bismarck

David, thank you, that is really helpful. Thanks.

Man, there are a lot of threads that are just lost to follow up.

Question for the moderators or those wiser than me -- is there a way to see which hair loss surgeons are financial contributors to the site (ie. advertise here)? With this place being the largest online forum in the world for surgical hair loss I just wanted to understand everyone's relationship on the site (similar to how researchers and physicians have to disclose financial relationships when giving medical talks to patients). Thank you!

Thanks, I appreciate your optimism about the future of hair loss research, and my hair loss in particular. 10,000 hairs would be amazing. However, as Mark Cuban once said, it's a bad idea to start a business on a loan. And I have to accept on some level that medical therapy means that to some extent, many of the hairs I have may actually be 'on loan'. If I stop responding to what I'm already on, I am almost out of options as far as medical maneuvering (I suppose RU would be the last stop, spironolactone is just too extreme for me). As a somewhat unrelated aside, regarding your predictions, I am not as confident as you are about stem cell research/hair multiplication. Having researched hair loss myself for the last 12 years, I have just not seen the developments we were once so optimistic about. Dutasteride was really the last major medical breakthrough, and FUE the last technical breakthrough. With the sluggish economy not showing signs of recovery any time soon, if ever, research funding (ie. the NIH) is at an all time low. Without America to lead the way, the last 7 years for medical and surgical innovation have not been as impressive as the 7 years before that, at least by scale, and likely will continue to stall as oil prices climb and potable water declines. China is spinning its wheels as well, although certainly much of the great research out there is coming from the so called Asian lions. Garza, Cotsarellis, et al. have been knocking at the door of stem cells and dermal papillae for some time, but have really not shown anything impressive as far as clinical application. The somewhat infamous Dr. Nigam now appears to be on the lam. The desire to clone follicles is similar to the desire to effectively clone in general, and has somewhat of an analogy to finding the cure for the common cold or the HIV vaccine. Just when we think we're about to figure it out, the damn thing slips through our fingers. Theoretically simple, practically impossible. I worry that will remain a medical mirage for quite some time. Back to your suggestion, I have a huge amount of respect for Erdogan, but his graft counts are a bit steep for me. I also worry about what transplanting that fast does to yield. I've seen the videos, but 4500 in a single day is really something. I'm sure medical assistant labor is cheaper and more plentiful in Turkey, but nonetheless. Alright, back to combing through the patient results threads. Again, thanks to everyone for your thoughts and insights.

Thanks for posting results. How are things coming along?

Interesting aesthetic point. Judging from different surgeon's picture's, some prefer the more rounded contour, while others prefer sharper angulation. Ultimately, there is no realistic way to predict what the surgeon will do beyond developing a consensus statement by comparing yourself to past patients that have hair lines similar to yours. Honestly, if you saw the diagrams and databases I've made on my computer...it looks like a beautiful mind. Not sure if I'm going off the deep end or about to win the Nobel prize. Either way, the lesson I'm realizing more and more deeply is to not do anything without research. Surgery is effective, but it is a painful process, and basically irreversible. Nothing in life worth having comes easy. And so here we are in the rabbit warren. :rolleyes:

Great progress sir, don't lose hope. The shock loss or so called ugly duckling period will be over before you realize it. Keep posting pics, and have faith. I certainly have respect for the difficult path you've been through so far. There is nothing easy about hair transplants.

Joe, you are definitely right about this. From his body of work here alone, Rahal is a world class surgeon and one of the true elites in hair transplantation.

Lorenzo is king of crowns.

Here is an interesting post by Mwamba that seems to answer the above (emphasis my own): So by the numbers, 5600-6400 grafts total are available in the average donor. I am not sure if I read into the earlier statement right, but because FUE can go into the so called forbidden area, 1200 more grafts are available as compared to FUT? Mwamba cites his yield as 98-99%, which I imagine are similar to Lorenzo's, and I imagine considerably above the non-elites, although it is of course by self-report. Does anyone know if formal FUE yield averages have been published in the peer reviewed medical literature? (ie Pubmed)

Wow, excellent thread. Perhaps one of the best ways to understand the difference 1100 grafts can make.

