-transplanting the hairs, and showed me individually what he noted as the 'excellent quality' of grafts he had obtained.

 

This was reassuring.

 

One thing that I regret about this visit is that I have a nature to ask many questions. Konior was patient, but I believe I gave him the impression of being 'high maintenance', which ultimately led to our later decision to defer the surgery until my hair loss had progressed further, or I was more ready to accept the relatively low possibility of an unsuccessful procedure.

 

This was his suggestion, not my own, though I later agreed. I have been described as a Norwood 2-3V, depending on the surgeon, and concealing the more subtle aspects of my hair loss with dermatch and Toppik are still possible.

 

I also later asked him if he could point out which cases of his were FUT or FUE amongst his online postings, to which he noted, "Attempting to gauge or guarantee your potential result by looking at other pictures is simply impossible." I was hoping to get an idea of what a reasonable outcome was at his clinic, not a guarantee of my own.

 

He said the majority of his cases were FUT, although he did a significant amount of FUE (when I asked him if it was about 80:20 he said, 'that sounds about right'). This surprised me as to somewhat because of the relative absence of FUE online (which makes me wonder if some of them are actually FUE cases, and just not noted as such). As Spanker noted, only a minority of patients come back for follow ups. Perhaps the FUE cases are more often out of state/country. Similar to Hasson and Wong, I'm sure he has no shortage of strip.

 

Tom took me to see two other patients of his during my time there. One was a strip case that looked literally like a work of art. Another was a revision of a bad strip scar an unnamed 'elite' surgeon well known here. Both patients were exceptionally enthusiastic about Dr. Konior.

 

Konior later told me that the risk of a below average outcome was 1%, but that because of my extensive questioning, he felt that my expectations of what 'average' was were too high. Looking back on it, I wished I better expressed that my questions were not due to lack of confidence, but rather my inquisitive nature, but I understood his point.

 

I also asked him to indicate which of his posted cases on here here FUE beyond the limited number we know about -- (Mcmarkrazz, BoulderBalder, the darker skinned gentleman that he posted, etc.), and he noted that pictures were not a realistic way to gauge one's personal outcome. Again, I understood his point, but was just trying to see what was typical.

 

Ultimately, he asked me to consider deferring surgery or selecting another surgeon. I thought about it for a few days, and finally realized that he was right.

 

We spoke briefly about Spanker, incidentally, and he noted that similar to him, I had a very 'cerebral' approach to hair loss, and noted that he was a 'cool dude' which I thought Spank would appreciate.

 

Those of you who have been on here longer know that Spanker was first a patient of Konior, then his online representative on the forums here, and I believe a fishing partner on at least one occasion.

 

Although we did not have the surgery, I still have incredible appreciation for his professionalism and office staff. The hairline he designed was graceful, and the grafts he tested with me, as far as I can tell, were well accepted. Although the flight and travel expense to Chicago were a cost, overall, I feel it was worth it for the understanding of hair restoration and his specific thought process.

 

For the time being, I am going to hold off on surgical intervention, and consider how much longer I can deal with painting my head. Although it is humbling to be told by a girl you're talking to at a coffee house that 'you're too old' when she's only a few years younger, perhaps the perception of age has more to do with how you carry yourself (or maybe I should go to more dimly lighted venues).

 

I will continue managing my hair loss as I have, with medical management and cosmetics. I look forward to posting my surgical photos, I expect in Spring of 2015. Until then, buen provecho.

At what stage in your research did you become aware that FUE was a blind surgery? How much study did iy take?

 

 

Yes, it is blind. You don't know where the follicle ends with FUE, you're just going on feel. Wesley has spoken about using high-frequency ultrasound to reduce this risk, but we're not there yet. That's why FUE can have a higher transection rate than FUT. Plain and simple.

 

What is a strip residency?

 

For your research, I had strip in 1988, the same year FUE started. FUE was cockblocked by stateside in the states, and the originator developed a rqther caustic attitude, furtyer styming its progress.

 

There is no such thing as a strip residency. Not sure where you got that. I am referring to training during residency.

 

For the dates, I am referring to the first published peer reviewed articles on Pubmed.

 

Strip was everybit as cavalier as FUE.. remember, it is he sqme guys.. residencies and research rank very low-y on the HT world..its not rocket science, a very simple procedure..

I would disagree with both of these statements. If it was simple, we would see a higher success rate and graft yield. The difficulty of the procedure is reflected in the number of disappointing outcomes posted online and in the literature. And like any new procedure, formalized training and research come later.

 

In the beginning, yes, it was the unregulated cowboy medicine and economic opportunism that you refer to, but with time, a formalized reproducible technique has emerged, and will continue to develop. You can't abandon the scientific method.

Hairfarmer,

 

Just to understand your perspective, can you draw the "ideal" hairline that you would have preferred?

 

Although there are some subtleties, it is difficult to understand the degree of your dissatisfaction based on these pictures.