It is a subtle balancing act. At times, I feel like I'm using a loan shark to pay off credit cards, or borrowing against my home. Tricky to avoid cutting off the nose to spite the face. This is one thing I have struggled with. Even the top surgeons don't seem to have many cases online that aren't self-submissions. The foreign forums seem to help a bit with this as the docs themselves don't seem to post as much there. Where else would someone go if they wanted more patient sourced cases as opposed to surgeon/representative sourced? Granted the pics are often not as clear or well done, but it does follow that you are getting a more random sampling. Also, I know Lorenzo gets cited as having the best yields out there (albeit perhaps conservative with hairlines), but is there anyone else that stands out in the international market? As you point out, it seems nearly impossible to know with any degree of certainty, as the surgeons that post more cases may have just been doing FUE longer, have higher volume, or more assertive internet presence. I wish I had a crystal ball (or crystal bald, as it were). I definitely see your point -- insightful as always. One thing you mentioned that caught my eye, you stated the average male has 5-6k grafts by FUE. Does FUT offer more or less by comparison? I know this has been discussed before, and that historically it was higher, but has this equalized with time? Thanks London, I definitely noticed your pics before and appreciate you taking time to chronicle your experience. You went with the best and got a really solid result. I agree, many of Feriduni's hairlines don't seem aggressive at all, at least from the cases I've seen. Often, he seems to remain conservative and "fill in" or "reinforce" what is already there, rather than lower it. Bisanga seems a bit conservative as well to my uneducated eye, although Mwamba may be a bit more assertive in this sense. Thank you guys again for your opinions and insights. This place is a candle in the dark.

Out of curiosity, why did his hair color change? I've noticed this with some other surgeon's pictures as well -- is it lighting, or somehow related to the procedure?

Very interesting first picture -- thanks for explaining your thought process in detail.

One thing that is fairly confusing to me is how dramatically different the number of grafts estimated between the surgeons were. Bisanga listed 1500, Mwamba 2000-2500, Hakan Doganay 2000 and Erdogan 3000. They have all been described as being part of the elites of FUE, so what would account for this? Is there really that much variability in the procedure? Looking at Erdogan's 3000 graft procedures here, it feels like my Norwood is not on the same level as for what he typically needs to graft x3000. I would hate to deplete my donor zone unnecessarily.

Are your scars from strip or FUE?

I know this is an old thread, but I just wanted to bump it as an incredible example of the subtle aesthetic sense that Mwamba brings to the table. Truly unparalleled.

I don't think Erdogan meant to literally fill the areas he circled on the diagram, as his number of grafts was also cited 2600. I don't think it would be possible with that number of grafts. Bottom line is I need to spend more time on their previously published patients to see what they're comfortable with doing, and what they have tended to do in the past. Ah I see, thanks. It's interesting that by the rule of thirds, the hairline should be close to the bottom of the circle on Erdogan's diagram (slightly below the bottom of the cm). But I certainly understand the points made in this thread about not a balance between a good hairline and maintaining a strong donor reservoir. Thanks to everyone for your insights and guidance.

Wow, really helpful illustrations. Thanks for taking the time to do that. It does seem that bringing down the widows peak helps the hairline look more natural, and also leads to more angulation at the temple to allow things to flow better. How many grafts would you estimate that would need? I think I've seen cases that looked like that amongst Mwamba's work, Feriduni's may be slightly more conservative. Definitely gives me something to gear myself towards. Curious, what program did you use to do that? Photoshop? I'm sorry, I don't completely follow -- hair above the red line? Also, what is your rule of 1/3rds?

Matt, thanks for your input. I have followed your hair loss experience for quite awhile, and appreciate your wisdom. I see your point that medication or not, there is no guarantee regarding long term stability, and I should not be too aggressive (and we do not have much long term data on Dut). Do you think 2000-2500 grafts is too much? It seems from your response and the diagram you sketched that you feel Erdogan, Doganay and Mwamba are being too aggressive. Mwamba indicated he would lower my hair line ~1 cm, which I did not think was too much. I have to say that I really dislike my temples and would like to have a nice hairline into my 40s. Once DHT resistant follicles are implanted, I feel like you are drawing a line in the sand so to speak (ie. transplanted follicles are much less likely to recess). If I have to wear a hair piece or coloring to cover up the thinning hair deep to my DHT resistant hairline after that, I would prefer this to a higher hairline with greater density at the high scalp. But your post really brings up the central crux of the issue -- how do you want to distribute your plugs in the long run? Either: 1) A lower hairline with thinner density, or 2) a higher hairline with greater density? Only time will tell how thin the density or how high the hairline, depending on which surgical approach is taken. Cosmetics seem to lend themselves to disguising the former better, but as life gets on and we become lazier, perhaps the latter is preferable. If this is really what it comes down to I think to have 5-10 more years of a lower, 'age-inappropriate' hairline is worth it for me. I am not married and would like to pretend I am still young for a few more years. If I hit 40 and realize I still want to play at Peter Pan, at least the cosmetic option would still be available with a lower DHT resistant hairline. If, on the other hand, I went with a higher hairline with a denser vertex, I would not be able to disguise it that well. Does this sound like a reasonable thought process? Have others gone through the same thinking? I have spent so much time on these forums, I feel like I've disappeared down the 'rabbit warren' as Spex is fond of saying. Any other insight would be much appreciated.

Attached is the symbolic diagram sent to me by Erdogan. It seems very similar to what I am looking for. The surgeons that seem to have shown consistent work on lowering hairlines for lower NWs seem to be Erdogan, Mwamba, and Doganay. Doganay is manual, as I mentioned, so I am more hesitant with him. Konior is excellent as well, and perhaps one of the best strip surgeons for similar work, but for better or worse, I am not a huge fan of FUT.

Hm, that is interesting. Perhaps they dyed it?

Thanks for sharing your experience. Does Feller still do motorized extractions?

was this with FUE or FUT?

A little background -- I am 34, and have been described as a NW2 to 3V. Medical therapy wise, I have taken Ketoconazole for the last decade, 1% switching to 2% this past year. I began finasteride 3 years prior, but 6 months after switched to dutasteride, which seemed to put a pause on my my hairloss, although without much regrowth. I've taken Minoxidil inconsistently, although it messes up my eyes for some strange reason. I have been spending too much time on the forums. Ultimately, I feel I have a milder case of hair loss, and don't want to deplete my donor zone, but I do want a meaningful difference. I was wondering who you all think the best FUE surgeon would be for my degree of loss? It seems the European FUE docs are worth their salt. Based on the advice here and review of pics, I've come to favor Bisanga, Feriduni, Lorenzo, Mwamba, and the Dogans. Here is my experience thus far -- It seems Lorenzo is conservative at hairlines, although a vertex master. Pricing wise, he does not seem that different from the Belgian superstars from what has been posted here, although I will have a better idea of his rates when we speak. Bisanga's rep said they would go fairly conservative, and stay away from the vertex due to the risk of shock loss. For the frontal hairline, he said they would do about 1500 grafts. It seems that a lot of his cases are "fillers". ie. the patient will have thinning in front and Bisanga will go behind the hairline to fill in the areas of thinning, and create a more defined hairline. However, I haven't seen many milder cases (ie. NW 2-3) where he actually brings the frontal hairline down significantly. Feriduni is good, he also seems conservative for my taste. For many of his posted hairlines he seems to barely brings down the line 1 cm, and sometimes even less. Not quite as conservative as Bisanga, but sometimes I can barely tell he was there, in both a good and bad sense. He is also booked till July of 2015. Even for consultation he is backed up 1-2 weeks, and has not formally responded to me as of yet. Perhaps the busiest of the hair loss surgeons I have contacted thus far, I'm sure in large part due to his conscientious work ethic and strong online presence. Mwamba seems excellent. Although based in Belgium, he seems to favor the more aggressive approach of the Turkish docs, which I like. He actually spoke with me directly on the phone and spend at least 15 minutes in consultation. He cited 2000-2500 grafts overall with PRP to my vertex, for which he would add 800-1700 euros, depending on how many areas were treated. 90% of his work is manual. He was honest in stating that if his hands were tired, he switched to mechanical harvesting about 10% of the time, and I appreciated his being straightforward about this. His price was 5 euro if I let the techs do the implants, 10 if I let him. The results on here speak loud, so I don't really have a major issue with this. The "Dogans" -- Doganay and Erdogan seem to have a lot of strong hairline work in people with lower Norwoods on FUE gallery. I also like that they are more aggressive than the western European docs. Erdogan is only manual with assistant based extractions. I spoke with Erdogan's assistant who sent me an estimate of 2600 grafts, with 600 being for the temples specifically, with a symbolic diagram illustrating where he would place the implants. He uses the manual technique, and his assistants do the extractions. Koray himself does the incisions. The price is about half that of Mwamba and Lorenzo. Doganay is motorized with a premium for manual work, which seems to imply that he is less comfortable with it, although his rep indicated that he stated that there is no difference as far as outcome. Punch sizes range from 0.6 - 0.8 mm. They include free PRP and are also about half the cost of the western Europeans. Konior is excellent, but I'm am less in favor of FUT. From the posts here it seems that while he can do FUE, it's not typically in his wheelhouse. I will post the symbolic diagram Erdogan sent in a second post. Other surgeons that I have not done as much research on have been Reddy (UK) and Rahal. I generally have avoided the motorized guys like Feller and Baumann because it just seems like a recipe for disaster and lends itself to donor site depletion/decimation. The information out there is overwhelming. Between google, the major surgical forums, the videos, the podcasts, it is possible to be literally inundated with information 24 hours a day. As I am currently on a break from work, this has been precisely what I have been doing. It has been quite an odyssey, and I'm sure I'm not alone on this one. Hair can be so personal and so important in nearly every aspect of life, both professionally and personally. Please feel free to share any thoughts you have, either on the surgeons I have mentioned, ones that I have not